First aid kit – antiseptics

[Lophophaps]

There's a number of different types of antiseptics. The first distinction is liquid, single use in a foil pack, or cream. Next is the type. I'm advised that alcohol wipes cause damage to the skin and are no longer recommended for cleaning a wound. Betadine is also problematical: some people are allergic to iodine. Saline solutions are least likely to cause irritation, but may not have the antiseptic properties of others. Not many people are allergic to Chlorohexidine. Saline is available in small vials.

So the question is, what sort of antiseptic is carried and why?

[corvus]

There's a number of different types of antiseptics. The first distinction is liquid, single use in a foil pack, or cream. Next is the type. I'm advised that alcohol wipes cause damage to the skin and are no longer recommended for cleaning a wound. Betadine is also problematical: some people are allergic to iodine. Saline solutions are least likely to cause irritation, but may not have the antiseptic properties of others. Not many people are allergic to Chlorohexidine. Saline is available in small vials.

So the question is, what sort of antiseptic is carried and why?

Depends on what the First Aid Kit is used for personal or group,in my personal kit I carry Skin Prep Wipes and Saline,for a group I would include Betadine and perhaps Tea Tree Oil.

[Mark F]

I am a believer in only needing a minimal first aid kit. If it is serious then evacuate. I carry a couple of alcohol wipes and a very small dropper bottle of Betadine. The alcohol wipes serve to clean around a wound and to clean areas that need patching on my Thermarest etc. Betadine on a wound when putting on a bandaid or dressing. I would normally wash out a wound with water or if possible saline solution.

In reality I have not had to use this part of my first aid kit for over 5 years - touch wood.

[GPSGuided]

From a clinical perspective in terms of dirty/contaminated wound management, you can consider the following points,

- Location and how long are you going to be out from formal medical care? If it's within a few hours, there's not going to be much difference as to the degree of antisepsis and treatment one applies. The hospital can perform the formal 'clean' and institute antibiotic therapy as needed.
- Debulk the contaminant load. This is the simplest and always the first step, implemented by removing (washing) the dirt/foreign material away form the wound. Given it's already a dirty wound, it really matters little on the type of water used, as long as it's not a cesspool of 'bugs'. It's all about dilution of the existing bacterial load/concentration.
- Basic antisepsis. Wash/irrigate with water that's suitable for drinking, copious amount. The sole purpose here is to wash the contaminants away, often in hard to reach pockets. Following, apply antiseptics with the aim of further reducing the bacterial load by killing what remains. Here, I'd suggest that liquid solutions are of limited use as they flow and don't hang around. Out in the bush, I'd use ointments or cream, one that keeps the antiseptic concentration on the wound to continue to kill and limit the growth of bacteria, until one receives definitive medical care. For this and personally I use Betadine out of long time practice habit but Chlorohexidine is just as fine too if one is allergic to iodine. A small red tube of Betadine ointment stays in my first aid kit, one that can also be used for water treatment in an emergency.
- Dressing. Dressing keeps the wound moist and protects it from further contamination. It can also help to keep the antiseptics in place. If one is out there for a longer period of time, then re-cleaning and dressing changes are important to ensure there's no build up of bacterial growth underneath.

The concern over tissue damage really is not a significant issue that needs to be considered in this context for the types of wound likely to be encountered here. Just also to say that Betadine and chlorohexidine solutions are used to irrigate very large areas of open wounds without problems. Won't do the same with alcohol though.

Hope this helps.

[Gadgetgeek]

Betadine is a bit easier on the tissue than alcohol, so it will not slow healing as much. Get stuff cleaned out as best you can, and monitor it. For most folks an infection won't set in super fast, but age, circulation and location all play a point. I don't carry much for antiseptics, since I figure i'll be out before they matter, but its not a bad plan if you or anyone you walk with has any immuno-compromise. That's not that hard to have happen, be it high stress (long distance fast-hikes), other health conditions, or simply age (young or old). So its worth keeping in mind.

[slparker]

Carry salt and mix it with water to make saline and irrigate the wound with that. I do not take a disinfectant to the field when walking. A syringe is also useful to direct a stream of saline clean a ragged contaminated wound bed. As GPSG states, potable water is fine for wound care in the field.
The disinfectant properties of betadine last 15 minutes and is used mostly now as a presurgical prep. It has been also been demonstrated to be cytotoxic and inhibits healing.
I would not use betadine or any other disinfectant on a laceration in the field. Not because they are particularly harmful, butbecause they are unlikely to do much- and I could be carrying another wound dressing instead.

[GPSGuided]

For the type of well vascularised acute wounds we are talking about, Betadine's cytotoxic impact is trivial. More relevant is its antiseptic properties when called for, so I wouldn't discount it. Of course, one can go for similar with chlorohexidine if one is really really really concerned. For non-military and simple application, few are likely to carry fancy dressings. Agree on battle trauma, typically a dirty wound of significance, antiseptics are meaningless when there's rapid evacuation coming. Here we are more likely to be talking about cellulitis prevention.

For an article,

http://www.medscape.com/viewarticle/456300


Sent from my iPad using Tapatalk

[slparker]

What's the citation for the article? It's behind the medscape firewall.

[GPSGuided]

Bummer... It's a review article. Medscape provides free accounts for non-professionals too.

[slparker]

I have access to health journal articles at work I just need the name and author.

[GPSGuided]

If theres a reluctance, then either I'll have to find another review article or you can find another elsewhere. Said MedScape article was authored by Anna Drosou, MD, Anna Falabella, MD and Robert S. Kirsner, MD, and there are plenty of research journal articles on this and related subjects by RS Kirshner who is obviously the leader of the group. This article was chosen as it's a legitimate source that anyone can access and read the full article. No point in referencing a professional research journal article here that most can only read the abstract at most. Fact is, lab data don't always translate to clinical objectives and on discussions like this, review articles are best for a big picture overview. As also said, battle trauma objectives and treatments guidelines are also quite different to civilian scenarios.

[slparker]

This information from 2014 is taken from the American Wilderness Society Practice Guidelines for Basic Wound Management in the Austere Environment*:

1. An attempt at wound cleansing is recommended in the presence of high bacterial contaminants and dirt.

2.There is no evidence that sterile, rather than clean,technique decreases the incidence of wound infection after management of lacerations.

3. The use of high-pressure irrigation (6–12 psi) is recommended to lower wound infection rates, especially in the case of open fractures. In the field, 8 psi can be exerted by fluid
delivered by a 35-mL syringe through a 19-gauge needle. In a wilderness setting, potable water is the preferred solution for wound irrigation.

4. Irrigation: additives
Additives to irrigation solution have included antibiotics, antiseptics (povidone-iodine, benzalkonium chloride, chlorhexidine gluconate), and surfactants (such as castile
soap). Although some of these agents have demonstrated efficacy in decreasing acute bacterial counts in contaminated wounds all are toxic to tissues, can increase problems associated with wound healing,and result in a significant rebound bacterial count at 48 hours.

Recommendation
If irrigation is performed, additives should not be used

5. Abrasions should be managed with the same recommendations as lacerations. Rather than closure, these wounds should be covered with a nonadherent dressing.

*Quinn, R (et al), 2014 Wilderness Medical Society Practice Guidelines for Basic Wound Management in the Austere Environment, Wilderness & Environmental Medicine, 25, 295-310.