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Dangerwolfe

Suturing: an ounce of prevention

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Hi Folks,

 

I believe that suturing is a critical medical skill I need to have not only for myself and mine, but to help others and trade as a skill. I've already watched some vids on the subject but would like to get some actual experience and further knowledge on the subject. I figure that cuts, gashes rips etc. may become a lot more common during an extended SHTF, and properly repaired skin integrity on the quick could easily save limbs and lives......

 

Can anybody with medical knowledge and especially medical combat experience point me towards some good resources on the net etc. about wound treatment, when to suture and when not, how to prep and sterilize the area, what tools/materials, etc. that I should stock? How can I practice it?

 

Where could I volunteer to learn these skills? (ICU?)

 

Much obliged.

 

Wolfe

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Buy a jar of Pickled Pigs feet to practice on. Its what Med students do

 

Yes, this is really a good idea. I've seen them used in some of the vids:

 

 

 

The wife however might not like the idea so much :P

 

Cheers,

 

Wolfe

Edited by Dangerwolfe

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A couple of questions first. What is your current level of training? EMT or higher? In most places in the US you can't do sutures, unless you are a medical professional. And mostly its DRs. in the ER.

Under austere conditions it may be better to leave the wound open unless you are absolutely certain that it is very clean. Also you wouldn't want to close any wounds from animal bites as they would need to be cleaned daily.

It is probably better to learn how to make butterfly closures.

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Under austere conditions it may be better to leave the wound open unless you are absolutely certain that it is very clean. Also you wouldn't want to close any wounds from animal bites as they would need to be cleaned daily.

It is probably better to learn how to make butterfly closures.

 

... and how to PROPERLY clean wounds, if you do think sutures are neccessary

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A couple of questions first. What is your current level of training? EMT or higher? In most places in the US you can't do sutures, unless you are a medical professional. And mostly its DRs. in the ER.

Under austere conditions it may be better to leave the wound open unless you are absolutely certain that it is very clean. Also you wouldn't want to close any wounds from animal bites as they would need to be cleaned daily.

It is probably better to learn how to make butterfly closures.

 

Hi EX,

 

First of all, thanks for the feedback, much obliged.

 

I trained with the paramedics in Orange County many moons ago as a teen, got my advanced first aid cert as well, again long ago. Took about a year of pre-med in school, should have continued, really had the knack for it but you know young people....not the best decision makers, LOL. I'm going to re-up my first aid cert. Unfortunately, nothing like Junior Colleges here in France so I may join the Red Cross for further training.

 

I fully agree, one should ABSOLUTELY have the correct credentials/experience before they are allowed to touch a patient. That said, I don't think anybody needing stitches or medical care in an SHTF situ will ask for my credentials.....lots of wrench turners and carpenters will be out there, but a huge shortage of qualified medical folks, so adding medical skill set I've decided to focus on.

 

I will continue to post links I find valuable. Here's a good one that goes into a lot of detail:

 

http://emedicine.medscape.com/article/884838-overview

 

Like NavyVet says, you need to consider many things like if sutures are even necessary, getting the wound clean, etc. Lots of general knowledge and minutia such as "capillary effect" of multi-filiment sutures as a path for pathogens entering into the wound....but if it were that simple anybody could do it.

 

Wolfe

 

PS: could also volunteering at the animal clinic....

Edited by Dangerwolfe

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THere are many different sizes and types of suture materials to use for different types of wounds. Be sure to learn the difference in materials and techniques.

 

Yes, I will definitely learn as much as I can and practice up. The kind of suturing I am focusing on is wound closure, repairing the integrity of the skin mostly and perhaps a bit of vessel ligation, not repairing internal damage (surgery is a whole other game). Therefore, plain surgical gut, or fast absorbing surgical gut is a good choice.

 

Wolfe

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If your in the woods or afraid of legal consequences stick with Quick Clot for stuff a normal bandage cant handle. Once it goes on it stays on until you get to the hospital though as it is somewhat fused with the clotted blood.

 

For smaller stuff there's also superglue but save it for friends and family as it is not a proper medical technique.

 

Hi Autonomous,

 

I don't intend to suture anyone if a regular trained medic is available or will be available to do the job, but in an extended SHFT I see wound treatment and closure as a really great skill to add.

 

I can imagine lots of folks dropping over in an SHTF from nasty infections resulting from open and improperly treated wounds. Antibiotics are great but it's best not to get to that point......especially if they aren't available.

 

Wolfe

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Here's our video on suturing pig's feet....

 

Hi Dr. Bones!

 

Much obliged for this excellent video on suturing. It answers many of my questions.

 

I will definitely start spending some time reading your website and blogs. I noticed you offer a suturing kit as well. I live in France so I may try to get something locally unless I return to the US this summer for a visit. However, I'm very interested in your book on survival medicine. I will see if I can get it on Amazon.fr.

 

I'm also looking into getting my EMT, but I need to find the equivalent here in France. US it's a cake walk; just take the classes at a JC and volunteer at the hospital. Here, it's not so simple. I travel so much it's not really practical to join the Red Cross, etc...... Perhaps you have a website or other books you can recommend?

 

Take care and thanks again for the info.

 

Wolfe

Edited by Dangerwolfe

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Dangerwolfe-- check out the book "Medicine for the Outdoors" from Elsevier (www.us.elsevierhealth.com/Medicine/Emergency-Medicine/book/9780323068130/Medicine-for-the-Outdoors/).

 

This book is filled with tons of information on how to properly handle medical emergency scenarios such as emergency suturing. I bring this book along with me on all of my trips just in case-- it's a great resource.

Edited by hikinged

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Hi Hikinged,

 

That's an excellent book. Our book "The Doom and Bloom Survival Medicine Handbook" is different from it in that our book assumes that there are NO modern medical facilities accessible for the long term. It never ends a section with "and go to the hospital" because it assumes YOU are the end of the line when it comes to the medical well-being of your group.

 

Dr. Bones

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Hi Folks,

 

Just received my order from the Apprentice Doctor:

 

http://www.theapprenticedoctor.com/secure/showitem.php?item_id=2

 

This kit is essentially a complete course on suturing on DVD, plus tools. I also ordered the instrument upgrade and am impressed with the quality of the tools. Have not viewed the CD yet, need go to Moscow tomorrow but will take a look on my laptop during the trip.

 

That said, I intend to order Doom & Bloom Survival Medicine from Doc Bones & Nurse Amy, we need to support our fellow preppers and professionals who care enough to help us all.

 

I let you know what I think of the course later.

 

Regards from La Belle France.

 

Wolfe

Edited by Dangerwolfe

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Just an update on the Apprentice Doctor kit:

 

It's very complete and teaches how to tie the most common surgical knots, EIGHT different ways/stitches to suture, when to use them, what type of suturing materials/needles/anesthetics, hygiene, when stitches are not appropriate, etc....surprisingly complete!

 

Combine this kit/course with other sources such as Youtube vids on the subject, medical procedural guides, etc. and you can acquire a surprisingly broad knowledge base, plus the techniques and practice to handle most minor lacerations and wound repairs.....and even the not so minor......

 

I'm totally satisfied and impressed with this product, it's fun too! Still going through the videos, have not actually started practicing yet. It is an art, not like repairing socks, you need to be very careful and accurate, etc. Also, I think it would be very difficult to stitch someone up without any anesthetic.....if they are screaming and moving all over the place....

 

Note: I would also recommend checking out and stocking medical adhesives (think of superglue specialized for tissues). Problem is it appears that medical adhesives seem to work best for small lacerations and not the long gaping nasty stuff, deeper wounds where you need to repair several layers of tissue, or closing wounds under tension.....perhaps Doc Bones and Nurse Amy have something to add here.

 

Wolfe

Edited by Dangerwolfe

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Hi Wolfe,

 

Dermabond is by prescription and costs about $50 a shot. Although regular superglue may cause a irritation on the skin of some people, in a survival situation I'd go with it.

 

With regards to the kit you got, I can't comment much on it as I haven't seen it before but I can say that you should concentrate on the closure methods that save the most suture while having more than a couple of knots. Those who aren't pros and who will not have access to fresh sutures (think collapse) should have plenty of knots in their closure to assure the integrity of the closure and save as much material as possible. This is what we teach in our classes. Remember, our main concern is what will hold out the longest in a long-term disaster scenario.

 

Dr. Bones

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Hi Wolfe,

 

Dermabond is by prescription and costs about $50 a shot. Although regular superglue may cause a irritation on the skin of some people, in a survival situation I'd go with it.

 

With regards to the kit you got, I can't comment much on it as I haven't seen it before but I can say that you should concentrate on the closure methods that save the most suture while having more than a couple of knots. Those who aren't pros and who will not have access to fresh sutures (think collapse) should have plenty of knots in their closure to assure the integrity of the closure and save as much material as possible. This is what we teach in our classes. Remember, our main concern is what will hold out the longest in a long-term disaster scenario.

 

Dr. Bones

 

Thanks for adding your to this thread Doc, I appreciate it. Great advice about saving suture material. Yes, I've heard superglue will work in a desperate situ, thanks for confirming it.

 

Doc, you may want to pick up one of these kits from www.theapprenticedoctor.com yourself just to give you some ideas. No reason why you could not offer a competing product.

 

I guess the tools themselves come from India which is fine, but they are low-grade quality. In other words, fine for practice and in a pinch, they will certainly work, but I don't see them lasting long with repeated use.That said, I imagine thousands of small time doctors and medical pros in india using this very kit anyway!

 

The kit quite complete with a needle holder, sharp-sharp scissors, blunt-sharp scissors, flat forceps, rat-tooth forceps, sharp probe, blunt probe, two tissue hooks, gloves, 3 rolls of 4/0 silk (non-sterile), 12 No. 16 non sterile looped cutting needles and a zippered carrying case!

 

Now interestingly, the kit also contains one sealed sterile disposable scalpel, a sealed sterile package of 75 cm 4/0 nylon with an atraumatic reverse cutting needle, a sealed sterile package of 75cm 3/0 chromic catgut with a atraumatic reverse cutting needle,

 

Finally, I paid the extra $20 and got the tool Upgrade Package which contains a needle holder, rat-tooth forceps and a sharp-blunt scissors specialized to cut sutures all of excellent quality! Absolutely well worth the 20 bones! These tools are very nice!

 

Again, it would be nice to have some anesthetic and sterile syringes or ones that could be sterilized.....

 

Hope I never need this stuff but very glad to pick up the specialized skills/knowledge.....

 

Cheers,

 

Wolfe

Edited by Dangerwolfe

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Guest kevin

more threads like this please....great stuff doc, thanks

i do have a question for you doc...i use regular super glue on cuts sometimes so i know it works, but is it the same as the medical stuff? is there a way for the regular joe to get it if not? and lastly how deep a cut is super glue an option for?

Edited by kevin

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more threads like this please....great stuff doc, thanks

i do have a question for you doc...i use regular super glue on cuts sometimes so i know it works, but is it the same as the medical stuff? is there a way for the regular joe to get it if not? and lastly how deep a cut is super glue an option for?

 

Hi Kevin,

 

Medical adhesives are definitely not the same stuff as superglue even though some work the same. Here is a guide that may spread some light on the subject:

 

http://www.thomasnet.com/articles/adhesives-sealants/medical-adhesive-buying-guide

 

Now, when is glue better than stitches, that's a different question. This link explains a lot but in short, glues are faster, painless, much easier to use but limited in applications. Stitches apparently can always be used, and often with less scarring and better results if done correctly but the pain factor is huge without anesthetic.

 

http://childrensmd.org/browse-by-age-group/newborn-infants/skin-glue-or-stitches/

 

I just figure in a SHTF medical adhesives will be tough to come by after they run out.

 

Now, the numbing cream mentioned sounds very interesting! I wonder if that stuff could be home-brewed.......

 

Wolfe

Edited by Dangerwolfe

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stitching depending on where is not that painful it ain't fun but hey ya gotta do what ya gotta do.

 

ether is widely available but you upchuck upon revival generally i would love to et my hands on legal

 

chloroform but that too is not the best in the world even under some pain can wake you that is why

 

doctors have a tool kit with injectables local and nerve blockers as well as gas and propofol { I like it }

 

stuck me and told me to count backwards from 100 all I said was that sh*t burns laughed and

 

they said I was out, when I woke it was groggy for a minute and just fine after..

 

and others and you got to know weight allergies and most people do not know so if there is an allergic

 

reaction a whole new set of protocols. but I am going to get the dr bones dvd it sounds good.

 

and I have a couple of kits already old school scalpels that can be sharpened and some new throw aways.

 

and a half dozen sterile minor surgical kits and suture removal kits, saline etc....

 

I think you can use eye wash as it is sterile saline ask dr bones

 

I had a motorcycle wreck and they had to clean the scuff marks and they were not tender the scrubbed

me with provoidine and picked out gravel with a probe and hemostats rewashed and checked again

covered it and some antibiotics and a shot of the same and I did not get any anesthetic.

 

had stitches in my head a few times and legs arm no anesthetic there either some times I got it for the pain after I guess so the pills would kick in before it wore off.

 

all I know is I don't want to go back to the civil war style of bite this stick surgery many died from shock.

 

the rest from gangrene survivors were I guess 50/50

 

now as long as you got a spine working and one of each dual organ and your medulla they can tie you in a wheel chair and you can run it with your eyeballs some might want that but after one wreck with my own blood I wrote DNR on my forehead the doctor thought is was presumptuous but I made it clear I was not putting up with certain things and we had a semi agreement I know he would do for his license and not my request.

but after they knock you out your not in control I have a living will now I would advise all to consider this either way you decide.

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Suturing Under Austere (SHTF) Conditions:

 

Great vid series, lots of good tips like DON'T put Hydrogen Peroxide in wounds! It's cytotoxic (kills cells) and so does Betadine..... Betadine only for really dirty wounds and flush afterwards.....

 

http://cpr-first-aid.wonderhowto.com/how-to/suture-wound-with-first-aid-kit-austere-conditions-371915/

 

Enjoy.

 

Wolfe

 

PS: Still working my way though the suturing exercises. Fantastic kit!

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Absolutely right, Wolfe,

 

clean drinking water is better to clean wounds, at least after the first flush, than hydrogen peroxide or straight Betadine...

 

Dr. Bones

 

Thanks for adding Dr. Bones. It's just amazing how much basic information like this I did not know because I never had the need to know it....or survived not knowing it! LOL! Regarding wound cleaning I understand the basic idea is the old hack "the solution to pollution is dilution" i.e. essentially exactly what you said: flush the wound repeatedly with clean water under slight pressure (saline if available or highly diluted Betadine if contaminated, then flush out the Betadine.....).

 

So I guess Mom running tap water over that finger cut was not too far off after all :)

 

One thing I might ask you is how do you know when sutures are tight enough or too tight? My understanding is that the suture should just approximate (bring together) the edges. It's tricky to tie a line of interrupted sutures evenly.....

 

Wolfe

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