Friday, February 12, 2016

Wilderness or Grid Down Medical Skills 7: Suturing

Medical training is serious and should be given by competent medical professionals. This article and the whole medical series is not medical advice. It is for informational purposes only. Find good medical training in your area before actually doing the procedures in this series.
This is a series designed to give you a basic medical knowledge of what I consider medical skills you should have if there is no help in sight. The skills are:
Broken bones
Establishing an airway
Deliver a baby
Know The Symptoms of a Heart Attack, Heat Exhaustion or a Stroke
Basic Wound Dressing Techniques
One of the most important survival skills you will ever learn is how to properly administer first aid. This is something I have given considerable thought to because I live away from care. But in all honesty, the more we can do at home, the better. Apart from the distance involved, which could be the difference between addressing something quickly or facing the consequences, the quicker we all rely less on modern conveniences, the better off we will be.
If you build your own first aid kits (and you should) they will be stocked with supplies for suturing, but using those supplies is not as simple as it sounds. Improper suturing can often times be more harmful than actually allowing the laceration to close on its own. Understanding the mechanics of suturing and applying them correctly can mean the difference between life and death for the individual with an injury.
Deciding When to Suture
In most cases, the best option of closing a wound is the least invasive one. Many lacerations can be closed with steri-strips, glue, or other similar techniques. Sutures should only be used as a last resort. The primary goal of any wound repair should be to clean and bandage the wound and then allow it to close on its own. The human body is amazingly adept at healing when given the chance. However, when the wound will not stay together with strips or glue or is bleeding too profusely, suturing may be the most sensible decision.
Suturing Supplies
Once you have decided to suture a wound, specific criteria must be met in terms of the actual supplies. Ideally, your medical kit will include a suturing kit stocked with all the correct items you will need. However, you should know what pieces are absolute necessities to ensure you have them well stocked and on hand.
• Clean water
• Betadine
• Needle Driver
• Irrigating Syringe
• Suture material
• Gloves
An important note must be made regarding suture material. If you are creating your own medical kit, you will need to ensure you have appropriate suturing material. There are multiple varieties of needle shapes, needle types, and suture threads. Most common muscle tissue, arm, and leg wounds can be closed with suture thread size 4 and 5. For more delicate areas like the mouth, suture size 2 or 3 is preferred. Most wounds can be closed with thin, curved needles. Keeping a variety of these suture materials in your kit will make sure you have the supplies you need if the situation calls for them.
Cleaning the Wound
In every instance of dealing with a skin lacerations, cleaning the wound is the first and most critical step. In the last post we went into detail about wound care so I’ll refer to that. But know that cleanliness and infection prevention or management is extremely important.
Beginning the Process
Once bleeding has been stopped or slowed, and the wound has been cleaned, suturing can begin. It is imperative you keep the injured area as clean and sterile as possible before, during, and after. Although that is often difficult in survival situations, it will go a long way in minimizing the risk of infection. One way to accomplish this is to wear sterile gloves and to have all materials cleaned, prepared, and ready to go before you begin the procedure. This will reduce the amount of time you will actually be handling the wound. Orient the wound so that it is parallel to your body to also allow you to work quicker.
Suturing the Wound
In its most basic form, a suture is simply a series of knots tied over an open wound to enable and aid the skin to close properly. A variety of knots can and have been used, each of them specifically suited for a certain type of injury. However, in a survival situation, the goal should always be health. Learning the most basic form of knots will allow you to close the wound properly.
Basic Steps
Although it may seem like a large amount of information, suturing a wound can be a simple process, particularly if you have practiced for it. Just remember these key basic steps:
1. Observe the wound and determine the best way to close it.
2. Put gloves on to minimize potential infection.
3. Clean and irrigate the wound, removing any foreign matter or debris.
4. Thread the curved needle, or open your suture kit and grasp the needle with your needle driver.
5. Start at the center of the laceration and work outwards.
6. Leave approximately 1/8 an inch between each stitch.
7. Bandage the wound to minimize later infection.
After the Suture
Aftercare is a unique element in survival medicine. Although patient comfort is definitely important, the primary focus here is avoiding infection. Regularly changing bandages, which means twice a day, keeps the laceration clean and allows you to check for any sign of infection. If the wound does not appear to be healing, or if there is any infectious evidence, it may be necessary to reopen the wound and determine if any foreign debris remained inside that you may have missed.
Looking at wound care realistically you will fast realize that you need a lot of supplies to care for a wound. And that is a wound that is not infected and is healing quickly and well. If there are complications, your supplies will be even more taxed. Know this when you prepare your kits and supplies.
Besides suturing there are other ways to manage a wound.
Skin tape (Steri-Strips) is a thin adhesive strip that you would use to close small wounds. You just apply it across the injury (making sure the edges are aligned) and pull the skin on either side of the wound together to line up with one another.
Glue can also be used. Super Glue and medical cyanoacrylate glue used in hospitals and doctors' offices apparently have an identical composition. I've seen super glue work many times with children, and, I’ve used it myself. You just clean the wound really well with warm water and soap dry the laceration and place small beads (droplets) of the glue at the ends and a few in the center. No need to apply a heavy line (and in fact it usually will not hold as well). The glue will hold and begin to sloth off around 3 to 7 days - more than enough time for healing. And, it doesn't scar as bad a sutures would (sometimes not at all!)
Be aware that if a wound should be closed, use the less evasive way possible.
Suturing can be practiced on a pigs foot or an orange. There are many instructive videos on the internet but ideally, find a medical professional who can teach you. Like anything else, practice makes perfect. Or perfect practice makes perfect.
This was the last skill in this series. You may find other basic medical skills that you can learn and practice. Taking vital signs might be another one. Blood pressure, pulse, and temperature can tell you a lot about what is going on with someone. Another skill might be starting and maintaining an IV. Find good information and get good training. Be careful with the information that is out there, including what I’ve just presented. Find a good source of medical knowledge, (a doctor, nurse, EMT, or medic you know that you can trust) and compare what you learn with their advice.
Semper Paratus
Check 6