Abrasive wounds

[LaaMok]

any doctors/nurses on here.

 

I have been reading up on treatment of abrasion wounds aka road rash.

 

The doctors in Thailand like to scrub you with iodine then alcohol and the pain is the worst you can get IMO, they recommend changing the dressing daily.

 

I have been reading online and it seems, advice goes against this. and they think cleaning with saline is enough. Some even say the bandaging doesn't need to be changed for days.

 

I think my wounds have become infected and i am taking anti-biotics, i am changing my dressing every 12 hours currently.

 

any advice?

[dudebrah]

i thought that if your in a clean enviroment , you should apply antiobiotic ointment and let the wound breath . Yyou only need to cover it up if you are going outside where it can get dirty

[LaaMok]

i thought that if your in a clean enviroment , you should apply antiobiotic ointment and let the wound breath . Yyou only need to cover it up if you are going outside where it can get dirty

 

i did read that somewhere, why dont the hospitals tell us this, instead of making us go through all this pain

 

 

i think andys wife has some of that coming now

[Duke of Dodgington]

any doctors/nurses on here.

 

I have been reading up on treatment of abrasion wounds aka road rash.

 

The doctors in Thailand like to scrub you with iodine then alcohol and the pain is the worst you can get IMO, they recommend changing the dressing daily.

 

I have been reading online and it seems, advice goes against this. and they think cleaning with saline is enough. Some even say the bandaging doesn't need to be changed for days.

 

I think my wounds have become infected and i am taking anti-biotics, i am changing my dressing every 12 hours currently.

 

any advice?

 

I dumped a bike on it's side about 6 years ago in Thailand. Lost pretty much all the skin on my left arm, leg, and shoulder. They cleaned it with saline, and then put some plastic mesh looking stuff onto it, before putting the bandages on. They also kept it lubed up with some white cream that contains some silver or something. The plastic mess helped keep the bandages from sticking so bad to the wounds, and helped keep the wounds from breaking open so much and oozing out liquids. I did go in every other day to have the bandages changed, but the plastic mesh was left on until the healing was alsmost done. It came off pretty simple without much pain with the scabs. As it came loose, I actually trimmed it off leaving the parts still stuck on in tact.

 

I would not stop cleaning it though. The worst thing you could do. I used Poroxide and cleaned it myself after the first week or so.

[Goldfishpie]

Don't use alchohol often on it. A couple of years ago I grazed my leg on a curb in Nana. Didn't think anything of it as it was only a scratch. Carried on my session down to Soi Cowboy where it started to chuck it down. Roads flooded and all that. Ended up walking through water.

Cleaned it with alchohol every day but it didn't go away. It got bigger and bigger until it was halfway up my leg. Ended up going to the doctors as it was obviously infected. He told me that the alchohol actually burns it and had caused the spread of the infection. Had to go back every day after that for him to clean it out with scalpals and things (not nice).

 

So don't use alchohol!!!!

[luv.you.long.time]

Bryan,

 

I got a nasty injury when I was trekking in Chiang Mai neck of the woods when my ankle was sliced up pretty deep when a piece of bamboo broke on the raft.

 

I too was a little concerned when they told me to go to a clinic every day to get this done. Also, they used to pick at, what I thought was skin growing back and I actually told them not to do that (firstly cos it was agony and secondly, I thought that was my body repairing the wound).

 

Anyways, I had to continue the treatment 5 days later when I was back in the UK. I discussed with my nurse what had been happening and what the medical folks had been doing. This is what she said:

 

1) Because of the humidity and heat, its difficult to keep the area dry, so changing dressings daily and cleansing the wound was essential every day

2) Picking the mushy skin-like regrowth was needed (as it isn't actually skin, it hinders the repair).

3) I was given antibiotics when I got home as it wasn't looking too clever. I think this because it happened during Songkran and the dirty water being thrown seeped into the wound.

[beenthere]

I am a nurse of a surgical ward and deal with various wounds everyday. Wound treatment has changed a lot in recent years, so here's a wee bit you should know.

 

Firstly, the abrasian. Yep, it is still standard practice to scrub the fuck out of it if it is from something like gravel rash, and they still scrub the fuck out of deep burns, however they make sure planty of anaelgesia is given first.

 

For first cleaning these days, sterile saline or tap water (talking here civilized countries where water is safe to drink) is used. We use the 3omL bottles of saline. Alcohol, clorhexadine, iodine etc destroy new skin so should be avoided.

 

Clasically saline soaked swabs were used and the wound was swabbed to get rid of muck, however this invariably removes new skin cells as well. The current thoughts are to irrigate the wound with plenty of saline and then a bit of gauze used to pat dry. With more complicated wounds, debridement is necessary, but we are talking abrasians here.

 

There are many dressings for such wounds, and yeah, they should be dressed. The plastic grid someone mentioned is probably Mepitel, which is a silicon based non-adhesive matrix designed to sit on skin for up to 10 days. Depending on how much exudate there is, something absorbant can be put on, or just a simple bandage. The mepitel draws exudate up, so the bandage or absorbant dressing can be chnaged as required and the mepitel left in place.

 

Contrary to popular belief, dry wounds will not heal, as skin needs a moist environment. his is one reason why an abrasian should be covered. Another is that it is liable to infection. To be honest, in hospitals we have a wide aray of dressings we can use. Someone mentioned the silver ones-Acticoat. These shouldn't be used without medical supervision because teh silver can damage and macerate other skin, and to be honest it is mega overkill.

 

Antibiotic creams are rarely used these days as many strains of bacteria are resistant to the antibiotic and the cream just becomes a breeding ground for them.

 

For common, everyday life in say Thailand, after cleaning an abrasian, I would advise a non-adhesive dressing-sterile gauze, and a light roller bandage.. Change daily. Before changing soak the gauze in saline so it doesn't stick to the skin. If you can get some mepitel, use it and maybe some gauze on top than a roller bandage.

 

Any questions?

[Goldfishpie]

Great info tanks. I think a lot of people will be seeking further advice from you. Maybe they should make a special section for you "Beenthere's surgery"

[beenthere]

Great info tanks. I think a lot of people will be seeking further advice from you. Maybe they should make a special section for you "Beenthere's surgery"

My pleasure, advice on STIs also freely given, though not from experience.

[luv.you.long.time]

Great post.

 

Can I clarify with you with my concerns from my bamboo sliced wound (It was about three inches in diameter).

 

The Thai nurse was picking the whiteish skin-like substance that was growing on the wound. It was feckin agony. I had to tell her to stop. My nurse said it was important / preferable to get rid of this. I never really understood exactly what this was ?

 

Can you explain ?

[oldie]

Coconut water?? Be about as sterile as you'd get. Saw it used as a drip in the field in Cambodia way back when.

[prak]

Scoff if you will.

 

This worked for me on my worst road rash ever (large patches of missing skin peppered with some deep gravel wounds).

 

Went to the hospital for the initial cleaning (as well as putting my leg in a cast). They used the good ol' scrub-the-hell-out-of-it-with-a-plastic-brush method of removing the dirt and embedded rocks. Ow. Ow. Ow.

 

Get the biggest non-stick gauze pads you can find - the kind that feel "plastic-like" on the wound side. Now... bear with me here... pour 100% real honey directly over the wound, completely covering it all in a fairly thick layer. Cover with the gauze pads, and wrap with bandages or tape over to keep everything in place and leak-free. Change every couple of days or more often if you feel the wound sticking to the gauze or if you see blood or body fluids leaking.

 

My nature-freak girlfriend of the time was caring for me through all this, I thought she was nuts. I just figured I had to let her do it and go to the hospital if anything went wrong. Now I do not believe all that hippie, holistic, nature bullcrap, but I shit you not, this was the speediest, most complete recovery I have ever had from such trauma. Years later, I bear only a few small scars from the ordeal.

 

I have since learned that some honey can carry botulism, so maybe I would not do again (since I've got some cash for doctors now), but seriously a small miracle in a time when I had no money. I read there is some research into honey's medical uses, but they need to speed that up, I can tell you first hand, works like magic.

[lantern]

^^

No need to scoff. That's very good advice PraK.

 

Another trick I often use is Tea Tree Oil.

 

Pour it on any wound, as soon as you can.

If you get it on soon enough the wound will not go bad.

 

Get well soon Bryan. Catch you in August.

[beenthere]

Great post.

 

Can I clarify with you with my concerns from my bamboo sliced wound (It was about three inches in diameter).

 

The Thai nurse was picking the whiteish skin-like substance that was growing on the wound. It was feckin agony. I had to tell her to stop. My nurse said it was important / preferable to get rid of this. I never really understood exactly what this was ?

 

Can you explain ?

Yep, it's called debridement and usually done under a local, or well morphined up. Basically anything that isn't pink/red that is in there is dying tissue, and this actually not only inhibits healing, but leads to infestion. We like to remove this stuff to the extent that there is bleeding because bleeding=healthy tissue. Dying tissue still has a nerve supply, but maybe no blood supply. Basically she was right because not getting rid of this would cause problems. Please see maggots which will appear in a post later-I have just scanned all these posts.

Cheers.

[beenthere]

Coconut water?? Be about as sterile as you'd get. Saw it used as a drip in the field in Cambodia way back when.

Yes it is. Not sure I'd use it as a drip as it is not the same osmolarity as saline/blood, but definitely as a sterile Liquid.

[beenthere]

Scoff if you will.

 

This worked for me on my worst road rash ever (large patches of missing skin peppered with some deep gravel wounds).

 

Went to the hospital for the initial cleaning (as well as putting my leg in a cast). They used the good ol' scrub-the-hell-out-of-it-with-a-plastic-brush method of removing the dirt and embedded rocks. Ow. Ow. Ow.

 

Get the biggest non-stick gauze pads you can find - the kind that feel "plastic-like" on the wound side. Now... bear with me here... pour 100% real honey directly over the wound, completely covering it all in a fairly thick layer. Cover with the gauze pads, and wrap with bandages or tape over to keep everything in place and leak-free. Change every couple of days or more often if you feel the wound sticking to the gauze or if you see blood or body fluids leaking.

 

My nature-freak girlfriend of the time was caring for me through all this, I thought she was nuts. I just figured I had to let her do it and go to the hospital if anything went wrong. Now I do not believe all that hippie, holistic, nature bullcrap, but I shit you not, this was the speediest, most complete recovery I have ever had from such trauma. Years later, I bear only a few small scars from the ordeal.

 

I have since learned that some honey can carry botulism, so maybe I would not do again (since I've got some cash for doctors now), but seriously a small miracle in a time when I had no money. I read there is some research into honey's medical uses, but they need to speed that up, I can tell you first hand, works like magic.

Honey is good stuff, very antimicrobial, and funnily enough a few weeks ago I had to guest on another ward where I was looking after an old lady with VRSA. Her daughter, a new age whateverist phoned to ask about her and recommended some certain honey. I tried to explain and in the end humoured her. Her mother, when I told her, it turned out was an ex nurse and admitted it was nonsense. Many of these infections are unfortunately systemic and need intravenous antibiotics, honey will not cure these as it only works on the surface. Additionally, if there is a bacterial strain that is resistant to the compounds that makes honey anti-bacterial, it is a perfect breeding ground.

 

Wound healing is not a simple process, and the older one gets, and the state of one's health, especially diabetics or smokers, can make a huge difference.

[beenthere]

^^

No need to scoff. That's very good advice PraK.

 

Another trick I often use is Tea Tree Oil.

 

Pour it on any wound, as soon as you can.

If you get it on soon enough the wound will not go bad.

 

Get well soon Bryan. Catch you in August.

TTO is good stuff, very anti-fungicidal, however the 'any wound' bit is not right unfortunately. Trust me.

[beenthere]

Don't think I am not into alternative treatments. A paper I read recently (a few years old) was saying how useful certain maggots were, especialy for diabetic wounds which are multi-resistant. They eat dead flesh and bacteria irrespecive of their drug resistance. Unfortunately the medical profession needs a bit more coaxing!

[oldie]

oldie: Coconut water?? Be about as sterile as you'd get. Saw it used as a drip in the field in Cambodia way back when.

 

beenthere: Yes it is. Not sure I'd use it as a drip as it is not the same osmolarity as saline/blood, but definitely as a sterile Liquid.

 

Sorry, can't do the quote thingy, but when I was writing about the drip episode I recalled what a colleague in the bush in Australia once told me. He was Portuguese and said he'd been chopped up by Fretilin in Timor when he was in the military. Didn't pay too much attention, so he whipped off his shirt and OMG. Slashed to buggery as it were. Said he'd been left for dead and when his comrades found him they had no blood so whacked some horese blood in. "That's why I'm so crazy, now" ... Yes, he was one absolute nutter OK, not surprising regardless of the horseblood but beenthere, I've always wondered if that part of his story was plausible. Seems impossible to me but certainly something saved him.

[Anokanite]

Have read that, in WWII, both sides used coconut water for blood transfusion's until real blood was obtained. Didn't say nothing about the results though. I laid the first bike I rented down a few years ago. Went to hospital, cleaned bandaged, and tetanus shot. changed dressing every day. Owner of bar I hang at said he didn't agree with what they were doing, because it needs air to heal. I remembered that's what mom said when I was young. So I started taking the dressing off when I went to bed then went in 1st thing it seemed like it healed faster. Then I went to Myanmar, got dressings changed

but the tape wouldn't stick, tried a clinic, then a hospital same results. Then went to several drug stores one had tape that stuck, two small rolls. luckily it was healed enough not to get infected. Was glad to get back to LOS.

Edited June 29, 2009 by Anokanite

[oldie]

hi again beenthere

 

on further recollection since the above post re. horseblood (sorry, we are talking 20 plus years ago), I'm now nclined to think my Portuguese workmate said they didn't have ENOUGH human blood so they had to top up with horse blood. Pretty sure I've got the whole thing right, now. The guy would've had no reason to embellish the story: getting slashed all over and surviving is about as dramatic as you can get. He was definitely on something; if it wasn't horse blood then it was some other substance: talked at a zillion miles an hour (and English wasn't his native language) and yes, he worked like a horse. Feverish energy.

[beenthere]

hi again beenthere

 

on further recollection since the above post re. horseblood (sorry, we are talking 20 plus years ago), I'm now nclined to think my Portuguese workmate said they didn't have ENOUGH human blood so they had to top up with horse blood. Pretty sure I've got the whole thing right, now. The guy would've had no reason to embellish the story: getting slashed all over and surviving is about as dramatic as you can get. He was definitely on something; if it wasn't horse blood then it was some other substance: talked at a zillion miles an hour (and English wasn't his native language) and yes, he worked like a horse. Feverish energy.

Mate, no way on this earth would horse bloos not have killed him. Even human blood of the exact matching type causes reaction is most people, the right species-ie humans causes problems. Horse blood would have caused almost instant death.

[Heart Sink]

As 'been there' has already said wound management has changed a lot over the years. There are still a wealth of 'old wives tales' , and many professionals practise is still based on tradition, or anecdotes. There is little evidence-base.

 

I think the old adage " The solution to polution is dilution" rings true. It doesn't really matter what you clean the wound with as long as it is plentiful, regular, and done thoroughly. Saline (or tap water as BT mentions -not in thailand tho)is cheap and effective. There is remarkably little convincing evidence chlorhexidine or povidon-iodine preparations are superior.

[oldie]

Yes, all logic suggests you can't shove horse blood into a person, but am convinced the guy had no reason to BS, so have just googled " horse blood human transfusions". Couldn't get it to copy-paste, but fished out this .......As late as the end of the 19th century, blood was commonly transferred from one animal to another and even from animals to human patients .. some of (the latter) appeared at least temporarily to be successful ........In 1921 Rene Cruchet transfused blood from horses (and other animals) into dogs: the promising results saw him inject horse blood into 12 patients -- 9 with TB, 1 'insane', and 2 others. One died immediately from the horse blood, but Cruchet claimed the others improved their conditions and that patients 'even asked urgently for' more of the same.

 

That Portuguese guy I can only describe as being 'frenetic'. Maybe the horse blood did to him (and to Cruchet's subjects) what a blood pressure medicine did to those males originally prescribed viagra who kept going back pounding on the doctor's door for more.

[oldie]

Having hi-jacked Laa Mok's original thread, to return to topic whatever happened to just pissing on the wound?? Free, ultra-convenient, available throughout the day, and it works if you believe in it strongly enough.