Big cuts that need stitches....do you bandage it with pressure or without?

[Bernhard]

And if they aren't with you any longer? Say, on their way to the ER via POV?

I stated that if I let them go on their own, I most probably would bandage.

If it is a deep enough lac to need further attention, it gets bandaged.

Not if I can have an eye on it. Exceptions etc are in my posting above.

Now, getting into the microbiological aspects... ALL WOUNDS ARE CONTAMINATED.

Agreed, no need to damage your shift key. I meant contamination in a more general sense - the microbiological infection is treated by the clinical handling and/or the patient's immune system anyway. What I meant is to be contaminated with real dirt or coming in contact with something other than air - as opposed to "an forearm calmly lying on the patients belly". This means I tend to pad even a minor wound if it's in a dirty setting, where I would leave it open if it's just a hop from the street to the ambulance.

Why not?

Because I always (sic!) get suspicious if I read "always".

If it helps in patient care and it's needed to protect from real dirt, then I would tend to bandage/pad it, yes.

I wouldn't do it just for precautional bleeding control (original statement was: it does not bleed at the moment) and not for microbiological protection (it won't help anyway). And this given a short transportation time under my supervision. In a field setting (no transport needed or available for hours), with prolonged transportation time, or self-transportation I would give more care to a non-bleeding wound. But not in any case or "always".

Just because we are the ones who deal with things as they become issues doesn't mean we shouldn't work to prevent and issue from happening, or becoming worse, IMHO.

I can't deny this completely. But regarding wounds and as said by others, I can't see any real issue with bandaging a non-bleeding wound in the given boundaries. It won't prevent infection (as it already happened) and a clear non-bleeding wound rarely starts bleeding from nowhere. In reality, the non-bleeding wound in my ambulance would be accompanied by some more trauma which needs my time more.

In fact, with minor wounds which I don't see a need to get to a doctor, I normally advise the patient to open my bandage when at home and let it heal on fresh air. My bandage then is only a protection until they get home. But that would be out of scope here, because the original poster gave "needs to be stitched" as a criteria.

[HERBIE1]

Actually, most irrigation is overrated. I didn't say it wasn't necessary but way overrated. As is sterile technique to repair simple wounds.

http://www.ncbi.nlm....pubmed/17456554

http://www.ncbi.nlm....pubmed/12216046

http://www.ncbi.nlm....pubmed/14985664

Truly fascinating stuff, but also common sense when you think about it. Think about how many people grew up with buttery fly band aids from mom(now Steri Strips) to close wounds that could easily have needed sutures. As long as the wound was cleaned, none of us died from that lack of sterile technique. Granted, a few of us may be sporting interesting scars from our escapades, but I never expected to be in a beauty pageant either. LOL

[ERDoc]

Because EBM says it's not a better solution and there is no risk. Try reading the studies.

[nypamedic43]

I dont know about any of you...but I dont carry iodine on my ambulance except in the IO kit. If there is debris in the wound, I would irrigate it with sterile water and then bandage it. If its bleeding, then it gets a pressure dressing and elevation. I dont bandage all cuts and scrapes. Unless there are other traumatic injuries, I dont usually transport either, as long as they are capable or of age to refuse transport. If they are underage, I transport. If they are drunk, I transport. For the hospitals in the area I live in, transport time is less than 10 minutes.

I had a kid today that put his hand through a window. He had a bleeding cut on his thumb and scrapes on his arm. The thumb got my attention. The scrapes had stopped oozing and the blood had clotted. So the thumb got bandaged and the scrapes got left alone. Mom was freaking out..I spent more time trying to get her calmed down than I did while assessing him, getting vitals and bandaging his thumb.

[Chief1C]

First Aid is a form of art, I'm anal about bandaging, unless there's blood squirting all over me. Then I use a pressure bandage...and when I can't see blood anymore, I neatly finish wrapping it. Depends on the size, type, cause; as to how it's bandaged...in my ambulance. I have on several occasions, not EMS calls, 'ditch doctoring' calls, just went ahead and glued or sewn things. Wouldn't do that for someone who called 911, but 3am, I'm drunk and fell, help me out, yeah, why not. How did I learn how to suture? You can teach yourself, if you lack a family member with a medical license; on the other hand, I learned from someone more qualified than youtube and an orange.

[Siffaliss]

Fortunately suturing is in the scope of practice for paramedics here. Medical director in larger centers won't allow us to do it on car, likely do to a very short transport time to hospital and of course, plastics. As for remote northern locations, it gets done all the time. Glue, thread, whatever is best for that situation. Some suturing taught to us is to stop bleeding (usually arterial) for the time being and transfer to a more appropriate facility, it's not all just fixing a cut.

Judgement call as always.

[Bernhard]

In your practice what do you use to irrigate wounds tap water or steril water?

Rarely I would irrigate wounds anyway. Larger pieces of dirt may be mechanically removed by soft dabbing, but if this doesn't work or is too time consuming I simply leave the dirt in the wound and let the hospital/physician do their work.

If a small wound has a little bit of dirt in or close to it, and the patient doesn't need to see a doctor anyway for this cut, I use non-alcoholic wound desinfectant (contains chlorhexidine) to clean. Along with an advise to see a doctor if wound gets irritated or if tetanus vaccination is too old.

No water. Only for private use (kid, wife, dog, myself), I may additionally use clean water from the tap, knowing we have almost sterile water here, even without treatment.

[ERDoc]

Read them and wholeheartedly agree. Not that it matters if I agree or not. I just have to remember once again to make note that most of you guys work in clean environments where water is considered "safe". I was thinking of the third world but that doesn’t matter either. We never trust water as it is untreated and comes directly from the river. We joke that we have immune systems forged in fecal matter.

In your practice what do you use to irrigate wounds tap water or steril water?

Here is a pretty good read with a different approach but with basicly the same results

http://www.thecochra...le/CD003861.pdf

I can see not using tap water if you live/work in an area where the tap water is not drinkable. Makes good sense. As for me, where I work, the techs set everything up before we ever get to the room. So just because it is set up, I use the saline on the suture tray. I still use sterile setups because I think the pts expect it. In this day, where pt satisfaction decides if you have a job or not it's sometimes beneficial to do things even if they don't make a difference medically.