Cleaning Cuts

[banana5]

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[deleted87716]

Superficial wounds should be irrigated with clean (not necessarily sterile) water to remove loose dirt and debris. Dried blood may be cleaned using hydrogen peroxide. There is no need to put hydrogen peroxide or alcohol directly into a wound. Dry the wound carefully after irrigating it, and apply bacitracin and a clean, dry dressing. That's pretty much it.

 

[Hawkeye Kid]

agreed. it's pretty much widely accepted that hydrogen peroxide and most detergents are cytotoxic and should not be used (the exception being peroxide for dried blood as kent mentioned, but NOT IN THE WOUND itself). for most cuts--even many that may need suturing--running it under clean water is usually enough. for anything dirtier, they probably need to be seen in an ED or urgent care b/c it probably needs to be closed. that said, my parents held me under a stream of peroxide countless times and i turned out ok. well, my cuts healed, at least. 😉

 

[deleted87716]

my parents held me under a stream of peroxide countless times and i turned out ok. well, my cuts healed, at least.

At least your parents didn't slather your wounds with Merthiolate like mine did. 🙄

 

[southerndoc]

At least your parents didn't slather your wounds with Merthiolate like mine did. 🙄

Oh man, does that crap ever burn!

 

[swaamedic]

ya know, i was in the ED planning on sewing up a guys frontal head lac, complex multilayer which was cleaned w/ sterial H2O when along comes the 4rth year surgical resident who dumps a crap load of betadine directly into the wound........i didn't say anything but i didn't feel that this was necessary since the wound was already cleaned w/ sterile water. I have no idea what the surgical literature says about this, any thoughts on the matter???????????????????

 

[docB]

ya know, i was in the ED planning on sewing up a guys frontal head lac, complex multilayer which was cleaned w/ sterial H2O when along comes the 4rth year surgical resident who dumps a crap load of betadine directly into the wound........i didn't say anything but i didn't feel that this was necessary since the wound was already cleaned w/ sterile water. I have no idea what the surgical literature says about this, any thoughts on the matter???????????????????

Interesting question. I've seen ortho irrigate open fractures with SNS mixed with betadine many times. Maybe the surg lit is different than ours.

 

[SoCuteMD]

Interesting question. I've seen ortho irrigate open fractures with SNS mixed with betadine many times. Maybe the surg lit is different than ours.

I think I read somewhere on this board that betadine should not be used to irrigate as it causes some sort of problems. (sorry, I can't make specific and evidence based statements at 2:35 AM).

In any case, the chief of EM at my school told us that it's more volume than anything else when cleaning the wound. If you can get it over a sink, do so. If you can't get it over a sink, use saline generously.

 

[GeneralVeers]

I think I read somewhere on this board that betadine should not be used to irrigate as it causes some sort of problems. (sorry, I can't make specific and evidence based statements at 2:35 AM).

In any case, the chief of EM at my school told us that it's more volume than anything else when cleaning the wound. If you can get it over a sink, do so. If you can't get it over a sink, use saline generously.

Betadyne can be used to clean the skin around the wound, but should not be put directly into the wound itself. The current research suggests that this inhibits wound healing.

 

[EM2BE]

Betadyne can be used to clean the skin around the wound, but should not be put directly into the wound itself. The current research suggests that this inhibits wound healing.

This is a little off-subject, but still on. I had listened to a podiatrist tell his patients after ingrown toenail removal to put betadyne drops in the area of skin where the nail was removed. Is this considered an open wound or cleaning the surface? (All I know is that if you put hydrogen peroxide on those toes when the 'wound' is fresh, it starts throbbing really bad. 😱 )

 

[GeneralVeers]

This is a little off-subject, but still on. I had listened to a podiatrist tell his patients after ingrown toenail removal to put betadyne drops in the area of skin where the nail was removed. Is this considered an open wound or cleaning the surface? (All I know is that if you put hydrogen peroxide on those toes when the 'wound' is fresh, it starts throbbing really bad. 😱 )

The betadyne actually works for ingrown toenails (I've used it on myself before). It is cytotoxic, and kills the tissue around the ingrown toenail, thereby stopping the pain and swelling.

 

[mikecwru]

Interesting question. I've seen ortho irrigate open fractures with SNS mixed with betadine many times. Maybe the surg lit is different than ours.

Are you accusing a surgeon of reading a journal article?

mike

 

[deleted87716]

along comes the 4rth year surgical resident who dumps a crap load of betadine directly into the wound.

Sounds like he's spent some time working under an "Olde Farte." 😉

 

[Febrifuge]

Tap water works! : http://www.aemj.org/cgi/content/abstract/5/11/1076 (1998)

Totally! : http://www.ncbi.nlm.nih.gov/entrez/..._uids=15580097&query_hl=1&itool=pubmed_docsum (2004, review)

 

[docB]

Are you accusing a surgeon of reading a journal article?

mike

Perish the thought!

However, swaamedic asked a good question. Since we in EM "know" that putting a cytotoxic agent in a wound is bad why is it that we all see surgeons do it frequently. Does their lit say different? Is it because they see different kinds of wounds? Huh?

 

[Pose]

At our ED (I work as a tech) they have us irrigate wounds with 1-2L of NS, with a "gun-cup-thingy." It seems a bit wasteful, given the tap (found in every room) could offer better results.

Perhaps I should pitch this to our nurse manager? Or is the high-pressure suction gun a completely different technique than discussed in the study?

One related question I have, however, is for cleaning terribly-dirty abrasions. You know the kind where someone has fallen, scraped a hefty portion of skin from say, a forearm, and then rolled in a puddle of mud 2 days prior to coming in for a headache. The latest instructions we techs were given was to scrub the area with the surgical scrub brushes -- the two sided sponge soaked in a betadine-ish substance.

What would this be a case for?

 

[spyderdoc]

One related question I have, however, is for cleaning terribly-dirty abrasions. You know the kind where someone has fallen, scraped a hefty portion of skin from say, a forearm, and then rolled in a puddle of mud 2 days prior to coming in for a headache. The latest instructions we techs were given was to scrub the area with the surgical scrub brushes -- the two sided sponge soaked in a betadine-ish substance.

What would this be a case for?

For really dirty abrasions, I like to spread some topical lido jelly over the raw abrasion to take some of the sting out, wait a few minutes, then go to town with a terry cloth wash cloth or towel, wet w/ dilute betadyne or Hibiclens. The towel works better than the surgical brushes because of the little terry cloth nubs within the towel do a better job to clean out all that stuck in grit.