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Topical Bandaging Module
Spenco 2nd Skin burn dressing kit
Gauze, high absorbent, sterile, 2-ply, 3" x 3". pkg/2, 2 pkg
Coverlet bandage strips, 1" x 3"
Adhesive tape, waterproof, 1" x 15'
Maximum-strength triple antibiotic ointment with pramoxine, 1 oz tube
Hydrocortisone cream 1%, 1 oz tube
Clotrimazole cream 2%, oz tube
Dental supplies as indicated in chapter 5
1 needle holder
Adson tissue forceps (1 with teeth, one without)
3-0 Ethilon sutures
5-0 Ethilon sutures
3-0 gut (dissolvable) sutures
SPENCO 2ND SKIN
Truly a major advance in field medicine. This inert hydrogel consists of 96% water and 4% polyethylene oxide. It is used on wet, weeping wounds to absorb fluids and protect the injury. This is a perfect prevention or cure for friction blisters. It revolutionized the field treatment of first-, second-, and third-degree burns, as it can be applied to all three as a covering and for pain relief. This item should be in every medical kit. The ideal covering pad is the Spenco Adhesive Knit bandage. If used in treating blisters, remove only the outer covering of cellophane from the 2nd Skin, cover with the Adhesive Knit bandage, and occasionally dampen with clean water to maintain the hydrogel's hydration. It will last a lot longer this way when in short supply. There are a variety of similar dressings sold in virtually all drugstores that are labeled as such.
✓ The cooling technique for burns (see page 139) and a piece of tape over hot spots (see page 138) can simulate the benefits of Spenco 2nd Skin. Cellophane, plastic food wrappers, or plastic sheeting of any kind makes an excellent wound covering. When held down with tape of any type, a cellophane dressing is nonadherent and seepage leaks from the unsealed edges. The wound can be observed through the cellophane, and the increased and appropriate moisture level of the dressing increases the rate of wound healing.
HEMOSTATIC DRESSINGS
There are now three hemostatic dressings approved by the military. Since the addition of QuikClot Combat Gauze (Z-Medica Corporation, Wallingford, CT, USA; www.quickclot.com) in April 2008 to the Tactical Combat Casualty Care (TCCC) Guidelines, and based on the recent battlefield success, Celox gauze (Medtrade Products Ltd., Crewe, UK, www.celoxmedical.com), and ChitoGauze (Hem Con Medical Technologies, Portland, OR, USA; www.tricolbio medical.com) have been added. When used they must be placed over the wound on top of the bleeding vessel, not on top of other bandage material. Direct pressure must be applied continuously for a mini mum of 5 minutes or as per the manufacturer's recommendation.QuikClot Combat Gauze has an "official" shelf life of 2 years.
✓ Gauze dampened with epinephrine or nasal decongestant can help decrease oozing blood.
NU GAUZE PADS
Johnson & Johnson has developed a gauze that is 2-ply yet absorbs nearly 50% more fluid than conventional 12-ply gauze pads. This may not seem important until a rapidly bleeding wound needs care. For years J&J has made a Nu Gauze strip packing dressing, the Nu Gauze pads are a completely different material. They are a wonderful advance in gauze design.
✓ Cotton T-shirts or other clothing, bandannas.
SURGICAL KIT
Consisting of 1 needle holder, 1 Adison forceps with teeth and 1 without teeth, 3-0 Ethilon sutures, 5-0 Ethilon sutures, and 3-0 gut sutures. The 3-0 and 5-0 sutures should have 3/8 circle, cutting needles. The gut sutures are best placed with a half circle for use potentially within the mouth.
✓ Many surgical kits are available online, including practice kits. Once in the field, butterfly bandages can be fashioned from tape as described on page 126. Lacking other means of fastening gaping wounds together, use the technique of open packing the wound with a wet-to-dry dressing described on page 122.
IRRIGATION SYRINGE
Required for forceful irrigation of wounds, the best has a protective spray shield, such as the Zerowet Splashshield; otherwise, wear glasses to protect your eyes from splash contamination.
✓ The solution to pollution is dilution. Forceful irrigation is the best method for cleaning a wound and diluting the germ count enough so that the body's immune system can kill the remaining germs. With out a syringe, augment the volume of water you are pouring on the wound with a brisk scrubbing action using a soft, clean cloth.
MAXIMUM-STRENGTH TRIPLE ANTIBIOTIC OINTMENT WITH PRAMOXINE, 1 OZ TUBE
Each gram of this ointment contains bacitracin, 500 units, neomycin sulfate, 3.5 mg, polymyxin B sulfate, 10,000 units; and the anesthetic pramoxine hydrochloride, 10 mg. For use as a topical antibiotic in the prevention and treatment of minor infections of abrasions and burns, this formulation also is an anesthetic that numbs the skin. A light coat should be applied twice daily. Neomycin can cause skin rash and itch in some people. If this develops, discontinue use and apply the hydrocortisone cream to counter this effect.
✓ Honey or granulated sugar placed on wounds is painless and kills germs by dehydrating them. A strong sugar solution draws the fluid from the bacteria, but human cells are able to actively avoid the dehydration process and are not injured with this technique.
SAM SPLINT
This padded, malleable splint provides enough comfort to be used as a neck collar. It is adequately rigid to splint any extremity as well as universal, so that only one of these need be carried for all splinting needs. This item replaces ladder splints, etc. I never recommended the inclusion of splints in medical kits until this product was developed. It weighs less than 5 ounces.
✓ Malleable splints can frequently be made from stays found in internal backpack frames. Other stiff materials can also be used, such as strips of Ensolite foam pads or inflatable pads, held in place with tape or torn cloth.
HIBICLENS SURGICAL SCRUB, 4 OZ BOTTLE
This Mölnlyce Health Care product (chlorhexidine gluconate 4%) far surpasses hexachlorophene and povidone-iodine scrub with regard to its antiseptic action. The onset and duration of its action is much more impressive than either of those two products.
✓ Many surgical scrubs are available without prescription and are ideal for use, but they can all be replaced with potable (drinkable) water irrigation. Remember, the solution to pollution is dilution."
OPCON-A OPTHALMIC DROPS
This product is a combination of naphazoline (0.0267%) and pheniramine maleate (0.315%) made by Bausch and Lomb. These eye drops are used for allergy relief, to remove redness, and to alleviate discomfort from smoke, eye strain, and so on. They will not cure infection or disguise the existence of a foreign body. Place 1 drop in each eye every 6 hours.
✓ Rinse eyes with clean water. A wet, cold compress relieves eye itch and pain.
HYDROCORTISONE CREAM 1%, 1 OZ TUBE
This non-Rx steroid cream treats allergic skin rashes, such as those from poison ivy. A cream is ideal for treating weeping lesions, as opposed to dry scaly ones, but will work on either. For best results, cover with an occlusive dressing (plastic cover) overnight.
✓ Blistery rashes can be soothed and the leaking fluid dried by apply ing a cloth made wet with concentrated salt solution.
CLOTRIMAZOLE CREAM 2%, .5 OZ TUBE
This is one of the most effective antifungal preparations available for foot, groin, or other body fungal infections. Brand names are Lotrimin and Mycelex (vaginal cream). The vaginal cream in a 2-ounce tube is less expensive and works well on the skin surface as well as vaginally.
✓ Dry, itchy lesions of any type respond to a soothing coating of cooking oil.
CAVIT DENTAL FILLING PASTE
Use this for temporarily filling cavities and repairing broken bridge work. Without being able to drill out the underlying decay, the cavity will need to be seen as soon as possible by a dentist for proper care or an abscess may form.
✓ Use oil of cloves (eugenol) to line the cavity for pain relief. A mix ture of zinc-oxide powder (not the ointment) and oil of cloves, made up as a thick paste, can also be used as a temporary filling.
PROTECTIVE GLOVES
Due to concerns with blood-borne pathogens (e.g., hepatitis B and C and HIV), it is prudent to carry protective gloves for first aid use. These can be nonsterile (they are readily sterilized by boiling or treat ing with antiseptics). Vinyl gloves will last much longer in a kit than latex gloves, but the best are nitrile gloves.
✓ Use an empty food bag or waterproof stuff sack as a glove, or wrap your hand in the most waterproof material available.