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Old 02-17-2012, 11:00 AM
allmightyoz allmightyoz is offline
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Default Suturing, Local Anesthetic, info please



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I see some people carry sutures and tools in their bobs, but do they even know how to properly suture a wound? I too am one of those people that carry sutures and tools. I hate to say it but, my information on their use has come from many youtube instructionals and practice on many wounded chicken breasts. I feel that if I did have to stitch up a large laceration on a remote hike, shtf, etc, I would do a decent job on it having never actually stitched up a living person. I feel that I would do a better job on myself than someone else though.

One thing I worry about is the pain. I have never had stitches, so I am unaware of this. I would like to get some local anesthetics OTC, if this is even possible. I have done injections on myself numerous times (allergy/asthma shots at home, joy!) so I feel confident in an injectable solution. Does anyone with medical experience or first hand experience in stitching theirself or another have any insight into this? Also I would love to have any of your suggestions.

Thanks
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Old 02-17-2012, 11:02 AM
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Originally Posted by allmightyoz View Post
I see some people carry sutures and tools in their bobs, but do they even know how to properly suture a wound? I too am one of those people that carry sutures and tools. I hate to say it but, my information on their use has come from many youtube instructionals and practice on many wounded chicken breasts. I feel that if I did have to stitch up a large laceration on a remote hike, shtf, etc, I would do a decent job on it having never actually stitched up a living person. I feel that I would do a better job on myself than someone else though.

One thing I worry about is the pain. I have never had stitches, so I am unaware of this. I would like to get some local anesthetics OTC, if this is even possible. I have done injections on myself numerous times (allergy/asthma shots at home, joy!) so I feel confident in an injectable solution. Does anyone with medical experience or first hand experience in stitching theirself or another have any insight into this? Also I would love to have any of your suggestions.

Thanks
A shot of Whiskey or Vodka will help with the pain.
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Old 02-17-2012, 11:06 AM
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Rub some dirt on it nancy!

In all seriousness though, if you are wounded enough to need stitches, I would wager that the wound itself is going to hurt more than you applying stitches. I have had stitches before, however I had a local anesthetic injected into the wound.

Some hard booze would probably help.
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Old 02-17-2012, 11:10 AM
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Booze thins your blood and is not the best thing right before surgery.

If the pain is that bad, they'll probably pass out and then everything will be good.

Az
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Old 02-17-2012, 11:18 AM
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1% to 2% lidocaine with a dab of epinephrine (no epi on fingers, nose, penis or toes) Injected around the periphery of the laceration.
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Old 02-17-2012, 11:18 AM
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Stitches kind of have a burning sensation when being applied or removed. There is an initial sting from the needle prick, and then a slight burning sensation as the suture slides through not near as painful as the wound itself. There are topical's like lidocaine you can purchase that will help. If you are wounded bad enough to need stitches the pain you are feeling will mask a lot of the sensation of applying sutures.

The main discomfort will mostly come from cleaning and probing the wound to remove debris. You will want to pour Peroxide or Alcohol in it to flush it out, and clear away the blood, might sting a little. If the cut is jagged you will need to trim the sides even to have even edges to suture together, that may be a little discomforting as well. A good sharp scalpel or exacto knife is good for this or a razor blade in a pinch. Pain is relative to your mind set. As stated previously a good shot of whiskey will go a long way. Not a bad idea to have a pint of your favorite in the BOB in a stainless flask. If it is 90 proof or better you can use it as an accelerant to start a fire, flush and clean wounds, as a pain killer, ant-anxiety medicine, or to just have a drink.
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Old 02-17-2012, 11:23 AM
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Booze thins your blood and is not the best thing right before surgery.
Right. And people giving out advice to just take a swig of whiskey is the exact opposite of the response that I wanted. Even though I asked for someone that had experience or knowledge of suturing... HELPFUL, thoughtful, and clear responses would be appreciated, maybe even a firsthand account of HOW well using booze as a local worked. Inaccurate advice could be taken and used by the wrong person (such as the guy who shot his thumb off when "teaching" his kids weapons safety and use on Doomsday Preppers).
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Old 02-17-2012, 11:28 AM
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It would be nice to have some anesthetics. Once after the Doc removed about 150 ml of gravel out of the hole in elbow, I flinched on the last stich in the proud flesh. He look me in the eye and said "Oh yea, I never gave you anything for the pain." I told him its a little late now. I have always taken out my stiches. My last were staples but I could not see well enough to do them and my hands were to shakey to use the little tool. I'm thinking anyone needing sewn up will be glad to put up with the pain rather than bleed to death.
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Old 02-17-2012, 11:41 AM
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Originally Posted by allmightyoz View Post
Right. And people giving out advice to just take a swig of whiskey is the exact opposite of the response that I wanted. Even though I asked for someone that had experience or knowledge of suturing... HELPFUL, thoughtful, and clear responses would be appreciated, maybe even a firsthand account of HOW well using booze as a local worked. Inaccurate advice could be taken and used by the wrong person (such as the guy who shot his thumb off when "teaching" his kids weapons safety and use on Doomsday Preppers).
First hand experience, I cut the crap out of myself could not go to the doctor, had to stitch up. It hurts, the needle feels like a needle going in, suture burns going through the skin. Other than the wound itself, the next most painful thing was pouring alcohol in it to flush it out. I would have really liked a big shot or two of whiskey. Oh and having 1 or 2 ounces of alcohol just before you start will not immediately thin your blood as to cause uncontrolled bleeding. Also the calming effect of a shot or two goes a long way to settle your nerves as you stitch yourself. You are not going to get OTC injectable novacaine. Topicals are good after the fact not during. After irrigating the wound with alcohol the only other thing you want inside it triple antibiotic ointment.
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Old 02-17-2012, 11:43 AM
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Depends, some smaller wounds it's quicker to just throw in a couple of sutures, but I really liked it when I learned to use staples.

Carry general sizes 3/0 is good for most things, with 5/0 and 6/0 being for delicate things like faces and lips.
Absorbable suture for delicate work and internal wound closures, non absorbable for tougher areas.

You can buffer the burning of the lidocaine with some sodium bicarbonate.
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Old 02-17-2012, 11:47 AM
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I think I read somewhere on here NOT TO POUR ALCOHOL OR PEROXIDE into an open wound. SALINE to clean only.. Correct me if I am wrong but I think I saw this posted by a nurse.
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Old 02-17-2012, 11:57 AM
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I have a nasty scar on my leg from home done sutures. Usually the cut hurts worse than poking the needle through the skin.
@Pyro You are correct, alcohol and hydrogen peroxide kill cells, which is why they are only for superficial wounds. But I believe the people here meant the drinking kind meant for numbing the brain
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Old 02-17-2012, 11:59 AM
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Originally Posted by allmightyoz View Post
Right. And people giving out advice to just take a swig of whiskey is the exact opposite of the response that I wanted. Even though I asked for someone that had experience or knowledge of suturing... HELPFUL, thoughtful, and clear responses would be appreciated, maybe even a firsthand account of HOW well using booze as a local worked. Inaccurate advice could be taken and used by the wrong person (such as the guy who shot his thumb off when "teaching" his kids weapons safety and use on Doomsday Preppers).
Even though one shot of 100 proof isn't going to thin your blood so much you can't clot. Wounds will bleed regardless, and if the wound is large enough you have to worry about severe bleeding, then giving someone alcohol shouldn't be your focus in the first place.
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Old 02-17-2012, 12:04 PM
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I think I read somewhere on here NOT TO POUR ALCOHOL OR PEROXIDE into an open wound. SALINE to clean only.. Correct me if I am wrong but I think I saw this posted by a nurse.
Personal experience in 3 separate emergency situations used isopropyl alcohol. Saline will not adequately disinfect a wound. If you fell put your hand out and it went down in a pile of trash and you came up with a large cut. Saline is not going to kill aggressive bacteria like the ones that cause necrotizing fasciitis, Strep, Staph, Vibrio or MRSA types. Alcohol will. In a hospital where they can treat you with antibiotics after irrigating with saline, scrubbing with abrasion block, and closing the wound sure not alcohol. On a 3 day outing in the wilderness and cut yourself use alcohol, clean and disinfect.

Also use 90% alcohol not 70%, high flash point for evaporation and better antiseptic properties, also no mint treated alcohol (the green bottles) 90% alcohol 10 % water. Guess what most Antiseptic wound cleanser that come in First Aid kits and First Responder kits have in them as an ingredient alcohol. Prep pads for cleaning around wounds are Alcohol prep pads. During the civil war when they first started performing battlefield surgery what did they discover that led to fewer infections and better recovery disinfecting wounds and instruments with, you guessed it alcohol.

http://www.mountainside-medical.com/...Treatment.html

Alcohol for first aid kit and used in emergency situation is fine. My qualifications; Red Cross CPR and First Aid certified and a CNA.
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Old 02-17-2012, 02:06 PM
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this is my setup technique for suturing-

clean wound area, irrigate wound with sterile water or normal saline.

prep sterile field and lay out instruments and suture materials

put on sterile/surgical gloves

clean the wound with povidone pads in circular motion starting from wound edges working out.

Anesthetize wound (if lidocaine is available)

approximate wound edges, trim edges if jagged and severely damaged

apply sutures using most appropriate stitch for wound- either simple uninterrupted, interrupted, mattress suture, etc.

clean area again

apply clean dry sterile dressing to area.

use triple antibiotic cream on wound, but not making it gooey or wet.

Observe for signs of infection- heat, redness, drainage, etc.

Remove sutures in about 10 days or so depending upon wound size location.
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Old 02-17-2012, 03:27 PM
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Saline is fine...U need volume standard rule of thumb say for an open fracture is 9 liters..
Dilution is the solution to pollution...
Also some wounds are clean with 3 cc's of fluid and some are still dirty with 10 liters of fluid
Thus when and if to close a wound takes sound experienced medical judgement.
Open wounds do not creat abscesses, can be closed later, or allowed to granulate in over time..just kkeeping them clean as this progresses.
Old rule of thumb was do not put into a wound that which youwould not put into your eye.
Just use soap and water..it will most of the time do fine.
Judgement comes frum lots of experience..that can't be taught.
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Old 02-17-2012, 03:52 PM
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Last time I got cut practicing knife skills, I just washed it out really good, soaked the area in Rum with a soaked paper towel untill I could not feel much (about 20 minutes), then made my daughter sew me up. Today, I hardly even have a good scar to brag about.
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Old 02-17-2012, 04:02 PM
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Originally Posted by Doc_Shane View Post
this is my setup technique for suturing-

clean wound area, irrigate wound with sterile water or normal saline.

prep sterile field and lay out instruments and suture materials

put on sterile/surgical gloves

clean the wound with povidone pads in circular motion starting from wound edges working out.

Anesthetize wound (if lidocaine is available)

approximate wound edges, trim edges if jagged and severely damaged

apply sutures using most appropriate stitch for wound- either simple uninterrupted, interrupted, mattress suture, etc.

clean area again

apply clean dry sterile dressing to area.

use triple antibiotic cream on wound, but not making it gooey or wet.

Observe for signs of infection- heat, redness, drainage, etc.

Remove sutures in about 10 days or so depending upon wound size location.
Excellent reply! As part of initial care and as long as it is not a vein or artery, letting a wound bleed a little is not a bad thing, as this can help clear away debris. Cleaning with saline or not is situational and also based on volume, which was a good point I read. If you fell and you hand went into a sesspool of stagnant water with animal feces and the like in it, a little alcohol might be a good idea. But I digress. Great post!
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Old 02-17-2012, 04:05 PM
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Quote:
Originally Posted by gearedandready View Post
Excellent reply! As part of initial care and as long as it is not a vein or artery, letting a wound bleed a little is not a bad thing, as this can help clear away debris. Cleaning with saline or not is situational and also based on volume, which was a good point I read. If you fell and you hand went into a sesspool of stagnant water with animal feces and the like in it, a little alcohol might be a good idea. But I digress. Great post!
I flush the wound with alcohol. Not only does it help disinfect the wound, it helps numb the area from the inside as well as the outside.
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Old 02-17-2012, 04:15 PM
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Go to a butcher shop and see if you can get some pork bellies, make incisions and lacerations, etc. to the them and then suture them. This gets you used to how it feels to pull the needle through tissue and also allows you to practice your technique and try different stitching methods.

A good book on this subject can be found here

http://ebooks.cambridge.org/chapter....0511551123A009
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