-Wound Closure in the Field.

So now that we've got the bleeding under control, the next time we go to change out those dressings, clean the wound, and kind of prevent infection, that's our next concern. You know, after stopping the bleeding, after worried about shock, you know, now we're worried about infection. So wound irrigation and wound closer techniques. Contrary to popular belief, carrying a suture kit for anything other than gear repair doesn't really pass critical thinking. I worked in an emergency room for a few years, and I used to assist doctors and PAs with suturing techniques. And one thing that I can tell you is that suturing is not a bleeding control technique, especially not in a field environment. That's why, you know, EMTs and paramedics are not suturing people in the field. What suturing does, for superficial suturing anyway, is bring the ends of the wounds, the edges of the wound, closer together to prevent infection. And it also limits the amount of dirt and debris that can get inside that. Well, I can limit the amount of dirt and debris that gets inside that wound with dressings and bandages as well. But as far as closing that wound together to kind of promote healing and lessen the scarring, which is really what suturing is for superficially, I can do that with some improvised techniques. Working with doctors and PAs in a setting where we had outstanding lighting and a very clean environment and doctors and physicians assistants that are trained in suturing techniques that have been doing it for years on another person, mind you, and also with at least a local anesthetic, that's one situation. Now, if you are a layperson that don't have those skills and that experience and that environment, if you're trying to suture yourself in the field with poor lighting, poor conditions, dirty environment, without anesthesia, even if you have the proper equipment, it's probably not the best idea. Because again, it's not a bleeding control technique. So really, all you're trying to do is promote healing by bringing the edges of that wound back together and lessen the scarring. Is it really that much of a concern to where you need to try to do this invasive suturing technique where you're driving more dirt and causing more injury to that tissue for what? It can be done when you get out of there and get back to the hospital. There's nothing that urgent that needs to be sutured in the field and that's why it's not done. So if you're carrying a suture kit, it's great for gear repair. It's great for sewing your clothing back together. But as far as sewing yourself up, there's no point in doing that in the field, really. At worst case, if you didn't get back and get a sutured in time is you have a raised scar instead of a nice, you know, clean scar that you're able to pull off with proper suturing. So enough about the suturing. Let's talk about what you actually can do in the field to promote healing that's non-invasive. There are three different techniques that I'd like to show you. Of course, you could use Steri-Strips if you have those in your kit. But you can also just use tape. Now, going back to kind of the suturing and the duct tape technique, you know, we're not just bags of blood. You can't just cover up a hole and keep all the blood underneath the skin and that be effective. That's not the way it works. It has to be in the vessel so that it can be delivered to tissue. So you can't just seal it up and kind of have that out of sight, out of mind medical principle. That's not really a thing. You want to close it up, bring the edges of the wound closer together so that it will promote healing. But it also still needs to drain and you still need to be able to clean it. So, improvising Steri-Strips. With that, let's talk about irrigating before we go to do any of these techniques. If all you have is some disinfected water, that's all you really need. Soap and water, even better. But water at a minimum, for sure, is all you need. As clean a water as possible. Now, if you're in a desert environment and this is the only water you have for hydration, then something that is as non-critical as a wound closure technique is not something you want to waste this water on. You need to focus on hydration as well. But if you do have some water available, then what you can do is irrigate that. And I like to irrigate with a full 32 ounce, you know, one liter bottle of disinfected water. And what I'll do is I'll raise this up as high as I possibly can above the wound. And then I'll let that stream pour down into that wound. And that height gives it enough velocity and pressure to when it hits that wound, it's got enough pressure behind it to actually clean it out. And I'll do at least a full 32 ounce bottle of water, disinfected, if that's what I've got, to kind of clean that out before I close this wound up as best I can. After the wound is irrigated, then I want to kind of, I say close it up, but I want to close the edges of the wounds together. I don't want to completely close any of the wounds up because I need them to still be able to drain so I don't cause any sort of abscess, any sort of infection. For this one, if you have bank line and a canvas needle or a sail needle, what you can do is take two strips of this tape, reinforce that by running some bank line underneath it. That basically just keeps it from ripping out. Run that parallel to the laceration. If you need to, you can put some additional strips to keep it down. And then you can take that needle and thread, and what you're going to do is carefully, without puncturing the skin, come up behind the bank line in that tape. Go through where it's double layered and continue on, just doing kind of a whip stitch. Just doing kind of a whip stitch and pulling that together as I go. So I go through both layers, behind that bank line, which is reinforcing it so it doesn't rip out, hopefully not dragging too much hair through the wound, and then tighten it as I go. That's going to bring it together and it's still going to have enough space to where it can drain, and I'm not causing any additional injury here yet. Do you want your glasses on? I do wear those, but not for this. And you'll continue this all the way down, this whip stitch, until you've completely closed that up, and then you'll finish it off. I'm going to fast forward here a little. I'm going to close that by going as tight as I can. Then I'm going to go back through the exact same holes for a second loop. I'm going to leave myself a little loop here. I'm not going to fully close that off. It can get tough to get it through that second time. Now what I'm going to do is take the end and go through that loop twice, making a round turn. Sometimes you have to take it off the needle to do that. Don't lose your needle. So I've got that loop from the second time around. Bring the ends through twice. Once. The bank line's coming apart on me. Twice. Now when I pull, it's going to lock that round turn down on top of there, and you can just snip that off or you can leave it right there. So this would be my preferred technique if I have a needle because it does a really good job of closing that wound up. Again, if this was starting to come up and I needed extra adhesion, I can run additional strips parallel to that bone and I'm not going to have to worry about any CMS issues down here. So this is my preferred technique for improvising a wound closure with bank line, duct tape, and a sail needle. Zach, you want to pull it? You want to go for it? Because he's been doing it to you. Thank you, sir. May I have another? You had that coming. All right, now that we're going to bring the needles out, you'll have to come around here. Damn you!