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08-14-2023, 04:00 AM #7911Senior Member
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08-15-2023, 12:31 AM #7912Senior Member
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08-15-2023, 01:00 AM #7913Senior Member
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08-16-2023, 05:16 AM #7914Senior Member
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08-16-2023, 05:35 AM #7915Senior Member
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Yukon Ali
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08-16-2023, 06:37 AM #7916Senior Member
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The Top 50 Survival Blogs
By admin on Saturday, October 15th, 2011 | Comments Off
=> View these other great Survival Blogs that almost made the Top 50!
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08-16-2023, 06:43 AM #7917Senior Member
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How to Clean a Leather Belt (and virtually all other leather products)
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08-18-2023, 06:20 AM #7918Senior Member
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Basics of Wound Care – Part 1, by D.C.
SURVIVALBLOG CONTRIBUTOR AUGUST 17, 2023
This article is intended to provide readers with a simple overview to wound care and a general understanding of related terms. I am a licensed Physical Therapist Assistant who spent time training in wound care as it relates to that specific healthcare discipline. Physical therapy’s role continues to expand when it comes to wound observation, treatment, and patient education. Much of this information will be valuable to “preppers” due to the assumed lack of easy access to medical care. It will hopefully give readers confidence in recognizing and treating certain common wound types and provide a better idea of what types of first aid dressings to purchase. Wounds improperly treated can be detrimental to one’s overall health – affecting all other systems within the body in addition to the first observed damage to the integumentary system.
Note: For this piece, burns will be considered separate from other wound types for clarity
of explanation.
The first thing to consider when observing the wound is the phase of healing. This will determine the most important steps to take. There are three overlapping phases. Immediately after a wound occurs, our bodies initiate the inflammatory phase, lasting roughly from day 1 to day 10. This stage is characterized by the five cardinal signs of inflammation (tumor/swelling, rubor/redness, calor/warmth, dolar/pain, and functio/loss of function). As these cardinal signs begin to subside, the body will enter the proliferative phase (from 3 to 21 days). Here, formation of new tissue, called granulation tissue, begins. Capillaries, or blood vessel endings, start to bud and fill the wound bed. They create a positive environment for the development of epithelial cells that will become the new epidermis, or outermost layer of skin. Finally, we have the maturation phase. This phase can last anywhere from 7 days after the injury to 2 years post-injury. The differentiation of cell types is observable through the formation of a scar, originally immature, raised, and red. Later, the scar will be distinguishable by a pale, flattened, pliable surface. A mature scar typically possess 75-80% of the strength seen in the original tissue. Keloid or hypertrophic scarring may also occur, meaning the skin remains raised due to excessive collagen lysis (formation).
Occasionally, wounds are unable to follow this three-step process independently. A wound may require assistance to heal by “intention.” Primary intention is frequently seen if minimal tissue loss has occurred. The wound is properly cleaned, then smooth edges are either stitched, stapled, or adhered with wound glue to facilitate healing. This process is considered uncomplicated and typically results in a clean, quick progression.
Secondary intention refers to allowing a wound to close on its own through the body’s natural healing process, but this may require regular inspection, cleaning, wrapping, etc.
Lastly, tertiary intention. This is also considered delayed primary intention healing. A wound may be intentionally left open to delay progression in the instance of impaired vascular supply or infection.
Next, let’s consider the types of wounds we may encounter with a few short definitions.
Starting with acute wounds:
Abrasion – a scrape where the superficial skin has been rubbed or torn off. It is caused by a combination of friction and shear forces, typically over a rough surface.
Avulsion – This is also referred to as a “de-gloving.” It is a serious wound that causes the skin to be detached from underlying structures.
Incisional wound – Usually associated with surgeries, this is created via a sharp object (such as scissors or a scalpel).
Laceration – This can be considered either a wound or an irregular tear of tissues resulting from trauma. The characteristics of a laceration depend on the mechanism of injury; shear, tension, or high-force compression.
Penetrating – This wound enters the interior of an organ or cavity through various mechanisms.
Puncture – Occurs when a sharp, pointed object penetrates the skin and underlying tissues. Risks of contamination and resulting infection are possible, but there is typically little damage beyond the immediate area of the injury.
Skin tear – When fragile skin experiences trauma from bumping into an object, adhesive removal, shear, or friction forces, a skin tear may occur. This can range from a flap-like tear with either viable or non-viable tissue, or full-thickness tissue loss.
Next up, ulcers:
Arterial insufficiency – When blood flow is diminished or blocked, ischemia can result in distal areas of the body, primarily in the lower extremities. These ulcers are frequently found near the lateral malleolus (bony prominence on the outer side of the ankle). They may appear as a hole-punch shape, with minimal swelling and drainage. The surrounding area is shiny, light in color, and hairless. Recommendations include rest, limb protection, and avoiding unnecessary elevation of the leg. This will greatly increase pain and result in further loss of blood to the affected area. Use of heating pads or soaking the lower limb in hot water may be beneficial in managing symptoms. Continuing to move the leg is especially important to increase the blood moving all the way through the limb.
*Note: if the individual is experiencing congestive heart failure, use of heat and exercise may be contraindicated due to the excessive strain they place upon the heart.
Venous insufficiency – Our veins contain tiny valves within them that help push blood back to the heart, against the force of gravity. When these valves malfunction, venous insufficiency, leading to venous ulcers, may occur. These wounds are most often located near the medial malleolus (bony prominence on the inside of the ankles). The wound appears irregular in shape and usually has excessive drainage. The surrounding skin frequently turns a brownish tint. Limb protection is also very important with these ulcers. Compression to control swelling, elevation to promote blood return, and regular exercise/walking are all beneficial.
*Note: compression is contraindicated if venous swelling has occurred secondary to congestive heart failure.
Neuropathic – These appear primarily on weight-bearing areas of the body, specifically the bottoms of the feet. When individuals with decreased sensation (often from diabetes and / or peripheral neuropathy) fail to detect and respond to prolonged stimuli to that region, a neuropathic ulcer may result. People at-risk for these should be sure to wear correctly fitting shoes and seamless socks. Limb protection and inspection is needed.
Pressure (also called decubitus ulcers) – These result from sustained pressure on tissues that exceeds the pressure within capillaries. Bony prominences are especially at risk for localized ischemia and necrosis. Frequently, these begin to appear as a deep purple bruise or blister underneath intact skin. The outer layer of skin then opens to reveal deeper levels of damage. Prevention is key through re-positioning at a minimum of every two hours, management of excess moisture near the wound, and limiting of friction forces over fragile skin.
Pressure wounds are classified differently than most other wounds. They are considered one of the following:
Stage 1- Non-blanchable erythema (redness) of intact skin.
Stage 2 – Partial-thickness skin loss with exposed dermis (second layer of skin).
Stage 3 – Full thickness skin loss, often with epibole (rolled edges), slough, and tunneling. Muscle, tendon, ligament, and bone may be exposed.
Stage 4 – Full-thickness skin and tissue loss with exposed and directly palpable muscle, ligaments, tendons, bone, etc.
Unstagable – Wound is obscured by slough or eschar (non-viable “dead” tissue).
Deep tissue pressure injury – Persistent non-blanchable deep red or purple discoloration.
Other common wounds are also classified by the depth of tissue they affect:
Superficial – Trauma caused to the skin with the epidermis remaining intact. This could be considered a non-blistering sunburn and it typically heals quickly during the inflammatory phase.
Partial-thickness – These extend past the epidermis and into, but not through the dermis. Blisters, abrasions, and skin tears are examples. Re-epithelialization will usually be the common mode of healing, however deeper wounds may require additional care.
Full-thickness – A full-thickness wound extends past the dermis and into the subcutaneous fat, the deepest layer of our skin. These are often deeper than 4 millimters, but this may vary by anatomical location. Secondary intention is the most common method of healing.
Subcutaneous – Very deep structures such as subcutaneous fat, muscle, tendon, or bone will be impacted. Secondary intention remains the most common method of healing.
Next, let us consider some common characteristics of wounds – as this also determines how to best approach them. Exudate (drainage) is seen in numerous wound types, but the appearance and its meaning greatly vary. Serous exudate is very common and considered a normal part of a healthy, properly healing wound in the inflammatory or proliferative phase. It is either clear or very light in color with a watery consistency. Sanguineous is similar, but presents with a tinge of red. This is either due to blood vessel growth or the disruption of otherwise viable blood vessels in or around the wound.
Next, serosanguineous has a light red or pink coloring. It is also considered healthy in healing wounds if found during the inflammatory or proliferative phases. A few types of exudate are considered problematic, however. One such type is seropurulent. This tends to be cloudy or opaque, with yellow or tan coloring. Consistency remains thin, watery. This is an early warning sign of potential infection. Lastly, we have purulent exudate. This is thick and viscous and frequently has a yellow or green color. Always abnormal to see, it is a prime indicator of an infected wound site.
(To be concluded tomorrow, in Part 2.)
Basics of Wound Care - Part 1, by D.C.. Types of dressings to purchase. (survivalblog.com)
Last edited by Airbornesapper07; 08-18-2023 at 06:24 AM.
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08-18-2023, 06:23 AM #7919Senior Member
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Basics of Wound Care – Part 2, by D.C.
SURVIVALBLOG CONTRIBUTOR AUGUST 18, 2023
(Continued from Part 1. This concludes the article.)
Another aspect of wounds to consider is whether or not necrotic (dead) tissue is present. Necrotic tissue is “dead” or non-viable tissue that delays the progression of healing. There are a few types you may find. Eschar is black or brown and described as hard or leathery. It firmly attaches to the wound bed and obscures the depth of the wound. Gangrene is tissue decay secondary to an interruption of blood flow to a specific area of the body. This is most seen in the distal extremities, but it can affect muscles and internal organs. Another necrotic tissue type is hyperkeratosis, more commonly known as a callus. Observed to be either white or gray, it varies in texture from firm to soggy based on the moisture level of the periwound area. If a wound is covered is obscured by a thin, stringy or mucinous, clumpy layer—this is likely slough. Slough tends to be yellow in color, moist, and loosely attached to the wound.
There is a helpful classification system used to simplify wound bed coloration. Conveniently, it is dubbed the red-yellow-black system. If the area is red/pink, protect the wound. Granulation tissue should be present, so a slightly moist environment may be most helpful. If you see yellow, slough should be removed and drainage should be absorbed. Black tissue indicates thick eschar that needs to be debrided.
Okay, so you see a wound, stagnant in its healing, and requiring debridement to continue progression. What next? There are a few types of debridement you may choose from. All debridement types are considered either selective (only removing specific portions from the site) or non-selective (discarding all tissue on the most superficial part of the wound). Starting with a selective form, autolytic debridement uses the body’s natural mechanisms to discard nonviable tissue. Dressings that aid in establishing a moist healing environment may be used to facilitate this process. It is pain-free and non-invasive, however, healing times may be longer than with other methods.
If autolytic debridement is unsuccessful, enzymatic debridement utilizes a topical application of an enzymatic preparation. A few are available on Amazon. It can be used for both infected and non-infected wounds to slowly establish a clean environment. Its use should be discontinued after all devitalized tissue is removed, otherwise healthy skin nearby may be damaged.
Non-selective debridement is most commonly performed via wet-to-dry dressings. This process involves the application of moistened gauze to the entirety of the wound bed, where it is allowed to dry. As it dries, the gauze will adhere to the wound. Later, this dressing is removed, re-opening the wound by removing all tissue, both viable and nonviable, found underneath. This process may cause bleeding and be painful. It may be beneficial, however, for wounds with moderate amounts of exudate or necrotic tissue. Wet-to-dry debridement should be used sparingly since valuable granulation tissue will be lost each time.
Water is frequently used for debridement through either wound irrigation techniques or hydrotherapy. With irrigation, pressurized fluid, often with a pulsatile lavage, can be used on infected wounds or wounds with large amounts of exudate and loose debris. Hydrotherapy is completed in a whirlpool tank to soften and loosen debris adhering to the wound bed. However, maceration from long-term exposure to hydrotherapy should be avoided.
The type of dressing you select to protect each wound type is one of the most important aspects of your wound care procedure. Below is a brief description of each common dressing type and their functions.
Alginates – These dressings are created with a derivative of seaweed extract, specifically the calcium salt component of alginic acid. They are highly absorptive and frequently used for wounds with copious amounts of exudate. Keep in mind, however, that these dressings are non-occlusive. Their highly permeable nature often necessitates a secondary dressing and may require frequent changing. Alginates can aid in autolytic debridement, offer protection for microbial contamination, and can be used on both infected and non-infected wounds.
Foam dressings – Dressings composed of foam are derived from a hydrophilic (meaning it dissolves in /mixes with water) polyurethane base on the inside and hydrophobic (repels water) outer layer. With this combination, the dressing is able to effectively absorb moderate amounts of exudate. Foam dressings can be purchased in sheet or pad form with various levels of thickness. You can also select either adhesive or non-adhesive. Non-adhesive dressings will require a secondary dressing, as well. Another advantage of foam includes the moist environment it provides for wound healing and autolytic debridement.
If using this dressing, be sure to watch for rolling of the dressing in areas of excessive friction and trauma to the surrounding area upon removal.
Gauze – This is by far the most readily available type of dressing. Very familiar to most, gauze is manufactured with thin yarn threaded into a weave. Sheets, rolls, packing strips, squares, and other varieties are available for fairly cheap prices when compared to other dressing types. These convenient wound dressings have several advantages. They can be used for both infected and non-infected wound beds. They are practical for wet-to-moist or wet-to-dry debridement. You can modify the number of layers applied based on the amount of exudate present or protection required. Gauze can also be combined with other dressings and/or topical agents.
However, there are also some negatives to consider. Gauze will typically adhere to the wound bed and periwound area and traumatize that valuable granulation tissue upon removal. It is highly permeable, requires frequent changing, and can increase the risk of infection (in comparison with more occlusive options).
One common gauze variation you may encounter when stocking your first aid supply kit is impregnated gauze, simply indicating that materials such as petrolatum, zinc, or antimicrobials have been added.
Hydrocolloids – These consist of gel-forming polymers, often gelatin or pectin and a backing made from adhesive foam or film that firmly holds the dressing in place. Since the dressing does not attach to the wound itself, it is anchored to the surrounding skin. As exudate is absorbed, the hydrocolloid will swell into a gel-like mass. Due to these characteristics, this is a practical choice for either partial or full-thickness wounds. Permeability, thickness, and transparency will vary. They will provide moist environments and protect much-needed granulation tissue for improved healing. They also promote autolytic debridement, offer microbial protection with a waterproof surface, and can be used as a stand-alone dressing.
Keep in mind, however, these should not be used on infected wounds. They will trap bacteria already in the wound bed and provide a petri dish-like environment for bacteria to multiply rapidly. Take into consideration the type of exudate observable and its indication before making this selection.
Hydrogels – In either sheet or amorphous forms, hydrogels are made exactly like you might picture them. They are made with water and gel-forming materials, such as glycerin. With this makeup, they retain moisture, provide a moist environment, and are beneficial for superficial and partial-thickness wounds that could use autolytic debridement. One characteristic unique to this wound type is that it can reduce pressure on the wound, therefore decreasing some pain caused by inflammation.
Secondary dressings over top are most often required with hydrogels as there is minimal ability to adhere to the wound. The dressing can also dehydrate and should not be used if excessive drainage is noted.
Transparent film – Thin membranes made from transparent polyurethane with water-resistant adhesives, transparent films are permeable to vapor and oxygen but almost entirely impermeable to bacteria and water. They are highly elastic, meaning they conform well to body contours for wounds over irregularly shaped areas, bony prominences, etc. The biggest benefit – transparent films allow easy visual inspection of progress without disruption or unnecessary waste of first aid supplies.
These are usable for superficial or partial thickness wounds with minimal to no drainage. Films provide a moist environment, enable autolytic debridement, resist friction and / or shearing forces, and are cost effective over time.
Be careful with these, though. If excessive exudate accumulates under the dressing, periwound tissue will likely be damaged from maceration. Also important, do not use films on infected wounds, the results are similar to hydrocolloids.
Silver and Iodine – You may frequently see a wound dressing advertised as having these properties added to it. Typically, we select a dressing with silver or iodine when in need of an antimicrobial agent. They were first used in topical agents and now have become common in the dressings themselves to address microbial control and aid in preventing infections before they have a chance to start.
Honey – While pure honey has been used on wounds for hundreds on years, medical-grade sterile honey was introduced to the market in 1999. Since then, it has also become a common aspect of wound care, either as a topical application or added directly into dressings. If you encounter this, it may an excellent add to your first aid kit. It is bacteria-resistant due to its acidic properties and low-water content.
In addition to dressings, you may see wound-specific topical applications for sale. These include: therapeutic moisturizers, liquid skin protectants, moisture barriers, skin cleansers, and wound cleansers. Therapeutic moisturizers are lotions or creams designed to replenish moisture lost secondary to cleansing or air exposure. Liquid skin protectants work as sealants by drying into a thin plastic film, thereby providing minimal moisture retention. Somewhat similarly, moisture barriers adhere to the skin. However, these products can also help repel extra moisture from protected and periwound areas. Skin and wound cleansers are much like they sound. Skin cleansers are typically pH balancing and less drying than most soaps. Wound cleansers, on the other hand, can serve multiple purposes based on the individual product. They can vary from basic saline solutions to cytotoxic compounds used to remove foreign materials, exudate (excluding necrotic tissue), and dried blood from the site.
One type of wound that requires unique treatment is a burn. Burns are classified as thermal (caused by extreme temperatures), electrical, chemical, or radiation. In addition to the symptoms associated with the actual injury, the is a high likelihood of hypovolemic shock (an emergency condition where the heart is unable to pump a sufficient volume of blood due to significant fluid loss) after large areas of the body are burned. Vitals should be taken and monitored for signs of irregularity. Heart rate should be watched especially closely after electrical burns, as electric shocks can affect the sinus rhythm of the heart.
After taking vitals, assessing the wound is the next step. Burns are classified in several ways. One is through the three Zones of Injury. First, the zone of coagulation. This area is the most damaged with unsalvageable cells. Next, the zone of stasis contains less severe damage and surrounds the previous zone. On the outermost part of the burn, you will see the zone of hyperemia. Here, the skin will be inflamed, but ultimately experience a full recovery.
Another classification is through the “rule of nines.” Physicians use this to determine approximately how much of the body is affected by the burn(s). For the purpose of this article, only adult values are considered, but for children under nine years old, the head/neck region is given a larger percentage and the extremities are slightly less.
This classification does not allow for the severity of the burn, only the gross area affected. Severity is instead classified similarly to ulcers (discussed above). Since they follow the same pattern as it relates to levels of skin and subdermal structures exposed, we will focus here on how they specifically relate to burns. Superficial burns, like minor sunburns, appear red and heal without scars or peeling. If a burn produces blisters and extends to the upper dermis, it is classified as superficial partial-thickness. These burns are painful and take approximately five to twenty-one days to heal with minimal to no scarring seen afterwards. A deep partial-thickness leads to broken blisters, discoloration of the area, and edema. The entire epidermis and most of the dermis will be destroyed leading to damage of nerve endings. With this, pain is typically moderate to minimal. Healing occurs anywhere from twenty-one to thirty-five days and may involve formation of keloid or hypertrophic scarring.Head and neck 9% Anterior trunk 18% Posterior trunk 18% Bilateral anterior arms, forearms, and hands 9% Bilateral posterior arms, forearms, and hands 9% Genital region 1% Bilateral anterior leg and foot 18% Bilateral posterior leg and foot 18%
A full-thickness burn is a severe burn, typically treated with a skin graft to repair tissue (damage extends to the subcutaneous fat layer). Pain will generally remain at a low intensity due to significant nerve ending loss. Debridement of eschar may be necessary. Weeks to months may be required for complete tissue healing. Lastly, subdermal burns indicate complete destruction of all skin layers, likely leaving muscle and bone exposed. If this occurs, surgical interventions and extensive healing times are indicated.
A few at-home burn treatments that you can implement include proper positioning and scar management. Starting with positioning, one of the biggest secondary complications to occur after a significant burn is a pathological contraction of the area. For example, if a burn were to occur to the skin of the anticubital region (inside of the elbow), we are likely to hold our arm in a protected, bent position while healing takes place. However, with long periods of immobilization, the joint itself can become “stuck” in a shortened position and loose the potential to attain full range of motion upon recovery. In addition, the new skin cells formed will conform to this shortened position and lack the elasticity to stretch through full extension of the arm. To prevent future loss of function, it is best to secure the joint in a more extended position, limiting “protected” flexion-based postures. As healing progresses, taking the joints directly affected or near affected regions through maximum, yet pain-free range of motion is recommended.
Scars also have the potential to limit motion of the affected area. Common treatments for this include compression garments to minimize scar formation and transverse friction massage – quick, aggressive movements of two fingers held straight over the surface of the skin and moved perpendicular to the line of the scar. Desensitization techniques can also be helpful when attempting to assess and encourage nerve ending viability in the area. This can be accomplished through regularly introducing a wide variety of textures/sensations to the area. Good examples would be common household items such as cotton balls, dry rice, paper, fabric, water etc. Exposing the area to different temperatures, vibration, and tapping is also recommended. This process should be completed multiple times per day, every day.
While this just scrapes the surface of all that is involved in wound recognition, assessment, and treatment, I hope that this piece is an advantageous starting point for my fellow preppers. In Jeremiah 30:17, we are told, “For I will restore health unto thee, and I will heal thee of thy wounds saith the Lord.” I believe God provides us with all the resources we need to properly prepare for the end times, it is simply up to us to utilize it accordingly.
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08-19-2023, 01:21 AM #7920Senior Member
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