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Wednesday, August 25, 2021

The Right Way to Clean Abrasions

Using iodine, rubbing alcohol, peroxide, or whiskey to clean a wound makes for good TV drama. Tough guys wince or swear, children whimper and cry. In reality, it makes for dead tissue which then has the potential to get infected and create a whole other host of problems. And, on top of that, you are wasting what may be very precious disinfecting agents. So let's learn to clean a wound properly.

Assume your teenage boy has come to you with a really nasty road rash. It's kind of sizable and extremely dirty--sand, mud, organic matter--all kinds of grossness. And it's bleeding a bit. What do you do first?

Stop the bleeding. Right. Now it may be hard to tell whether the bleeding has actually been stopped with all that gunk in the wound, so you may have to use some water to wash it out so you can see better. If you've washed it out and you now see that it's still bleeding--oozing out and pooling, then go back to applying pressure to stop the bleed. Only once the bleeding has completely stopped do you go on to the next step.

Once the bleeding has been stopped, it's time to debride the wound, i.e., remove all the dirt, dead tissue, gunk, bacteria, etc. Clean water--it doesn't have to be sterile--is all you need. Tap water, bottled water, a clean, clear mountain stream. Boiled water. Saline solution, sterile or not. It all works. (If you're really desperate, fresh urine from a person without a UTI is said to be sterile. Let's hope we don't get desperate.) Never use iodine, rubbing alcohol, peroxide, or any alcohol used for drinking. That only works on TV, and you are not on TV. All of those will kill healthy tissue (because those disinfecting agents are being used to kill living things like bacteria) and make it dead tissue that can create an infection. And then you'll need to re-open the wound, clean it out properly, waste supplies, and maybe even need to start using some antibiotics. Just do it right the first time.

You may need a whole liter of water, even for a small injury. It's not an exaggeration. And yeah, that's not how they do it on TV. Back to our teenage boy with the nasty road rash. You're not simply pouring water from a bottle or using a washcloth. You're going to need to create some pressure to dislodge that debris in the wound. Your best options for doing this are a large syringe (without the needle), like around 60 ml. A curved tip might be nice. Or you can use a perineal bottle (usually simplified to peri bottle), the bottles given to new mothers in the hospital to rinse with every time they use the toilet. Both of those will create nice, gentle pressure for removing debris. You don't want a fire hose that is going to do more damage. And don't be surprised if you need to refill a few times. It would be nice to get it all done at once, but a larger bottle or syringe may be more difficult to manage.

If the wound is substantial, or if it has some larger contaminants that irrigation alone can't dislodge, you'll need some tools. Doctors call them forceps. The rest of us call them tweezers. Tweezerman point tweezers are the way to go. Uncle Bill's sliver gripper tweezers are also nice. This is not an item you want to go cheap on.

Once you have thoroughly debrided and irrigated the abrasion so that there are no contaminants or dead tissue left inside the abrasion, it's time to clean around the wound. Now you can use iodine, rubbing alcohol, peroxide, etc. Start at the edge of the wound and in a circular motion work your way out. Take care not to make any contact with the wounded tissue as you are doing this.

After the area around the wound is dry, finish up your treatment with a bandage or gauze (possibly spread with triple antibiotic) and tape to protect the wound from getting contaminated and infected.

This is probably where the doctor would stop, and hopefully it's all that is needed. But what if things have really and truly fallen apart? What if it's only you providing care? What if you missed something? What if there is no triple antibiotic to spread on the bandage? You might consider covering the wound with sugar, granulated pure cane sugar. It's a natural antibiotic and provides some pain relief as well.

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