One question that always comes up in class is “how do we handle these injuries long term”. And the quick answer is you better have a PA or NP at least in your group, if not an MD. The long answer is a post in itself written by someone with those credentials. However, we do need to have a discussion about nursing care. No, I’m not talking about people in scrubs, I’m talking about the skillset of nursing care. Changing bedpans, dressing changes, things like that. One thing that is very important for nursing care is debridement.
Debridement is the removal of dead or infected tissue and contaminants to encourage new tissue growth and proper healing. The term was invented during World War 1. They didn’t have antibiotics back then and had to use debridement and antiseptic fluids to prevent and treat infections. Dakins Solution is an antiseptic that was created during World War 1 just for those reasons. It is preferred because it doesn’t irritate healthy tissue and is extremely effective against bacteria. Studies have been performed and show that isopropyl alcohol or hydrogen peroxide don’t offer any advantages over Dakins Solution for preventing infection.
The solution should be diluted to prevent tissue damage. The recipe from the CPG is for a “half strength” that then gets diluted for actual use. Only make up the solution as needed. The components store perfectly fine on their own. The recipe is 1L of boiled water(let cool to room temp before use to prevent burns to casualty), 5ml (or 1tsp) of household unscented bleach, and 1/2 tsp of baking soda. Dilute this 1:10 with water for use. Dakins solution should be used liberally for full effect. Per the CPG, 1–3L for small or clean wounds, 4–8L for intermediate or dirty wounds, and ≥9L for large or very dirty wounds. Make sure the pressure used for irrigation doesn’t exceed 15psi. Poking a hole in a water bottle with a needle will give about 6 psi.
Dakins solution is absolutely relevant in today’s shortage of hydrogen peroxide and isopropyl alcohol. Plus it makes packing for a guerilla hospital stupid easy. You are putting away things to set up your own clinic, aren’t you?
Most wounds you see won’t be gunshot or shrapnel wounds. It’s going to be chainsaw injuries, knife wounds, the things people normally just go to urgent care or ER to get taken care of.
But that’s an entirely different post.
Stay safe, and God Bless.