Dakins Solution and Nursing Care for the guerilla or partisan.

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.
 

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About the Author: mechmedic

MechMedic is the owner of Stuck Pig Medical and medical instructor for Brushbeater Training and Consulting. After 5 years in the beloved Corps, Mech joined the National Guard where he became a medic. Lifelong survivalist, and overall outdoorsman. When not being a family man, he enjoys good bourbon and good cigars.

24 Comments

  1. Anonymous March 21, 2021 at 22:32

    5

  2. ChuckInBama March 21, 2021 at 22:50

    A great addition to the file.
    Thanks !

  3. Jon March 21, 2021 at 23:00

    MechMedic
    Has anyone done the math on making Dakins using pool shock? Asking because pool shock stores well.
    Keep teachin us. We’ll try to learn.

    • mechmedic March 22, 2021 at 09:06

      That I actually do not know. The biggest thing would be to make sure you’re adding a diluted shock that has about the same amount of sodium hypochlorite as household bleach (5.25%)

  4. Garry F. Owen, Trooper March 21, 2021 at 23:35

    Nasal saline spray can also be effective, and re-using the bottles with diluted Dakins solution should give the recommended 6 psi for proper cleansing and debridement.

  5. Anonymous March 21, 2021 at 23:56

    4

  6. dude March 22, 2021 at 00:37

    High value post.

  7. Hubbs March 22, 2021 at 02:50

    Retired orthopedic surgeon here who did final year of practice before retirement in “wound care” with VOHRA. Dakins ( a form of bleach) “frowned” upon for treatment of infected wounds but I and many other wound care physicians still used it as we thought it was better than other more costly antiseptics. Some others like betadine also had their problems. Sugar supposedly an option, as it will osmotically draw the moisture from the bacteria but I have never used it. Same with maggots. Gross as it may sound, they eat only dead necrotic tissue so they are nature’s debriders
    When I was in the jungles of Ecuador in 1997, fishing in the Piranha river off the Napo, my girl friend who wasn’t using a fishing pole to keep her line away from the shore got a snag, and the guide asked if he could use my pole to reach out and unsnag it. I then went with my Lorena Bobbitt knife (A huge knife and that’s what the guides called it- Lorena Bobbitt was from Ecuador) to cut myself a new pole and I started to notch the end. The knife was so sharp and the wood so splitable (and I so careless and stupid) that the knife split the pole cleanly in two and slid all the way down from the far notched end to my left hand which was holding the base of the pole and cut both my extensor tendons of my index finger right at the knuckle. (MCPJ) Extensor digitus indicus and the communis tendons. The guides wanted to return to Quito. I would have if it had been a flexor tendon injury as that is at high risk for infection because the synovial flexor tendon sheath is basically a tunnel for the infection to travel in. A very small feeding tube with as syringe of sterile water could be snaked into the tendon sheath if need be in a real fix I suppose to try to irrigate (flush) it out. My ex wife’s (filipina) relative was a farmer who had a similar flexor injury and died from septic shock from the deep space hand infection and tertiary tetanus. Very little health care out in the provinces (Negros Occ.) and even less if you have no money. If I had been there with my kit, I would have numbed the skin or even given combined median, ulnar and radial peripheral nerve blocks (as xylocaine does not work as well in an infected field), taken my scalpel and opened that baby wide open. The most common error is not opening an infected wound widely enough to let the infection egress presumably due to fear of cutting some other structure. Obviously, if you aren’t aware of the anatomy, you risk cutting a vessel, nerve, or more tendon. The bottom line, many wounds should not be closed unless they are clean, can be anesthetized with lidocaine to allow a thorough wash out and are in non -critical areas. Another common error is not realizing that a wound, especially one around the knee from a chain saw, or a knife or gunshot, communicates into the joint, and from there, you eventually get a septic/infected joint. The trick is to explore the wound, possibly even extending it to get better visualization without inadvertently penetrating into the joint, dragging outside contamination into the joint.
    In my case, I simply boiled clean rags in a pot of water for the usual 10 minutes, let the water cool, and had my girlfriend poor the water from the pot at a distance of 3 to 4 feet to get a good waterfall pressure cleaning effect, and then wrap the wound with the cloths. Three times a day. I even went Caiman hunting at night with the flashlight in the the dugout with the dressings on. Four days later, when I returned to the hotel in Quito, I got my suture set, lidocaine and 5-0 braided nylon and repaired the tendons by first exposing the wound longitudinally farther up the hand (proximally, converting it to an L shape) by placing my hand flat on the table with my wrist and fingers hyperextended, I was able to retrieve and approximate both ends of the tendons and repair them via a modified Kessler technique, place a tongue depressor underneath to keep the finger extended and wear a surgical glove over the tongue depressor and my hand to hold the tongue depressor against my finger and palm. The repair healed uneventfully with the usual 5 weeks splinting. It took a while to do the repair in the hotel room because my girlfriend kept fainting every time I asked her to hold one end of the suture while I pulled on the other to tie the knots.
    So now, if there is anyone in western NC in the Asheville area who could teach me, an old fart and his 17 yr old daughter who despite having danced in the Nutcracker as an extra for the Moscow Ballet actually likes shooting and wants me to take her back to the range ( I took her to the 2 day AR-15 Course at Blueridge Marksmanship last year, and she kicked my butt) how to sight in my “new” but old rifles (Springfield Supermatch with plain Duplex 8-25x 56 Japanese scope made for Springfield way back when-fired only ten times total, a 22 year old Remington 300WM with Shilen barrel, Remington 700 action, McMillian stock also only fired 10-20 times, and a Steyr SSG Manlicher .308 with double triggers and the German style post on a Steiner 10×40 fixed scope, also fired only about 20 times max, I would sure appreciate it.
    The time is getting near.

    • Halfwolf March 22, 2021 at 08:03

      Hey Doc. What is your opinion on homemade colloidal silver ? I’ve made my own just for poops and giggles and I was bored. Haven’t had a reason to use it.

      • Stanwyck March 22, 2021 at 13:32

        I’ve personally used and made colloidal silver and it’s an excellent antibiotic. Not the same on wounds as cayenne but good for many different uses.

  8. Cavguy March 22, 2021 at 08:54

    Have used Dakins Solution 0.125% on horse feet for thrush. Most equine east of the Mississippi have it to some extent. Do a good picking, then liberally apply the solution. Do this once every two to three days to get it under control, then every three to four days there after. I would wrap and tape aluminum foil around the GLASS bottle to keep sun out, and kept in a dark cabinet in the tack room, in order to extend its useful life.
    I found my instruction sheet from a college web page, just looked for it online and could not find it. I have it on an external drive, if you want it leave a comment and I will send it to NC after I dig it out.
    Saber 7

  9. Johnny Paratrooper March 22, 2021 at 10:24

    Great Post.

  10. Rooster March 22, 2021 at 10:30

    Good to hear on the Dakins solution Pigsticker. Hubbs, you and your daughter should come out to a training class and bring your rifle and gear for zeroing. Scout or one of the other fine folks that are there will be glad to help you out and the environment is very friendly for the TWO sexes attending…the gender dysmorphic are tarred and feathered(JK). The “self help” example was great to read and Ive been practicing suture techniques and have lidocain powder/saline viles to home brew some pain relief but it would be great to hear more about suturing techniques. Maybe doc you could suggest some suturing manual/books for study?
    R

  11. Stanwyck March 22, 2021 at 13:28

    Absolute best thing I’ve ever seen treat all sorts of wounds is CAYENNE. It will close up and heal ANY wound. If someone is having a heart attack or stroke, CAYENNE. The liquid form is best to take by mouth or smaller wounds but for large wounds that you want closed and healed you should use the powder.
    https://www.herbdoc.com/cayenne
    Research online and find out all the stories of how amazing Cayenne is for all sorts of things. I have used it to close wounds, fight off infections in my throat just as they are starting. For detoxing, an energy boost. A friend used it on a wound went to his doctor and the doctor couldn’t believe how fast the wound healed. I used it on an 87 year old woman who had a deep cut on her foot that wasn’t healing. As soon as I put on the Cayenne it started to heal. Cayenne helps the blood rush to the area of the wound which the woman had a problem with because of her poor circulation.
    You can grow your own cayenne and make it yourself for future use but for now just get some Cayenne and I’ve linked to the best most powerful that I know.

    • Bo March 25, 2021 at 09:07

      The only thing cayenne is going to do for a stroke or MI is have the patient die with a spicy mouth. NO evidence that this will do ANYTHING in these cases. Give me evidence or don’t give me anything.

  12. Ralph k March 22, 2021 at 14:45

    https://www.nursingcenter.com/journalarticle?Article_ID=1585988
    Above reference for Dakins solution, history and use. Previously described in reply to:
    G-MEDICINE: TREATING GUNSHOT WOUNDS IN GUERILLA FIGHTERS
    Posted by NC Scout | Aug 18, 2020 | AP Staff, Medical | 31 |
    As an aside, would have been an interesting sight to see Doc Hubbs, above, fishing for his tendons of his finger. Not an easy task, one handed nor with an assistant who swoons at the slightest sight of the red stuff. Here is a reference for making bleach from pool shock:
    https://readylifestyle.com/how-to-make-bleach-with-pool-shock/
    Stored liquid bleach loses about 20% of its efficacy after 1 year, so needs to be rotated. Pool shock last ~2 years, if stored properly, thats the key. Be careful, it is hygroscopic in nature, meaning it absorbs moisture readily, and it is a powerful oxidizer and can ruin just about everything it touches, including human tissue of course.
    Always remember, NO full strength bleach solution on or in the human body, EVER.

    • SOG March 22, 2021 at 17:07

      be careful about which other chemicals such as brake fluid stored around pool shock some chemicals mixed will cause ignition

  13. Anonymous March 22, 2021 at 15:07

    4.5

  14. Travis March 22, 2021 at 20:37

    Thanks for the post, great information.

  15. Eric Blair March 24, 2021 at 13:00

    long ago came across a compound called “SugarDyne.” Thick slurry made from adding tincture of iodine to granulated sugar. Mix til thick enough that it adheres’ to a tongue depressor or popsicle stick
    Osmotic action of this supersaturated paste kills bacteria, as they loose fluid across their permeable membrane into the SugarDyne
    Impressive results seen in a text, reflecting use in penetrating / severe injury from GSW in extremities.
    Pack wound, bandage, change 2x a day. Yes yes I know that t/i irritates viable tissue … meh ! … loose the foot or survive some pain

  16. erin March 24, 2021 at 15:20

    Raw honey works very well, even for wounds resistant to modern antibiotics.

  17. erin March 24, 2021 at 15:30

    Oh and maggots do an excellent job of debridement. An old remedy being resurrected.

  18. 71M March 24, 2021 at 16:39

    This, and comments, went straight to archive then hard copy for Pharmacist wifey.

  19. doug1943 June 23, 2021 at 11:22

    Whoa … lots of very good information here. This post, and some others, needs to be packaged up as a PDF file and made available for download on every possible site. Thanks so much, to both the original poster and to commenters.

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