# Wound packing



## Mase92 (Feb 4, 2013)

I seen this post a bit ago, it's kinda been an urban legend status now but I wanted to shed some light and clear the air. I guess in a pinch it would work but there are so many better options.

Oh, what am I talking about? Packing a wound with a tampon!

Don't do it.

Here's why!



> Hemorrhage Control - What Aunt Flow Didn't Know
> January 28, 2015 by Chris
> Every now and again, this bad recommendation surfaces. I actually saw this printed in an emergency veterinary book recently which prompted me to finally write this article. * It's time to bust this myth.*
> I think it was the 2008 SOMA conference and the medic's were presenting their combat medical vignettes. A medic was presenting his casualty vignette when it started going something like this:
> ...


More in next post!


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## Mase92 (Feb 4, 2013)

Here is the contents of a tampon:









Contents of a z-fold:









A simple roller gauze:









Now for the breakdown to the science of it.

Tampons are handy in a pinch, but unless you are a female who is menstruating and carry them, you've gone out of your way to bring an inferior product with you as part of a kit. Why is it inferior? as the article states there are several reason based on science but did you also know that most tampon's are NOT sterile, yes they are clean but not sterile.

They also absorb blood, not allowing the normal clotting procedure to take place. Most importantly they also are not meant to stop real arterial bleeds, a rich fast flowing blood that goes way beyond the function of a tampon. They wick blood away from tissue, the opposite of what you want happening in a gun shot wound, stab wound or blast injury.

There is 15 years of case study to back this. The advancement in tactical medicine or combat medicine has jumped by leaps and bounds since the start of Afghanistan. We have cheap, yet effective pressure dressings meant to stop an arterial bleed. Doing anything less than spending $6 for a proper pressure dressing is putting you, or your loved ones lives at risk for something that will not do the job.

The last thing you want to do is shove a plastic tube with that small a gauze wrapped around it into tissue that just sustained damage ballisticly, you could end up doing FAR more damage by moving shrapnel around and pushing it into another vessel or worse.

Still good for: What they are designed for and nose bleeds.

Sources:
http://privatebloggins.ca/?p=1026
http://www.personaldefensenetwork.com/tampons-for-drama-not-trauma/


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## Jim1590 (Jul 11, 2012)

Gotta say in my 17+ years working from MRT (lowest level) up through Paramedic Field Instructor at various places such as a vollie service, Level 1 Trauma center with 2 helicopters, 4 commercial EMS companies, 1 stint 3 years running as Lead Medic and Medical Director for a major Nascar event twice a year and coming into contact with more other organizations than I could care to recall.....

Never seen a tampon in a trauma bag. Or for that matter diapers . Course I have only been in a ambulance once in the past 6 years and that was when I was majorly dehydrated after a viral illness a year ago.

Was a running gag at one point that we needed a snickers bar for the diabetics.

Good pointers Mase, often I read and hear about what sounds good without actually looking at the should I.


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## mosquitomountainman (Jan 25, 2010)

Good point Mase. I had a doctor ask once just what people thought it was like to dig a tampon out of a deep wound once clotting had taken place. It all has to come back out before you can close the wound. 

Also, many preppers and survivalists don't understand the need for clean when suturing a wound. It must be clean and sterile inside before closing it up to the outside contaminants. Otherwise you just created the perfect environment for all those infectious little bad guys to grow and reproduce. In 99.9 percent of the cases you'd be far better off to simply control the bleeding until you can get proper emergency care.


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## Grimm (Sep 5, 2012)

mosquitomountainman said:


> Also, many preppers and survivalists don't understand the need for clean when suturing a wound. It must be clean and sterile inside before closing it up to the outside contaminants. Otherwise you just created the perfect environment for all those infectious little bad guys to grow and reproduce. In 99.9 percent of the cases you'd be far better off to simply control the bleeding until you can get proper emergency care.


As a kid I had a cat that my folks got declawed. She insisted on going outside even though she could not defend herself. Once she came home with a very large abscess at the base of her tail the size of a fist. The vet cut 2 drainage holes in the skin and packed the wound with ointment and antibiotics after is was flushed clean. He then tied a sterile gauze string between the two holes to keep the wound open to drain. I was the one who did the twice daily saline flushes and antibiotic packs while the abscess healed from the inside out.

I learned very early on that a dirty wound doesn't heal and can make things worse.


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## tsrwivey (Dec 31, 2010)

Jim1590 said:


> Was a running gag at one point that we needed a snickers bar for the diabetics.


Those ready made tubes of icing work great, much less of a choking hazard, but please not in red or blue :eyebulge:


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## Jim1590 (Jul 11, 2012)

tsrwivey said:


> Those ready made tubes of icing work great, much less of a choking hazard, but please not in red or blue :eyebulge:


Had a pt suffering low sugar levels at a super market. They got him a chair and called 911. We got there and were directed down one of the aisles. As I am getting everything together and have him sucking on a tube of insta glucose (I saved the IV meds for those unresponsive or a long carry down!(I kid!)), I look up and we are standing in the baking aisle. Right in front of the frosting. Those icing tubes were on the top shelf, 2 feet from this guys head.

Can't make this stuff up.

Then there was the one where the guy was wigging out with a sugar in the 20's. He was taking a shower and the helpfull officer pepper sprayed him to try and get him into compliance and get OUT of the shower. Meanwhile I had to stick my head in there to test his sugar and try to convince him to please come on out. The whole time I was doing a


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## drfacefixer (Mar 8, 2013)

Good read. I agree. I've pulled yards of packing out of wounds, but only a few tampons. Only other place than a vagina I would recommend using a tampon is in a bad nasal bleed. It works there because as it swells it becomes somewhat occlusive. Also, there is little risk of losing it. Like any other use for a tampon, it's a temporary measure. Any long term nasal packing needs antibiotics to avoid toxic shock syndrome. Most EMTs carry rhino rockets or similar more controllable commercial nasal packing instead of a tampon.


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## Mase92 (Feb 4, 2013)

Thanks for the positive feed back, I mostly come to this forum to learn and well, as most of you know I'm the token liberal guy who kicks the nest and gets everyone frustrated. 

I figured I'd contribute with a subject I know a bit about and shedding some light on a area of medicine I feel comfortable with as a topic. 

I hope this sheds some light on the possibilities of using the wrong item when there are much better and cheaper out there.


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## CrackbottomLouis (May 20, 2012)

This is the best temporary fix I've seen for a hemorrhaging bullet wound in some areas of 5 he body.
http://www.revmedx.com/#!xstat-dressing/c2500
I can see it keeping me in the fight long enough to take a couple more with me. Good thing to have.


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## PurpleHeartJarhead (Mar 23, 2014)

mosquitomountainman said:


> Good point Mase. I had a doctor ask once just what people thought it was like to dig a tampon out of a deep wound once clotting had taken place. It all has to come back out before you can close the wound.
> 
> *Also, many preppers and survivalists don't understand the need for clean when suturing a wound.* It must be clean and sterile inside before closing it up to the outside contaminants. Otherwise you just created the perfect environment for all those infectious little bad guys to grow and reproduce. In 99.9 percent of the cases you'd be far better off to simply control the bleeding until you can get proper emergency care.


I don't know about anyone else out here, so I am just speaking from my own experience. I am not a doctor, nurse, medic or EMT. I'm just a guy who had 17 new holes put into my body in Anbar Province, Iraq in 2005. I was wounded by shrapnel from a mortar from about 10-15ft; I had no body armor at that (John Wayne) moment.

First, everyone I saw in my time in the hospital at Landstuhl who suffered shrapnel, gunshot or puncture trauma were *NOT *sutured closed. The wounds were left to heal from the inside out. Don't believe the movies, you're not going to stitch up that gunshot wound entrance and exit like they always show in the movies.

Second, I had multiple surgeries, one purpose of which was the debridement of dead and dying tissue. You will need to be able to do this on your "patient" as well. Otherwise, closed or open, that wound will generate gangrenous tissue and the ensuing infection will kill him or her.

Third, if you think you have enough packing, you don't. My wife packed and unpacked my wounds for three weeks until they were closed enough to cover with simple gauze pads. When I left the hospital, they gave me 4 boxes, about twice the size of a box of cased paper. Each was filled with gauze rolls, packing, tape, saline solution, IVs and such. We used about a box per week for my wounds.

Fourth, medical tape will tear the crap out of the skin, use it sparingly where it comes in contact with the skin. This means more rolls of gauze for wrapping the packed wounds. The skin is already sensitive around the wound, bruised, weakened vessels, etc. and glue from the tape does nothing to aid this. Some tape is necessary, especially around a healing lung, (look up "sucking chest wound"). I can't say it enough, use it sparingly.

Fifth, sterile gloves. See the third item. Might as well add scalpel blades to this criteria as well. Debridement continues after the wound is closed. I don't remember the terminology, but as the wound begins to close, you get a grainy, granular crust that needs to be removed so the wound can continue to drain. That's what the doctor told me at Camp LeJeune Naval Hospital when he lined me up for yet another procedure after I thought I was done going under the knife.

6th, pain mitigation. If you have no means to reduce your "patients" pain intensity, be prepared to have them pass out from pain as you are changing the packing in a wound. It flippin' hurts and there is no real way around it, you *WILL *put your fingers/hands *INSIDE *the wound. Also, you need to be prepared to treat for shock as well, the extreme pain can make people shocky days after the wound occurs due to the pain. You need to be aware of the symptoms of shock and understand quickly your "patients" pain tolerance.

I could go on, but these are the most important things I learned through my own painful experience and asking questions of the things happening to me. I'm blessed for the experience. (Yes, blessed and not just for the survival aspect.)

This I promise you would-be field surgeons...if you have not been around a lot of serious, traumatic wounds and had at least some hand in the treatment of those wounds, find someone who is, so they can lend a hand or advise you if you are unsure. People say all manner of things from the comfort and convenience of their homes, but most do not live up to the hype at the moment of truth the first time around, particularly those not fully trained in such awful events. I'm not saying you can't learn, but the curve is steep and costly when you make a mistake.

Good luck learning, I pray you never have to use the skills you learn.


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## Mase92 (Feb 4, 2013)

Purple, thanks for the story and the experience. Pretty amazing really! 

The medicine we are doing now was taught to us because of the brave guys that treated those who suffered injuries like yours.

After 'Nam American emergency medicine changed tremendously, it's happening again based on what other seen and the changing world we live in.


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## PurpleHeartJarhead (Mar 23, 2014)

Mase92 said:


> Purple, thanks for the story and the experience. Pretty amazing really!


Amazing indeed, in so many ways.

-S/F Mase...PHJ sends


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## Cotton (Oct 12, 2013)

I served in the 80’s, thankfully never had to experience such. Blessings on you and yours PHJ. Weekend after next I’ll be learning “ditch medicine” from someone who did. He was a special forces medic in those days.

He’s well known now… I’m taking his course in wilderness emergency medicine with herbs. I have his book and read the syllabus, the course covers all you wrote about. It’s “ditch medicine” from someone who’s been there. I plan to post everything for our group.

The whole course is designed around the precept that a trauma center is days away or simply not available. What do you do then for life threatening illness or injury?


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## Balls004 (Feb 28, 2015)

Glad you are still around to share your story with us PHJ, and hope that your recovery is as complete as it can get after something like that.

Not to get off topic, but did you have any contact or assistance from the Wounded Warrior Project during or after your recovery? I ask this because I've sent them money for many years, and am wondering if they are being effective or am I paying for salaries and advertising. I can look it up on the non-profit watchdogs groups, but I'd feel better hearing it from the horses mouth.


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## drfacefixer (Mar 8, 2013)

PHJ, you are dead right. Its wet to dry dressings for at least a week if not longer after a bullet wound. ( The head and neck have neck a great blood supply, we close earlier and trade some risk for cosmetic outcome). The cavitation and stretch injury causes a lot of late tissue necrosis which require multiple washout outs in the OR. Limbs and abdominal cavities wait even longer with more wash outs. Shrapnel wounds and anything coming out of Iraq were placed on contact precautions because the soil was usually so contaminated with fecal bacteria. As you've seen first hand, it takes a lot of work and tons of materials to keep people surviving. Glad you made it.


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## tsrwivey (Dec 31, 2010)

Wound healing is a specialty in & of itself. The only serious wounds I've messed with are those of a diabetics. They were huge & even tunneled but the patients all had severe nerve damage so they never felt a thing. In a SHTF situation outside of a hospital, I don't know that you could control that pain.


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## PurpleHeartJarhead (Mar 23, 2014)

Balls004 said:


> Not to get off topic, but did you have any contact or assistance from the Wounded Warrior Project during or after your recovery?


*WWP is legit*. They were the first to contact me in the immediate aftermath, and they were relatively new at the time. They contacted me weekly for some time, then monthly. This went on for nearly two years. Now, I still hear from them on an annual basis as they do outreach to help those who may be hurting after the wounds heal. They are an outstanding organization, to whom I also donate.

I don't receive any help from them because I don't feel I need it. I have physically recovered and while there are scars and some other lingering effects, there are others who need the help more. Besides, I have ZERO complaints about the treatment I received from military medicine and most of the VA care since I've retired.

By no means am I anyone's pitchman; but please, if you are donating to the WWP, continue to do so with confidence, they are amazing. I have first hand experience and many friends who also received the help and support they provide.


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## bogey (Aug 10, 2015)

PHJ, thank you so much for all you've done and been through. And for sharing your experience. So sorry it happened to you. You apparently learned so much from your experience. 

Everytime I hear someone wanting suture materials for a kit, I cringe. It has it's place. But I think it is much less likely to be needed than some steri-strips or sterile saline for flushes. Will have vaseline gauze, iodoform gauze and things of that nature in mine. ABD pads, lots of 4x4 gauze and paper tape. Medipore tape too if available.

TBH, I think IV fluids would trump sutures. Even if someone isn't skilled at IV, subcutaneous fluids might help. Plug the hole with gauze and a pressure dressing and get fluids in to maintain blood pressure. 

Suturing up a a dirty wound - and doing it wrong as I'm sure the majority would - may only cause more problems in the way of infection, sepsis and certain death. Keeping it open to get it clean and heal from the inside out would be the best action, IMHO.


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## drfacefixer (Mar 8, 2013)

Interesting take bogey - you gave me another perspective. Do you work with animals or elderly? Subcutaneous fluids isn't often spoken of outside those realms. I do think you definitely cause less harm with subcutaneous fluids than with iv fluids, but you lose abilities to give intravenous medication and rehydration is slow. As you said, it "might help" however, standard of care is such that it is not recommended for treatment of shock. As it is, iv fluids tend to stay intravascular on average about 13 minutes. Subcutaneous fluids third space until drawn into circulation which can take some time. If circulation is already collapsing, that fluid is going to sit there quite a while. it's not uncommon to give a trauma patient 3 to 7 liters of iv fluids. That's definitely more than you would ever want to carry in your pack. Colloids can cut that volume down some, but then come other problems. Suturing has its place in closing non life threatening wounds and dry controlled surgical wounds. One reading this thread should not just assume a missed IV line can run subcutaneous and fulfill the same purpose. Extravagation in a forearm or hand can have horrible consequences. Subcutaneous fluids has its own technique, timing, and methodologies. Honestly, I hadn't thought of it since med school. Also good to understand, that just because you blood isn't pooling out onto the floor because you stitched a hole, shut doesn't mean the bleeding is controlled. You can easily bleed out into the chest, abdomen or a thigh without any noticeable swelling.


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## bogey (Aug 10, 2015)

Absolutely agree. Was never my intent that someone should think subcutaneous could stand in for intravenous fluids. My thinking is if a completely unskilled person unable to get an IV, as a last ditch effort, subcutaneous may offer something, possibly only psychological relief for both patient and caretaker. Certainly not what I would consider appropriate for standard of care considerations. But I'm talking about laypeople with little to no training in an emergent situation with no help on the horizon. And I don't know that IV medications would be available at all.

And if packing a wound with gauze, applying a pressure dressing and said person is going into hypovolemic shock, it's doubtful IV fluids are going to be effective at that point as well in this type of situation. And colloids would be generally unavailable, I'm thinking. If someone able to appropriately suture whatever is bleeding inside were available, well, better outlook and sutures on hand would be awesome. I guess I'm picturing too many people anxious to whip out a suture kit and sew away without consideration to what they are sewing up inside the wound. Well intentioned, but could turn ugly so fast. Also sewing closed the skin with internal bleeding going on... I do know that there are appropriate places for the use of sutures. I guess I just don't credit too many people without some medical knowledge to have the judgement for when it should be used. Maybe it's just the people I know 

Extravasation is a really ugly thing. I've seen it. And infiltration could potentially cause compartment syndrome with a missed IV even of a somewhat innocuous fluid, if run continuously, much less a medication that is a vesicant. Especially if the swelling and edema are missed by an unobservant or untrained person.

And yes, bleeding out internally without swelling can most certainly happen. Have seen that too. Specifically, a post surgical patient with a relatively stable blood pressure, that just didn't look right. Got that gut feeling something is wrong. Couple of calls to the surgeon in the middle of the night to be told to give one liter of LR and not to call again. Finally, was able to grab a doctor not on the case, in desperation while administering said liter of LR. Literally drug them into the room. They took one look at the patient and ordered to go to ICU. Patient still talking - although to dead relatives - and with a low/normal blood pressure. Skin looked like wax. Anyway...

Work with animals because we have always owned a bunch.  Gave subcutaneous fluids to one of our dogs in kidney failure not too long ago. Also work hospice, oncology (nasty extravasations. Have had to do Totect administration when it was available), general med-surg, ICU step-down, telemetry, and I guess with the elderly because in one recent shift my youngest patient was 76. We do use subcutaneous infusions somewhat infrequently with hospice at times.


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