Subject: Re: First-aid

From: [email-masked] ()
Date: Wed, 29 Mar 1995 17:36:59 GMT

In article <[email-masked]> [email-masked] (Hal Lillywhite) writes:
>In article <[email-masked]> [email-masked] (Ron Davis) writes:
>>In article <[email-masked]>, [email-masked] wrote:
>
>>>Worthless.  Alcohol is a rotten disinfectant unless you scrub with it.
>
>
>>   If alcohol is useless what would you suggest as a substitute?
>
>As has been mentioned here before, *the* topical disinfectant is
>10% povidone-Iodine.  The best known brand name is Betadyne but
>cheaper generic substitutes are available and just as effective.
>For use directly in a major wound it is still effective when diluted
>to 1% with potable water.  (A 10% solution is a bit strong for such
>a wound.  It would both sting and damage tissue.)  The biggest
>problem is that some people are allergic to iodine and obviously
>should not have this stuff brought into contact with open wounds.
>For those folks Hibiclens is probably the best substitute.

Some quick points:

 Alcohol (ethanol) is a fairly good disinfectant, being fast acting,
 however, it suffers from several defects:

 It can damage cells and induce a strong pain response, and thus
 should never be used for other than superficial wounds.

 It does not have good penetration ability and is not persistant;
 this means that the wound must be clean before it is used, or
 bacteria on the back of that piece of dirt won't be killed because
 they won't be exposed to the alcohol, and that, once the alcohol is
 gone, the wound may be reinfected (this is why you see such things
 as tincture of iodine and tincture of merthiolate - although the
 alcohol in these today is usually isopropyl - the alcohol gives
 a fast kill off of most bacteria and the iodine or merthiolate
 gives you persistance). The penetration problem noted above
 is the basis for the statement that "alcohol is a rotten disinfectant
 unless you scrub with it."

 Povidone-iodine is a good wound treatment for people without
 iodine sensitivity (always ask!)*.

 Hibiclens will cause tissue reactions, and should not be used on
 deep or penetrating wounds.

 WRT survivalist situations, both povidone-iodine and hibiclens
 suffer from the expiration date problem - they are not going to
 be around forever.

 In general, the survivalist would want to consider ethanol (distilled)
 as a surface disinfectant and as precursor chemical for the manufacture
 of anesthetics.

 For the treatment of wounds other than superficial wounds, options
 in a long-term survival situation would include:

  Use of massive saline lavage - in short, you keep the wound
  clean using lots of normal saline solution - this doesn't
  kill bacteria, it just keeps the bacteria count down at a
  level where the body can handle it; normal saline made from
  clean, ideally distilled, water and salt (NaCl) would
  probably be a produceable resource.

  If supplies of hypochlorite bleach are available, use of
  the Dakin-Carrel method as demonstrated in WWI. (Hypochlorite
  bleach is a useful stockpile item because of relatively long
  shelf life; it is an anesthetic precursor also; sodium hypochlorite
  is relatively easy to synthesize and might be available as a
  manufactured item even under conditions of radically reduced
  technology.) The WWI technique is suggested for survivalist
  situations over later versions which used more complex solutions
  because of its low complexity and use of only simple materials;
  if better materials are available, obviously these would be used.
  There are several references to this process: one of the clearest
  is the chapter in W. W. Keen's book "The Treatment of War
  Wounds" (W. B. Saunders, 1917) which describes the Dakin-Carrel
  Method and which includes good illustrations of the treatment
  process.

  Maggot therapy, which was previously discussed on this newsgroup.

*A note on asking: always be sure the patient understands what
you are asking - there is the classic case of the nurse who,
wishing to be sure that the nice old lady wasn't allergic to
penicillin, made a point of asking her if she had ever been
given penicillin before. The nice old lady answered that "yes,
she had received it before." Thus reassured, the nurse gave the
injection. The nice old lady immediately went into a massive
allergic reaction, from which she was saved by prompt and
equally massive countermeasures by the ER crew. The nice old
lady, conscious, if weak, and noticing the distress of the
nurse who had given the injection, said: "Don't be so upset,
dear, this is just what happened the last time they gave it
to me."

Probably apocryphal, but it makes the point :-)

******************************************************************************
Renegade academician. They're a dangerous breed when they go feral,
academics are...a chemist, too.
		    -(James P. Blaylock in "Lord Kelvin's Machine")

My organization hasn't agreed with any of my opinions so far, and
I doubt they'll start now.

Stanley Roberts

---

From: [email-masked] (Yes, I'm still here...)
Date: 29 Mar 1995 21:38:14 GMT

Stanley -

Excellent post regarding irrigation.

A couple of points,

> however, it suffers from several defects:

Everything I've heard in the last few years says alcohol is not a good
antimicrobial agent, including the microbiology course at San Jose City College,
for what's that's worth.

I'm getting used to these contradiction however and since I didn't do 
the tests myself, I'll have to leave it at that.

To add to your irrigation information, all the current sources, including
Dr. Eric Weiss (one of the 5 or 6 MD's involved in wilderness medicine
education) city tap water may prove more effective in wound irrigation
than even sterile saline.

In any event, as a rule, any water clean enough to drink is clean enough
to use for wound irrigation.

Greg

---

From: [email-masked] ()
Date: Fri, 31 Mar 1995 19:11:57 GMT

>the tests myself, I'll have to leave it at that.

A lot depends on what organisms you run the tests with, of course.
Certainly there are some organisms that are resistant to ethanol.
OTOH, there are organisms that aren't, including some resistant
to other antibacterials. (see appended references)

A lot also depends on how you use it, and it is important to remember
that it is not persistent. In particular, the use issue is a pain.
Just pouring it on something generally leaves you with a surface
that remains contaminated after it evaporates or is poured off.

It is not a good disinfectant for large wounds for the reasons
given in the previous post.

In a long term survival situation, I think ethanol has the following
going for it wrt medical uses:

    It can be prepared with very low technology (and, in fact, would
    probably be available as "trade goods" relatively rapidly after
    even a major disaster due to use for human consumption :-).

    It is a useful precursor for other medically useful materials.

    It can be used as a disinfectant for minor wounds (scratches),
    as a sterilant (by evaporation) for cleaned medical goods, and
    as a preoperative skin disinfectant.

    It can be used for cooling (applied to the skin) for control
    of high fever.

    In can be used as a solvent in various drug formulations,
    including formulations intended for oral administration.

    It can be used as a fuel for alcohol lamps in your microbiology
    facility.

For these specific uses, and with the understanding that it is
used by someone who knows how to use it, I would recommend it.
I would strongly agree that it is _not_ the be all and end all
of disinfectants that it is frequently thought of being popularly.
A lot depends on what you have available to you, and, when you've
got something better, I definitely wouldn't use ethanol.

>to use for wound irrigation.

For simple irrigations, I would go along with the idea that
purified tap water is probably at least as good as good as
sterile saline (among other things, the residual chemicals in
the tap water can kill bacteria that are not dislodged). I would
also agree that water pure enough for drinking is useful for
irrigation in survival situations (watch out for iodine
sensitivities if you are using iodine-purified water, of course).
My reason for suggesting normal saline was that I was thinking
in terms of repeated or continuous lavage of a large wound, in
which case I feel you want to use saline or better isotonic
solutions in order to avoid causing too many imbalances.
(I am including surgical wounds here as well as injury wounds;
consider surgeries under austere conditions where you may need
to do a delayed closure but also need to insure that the wound
wound does not dry - the normal practice of placing a drain may
even be inappropriate in the austere environment due to the
possible increase in the frequency and magnitude of infections).
Since I very cleverly kept this thinking to myself, my post
was unclear. Certainly, when using pressurized irrigation
(probably using a syringe under austere conditions) as part of
the initial cleaning/debridement of the wound, saline is optional.

Some references on ethanol (EtOH):

Bloomfield, Sally F.; Arthur, M.; Begun, K.; Patel, H.; "Comparative
testing of disinfectants using proposed European surface test methods,"
Lett. Appl. Microbiol. (1993), 17(3), 119-125

(based on results reported in table 5:
      EtOH produced log redns. in viable count of >6.4 (i.e., no
      detectable survivors) after a 5-min contact period against
      Staphylococcus aureus and Enterococcus faecium, of >6.0
      against Pseudomonas aeruginosa, and of >5.4 against Candida
      albicans.  Increased activity was obsd. by increasing the
      disinfectant contact time to 30 min.)

Miyoshi, Toshiyuki et al; "The effects of disinfectants on Staphylococcus
aureus," J. Jpn. Soc. Hosp. Pharm. (1993), 29(12), 1411-14

(excerpted from the abstract:
     Effects of various disinfectants on the growth of 9 and 1 clin.
     isolates of methicillin-sensitive and -resistant S. aureus, resp.,
     were investigated.

     EtOH for disinfection, 0.1% benzalkonium chloride, 2% glutaraldehyde
     ^^^^
     soln., 1 and 10% providone iodine soln., and 1% sodium hypochlorite
     also showed good disinfection.)               ^^^^^^^^^^^^^^^^^^^^^^

Use as a sterilant:

Kanai, Mieko et al; "Bactericidal effect of evaporated ethanol,"
Bokin Bobai (1994), 22(1), 23-7

(excerpted from the abstract:

     The authors investigated the bactericidal effect of evapd. ethanol from
     solns. in closed cells at 5, 20 and 35 degrees C, and obtained the
     following results: 1) evapd. ethanol showed a dramatic bactericidal
     effect on bacteria inoculated onto the filter paper in wet
     conditions.  This effect appeared to be mediated by the ethanol
     absorbed in the water around the bacterial cells.  2) The
     bactericidal activity of ethanol in the vapor form was dependent on
     the temp. and assocd. with evaporization velocity of ethanol and d.
     of vapor.  The amt. of absorbed ethanol in filters increased in
     accordance with the extended exposure time.  The concn. of absorbed
     ethanol in the filter for the perfect-thermal-death points for three
     bacterial strains tested such as Staphylococcus aureus, Escherichia
     coli and Salmonella enteritidis was 45-48%, 35-37% and 28-37% at
     5 degrees C, 20 degrees C and 35 degrees C, resp.  3) Complete
     sterilization could be achieved by evapd. ethanol from 60% soln. kept
     at room temp. as well as that from 95% ethanol soln. for the strains
     examd. here.  These data imply that ethanol for gaseous sterilization
     at room temp. could be applied in many fields.)

And we haven't even touched on the efficacy of silver and its
compounds against bacteria.

Stanley Roberts