Thursday, December 18, 2008

Wound Care and Non-Adherent Dressings

On our ambulance, the two least used forms of dressings are occlusive dressings and non-adherent dressings. It is easy to explain why we don't use occlusive dressings (ed: sucking chest wounds, while popular on ER, are NOT the mainstay of our site EMS), but it is a little bit harder to explain why we don't use non-adherent dressings often.

Typical wound care for an EMT-Basic consists of slapping a stack of 2x2, 3x3, or 4x4 gauze pads on the wound while applying direct pressure. If we have other things to do we'll ask the patient to hold the gauze, or tape it down. I can't ever recall ever using a non-adherent dressing or being asked for one; moreover, our wound care protocols do not give mention to them. Interestingly enough, before yesterday I probably would have been unable to give an indication for a non-adherent dressing without a little bit of thought.

Nothing could teach me the primary indication of a non-adherent dressing better than when I injured my knee yesterday. Just two small gouges, nothing big. I irrigated and debrided the wound, applied a 2x2" gauze, and secured the bandage with 1" cloth tape.

When I went to take a look at the wound that night, I was somewhat suprised to find the gauze had become part of the clot. I was even more supprised at the level of pain I was confronted with while removing the gauze-clot. The woven gauze had to be removed one strand at a time, even after applying warm water. It was at this point I had an epiphany.

My jump bag contains 4x4" non-adherent dressings that, surmising from their name, would not adhere to my wound like the gauze had. Sure enough, after cutting down the dressing to form a smaller 2x2" form, I applied the non-adherent dressing under a 2x2" gauze dressing, and taped the new and improved bandage down. Removal this morning was pain free, and further more I did not have to break any clots that had formed!

It only takes 5 seconds of googling to find that everyone from studies, to nurses, to patients emphatically support non-adherent dressings for wound care. Thanks to a personal lesson in pain, my own protocol for wound care will now include a non-adherent dressing for any wound (which will produce an exudate) upon which a dry sterile dressing will sit.

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