Years ago, a friend of mine was in med school, and headed off for a semester in the rainforest of Ecuador, performing basic medicine and stuff for people who rarely got to the city to see a doctor. He called me up, on a Sunday afternoon, with this question:
"Our dentist in the group just realized she doesn't have a source of suction, you know, like the vacuum that slurps saliva out of the way during a procedure. We're in Houston and our flight leaves in 6 hours. Any solution needs to work off-grid for a month. Got any ideas?"
I thought for a moment, and said "Hit an auto parts store. Get a brake-bleeder kit. This has a hand-pump vacuum with a clear collection jar. Aim for one with a glass jar if possible, since it'll be easier to clean. Should set you back about thirty bucks."
And we didn't speak again for a few months. When he was stateside again, he said the brake bleeder kit had worked so well and was so simple to operate, they'd often just hand it to the patient. Not only did this free up a physician, it also gave the patient something to do during what's often a nervous and fidgety time, and may have thus decreased the need for sedation in some procedures.
Sometimes it really is that simple. He had numerous stories of doctors in hospitals picking the brains of janitors -- they called it a "facilities consult" -- to see if they could MacGuyver a solution to a problem that the medical industry hadn't packaged yet. PTFE plumber's tape apparently comes in a medical grade too, but sometimes you need to toss around ideas with some other hands-on maker-fixer sort of people before you figure out how to apply it.
One prominent example is superglue, which started being used by medics in the Vietnam War to control bleeding until a soldier could get to a hospital. Now you can buy special medical versions of the stuff at any drug store.
I think I've read that superglue was invented in WWI for exactly this purpose.
But beware that closing up a wound increases the chance of infection, so only do this if you're sure that you've been able to sterilize the wound first or if there is no other option for stopping the bleeding.
Otherwise it's best to leave the wound open and wrapped with bandages, and make sure to change the bandages at regular intervals.
If you need to control bleeding quickly you can also use hemostatic gauze which contains a clotting agent such as kaolin clay. The gauze can be used to pack arterial wounds where a tourniquet can't be used. I keep a pack of it in my backcountry first aid kit in case someone's bleeding from an artery and I can't get a tourniquet on it, which sometimes happens when the artery retracts into the body after a cut.
Yeah. I am not a doctor, but I do have some limited first-aid training. I'm not advocating that everyone should use this type of gauze. But I was pointing out that in the case of severe bleeding this gauze would be better than simply closing the wound and hoping for the best. In fact, during my training I was told that you don't want to close an arterial bleed, because the artery will simply continue bleeding copious amounts of blood into the (now closed) cavity.
In my mind use of a medical device such as this type of gauze should be the subject of a risk/benefit analysis, where the risk is potential for burning in some cases versus the risk of bleeding out. If you've got a cut that isn't pumping arterial blood then you can probably rely on the body's own copious clotting agents to stop the bleeding. However if the patient is likely to bleed out, then it may be better to use quikclot gauze or similar, because the choice is "die from blood loss" versus "receive some burns."
A different calculus might apply in cases where you're not in the backcountry because the medical response speed is much faster. I wouldn't assume that search and rescue has a response time less than 6 or 8 hours, and if the conditions are especially shitty and you're far enough away from a trailhead it might be a day or two before you can expect rescue. From what I understand it can take an hour or two before the SAR people in my area are even headed toward their base. From there it could be another hour or two before they can mount a response, and then there's time spent in transit and time spent searching for you.
Under those conditions it shifts the mental calculus from solutions that will work for less than an hour toward solutions that will work for hours or days. So it's probably better to take a burn that won't get much worse instead of an arterial bleed that will kill you in less time than it takes for SAR to start driving to the chopper from wherever they're on-call at.
Those burning clot agents aren’t used anymore (at least in the US/Israel/Europe.) I just did a trauma refresher with the Stanford trauma center and that very question came up. That study you referenced is 10 years old. The new stuff doesn’t burn.
Except that bandages fall off when you're working, especially if you're working on something dirty. Whereas super glue holds a cut shut even if you're covered in oil. Or, if the cut is on a finger, super glue allows you to keep working as if you aren't even cut.
Superglue / cyanoacrylate wasn't discovered until the 1940s. They were trying to create clear gun sights when they discovered the fact that it sticks to everything. My understanding is that it wasn't used in the field to close wounds until the Vietnam war.
Nowadays they have blood clot kits you just pour into the wound. It solidifies very quickly stopping most external blood loss but has to be surgically removed by the attending physicians.
If you need to clot a wound and have only common household products, ground black pepper and coffee grounds make for excellent temporary scab substrates.
There used to be a product (I believe from johnson and johnson) called liquid bandage.
It was a two-part formula, combining a treated applicator like a cotton swab and a bottle of adhesive.
You had a cut, you put a drop of liquid from the bottle onto the end of one of the swabs and touched it to the cut on your finger or wherever. The two parts together formed the adhesive.
It instantly secured the skin together.
It was the BEST. It would fix a paper cut immediately and securely. You would not accidentally dribble adhesive and stick your fingers together.
They pulled it from the market, for some reason shrouded in mystery.
Now all you can find is nexcare nu-skin which is not very good at all. (Basically it sort of covers your skin, but doesn't secure anything)
TIL that that is not what neosporin is.
Since hearing about that liquid bandage thing back in the 00s, I started hearing about people in the US putting "neosporin" on minor injuries; I had just assumed it was the liquid bandage stuff.
I only just googled what neosporin was now.... it's a topical antibiotic.
I actually use this one all the time. I do a little wood working and if I slice open a finger, I just grab my Rockler CA glue, put some on, squeeze the slice shut and wait about a minute.
If you purchase liquid bandage in a drug store, it is just sterile CA glue.
Superglue is extremely effective at paper cuts, and sealing cuts in cold, dry weather that otherwise crack further. Any small "slice" type injury I use it over a bandage.
It is very effective and I've used it successfully at least a dozen times. However, you virtually guarantee a scar if you use super glue. Most of us dudes don't care (as long as it's not on the face), but it's something to think about when treating others.
You can get spray like bandages now. Which feels like a combination of glue and some sterilization stuff added in. Stings a little bit and then dries out and sticks like glue.
The issue is not the compound itself, it's the impurities in the packaged substance. You don't know what possibly-toxic impurities or allergens might be present in a tube of hardware store adhesive, since they probably don't affect the glue's ability to do its intended job.
Also cyanoacrylate glue has a tendancy to react exothermically with cotton, which is a common bandage material. For the layman this means that it can get burning hot if you get some on a cotton bandage. The medical-grade superglue does not have this problem.
If you have the opportunity to use something better, then obviously use something better. But in practice these objections are not a huge deal for the vast majority of people closing their wounds with CA glue.
Pro-tip: you don't need to put the CA glue inside your wound. Squeeze your wound together, put the CA glue on either side of it on your intact skin, then place a piece of thread across the wound, fasted to the skin on both sides with the CA glue. The effect is a do-it-yourself suture without needing a needle.
And YES, it's exothermic with the thread. So obviously don't use a lot of it. Use the absolute bare minimum and don't attempt it with wounds severe enough that a lot would be required. If you slather on the glue than slap a patch of denim over the wound, you're going to get burned badly. Don't do that.
How do you hold the wound shut, hold the thread in place, and apply glue all at the same time without getting the glue everywhere, especially over the hand holding the thread?
I always just use a single-ply piece of paper tissue, and soak that in the glue. It's too thin to hold much glue, so it doesn't get that hot - if you need more strength, you can add more layers. And it can be applied one handed - place tissue over wound and apply glue. Done.
Cyanoacrylate rapidly hardens when it contacts moisture, so impurities are of little concern in my opinion, as they will be trapped in the polymerized glue (mixed with some clotted blood).
According to medical literature, people regularly ingest superglue without any issues (mostly children). They even put it in their eyes accidentally (it turns out that it's a bad idea to store your nail glue in the same drawer as your eyedrops, especially with impaired vision) without any damage aside from a few days of discomfort.
Being able to apply suction on my command seems like an added benefit. Sometimes I think I'm going to choke at the dentist waiting for him to start vacuuming. Could be comforting for people who aren't typically in the sort of situation and feel out of control of themselves.
Just set up a signal with your dentist before hand. "Hey doc, just to let you know I am sensitive to my own saliva, when I point to my mouth can you do the straw thingy?"
Yup, or even ask if you can work the suction yourself. I've done this lots of times with my current dentist.
I hold the handpiece out of the way, and if I feel like I'm drowning, I kinda wiggle it in the direction of my mouth, they make room, and I go in and vacuum things up. If they see the need before I do, they just say "suction", just like they'd say it to any other assistant.
It's no different than holding my own jaw open. If the patient is awake, they're part of the procedure. Might as well make the most of that. And if it means less anxiety and discomfort, which means you're happier and more likely to return, that's a win for everyone.
During one visit, I noticed that the swing-arm lamp had a flat plastic cover on it that acted as a mediocre mirror, and I could see what they were doing in my mouth. As soon as I noticed that, the random shoving and scraping (which always made me nervous as hell) gained context of the work they were doing, and I calmed way down. I ask for the lamp every time now.
> "I've seen third world doctors use super glue to seal cuts."
Expanding on this a bit, commercial cyanoacrylate (such as Super Glue or Krazy Glue) was used during the Vietnam War by US personnel for wound closures, but was not approved by the FDA for medical purposes because its side affects hadn't been explored. Dermabond and other medical grade cyanocrylates have since been approved.
That sounds good, but it's not true. There's a world of minute clinics out there with PAs and LPNs. There is mail order medicine and Walmart's pharmacy. There are bronze plans/borderline broken leg plans. There's a real problem with medical care access and finances, but it's not gold-plated or nothing.
This sounds really good to the ear, but it's just not true is it? Americans have a lot of choice when it comes to these things, at least compared to healthcare.
It's a byproduct of regulation. When you start telling people they can't consume this substance, or buy a car with fewer than this number of airbags, or without traction control, or you can't sell an apartment with a size smaller than this, you create consequences. Maybe people buy used cars instead of new cars. Maybe they live in illegal units that skirt the regulations not just on sizing, but on fire safety. And so on. You create black markets.
This is absolutely not to say that regulation is bad! It is just to point out that it creates unintended consequences you have to be aware of, and place the slider of regulation in the appropriate place.
After all, we all intuitively know that a minimum wage of $500/hr and a minimum allowable housing size of 7000sqft won't work! But we also know that telling a surgeon "just use whatever you find lying around" may not be the best approach either.
We have some level of choice with respect to healthcare as well. I'm just thinking of other nations I've traveled, in which lots of people chose to live in housing that wouldn't be allowed here, and drove vehicles that wouldn't be legal to sell here.
You might argue with the idea that they "chose" those things. That argument would apply just as much to health care. Yes, if someone had the choice between vast wealth and penury, one would choose vast wealth. Given the condition of penury, however, what's wrong with e.g. a tuk-tuk or a corrugated tin shack? Are those not better than living on the street in a cardboard box and walking everywhere you go?
Sure, American medicine does, for non-human animals. I suspect that at least part of the difference is that veterinary medicine is mostly uncorrupted by insurance.
And there is little reason to use hardware store cyanoacrylate glue on skin — you don’t know what’s in it, and there is evidence that hardware store formulations may cause issues on skin. Animals get to use a product such as Vetbond, which is designed for the purpose and is not much more expensive. (A whole bottle of Vetbond, which is reusable, seems to cost a little less than a single Dermabond applicator.)
It's in use in America too. A couple years ago I dropped a knife and like an idiot tried to catch it, of course I didn't succeed it wound up stuck in the palm of my hand making a cut about .5" to .75" long and .25" to .5" deep (didn't measure quite how deep it was at the time you know other priorities) and the hospital cleaned, irrigated, disinfected and then glued it shut. Worked pretty well.
Using superglue to keep paper cuts closed is a household remedy, at least in American midwest. But most paper cuts are hardly considered to require medical attention. I assume you're talking about surgical cuts that would otherwise require small sutures?
Anecdote: I had a surgical incision around six inches long glued shut after an operation in the UK. No stitches. I was surprised, but from talking to the nurses it sounded like that was standard procedure. Judging from other comments, the stuff they used (DermaBond) is a variant of superglue.
After a major knee surgery my incision was closed up with staples that looked suspiciously similar to ones I've seen in an office supply store. Well, except the price; I think the surgical ones cost several orders of magnitude more.
When I worked in food service we had a brown medical looking bottle of "liquid bandage" that was basically just weak crazy glue. We had to use that if we cut ourselves to make sure not to contaminate the food. Once I found out what it was I started using normal crazy glue gel instead. Closed up the cut, kept it clean, totally waterproof. I keep a bottle of it in my medicine cabinet to this day.
"Our dentist in the group just realized she doesn't have a source of suction, you know, like the vacuum that slurps saliva out of the way during a procedure. We're in Houston and our flight leaves in 6 hours. Any solution needs to work off-grid for a month. Got any ideas?"
I thought for a moment, and said "Hit an auto parts store. Get a brake-bleeder kit. This has a hand-pump vacuum with a clear collection jar. Aim for one with a glass jar if possible, since it'll be easier to clean. Should set you back about thirty bucks."
And we didn't speak again for a few months. When he was stateside again, he said the brake bleeder kit had worked so well and was so simple to operate, they'd often just hand it to the patient. Not only did this free up a physician, it also gave the patient something to do during what's often a nervous and fidgety time, and may have thus decreased the need for sedation in some procedures.
Sometimes it really is that simple. He had numerous stories of doctors in hospitals picking the brains of janitors -- they called it a "facilities consult" -- to see if they could MacGuyver a solution to a problem that the medical industry hadn't packaged yet. PTFE plumber's tape apparently comes in a medical grade too, but sometimes you need to toss around ideas with some other hands-on maker-fixer sort of people before you figure out how to apply it.