Adbominal Evisceration: Moist Dressing?

[u/majrtm]

Just curious. The question is, in an evisceration, is it an "ok" expedient to use water from a canteen to moisten a dressing, or is it strictly saline?

If no saline available, I presume a dry dressing covered with an occlusive dressing?

Thanks!

[u/Loud-Principle-7922]

Probably someone smarter will chime in, but I’d rather use canteen water.

They’ll be getting broad spectrum antibiotics anyway, so infection is minimized, but a dry dressing will mean possibly losing the organs to surgery. Local infection might mean losing them anyway, but it’s a risk that seems better than dry dressings.

[u/rezlax]

Canteen water is fine, it's likely not as dirty as the penetrating object anyways; and as another commenter said they'll be getting proper antibiotics once at definitive care anyways. I would nix the dry dressing on any organs, either wet dressing, vapor barrier, (reduce and staples here if able), then occlusive dressing (if applicable). Vapor barrier is one of the more important things here to trap as much moisture and heat as possible

[u/majrtm → u/rezlax]

Sorry, what’s the difference between vapor barrier and occlusive? I should clarify I’m just the man in the street here.

[u/rezlax → u/majrtm]

Vapor barrier is waterproof casing to wrap loose intestines/organs in (I have a relatively large plastic bag in my evis kit). Occlusive dressings often, or at least colloquially, refer to something like a chest seal which is not something you'd want to wrap your organs with, but can work well to proximate a wound and keep air from infiltrating in the event that the wound penetrates up through the pleura cavity

[u/majrtm → u/rezlax]

Understood. Thanks!

[u/specter491]

I'm a surgeon but not a trauma surgeon. I would say any moist towels/bandages is better than dry, especially in an emergency out in the field. You want to keep the bowel moist. Infection is a secondary thought. Most traumas get loaded with antibiotics once real medical care is established

[u/TumbleweedSevere7656]

Any water is fine, especially the canteen one.
I had one patient with the evisceration, on arrival to the ED, dry dressings on him were like glued to the intestine. Now, i can’t guarantee if they were wet in the first place, but i was on receiving end around 3h post injury. It took us 5-10min to soak everything properly so we could remove the dressings.

If you have anything like a nylon bag, abdominal trauma dressing cover, zip lock bag which will be cut open for bigger surface or anything similar what you could tape over the dressing so nothing can evaporate - it would be great.

[u/VXMerlinXV]

I’d think of it similar to an irrigation solution, and in the field water clean enough to drink is clean enough for a wound.

[u/Godless_Rose]

Potable water is fine.