A comparison of the efficacy of pulsed mechanical lavage with that of rubber-bulb syringe irrigation in removal of debris from avulsive wounds

Green, Vernon A.; Carlson, Harvey C.; Briggs, Robert L.; Stewart, Jack L.

doi:10.1016/0030-4220(71)90264-7

Cited by 13 publications

(8 citation statements)

References 1 publication

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“…Consensus on Science Evidence from 6 LOE 1 clinical trials, 214 -219 1 LOE 2 clinical trial, 220 1 LOE 1 meta-analysis 221 of simple traumatic lacerations in the emergency department, and 6 LOE 5 animal studies [222][223][224][225][226][227] demonstrated that irrigation is better than no irrigation, that higher irrigation pressures are more effective than lower pressures, that higher volumes are better than lower volumes (within a range of 100 to 1000 mL), and that tap water is as good as (or better than) any other irrigation solution in reducing infection rates. In 1 small LOE 1 clinical study, 228 body temperature saline was more comfortable than cold saline, and in 1 LOE 5 inanimate study, 229 soap and water were more effective than irrigation with saline alone.…”

Section: Fa-802bmentioning

confidence: 99%

Part 13: First Aid

Markenson¹,

Ferguson²,

Chameides³

et al. 2010

Circulation

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The International First Aid Science Advisory Board identified 38 questions in first aid practice that had not been subjected to an evidence review process or that needed to be updated since the 2005 process. Two or more members of the International First Aid Science Advisory Board volunteered to independently review the scientific literature and complete an evidence-based review worksheet summarizing the literature (see Part 2 of this supplement for additional information). After the evidence was presented to the full board, a draft consensus summary of the scientific evidence and a draft consensus treatment recommendation were developed and represented at a subsequent meeting. Thus, each question, evidence-based review, draft summary of science, and draft treatment recommendation was presented and discussed on 2 separate occasions, and a Consensus on Science and Treatment Recommendation was reached by the Board. This document is a report of the group's consensus.As in 2005, the worksheets revealed the continuing paucity of scientific evidence to support specific first aid interventions. Very little research is being conducted in first aid, and most of the recommendations are extrapolations from research and experience in other medical venues, animal studies, and case series. It is hoped that this document will be a stimulus to future research in first aid. First Aid for Medical Emergencies SummaryThe medical questions addressed include poisoning, anaphylaxis, oxygen administration, and aspirin administration for a suspected coronary event.No changes were recommended for first aid management of acute poisoning.In reviewing epinephrine administration for anaphylaxis, evidence was found that laypeople and some medical and prehospital professionals are unable to recognize the signs and symptoms of anaphylaxis and therefore cannot, without training, make an independent decision to administer epinephrine with an auto-injector or to administer a second dose if the first is not effective. This issue takes on added importance in view of legislation in some jurisdictions that permits these actions.No evidence was found, except in decompression injuries, to support the routine administration of oxygen by first aid providers.The administration of aspirin to a victim experiencing chest discomfort is problematic. The literature is clear on the benefit of early administration of aspirin in an acute coronary event, except when there is a clear contraindication, such as aspirin allergy or a bleeding disorder. Less clear, however, is whether first aid providers can recognize the signs and symptoms of an acute Consensus on ScienceThere are no human studies on the effect of treating oral caustic exposure with dilution therapy. One in vitro LOE 5 chemistry study 2 demonstrated no benefit from the addition of large volumes of diluent to either a strong base or a strong acid. Five LOE 5 animal studies 3-7 demonstrated histological benefit to the esophagus when a diluent was administered following exposure to an alkali or acid. Treat...

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Section: Fa-802bmentioning

confidence: 99%

Part 13: First Aid

Markenson¹,

Ferguson²,

Chameides³

et al. 2010

Circulation

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“…A review of the literature reveals that irrigation delivered at the wound surface with a pressure of 10 to 15 psi effectively removes debris, decreases bacterial colonization, and prevents clinical infection. [13][14][15] Furthermore, even with pressures as high as 90 psi there is no evidence that bacteria are driven deeper into the wound, leading to bacteremia and thus tissue destruction. 16 -19 The use of pulsed lavage irrigation in place of whirlpool therapy is the result of a study by Haynes and colleauges 20 in which the rate of granulation tissue formation was compared following pulsed lavage or whirlpool.…”

Section: Hydrotherapymentioning

confidence: 99%

A Review of Mechanical Adjuncts in Wound Healing: Hydrotherapy, Ultrasound, Negative Pressure Therapy, Hyperbaric Oxygen, and Electrostimulation

Hess

Howard

Attinger

2003

Annals of Plastic Surgery

115

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Chronic or non-healing wounds may develop in the setting of many diseases and are the source of considerable morbidity as well as health costs. These wounds demand an aggressive, multifactorial approach including surgical debridement, revascularization, antibiotics and dressings. In addition several adjuvant treatment methods have been developed to further stimulate healing. Whirlpool, although used frequently, has not been proven to be of benefit. However, pulsed lavage does show a promising future. Ultrasound has demonstrated beneficial effects but further controlled studies are needed. Subatmospheric pressure therapy is associated with few complications and is fast becoming a mainstay of adjuvant therapy. Hyperbaric oxygen therapy has been shown to be effective for many types of wounds. Unfortunately, cost and access to chambers may prohibit its use on a routine basis. Finally, electrostimulation may be one of the up and coming therapies for the future. Though, more studies are needed to determine the mode of delivery for various types of wounds.

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“…3,[57][58][59] Strength of recommendation: C a. Irrigation pressure should range between 4 and 15 psi (27.58-103.4 kPa). 3,57,[59][60][61] Strength of recommendation: C b. To avoid driving debris and contaminants deeper into puncture wounds, an irrigation pressure of 2 to 4 psi (13.79-27.58 kPa) should be used.…”

Section: Recommendationsmentioning

confidence: 99%

“…3,[57][58][59] Recommended pressure ranges from 4 to 15 psi (27.58-103.4 kPa) for all wounds except punctures, for which 2 to 4 psi (13.79-27.58 kPa) is recommended to avoid driving debris and contaminants deeper into the wound. 3,57,59,61 Hydrotherapy. Whirlpool baths and soaks use potable tap water to soften and remove devitalized tissue and toxic debris and dilute the bacterial content of the wound bed.…”

Section: Debridementmentioning

confidence: 99%

“…To avoid driving debris and contaminants deeper into puncture wounds, an irrigation pressure of 2 to 4 psi (13.79-27.58 kPa) should be used. 3,57,[59][60][61] Strength of recommendation: C 16. Hydrotherapy debridement (eg, whirlpool baths and soaks) should be avoided because it presents a risk of cross-contamination and is neither cost-effective nor time-effective.…”

Section: Recommendationsmentioning

confidence: 99%

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National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

Beam

Buckley

Holcomb

et al. 2016

Journal of Athletic Training

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Objective: To present recommendations for the cleansing, debridement, dressing, and monitoring of acute skin trauma in patients.Background: Acute skin trauma is common during participation in athletic and recreational activities. Clinical decisions and intervention protocols after injury vary among athletic trainers and are often based on ritualistic practices. An understanding of cleansing, debridement, and dressing techniques; clinical features of infection and adverse reactions; and monitoring of acute skin trauma is critical for certified athletic trainers and other allied health and medical professionals to create a local wound environment that promotes healing and lessens the risk of complications.Recommendations: These guidelines are intended to provide the certified athletic trainer and others participating in athletic health care with specific knowledge about and recommendations for the management of acute skin trauma.Key Words: abrasions, avulsions, blisters, incisions, lacerations, punctures, cleansing, debridement, nonocclusive dressings, occlusive dressings, infection, adverse reactions T raumatic injury to the skin is common among athletes participating in all sports.1 The exact frequencies of abrasions, avulsions, blisters, incisions, lacerations, and punctures are difficult to calculate because many patients do not seek medical attention after injury; for others, their activity level is initially unaffected, and the injury is not recorded on surveillance reports. Unreported skin trauma and inappropriate wound management can result in delayed healing, cross-contamination, bacterial colonization, and infection, adversely affecting the overall health and playing status of the patient. Managing acute skin trauma through appropriate cleansing, debridement, and dressing techniques can create an environment conducive to healing and lessen the risk of complications. 2,3Wound-management techniques have undergone drastic changes over the last 50 years, and other allied health care professions, organizations, and facilities have developed guidelines that serve as standards of care. [4][5][6] However, guidelines for the management of acute skin trauma by athletic trainers (ATs) are limited in the literature.1,7 The development and implementation of cleansing, debridement, and dressing techniques for acute skin trauma are critical for ATs to successfully deliver health care services to patients. The following review and recommendations provide information on the management of acute skin trauma and guidelines for ATs and other allied health and medical professionals who care for patients. RECOMMENDATIONSThis position statement is based on current research and literature with regard to the cleansing, debridement, dressing, and monitoring of acute skin trauma. We independently categorized the studies and literature using the Strength of Recommendation Taxonomy (SORT) developed by the American Academy of Family Physicians. 8 The taxonomy grades the quality of the data from the literature (level of evidence) and p...

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A comparison of the efficacy of pulsed mechanical lavage with that of rubber-bulb syringe irrigation in removal of debris from avulsive wounds

Cited by 13 publications

References 1 publication

Part 13: First Aid

Part 13: First Aid

A Review of Mechanical Adjuncts in Wound Healing: Hydrotherapy, Ultrasound, Negative Pressure Therapy, Hyperbaric Oxygen, and Electrostimulation

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

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