Cauterizing the Wound.

[djb204]

Ok, so you bleeding out, no first aid supplies and it's too risky to gather natural resources before you bleed out. But you have rifle round, a match, and knife if you need to open the rifle round.

Should cauterizing a wound be added? It would probably drain you a lot, and may even knock you out, but would stop the bleeding for sure. 

[Dirmagnos]

That crap you only see in movies. Tourniquet is far more superior in terms of arresting bleeding, not to mention numerous, possible lethal, side effects of improper cauterization(toxicity, infection, shock, additional damage to soft tissues or organs, etc).

Cauterization in conditions given in the game is right next to amputation in terms of being last resort action. Nowdays its either performed in sterile conditions by trained (medical)personnel or done chemically. Doing it with gunpowder looks cool, unfortunately its the worse way of doing it and irl it would cause more problem that it would solve.

[TheRealNFK]

Is this what you had in mind?

 

[Boston123]

Yeah..... no.

You go cauterize your own wound, pass out from the pain, then bleed out while unconscious.

Not to mention that the style of cauterization you are going for is very, VERY  "indiscriminate". If you aren't careful, you are likely to seal the blood vessel shut. I, for one, would much rather bleed to death than die from gangrene poisoning. Bleeding out is much faster, and hurts less.

"Real" cauterization is only done by trained professionals, and even then, they accomplish it using specialized tools and only seal up (relatively) small wounds.

99.999% of the time, you would be better off using a tourniquet. Stop the bleeding with a tourniquet, then either suture up the wound (which can be actually really hard to do in real life. I, for one, don't know how to suture, "properly" that is) or use pressure bandages.

Above all else, if you sustain a wound in a survival situation that requires a tourniquet, you are most likely going to die anyway. If not from blood loss, then from infection. 

[vancopower]

You can not

4 hours ago, Boston123 said:

Yeah..... no.

You go cauterize your own wound, pass out from the pain, then bleed out while unconscious.

Not to mention that the style of cauterization you are going for is very, VERY  "indiscriminate". If you aren't careful, you are likely to seal the blood vessel shut. I, for one, would much rather bleed to death than die from gangrene poisoning. Bleeding out is much faster, and hurts less.

"Real" cauterization is only done by trained professionals, and even then, they accomplish it using specialized tools and only seal up (relatively) small wounds.

99.999% of the time, you would be better off using a tourniquet. Stop the bleeding with a tourniquet, then either suture up the wound (which can be actually really hard to do in real life. I, for one, don't know how to suture, "properly" that is) or use pressure bandages.

Above all else, if you sustain a wound in a survival situation that requires a tourniquet, you are most likely going to die anyway. If not from blood loss, then from infection. 

You can not just say this method is better that this one. It depends on the situation, for example if it is deep wound especially if you hit a vein, cauterizing it will only make it worse tourniquet is the way to go here and someone should sew up the wound as fast as they could. However small cuts and light wounds like wolf bites, you better treat them with cauterizing because you can get rabbis from the wolf saliva which you need to burn off as fast as you can. Also tourniquet is not really a solution until you sew up the wound stopping the blood flow may indeed cause a gangrene. I saw this with my own eyes a guy who cut himself on a glass window I transported him to the hospital , and saw his arm turn white and almost blue as the surgeon put some kind of device to stop the bleeding and then he sew up his arm. I believe that if he didn't sew up his arm in time gangrene would likely follow. 

The worst case of injury is when you have some object stuck like a piece of wood or a bullet then nothing can save you except if you are trained like Rambo here to perform the operation  yourself  

To sum up how this can be introduced in to the game well, they already made this complex medical system so they should make different wounds to the treatable with different methods for example wolf bites cauterizing, bullets wounds tourniquet and find someone to perform operation in a short time, swelling and bruise ice packs made with cloth and ice which is in abundance, and off course the most important ingredient of all time. I think that wounds heal up very fast in TLD which makes melee wolf hunting preferred choice. I have mentioned this many times here it goes again they should make wounds heal up much slower like in real life, also the penalties should remain until the wound is completely healed. For example it is silly to attack a wolf bandage yourself apply antiseptic sleep and the next day be good as new.    

[cekivi]

Even with small cuts you're likely better off with soap and water with liberal amounts of antiseptic than cauterization. Cauterizing does cause scarring that decreases the effectiveness of that tissue. It's harder, more prone to freezing, not as supple, etc. I'll stick with peroxide and bandages

[Boston123]

41 minutes ago, vancopower said:

You can not

You can not just say this method is better that this one. It depends on the situation, for example if it is deep wound especially if you hit a vein, cauterizing it will only make it worse tourniquet is the way to go here and someone should sew up the wound as fast as they could. However small cuts and light wounds like wolf bites, you better treat them with cauterizing because you can get rabbis from the wolf saliva which you need to burn off as fast as you can. Also tourniquet is not really a solution until you sew up the wound stopping the blood flow may indeed cause a gangrene. I saw this with my own eyes a guy who cut himself on a glass window I transported him to the hospital , and saw his arm turn white and almost blue as the surgeon put some kind of device to stop the bleeding and then he sew up his arm. I believe that if he didn't sew up his arm in time gangrene would likely follow. 

The worst case of injury is when you have some object stuck like a piece of wood or a bullet then nothing can save you except if you are trained like Rambo here to perform the operation  yourself  

To sum up how this can be introduced in to the game well, they already made this complex medical system so they should make different wounds to the treatable with different methods for example wolf bites cauterizing, bullets wounds tourniquet and find someone to perform operation in a short time, swelling and bruise ice packs made with cloth and ice which is in abundance, and off course the most important ingredient of all time. I think that wounds heal up very fast in TLD which makes melee wolf hunting preferred choice. I have mentioned this many times here it goes again they should make wounds heal up much slower like in real life, also the penalties should remain until the wound is completely healed. For example it is silly to attack a wolf bandage yourself apply antiseptic sleep and the next day be good as new.    

Yeah, no, I can definitely say that my method (tourniquet and pressure/suturing) is better than yours.

"gangrene" isn't a disease, it is when the flesh is rotting away, usually due to a lack of blood supply. Now what causes long-term lack of blood supply?

Cauterization. 

But, if you want to ruin your knife by heating it red-hot, then pressing it to your flesh, be my guest. At least with a tourniquet, you lose feeling in the limb.

[vancopower]

1 minute ago, Boston123 said:

Yeah, no, I can definitely say that my method (tourniquet and pressure/suturing) is better than yours.

"gangrene" isn't a disease, it is when the flesh is rotting away, usually due to a lack of blood supply. Now what causes long-term lack of blood supply?

Cauterization. 

But, if you want to ruin your knife by heating it red-hot, then pressing it to your flesh, be my guest. At least with a tourniquet, you lose feeling in the limb.

I never said that gangrene is a disease. Did you read the whole thing I specifically mentioned that I saw blood loss in somebody's arm and it turned white oh I hate to repeat myself anyway it is not my method people  Cauterized wounds long before you and I ware even born. and yes it is still effective method in dire conditions, and yes putting pressure is better and going to the hospital but we are not discussing what you should do in real life here we are discussing what is plausible in TLD yes?

[cekivi]

I think the main problem we have is anything drastic enough to require cauterization will likely cause death outright. Either from infection or from tissue loss. Any flesh wound that can be cauterized without risking major blood blockages to organs or leaving large gaps in flesh can likely be treated just as well with a bandage and time. Cauterization is normally used to seal off cuts and kill germs. The only practical application I see for it in the game is if you lost a limb and need to cauterize the stump. In this case, yes, it would save you if you can stay conscious through the process. Otherwise you may be doing more harm than good.

OK, the other exception would be amputating toes and fingers due to frostbite to avoid gangrene. But since that's not a mechanic in the game right now my original argument stands. 

[Boston123]

2 hours ago, vancopower said:

I never said that gangrene is a disease. Did you read the whole thing I specifically mentioned that I saw blood loss in somebody's arm and it turned white oh I hate to repeat myself anyway it is not my method people  Cauterized wounds long before you and I ware even born. and yes it is still effective method in dire conditions, and yes putting pressure is better and going to the hospital but we are not discussing what you should do in real life here we are discussing what is plausible in TLD yes?

The whole point of this topic is to get it through your head that cauterization isn't plausible, not in TLD and not in real life.

In literally every situation where cauterization might "help", ligature (tying blood vessels shut), or the use of a tourniquet will be just, and almost-overwhelmingly-more, as effective. Plus, faster. With cauterization, you have to have a hot enough heat source, THEN  wait for the cauterization implement to heat up, THEN wait for the wound to burn shut.

As opposed to a tourniquet, which can be applied to a limb in literally 30 seconds. Not to mention that a tourniquet is a hell of a lot less ....... "permanent" than cauterization. With a tourniquet, you can apply it, suture the wound shut, then loosen it, to test if the sutures hold and the bleeding has stopped. If it has, then you are good, and you can remove the tourniquet. If you are still bleeding, tighten the tourniquet and wait a couple of hours for the body to seal the wound shut.

Contrary to "common knowledge", tourniquets are perfectly safe to use for long periods of time, so long as you use a wide enough band. You can leave a tourniquet on a limb for HOURS, and the limb will be fine. You can even use a tourniquet over multiple days, as you can loosen it, to allow blood flow into and out of the limb, then tighten it.

You saw the man's limb "turn white" not because of blood loss, but because the blood was literally cut off from the limb. Likely, the surgeon applied what is called a "hemostat", which is effectively a small metal tourniquet, shaped like a pair of pliers, that snaps shut and holds a blood vessel closed. The surgeon then sutured the cut blood vessel together.

Gangrene takes a while to set in, usually, and is dependent on blood flow to the affected area. It isn't just BAM GANGRENE

Also, finally, Cauterization of wounds, at least on the large scale you refer to, fell out of favor almost 150 years ago, at the end of the US Civil War. Surgeons would use cauterization to seal up amputations, only to end up killing the patient. They proceeded to go "hmm, maybe we shouldn't do that........", and with the development of antiseptic, anesthesia, and the "Germ Theory", developed "better" alternatives. Nowadays, cauterization isn't widely used, and even then, it is done using special tools and on small areas of the body.

The cauterization of wounds that you see in movies is precisely that: a movie stunt, and nothing more. In "real life", you likely couldn't survive what they do. As it should be in TLD.

[djb204]

9 hours ago, Boston123 said:

You go cauterize your own wound, pass out from the pain, then bleed out while unconscious.

Is the wound is cauterize do, how can you bleed out?

[cekivi]

4 minutes ago, djb204 said:

Is the wound is cauterize do, how can you bleed out?

If you pass out before sealing the wound completely you'll slip into the long dark without being able to fix it.

[cekivi]

1 hour ago, Boston123 said:

Contrary to "common knowledge", tourniquets are perfectly safe to use for long periods of time, so long as you use a wide enough band. You can leave a tourniquet on a limb for HOURS, and the limb will be fine. You can even use a tourniquet over multiple days, as you can loosen it, to allow blood flow into and out of the limb, then tighten it.

Did not know that. I was always told that long term tourniquet application will almost always result in tissue death and clots. Where did you come across this?

[Dirmagnos]

Issue is not application of tourniquet, but moderation. You dont wannt it 2 tight to cut off blood flow completely(and tissue death), but you dont wannt it 2 loose so that blood would pump at full volume(less pressure is good when pipe is shot).

[djb204]

1 hour ago, cekivi said:

If you pass out before sealing the wound completely you'll slip into the long dark without being able to fix it.

The game doesn't have the "progression of treatment" thing. You can't take one pain killer when the game says take two, you can't only bandage half your wound with a bandage. So I assume cauterizing a wound in game wouldn't be done in stages either lol. Putting a flame to gun powder isn't going to burn in sections lmao

[Boston123]

1 hour ago, cekivi said:

Did not know that. I was always told that long term tourniquet application will almost always result in tissue death and clots. Where did you come across this?

A LOT of the damage that can be caused by tourniquets 1) can be averted by strategically loosening and tightening the band, therefore controlling the flow of blood, and 2) is potentially caused by using too narrow of a tourniquet band. Too narrow of a band will actually cause damage to the flesh and nerves underneath.

When you use a tourniquet, you are doing so in order to "control" (usually stop, but you can actually have a great deal of control over how much blood flows into and out of the limb) the flow of blood through the limb, and by proxy, out of the wound. When you are treating the wound, you generally want to prevent any blood from moving through the limb, so you can actually close the wound up (through suturing, or through application of bandages). You don't leave the limb "shut down" for long periods (although, generally, a couple of hours won't exactly hurt someone, which should technically give you plenty of time to either bring them to a hospital, or go get help), but the beauty of a tourniquet is that they can be loosened and tightened as needed. After "closing up" the wound, you can loosen the tourniquet slightly as needed, to allow for blood to flow in and out of the limb, while maintaining control over any bleeding. Carefully timing this can, technically, let you leave a tourniquet on "as long as you have to"

Most "professionally made" tourniquet bands (you can actually buy them pre-made) have straps that are around 2 inches wide, which lets you close off the major blood vessels without actually damaging anything underneath. In "impromptu" tourniquets, the band tends to be made from much narrower material, which has a tendency to "garrote" the limb and cause damage to the flesh and such wherever it tightens.

[hauteecolerider]

Okay, I've had a bit too much beer in me right now, but I'm seeing so much crap around the whole cautery thing here I just can't keep my mouth/fingers shut.

As a medical professional who has used both ligature and cautery in surgery (and I've had tons of surgical experience, both emergency and elective, thank you very much), I can't believe the stuff that is being said about cautery here.

First off, John Rambo doesn't know what he is doing in that clip. Cauterizing a penetrating wound entering a body cavity? He just fried his own intestines and set himself up for peritonitis. Yes, it makes for great film scenes, but that is all it's worth. Medical professionals around the world cringe at that scene. Um, no. 

Besides making the patient smell like a BBQ gone bad, cautery is dangerous. IT DOES NOT STOP THE BLEEDING!! It is only effective for sealing blood vessels off once the bleeding is controlled - either through ligature (closing the blood vessel by tying suture around it) or the use of a tourniquet. In other words, your surgical/wound site has to be DRY for cautery to work. I've used it often enough to know I much prefer ligature. Better in the long run, as it leaves less dead tissue in the wound to serve as a nidus for infection. I prefer to use cautery very sparingly, and only on "oozers," not on "gushers" or "pumpers." And where do you find "oozers?" Primarily in subcutaneous fat (the layer of fat that is under the skin. Think 'love handles').

Oh, and nidus = origin of infection

Tourniquets only work on extremities - i.e. limbs. So torso wounds are inherently more life-threatening than limb wounds. Head wounds, okay don't get me started on those. 

Because veins are more superficial than arteries, this makes tourniquets a mixed blessing. You want to control the arterial bleeding (the bright red spurting stuff they show on M*A*S*H - anyone remember that show?) without compromising blood flow (which provides oxygen to the affected tissue). You don't want to choke off blood flow but you don't want to lose all of it either. So the proper application of tourniquets implies constant supervision of the limb to which the tourniquet is applied so that blood flow isn't cut off so much that tissue (i.e. fingers and toes) die off from lack of oxygen.

The best tourniquets for limbs are wide bands - they can be ACE bandages or 2" gauze bandages that can be alternatively tightened and loosened to keep blood flow minimal - just enough to keep the limb alive but not so much that there is significant risk of bleed out before a more permanent solution can be applied (either the wound forms clots or a surgeon applies ligatures).

 Depending on the nature of the wound, once blood loss is stopped, the wound may not require closure. In fact, I never sutured bite wounds closed. It's a sure-fire recipe for abscessation. Nope, not gonna do it. Bandaging, maybe. Cleaning, cleaning, cleaning - definitely. Dirty wounds are never closed, but allowed to heal by second intention. Yes, it's going to lead to more extensive scarring, but who cares? Vogue magazine isn't being published anymore in TLD. As long as the tissue heals and limb function is restored, we can survive. 

I could go on, but I'm too drunk on brandywine beer to trust myself not to cuss anyone out anymore. So I'll close for now, and return to this later. I might correct myself, or I might add more info. Or I might decide I've said enough. 

[TheRealNFK]

57 minutes ago, hauteecolerider said:

First off, John Rambo doesn't know what he is doing in that clip. Cauterizing a penetrating wound entering a body cavity? He just fried his own intestines and set himself up for peritonitis. Yes, it makes for great film scenes, but that is all it's worth. Medical professionals around the world cringe at that scene. Um, no.

I provided the Rambo clip because it's probably the origin point for lot of people's idea that life-threatening wounds can be solved by burning them with fire. The OP's original wording is practically a description of that hilariously absurd scene.

The whole badass-hero-burns-away-his-own-wound thing is pretty much a movie cliche at this point.

 

[SteveP]

A wound that needed a tourniquet would require surgery. If you had an NPC that could help with it, that would be fine. If you have a bleeding arterial wound you have to compress it and then stitch it. I don't know under what circumstances cauterization was used but here is a guideline:
http://www.advancedtissue.com/cauterizing-a-wound-when-to-use-in-practice/

Using gunpowder is a faster option than building a fire. When you have wounds that severe, you need to stop the bleeding immediately. There is inevitably, the risk of complications however the main point is saving the victim's life.

I don't know if it should be in the game; it's not something you want to encourage as a practice in real life however it is a skill that you would want to know how to do and when if there were no alternative. I would prefer to know than not know, just for the day when the big one strikes.

If the player encounters NPCs and happens to get shot or someone gets shot, you might want to have this contingency especially if it's incorporated into the story. It certainly would make for a dramatic situation! Wounds from a cougar or bear could be severe enough to require cauterization if compression is not working.

[hauteecolerider]

@SteveP

I speak from experience here. You cannot cauterize a bleeding wound while it is bleeding. If compression isn't enough, if a tourniquet isn't working, cautery certainly isn't going to be effective, either. You are advocating third-degree burns that will only create a whole 'nother can of worms. Things like dehydration, protein loss, gangrene, release of toxins, infection, etc etc etc.

A veterinary colleague has a signature that has stuck with me. All bleeding stops. Eventually. If your wound is bleeding that bad that you can't stop it with compression, you are going to die. That's it. There is nothing you, as a lone survivor in the Canadian wilderness, can do to change it. 

In the bad old days, such as the Civil War, the mortality rate from amputations was shockingly high. More soldiers died in that surgeon's field tent or in postoperative recovery than in the actual line of fire. Let's take a look at battlefield surgery in the US Civil War:

Quote

The ones wounded through the head, belly, or chest were left to one side because they would most likely die. This may sound somewhat cruel or heartless, but it allowed the doctors to save precious time and to operate on those that could be saved with prompt attention.

This is just as true in TLD. Penetrating injuries were almost always fatal if not treated under hospital conditions.

Quote

Deciding upon an amputation, the surgeon would adminster chloroform to the patient. Holloywood's portrayal of battlefield surgery is dramatized and largely false; anesthesia was in common and widespread use during the war.... it would make more complicated and longer operations possible as the era of antiseptic surgery began in 1865 (too late for the poor Civil War soldier). With the patient insensible, the surgeon would take his scapel and make an incision through the muscle and skin down to the bone. He would make incisions both above and below, leaving a flap of skin on one side.

Taking his bonesaw (hence Civil War slang for a doctor is a "Sawbones") he would saw through the bone until it was severed. He would then toss it into the growing pile of limbs. The operator would then tie off the arteries with either horsehair, silk, or cotton threads.* The surgeon would scrape the end and edges of the bone smooth, so that they would not work back through the skin. The flap of skin left by the surgeon would be pulled across and sewed close, leaving a drainage hole. The stump would be covered perhaps with isinglass plaster, and bandaged, and the soldier set aside where he would wake up thirsty and in pain, the "Sawbones" already well onto his next case.

*italics are mine for emphasis

The survival rate for these procedures (called primary amputations - amputations performed due to the initial trauma) was nearly 25%

Then the soldier has to deal with the consequences of the lack of asepsis (which did not become established medical procedure until the 1880's). 

Quote

Of these, the most deadly was probably pyemia. Pyemia means, literally, pus in the blood. It is a form of blood poisioning. Nothing seemed to halt pyemia, and it had a mortality rate of over 90%. Other surgical diseases included tetanus (with a mortality rate of 87%), erysepilas, which struck John B. Gordon's arm after he was wounded at Antietam, and osteomyelitis which is an inflammation of the bone. Also, there was something called "Hospital Gangrene". A black spot, about the size of a dime or so, would appear on the wound. Before long, it would spread through, leaving the wound an evil smelling awful mess. The Hospital Gangrene of the Civil War is an extinct disease now.

Believe me, under the circumstances of TLD, these diseases aren't going to be extinct! They will come roaring back!

I know the game is not meant to be a reality sim, and as such it's fine. But I do not want to see cautery added to the first aid kit. It would be totally immersion breaking for me. I do not even want to see NPC's coming at me with a red-hot knife. 

[cekivi]

It's really interesting reading the level of detail that experts can supply for some of these posts

[Scyzara]

I agree to @hauteecolerider. Cauterization is a very two-edged sword that can easily do more harm than good, especially if you have no clue what you're supposed to do exactly. And it's beyond my imagination how one could stop a truely lethal bleeding by cauterizing his or her own wound.

Even if you somehow managed to decrease the bleeding enough to make cauterization possible (pretty unlikely if the wound is severe enough to be lethal), you would probably fall unconscious long before you had prepared your cauterization equipment, let alone completed the extremely painful cauterization process.

The only way how I could actually see cauterization have any use in a TLD-like situation (in real life, I mean) would be the disinfection of a festering, but superficial skin wound. Something along the lines of an infected scratch maybe. But even then cauterization should definitely never be the first choice as long as you have antibiotics, alcohol, iodine or anything else  with antiseptic or antibiotic properties at hand. I guess even just cleaning the wound with hot water multiple times a day would be a better choice than burning it.

The odds to destroy larger amounts of healthy tissue (which might then lead to an even worse infection, intoxication and sepsis as mentioned by @hauteecolerider) due to "unprofessional" cauterization are just too big. Especially if you've never cauterized a wound before and try to use yourself as a guinea pig to learn it.

[Patrick Carlson]

Interesting discussion happening here. (If also a bit grim, but we like that. )

Are we blaming Mr. John Rambo then for popularizing this survival legend? I've noticed it pops up in lots of films. 

 

 

 

[hauteecolerider]

8 minutes ago, Patrick Carlson said:

Interesting discussion happening here. (If also a bit grim, but we like that. )

Are we blaming Mr. John Rambo then for popularizing this survival legend? I've noticed it pops up in lots of films. 

 

 

 

Grim and graphic, no problem! Been there, done that, sadly a little too often.

I guess that's why scenes like the one popularized by Mr. John Rambo (though he isn't the first . . .) rankle me so much. Cinema tends to treat these kinds of situations as being tough man territory, when pros like me have seen just what happens when something this stupid is done. 

Huh huh, riiight. 

[TheRealNFK]

Film and television have an extensive history of presenting amateur cauterization as a simple and effective method to seal life-threatening-wounds, just check out this page on TV Tropes, called "Heal It With Fire":

http://tvtropes.org/pmwiki/pmwiki.php/Main/HealItWithFire

Popular examples include Rambo III, Braveheart, Boondock Saints, 300, plus all sorts of television episodes. I remember watching an episode of Lost with a friend when it came up, and he joked "Sayid is about to Rambo-ize Charlie's head wound."

It's a quick way to amp up the drama in a scene, and that's what most screenwriters lean towards, facts be damned. Unfortunately, some viewers are foolish enough to think it might actually work.