Wound irrigation with drinking water?

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Re: Wound irrigation with drinking water?

Post by IANMCDEVITT » Mon Jun 10, 2013 4:44 pm

"sally forth" ?........your killin' me man.............a Marine that uses "sally forth".............I'm tellin' :clownshoes:

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Re: Wound irrigation with drinking water?

Post by Metallitera » Mon Jun 10, 2013 5:15 pm

Bedsit Bob wrote:Use urine. It's sterile.

If he's squeamish, use his own.

If he's not (or unconscious), use anyone's.

Although it may be sterile, it is an EXCELLENT breeding ground for bacteria, as are blood clots (which are what youre really trying to remove, along with FBOs, when your irrigate), which is why one should NOT use urine to irrigate, but rather the cleanest WATER around, the more the better.
Doctorr Fabulous wrote:Fuckin' a, but lets have a bit more responsibility before we start recommending you expose a fucking dangerous wound to the cacophony of heinous shit that lives in your mouth, especially in a situation where you can't just sally forth to a hospital when your wound gets all inflamed.
I agree.

Guys, we in the medical field practice evidence based medicine vs. online blog/forum based medicine for a reason.........
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Re: Wound irrigation with drinking water?

Post by Jorian » Mon Jun 10, 2013 5:30 pm

Doctorr Fabulous wrote: ...saying that because of that, saliva or wound licking is going to help heal wounds is the equivalent of saying that since radiation is used to kill cancer (chemotherapy) that a exposing yourself to tritium gas will help kill off the flu.
That is about right.
Fuckin' a, but lets have a bit more responsibility before we start recommending you expose a fucking dangerous wound to the cacophony of heinous shit that lives in your mouth, especially in a situation where you can't just sally forth to a hospital when your wound gets all inflamed.
Recommending????? :lol:
I recommend not getting hurt in the first place. But if there's a wound that needs irrigating, I'd recommend using water that is fit to drink at least. Not saliva, human, canine or other.

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Re: Wound irrigation with drinking water?

Post by Doctorr Fabulous » Mon Jun 10, 2013 5:37 pm

Jorian wrote:
Doctorr Fabulous wrote: ...saying that because of that, saliva or wound licking is going to help heal wounds is the equivalent of saying that since radiation is used to kill cancer (chemotherapy) that a exposing yourself to tritium gas will help kill off the flu.
That is about right.
Fuckin' a, but lets have a bit more responsibility before we start recommending you expose a fucking dangerous wound to the cacophony of heinous shit that lives in your mouth, especially in a situation where you can't just sally forth to a hospital when your wound gets all inflamed.
Recommending????? :lol:
I recommend not getting hurt in the first place. But if there's a wound that needs irrigating, I'd recommend using water that is fit to drink at least. Not saliva, human, canine or other.
Eh, the way mikeyboy said it and the way I read yours, it came off as though you thought it would be beneficial to let a dog lick an open wound when you could use clean water.
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Re: Wound irrigation with drinking water?

Post by Browning 35 » Mon Jun 10, 2013 6:32 pm

Bedsit Bob wrote:Use urine. It's sterile.

If he's squeamish, use his own.

If he's not (or unconscious), use anyone's.
I can see using it as a last ditch method of cleansing a wound if I had....
  • No sterile saline
  • No normal saline in 500 or 1000 ml NS bags that I could just puncture and pour on them
  • No bottled water or water of any kind
  • No way of calling 911, the Coast Guard or whoever for assistance of any kind and/or if help was going to be a long time reaching us and a wound was going to fester in the meantime.
There is some actual evidence that urine on wounds does have some cleaning and healing properties. For instance I found *This* and I've read it in US Military survival and emergency medical books before. The Greeks, Romans and Vikings all used it as well in some fashion for cleansing battlefield wounds as well.

In the Military manuals they generally throw in that someone should use it as a last ditch method of cleaning a wound in dire circumstances (stuck in the middle of the desert for a few days with a buddy with a gunshot wound with very little first aid equipment, no water and no way of calling for help).

I mean if the next time I went on a call and someone needed their wound irrigated right before bandaging and I just whipped my cock out and pissed on their wound for them I'm pretty sure I'd lose my cert and be brought up on some sort of assault or sexual assault charges (not sure which).

Just saying...[gotta throw in a disclaimer of some kind]
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Re: Wound irrigation with drinking water?

Post by IANMCDEVITT » Tue Jun 11, 2013 6:21 am

Wow, some wild shit coming out here. Dr. Fab and Jorian are holding their own BUT........well, in my LIMITED experience as Senior Medical Trainer for the entire continent of Africa for the last three years? After 27 years on the street? After Triple Canopy, blah-blah-blah Iraq, Afghanistan, Saudi (in the Rub), Central America SAR missions, Cambodia, Alaska with Chris Janowsky for four years, training every alphabet agency from several countries?....I HAVE NEVER PISSED ON A WOUND NOR SEEN IT DONE, NOR TALKED TO A MEDIC WHO'S DONE IT, I HAVE NEVER ADVISED, NOR HEARD ADVISED BY A TIER 1 MEDIC TO PISS OR HAVE A DOG LICK A WOUND.......IF IT COMES DOWN TO IT AND YOU REALLY FEEL THE NEED TO GET DEBRIS OUT OF A WOUND, REMOVE WHAT YOU CAN BY HAND, THEN AGGRESSIVELY CLEAN WOUND IN ONE DIRECTION WITH (REASONABLY) STERILE GAUZE........LET THE WOUND BLEED OR WEEP.........PACK, THEN RE-BANDAGE.......PLAN ON CHECKING SAID WOUND MULTIPLE TIMES DAILY, CHANGING PACK.........SAID WOUND SHOULD HEAL FROM THE INSIDE OUT............That's just my advice..........now feel free to piss on each other.. :crazy:

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Re: Wound irrigation with drinking water?

Post by Jorian » Tue Jun 11, 2013 12:47 pm

Doctorr Fabulous wrote: Eh, the way mikeyboy said it and the way I read yours, it came off as though you thought it would be beneficial to let a dog lick an open wound when you could use clean water.
I have one word for that:

EEEeeeeuw!
:)

Mea culpa - facetiousness is sometimes hard to convey on teh interwebs... I was only saying it might be better a dog than your girlfriend. I'd go with what Ian says though - let it bleed, wipe it out if no clean liquids are available then do it again. And again, unless blood loss is becoming an issue.
Last edited by Jorian on Tue Jun 11, 2013 12:51 pm, edited 2 times in total.

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Re: Wound irrigation with drinking water?

Post by Jorian » Tue Jun 11, 2013 12:49 pm

Dupe... grrr.

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Re: Wound irrigation with drinking water?

Post by Veritas » Tue Jun 11, 2013 3:49 pm

Since this has gone to a strange place, lets redirect the question into: What if you had no liquid to irrigate a wound? Might be a more constructive discussion point.

I would do what IAN alluded to and do repeat dressing changes, and debride the wound often by just scrubbing with gauze. Hopefully the necrotic tissue, debris, bacteria, etc would all start to come out with the body's inflammatory response. Not evidenced based, just me hypothesizing.

The clean water/tap water thing is not in debate, it's okay to use non sterile water. But the caveat is that it be clean. Not contaminated with organic material, ie not urine, saliva, etc. I know many of you are medical, how many times have you seen a urine culture come back with "No colonies" versus "<10k colonies" or something equivalent? Urine is hardly ever sterile out of the body, regardless of it's sterility out of the nephron...
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Re: Wound irrigation with drinking water?

Post by Metallitera » Tue Jun 11, 2013 6:59 pm

Veritas wrote:Since this has gone to a strange place, lets redirect the question into: What if you had no liquid to irrigate a wound? Might be a more constructive discussion point.

I would do what IAN alluded to and do repeat dressing changes, and debride the wound often by just scrubbing with gauze. Hopefully the necrotic tissue, debris, bacteria, etc would all start to come out with the body's inflammatory response. Not evidenced based, just me hypothesizing.

The clean water/tap water thing is not in debate, it's okay to use non sterile water. But the caveat is that it be clean. Not contaminated with organic material, ie not urine, saliva, etc. I know many of you are medical, how many times have you seen a urine culture come back with "No colonies" versus "<10k colonies" or something equivalent? Urine is hardly ever sterile out of the body, regardless of it's sterility out of the nephron...

Ya, packing the wound is pretty much the only other option IMHO. Just like an abscess. Pack & change often, and remove necrotic tissue. The issue of maggot use will take this thread off down another dark road again so I'll just stop there LoL

manually debride, pack and cover, repeat. wounds take much longer to heal and leave nasty scars this way, but its better than the alternative.
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Re: Wound irrigation with drinking water?

Post by CowDoc » Thu Jun 13, 2013 7:44 pm

I've performed more wound lavage in fields and barns than I can remember and still have to do it on my own livestock.

Consequently I tend to seek out medical literature on the subject.

To date this is my favorite review paper: http://emedicine.medscape.com/article/1895071-overview" onclick="window.open(this.href);return false;

Bottom line: normal saline is better than sterile water is better than potable water. Since during backcountry trips I always carry the Sawyer (squeeze) filter and tablets I maintain I will always have a adequate supply of irrigation water and the equipment with which to use it.

It could be argued that I should carry dedicated irrigation fluid, but I simply can't afford the space or weight.

Put into practice below are the my instructions in my first aid kit in my S&R bag.

Wilderness Wound Care Field Kit

• The enclosed bag can be filled with a wound irrigation solution and squeezed, creating a pressure stream through the perforated cap, to flush and clean wounds in the field.

• For smaller wounds, syringe/needle or syringe/irrigation nozzle combinations (all included) can be used to create higher pressures than the bag.

• Similar irrigation devices can be improvised by perforating the caps of disposable water bottles or other flexible/collapsible containers.

• The ideal lavage solution is sterile saline. However tap water or other water which has been rendered potable (drinkable) by boiling, filtration or chemical treatment can also be used. Chemical treatment should be avoided if possible.

• The Sawyer Water Filter found in this day-pack can be used to remove particles of at least than 1 micron, the average size of a bacterial cell. Chlorine tablets are also included and can be used if adequate water filtration is not available.

• Untreated wilderness surface waters (i.e. creek or pond sources) should NOT be used to irrigate wounds because of fecal contamination by wildlife and free ranging livestock. At a minimum such water should be chemically treated to render it potable prior to its use as irrigation solution.

• Wounds should be flushed (“lavaged”) using muzzle pressure of 10 to 30 psi, approximately the pressure created by a 35-ml syringe and 18 to 19 gauge needle (enclosed).

• Volumes of 100 to 200 milliliters of irrigation fluid per inch of laceration or square inch of wound are commonly used. More irrigation is required for more contaminated wounds.

• For abrasions such as “road rash” that are heavily contaminated with foreign material (dirt, oils, organic matter) use of antibacterial soap may be necessary to scrub out (debride) the wound. Castile soap and gauze dressing are included.

• For painful abrasions, over-the-counter anesthetic spray (included) can be used to numb the wound prior to debridement.

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Re: Wound irrigation with drinking water?

Post by Jorian » Fri Jun 14, 2013 7:13 am

CowDoc wrote:
• The Sawyer Water Filter found in this day-pack can be used to remove particles of at least than 1 micron, the average size of a bacterial cell. Chlorine tablets are also included and can be used if adequate water filtration is not available.

Warning: Thread drift

That Sawyer Squeeze filter is rated to zero point one micron - the filter cartridge itself is simple - a canister packed with hollow fibers, emulating dialysis filters. Anything coming out the other end is going to be at least as good as bottled water unless there are dissolved materials in the original dirty water supply. Well worth the cost, size and weight to carry. (Can't say enough about what those folks have done for the third world... )

The only drawback to those filters is their vulnerability to damage by freezing, afaik. You have to clear the cartridge or freezing will crack the case.

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Re: Wound irrigation with drinking water?

Post by movingchicane » Fri Jun 14, 2013 8:07 am

Would a iodine tab in the nalgene of drinking water make it better or worse? I usually carry some for "plan c" of water purification out in the wilds.
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Re: Wound irrigation with drinking water?

Post by Chirpy » Fri Jun 14, 2013 8:20 am

What if I pee on the dog before he licks my girlfriend?

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Re: Wound irrigation with drinking water?

Post by Murphman » Fri Jun 14, 2013 9:09 am

Chirpy wrote:What if I pee on the dog before he licks my girlfriend?

:clownshoes:
/thread
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Re: Wound irrigation with drinking water?

Post by Jorian » Fri Jun 14, 2013 11:32 am

movingchicane wrote:Would a iodine tab in the nalgene of drinking water make it better or worse? I usually carry some for "plan c" of water purification out in the wilds.
Iodine does kill stuff... but after going through a 0.1 micron filter there's not going to be much to kill, if anything. If you carry iodine tablets, it is a good idea to also carry some vitamin C tablets to neutralize it before drinking.

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Re: Wound irrigation with drinking water?

Post by CowDoc » Fri Jun 14, 2013 5:42 pm

"Would a iodine tab in the nalgene of drinking water make it better or worse?"

My personal opinion is, assuming nothing else was available, I would be happy to use clean potable water (drinkable, tap water) and soap for irrigation.

If there was any concern about the microbial quality of the water (the water source or how dirty its container was) then I would sanitize it with the iodine tablets and let it sit the required 30 minutes. Another option used in third world countries is to boil the water and let it cool to body temperature.

Honestly, I believe that we sometimes over-think the issue. We’ve used soap and tap water for years.

Perhaps not surprisingly there has been increased interest in the use of soap to irrigate wounds, particularly in musculoskeletal injuries, with some studies showing no advantage of bacitracin, a potent antibiotic over liquid Castile (olive oil based) soap.

http://www.ncbi.nlm.nih.gov/pubmed/10406699" onclick="window.open(this.href);return false;
http://www.ota.org/international/Salta/ ... 20Care.pdf" onclick="window.open(this.href);return false;

My policy for livestock and horses is to keep it pretty simple:

If the wound is highly contaminated I’ll use a Castile Soap or Betadine scrub to remove the foreign matter. You simply scrub and irrigate until the wound is free of visible dirt. This is followed with a low-medium pressure irrigation with saline or sterile water to dislodge any remaining adhering bacteria that you can and wash out soap residue. Cleaner wounds simply get less aggressive debridement.

Whether or not I close the wound depends on a variety of factors including the how old the wound is, how contaminated it is and how devitalized the tissue might be. Steri-Strips & Permabond are honestly going to fit the bill for the vast majority of wilderness first aid kits. The primary reason for the sutures/lidocaine and veterinary sedative in my kit is for large animal rescue.

I would use a similar rational in the backcountry for wounds in humans if medical attention was going to be delayed.

That’s a really big “if”. We still consider the “golden period” allowing for primary wound closure to be something up to between 12 to 19 hours:

http://www.jlgh.org/JLGH/media/Journal- ... rson54.pdf" onclick="window.open(this.href);return false;

I air lifted an injured hiker out of the coastal range last weekend. Time from injury to ambulance was 4 hours.

If your transport is not going to be delayed, wash the dirt and leaves off the wound, slap a dressing on it and get busy with extraction.

Just my 2 cents.

P.S. Oh, let’s please take a moment for a reality check on this notion of using urine as an irrigation fluid.

Google “Blood-borne Pathogens Standards”

If you’re so short of water that you can’t boil, filter or treat enough to wash out a wound with soap, you’ve got bigger problems.

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Re: Wound irrigation with drinking water?

Post by MarkW » Sat Jun 15, 2013 8:38 pm

CowDoc wrote: Honestly, I believe that we sometimes over-think the issue. We’ve used soap and tap water for years.

Perhaps not surprisingly there has been increased interest in the use of soap to irrigate wounds, particularly in musculoskeletal injuries, with some studies showing no advantage of bacitracin, a potent antibiotic over liquid Castile (olive oil based) soap.
Heck, anyone who has read the entire label on a bottle of Doc Bronner Castile Soap could have told you that! LOL!!!

Seriously, I am glad that you have posted on this thread. Anyone who has grown up with or treated livestock realizes that oftentimes the body does a pretty good job of taking care of itself, even without any external medical intervention.

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Re: Wound irrigation with drinking water?

Post by medic photog » Sat Jun 15, 2013 10:30 pm

[/quote]

Heck, anyone who has read the entire label on a bottle of Doc Bronner Castile Soap could have told you that! LOL!!!

Seriously, I am glad that you have posted on this thread. Anyone who has grown up with or treated livestock realizes that oftentimes the body does a pretty good job of taking care of itself, even without any external medical intervention.[/quote]

Doctor Bronner's is the shit, love the bottle. As one of my favorite ER docs here says,"Despite our best efforts, the patient still survived.".

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Re: Wound irrigation with drinking water?

Post by Veritas » Wed Jul 03, 2013 12:24 am

I would say no to the iodine tabs. Just regular soap and water. Or better, just lots of water. It's about the only time that quantity, not quality is better (to a point, of course, a bunch of shit water is a terrible idea).
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Re: Wound irrigation with drinking water?

Post by Blacksheep » Wed Jul 03, 2013 1:46 am

So to clarify... minor backwash is not a huge deal in this scenario?
Obviously the cleaner the water.the better.. I just was curious if backwash meant the water is unclean
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Re: Wound irrigation with drinking water?

Post by sbjerry9 » Sun Jul 07, 2013 10:08 pm

One thing that you could do is to make a solution called Dakin's Solution.

"Dakin's solution is used to prevent and treat skin and tissue infections that could result from cuts, scrapes and pressure sores. It is also used before and after surgery to prevent surgical wound infections.
Dakin's solution is a type of hypochlorite solution. It is made from bleach that has been diluted and treated to decrease irritation. Chlorine, the active ingredient in Dakin's solution, is a strong antiseptic that kills most forms of bacteria and viruses.
How to use Dakin's Misc
Pour, apply or spray onto the injured area. When used on wounds, Dakin's solution can be poured onto the affected area as an irrigation or cleanser. It is also used to wet certain types of wound dressings (e.g., wet to moist dressing). Follow your doctor's instructions exactly.
The body's own wound-healing tissues and fluids can decrease the antibacterial effect of Dakin's solution. Therefore, this solution is often used only once daily for minor wounds and twice daily for heavily draining or contaminated wounds. Use this product as directed by your doctor.
Protect the surrounding healthy skin with a moisture barrier ointment (e.g., petroleum jelly) or skin sealant as needed to prevent irritation.
Inform your doctor if your condition does not improve or if it worsens. Discuss other treatment options with your doctor."

How to Make.

Supplies:
Sodium hypochlorite solution 5.25% (Clorox® or similar household bleach).Be sure to purchase unscented bleach. We do not recommend using ultra
bleach products that are more concentrated and thicker.

Sodium bicarbonate (baking soda)

Clean tap water

Clean pan with lid

Sterile measuring cup and spoons (Refer to handout on How to Sterilize Equipment or use a dishwasher on highest setting for hot water and heat)

Sterile jar with sterile lid (see above)

Making the Solution:
1. Wash your hands well with soap and water.
2. Gather your supplies.
3. Measure out 32 ounces (4 cups) of tap water. Pour into the clean pan.
4. Boil water for 15 minutes with the lid on the pan. Remove from heat.
5. Using a sterile measuring spoon, add ½ teaspoonful of baking soda to the
boiled water.

I have worked as a Wound Care Tech., in a Hyperbaric and Wound Care center, and the Dr's would make the solution as needed. I asked about making it in the field and they reminded me that in the field nothing is sterile, and making it as needed using clean water would be better then water alone, and to scrub the wound bed of dirt and grime. They also suggested to just pack the wound with a wet to dry dressing and transport ASAP. All that a wet to dry dressing is a moist dressing directly in the wound bed. Don't make it to wet as it will cause maceration (the softening and whitening of skin that is kept constantly wet) of the wound.

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Re: Wound irrigation with drinking water?

Post by electromage » Wed Jul 10, 2013 5:43 am

Something to note about the Datrex water pouches is that if you cut off a small bit of the corner, you can get some pretty good pressure.

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Re: Wound irrigation with drinking water?

Post by medic photog » Wed Jul 10, 2013 8:09 pm

sbjerry9 wrote:One thing that you could do is to make a solution called Dakin's Solution.

"Dakin's solution is used to prevent and treat skin and tissue infections that could result from cuts, scrapes and pressure sores. It is also used before and after surgery to prevent surgical wound infections.
Dakin's solution is a type of hypochlorite solution. It is made from bleach that has been diluted and treated to decrease irritation. Chlorine, the active ingredient in Dakin's solution, is a strong antiseptic that kills most forms of bacteria and viruses.
How to use Dakin's Misc
Pour, apply or spray onto the injured area. When used on wounds, Dakin's solution can be poured onto the affected area as an irrigation or cleanser. It is also used to wet certain types of wound dressings (e.g., wet to moist dressing). Follow your doctor's instructions exactly.
The body's own wound-healing tissues and fluids can decrease the antibacterial effect of Dakin's solution. Therefore, this solution is often used only once daily for minor wounds and twice daily for heavily draining or contaminated wounds. Use this product as directed by your doctor.
Protect the surrounding healthy skin with a moisture barrier ointment (e.g., petroleum jelly) or skin sealant as needed to prevent irritation.
Inform your doctor if your condition does not improve or if it worsens. Discuss other treatment options with your doctor."

How to Make.

Supplies:
Sodium hypochlorite solution 5.25% (Clorox® or similar household bleach).Be sure to purchase unscented bleach. We do not recommend using ultra
bleach products that are more concentrated and thicker.

Sodium bicarbonate (baking soda)

Clean tap water

Clean pan with lid

Sterile measuring cup and spoons (Refer to handout on How to Sterilize Equipment or use a dishwasher on highest setting for hot water and heat)

Sterile jar with sterile lid (see above)

Making the Solution:
1. Wash your hands well with soap and water.
2. Gather your supplies.
3. Measure out 32 ounces (4 cups) of tap water. Pour into the clean pan.
4. Boil water for 15 minutes with the lid on the pan. Remove from heat.
5. Using a sterile measuring spoon, add ½ teaspoonful of baking soda to the
boiled water.

I have worked as a Wound Care Tech., in a Hyperbaric and Wound Care center, and the Dr's would make the solution as needed. I asked about making it in the field and they reminded me that in the field nothing is sterile, and making it as needed using clean water would be better then water alone, and to scrub the wound bed of dirt and grime. They also suggested to just pack the wound with a wet to dry dressing and transport ASAP. All that a wet to dry dressing is a moist dressing directly in the wound bed. Don't make it to wet as it will cause maceration (the softening and whitening of skin that is kept constantly wet) of the wound.
So, what do you do with the Clorox?

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