Son-of-a-bitch!. I did NOT just do that!


Shit....yes I did do that!!!

Well,
I thought I had finally had myself in a good set up. Found a place up in the hills, about 4 miles from the nearest dirt road. It's got a small stream nearby, and some bramble fruit canes covered by the snow that should yield some fruit in the spring. Plenty of trees, so I went the log cabin route....okay, log hut route. It's only 12ft by 16 ft, but that's more than enough room for a bed and storage. Maybe I'll add a window one of these days. The small stone oven I built inside keeps it warm enough, and the mud/clay out of the stream bank made a fairly decent chimney. I'm still careful to not go to sleep until the fire is down to quiet embers.

Speaking of embers, and fires, and...wood.

I was trying to get some more wood split, I've gotten pretty good at it over the past month (once the blisters healed) and thought I'd do it right before "lunch".
Let me sidetrack here for a moment....'cause frankly I really don't want to talk about what this is all about. Really. Rather. Not.
Lunch.....what a damn fine word that is, and an even finer thing. You have NO idea how fine a thing until you haven't had it for a few months, and it's siblings breakfast and dinner. Really....some of the finest minds must have spent some time coming up with those words. Din-ner...it's got a nice settling cadence to it, don't you think? Put's one's mind in the right frame to sit down and eat, then grow sleepy with a pleasantly filled belly. Peaceful.
Breakfast is masterful as well. Break Fast. Breaking one's fast. Let me tell you, after the scarcity of food theses last few months, I'm a man who votes a solid party line behind the concept of breaking fasts. Of all the things out there that need breaking, fasts are the ones I like to break the most. I'd like to specialize in that for a profession if the world ever climbs back up out of the crapper.
But Lunch. Lunch has a nice sort of whimsical quality about it. It's such a nice marker for time in your day....it tells you you're half way done. Time to take a breather, relax a bit. After not having it for so long I've grown very fond of it now that it's back in my life. It's the simple things, you know. That make life enjoyable. Thrown a couple of handfuls of root veggies in the pot (made it myself from the clay by the stream....I'm very proud of it, even if it's got a crack and is a bit lopsided), a few pinches of salt, and the hindquarter of that hare I snared 2 days ago. I even threw in some pine nuts. Such gourmet food here in my PAW chateau.) I could smell slow cooking it while I was out slitting wood. So delicious, and much more refined than the rats I was eating on my way out of the urban area. You really can't do much with rat, you know. Rat-ona-stick is about it, roasted over a small fire. More than a touch gamey. Not proper fare for one of the new Country Gents like me, now that I'm landed with a country estate.
Anyway, there I was, happily splitting some wood to heat my home and cook with....smelling my gourmet PAW lunch cooking, with merry thoughts of my food digesting in my belly while warm and safe with (mostly) solid walls around me. Security, safety, and contentment.
Right up to the point where I buried this fucking axe into my foot. Right between my 2nd and 3rd toes on my right foot. About 3 inches in. Completely. And through the sole of my almost serviceable boots.
In fact, I did it so well I think I've stuck myself to the chopping log with the axe. There is a small pool of blood on the log, oozing out of the boot and steaming in the cold air. I'd pull the axe out, but it hurts to move it even a little bit.....and I really don't want to look at it all that much. Not at all, to tell the truth. I'd even trade my gourmet lunch to someone if they could fix things so I don't have to look....to just get back the last 5 minutes. I don't feel much like eating now anyways, and it would be a shame to have such a fine meal go to waste.
The pain is very......painful. Exquisite, in a sad sort of way. Vivid.
I wonder if I can do that Vulcan hand thing with my foot now? OUCH!!!!!!!
Bad Bad Bad idea.

How long ago did I have a tetanus shot?
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Nope. The axe is still there.
I hoped that if I didn't look at it, it might go away.
It didn't.

I'd be willing to throw in the dried berries and hazelnuts I was saving for desert along with the lunch if someone could fix this. Really. No problem. They could even stay for supper. I was gonna make baked cattail tubers and shish-kebobed squirrel. It doesn't even taste like rat.

Anyone?
Please?

I love your set-ups!

Axe out, boot off and get a big dressing on to stop the bleeding. See what the others say bit haemostasis first.

Whats the question ? A nice sarcastic story that goes nowhere. If your asking what to do then just stop being a girly man and pry the axe out and stitch the puppy up. If you wait it will hurt even more, best to get right to it. Any tremendous accident while your alone without any hope of others is a probable death if it gets infected as you will lose the ability to take care of yourself.

I'm certainly no podiatrist, although looking at the dorsal view above and based on your description of the injury, it's unlikely that you would have fractured anything unless the axe blade made it all the way back to the tarsometatarsal joint (although dislocation of the 2nd/3rd metatarsal bones is certainly possible).

Unfortunately the same cannot be said for the metatarsal ligaments, numerous muscles, and the medial plantar nerve. The medial plantar artery runs parallel to the nerve, so that's most likely the main source of the blood that's running out of your boot.

The good news is that with any kind of self or buddy care you're probably not going to immediately go into hypovolemic shock from this type of injury. The bad news is that without more advanced medical care and/or foot surgery your piggies aren't likely going to be going to market anytime soon, and any subsequent secondary infection that develops in the PAW without proper antibiotics will not lead to anything good.

Near term, compression and elevation should quickly stop the bleeding, and copious amounts of irrigation will help limit the likelyhood of infection. I would dress the wound somewhat firmly for support, although I'd also leave the toes exposed slightly to monitor for proper circulation. You should obviously try to keep the wound clean, and avoid placing too much weight on it until it heals.

Long term, the PAW is clearly not going to be a friendly place for anyone with any kind of medical disability, serious injury, or chronic disease - I would not care to be in your shoes (bhwaaaa, i made teh funny).

Jim

Lowkey, I really like you man.


However, given the bad luck and clumsy nature of these most entertaining and somewhat educational posts, you're totally fucked come a PAW or whatnot....

Ok, here's what I know about tetanus:

It is actually found in soil, not specifically in rust. However, if said rusty thing has been in soil, it can have tetanus on it.

A tetanus vaccine is good for about 7-10 years, give or take a few.


That was the limit of my knowledge.


Here is what Wikipedia tells me about tetanus:
A quick and easy method of determining if someone has tetanus:


It is susceptible to penicillin, although that can supposedly increase the spasms (metronidazone IV is apparently the antibiotic of choice). Nonetheless, it will probably work. So, that's a (relatively) easy antibiotic to either have or come across in the PAW.

As long as they were able to eat, I'd probably just try to keep the person well-fed (apparently, they need a lot more calories than usual), and if I could scrounge up some magnesium, I'd maybe try giving them that (although since I know nothing at all about how to determine the appropriate amount, I might just go with nutritional food and hope for the best). Also, if I could find some sort of mouth guard to protect their teeth while their jaws were in spasm, I might experiment with that.



As to the foot trauma, I got nothing.

Do we need an axe safety thread? Or better yet, an inclusive edged tool safety thread?

I might should put one together before someone gets a serious boo-boo trying to split a log with a cheap half-tang machete with a fucking saw blade on the back side (I'm looking at you, Gerber). Or splits their toes chopping wood with an axe that's too short.

Anyway, my PAW response would be to pack the wound with sugar and hold it shut until the bleeding stopped, then keep it tightly swaddled until fresh meat bridged the gap. I would hobble about as gingerly as possible in the meantime to avoid re-opening the cut. Dunno about dealing with tetanus.

Always use an axe with a long handle when splitting wood. Long enough that when brought down in front of you the axe strikes the earth a significant distance from your feet or legs. That's usually about 1 meter in length for average sized people. If the handle is to short for that, make a new one. Also, sharpen your axe properly. Dull axes are dangerous (they glance off), and improperly sharpened axe blades can fracture sending chips of the blade into your face.
The F/U in the above start is solely for educational purposes. I'm neither that clumsy or that stupid

Yup.

It's not easy to find a long enough handle when you're 6'4".

So, I've pulled the axe out, removed the boot, and wrapped a whoppin big dressing on my foot and crawled into my cabin.

I've elevated my foot, and kept pressure on the wound. The bleeding seems to have mostly stopped now.

Should I go ahead and boil some water (to sterilize it) and allow it to cool while covered to irrigate the wound?

Once the irrigate/not to irrigate question is answered-
When should I try to sew this up? Should I? If I should, how in hell am I going to do that.....it's hard to keep the injury still and stable while twisting my ankle.
If not, should I just sort of "bundle" the two halves of the wound together.....kinda like rubber banding the two severed parts? Should I splint it?

How about prophylactic use of anti-biotics? I know prophylactic use of them is not really a great idea in general....but sweet jumpin jebus.....I've split most of my foot in 2. In the PAW. I'm not even sure if my socks were clean!!!.


And finally, assuming I survive without dying of infection, without starving to death because I'm crippled up, wihtout getting eaten or killed by something or someone because I'm now slower than a ground sloth using a walker....and assuming that one day the skin on my foot closes up over this wound, the angry redness goes away, and the pain stops-
Will I be able to use my foot normally again? If not, how much loss of use can I expect?

I have nothing helpful to add, other than to point you towards a video that I found the other day.


Warning: possibly NSFW or the faint-hearted. SERIOUS gore.

http://erstories.net/archives/1420


Just a helpful thing to think about when jumping off of things in the PAW.

Ragnar Benson's book "The Survivalist's Medicine Chest" and "Do It Yourself Medicine" tell the story of an older woman in Africa who chopped wood for his camp, who chopped into her foot edgewise, basically breaking several of the bones.

They applied a tourniquet to staunch bleeding, reset the bones as best they could, irrigated to all ends of the earth, and other things. They did perform a nerve block (not able to do in Low Key's situation). Lastly, they made a vaseline/penicillin salve that they applied to the wound as they sutured it up, using a straw left in the wound to facilitate draining. Then, they kept her in mosquito netting, and kept her leg elevated. After about 10 days, she was able to limp around on a crutch, and within a month she was back to chopping wood. Walked with a limp for 6 months, and barely noticable limp after that.

In your scenario, you've got all the wonderful snow... assuming you don't pass out from pain, you might be able to perform these kinds of things on yourself. Without antibiotics, but given that it's wintertime as opposed to a humid African jungle, your odds of keeping infection free might work. I'd bet that if you were really on the ball and hadn't been using your ax to clean out your latrine, that you'd come through with a lot of pain, agony, and grief.

Too bad you're all alone Low Key. You've got this great setup but no hot PAW chick to share it with.

Oh...no. I'm not alone, and there is a pic or 2 of my hot hot hot and fantastically wonderful wife in a thread somewhere on the site


It's just that there is no way in hell I'm going to put my wife in one of these threads....once I start them they sometimes get a life of their own and write themselves....
Have you seen what I do to people in them??!?!!

No way I'm putting my wife at risk of that!

A) I like the story set up.
B) Treatment logic is solid (pry axe out, stitch) if a bit lacking on wound hygiene, but is kinda similar to saying that for appendicitis you need to just "split your gut open, cut out your appendix, then stitch that fucker up!" or for a shattered femur "cut your thigh open, use a hemostat on your ruptured femoral, shoot some screws into what's left of the bone, then stitch that fucker up!" Yeah, it's kinda that simple, but in reality it's mostly not...

Good responses so far. Nothing to add as far as treatment options.

I HAVE thought about using snow/ice water as an anaesthetic before, though (another poster brought that up, methinks). I don't know how long you have after a limb get numb enough for a patient to handle stitches or debridement before you start to get cold damage to the tissue.

Thoughts?

Damn, that'll leave a mark.

Jim

Huh. I probably should have put that in the head trauma thread.


Oh well, not like it matters much either way. Dude is, as far as I can tell, hardcore FUBAR.

Ooooohh, Oooooohhhh......*waves hand frantically*


I actually DO have something to contribute, other than my snarky man-love comment before.


I'm definately not a pro by any stretch of the imagination. However, I'd imagine the skin stapler and vials of Dermabond I keep in my PAW meds cabinet would be a lot easier on closing your wound solo as opposed to trying to stitch yourself up. Especially with no anethesia or some stiff alcoholic beverage to take the edge off.

Thoughts?

It's not something I'd want to face.

Yeah....those staplers still hurt! I've had them used on my scalp before....with no anesthesia.

BUT.....you may be right. Possibly much easier to close this wound solo with one, if it should be closed rather than just bound in place.
I also suspect that splinting this to prevent movement of the 2 halves would be a good idea.....but once again, what the hell do I know

Staples and glue are fine for skin wounds but would be no good for deeper wounds where the deeper layers must be sutured. Just stitching (or gluing) the skin would create dead space that would fill with fluid and very likely become infected. You'd be better leaving the wound open to heal by second intention.


I have stapled my hand back together and it stings but is bearable. Make sure if you have a stapler in your bag you have a staple remover as they are buggers to remove otherwise.

LowKey - I'd leave it open but I agree splinting or strapping would aid heeling and most importantly reduce pain!

Okay, now for a variant of the original type of injury.....instead of your foot, you've split your hand.
Maybe not with an axe or hatchet (good grief I hope no one reading this would be that foolish), but perhaps you accidentally jammed/slid your had forward onto some jagged plate glass or sheet metal trying to break your fall or stop a face first slide.


Anyway... what would be different, if anything, about the treatment?
Aside from being damn awkward to do anything with only one hand, possibly your non-dominant one at that.

Just the same really

This is the thing with most things medical. There are only a limited number of things that can actually happen, so once you have learnt how to deal with them you can extrapolate your knowledge to similar situations. A bleeding wound is a bleeding wound!

I was thinking more along the lines of what possible nerve damage might be caused. With the foot, it would be inconvenient. With your hand....I'd hate to loose any significant amount of dexterity because of the wound.