WWYD for the First Aid section: Rusty Nail.

Discussions of the best (or worst) equipment to have on hand for use in the event of an injury during an emergency.

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WWYD for the First Aid section: Rusty Nail.

Post by crypto » Mon Jul 22, 2013 6:35 pm

Scenario: It's Fall 2012 and you live on an east coast island. You have elected not to evacuate in the face of Hurricane Sandy because you live safely above the anticipated storm surge line. You have adequate supplies to ride out the storm, and are concerned that if you leave, you will not be allowed back in time to mitigate damage to your home due to after-storm wind and rain.

You ride out the storm relatively unscathed, and the next day venture out of the house to survey damage to neighboring homes, so you can report to those who did leave what the condition of their houses are. Stepping around a corner, you feel a sharp pinch from your left foot, and look down to see a bent, rusty nail protruding from the top of your shoe. You quickly lift your foot up off the nail, and hobble back to your house to clean and dress the wound. You disinfect the wound as best as you can, take several motrin, and apply folded 4x4's and tape.

As you feared, the bridge to the mainland has been knocked out, and the ferries have scattered to safe harbor. You settle down to sleep.

You are awaked by throbbing pain and heat in your left foot at 4am, and look down to see it is swollen and red, with a yellow discharge seeping from both sides of the wound.

EMS will not be able to make it to your island for a week. You're on your own. What do you do next?
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Re: WWYD for the First Aid section: Rusty Nail.

Post by Jamie » Mon Jul 22, 2013 6:50 pm

Start taking antibiotics...failing that, I'd boil some salt (or salty) water, and once it cooled a bit, soak my foot in it, and repeat as needed...failing that, I'd soak my foot in a vodka bath to try and kill off the bugs...also, wash and dress the wnd with tons of antibiotic goo, trying to squish it inside the hole...

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Re: WWYD for the First Aid section: Rusty Nail.

Post by crypto » Mon Jul 22, 2013 7:02 pm

I'm trying to avoid antibiotics here, after being told by the pro medics in 2 other threads that lay people don't need to stock antibiotics, that they are extremely dangerous, and no one knows how to use them.
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Re: WWYD for the First Aid section: Rusty Nail.

Post by Jamie » Mon Jul 22, 2013 7:06 pm

crypto wrote:I'm trying to avoid antibiotics here, after being told by the pro medics in 2 other threads that lay people don't need to stock antibiotics, that they are extremely dangerous, and no one knows how to use them.

Then skip the first 5 words and read the rest of my post... :wink:

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Re: WWYD for the First Aid section: Rusty Nail.

Post by crypto » Mon Jul 22, 2013 7:14 pm

okay, so salt water baths, yeah. maybe direct wound irrigation under pressure?
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Re: WWYD for the First Aid section: Rusty Nail.

Post by Jamie » Mon Jul 22, 2013 7:20 pm

Hot baths to loosen and open things up, salt or vodka to kills things in the wound, rinse and repeat and pack/dress with anitbiotic goo as far in the hole as I could stand to jam the nozzle of the goo tube...

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Re: WWYD for the First Aid section: Rusty Nail.

Post by Gingerbread Man » Mon Jul 22, 2013 7:28 pm

Salt water bath, loads of irrigation, and topical antibiotics. Monitor for fever, keep it dry/dressed and make all efforts to contact ems.

Reminder, keep up on your tetanus shots.
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Re: WWYD for the First Aid section: Rusty Nail.

Post by Browning 35 » Mon Jul 22, 2013 7:30 pm

crypto wrote:I'm trying to avoid antibiotics here, after being told by the pro medics in 2 other threads that lay people don't need to stock antibiotics, that they are extremely dangerous, and no one knows how to use them.
That's generally because some people take antibiotics when they're not needed or they don't finish a course when they are. Or they take a certain antibiotic when it's not for that kind of infection because they haven't done any kind of research on it.

The answer from most medical professionals is going to be to seek medical attention for whatever is ailing you currently and generally that's pretty good advice.

However if someone has gotten an extra refill on their antibiotics to put away, they're not out of date, they're not allergic to them and they know exactly what kind of infection that specific medication treats telling those people not to take those meds when their foot is swelling up, red with pus coming out is retarded. Sorry, but it is.

In EMS there's such a thing as being a 'Para-God' and I although I haven't seen those threads I imagine its just a case of that.

Wouldn't use any kind of alcohol though. Alcohol, hydrogen peroxide, iodine, or Mercurochrome can damage the tissue and prevent healing. You're better off with clean water, soap, clean bandages and a thin layer of triple antibiotic ointment.
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Re: WWYD for the First Aid section: Rusty Nail.

Post by crypto » Mon Jul 22, 2013 7:43 pm

I'm just wondering if theres a non-antibiotic solution for a common injury mode like this.

I picked 'rusty nail' because some of you forum old-timers will remember hk33k dying from precisely this injury.
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Re: WWYD for the First Aid section: Rusty Nail.

Post by dallas » Mon Jul 22, 2013 7:52 pm

crypto wrote:I'm just wondering if theres a non-antibiotic solution for a common injury mode like this.

I picked 'rusty nail' because some of you forum old-timers will remember hk33k dying from precisely this injury.
Betadine and sugar is excellent for wounds as long as they are open so that you can pack them.

http://journals.lww.com/smajournalonlin ... nd.10.aspx" onclick="window.open(this.href);return false;

http://www.academicjournals.org/MPR/PDF ... t%20al.pdf" onclick="window.open(this.href);return false;

Heat is not a bad idea either.
Last edited by dallas on Mon Jul 22, 2013 7:58 pm, edited 1 time in total.

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Re: WWYD for the First Aid section: Rusty Nail.

Post by Browning 35 » Mon Jul 22, 2013 7:56 pm

crypto wrote:I'm just wondering if theres a non-antibiotic solution for a common injury mode like this.

I picked 'rusty nail' because some of you forum old-timers will remember hk33k dying from precisely this injury.
There's a chance the person wouldn't be become deathly ill or die. Before antibiotics people suffered such injuries and made it. Wouldn't want to bet my foot, leg or life on it though.

Here are the dangers...
Dangers of rust in cuts (*Click*)
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Re: WWYD for the First Aid section: Rusty Nail.

Post by cv66er » Mon Jul 22, 2013 7:59 pm

Poultice of plantain leaves maybe? It's either that or get the wound to drain faster by using that foot to kick yourself for being so stupid.

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Re: WWYD for the First Aid section: Rusty Nail.

Post by TacAir » Mon Jul 22, 2013 7:59 pm

Our planned method of dealing with this.

Since the nail went through the foot...

Remove boot and sock. Prepare a betadine (povidone-iodine) solution in an emesis basin (or SS salad bowl) with warm water. Use enough of the PVPI solution to darkly color the water.

Soak the foot for at least 20 minutes, if the bleeding isn't copious, let the wound bleed.

Rinse the foot and dry using care around wound site. Apply an antibiotic paste to top and bottom of foot, dress and bandage. Check twice daily.

If signs of an infection appear, start with warm salt water soaks, dry and loosely bandage. Seek medical help.

(Sorry to hear about hk33k. Did he have any underlying medical conditions?)

About that paste
http://www.livescience.com/14124-sugar- ... tions.html

http://www.dailymail.co.uk/health/artic ... otics.html

And --
In 1966 a nurse at the Frenchay Hospital in Bristol, England, reported that two men suffering from bedsores and infected amputations resistant to standard treatments were successfully healed using honey. She had gotten the idea from an article in a popular magazine.

In 1980, Dr. Leon Herszage reported that over the course of the previous four years he had applied sterilized granulated sugar to the surgical wounds of 120 patients and had achieved a cure rate of over 99 percent.

Dr. Richard Knutson of Greenville, Mississippi treated burns, ulcers, lacerations, gunshot wounds, and amputations at a trauma clinic of the Delta Orthopedic Center. His 5-year study of 605 patients treated with sugar-iodine pastes, published in 1981, showed that 98 percent experienced complete healing. He has since treated several thousand patients, with a nearly 99 percent success rate. These figures compare to 94 percent for patients in the same clinics with the same types of injuries and infections who were treated with the more usual antiseptics and antibiotics. The sugar treatment worked better!
SOurce

Sugar and iodine is something that been in use for some time - by Vets.
(see this article in the professional magazine American Farriers Journal

ALWAYS seek professional medical care in any injury.
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Re: WWYD for the First Aid section: Rusty Nail.

Post by Doctorr Fabulous » Mon Jul 22, 2013 8:04 pm

So the bets argument presented against legally obtained antibiotics for this case is "well some people are too dumb to use them correctly."

If that's how things are done, I assume we'll be shutting down the firearms section of the forum because there's a lot of people who are too dumb to use them.
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Re: WWYD for the First Aid section: Rusty Nail.

Post by crypto » Mon Jul 22, 2013 8:10 pm

TacAir wrote: (Sorry to hear about hk33k. Did he have any underlying medical conditions?)
No, just stubbornness. He didnt go in for treatment until he had streaks going up his leg, was hospitalized, went completely septic, and died in the span of about a week.

It was pretty shitty, the guy had won the florida lottery for a ton of money and his full-time job was collecting and shooting machineguns on private land he bought. He was living the dream and died from a rusty nail.
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Re: WWYD for the First Aid section: Rusty Nail.

Post by shrapnel » Mon Jul 22, 2013 8:12 pm

crypto wrote:
TacAir wrote: (Sorry to hear about hk33k. Did he have any underlying medical conditions?)
No, just stubbornness. He didnt go in for treatment until he had streaks going up his leg, was hospitalized, went completely septic, and died in the span of about a week.

It was pretty shitty, the guy had won the florida lottery for a ton of money and his full-time job was collecting and shooting machineguns on private land he bought. He was living the dream and died from a rusty nail.
I thought it was diabetes. I think we've had this conversation before, actually.
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Re: WWYD for the First Aid section: Rusty Nail.

Post by dallas » Mon Jul 22, 2013 8:16 pm

I forgot to mention. Unless you are up to date on your tetanus, you have a good chance of not making it no matter what antibiotics you have stashed away in that scenario.

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Re: WWYD for the First Aid section: Rusty Nail.

Post by rhi » Mon Jul 22, 2013 8:29 pm

I keep some of this stuff:
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around. It's not for puncture wounds, but if Jamie's regimen of salt water soaks and OTC triple antibiotic goo didn't help in 12 hours or so and we were still cut off from outside help. Hell yeah.

Also, yeah I have antibiotics. Yeah, I know the limitations and contraindications. Hell, in a previous career I cultured and isolated novel ones from samples and synthesized new ones for clinical trials. Fuck a bunch of sepsis. I'll give it 24 hours to resolve without abx, but after that I'm taking the pill. :evil:

Keeping up to date on the tetanus shot is a prep everyone should prioritize
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Re: WWYD for the First Aid section: Rusty Nail.

Post by dallas » Mon Jul 22, 2013 8:36 pm

Jamie wrote:Hot baths to loosen and open things up, salt or vodka to kills things in the wound, rinse and repeat and pack/dress with anitbiotic goo as far in the hole as I could stand to jam the nozzle of the goo tube...

Jamie
If you are squirting neomycin in the wound, you might want to have a dialysis machine handy.

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Re: WWYD for the First Aid section: Rusty Nail.

Post by abelru » Mon Jul 22, 2013 11:31 pm

Two words to consider;
1) Pseudomonas
2) auriginosa

Four other words to consider;
1) Foot
2) infections
3) suck
4) balls

Puncture wounds through sweaty, nasty, fetid footwear are known to carry an increased risk of resultant P auriginosa infection. So much so that prophylactic coverage with fluoroquinolones (or a suitable alternative) is standard of care for just such an injury.

Considering this (and assuming the unavailability of antibiotics), I would explore the puncture site and consider debridemont of any questionable tissue, and evacuation of all purulence followed by aggressive soaks with a hypertonic solution or a betadine solution. Would consider concomitant fasciotomy if swelling is significant since I'm already cutting my own foot.

But also considering the fact that normal/first world treatments are unavailable, would also consider early amputation if entire foot is erythematous with pus expressing from the puncture site(s). Especially if I am beginning to demonstrate signs of systemic response/sepsis.
Although, as I think about it, a partial amp or disarctic of my own foot sounds like a fucking nightmare.

Really. A fucking nightmare.
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Re: WWYD for the First Aid section: Rusty Nail.

Post by crypto » Tue Jul 23, 2013 12:07 am

rhi wrote:
Keeping up to date on the tetanus shot is a prep everyone should prioritize
Absolutely. Fortunately I'm so fuckin clumsy I get one at the urgent care every few years with stitches. :crazy:

As bad of a way to go as tetanus is though, sepsis kills a lot faster.
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Re: WWYD for the First Aid section: Rusty Nail.

Post by Braxton » Tue Jul 23, 2013 12:42 am

Spray the puncture liberally with carb and choke cleaner*. Use the little tube they give you to get deep into the wound. This will flush out all the crap left in from the nail.

Now that you have it clean and filled with a flammable substance, light that shit on fire. Fire kills all, and stops the bleeding.

I am 100% serious.

I have done this before.

ZS people ( including a MD) have watched me do this to myself.

I an't dead yet.

*In a pinch Brake Cleaner can also be used. But it does not burn as well.
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Re: WWYD for the First Aid section: Rusty Nail.

Post by NamelessStain » Tue Jul 23, 2013 6:01 am

Doctorr Fabulous wrote:So the bets argument presented against legally obtained antibiotics for this case is "well some people are too dumb to use them correctly."

If that's how things are done, I assume we'll be shutting down the firearms section of the forum because there's a lot of people who are too dumb to use them.
"Too dumb" and "careless" aren't the same. If someone is too dumb to use a firearm, they probably can't even figure how to get a safety off. If they are careless, they have an ND at the range and endanger others.

Too dumb doesn't really worry me much, careless scares the SHIT out of me.
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Re: WWYD for the First Aid section: Rusty Nail.

Post by CrossCut » Tue Jul 23, 2013 7:31 am

Not just a puncture, but a perforating wound (entrance and exit), contaminated, and now infected.

The solution to pollution is dilution. Initially, antiseptic (betadine/hibiclens) diluted in clean water or saline, then just the water/saline (and debridement) with each dressing change. I'd have started antibiotics immediately, Keflex probably (but thanks for those two words abelru). I'm not a doctor, but antibiotics are a no-brainer with a wound like this and help a week away. Doctors will debate whether it's appropriate to start antibiotics prior to signs of infection, but none are going to argue about it once infection is confirmed. If you don't have any, get some and some references on proper selection.

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