How would you treat this? (NSFW)

[dallas]

As a nurse... I would suggest stop the bleeding 1st. Coterize it if you have to. Find a way to the ER next and let them deal with it. The toe may be salvagable, you may not need to amputate it but it does look pretty horrid. If you were far from anywhere where you could get help and you had to treat it yourself then stop the bleeding any way you see fit and keep it elevated as you keep applying wet to dry dressings and keeping the wound clean. If needed maggots can clen off the bad meat of the toe if it were to become infected but this is a total jeramiah johnson scenario if you had to work it out yourself in a doomsday scenario where there was no help to be had, but if it isn't a doomsday scenario and you could find a way to a hospital that would be the ticket to take.

Cauterizing just kills more tissue that will need to be debrided. Now you have a bigger wound to deal with. You can stop bleeding without it.

[zenlunatic]

@original post

Suck it up and hump 40 miles with your BoB. This is a great opportunity to practice a bugout with real-life factors.

[dallas]

Yep, I've done exactly one finger myself, also. But the tool we used to do that, I don't have sterile and at home. I was contemplating what tools I could scrub the shit out of and then run thru the pressure canner. I was wondering if anyone did have that kind of thing sterile at home.
I do have lidocaine, I was thinking this may be why the docs in all the cowboy movies drank so much, when you had to listen to your patients screaming in pain, bucking the ropes&people holding them, and still focus on doing your job.
It's the decision making principles and experience applying them- when and why, exactly, is it best to amputate? (which is why I love your link!!!) - that I feel I lack the most, and there's no real room for error in that situation.

A Rongeur would be money for nipping back the bone. If none were available, I think I'd opt for a shit-ton of anesthesia (Bier block the leg?) and roll with an Exacto saw or wire saw. Both of which are easily procured and cheap. I know of a few institutions that use wire saws for long bone amps, and they work very well. I would assume that if you were able to secure the distal tip of the toe, a wire saw would fit the bill beautifully.

I would still assert that this injury is likely not nearly as catastrauphic as most here seem to be asserting. Even in a hypothetical ultra-austere environment, using the sound principles of good wound care could (conceivably) result in an acceptable outcome. Perhaps not optimal, but acceptable. Food for thought, YMMV, and all that jazz...

If you can keep it from getting infected, it could heal with secondary intention. I wish I could find the pictures of a GSW through a foot in a developing country. They keeped it packed with sugar and betadine and it eventually healed.

If it had to come off, disarticuation would be the way to go. There is enough tissue on the medial for good flap.

[zenlunatic]

This is the part in a EOTWAWKO zombie flick/book where you cut your losses, and watch your party walk away into the sunset with your gear minus your vodka (you do have liquor in your bob right).

[bonanacrom]

How would I treat this ? Step one - Take gun from moron. Step two - Slap moron upside the head and say " dumbass " Step three - Leave and hope I never saw the dangerously incompetent moron again.

[dallas]

How would I treat this ? Step one - Take gun from moron. Step two - Slap moron upside the head and say " dumbass " Step three - Leave and hope I never saw the dangerously incompetent moron again.

I have to say you have the best advice so far if he did shoot himself.

[Krustofski]

So what's everybody think they're taking this toe off with, btw? I don't keep sterile surgical stuff for that at home, nor would I be really comfortable doing it, it's not something I'm experienced in. (Not saying it's not the best course of action, it may well be - but it's not a simple course of action at all...)

Scalpel, needle noose pliers, and a nail cutter, all sterilized in alcohol, at the metatarsophalangeal joint, while trying to minimize bleeding. If available: Octenidine or chlorhexidine wound antiseptic, antibiotic ointment, oral antibiotics.

The only thing I ever amputated was the tail of a mouse (spreading infection), and while it worked, it still ended in a mercy kill due to too much pain.

I'm not saying it's easy, or that I'd feel comfortable, let alone competent enough, to do it, but it's only going to improve chances of survival, isn't it?

[Ninja Medic]

Rub Some Tussin on it!

[KnightoftheRoc]

I'm late to the party, and NOT a medico. So, someone please explain to me why the exposed bone seems to mean "amputate" to so many people posting, please? Because my first reaction would be to clean the wound, sterilize, pack and cover. My hope would be to stave off infection while the body "fills in" the hole. As I said, I'm not a doc, I've never treated a wound like that, nor had one, thankfully.

But, given the OP's scenario of me being all this patient has (God help his dumb ass), I'd like to know why (or if) what I'd do would be wrong. 'Cause you just never know...

[drewder]

How would one go about amputating a toe?

Sterilize, chop, cauterize?



I've seen nastier things before, but that pic really makes my butthole pucker

One or two more .45 rounds ought to do the trick.

My girlfriend is currently in Med.School. I showed her your comment about using one or two more rounds of .45 to take care of it... She quickly interjected with a very harsh "NO" and a stern look on her face. Then completed her thought without missing a beat, "That would be a terrible waste of ammo..."

There are at least 2 reasons in this post that shows why I am with her.

[pitchfork]

So....GORE-TEX does have it's limitations!

[crypto]

Whats the story on this ND, anyway? Another shining example of how 1911"s are the finest handgun in the world?

[VXMerlinXV]

True, had it been a 9mm, a little Kiwi and the shoe would have been fine...

[eugene]

I think the one thing every one is missing is with a chunk that large one foot will weigh less than the other so you'll be out of balance when trying to walk/run.
So the only obvious answer is you must do the same to the other foot to get your balance back.

[Unorthodox]

Whats the story on this ND, anyway? Another shining example of how 1911"s are the finest handgun in the world?

No, Glock.

[jnathan]

The story is that continuing to use the euphemism "negligent discharge" is lame. It's like all the other politically correct language intended to soften words people find hurtful. If you shoot yourself in the foot and call it a negligent discharge, you aren't fooling anyone.

You can chop a toe off, cauterize it and not die of blood loss (or kill your patient). But without antibiotics, infection would kill you or your patient.

-Jeff

[RachelBB]

How would I treat this ? Step one - Take gun from moron. Step two - Slap moron upside the head and say " dumbass " Step three - Leave and hope I never saw the dangerously incompetent moron again.

Yeah, I was going with stop the bleeding, then assess for concussion from the blow to the head the idiot was given.

Lots of saline for cleansing, antibiotics if you have them. Taking the toe off would probably be best, but so few of us are prepared to do that. It would probably be a deal breaker, eventually. Pt wouldn't be able to bear weight for weeks and would be at such high risk for infection.

[MaconCJ7]

The story is that continuing to use the euphemism "negligent discharge" is lame. It's like all the other politically correct language intended to soften words people find hurtful. If you shoot yourself in the foot and call it a negligent discharge, you aren't fooling anyone.

-Jeff

?? Negligent is the proper word. The dude was a jackass (assuming it is self inflicted). If it were to be called an "accidental discharge", I would find myself in agreement with you. But, I could be completely missing where you're coming from, and I'm always open to others thoughts.

[TDW586]

The story is that continuing to use the euphemism "negligent discharge" is lame. It's like all the other politically correct language intended to soften words people find hurtful. If you shoot yourself in the foot and call it a negligent discharge, you aren't fooling anyone.

-Jeff

?? Negligent is the proper word. The dude was a jackass (assuming it is self inflicted). If it were to be called an "accidental discharge", I would find myself in agreement with you. But, I could be completely missing where you're coming from, and I'm always open to others thoughts.

+1, I am highly confused by jnathan's comments.

Sent from my SGH-T839 using Tapatalk 2

[jnathan]

While you are being negligent in shooting yourself in the foot, referring to it as a negligent discharge or simply an "ND" rather than saying "I shot myself" comes across as an attempt to diminish stupidity. It's one of those things I find amusing and silly at the same time.

And in the end, if the victim really was going to have to go without any kind of outside aid at all, I'd do what I could to make them comfortable after treating what I could. Ultimately, they'd probably die of infection and feel extremely negligent indeed.

-Jeff

?? Negligent is the proper word. The dude was a jackass (assuming it is self inflicted). If it were to be called an "accidental discharge", I would find myself in agreement with you. But, I could be completely missing where you're coming from, and I'm always open to others thoughts.

Indubitably, my good sir and/or madam., I am highly confused by jnathan's comments.

Sent from my SGH-T839 using Tapatalk 2

[TDW586]

Uhh...yeah, I don't see that at all. Doesn't make any sense to me...the point of the phrase "ND" is to express that the act was negligent and foolish, as opposed to the "AD". Whatever floats your boat, though.

Sent from my SGH-T839 using Tapatalk 2

[Shiloh]

neg·li·gent
   [neg-li-juhnt]

adjective
1.
guilty of or characterized by neglect, as of duty.

2.
lazily careless; offhand.

OR


negligent (ˈnɛɡlɪdʒənt)

— adj
1.

habitually neglecting duties, responsibilities, etc; lacking attention, care, or concern; neglectful

2.

careless or nonchalant.

Yeah, seems to fit.

[jnathan]

Two problems with this.

1. Pasting a quote form a dictionary isn't the "nuclear option" in Internet discussion. Rather, it's the equivalent of punting in Football. You've given up making a legitimate point of your own in the hope that there's enough in the dictionary definition to make your point. There isn't in this case.
2. People will occasionally say "I ND'd myself" when they meant to say, "I shot myself". The difference is simply that if you negligently discharged, you either came in your jeans, shat yourself or peed your pants. And, reducing this down to a "negligent discharge" omits perhaps the one important bit, that whole point about personal responsibility and who did the shooting.

So, to recap, if you did the shooting, you didn't ND yourself, you shot yourself. Referring to someone as the victim of a negligent discharge is fine, but the only way for that to be accurate in the case of a self-inflicted gunshot is to literally say "Bubba was the victim of a self-inflicted gunshot by way of a negligent discharge". Or you could much more simply state that, "Bubba shot himself" or if you're of the Southern persuasion, "Bubba shot his self".



-Jeff

neg·li·gent
   [neg-li-juhnt]

adjective
1.
guilty of or characterized by neglect, as of duty.

2.
lazily careless; offhand.

OR


negligent (ˈnɛɡlɪdʒənt)

— adj
1.

habitually neglecting duties, responsibilities, etc; lacking attention, care, or concern; neglectful

2.

careless or nonchalant.

Yeah, seems to fit.

[MacAttack]

Who cares what its called?

The point is there is a big chunk of meat missing from that guys toe.

The everyone saying to clean it, cover it, and let nature close the hole back up. Exactly how long will that take? How often would you change the dressing?


I can see a skin flap being possible using the skin off the top of the foot. Cut out a "patch" next to the wound leaving about 30% connected to the original area and flipping it around to cover the damaged area. It might be a bit wrinkled but the blood flow should still work. If you cut the flap the right way it should stitch closed quite well. Maybe a rounded spear point shape.


I remember a few pictures of nose reconstructions using the skin off the inner arm while it was still attached to the arm as a nose cover. the patient would have his arm stuck up over his face and head for a week of three until the skin flap looked like it took. Then it was detached from the arm and the hole in the arm was stitched up.



Personally before I tried something like this I would want a map or diagram of the nerves and veins. Don't want to start cutting into the wrong stuff trying to save a toe in the PAW.


Don't know if this is true but I have heard that letting a live bone dry out causes problems. Is this true or not or just bad rumor?