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

Post by dallas » Tue Nov 12, 2013 8:11 pm

Just stick a few maggots in the cut.

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Doc_45ACP
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Re: WWYD for the First Aid section: Rusty Nail.

Post by Doc_45ACP » Thu Nov 14, 2013 3:01 pm

I'm surprised no one mentioned saucerization yet. I've had several ER patients who stepped on rusty nails through their boots. As was previously mentioned, pseudomonas is the concern since it likes to live in warm, moist places, like shoes.

Sauzerization is performed by removing a small shallow circular area around the puncture to increase drainage. Without going into too much detail, the skin in the bottom of the foot is thick. Once the nail is removed, the hole is very small and serves to "lock in" all the bugs that the nail introduced. This can easily lead to an abscess. By cutting out the section of skin with the puncture, you remove many of the offending microbes that were trapped under the skin and facilitate drainage of the wound.

To perform the procedure, do it ASAP after the injury, the longer you let it marinate, the higher the liklihood of infection. Local anesthetic is highly suggested! I keep lidocaine in my kit for such things. It can be done without it, however remember that you're cutting off a chunk of skin, so it will hurt. Use a sharp sterile blade, preferably a scalpel, if available.

After the procedure, soak the would in a betadyne solution then apply your topical antibiotic of choice and a sterile dressing. Your cut shouldn't be deep enough to require packing.

There are a number of antibiotics that cover psuedomonas, however, I feel that with prompt and effective wound care as above, you shouldn't need any.
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dallas
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Re: WWYD for the First Aid section: Rusty Nail.

Post by dallas » Thu Nov 14, 2013 9:48 pm

Doc_45ACP wrote:I'm surprised no one mentioned saucerization yet. I've had several ER patients who stepped on rusty nails through their boots. As was previously mentioned, pseudomonas is the concern since it likes to live in warm, moist places, like shoes.

Sauzerization is performed by removing a small shallow circular area around the puncture to increase drainage. Without going into too much detail, the skin in the bottom of the foot is thick. Once the nail is removed, the hole is very small and serves to "lock in" all the bugs that the nail introduced. This can easily lead to an abscess. By cutting out the section of skin with the puncture, you remove many of the offending microbes that were trapped under the skin and facilitate drainage of the wound.

To perform the procedure, do it ASAP after the injury, the longer you let it marinate, the higher the liklihood of infection. Local anesthetic is highly suggested! I keep lidocaine in my kit for such things. It can be done without it, however remember that you're cutting off a chunk of skin, so it will hurt. Use a sharp sterile blade, preferably a scalpel, if available.

After the procedure, soak the would in a betadyne solution then apply your topical antibiotic of choice and a sterile dressing. Your cut shouldn't be deep enough to require packing.

There are a number of antibiotics that cover psuedomonas, however, I feel that with prompt and effective wound care as above, you shouldn't need any.
I have seen the same thing done with a punch biopsy. You just have to know what is below.

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

Post by uzijen » Mon Jun 16, 2014 2:22 am

Maybe I'm a little late to the party, but since I was the one who held Pat (aka HK33k) while he died, I think I'm a better authority on how it occurred. He had a pre-existing injury in his foot that he was NOT aware of. We were at the range, he felt something "pop" in his foot and then (screw you for making me correct this, btw.) it became a large boil-like area on the ball of his foot. Google my name or SFA0125 if you wanna see how they cut out half of his foot. It's on Photobucket. Anyway, he didn't die from that. Yes, he was an undiagnosed diabetic - blood sugar of 375 at admission. However, the official cause of his death was "Pulmonary Embolism". Five blood clots from his GOOD leg (as a result of not being properly mobilized) ran up into his lungs when I was helping him to the restroom. I pulled his tongue out of his throat, mobilized him properly and was able to kick at the intercom until I got it in my hands, at that time I called Code Blue. One was issued, nothing could be done and that's that. So no, it was not "stubbornness" as he had been to the doctor three times in the past week, prior to this issue. It was a lack of foresight on the part of the doctor and a severe case of malpractice on the part of South Seminole Hospital.


SFA0125 ~ RIP HK33k

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

Post by uzijen » Mon Jun 16, 2014 2:39 am

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.
Even though I already replied and gave the details as to how he ACTUALLY died, I feel it necessary to clarify that he did NOT win the lottery. Nor did he/we just sit around collecting guns. He had a classified government job that I will not speak of. He had a trust fund from where his father was killed in the Ocala National Forest by a logging truck while Sam (his daddy) was riding his motorcycle. Pat's mother spent days searching for Sam and finally found him listed as "John Doe" at a hospital far away. The logging company was at fault, hence Pat's money. I also had money that went into the venture. Again, he did NOT win the damned lottery - if he were alive he would laugh his ass off at that. Also, his death was not related to a rusty nail. If anyone would like further details, please PM me or hit me up here, because all of these details are WRONG. :)

Furthermore, he did not go "septic". He developed gangrenous tissue as a result of being an undiagnosed diabetic and having a foot injury. He went three times to CentraCare in FL and each time they couldn't be bothered to check his blood sugar, just pumped him full of damned antibiotics. If they weren't such incomps than perhaps he would be telling this story and not me. However, as I said in my other post, his cause of death was nothing to do with his foot - yes it was gruesome and I was in training to help the nurse that was to come to our house once or twice weekly to help with the V.A.C. Unit. But what killed him was the fact that those assholes didn't mobilize his good leg. That's where the clots formed. That's where all 5 of them stormed up his body into his lungs and left him reaching out to me. His last words were "I love you baby" as he touched my fingertips. I was the one who informed his 73 year old mother after laying on his dead body for 2 hours. I also escorted her back to the hospital to see her son one last time. Whatever stories have been told, this is the truth.

Trust me, I was there.

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

Post by uzijen » Mon Jun 16, 2014 3:06 am

dallas wrote:Just stick a few maggots in the cut.
Negative. Maggots would just continue to feast on the flesh, worsening the problem instead of bettering it. Perhaps you're thinking of leeches? Even then, not so much. I would suggest (as disgusting as it is) sucking out the initial poison of the metal, followed by flushing with clean water and/or antiseptics (if possible). Clean bandages EVERY DAY and no wet socks/shoes to allow infection to brew.

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

Post by uzijen » Mon Jun 16, 2014 3:08 am

Doc_45ACP wrote:I'm surprised no one mentioned saucerization yet. I've had several ER patients who stepped on rusty nails through their boots. As was previously mentioned, pseudomonas is the concern since it likes to live in warm, moist places, like shoes.

Sauzerization is performed by removing a small shallow circular area around the puncture to increase drainage. Without going into too much detail, the skin in the bottom of the foot is thick. Once the nail is removed, the hole is very small and serves to "lock in" all the bugs that the nail introduced. This can easily lead to an abscess. By cutting out the section of skin with the puncture, you remove many of the offending microbes that were trapped under the skin and facilitate drainage of the wound.

To perform the procedure, do it ASAP after the injury, the longer you let it marinate, the higher the liklihood of infection. Local anesthetic is highly suggested! I keep lidocaine in my kit for such things. It can be done without it, however remember that you're cutting off a chunk of skin, so it will hurt. Use a sharp sterile blade, preferably a scalpel, if available.

After the procedure, soak the would in a betadyne solution then apply your topical antibiotic of choice and a sterile dressing. Your cut shouldn't be deep enough to require packing.

There are a number of antibiotics that cover psuedomonas, however, I feel that with prompt and effective wound care as above, you shouldn't need any.


Well put.

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

Post by ppfd » Mon Jun 16, 2014 2:10 pm

Didn't know Pat.
Thanks for the correction and sorry for your loss.

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

Post by dallas » Tue Jun 17, 2014 9:17 pm

uzijen wrote:
dallas wrote:Just stick a few maggots in the cut.
Negative. Maggots would just continue to feast on the flesh, worsening the problem instead of bettering it. Perhaps you're thinking of leeches? Even then, not so much. I would suggest (as disgusting as it is) sucking out the initial poison of the metal, followed by flushing with clean water and/or antiseptics (if possible). Clean bandages EVERY DAY and no wet socks/shoes to allow infection to brew.
Sorry, maggots are really used in medicine. Sucking on it is the worst thing to do. Your mouth has all types of germs.

http://onlinelibrary.wiley.com/doi/10.1 ... ated=false

http://img2.tapuz.co.il/CommunaFiles/28810385.pdf

http://www.biologiq.nl/UserFiles/2%20Ma ... tients.pdf

http://en.wikipedia.org/wiki/Maggot_therapy

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

Post by grennels » Wed Jun 18, 2014 9:28 am

Maggots will eat only the dead, decaying flesh.
Shot 'em, now I'm gonna hang 'em, then I'm gonna burn 'em!
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Re: WWYD for the First Aid section: Rusty Nail.

Post by painiac » Wed Jul 23, 2014 11:31 am

grennels wrote:Maggots will eat only the dead, decaying flesh.
This is true.
They may start to eat healthy tissue if left in past the point of debridement, which is why you remove them. They definitely preferentially eat dead tissue first.

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