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PostPosted: Tue Jul 23, 2013 9:12 pm 
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TacAir wrote:
(The 'other' common problem with mech troops (or a pilonidal cyst) - no fun for a field treatment.)


Must resist. Bite my tongue. I give up. That is a real pain in the rear. :lol:


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PostPosted: Tue Jul 23, 2013 10:04 pm 
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Great thread... A few thoughts:-)

Sounds like a great use for a Combat Pill Pack :lol:

-A full cycle of a few different types of antibiotics can easily fit in a film canister so I would not be afraid to keep them handy... This kit for example is smaller then a deck of cards.Image

-If the wound starts showing signs of infection and I don't get ABX then we gotta get the infection out and get the wound cleaned, the first thought that came to mind is to use a chest dart to encourage the drain and to facilitate flushing with water or saline then move up to cutting it open to clean and pack it if the situation worsens. I don't think Soaking is gonna cut it (no pun intended).

-Shoot carburetor cleaner into it and light it on fire WTF! May have better luck heating a cleaner nail cherry red and pushing it through the same hole again, it sounds like something Rambo would do:-)

-If the brake cleaner has chlorine in it ANY open flame applied to it will make Phosgene gas.


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PostPosted: Tue Jul 23, 2013 10:10 pm 
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For real though:
I watched braxton dig a sharp rock out from under about 1/4" of skin with a leatherman, and then irrigate it with Brakleen. He did this in the presence of a doctor who was laughing his ass off the whole time. There were multiple witnesses. He didnt flinch.

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PostPosted: Wed Jul 24, 2013 7:39 am 
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Doctorr Fabulous wrote:
Metallitera wrote:
Wear real boots with a sturdy sole, and watch where you're stepping. [/thread]

That's bullshit. Ain't a hiking boot on the market that will stop a rusty framing nail coming your your foot, not to mention that most of us cannot wear hiking boots 24/7. Shit's bad for you.

But beyond that, that's like saying you don't worry about defending your house because burglars don't coem to your neighborhood. It's good advice until it doesn't work.


Hey, guys. There's a right way and a wrong way to disagree with each other. I think the point this guy was making is that sturdy footwear can avoid most of these problems. Granted, that may not seem helpful given that this is in First Aid and the question is about what to do *if* you step on a rusty nail, but the general point about the importance of a good pair of shoes or boots is one that many people do need to hear. I was surprised to read a post recently by a forum user who said that he only had two pairs of shoes--flip flops and dress shoes. Personally, I don't think flip flops even count as shoes, but I digress. Having a couple pairs of good shoes is such a fundamental, necessary thing that most of us just assume everyone else already understands this. But some people don't, so there's no harm in reminding them. I would go so far as to say a good pair of shoes or boots is more important than a firearm if I had to choose between one or the other. Shoes and sturdy clothing is a must, I'd say even before firearms, tools, a well stocked pantry, BOB or first aid kit.

But Doctorr's point is well taken, too--a good pair of shoes doesn't mean bad things can't happen. Nails can pierce most footwear. A lot of shoes don't cover the lower leg, etc., so getting punctured by a rusty nail is something that can and does happen, which is why we have a first aid section.

So, please keep in mind, folks, that you can disagree without being a dick about it.

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PostPosted: Wed Jul 24, 2013 8:41 am 
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Good thread, Crypto.

The invasive interventions suggested (injecting disinfectant under pressure, inserting drains, etc.), appear to have at least as much potential to make things worse as they do better. Is this one of those cases where we have to reluctantly admit that for injuries like this there really isn't a good treatment in the absence of antibiotics? Try to prevent the injury (stay current on your tetanus shots and wearing steel shank boots is a no-brainer when you're working in a disaster area), try to clean it as soon as you get it, and that's about it. Either you fight off the infection, or it kills you.

Oh, and another ounce of prevention? If the nice folks in the squad cars or big red trucks are suggesting you should leave the area, you might want to consider doing just that... :wink:

Finally, in this scenario the poor unfortunate goes from stepping on a nail to an infected, weeping wound in less than 24 hours. Can that level of infection set in that quick?

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PostPosted: Wed Jul 24, 2013 8:51 am 
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crypto wrote:
yeah, I guess what I was really looking for here was ideas about how to irrigate the inside of a swollen puncture wound, because I don't have any good ideas for that.


A PVC (peripheral venous catheter) and a sterile syringe.

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PostPosted: Wed Jul 24, 2013 9:03 am 
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DannusMaximus wrote:
Finally, in this scenario the poor unfortunate goes from stepping on a nail to an infected, weeping wound in less than 24 hours. Can that level of infection set in that quick?

Yes. Maybe not tetanus, but poopwater. It doesn't have to go completely septic for it to get bad in under 24hr. Part of the reason for needing it treated is ensuring that you don't end up with a prolonged hospital stay when the hospitals are running on generators, to echo the original scenario.

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PostPosted: Wed Jul 24, 2013 9:04 am 
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good boots.
http://shop.sportsmansguide.com/net/cb/ ... 7Aod4mkAmg


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PostPosted: Wed Jul 24, 2013 9:10 am 
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Doctorr Fabulous wrote:
DannusMaximus wrote:
Finally, in this scenario the poor unfortunate goes from stepping on a nail to an infected, weeping wound in less than 24 hours. Can that level of infection set in that quick?

Yes. Maybe not tetanus, but poopwater. It doesn't have to go completely septic for it to get bad in under 24hr. Part of the reason for needing it treated is ensuring that you don't end up with a prolonged hospital stay when the hospitals are running on generators, to echo the original scenario.


We have had cases of this down here that have gone from a scratch to amputation of the whole limb in less than 12 hours.
http://www.cdc.gov/nczved/divisions/dfb ... s/vibriov/


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PostPosted: Wed Jul 24, 2013 9:32 am 
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dallas wrote:
Doctorr Fabulous wrote:
DannusMaximus wrote:
Finally, in this scenario the poor unfortunate goes from stepping on a nail to an infected, weeping wound in less than 24 hours. Can that level of infection set in that quick?

Yes. Maybe not tetanus, but poopwater. It doesn't have to go completely septic for it to get bad in under 24hr. Part of the reason for needing it treated is ensuring that you don't end up with a prolonged hospital stay when the hospitals are running on generators, to echo the original scenario.


We have had cases of this down here that have gone from a scratch to amputation of the whole limb in less than 12 hours.
http://www.cdc.gov/nczved/divisions/dfb ... s/vibriov/

:shock:

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PostPosted: Wed Jul 24, 2013 11:27 am 
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Kelvar wrote:

So, please keep in mind, folks, that you can disagree without being a dick about it.




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PostPosted: Wed Jul 24, 2013 11:47 am 
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First, HOPE your tetnus shot is "up to date". If not, go do it now… "… if you haven't had a booster shot within the past 10 years or aren't sure of when you were last vaccinated… "
http://www.mayoclinic.com/health/tetanu ... N=symptoms

From "Ditch Medicine"
http://www.scribd.com/doc/123922380/ditch-medicine

Debride / clean wound. "… Once bleeding is under control, deep wounds are treated by pouring granulated sugar into the wound, making sure to fill all cavities…" [Once the sugar dissolves] "… So as to continually inhibit bacterial growth, the wound is cleaned with water and repacked at least one to four times daily…)

If traditional oral antibiotics are being avoided, then read up on vitamins such as grape seed complex, olive leaf extract, oil of oregano, and grapeseed oil.

Also research iodine. Topical it can be absorbed even thru intact skin & fight infection, as can oral doses.

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PostPosted: Wed Jul 24, 2013 12:06 pm 
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What about using honey? I thought I had read something about using honey on infected wounds...


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PostPosted: Wed Jul 24, 2013 12:18 pm 
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Getting honey (or any other topical application) into a closed wound channel is the trick here.

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PostPosted: Wed Jul 24, 2013 12:26 pm 
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PostPosted: Wed Jul 24, 2013 12:30 pm 
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crypto wrote:
Getting honey (or any other topical application) into a closed wound channel is the trick here.


I'm theorizing in my head as to why honey would work. Wha'ts the science behind it? I guess, a pure, free of any other debris/germs, and oxygen free enviroment?

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PostPosted: Wed Jul 24, 2013 12:39 pm 
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Gingerbread Man wrote:
crypto wrote:
Getting honey (or any other topical application) into a closed wound channel is the trick here.


I'm theorizing in my head as to why honey would work. Wha'ts the science behind it? I guess, a pure, free of any other debris/germs, and oxygen free enviroment?


http://www.sciencedaily.com/releases/20 ... 111037.htm

That might help. Or this...

http://www.benefits-of-honey.com/antibiotic.html

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PostPosted: Wed Jul 24, 2013 1:02 pm 
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Gingerbread Man wrote:
crypto wrote:
Getting honey (or any other topical application) into a closed wound channel is the trick here.


I'm theorizing in my head as to why honey would work. Wha'ts the science behind it? I guess, a pure, free of any other debris/germs, and oxygen free enviroment?


Honey is the shit, and there is evidence to suggest that it promotes tissue growth with various growth factors and inflammatory mediators present in it. I use it all the time on wounds because for many wounds, even in the fully-stocked 21st century, it's still the best choice in some cases.

Short answer: It's highly osmotic like a sugar compress and dries out the bacteria.

Long answer: Honey has been kicking bacteria's ass for millions of years, and it's got all kinds of interesting shit in it that can not only keep a wound clean, but unlike alcohol, betadine, CHG, phenol, brake cleaner, and fire (all previously suggested), it's going to either neutrally or positively affect tissue growth.

Turns out all those goofy, blogging, ear-candling homeopathic goobers are actually right about honey. :awesome:


I think the trick is cleanliness and wound care prior to cellulitis setting up. Once cellulitis sets in, there's little you can do, and trying to get a wick and a drain in it might help a little bit. Another thing to mention is blood. Blood can wash a wound out pretty well, carries your immune system around with it, and starts out inside the foot already. The key is getting enough bacteria out that your immune response can take care of the stragglers.

Good thread. :clap:


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PostPosted: Wed Jul 24, 2013 1:12 pm 
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So, honey is like salting wounds? It creates an environment that bacteria is unable to live/grow in?

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PostPosted: Wed Jul 24, 2013 1:13 pm 
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Gingerbread Man wrote:
So, honey is like salting wounds? It creates an environment that bacteria is unable to live/grow in?


Bingo.

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PostPosted: Wed Jul 24, 2013 1:24 pm 
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NamelessStain wrote:
Gingerbread Man wrote:
So, honey is like salting wounds? It creates an environment that bacteria is unable to live/grow in?


Bingo.

Much less painful in my experience.

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PostPosted: Wed Jul 24, 2013 1:50 pm 
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First, you have picked a unique problem. As has been mentioned, penetrating wounds to the sole of the foot, especially through a shoe, are a special type of injury specifically. This would be totally different scenario if you cut a bare foot on broken glass, or grabbed a rusty nail with a gloved hand.

To speak specifically to the scenario, I would not introduce anything into the wound that could potentially fuel a bacterial infection. I know honey was touted as a good antiseptic, but the studies I have read deal more with chronic wounds, and superficial ulcerations, not deep wounds or puncture wounds. Definitely do not use sugar water, and betadine solutions have little to no role in irrigation, which would be the key here and in any traumatic wound scenario. Betadine has to dry to kill bacteria, and likely you will not dry out a puncture wound. Alcohol, corrosive chemicals, cautery, are all absolutely ridiculous, and even though a physician may have laughed at you, I doubt he would be reaching for brake cleaner if you saw him in the office.

As the surgeons say, the solution to pollution is dilution. You need to irrigate the wound with a lot of water. You need to make sure it gets in the wound, and then out. Hand surgeons will occasionally core out cat bites and other puncture wounds prone to high bacterial counts to get good wound irrigation. You don't need antibiotics if the wound is clean enough that your body can fight the infection on it's own. I don't normally suggest cutting open a wound, but you would likely need to in this instance as you have no way of getting an Xray or ultrasound to look for a foreign body. You must remove any potential foreign body, and if you need to open the wound up to do it, so be it.

You could certainly soak it, but honestly once you irrigate it, explore it, remove any foreign body, it's just basic wound care. Don't pack it, just keep topical antibiotic ointment, change dressings, and you'll probably be okay as long as you don't have diabetes.

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PostPosted: Wed Jul 24, 2013 1:53 pm 
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Just to dispel a myth I keep seeing on here, you don't need to pack or drain a wound that is not infected. Packing/drains/any foreign body does not prevent infection. You place these things in wounds/abscesses that require draining of pus, not to prevent a fluid collection prophylactically.

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PostPosted: Wed Jul 24, 2013 2:22 pm 
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Gingerbread Man wrote:
So, honey is like salting wounds? It creates an environment that bacteria is unable to live/grow in?


Yes but also.....

Salting or sugaring wounds can dehydrate your granulation tissue cells right along with the bacteria and actually slow wound healing a bit (not by much). Honey, in some studies, appears to actually have some tissue growth factors present in it that can promote wound healing as well as killing bacteria and preventing their growth.

There are only a few products that can reasonably claim to do that, and they are orders of magniture more expensive than honey (which, the medical-grade stuff is pretty expensive anyway).

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