What would YOU do?

[Sniper-T]

S has hit the fan, the world is upside down, 911 is AWOL. Your significant other just came in, with their face screwed up in pain. They manage to stutter out "I messed up my hand"

If xrays were available, this is what it would show. to limit the puke-factor, the actual photo will not be shown. Add this mess to some minor all-over lacerations, and one quite deep cut between the second and third fingers.

http://i605.photobucket.com/albums/tt140/Sniper-T/Untitled-1.jpg

Oh, and they are starting to show signs of shock

What would you do??

[slowz1k]

S has hit the fan, the world is upside down, 911 is AWOL. Your significant other just came in, with their face screwed up in pain. They manage to stutter out "I messed up my hand"

If xrays were available, this is what it would show. to limit the puke-factor, the actual photo will not be shown. Add this mess to some minor all-over lacerations, and one quite deep cut between the second and third fingers.

http://i605.photobucket.com/albums/tt140/Sniper-T/Untitled-1.jpg

Oh, and they are starting to show signs of shock

What would you do??

Get them horizontal first. Wrap them up in blankets. Get the arm elevated and compress to try to control the bleeding. Head to hospital if it exists, If not, and I'm the only medical care they're going to receive....
I'm going to clean the wounds thoroughly. Infection would be my biggest concern.
Knowing the hand will never fully recover from that kind of damage without professional care, I'd suture and reset what I could.
Again... I feel that Infection will be the big problem in a post event injury like this.

Please tell. What happened to this hand? Never seen ANYTHING like that before!

[Sniper-T]

for this, we'll say that you are alone in dealing with it. I took some liberties in minimizing the amount of tissue damage, to start with.

This individual was the unfortunate example of why not to hold onto fireworks too long. Granted, post SHTF not many of us will be playing with fireworks, although we may be playing with gunpowders, explosives, fuels etc. A nice little reminder to pay attention and be careful.

Here's a couple links about the injury, the first being the same picture, with the explanation; and the second an actual photo of the injury (the squeemish may not want to click that one). For now, let's focus on the discussion presented, and future scenarios can escalate to something similar to the real story here.



http://gingerdead.com/2008/07/02/boom/

http://www.bestgore.com/bloody-injuries/aftermath-hand-destroyed-firecracker/#

[slowz1k]

for this, we'll say that you are alone in dealing with it. I took some liberties in minimizing the amount of tissue damage, to start with.

This individual was the unfortunate example of why not to hold onto fireworks too long. Granted, post SHTF not many of us will be playing with fireworks, although we may be playing with gunpowders, explosives, fuels etc. A nice little reminder to pay attention and be careful.

Here's a couple links about the injury, the first being the same picture, with the explanation; and the second an actual photo of the injury (the squeemish may not want to click that one). For now, let's focus on the discussion presented, and future scenarios can escalate to something similar to the real story here.



http://gingerdead.com/2008/07/02/boom/

http://www.bestgore.com/bloody-injuries/aftermath-hand-destroyed-firecracker/#

After seeing the photos I'd like to change my answer to amputate and cauterize.

[apssbc]

The only thing life threatening about the injury is infection. Bleeding is controlled or can easily be controlled. If there was absolutley no surgical care, vet ect avaliable I would:
1.Lay person down and try to make them comfortable.
2.Emotional shock is what they are going into chances are they wont bleed enough to die. If they are tournequit it.
3.Pain killers if avaliable, not asprin due to blood thinning properties. Alchol would be considered. If none give them some wood to bite and get someone to hold them down.
4.Clean this with filtered water, betadine, peroxide/water mix if avaliable. Clean well...
5.If we going off the xray, I would sew up the bleeding vessels, clean the wound some more and set the wound.
6. After setting the wound, stitch what skin can be stitched.
7. Cast and immobilize if possible.
8. Continue cleaning, antibiotics, and dressing changes.
9.Pain control if possible.
10. Long term use of the hand will be virually nonexistant. This wound is very bad and wont heal well without massive surgery.

Now after looking at the picture, I would rather amputate. I would rather go it without a hand then risk death from everywhere the infection can hide in that wound. Plus post shtf that gimp hand will just get in the way. Cut, cauterise, and let heal. Thats what I would want judging from the picture.

[Sniper-T]

I think most people would (amputate), but for our scenario, lets stick with the superficial flesh wounds. Lets say you were jury rigging an old belt to a tractorwheel to drive a water pump, and ran your hand through the pulley...twice!

[apssbc]

I would do 1-10 for your scenario.

[mitunnelrat]

Now after looking at the picture, I would rather amputate. I would rather go it without a hand then risk death from everywhere the infection can hide in that wound. Plus post shtf that gimp hand will just get in the way. Cut, cauterise, and let heal. Thats what I would want judging from the picture.

I have no aspirations in being your SO, or even your bitch... but... should I mangle my hand like that, would you be able to fuse a socket or threaded nut of some sort to to bones in my forearm? At least then the remaining appendage could be used as an adaptable stabby/ slammy thing.

[apssbc]

Giving it some thought, I dont think that would be doable. The infection chances alone make it a risky plan. There would be a partly open wound into the hand where the stabbing object comes out of the skin.

There are no solid bones to attach to, too many bones in the hand. Trying to attach to the radius and ulna would require driling. Then attaching a plate between the bones. However the bones would not be able to move and rotate the way they are naturaly supposed to do.

In conclusion I dont see it working.

http://www.dontbeasalmon.net/images/photos/hand%20and%20wrist%20bones.jpg

[Sniper-T]

I Think a lether 'cuff' over the stump, secured to the forearm and behind the elbow would make a better point to fasten stabby/slammy things to; but I would also imagine it would be a good long while before you would want to do anything other than cradle it gently on a pillow, and scratch at the phantom itches 3 inches beyond the stump.

[Echo2]

As above to treat for shock...if the event has occurred....I'm at BOL.....praying that nothing has happened to trauma nurse and veterinarian.

Pull med record and see who is match for blood donation....get room prepped for surgery....instruments....lights.....sterile pads.....meds.

This will not be a easy thing to do.....amplified by the feelings for the person you're working on.

Looks to me that amputation of the last 2 digits is likely.....save as much skin as possible to aid natural bandage and possible feeling.....set 2 remaining finger stubs....immobilize.

Keeping it clean and allowing it to weep is going to be key.....If I'm at the BOL.....the antibiotics start right away....dressing checks and observation on very regular basis.

Be prepared for the total loss of the hand.

If we are in the field with no support......cleaver and cauterizing....bandage...pray.

shit....:(

[4suchatimeasthis]

To be completely honest, I would probably puke, and pass out. For whatever reason, I can deal with animal blood and gore a lot better than human. I've played operation on a horse that impaled itself on a post (you could fit a fist into the chest cavity, and the crazy thing lived!), and another one that went through 6 strands of high-T fencing, it was a nightmare, and ugly, but they both lived. But a person, and not just any person, but my SO?

Sorry, I am pretty sure I couldn't hack it. :(

[eagle326]

Amputate

[Sniper-T]

how about some details there Eagle... Red hot katana? Or? Followup?

[bacpacker]

Never having dealt with anything near that bad, I can only guess.
1) PUKE
2) Try and get my shit straight
3) Treat for shock
4) Elevate arm and get the bleeding stopped
5) Give some painkillers
6) After a period of time for the painkiller to kick in start cleaning the hand as well as possible.
7) Pray to God I can find someone who can help do something, cause this is way out of my skill set.

[eagle326]

how about some details there Eagle... Red hot katana? Or? Followup?

Well sniper you said 911 was upside down. In this situation I would think hospitals are negative. Now looking at the pictures and seeing my S.O. with this injury would make me think ; Hand or possible death due to infection. Even if a hospital or even a doctor were available doesn't make me think they can save most if any due to the micro surgery involved.

I would err on the side of life versus death in this situation. If I had to I'd revert back to Civil War surgery for this if I had to. Not the route I'd want to go ; But a life saved is precious even if you're missing a body part. This wound no matter how you got it is a life or death one in a SHTF senario. Hope this explains my short response.

[izzyscout21]

Holy amputation Batman!

Chop, chop...............:cool:

[Gunfixr]

Wow.

We went from best treatment we could muster, to amputate, to fit an attachment for a "stabby thing".

I'm not so sure I want you guys working on me.

I made some home made firecrackers when I was a teenager. Still have all my fingers.

But then, I always used electrical igniters from a nice safe distance.

[ladyhk13]

After looking at the pic I honestly see no way the hand can be saved. The fingers are all but amputated already, the skin, muscle, bone, nerves and circulatory system have all been destroyed and to try and set it and sew it up would not only create infection no matter how much you cleaned and drained it, unless you are a neurosurgeon you will never be able to reattach the nerves, tendons, major veins or any number of other things that go into trying to fix this type of injury without pretty much guaranteeing gangrene and sepsis.
Never give someone alcohol if you have other pain meds due to it causing excess bleeding (that's why tatoo's aren't done to people who have been drinking). Knock them out with drugs if possible and take the hand. Of course treat for shock first and I would suggest strapping them and the arm down before cutting. Make sure you feel for the space where the wrist comes together with the ulna and radius and don't just CHOP or there will be a whole new set of problems. Time and caution must be taken. If you have I.V. solutions start one first. If not, you can always make one by mixing sugar and water, tubing and finding some kind of needle (that would be the hard part - I would be adding some I.V. kits to your first aid kits).
I may be forgetting some things but those are the high points I would bring up.

[LUNCHBOX]

I say get that tractor wheel fixed and then we will deal with that scratch you have on your hand.

Of course, amputate comes to mind also.

[Sniper-T]

Obviously, there is no 'right' or 'wrong' answers. The question is "what would YOU do"? Each of us has a different skill set, and different set of supplies. The question is just designed to make us think of a possible activity, and the consequences should an accident happen.

That said, from the first part, where it just looked like a bunch of dislocated fingers and a broken hand without serious laceration, I would have given my wife one of my good painkillers (they make her sleep almost immediately), then gently but firmly reset the bones, and stitch or glue the laceration after a good cleansing. I would then make a slip on cast to help immobilize the hand, but still be able to slide it off to change the dressings. And then start a round of antibiotics.

The second part, with the completely mangled hand, I would knock her out as above, and then slowly start cutting away the damaged tissue and bone. I would try to keep any decent sized chunks of skin attached (near the wrist), and then separate the hand from the arm at the wrist. If I was able to keep enough skin to cover the stump I would, or I think I would slice a patch off her butt to cover the end. I would cauterize all of the blood vessels as I came across. Naturally, clean clean clean, and then antibiotics.

And prayer.

[Sniper-T]

Anyone who wishes to still answer the previous questions please do so... but here is another scenario:

You are with your group, minus any medical people that may be on their way, when you are confronted with several 'questionable' individuals. You are ready to defend, but you are talking amicably and exchanging information. Talk turns to trading some stuff, when out of the blue; one of the guys takes a swing at you with a tire iron. You get your arm up to defend, and draw and fire. The hooligans are quickly dispatched by your group, but the damage is done.

The tire iron blow landed squarely on your arm (which saved your head!), and you look down and see this:

http://i25.photobucket.com/albums/c95/Nmosch55/arm.jpg

Same scenario (no hospitals, no doctors); same question, What would YOU do??

[Brownwater Riverrat 13]

Well, I'm FUBAR, and it smarts! Sooooo, anybody got a couple of sticks, a knife, gimme your shirt so I can cut it up into strips and tie these sticks around my forearm. I do all this while I place my bad hand (left) on a rock palm down about knee high, place right foot on the back of my left hand and pull....... setting what little bones that will fall into place. I use my right shin and calf to press up against my broken forearm to hold the sticks while tying them around my forearm. While my group stand around in awe......................... Chuck Norris weeps.


Be safe.............the night is your friend.

[realist]

Scenario one:
1. Anesthetize
2. Debride the wound
3. remove whatever is not salvageable
4. Bandage
5. Administer antibiotics
6. Watch for infection

Scenario #2
That b broke Batman........
Step 1
1. Check for circulation
2. Elevate
3. pain meds
4. Ice to help reduce pain and swelling

The best thing about this is that it is a closed fracture. It will probably have to put into traction to straighten it out. If so then important to make sure circulation is not cut off.

[Brownwater Riverrat 13]

Scenario one:
1. Anesthetize
2. Debride the wound
3. remove whatever is not salvageable
4. Bandage
5. Administer antibiotics
6. Watch for infection

Scenario #2
That b broke Batman........
Step 1
1. Check for circulation
2. Elevate
3. pain meds
4. Ice to help reduce pain and swelling

The best thing about this is that it is a closed fracture. It will probably have to put into traction to straighten it out. If so then important to make sure circulation is not cut off.

Remember........this happened to you, not being a smart ass, ok? But all your procedures are on target IMO, easy on pain meds. Depends on individuals, just a note. If you could take said person on a stretcher back to base camp or where ever, do it! Best way of keeping them calm, treating for shock and elevating such a wound. If not, this person will not last long on foot with such a trauma. Sure you could sling it after all the preps but due to the freshness of the wound and not know whether there was any serious internal damage/arterial/venus there's no knowing of internal bleeding from crepidation from such a fraction and their movements over time in transit. Seeings I also have an open window with a group, I would have them carry me back to base camp for further treatment.



Be safe.............the night is your friend.

[Echo2]

Get my bud to get me to the nurse.....while the rest go on patrol to ensure that any threats are dealt with.

I want my ass sedated well....I DO NOT want to wake up during the setting of the bone/fragments....hope for best...monitor for infection......

Thanks god it was left hand.

[realist]

My bad I was thinking that we were a base camp. So guys you now need to carry me. Can you get me a drink while you are at it......

[Brownwater Riverrat 13]

Well, it's just what I would have them do. Just my experience with fractures that serious and having to wait for looooong periods of time before any type of treatment can be obtained. PAIN is usually what's embedded in between points A and B. "Immobilize" is what's most important in this situation, if they freak out, "incapacitate the victim" that's how I was trained. Nobody ever sees what happens underwater anyway during a water rescue (different scenario of course).


Be safe.............the night is your friend.

[apssbc]

Well I would consider that fracture open due to blood on the dressing. I am unable to see the wound on my phone so I'm calling it open.

I would clean the outside after sedating the pt or giving them some pain killer. The sterilize myself and get my tool kit and give the wound a good probing looking for damage to tendons, muscles, and blood vessels. Then sew up best I can what I find inside. Then it's bone setting time, do that and reexamine for more damage inside, again fix what may be there. Place a cast or splint and start healing. Leave the wound open but covered untill I'm comfortable with no infection. Stitch it up when it's ready to be closed. Change dressings keep clean and do antibiotics.

I realized I wrote this as if I was doing it to myself. I would have to direct someone to do these things. I keep a copy of emergency War surgery just in case.

[mitunnelrat]

Though it would be somewhat interesting to run around as a real life cousin to Captain Hook. I should contribute a more serious response to this.

Given the parameters for scenario 1, I know I could treat the shock well, though I'm not confident I'd recognize it as quickly as I'd like. However, I'd probably be saved her falling out before she got off her feet because I'd have her lie down for the hand alone, being afraid she'd pass out as I attempted to reset it. I'm running pretty lean on pain killers right now; I haven't gotten new scripts for a while. A dowel and an ultram probably won't help much.
Anyway, I'd have her lie down, put pressure on the wound herself as I get equipment prepped and talk to her.

Dose her up, clean the wound, have her bit (Evolver will get it) the dowel, and reset. I can't sew wounds, so I'd have to rely on compression/ pressure bandages to get the bleeding stopped, and changing them daily.

If the serious laceration is bad enough I feel like I'd probably seal it with. Quikclot after thorough irrigation, and hope it doesn't get infected.

Then its time to scrounge for antibiotics.

Fireworks hand? Pretty much the same except for adding the amputation. I'd be inclined to try a flame sterilized filet knife while its still hot, since my undereducated self thinks it'd be sharp enough to get through cartilage, sensitive/ flexible enough to feel/ avoid bone, thin enough to make clean lines on the skin left to cover the wound, hot enough to cauterize as I go, and long enough I might not need to stop to sharpen it mid process...

Lacking suture skills and materials, I'd probably try super glue to seal the arm and finish the procedure.

If I ran my hand through a pulley like that I'd cuss like a soldier, then take a knee, a motrin, and a swallow of water...

... Or I'd cuss like a soldier, check for lacerations, responsiveness, and strength. Further response would be dictated by how it looks/ works, up to (and including) wishing it had been my left hand that got wrecked, rather than my dominant right hand.

In the final scenario, I'd almost be relaxed, as I'm almosy guaranteed to be under the care of far more capable people than myself. In this scenario I'd just have to follow orders.

[m4gery]

Just a side note, and it's for any scenario. Don't be terrified of tourniquets! They are NOT as dangerous as was thought years ago. Improper improvised ones CAN be dangerous. Those are ones that have a very narrow band (like string, paracord, small rope, etc.) These can cause cimcumferencial (did I spell that right?) tissue damage leading to compartment syndrome, leading to limb loss and other minor side effects.

Wider banded tourniquets such as the CAT and similar are lifesavers. Military research has shown they can be left on for up to 3 hours without permanent deficits. Look at these devices, and improvise accordingly.

Bear in mind: infection/complications MAY cause death later, but uncontrolled severe bleeding will cause death NOW.

Be careful, be safe. May you never need the advice!

[Sniper-T]

Let's try another one... same scenario, SHTF... you have no support, other than yourself. Your significant other has been whining about their foot for an hour or so, when you stop and remove their shoe, this is what you see:

http://i605.photobucket.com/albums/tt140/Sniper-T/Ivy1.jpg

Within seconds:

http://i605.photobucket.com/albums/tt140/Sniper-T/Ivy3.jpg


What do YOU do?
be specific

[apssbc]

I hate feet. I think I would clean it real well. Also clean my pointy object maybe sterilize in a fire. Pop it and drain it as best I can. Then wrap it with clean dressings and let the person rest a few days. Keep the dressings clean and monitor. Admin antibiotics if possible.

[Kodiak]

I hate feet. I think I would clean it real well. Also clean my pointy object maybe sterilize in a fire. Pop it and drain it as best I can. Then wrap it with clean dressings and let the person rest a few days. Keep the dressings clean and monitor. Admin antibiotics if possible.

Sounds about right to me.

[Brownwater Riverrat 13]

Just a side note, and it's for any scenario. Don't be terrified of tourniquets! They are NOT as dangerous as was thought years ago. Improper improvised ones CAN be dangerous. Those are ones that have a very narrow band (like string, paracord, small rope, etc.) These can cause cimcumferencial (did I spell that right?) tissue damage leading to compartment syndrome, leading to limb loss and other minor side effects.

Wider banded tourniquets such as the CAT and similar are lifesavers. Military research has shown they can be left on for up to 3 hours without permanent deficits. Look at these devices, and improvise accordingly.

Bear in mind: infection/complications MAY cause death later, but uncontrolled severe bleeding will cause death NOW.

Be careful, be safe. May you never need the advice!

Very good advice and something everyone should seriously tuck in the back of their mind (if you don't have one put it in the back of your head). Be mindful of the belt you are wearing. If you don't wear a belt because of "fashion" WELL GET USED TO WEARING ONE IN THIS DAY AND AGE, BECAUSE THE LIFE YOUR SAVING COULD BE YOU OWN OR SOMEONE ELSES! Or you might need to whoop someones ass with it. (have a good stout buckle with an "ANTHEAD")A good broad leather or one or those fancy tactical Cordura belts. This is serious busniess we are talkin here. This Brownwater Riverrat Out!................

P.S. HEY WHERE'S THE FRICKIN ANTHEAD BUCKLES? IT'S MY IDEA AND I WANT IT NOW!!!!!!!!!!!!!!

[Brownwater Riverrat 13]

Let's try another one... same scenario, SHTF... you have no support, other than yourself. Your significant other has been whining about their foot for an hour or so, when you stop and remove their shoe, this is what you see:

http://i605.photobucket.com/albums/tt140/Sniper-T/Ivy1.jpg

Within seconds:

http://i605.photobucket.com/albums/tt140/Sniper-T/Ivy3.jpg


What do YOU do?
be specific

I SEE SOMEONE'S NOT BEING HONEST WITH THEIR GROUP!" After saying a few choice words like "hurts don't it?, how long did you plan on waiting? etc." First I' d have to do a very close examination, there's always a possibility of punture wounds. If none are present treat as a blister as follows: Then It would be "suck it up cause this one's going to hurt, here's my aformentioned leather belt, bite down" I would lance the blister and drain, assuming we are on the move guessing that's how it occurred. Removing from my kit i'd use clean fresh water rinse an fresh gauze to dry, silver sulvadine slave (Burn cream) and then another double 4x4 gauze "dry" and ace wrap. Mean time one of our others would be fashioning a set of crutches for said "blister girl" to continue to hobble on to point "B". Now it there were no others in our group it would take a bit longer so I would have to fashion crutches my self. Also follow up with Benadril and antibiotics that we carry in out BOBs.(Discoloration) Now if there were puncture wounds present that calls for a different scenario. Do not elevate, keep low to prevent toxins from traveling towards the heart. Puncture, drain, oral anti biotics, antibiotic cream. clean dry gauze ace wrap, keep calm and imobile, do not want to heart beat to elevate/increase. Way to far past the "sucking poison" phase. Pull out my hand held Yeasu DT-60 SW radio and GPS give location/situation to authorities for an evac/exraction point. "this is my loved one" as stated in the scenario" Use a loose tourny (control method used here)just above the upper ankle to control circulation. Monitor vitals and treat for shock. Kiss her on the forehead and tell her she's gonna be OK the "sugarbear's here"

[The Stig]

I hate feet. I think I would clean it real well. Also clean my pointy object maybe sterilize in a fire. Pop it and drain it as best I can. Then wrap it with clean dressings and let the person rest a few days. Keep the dressings clean and monitor. Admin antibiotics if possible.

That.

If it truly is a blister a stern talking-to regarding letting others know before bad becomes worse would be added to the agenda.

[LUNCHBOX]

I say you take Mitunnelrat's appendage mounted staby thing from the crushed hand photo idea and go to town on this foot. There will be a lesson learned from this method...I guarantee it. hahahahahahahahaha

[Sniper-T]

That indeed is a blister, although the cause is slightly different. The victim had bad poison Ivy on the bottom of her foot, and then 'stubbed it' causing the blister. If you look closely at the first photo, you can see the bumps and pustules around the blister.

This is going to be nasty to treat, for in addition to the blister, you also have the poison ivy to deal with, and all the itchy contagion that it brings.

Another shot pre-popping:

http://i605.photobucket.com/albums/tt140/Sniper-T/Ivy4.jpg

And lets say the next day:
http://i605.photobucket.com/albums/tt140/Sniper-T/Ivy5.jpg

how does your treatment change? what are your follow up steps?