knife Cut in Jungle

Dew

Joined
Jan 25, 1999
Messages
188
I got a bad cut on my left fingers last week from my Dozier. It was quite deep and I was not so sure whether it should be stitched. I was alone and far away from hospital so I just managed to stop the blood and left the wounds as is. A week has passed but still feel pain from time to time (esp when exposed to cold weather outside.) Maybe it would heal faster if I had them stitched.

So my question is, suppose I'm out in the field and get a deep knife cut that may require stitches but a hospital/medic is not accessible, what's the best way to deal with the wound ?(hope Ron doesn't suggest using snare wires ..
smile.gif
) What would be the danger of leaving a bad wound without stitches?

Thanks for any response.

Dew.

BTW, got Greg's book and Hoodwood' s videos for X-Mas this year. Like them a lot.

[This message has been edited by Dew (edited 25 December 1999).]
 
deleted.

[This message has been edited by jrf (edited 12-26-2000).]
 
Wound Care 101:

BE CAREFUL - Prevention is the better than treatment!

K.I.S.S. - Always remember the basics; 1) Stop the bleeding (Direct Pressure, Elevation, Pressure Points) 2) Keep the wound clean 3) Keep the wound dry

Generally any wound that is deep, gaping open or involves an area with a lot of movement (like a finger) should be sutured. If you don't know how to suture don't attempt it. Any wound over 24 hours old should generally not be sutured.

Your primary concern should be cleaning the wound. Plain old soap and water is fine. Irrigate with clean water (water from purifiers using iodine filter elements are super - unless you are allergic to iodine). Dry the wound well and keep it dry and covered. Improvised butterflies and crazy glue works well in some cases. If you have a large laceration over a joint or an area with a lot of movement that cannot be sutured, dress and splint it.

Hope this helps

[This message has been edited by Barry L. Schuchart (edited 26 December 1999).]
 
Thanks guys.

The cut on my ring finger was pretty deep, but after I applied pressure for a (long) while the blood stopped and the wound was closed so I left it like that (and was crippled for the whole week). On another thread on general forum I read many people had their wounds stitched.

May I ask further what's the symptom of infection? Is it true that it will show up within the first 24 hours? and what's the sign of gangrene?

Dew.
 
Dew,

Again I think the answer to your question is prevention. If you sustain an injury while in the wilds you should seek medical attention as soon as possible. You should always keep your Tetanus current. Boosters are generally good for about 10 years. Good initial wound care is vital in helping to prevent infection. Most wounds will show some signs of minor local symptoms, reddness, swelling and pain. If the symptoms persist or worsen you should seek help. This is not something you should mess with on your own. Gangrene is the end result of a severe untreated infection. It is simply the death of tissue. If you are in a wilderness situation and are far from medical help your prognosis is very grim indeed.
 
I'm reminded of the days when I motorcycle-vacationed. I used to take a suture kit with me (my brother, a med student at the time, helped me put it together).
If you're badly cut - a bad suture job will get you to help before you bleed to death.

mosh
 
>>>May I ask further what's the symptom of infection? <<<

To understand infection, and how to tell if you have one, it is helpful to understand the process of normal wound healing, or inflammation.

When you are cut, the tissue around the wound immediately constricts, compressing the small vessels and slowing blood loss. In fact, for about ten minutes, all the blood vessels in the body reflexively constrict, in order to minimize bleeding. Platelets in the blood are attracted to the site of injury and form plugs in the torn vessels. Tissue clotting factors activate the clotting cascade; within minutes, clots of elastic protein fibers fill the wound. This is why, with the aid of direct pressure and elevation, almost all bleeding, even from serious wounds, will stop within ten to fifteen minutes. Over several days, the clot surface dries, forming a natural bandage in the form of a scab.

Underneath the clot, the process of inflammation forms an additional protective barrier. After about ten to fifteen minutes, as the clotting process blocks the bleeding from the injured vessels, the body releases vasoactive amines into the wound region, and these cause the *uninjured* capillaries to get larger and start to leak, so that blood plasma pours into the wound area. In addition, mast cells under the skin release histamine, which attracts white blood cells out of the blood vessels into the extracellular fluid, where they help to clean the wound. Polymorphonuclear granulocytes swallow and kill bacteria; macrophages consume and destroy other debris left lying around.

These processes explain the classical characteristics of acute inflammation, listed mnemonically as four Latin words -- rubor, calor, tumor, and dolor. Rubor or redness is due to the dilation of the blood vessels and the escape of red blood cells into the wound area. Calor or heat is also due to vascular dilation and increased local tissue metabolism. Tumor or swelling is caused by the leaking of fluid into the surrounding tissues. Dolor or pain is due to increased tissue tension from fluid accumulation. Some amount of redness, warmth, swelling, and pain are thus part of the normal inflammatory healing process. In addition, there may be a slight temperature elevation for a few days after a severe injury, and lymph nodes in the area of the wound may become mildly enlarged as they help trap bacteria and debris. Again, these signs are normal.

If the inflammatory process is being overwhelmed by invading bacteria, the body responds by *increasing* the local inflammation. It is thus *excessive* inflammation which, among other things, serves as a sign of a local infection.

-- Pain from a wound should normally subside by the second or third day. There may be an infection if pain persists, or especially if the pain increases rather than subsides.

-- Redness is usually limited to the margins of a wound, usually within a quarter inch. There may be an infection if the redness extends beyond the margins of the wound. In particular, a clear sign of infection is the presence of red streaks extending from the wound along a limb toward the body.

-- Severe swelling may be a sign of infection, especially if the skin temperature increases rather than decreases over time. Increasing limitations of motion, due to swelling and pain, may also indicate an advancing infection.

-- Pus is fluid filled with dead white cells. The presence of pus in a wound indicates a failure of cellular defense and confirms the presence of an infection. The pus may be whitish, green, or even reddish, depending on the infecting organism. Sometimes, but not always, there may be a foul odor.

It is possible for an infection to spread beyond the local area and enter the general blood circulation. This is septicemia, sometimes called blood poisoning. Signs of developing systemic infection include lymphangitis, or enlarged and painful lymph nodes, especially if they are beyond the immediate area of the infection; a high and persistent temperature elevation; chills, headaches, nausea, vomiting, or malaise. A person with a systemic infection is desperately ill and requires immediate evacuation.

Gangrene results from contamination of a wound by the bacterium Clostridum perfringens, widely found in soil and in the intestinal tracts of humans and animals. The bacteria grows and creates spores in dead tissue where the oxygen content is very low. This is why the proper debridement of dead tissue from a wound is extremely important, especially in a wilderness setting. The signs of gangrene include gas bubbles in the wound, drainage of foul-smelling reddish-gray fluid, and crepitus or a "Rice Krispies" feeling in the skin surrounding the wound. The gas bubbles come from the bacteria fermenting carbohydrates into carbon dioxide and hydrigen. Gas bubbles under the skin cause the crepitus. Gangrene is an immediately life-threatening condition, which may be fatal in as little as 30 hours. Immediate evacuation is required.
 
Thanks again for all good explanations. These are very informative and helpful.

Happy holidays,
Dew.
 
Concerning cuts to the fingers, I say go to the hospital. I had a cut to a finger, figured it wasn't that bad, and applied first aid. The cut healed beautifully(is that a word?!?). Only one slight drawback, the last joint of the pinky doesn't move now. Yes, a tendon was cut. If you get a bad cut, go to the doc.

Also, don't play with knives in the reverse grip unless they have a good guard! :)




[This message has been edited by K Williams (edited 26 December 1999).]
 
can anyone out there confirm?

does cayene powder stop bleeding?

I have read this somewhere and now carry an ounce just in case.I have applied it on a small slice on my finger and it worked but I can't tell for sure cause it wasn't too deep.

also I have found changing bandages and cleaning everyday is very important and that speeds up healing.

 
the one time i took a chunk out of the inside of my index finger with paramedic shears- i had to steristrip it myself after washing it with chlorhexidine solution. i wasn't out in the boonies either; i was in the hospital where i worked, the ER was too busy to look at it {patients are priority, not staff). all they did was immobilize it cause it had stopped bleeding. but when i looked inside it after dousing it i could see what i believe was the tendon- whewww, missed it by that much! crazy glue mixed with a lidocaine type solution could work- something like that is used by the old boxer trainers. but you can't put it on anything jagged or where you will have range of motion problems (knuckles, knees) and some are allergic to it. i remember the idiot that came into our e.r....he "won" a fight a couple days earlier punching a man in the mouth, and you guessed it, he didn't know why his hand was edematous- swollen like an elephant's d**k and just as red i'd imagine (since i never really got that close to a pachyderm to see...
smile.gif
anyway, the red streak was running up his arm, typical, and he had a nice case of septicemia to occupy his time while he discovered the benefits of using an open hand strike if you're gonna get your knuckles chewed on!......if you're not sure, just look for chills, fever, nausea, vomiting; you may think it's just the flu. they'll do a blood test to check for bacteria; the usual will follow- antibiotics, but they may have to do them IV. if you see the streaking or bruised-like splotches coming up from the area, get thee to an ER quickly. better safe than sorry. (that seems to be the mantra on this area of the forums...i like that, i'm learning cool things).

Fear is more fatal than hate.
 
chrisaloia,

Put the "cayenne" in your chili, not in an open wound. Stop bleeding with basic measures. If you really feel the need to put something on a wound use Neosporin or Bacitracin (Topical Antibiotic).
 
hey thanks barry,


I guess I was getting too indian for my own good. would bacitracin or neosporin be good for deep tissue cuts. I am glad for this thread cause it is telling me i need to take some courses or at least read some books.


thanks again

chris
 
Chrisaloia,

Putting some dry powder in a wound can help clots form. Whether this powder will do more good or bad in the long run is a very good question though. I _believe_ there are antiseptic powders you can get if you feel like tossing dry stuff on your injuries. Sulfa powder (If it's still used?) was one such thing. Helped clot blood and prevent infections.

Personally, I know what fresh peppers do to minor injuries, I sure as heck ain't putting powdered ones in a cut.

Stryver, who does like peppers, in his mouth...
 
You guys are doing really well. Walks Slowly's post reads like a medical text!

One thing, however. Sutures aren't anything special. They just hold the wound edges together. Taping or steri-stripping with splinting work just as well, so long as the wound doesn't keep popping open (which it won't if you have done your taping and splinting right).

The antibiotic ointments belong on top of the closed wound, NOT in the wound itself, as the petroleum base tends to retard healing.

I also agree with K. Williams. Get to an ER if you can. All lacs tend to look alike, and some real damage can be concealed under a benign looking lac. Remember the dictum of the ER doc: the definition of a minor hand injury is one on someone else's hand.

Good luck, and watch yourself around sharp objects. Walt Welch MD
 
Having had experience with this same issue just recently, I cut my index finger washign a glass down to the bone and around and across the knuckle, I say if you have access to a doctor and can have it stiched closed DO IT! Even with the stitching and wearing an aluminum brace for 2 weeks to keep the finger imobile it still broke open after the stiches were removed, although only slightly. It took a good month before it healed to the point where I could use it and even now after several months it is tender. I do not know what I would have done had I not had thos fixed correctly and had lost the use of it for a longer period or permanantly. Needless to say I found how much you depend upo each and every digit, especially your trigger finger or one of the 3 I use in my archery release.

------------------
Lee

LIfe is too important to be taken seriously. Oscar Wilde
 
I have a few thoughts on some of the points raised in this very interesting discussion.

>>>Does cayenne powder stop bleeding?<<<

There are lots of substances that are supposed to be bloodstoppers, such as cobwebs, sphagnum moss, and probably others I have forgotten. The problem with evaluating such substances is that bleeding normally stops on its own, and certainly can be stopped, even from very serious wounds, by simple direct pressure and elevation. It is therefore very difficult to tell which of these substances, if any, affect bleeding time, as opposed to using nothing at all. And it is difficult to know what value there is to using any of them, since you can stop almost any bleeding without them, and using them can introduce bacteria into the wound you have so carefully cleaned, and some, such as pepper, are just going to irritate healthy tissue.

>>>If you really feel the need to put something on a wound use Neosporin or Bacitracin (Topical Antibiotic).<<<

It is debatable whether antibiotic creams or ointments should be used prophylactically on a simple laceration in a wilderness setting. Certainly, antibiotic use is no substitute for aggressive wound cleaning. Also, in the wilderness, you are likely to have only one such antibiotic available. If an infection develops despite the use of that antibiotic, you have practically guaranteed that the infection is caused by a strain resistant to the only antibiotic you have. A wilderness caregiver might want to consider waiting to see if an infection develops in spite of appropriate wound care, and then using the antibiotic cream or ointment, in the expectation that the infecting strain is less likely to be resistant. On the other hand, where a wound is heavily contaminated, such as an animal bite, or considerable time has elapsed between the injury and the cleaning of the wound, it might be prudent to use a topical antibiotic, despite the risk of the emergence of resistant bacteria.

It might be worth pointing out that Smack et al., JAMA 1996;276:972-977, compared rates of wound infection among ambulatory surgery patients administered Bacitracin and those given only the base ointment –- Vaseline -– without any antibiotic at all. They found no significant difference in infection rates between the two groups. For whatever it's worth. :) It is certainly arguable that antiseptics provide little bacterial control beyond that provided by thorough wound cleaning.

 
I have a med kit that contains a bottle of boric acid. What/how do I use it?

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When the chips are down, the buffalo is empty.

 
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