Field surgery

At the end of August my sister and I went on a canoe trip in Algonquin park. We were on our second day when I got us lost. We spent about two hours fighting our way up a constantly narrowing river before I figured out where I'd gone wrong.

On the way back I slipped on a slimy rock. While trying to catch myself, I jammed my left-hand thumb against a waterlogged (also slimy) branch, bent back the upper-left quarter of the nail, and pushed some slivers into the flesh under the nail.

It wasn't very painful. I squeezed it to try to bleed out as much junk as I could, then turned my attention back to navigation.

Later that day I tried to clean the dirt from under the nail using my SAK Classic, but didn't have much luck.

That night it started to throb. I looked at it around 2:00 a.m. and noticed that it was swollen. The swelling sealed the nail against the flesh, preventing drainage. I squeezed some pus out, and went back to sleep.

Next day it was a little worse, but I put some triple-antibiotic as far under the nail as I could stand, put on a bandaid, and soldiered on.

That night I started to get concerned. At very least, if things kept getting slowly worse, I was looking at a painful two or three days. I worried that it might get worse faster.

The next morning I tried soaking some dental floss in alcohol (diluted methanol) and drawing it under the nail to sterilize the area and pull out the slivers and dirt.

This didn't prove very effective, but it did gradually inure me to the pain. Eventually, I decided I had to cut the nail away to get the underlying flesh cleaned out. (Not the whole nail, just the part that had been bent back.)

I was able to to do a pretty neat job of this using my SAK Classic. It's a Wenger, and while the scissors wouldn't work well, the blade was very sharp and slender, and did a great job.

After that, I started a routine of soaking my thumb in hot water morning and night, applying antibiotic cream, and covering it well. After two days it was back to normal -- or at least to the point where I was no longer worried.

Lessons learned:

1. Check all liquids and jells in my first aid kits on a regular basis. Almost all of the alcohol wipes were dry. I had to go through three kits to get enough that were still wet.

2. I'd sneered at the roll of white adhesive tape that came in one AMK kit I was carrying, but it was invaluable for protecting the end of my thumb. Humble stuff, but very versatile.

3. Carry salt. I'd stopped carrying a little plastic bag of table salt, but I would have loved to have had it to soak my thumb in. It's great for a sore throat as well.

4. I can't substitute or improvise an irrigation syringe. I'm going to start carrying one on long trips.

Bear

PS: I'm aware of the danger of topical application of methanol, but it was all I had. I'm considering using ethanol for my stoves in future.

Yowza! I was lucky enough to be near my doctor and his wonderful bag of tricks.

Note to self: give doctor's nurse a big "thank you" kiss.
Note #2 to self: keep DW from reading this board for a few days.

Self surgery is not something I'd want to try. That being said, would have burning/melting a hole through your thumbnail to relieve pressure help any? You needed to get the slivers out. I guess cutting away the nail was the only option, probably what a doctor would have done.

Would an irrigation syringe real have helped much?

-Blast

I read about a woman who accidentally slammed her finger in a door and the nail turned all black and blue. The doctor burned a hole in the fingernail to drain the blood out just like you suggested.

Burning nail holes is usually just for blood blisters. Heat up a paperclip til it's hot, and it 'melts' through. You can also drill through with a needle.

Alcohol pads dry up quick, like 6 months or so. Plan accordingly.

Field expedient syringe: poke a very small hole in the corner of a plastic bag, fill with water, squeeze. I suppose you could just spray it out of your mouth too, despite how dirty that water would become.

Salt is great, as it can also be used if you need to make a rehydration solution in case of severe diarrhea or vomiting on longer trips. You'd have to carry 4 times the amount of sugar too though.

I love my vial of poviodine - diluted it can be used as a gargle as well, and is a better diluted soak than the salt.

Eric

PS - good work on the injury

Also, does DW stand for Da Wife?

i would say the main message here is that you did not give up
in treating the injury but kept trying different methods to
clean and protect it..major injuries are rare,its the minor
ones that we all get that in a camping/survival sitution
become nasty..any thought on a antibiotic to put in a kit..
i have about 30 penicillin tabs in mine for treating dental
abcesses mainly..

I crushed the tip of my finger on day in an old fashined scissors gate elevator (ow!) The nail instantly turned black. I tried drilling through the nail with a needle, but was a little discourages at the progress so I simply inserted the needle under the nail from the front. Boy did it releave the pressure as blood squirted all over the place, but it felt soooo much better. The nail at this point was not attached to the nail bed and there was no pain from the needle. A couple of days later the nail proceeded to curl up away from the nail bed as it dried out. I borrowed a nail file from a female co-worker and remove it.

I have also used the ziplock with a pin hole in the corner as an improvised irrigation syringe. I was also talking to an army medic and he said that in Iraq the used to simply punch a hole in the bottle (peroxide, water, provodone???) and simply squeeze the bottle to irrigate.

Bill

heat a paper clip - it's blunt - and burn a hole. it's like a hot knife through butter.

if a needle touches the nail bed, OWWWW.

I have been using Everclear in my stoves and it works great.
I was beginning to think it was not that great an idea to cook using a fuel that had poison mixed in it.
It is hard to find anything purer than Everclear.
I use the stuff to de-grease my face, clean my glasses, disinfect wounds, and fuel my stove.

If you ever need to irrigate a wound, the consensus of the wilderness medical community is that it is completely OK to use any water source that is safely drinkable (filtered, treated, etc.). So I don't carry an irrigation syringe in my medical kit. I simply plan to irrigate wounds by using my drinking hose and drinking water pressurized by squeezing the bladder under my arm.

While likely a small concern, it still is a concern never the less. Bacteria from your mouth will have contaminated the mouthpiece and if the tube does not have a check valve installed, your reservoir as well could be contaminated. Not necessarily a big deal, just something of which to be aware.

Pete

Re improvised irrigation syringes, it was the slender, hard tip of the syringe that I couldn't improvise. I had lots of sterile water and spare plastic bags, etc., just no way to squirt it under my nail. -- Bear

IMHO you did the best thing possible. although you exposed the sensitive nail bed by cutting away the nail, you allowed excellent access for cleaning - which is the objective.

a caution with using a syringe - you run the risk of forcing dirt & bacteria further under / into a wound - unless you use a lot of water and can control the direction and flow of water. a bag is great.

Usually, DW = dear wife, DH = dear husband, DS = dear son, DD = dear daughter. (Don't ask!)

Interesting situation. I carry a surplus US Army field surgical kit (approx $40) and I need to check my antisceptic wipes. I also carry a 2 per day x 10 days supply of broad spectrum antibiotics. I renew the antibiotics annually through my Dr, who knows me and what my medical experience level is.

Yes, a roll of gauze, tape, ob pads, 3x antibiotic ointment, aspirin, Ace bandage, & an antisceptic goes a long way.

Maybe I'm being a wuss, but it sounds like you chose not to cut your trip short to go and seek medical help. Is this correct? If so, did you consider going back to find a doctor?

If it's Algonquin Park in Ontario, Canada that you are referring to (that's the only one I'm aware of), you were about 2 days by canoe, and probably several hours after that by car, from the nearest medical clinic. So if you continued on for another 2 days, that could put you 4 days from help if the infection turned really bad (e.g. necrotizing fasciitis, or the superbug that killed Jim Henson, or something like that).

Maybe I misunderstood, or maybe I'm just being a wuss.

I'm not criticizing, since I wasn't there and I don't know how bad the injury was. But I'm curious whether you thought about going back for help, and if so, how and why did you make the decision not to? (If, in fact, that's what you did.)

Probably a good idea to submerge the hose in boiling water for a little while prior to using it for wound care.

Yeah, I bet that last one would be pretty well abused if it wasn't in reference to someone's daughter. This tends to be a fairly civil board, however.

For those w/o daughters, you can PM me for the "world's greatest daughter joke."

Those sorts of infections are quite rare. I wouldn't necessarily head home unless a skin or extremity infection was getting worse despite my best efforts (and I usually carry some heavy duty antibiotics with me). In 14 years, I have only seen a single case of necrotizing fasciitis but (obviously) thousands of cases of minor infections that could easily be treated on an outpatient basis.

Jim Henson had group A streptoccocal pneumonia that resulted in Streptococcal Toxic Shock Syndrome. Again, extremely rare. However, on a general medical basis, someone with an obvious pneumonia should be be strongly considered for evacuation.

I've drilled through a nail with the point of a pocket knife blade and it actually works well. One has the ability to control it and not hit the bed as with the hot paperclip (the blood/fluid will issue forth at the first opportunity before that happens). I do understand in this case there was the need to get to foreign matter. I thought that was a great tip to puncture a plastic bottle to squeeze for irrigation. Would have never crossed my mind to do that.

This is only my second post to this forum, and I already feel like this is a place I will visit often.
I was a medic for many years, so I have developed my own first aid kit. I actually have several of them. But I have always kept betadine ointment and betadine prep pads in my kit for really dirty wounds. I found that betadine really helps keep the risk of infection down. Nothing is guarranteed 100% but I've been using it for years with good success.

I have a substantial first aid kit in my daypack all the time. It's seems that once you are a medic, you are always a medic. At my work, if someone gets really sick or hurt, I'm always summoned.

Jeff

Jeff,

Welcome to the fire newguy! I always appreciate having a good medic around. Care to say a little more about yourself?

-Blast

I have worked in military and civilian hospitals for 23 years and then changed careers. I grew a brain.

In the military I was a medic working in emergency rooms,ambulance services in Alaska, remote independent duty (24x7), ICUs, OR, Obstetrics/L&D, Pediatrics, and then moved into hospital administration/materials management. Then I grew a brain and changed careers.

I am constantly obsessed with improving my kits, upgrading, changing, improving the quality of the materials...I'm on a Titanium craze right now after finding a few bargains at clearance prices. I enjoy day hikes and fishing and I paint in six mediums and I'm into good quality production knives as EDC and survival blades. Too many hobbies...also hung up on Arcteryx line of equipment. There must be a support group out there for me somewhere.

Obsessed with good quality coffee too.
Jeff

Jeff,

I think you found a new home here with us. Gear freak? Oh yeah, we have those.

-Blast

Welcome and please do tell us more .

Pete

Sounds like you had a Paronychia or Felon. My wife had one after reaching into a Coke box and sticking a corner flap under her fingernail. A week later, it was quite inflamed and painful. The Dr. nearly sent her to a hand specialist after his initial treatment of draining and inserting a wick didn't work. He prescriped a strong antibiotic and hot water & Epsom soaks several times daily, which did the trick. If the pus pocket is is not relieved, it can infect the bone and that would really ruin a vacation.

Kodet and Angier's "Being Your Own Wilderness Doctor" recommends a 11 Bard-Parker scaplel and a "fish mouth" type incision into the pus pocket to relieve the pus. "This is not a pleasent procedure to undergo, but neglect will cause even more unpleasentness".

I found a copy of the book for 50¢ at Goodwill and scanned it into PDF. Makes a good addition to the FAK, even though it's 1968 vintage.

Old book. I have a hard time distinguishing between 'tried and true' old techniques and 'new and improved...the old way was all wrong!' techniques...but maybe that's just the worry wart in me.

Recently I picked up reprints of 'Camp Cookery' (1910) and Shelters, Shacks & Shanties (1914) and was amazed to learn just how many things haven't changed in the last 100 years...and how many great ideas have been buried by modern convenience and technology...sad really.

Pete,
I came across a set of M150 5.3 fl.oz and M200 7 fl oz double wall Snowpeak stackable cups that would normally cost about $48.00 for a 2 cup set. I didn't think $19.00 was too bad.

I also found a 20 -22 oz SnowPeak titanium cook pot with stainless steel lid that looks like a large cup with folding handles. I believe its a Snowpeak Minipot at $33.00. I didn't think $14.95 was too bad.

I already have a Snow Peak 450 cup and 300 double wall cup. And cook with a SP 3 piece Titanium cookset. Bought everything on reduced prices at two local outdoor shops. I'm just patient, check the stores frequently and wait for a far better than regular retail price. If I can find a price at 50 to 60% off retail, I'm happy.

This is off the Field Surgery thread topic, but we might as well cook well while our finger heals.

Totally agree on the Everclear. I used it with my home made stove on my Appalachian trail hike. Great stove fuel that also works to clean cuts and scrapes, freshen up etc...

Plus you can mix it with water and those little flavored Crystal Light packs for a nice adult beverage when you stop for the night... Orange flavored is particularly good...(I read this somewhere.)

IMPORTANT: You must get the Everclear 190 (95% alcohol). The Everclear 151 is only 75.5% alcohol and WILL NOT burn well in your stove. (Though it will in your tummy.) (Or so I've read...)

Only problem is, some states don't sell the 190. Florida does not. Georgia does. Those are the only two I know of for sure. (And shipping it is a big no no.)

I think it's the ultimate backpacking fuel. Multiple uses, can be stored in a light plastic container, the stove weighs only a few ounces, and less than an ounce of fuel will boil a cup of water in under 4 mins. Not as fast as a pressurized fuel stove - but a fraction of the pack weight. (And MSR fuel makes a lousy screw driver...) (Or so I've read.)

[quote=Erro...snip....Plus you can mix it with water and those little flavored Crystal Light packs for a nice adult beverage when you stop for the night... Orange flavored is particularly good...(I read this somewhere.)

...snip... [/quote]

I hear it's better with the lemon on a hot day - or so I hear

[quote]

A trashcan filled with Grape Hi-C, fresh fruit, and Everclear in a house filled with co-eds is also pretty nice...uh, so I hear.

-Blast

Potable alcohol over 90% is hard to find in some places. I've been looking for some for ages and have to stick to regular alcohol camp fuel.

I just hate the thought of burning up good sippin' booze! And for a slightly different taste, you might try the Crystal Lite instant tea. I didn't read that somewhere, I did it. And still do...

Y'all are giving me bad FLASHBACKS from the 70's, including the 3 day hangovers!!!!!

an Aloksak in any expedient carrier works great for me.

dchinell, you did a great job. Self-surgery is hard, one-handed even harder. I am glad it didn't get infected.

I am glad to see so many well read members on the forum! And such good listeners.

The ice packs in first aid kits degrade pretty quickly too. Ours failed after cleaning and bandaging my friends thumb that he almost cut off at the first joint. But we were able to get him stabilized and to a hospital within about an hour or so. He kept his thumb although it was a little questionable when it doubled as a pez dispenser. I am glad I got it cleaned and wrapped before his wife could see it. Thankfully, she only saw it after the stitching. Otherwise, she would have freaked...even more.

I would suspect hand warmers would go bad too, but have never used one here.

I use a swiss army messenger bag with a couple of those cheap insulated zippered lunchbags to separate bandages from meds/solutions, and then keep burn kits on the side in their own pouches. Hardware items like a stethoscope ride on top & the field surgical kit rides on the other side of the lunch pouches.