10 Things To Know – Part Four: Fix a shredded leg


Post by WildSnow.com blogger | September 20, 2007      

It’s not an uncommon event. You’ve got ski edges that recently enjoyed the caress of your file — in fact, they resemble the edge of a Samurai sword. You take a beater, and instead of carving snow said ski edge rips through your flesh like oversize weasel teeth enjoying a meal of raw chipmunk. It’s bad (the kind of hole you look into and say “ewwwww”), but you can probably still ski or walk and not need a rescue. What now? What if your first aid supply inventory starts and ends with duct tape?

This morning I posed those questions to Buck Tilton, co-founder of the NOLS Wilderness Medicine Institute and author of numerous books about first aid and associated backcountry subjects.

Buck’s take was this:

First, Buck told me, you’ve got to get a close look at the wound and make it accessible for treatment. That might seem basic, but it is common for people to try and deal with cuts while fooling around with nearby clothing. If the cut’s not bleeding too bad, you then let it bleed a bit to help clean it out, and flush with water. If the patient is bleeding profusely, you’d of course need to control that first by using direct pressure, elevation, and perhaps a pressure point (see first aid books for details.)

Buck mentioned that using regular drinking water for cleaning is fine if that’s all you’ve got (though sterile water is of course the ideal). Interestingly, he also said cleaning with things like iodine solution can damage tissues and slow healing, and thus plain water might always be the best alternative.

Finally, get out that duct tape, cut it into thin strips, and close the cut as neatly as possible by placing the strips across the cut. Then cover with the cleanest thing you can come up with. Limp out of the mountains and see a doctor immediately, as you may need stitches or antibiotics.

If the bleeding is serous and won’t stop, you of course need extreme measures. That stuff is tricky and best learned in a wilderness first aid class. Do you have first aid education? If not, consider taking a course from WMI, contact them for details. Buck wrote THE book, Wilderness First Responder. Every backcountry traveler should study it.

The list:
10. Jump start a car without blinding yourself.

9. First-aid a serious laceration.

8. Rip skins in the wind without giving your scalp a bikini wax.

7. Fix a broken ski pole with duct tape and pocket knife.

6. Do a jump turn in the face of danger.

5. Start a fire in the snow while you’re shivering.

4. Read a topo map quickly.

3. Quickly dig a person out of an avalanche.

2. Keep your feet warm.

1. Practice a humble mindset so caution rules the day.

Comments

8 Responses to “10 Things To Know – Part Four: Fix a shredded leg”

  1. Clyde September 20th, 2007 11:05 am

    For profuse bleeding, the best answer is a product called QuickClot Sport from Z-Medica. This is comes in two sizes of dressings that cost $10 or $15 each. The military and EMS have been using the powder form of zeolites for gunshot and other nastiness with great success. QuickClot is a more convenient sealed package that takes up no space and weighs nothing (almost). This is so far superior to the old school dressings or tampons that it should be included in any backcountry FA kit. Don’t bother with the silver version unless you’ll be days away from medical care.

  2. Lou September 20th, 2007 11:08 am

    Cool Clyde, thanks!

  3. Jay Jurkowitsch September 20th, 2007 11:26 am

    Once, again, the folks at NOLS have the answersto your outdoor questions!! Nicely done and look up QuickClot – it looks great.

  4. DaveC September 20th, 2007 4:14 pm

    Appropriate cleaning of wounds in the field is a high priority. Its less of an issue on snowbound terrain, but its still important. Practically, if the wound isn’t well cleaned in the field, the doctor/ clinic is likely to want to open things up again and clean them themselves (ouch!).

    Anyway, I like hydrogen peroxide as a field wound disinfectant. Its less toxic than iodine, and the foaming action on contact with blood helps clean as well as disinfect. I haven’t had any problem with it freezing, but I don’t use it often, and haven’t ever needed to use it in severe cold (e.g. below 0F).

    Also, although iodine and alcohol are not recommended for wound application, sterilizing things like tweezers or hands that are going to be in close contact with the wound is a good idea. Alcohol wipes for hands work well.

    QuickClot Sport sounds pretty cool – I’ll have to look in to that.

  5. cory September 21st, 2007 7:01 am

    Any beta on superglue? I’ve heard it was originally designed as a wound closure and works great as a quick-temporary fix.

  6. Justin September 21st, 2007 8:05 am

    Hydrogen peroxide is very harsh on tissue, it doesn’t just sterilize the wound, it kills tissue. I have seen wounds that don’t heal because people have been repeatedly cleaning them with hydrogen peroxide. If you use Iodine, dilute it with water to the point that it looks like apple juice. Really, sterile water (or even non-sterile tap water) is the best thing for wound irrigation. The most important thing is how much you use, the more volume and pressure (use a syringe without a needle) the better. Another important thing to know is that if you think your wound might need stitches, they need to be done within about 6-8 hours after the injury on most places on the body, up to 24 hours if the wound is on your face or scalp. Otherwise, the risk of infection is to high.

  7. Clyde September 21st, 2007 8:55 am

    Cory, there are different types of cyanoacrylate. Super/Krazy Glue is the ethyl type and it works but tends to irritate skin and may need acetone to unstick; cheap though. The octyl types (Dermabond) are made for skin but are spendy ($50) and hard to find. The butyl type is also for skin — Vetbond is not too expensive ($15), is dyed blue so you can see where it goes, and it’s sold online.

  8. Steve Jeff February 24th, 2009 10:59 am

    Spare binding screws good but also think about including superglue and wire wool to pack out ripped holes. Wire wool also good for fire starting and weighs nothing / packs in small gaps. Superglue also good for fixing cuts… see the thread “10 Things To Know – Part Four: Fix a shredded leg” in here someone talks about different glue suitability for this.

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