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swatsurgeon · 08-17-2004, 08:22

I agree with the quick Abx...never know how long it will take.
Great question on the what if you won't/can't evac for several days.......
1) Find a nice safe, quiet place that you can spend at least an hour
2) Dig into your personal anatomy book in your brain and look at the trajectory of the object. Do an Allens test...hold pressure on both the radial and ulnar arteries and close the fist tight to push all blood out the veins, remember you are occluding the arterial inflow. Let go of the ulnar first and watch the hand...if the whole hand pinks up than don't worry about the radial, you have good collateral flow around the hand and it can survive on only one inflow. Remove the nail, hold alot of pressure for 5 minutes on the site....don't crush everything, just firm enough to stop arterial flow. Slowly peal your finger/thumb holding pressure back off. If it bleeds, keep holding for 10 minutes. If it stopped or never bled, it missed the artery?? You do have to remove it to decrease chances of infection. Likely will develop tendonitis or osteomyelitis, keep on Abx, after 6-8 hours of no bleeding, can begin ibuprofen or the like,maintain neutral position and get aid when possible. Worst case scerio, direct pressure until it clots or place a tourniquet on over a folded (into a tightly comressed wad) 4x4 gause sponge to direct the pressure right over the arterial injury and the tourniquet holds it firmly with out compromising the entire hand.....been there, done that.

08-17-2004, 08:22	#11
swatsurgeon Guerrilla Chief Join Date: Jul 2004 Location: Phoenix, AZ Posts: 880	I agree with the quick Abx...never know how long it will take. Great question on the what if you won't/can't evac for several days....... 1) Find a nice safe, quiet place that you can spend at least an hour 2) Dig into your personal anatomy book in your brain and look at the trajectory of the object. Do an Allens test...hold pressure on both the radial and ulnar arteries and close the fist tight to push all blood out the veins, remember you are occluding the arterial inflow. Let go of the ulnar first and watch the hand...if the whole hand pinks up than don't worry about the radial, you have good collateral flow around the hand and it can survive on only one inflow. Remove the nail, hold alot of pressure for 5 minutes on the site....don't crush everything, just firm enough to stop arterial flow. Slowly peal your finger/thumb holding pressure back off. If it bleeds, keep holding for 10 minutes. If it stopped or never bled, it missed the artery?? You do have to remove it to decrease chances of infection. Likely will develop tendonitis or osteomyelitis, keep on Abx, after 6-8 hours of no bleeding, can begin ibuprofen or the like,maintain neutral position and get aid when possible. Worst case scerio, direct pressure until it clots or place a tourniquet on over a folded (into a tightly comressed wad) 4x4 gause sponge to direct the pressure right over the arterial injury and the tourniquet holds it firmly with out compromising the entire hand.....been there, done that. __________________ 'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that. (adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 ) Education is the anti-ignorance we all need to better treat our patients. ss, 2008. The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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