Author Topic: dealing with bad injuries in the wild  (Read 3195 times)

endurance

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dealing with bad injuries in the wild
« on: May 27, 2010, 08:51:17 AM »
First, one of the essential things in my first aid kit is percocet.  Never use it with joint injuries because you'll walk through worsening damage without knowing it.  Sometimes you want pain as a limiter.  However, for skin avulsions, lacerations, and non-weight bearing injuries, go for it.

Similar to berserker, my training is limited to EMT, a college course in the care and treatment of the injured athlete, plus life experience and stories from the GF (who's a CCRN/ICU nurse).  That said, I've been mountain biking with friends when they've broken collar bones, dislocated shoulders, and even a fractured femur and learned from the experiences.  I learned that a dislocated shoulder becomes harder to set with time and if not reset in the first 45-60 minutes recovery time can go from weeks to months because of secondary muscle and ligiment damage.  As a result, I searched out a website that had a procedure for relocating for emergencies and memorized the basics.  I can't recall the website, but I found it with a google search so it's not too hidden in the ether.

If a person is in excruciating pain, you really have two choices:  rapid transport or take a stab at fixing the problem.  Even if you haven't had the right training on how to repair a specific injury, if you have enough training and experience in similar procedures, you'll probably be the best hope for the individual.  Obviously there's liability in doing anything beyond your scope of training, but if it's my loved one who's suffering, I'm going to do my best to remedy the situation the best I can with the resources available.

IMHO, I got more out of my 'Care and Treatment of the Injured Athlete' course than I did out of my EMT.  Unless you have an exceptional wilderness first aid instructor, they want you to package and transport, not treat.  The injured athlete course helped me not only in assessing injuries, but also taping ankles, knees, and wrists to control motion in various axis.  It's definitely a class worth looking into as most colleges have something similar in their athletic training department.

Long-term, I think growing poppies would be the answer, but that's probably outside the scope of this question. 

Offline Asclepius

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Re: dealing with bad injuries in the wild
« Reply #1 on: June 04, 2010, 01:09:16 AM »
Does anyone remember Aron Ralston?

http://en.wikipedia.org/wiki/Aron_Ralston

JNeuser

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Re: dealing with bad injuries in the wild
« Reply #2 on: June 04, 2010, 06:29:07 PM »
I highly recommend taking a Wilderness First Responder course. I took a nine day course at the begining of May from Wilderness Medical Associates ( www.wildmed.com ).  WMA Promo Video

Offline joeinwv

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Re: dealing with bad injuries in the wild
« Reply #3 on: June 04, 2010, 07:34:34 PM »
Does anyone remember Aron Ralston?

http://en.wikipedia.org/wiki/Aron_Ralston

What likely saved him and made his escape possible was dehydration and the extent of the initial boulder crushing injury. Also a damn strong will to survive.

Offline drthumbs

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Re: dealing with bad injuries in the wild
« Reply #4 on: June 04, 2010, 08:15:10 PM »

wow, there  is some freakishly bad practice going on in parts of that video. 

At 1:05 a pt with apparent head trauma being slung and dropped on a long sine board.

But worst is 2:05.   

JNeuser

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Re: dealing with bad injuries in the wild
« Reply #5 on: June 04, 2010, 09:14:28 PM »
It was raw footage taken during a class. I'm sure there were lots of things done by the students that were less than perfect during the learning process. For the sake of argument.... given the 2 second clip shown of that scenario, one can't say for certain that the patient had head trauma or what other injuries there may have been to cause them to expedite the transport.

In regards to the worst @ 2:05 involving removal of the impaled object.... Again not knowing the particulars of that scenario it is easy to jump to conclusions. Sure when definitive medical care is just a little while away, by all means stabilize the object in place and transport. Standard procedure when dealing with impaled objects in the wilderness context(more than two hours from definitive care) is to remove the object unless:

-Impaled in the globe of the eye
-Removal will cause significant problems ( tissue destruction, severe bleeding, unmanageable pain)

Evacuating a patient with an impaled object will often risk more tissue damage than pulling it out. The longer the object is left in place the higher the risk of infection. Once the object is removed the wound is thoroughly cleaned and dressed.

Offline drthumbs

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Re: dealing with bad injuries in the wild
« Reply #6 on: June 05, 2010, 01:55:44 AM »
First, the quality of the video is somewhat lacking, and there are clips of what look to be training scenarios interspersed with what look to be real world incidents.

After reviewing the video again, I submit that it is difficult to determine the events leading up to the two seconds of video of the pt being moved. On further review, I cannot be sure that the pt is being moved to a backboard in a Stokes or if it is the padding in the Stokes.  I still find the scene suspicious.

The same goes for the impaled pt.  Difficult to determine what is going on for sure, but appears that an impaled branch is being removed from the thigh.  It could be the abdomen, but I do not think so.  Same rules apply, so lets say it is the thigh. How can you say for sure that the branch is not tamponading a damaged or bifurcated femoral artery. Even the presence of distal pulses is no clear indication. Remove it and you might prevent further damage (though you also may cause more), but if the femoral had been under tamponade, you now have a problem.  I can think of but a few scenarios that would justify such a procedure in the field. what is represented in the video does not match any of what comes to mind.

But you are right, not knowing the particulars of that scenario, it is impossible to judge 100% .  Regardless, IMHO, not expounding upon the particulars of that scenario, it was foolhardy to include that particular clip in a promo video. Just my $0.02.



I have been wanting to check out some of the classes from the WMA. Unfortunately, the classes are usually to far from me to consider.





Offline Doc K

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Re: dealing with bad injuries in the wild
« Reply #7 on: June 22, 2010, 01:58:49 PM »
But you are right, not knowing the particulars of that scenario, it is impossible to judge 100% .  Regardless, IMHO, not expounding upon the particulars of that scenario, it was foolhardy to include that particular clip in a promo video. Just my $0.02.

I would have to agree with Dr. Thumbs. 

I have been wanting to check out some of the classes from the WMA. Unfortunately, the classes are usually to far from me to consider.

You may consider attending courses/classes offered by the Wilderness Medicine Institute of the National Outdoor Leadership School or the Wilderness Medicine Society.

I have taken courses from both of these organizations, and know first hand that their education is top quality.  Also, the majority of the founders and leaders of Wilderness Medicine are part of the Wilderness Medicine Society.  When you attend their conferences, you have the ability to talk to the people who create medical guidelines and perform the research for all areas of wilderness medicine.  It's quite impressive.

I have not done anything with Wilderness Medicine Associates, so I cannot speak to their content at all.

Just my thoughts.  Hope this helps,
Doc K





Offline meancoyote

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Re: dealing with bad injuries in the wild
« Reply #8 on: June 22, 2010, 04:02:46 PM »
I work in some very remote places, in my lunchbox kit I too have Percocet. I also have Oxycontin. I had a bad injury April 13 and all my preps were a fail. I had to jump from a burning front loader and left my kit behind to burn. in the jump I broke my left calcaneus, my right arm, and some ribs. So I was laying in the middle of nowhere in lots of pain with out my kit. Two hours later I was flown to the hospital. something for the pain would have been nice.