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Q:

A sharp knife is excellent for making quick work of your game. Unfortunately, a sharp knife is also adept at making quick work of you and accidents do happen even among the best of us. Knowing how to deal with varying degrees of cuts in the field can save your life.

Take your left arm and lay it in your lap, fingers facing forward and palm facing up. Next find your radial artery about an inch towards your body from your palm on the outside of your wrist and about half an inch inwards to the right. You should feel a bounding pulse there. Now push it down until the throbbing underneath your fingers increases and then stops. Feel how much it takes to push down? Its not an insignificant amount. And should you be in the woods with a cut artery, this is how much (or more) it will take to stop the bleeding.

An old surgeon once said that the only missing clotting factor was silk. What he was getting at is once we know where the bleeding is coming from, pressure (in his case referring to the occlusive pressure of a silk suture) is all that is required to stop bleeding. Now while that doesn't hold completely true for some people with certain diseases, the vast majority of folks should be able to stop most cuts with simple pressure. Long gashes excluded, most cuts require only a single finger at the right spot with the right amount of force to stop the bleeding. The key is, knowing where to put that force and being able to exert the necessary pressure. Everything below is under the assumption that getting help is not an option and you are dealing with a limit amount of supplies

*****Simple Cuts*****

Assuming you were slicing your caribou and gave your self an inch long gash to your thumb, first and foremost, get your cut out of the guts and run it under the freshest water you have (boiled preferably). This is the time to take your finger off the cut and examine its depth and possible damage to surrounding structures. Does the blood look dark and is oozing out or is there a pulsitile flow to it meaning there's an artery involved. After a thorough rinsing, push the wound close for 10 minutes or more with your finger, giving the inside of the cut time to clot off. Even arterial nicks (assuming it’s not completely sliced through and your blood clots normally) will eventually clot off. Remember, you want to stop the bleeding at the site but not impinge on any blood flow beyond the cut. Once the blood flow has stopped, you next concern becomes preventing infection and reopening. Both of which are addressed with a good fitting, clean bandage. Shirt cuffs and shirt tails make excellent bandage pads and wraps with out taking away from your ability to keep warm. Make your best effort to get out to the woods. If you can't, make a couple more bandages and rotate them, boiling them and completely drying them before reusing if possible.

*****Bad Cuts*****

Alone in the woods with a bad (meaning large sized or arterial involvement) cut can very well be a death sentence. Exsanguination from the larger arteries (femoral especially) can lead to unconsciousness in 1-3 minutes and death shortly after. Now we've entered the realm of tourniquets. On the distal (meaning away from the body) extremities, you have around 2 hours of tourniquet time before the tissue of the limb begins to die. And that’s under the best conditions. Ideally you want to place the tourniquet as close to the wound as possible without actually being inside it. Pressure should be maintained until a tourniquet can be applied. To apply, take your belt, shoelace, strips of cloth or whatever you can find and encircle the limb and tie it securely and as tightly as you can. Next take a small, 6-8 inch long stick and insert it between the cloth and your limb. Rotate the stick until the proper amount of pressure is applied and bleeding appears to have stopped. Secure it with and additional loop of cloth, encircled around the stick once or twice and then tied in the same fashion around the limb as the first tourniquet. Elevate the limb as best you can and periodically check to ensure its tension and distal blood flow. For cuts high in the limb, all the same principles apply, but try not to damage the nerves in the area. If stopping the blood flow is possible without generately tingles and pickly sensations down the limb, wonderful. Otherwise you may have to choose between bleeding to death and a fully useful limb.

*****Dirty Cuts*****

There are really two main issues with dirty wounds. First, the initial cleaning and second the post cleaning complications. Assuming the worst, that you cut through the bowel and then cut yourself your wound needs around 15 minutes of thorough washing in clear flowing water (if possible) or boiled (not boiling!). Make every effort to remove the debris inside without further damaging the tissue. This should ideally be done for all wounds but especially for dirty ones. Afterwards, assuming your still in the woods, you may experience the formation of an abscess which is a collecting of bacteria and white blood cells that occurs when a cut is closed over and is not thoroughly cleaned out. This is an infection and you may have fevers, chills, headache, or fatigue as a result. Sometimes these need to be drained but often it can be difficult to determine whether an infected wound is just infected tissue (cellulitis) or an abscess (pus pocket). Both of which are usually red, swollen and painful. However, abscesses tend to have a "head", a white area of skin with pus underneath or fluctuance (which basically is the feeling of fluid inside a sack; think the way a blister feels). These need draining. And assuming the Calvary isn't on its way, your going to be the one to do it.

To drain an abscess, first sharpen your knife tip as best you can to a razors edge. Next boil the tip for 5 minutes in boiling water. Clean the top portion where you plan to make your cut as best you can. Now this hurts even when we do it in the hospital with anesthetics. So it’s really going to hurt in the field without them. But if you’re in a cold climate and have ice available you can ice this area for 10-15 minutes until numb and that can help reduce the pain. Likewise sometimes the area directly above the whitehead of the abscess is numb due to damage to the fine nerves of the area.

In making your cut, make it as long as the pus pocket feels wide, being careful not to make a new bleeding site. The idea here is you want to open all that pus to air so it can drain. Gently squeeze the nasty stuff out and leave the wound open, but covered with a bandage.

*****After the Field*****

Ideally, any cut greater than 1/4" x 1/4" deserves attention from a medical professional and will possibly need sutures. If while washing your gash you notice anything resembling silvery white cordage, it needs attention from an orthopedic specialist as there has likely been tendon involvement. If a cut involves the joint, and clear fluid has leaked out, again, orthopedics needs to see you now. Joints are meat and potatoes for bacteria and you risk losing everything downstream from the cut if it’s not attended to.

Hope this is some good food for thought for you guys. Best regards, Curtis

from Longwaytilldo on 04.23.11

Comments (2)

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from bberg7794 9/5/2011 at 08:45am

Fantastic post! Thank you for the summary.

+1 Good Comment? | | Report
from Bob Hansen 6/9/2011 at 01:51pm

Longwaytilldo has some very valid points. When I'm afield, I always have a first aid kit with me that I personally put together,
PLUS a store-bought trauma kit containing QuikClot (mentioned on other posts). You can never be TOO careful...!!

I keep one kit in my vehicle and one at home...with adequate refills on hand.

Before such trauma kits were available, I almost cut a thumb off while slicing an apple in half. I didn't even know it until I felt the blood dripping on my shoes. Fortunately, I had only about a mile to walk to find help, and all ended well.

Pathfinder Bob Hansen

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from bberg7794 9/5/2011 at 08:45am

Fantastic post! Thank you for the summary.

+1 Good Comment? | | Report
from Bob Hansen 6/9/2011 at 01:51pm

Longwaytilldo has some very valid points. When I'm afield, I always have a first aid kit with me that I personally put together,
PLUS a store-bought trauma kit containing QuikClot (mentioned on other posts). You can never be TOO careful...!!

I keep one kit in my vehicle and one at home...with adequate refills on hand.

Before such trauma kits were available, I almost cut a thumb off while slicing an apple in half. I didn't even know it until I felt the blood dripping on my shoes. Fortunately, I had only about a mile to walk to find help, and all ended well.

Pathfinder Bob Hansen

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