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Hi There Welcome to Medical Monday!!
Today’s Topic: Hand Injuries!!
We use our hands a lot during the course of a day and we will use them more during the apocalypse. What happens when you injure a finger? What happens if you accidentally cut off your finger? What do you do if you have to fist fight someone and you skin your knuckles on their teeth? If you were wondering, read on…
**WARNING** This only applies to the apocalypse. If you have a hand injury, get your butt to an Emergency Department or else you won’t survive the apocalypse because you will have a mangled hand!!
So IN AN APOCALYPSE,
Step 1: Get to a safe place.
Step 2: Stop any bleeding. If it is an artery, you need to apply pressure and hold the limb above the level of the heart for AT LEAST 20 minutes. If, however, the artery is cut longitudinally, this does not bode well and the limb will likely not make it. Also, NEVER CLAMP A BLEEDING ARTERY!! Nerves run right next to the artery and you WILL damage them. IF you feel that a tourniquet is necessary (it probably isn’t), release the tourniquet every 15-20 minutes to assess if they have stopped bleeding. If there is a small trickle of blood, just apply pressure to that area rather than reapplying the tourniquet.
Step 3: Assess the hand. Can you move all your fingers (1. open and close your fist 2. try separate your fingers)? Do you have feeling over your whole hand? Does anything look broken? This only matters if you are going to do something about it. Regular people cannot sew tendons back together. Hell, I’m not even sure I could do it correctly. And if there are more than 1 tendon that is severed, how would you know which 2 to put back together? This is more to assess prognosis and to allow the person to understand that their hand will probably never be the same again.
Step 4: CLEAN IT OUT!! You need about 4 liters of clean water to do this properly. You want semi high pressure. I always say carry a sports bottle top with you, as this makes the perfect pressure stream to clean out a wound. If there is any dirt or gravel in the wound, don’t be scared to pick it out. If you leave it there, it is just a source of infection.
Step 5: Wound Closure and Dressings. If you know how to suture, that is wonderful. If not, use some steri strips. Dressings are used to protect the wound and absorb drainage. You need to do it in layers, first something that won’t stick to the skin so find the good bandages with Vaseline or other non-stick substances. Then you need the squares of gauze. Then you use the roll gauze and secure it with tape. If the person needs a splint (if they can’t move things correctly or the wounds are severe enough and will break open if the person tries to use their hands), then it gets kinda complicated. First, find some sticks or a piece of bark that is stiff to use as support. Next position the hand into the “safe position”. Let’s practice the “safe position”. Put your elbow on your desk (or table or wherever you’re sitting). If you keep your wrist kind of straight but relax everything, that is the position you should splint an hand/wrist. The fingers are slightly bent, the thumb is perpendicular to the fingers and there is a slight curve to the wrist. Be sure to put something under the fingers that keep them in that position like a never opened ace wrap. Do not use an ace wrap for compression. This means don’t stretch it at all to put a splint in place, as this can stop blood flow and cause massive swelling. This should stay on for about 2 weeks with wound checks every day. Then as time goes on, it can come off during the day and activity as tolerated. Start with no more than an hour off on the first day. It should be at least slept in for 6-8 weeks, because you don’t want to injure it while you’re sleeping. Gradually increase the range of motion as well as the strength.
If you hit tooth or anything in the mouth and you break the skin on your hand, you need antibiotics. Augmentin (amoxicillin-clavulanate) 875/125mg twice a day for 5 days. If your penicillin allergic or need another medicine, Doxycycline 100mg twice a day for 5 days works too. Just beware – it causes you to burn after only a few minutes in the sun so apply the sunblock!
If you happen to cut off a finger in the apocalypse, then you have lost a finger forever. Cauterizing the end like Merle did in Season 1 might be a good idea AFTER you wash it out good.
If the wound starts getting infected, then Clindamycin would work best 300mg three times a day for 5-10 days, depending on the severity of the infection. Try to find some probiotics to take, as this drug can cause a nasty diarrhea that has the potential to make you super sick.
Moral of the Story: Protect your hands!!!!