Boating mishap

[Larry Patrick]

A few weeks ago after a rough ride in we went swimming in protected waters. The boat has a a stainless platform with corners that stick up. Its a mod for securing Honda 2000,right above step platform. My foot slipped and all my weight on my right foot slid across the corners of metal. Gash across width of my foot by instep it was deep could see tendons a lot of fiery shooting electric like pain in foot ,minimal bleeding. Was hot went swimming not a good choice ,got sand and gravel in there. Didn't want to sit in emergency room for 6hrs,so we went to walgreens for stuff, flushed it out cleaned it ect. Three weeks later healed except for scar tissue.Should have skipped swimming and went to hospital. Last season met a husband and wife that one broke leg and other an ankle on their boat same season. Good to slow down and be more careful,bought a heavy rubber matt to cover platform while swimming. When wife wants to go to boat without me,taking supplies ect,wont let her ,worried about a slip and fall with her ending up in water. Never used to worry about stuff like that but seems like its easy to have an accident wind ,dock,slack in lines boat moving ect.

 

[thataway]

Sorry to hear about the accident! Thanks for sharing! That will help all of us avoid an incident in the future. I am going to make a medical judgement--you were darn lucky not to get an infection. I used to inspect any boat for safety issues, which I put together a medical kit for long distance cruising, as part of my services. The sharp corners on the dinette table in some boats can be an issue; Certainly the side decks are--and that is why I recommend extra handles on the cabin roof (both fore and aft).

If there is a slippery surface, especially where it can cut--It should be eliminated, and a non skid pad put there permanently. A photo of the offending platform might help others to avoid similar "mis steps".

As for boarding the boat--it may be a good idea to take up on the lines when you are loading gear aboard. We usually load the boat from the trailer--either at home, or on the road--and may carry a ladder for just that purpose, even though the fender support, diamond plate fender, side bunk and inside step give reasonable access.

As for wounds--there are some very bad marine organisms--and pathogens in fresh and salt water which can grow in wounds. The best item to flush wounds is sterile saline. You can get it in containers, or in pressurized cans specifically for wound flushing. Conventional medical advice is not to use hydrogen peroxide or other similar materials for flushing wounds. I have seen too many bad infections from marine and fresh water wounds, that if any question, I do use peroxide, only quickly as a last flush. Debridement is important, so that all foreign particles are removed. I also tend to put triple antibiotic ointment immediately on the wound. A possibly contaminated wound should not be tightly sutured.

Glad it all turned out OK--and just a scan! Take care!

 

[Larry Patrick]

Thanks Dr Bob ,realized Later should have taken the time to get treated properly. Even if out of town and a possible long wait. Since the blood stopped fairly quickly,late in the day, I backed out of going,glad I got lucky and no infection.

 

[BrentB]

I am glad, too and seen lots of wound cultures.

 

[AstoriaDave]

I take along some chlorhexidine gluconate (aka CHG) antibacterial soap and give superficial wounds an immediate good scrubbing, followed by protection with a sterile dressing, most often a bandaid. On the water, and with our hands in fish guts, boat slime, and other nasties, renewal with CHG or similar at least once a day should be done.

I had two ingrown toenails corrected by surgery a couple years ago, which left some raw, open wounds, which were treated with 4:1 diluted betadine solution soaks for a period of a couple weeks plus, with no negative consequences. For those with iodine allergies, CHG was the alternative.

The down side to CHG is that it is harmful to eyes, and therefore cannot be used on the head. Other restrictions, also, such that my pharmacy only stocks it in the protected area behind the pharmacists counter, and issues verbal warnings with each purchase.

 

[BillE]

What is the bad rap on peroxide? I was raised on the stuff. My grandmother would flush out my every scrape and cut and I have continued the practice. I'm 62 and have not noticed any negative effects, unless getting old, fat, and bald are side effects. Maybe I should have avoided it!

 

[BTDT]

What is the bad rap on peroxide? I was raised on the stuff. My grandmother would flush out my every scrape and cut and I have continued the practice. I'm 62 and have not noticed any negative effects, unless getting old, fat, and bald are side effects. Maybe I should have avoided it!

On my bottle of hydrogen peroxide the warnings include baldness and weight gain :lol:

FWIW- I Googled wound care and found recommendations including adding salt to water for the rinsing of wounds. There was also mention that peroxide can be hard on tissue. Also for those who use contact lenses it seems you may already have a dual purpose saline solution on board

 

[BrentB]

I use it after a good rinsing in clean water then use hydrogen peroxide or H2O2, Wound care management varies among the public and health care professionals but the overall principle is the same to promote speedy healing and avoid infections. I dont use regularly use an ointment except on burns. This is for simple wounds but m2cw is skewed by seeing infected wound microbiology cultures and antibiotic resistant bacteria for 40 years and my heart goes out to folks with diabetic and chronic wounds where the health care team does everything to prevent a bone infection, also called osteomyelitis.

I am glad about your outcome


Lots of good or maybe not ! reading on infections from leisure-time activities. LOL

 

[localboy]

Install some non-skid? I found we'd always slip in the splash well when re-entering the boat from the dingy. A perfect spot for a broken ankle or torn knee something. I painted a nice pad of non-skid and now it is not a problem.

 

[thataway]

Both H2O2 and Betadine/other surgical soaps have been said to delay the healing process by being cytotoxic. Obtaining valid double blind studies is difficult, but generally this does not seem to be true in small concentrations. On the other hand, there is little evidence that they really reduce infection more than good debridement with saline and mechanical means. the "foaming action" of 3% hydrogen peroxide does appear to help debride a wound.

If you want to read further on this here is an article on Medscape: http://www.medscape.com/viewarticle/456300 It is possible that this is blocked only for professional subscribers, and If so, send me an e-mail, and I'll get you a copy.

Far from a conclusive double blind study, but when I was director of Athletic Medicine at CSULB, I mandated that all abrasions and wounds acquired by the football players on artificial turf, be mechanically scrubbed with Betadine and a surgical scrub brush, our incidence of wound infection dropped to practically zero.
Artificial turf is far more abrasive than a grass field, and the wounds seem to be far more likely to be infected. I have found that that scrubbing "coral cuts" with Betadine and a scrub brush also reduces the infection dramatically.

BTDT: Saline for irrigation, is 0.9% salt in water. Far better to use the prepared sterile solution than to add an unknown amount of salt to water which might be contaminated. I checked my local CVS yesterday, and they have several different saline wound irrigation products on the shelf.

 

[hardee]

“I take along some chlorhexidine gluconate (aka CHG) antibacterial soap and give superficial wounds an immediate good scrubbing, followed by protection with a sterile dressing, most often a Band-Aid.”

I was raised on hydrogen peroxide too, and had my share of cuts and scrapes on the farm and in the factory. As a medic in RVN, we used gallons of it, and H2O2 added into a bleeding wound foamed up very nicely, making a nice surgical prep. The wound was then sluiced with sterile saline and closed. Then when I started working in the medical community stateside we were instructed to use different methods for better wound care reasons, so I quit using it on myself as well. I quit in time, so I only go old and fat, but still have my hair.

As to the CHG, I have used that in cleaning medical equipment for years, and have had excellent results reports from the lab who swabbed our equipment for QA. Good to keep some on board, and home in the medicine cabinet.

Harvey
SleepyC:moon

 

[BTDT]

BTDT: Saline for irrigation, is 0.9% salt in water. Far better to use the prepared sterile solution than to add an unknown amount of salt to water which might be contaminated. I checked my local CVS yesterday, and they have several different saline wound irrigation products on the shelf.

Thank you Dr. Austin, and my better half has added wound cleaner to her Walgreen'a list.

My thought was that when a saline solution is not aboard/available, a tablespoon of salt in 10 tablespoons of water could be an emergency alternative? Your thoughts?

 

[BrentB]

I mentioned flushing the wound site with water bc often physiological saline is not available esp in the field.

m2cw
Clean the wound immediately using mild solutions of your choice, same for using an ointment then bandage

 

[Kushtaka]

Among the many things I do, I am a wilderness medic. In some cases this allows us to perform treatments that are usually only for physicians in hospitals.

At our most recent recert training our instructor heavily espoused povidone iodine solution for wound care and discouraged the use of H2O2. He also advised AGAINST prophylactic antibacterial ointment, especially if it comes in petroleum jelly. The idea being that a wound will heal more slowly with the ointment in there than without, unless there is an infection.

He qualified all of this with situational awareness. Sometimes you are in a place where a real debridement and cleansing of a wound is not possible. In those circumstances he encouraged the antibacterial use at first.

Keep in mind the point of the treatment is often not for the most optimal long-term outcome. A wilderness medic may deliver a course of treatment that will facilitate evac that may not be what would be ideal long-term, but perhaps the risk of staying in the field brings more dire consequences.

Under these circumstances we discuss cauterization of wounds, which is something that can do a lot of good if done properly, but can clearly cause injury if done improperly.

I have successfully stitched a bleeding artery closed in the past, but it was suggested that cauterization of the end of an artery could save someone's life in if a cut like the OP reported occurred and severed an artery.

These reality checks are very good reminders of how quickly things can and do go south out there. You are on your own, and you only have what you bring. Anticipating issues is the best way to efficiently stock your boat, and sometimes, you have to discover your unanticipated issues. Here's hoping everyone can do that in relatively consequence-free environments.

If you aren't sure about things, go get some education. I don't suggest that anyone go through the arduous Wilderness First Responder course if it is not necessary for your work, and/or you have a bunch of extra time and money, but the Advanced Wilderness First Aid offerings from legitimate sources are completely worthwhile. Standard Wilderness First Aid is great too, but it is a very rushed course with too much info packed into too short a time in my opinion.

A WFR Cert will, however get you most of the way to being an EMT as it covers more material than an entry-level EMT course. EMT's generally have a higher requirement for pediatric treatment, so our local FD has a course they provide for WFRs who want to work on ambulances that just provide the missing education in a half day. Most places will work with you like that. It's a great way to approach a career as a medic, as it affords you the opportunity to work in town and out!

 

[thataway]

Thank you Dr. Austin, and my better half has added wound cleaner to her Walgreen'a list.

My thought was that when a saline solution is not aboard/available, a tablespoon of salt in 10 tablespoons of water could be an emergency alternative? Your thoughts?

The ratio for normal saline is 1/2 teaspoon of salt to a cup of water. You should boil this and let it cool before using. Good idea to have some of the wound cleaning solution aboard. One problem with our boat water tanks, is that often they sit, part full, and I suspect that we don't shock them as often as might be a good idea. Also I see some owners using pre-filters when filling tanks. Particulate pre filters are fine, but carbon pre filters remove most if not all of the chlorine, and this can contribute to our small tanks growing bad stuff...since there is no residual chlorine in the water. We use a post tank filter on our boats.

When we were cruising full time, the water maker water went into only one of 3 tanks aboard (a 60 gallon tank) and the other two, 250 gallon tanks each were shocked with chlorine regularly, and were filled from local sources for bathing, washing machine etc. Only the RO water was used for drinking, and cooking/food prep. This was also used to back flush the water maker membrane; chlorine will ruin the membrane. Also chlorine is bad for aluminum tanks, so an alternative used by some is Sodium metabisulfate at a ratio of two tablespoons per gallon of water. I am not advocating this for C Dory, where the CL is fine in our systems, but pointing out in some boats CL is not a viable cleaning material.