I was stabbed accidently by a friend  last night while helping him work on his ladder deer stand. We were up 15 foot off the ground cutting off old zipties and burlap after hunting and after sunset. He couldn't stop the momentum after cutting one ziptie underhanded, swung and hit me in the wrist with a 4.5" pocket knife full force. I ended up with a 1+ inch deep stab wound about 2 inches long, two cut veins and a nicked artery. Took more work than I expected for ER doc to patch me up tieing off veins, stitching inside and outside.  Had a few self criticisms and was lucky it wasn't worse.

After Action Review:
-Don't us a dull knife in close proximity of others, especially while 15 feet off the ground. I didn't fall but came damn close. Use a fall restraint even when you'll only be a minute or two up a tree stand.
-Keep a medkit whenever in the woods.  It sucks trying to control bleeding with your hand and tshirt while walking 400 yards back to the truck.
-Periodically check medkit. Forgot I used up a lot of stuff including my quikclot on my dog last year.
-Getting stabbed in the wrist sucks. It stings and bleeds a lot more than I would have expected. If I had been alone it would have been difficult to control bleeding.
-Israeli bandages work great but the ER nurses had never seen one. I was able to put it on by myself at the truck because my friend wasn't handling the blood and guilt well at all. Nurse stuck the Israeli bandage in a biohazard bag and gave it back to me.
-I usualy do very well with blood and pain, but ended up close to passing out for a minute or two.

Input requested:
-I want to build 4 extra medkits/blow out kits plus restock my others.  Where to get cost effecitve supplies?
-Is expired quikclot, bandages, iodine, and other medical supplies okay to use?
-Any other criticism or improvements I missed?

Side cutters would work much safer if not completely better.

Glad you'll live.

I stabbed my self in the thigh one time opening up a box of nails.

Buried a retractable box cutter blade all the way into the meat. Barely bled, but damn that bitch hurt for days.weeks...

Stab wounds are no joke, and knives be serious business.

Glad you're ok (or going to be, at least). Thanks for posting this, maybe it'll make someone think twice and save themselves a trip to the E.R. or worse.

Edit not GD..

That is my biggest concern in the woods is a knife slip. Bad enough being cut in town but out in the woods complicates things.

I am guessing it wasn't a severe gusher but you mentioned fainting.
Would it have been better to stay put and have help come to you if there was enough blood loss to induce fainting?

Ouch.....

Glad it turned out ok for you at least.


Something I have found useful is to buy 4-5 of those very inexpensive plastic tool boxes at Home Depot for like $9.99.
I keep one in each vehicle and in the camper.

Stock with basic medical needs/ and wound care items.

The tool boxes are tougher then cheap nylon bags or those flimsy first aid boxes. And hold more then an ammo can will.

That way I know no matter what happens I will have a kit someone can grab quickly.

The feeling faint was mostly mental as doc tried to determine if artery was completely severed before shooting it up with a local pain killer.  I guess it was a combination of remembering how it felt getting cut, some blood loss and the pain of the doc prodding it.

A lot of the blood loss was trying to hang onto the stand with my good hand and regain my footing after the cut.  Then I tried to rush down the ladder without stopping the bleeding first.  It was squirting a little with each heartbeat and pouring in between.   A little blood can look like a lot but I have no idea how much.  I did soak through the tshirt I used to wrap it and soaked half the 4" israeli bandage.

Hindsight is 20/20. I spent the day kicking myself for a dozen mistakes I made.  The 5 minutes we would have saved trying to rush to fix the stand up cost me 6 hours in the ER.

Glad you're OK, OP. I always use a pair of dikes to cut wire-ties. Too risky for me to use a knife in that instance. In my experience,some of those ties can be unpredictably tough.

arterial bleed is a good time to use a tourniquet, no?

OP, glad you are OK.

-Whiskey

wrong type of wound for QC unless you just want to use it. pressure and elevation are your friends. if it had been worse a TQ would have been your best option. one thing to remember, once you place a bandage of any type, LEAVE IT IN PLACE. if it bleeds through then just add more on top of what you already used. on that wound in that location you could have probably stopped most, if not all the bleeding by using 2 fingers to apply pressure just above the wound.

buy your friend a pair of dikes for cutting zip ties for the next time.

There is a member here on arfcom that has a sig line that goes like

Slow is smooth...Smooth is fast


I find myself saying saying "smooth is fast" more and more.


OP best wishes on a quick recovery.

What's the other one?

 




 

A couple of useful sources for material & equipment:

Bound Tree has great selection (may be able to find better pricing)

Rescue Essentials does pretty well too

I see plenty other scars. You may want to find a different friend?

The other side I've got another nice scar that almost touching the new cut.  My right forarm's not been lucky around sharp objects.




Israeli bandage stopped the bleeding. Most of the blood on the bandage was from trying to put it on myself and the blood that was already on my hands.  I had to tighten it down pretty tight though.  I had a tourniquet and stuff for a pressure dressing to but didn't need them.  I went for the quikclot first but I'm glad I ended up not finding it and using the Israeli bandage.

I've got to see a doc for the followup to see about nerve damage and numbness.  Luckily it missed all the tendons and I've still got full use of my fingers.

In case you didn't get my internet sarcasm, I was just poking a bit of fun.

 

Glad you are OK.

...BLOOD CIRCLE!  The Boy Scouts aren't stupid.

I always carry a hemostat on me.  From porcupine quills to fish hooks they are nice to have, including bleeding.

Some training for your friend.  

The majority of instances like yours that I have experienced, most people lock up.  I too was accidentally stabbed in the wrist back in 1981.  No where near the damage you have.  It hit me from the side and was stopped by bone.  Shear stupidity on the part of one idiot caused it but all people present just froze.  I was 18, had tons of training as a kid and scout along with actual experience using those skills, including some serious wounds on others and huge hole in my own leg once and a day away from any medical help.

I have lost two friends in the field due to accidents and both times all people present were unable to function.  All these accomplished outdoorsmen collectively didn't know shit.  Even simple crap like calling or sending for help.  If people are use to taking direction in their daily life from someone, even if that person is injured and in shock, they will take orders from him..........while he makes all the wrong choices.  Never thought I would see that but frankly, it happens a lot.

Even in this forum you would be surprised how many probably can't survive for hours if injured, let alone 24 hours.

Glad you are OK.  Med kits are a good thing EMT training for your own use would be good. (Don't take the final test as you will then be required to provide assistance if someone needs it that you don't know if they have blood borne pathogens).

Side cutter are good but a folding knife can do the same thing by squeezing the blade back into the handle with the item being cut in the way. Proper maintenance of tools, safety equipment, med kits, sharpen edged tools all the things that get put off until you have more time.

Sorry, I revert back to team leader way to fast. I am glad you have a memory mark to remind you to slow down and be careful as Murphy always gets involved.  You were given a gift of a mortality  check and the med bill may be costly but the lesson may save your life or a family member.    

I've posted this before:

A man bled to death a few miles from where I live a couple of years ago.
He was skinning a deer on his driveway and cut/stabbed (?) himself in the thigh, cutting his femoral artery.

True story.

Tourniquet FTW.... I ALWAYS have one nearby... you just never know...

Ask me how I know...



 

Jesus....
 

Never used QC but we use a similar patch as a hemostasis aid. I'm pretty sure it's nothing but Voodoo. But again, no experience with QC.

That being said, direct manual compression will stop most arterial bleeds or at least prevent blood loss to sustain the patient until medical treatment.

We had a patient years back who had his femoral artery torn during a procedure. I was told to hold pressure until the OR was prepped. Blood products were administered in the ICU until the OR was ready.

Long story short, 4 hours post tear he rolled into the OR. BP was 120/80. Vascular surgeon opened him up, stitched the artery and he was DC'd home in two or three days.

By the way, damned good looking suture job by the MD!!! Looks like the subcutaneous layers were stitched well enough that the three surface stitches weren't even needed and you could have gotten by with butterflies.

Glad it worked out, OP.

LOL WAT? just because you have an EMS cert does NOT mean you are required to provide assistance to anyone. while individual state laws vary i know of none that require you to stop and render aid just because you hold an EMT card.

Quickclot, and all of the other homeostasis aids only work WITH direct pressure and for the most part they found there was not a significantly better bleeding control over direct pressure alone.

The Israeli bandage will not work better than a T shirt if equal pressure is applied, and if placed badly the Israeli will make the bleeding worse  . Most people fail to appreciate how much pressure is actually required to manage a wound and the amount of pain it will cause.

I have never in 15 years on an ambulance had an extremity injury that I couldn't manage with a simple dressing and pressure aside from a mid femur amputation . It hurts like hell, people complained and you have to hold it for a lot longer than your mental clock will tell you, but it works just fine.

I like t shirts because there is always one around.

The other thing to consider is that Quickclot can complicate recovery because it may kill tissue that will either need to be excised or cause infection later on.

um, NO. thats the whole point in why QC and others like it was created. so you dont have to provide direct pressure to the wound site. it was designed to be used by either the person shot/injured or another team member to stop bleeding so you didnt end up 2 men down in a fire fight. before QC and others like it if one member went down you ended up 2 men down because someone had to drop out of the fight to render aid to the person injured. QC allows quick application and little to no follow up in the field so the second person, if needed can treat and return to the fight. QC and others like it also doesnt kill tissue and hasnt for several years because of a reformulation that ended the exothermic reaction that the original QC had. there are several options out there and most can easily be flushed out of the wound with no lasting issues.

as for direct pressure. if it doesnt clot off within a couple of minutes its time to move on to other treatments. if you are providing direct pressure you cant continue to provide care to your PT so you would have to have at least another provider on board. we have moved to TQ's in such cases if bulky dressings and direct pressure dont take care of the bleeding quickly. a medic that is tending to only one wound on a PT is useless since he is committed to that one thing. toss a TQ on it and move on.

You may want to do some reading up on the subject -

http://www.naemt.org/Libraries/Trauma Resources/Prehospital Tobpical Hemostatic Agents.sflb
A study from the Naval Medical Center in Portsmouth, VA compared several
commercially available topical hemostatic agents to the application of direct pressure with
standard gauze.14
The authors used a swine model with a severed femoral artery and vein to
simulate a high-velocity projectile injury with jagged surrounding muscle. Combat Gauze,
WoundStat, Celox-A, and ChitoFlex were applied to the created injuries per the manufacturer
recommendations. They were then compared to each other and to standard gauze applied using
direct pressure. Manual pressure was held for 5 minutes and any bleeding occurring after this
was considered a failure of hemostasis. Primary outcome measures were failure of initial
hemostasis and the incidence of rebleeding. Secondary measures included total blood loss,
amount of rebleeding, and survival. WoundStat performed more poorly than Celox-A in
achieving initial hemostasis and in the incidence of rebleeding. Surprising to the authors,
standard gauze and direct pressure performed equally as well as the 4 commercially available
topical hemostatic agents. There were no significant differences in failure of initial hemostasis,
rebleeding, or death between standard gauze and the other agents.

http://www.cs.amedd.army.mil/borden/FileDownloadpublic.aspx?docid=f2f80257-baf2-4742-9158-313270bc03c0
Treatment—First Responder
?External hemorrhage from extremity wounds.
o Direct pressure at the site of injury is the most effective
and preferred method of hemorrhage control.
? If direct pressure fails to stop the hemorrhage, it signifies
deep, massive, or arterial injury, and will require surgery
or advanced hemostatic agents.
? Hold pressure for at least 5 minutes before looking to
see if it is effective.
? Impaled foreign bodies should not be removed because
profuse bleeding may occur.
Pitfall: A Bandage Does Not Equal Direct Pressure!
?A bandage may wick blood from the wound without
stopping the bleeding.
?A bandage hides ongoing bleeding.
?Hemostatic bandages are available on the battlefield to
assist in stopping bleeding. (See current TCCC [Tactical
Combat Casualty Care] Guidelines.)
? Elevation of the extremity will decrease most bleeding.
? Point compression of the proximal artery.
? May help slow bleeding while attempting to gain
better control at the wound site.
? May require compression at the pressure point for up
to 20 minutes to provide hemostasis.
? Table 6-1 shows the recognized pressure points.

Hemostatic Agents
?Currently, TCCC (Tactical Combat Casualty Care)
recommends Combat Gauze. See current TCCC guidelines.
?If standard measures, such as pressure dressings, do not
control bleeding, it is recommended that a tourniquet be
used and that the first agent be Combat Gauze.
?If the bleeding is external and not at a site where a
tourniquet can be applied, Combat Gauze can be used if
conventional pressure dressings fail.
?This product is to be used only on external sources of
hemorrhage.
?Blood and clot should be wiped out of the wound prior to
application.
?Remember, pressure must be applied for 3–5 minutes at the
bleeding site, after application of a hemostatic dressing.
Field Hemostatic Dressings—Considerations
?Do not use on minor injuries.
?Use on internal wounds is not yet recommended.
?Must apply pressure to the bleeding site after application.
?Effectiveness is limited if Combat Gauze is not in contact
with the bleeding source in a deep wound.
o Controlled Resuscitation (Permissive Hypotension)


Quick clot works by pulling H2O out to concentrate the clotting factors. Remember high school biology, the part about osmosis and cell heath? Pull the water out of a cell and it's going to die. Has noting to do with exothermic reactions.

Good information but I will impart this: I would never advocate only holding pressure on an arterial bleed for 5 minutes.

Routinely post arterial stick to a femoral artery I hold 10 minutes in an unanticoagulated patient.  If the patient has had any anticoags on board, I wait at least an hour and then I hold a minimum of 20 minutes.  These are anywhere from 5 French to 8 French (1.67mm - 2.67 mm) punctures.  

Early in my career I had a patient who had a tract ooze and a Cardiologist showed my how to hold it (different than holding the artery). He stated that "direct manual compression can stop any arterial bleed as long as the puncture is occluded."

It's worked well for me over the last decade.  

Again, I'm not against the idea of a hemostatic agent, I've just never had any experience outside of hemostatic patches (Quick Clot does have one on the market, just never used it).

All training that I have received in the use of QC involves direct pressure and then applying a pressure dressing if possible.  QC is not magic and will not stop bleeding immediately upon application.

I sliced a guy open cutting zip ties with a knife.

No more. Now I use snips, if not possible I saw the tie with the serrated part of my knife.

Didn't take picture before bandaging?   Fail.

This is true. Lawyer and former EMT here.

I can't imagine someone having advanced EMS training being required to stop and render aid.

in some states, as a member of a FD/EMS company there are times you do have a duty to act. Va requires you to respond IF you are on duty or signed up/assigned to a squad that its their day to cover. other than that you dont have to respond. most, if not all, "duty to act" only apply to those that are members of FD/EMS companies. anyone can get an EMT cert without being a member of a FD/EMS dept. those rules dont apply to non member card holders.

Well if it was the radial artery the ER Doc probably called the surgeon to suture it. You can tie it off since the ulnar artery is the major supply to th Also if you had quick clot and it was the artery it wouldn't have stopped it. Best thing to have in a situation like that is a tourniquet. The get to a real trauma specialist like a surgeon. But really if you took one finger and put it proximal and on finger distal on the artery you would stop bleeding. Not a big deal to someone trained.