Cuts and Such

Hand WoundNothing like a nice gaping wound to make people go weak in the knees. If the sight of blood makes you faint, you need to radically reevaluate your ability to survive. In self reliant situations, be it camping in the woods or natural disasters, you will have to deal with bleeding wounds. Here are some tips to keep you or other people from bleeding to death.

Begin by evaluating the wound. Where on the body is it? The size of the wound isn’t nearly as important as where on the body it is. A small cut to a major artery can be quickly fatal. Conversely, a large scalp laceration appears to bleed savagely but will stop on its own with little intervention. A serious survivor knows their science. Anatomy and biology should be in the mental toolkit of anyone committed to staying prepared. Get a good anatomy book and start learning about the sack of meat your soul inhabits.


The culprit is also important. What caused the wound? Don’t let the size of the wound or amount of blood fool you. Gunshot wounds may appear small and bleed little. Think about the mechanism and how much energy was required to inflict the wound. The more the energy, the more you should be concerned. If there is the potential for debris in the wound then care must be taken in stabilizing the patient. Shrapnel and glass can be imbedded in the wound and pose a hazard to both rescuer and victim.


The secret to success is compression. It doesn’t matter if it hurts. If the person with the cut isn’t screaming then you’re not pressing hard enough. Compress before anything else. Don’t worry about gloves. A dirty little secret about medicine. The gloves aren’t really to protect providers, we use them to protect you from germs. In a survival scenario you may not have the luxury of gloves and you need to stop the bleeding.


Use whatever absorbent material you have. A shirt torn to strips, handkerchiefs, tampons, socks, whatever you have place it on the wound and keep compressing.


If you can, keep the wound above the level of the heart. It decreases the pressure of blood at the wound site. This allows for clotting factors to accumulate and start forming the scab. Think of a slow moving river attracting debris and forming a dam.


Once you have applied enough dressings so that no new blood is seen soaking through, secure them in place with a bandage. Duct, electrical, or medical tape are all great choices if you have any. If you aren’t using a tourniquet make sure that the bandage does not compress any arteries. Check the pulse downstream of the injury. If it’s faint or absent, loosen the bandage.


This is a delicate art. You must judge the amount of blood loss vs the amount of time it will take to get to definitive care. If there is major arterial involvement and you are a long way from help, apply a tourniquet. Use something sturdy like a belt or a bandanna and tie it immediately above the injury. Insert a stick or pen into the tourniquet and twist it to tighten it further. Do not loosen it until you are able to get to real help.


This is what really kills people. It’s not blood loss, it’s germs. An example; during the American Civil War, approximately 620,000 soldiers died. Two thirds (~413,000) died from disease. What really saves lives is good nursing care. Once the blood has been staunched, clean the wound. The best is clean, warm water with a small amount of very mild soap. Hydrogen peroxide and rubbing alcohol are good but should be greatly diluted. Think two tablespoons in one liter of water. They are effective at killing germs but also cause tissue irritation and destruction if concentrated. Clean the wound gently, especially if you are out of lidocaine. Get any dirt and debris out of the wound to prevent infection. Change dressings and bandages every 24 hours if possible.


sewn lac

A laceration without arterial involvement will eventually close on its own. An ugly scar may form but you can generally leave a wound alone once it has stopped bleeding. If the wound is superficial, you can cut electrical or duct tape into thin strips (approximately 1/2 cm.) and tape the edges of the wound closed. Start in the middle of the wound. Place half the strip on the edge and pull it shut. Place the other half of the strip on the opposite edge of the cut and press down hard. Repeat the process along the wound, halving the distance each side of the center strip. You can also use a small amount of cyanoacrylate (aka super glue) on the surface of the cut to close it. Just make sure you don’t get any down in the wound bed.

Sutures are a whole different ball of wax. Like the tourniquet, this is a delicate operation. The hand shown here isn’t bleeding because I injected it with lidocaine and epinephrine. Try sewing this while it’s still bleeding. The other problem with closure is that if it’s not done right, it will cause worse problems. If there is too much space between the floor of the cut and the skin, an abscess will form. If the cut is extremely deep we close it from the bottom up using dissolvable sutures. If you’re wondering where to get dissolvable sutures remember that western people have been living in “survival” conditions up until recently. Galen was using dissolvable sutures made of animal intestine in the third century. You could also order some from Ethicon. It’s up to you. If you do have sutures or a needle and thread (dipped in rubbing alcohol) the process is fairly straightforward. Try and keep your hands, instruments, and the wound as sterile as possible. This may or may not be feasible but remember the real killer here isn’t blood loss, it’s infection. Drive the suture down through the epidermis in the center of the wound. Come up through the epidermis on the opposite side of the wound and pull tension. We use specific knots to tie the sutures but any strong knot will do. Repeat until the wound is closed.

Now you’ll be able to care for yourself and your loved ones should the situation rise. Look in your medical kit now and see if it’s adequate to respond to open wounds. Sticks and stones may break my bones but for heavens sake don’t faint if I’m bleeding.

-Richard Hammack


Thin Air

The air up here is starting to get crisp.

Right now many a mind is turning to the gnar gnar pow pow that is dusting the high peaks. College fratboys are selling off their furniture for season passes, yuppies are buying new boots and bindings, and everyone is doing gymnastics with their work schedules to have a midweek day off. Besides the ice, rocks, trees, and fratboys, there is another danger lurking the slopes. This threat is so serious that it can kill you without you doing a thing.

Some people may think that the problem with the high altitude on the ski slope is lack of oxygen. While it is true that there is slightly less oxygen in Vail than there is in Denver, the amount of oxygen isn’t the problem. The problem, the silent killer, is air pressure.

Now for some basic medicine and biophysics. Hang on, this won’t hurt, it’s really quite simple. Air goes in and out, blood goes round and round. See, not that hard. In order for the blood to go round and round, the heart has to pump. Like any pump, it exerts pressure to move the blood through the pipes. When your doctor tells you to cut out the salt and take water pills, it’s because there’s too much pressure in the pipes. Overtime this pressure can get so high that it can make the pipes rupture. When the pipes blow you need a priest not a doctor.

This pumping action of the heart drives the blood into and out of the lungs. In the lungs, tiny little blood vessels filled with blood from the body pick up oxygen and get rid of carbon dioxide. This whole process is known as “breathing” and it’s really important. Remember that part about pressure? These little vessels are also under pumping pressure from the heart. As you ascend up a mountain, the ambient pressure becomes lower than the pressure in the blood vessels in your lungs. The blood vessels pop and that whole “breathing” thing quits working.

Ladies and gentlemen meet barotrauma. That’s an awesome word for injuries caused by air pressure (either too much or too little). The thing about the lung blood vessels popping is called HAPE (High Altitude Pulmonary Edema) and it can put a real damper on a fun outdoor adventure. Things to look out for are cough (may be with or without blood), severe exercise intolerance, rapid heartbeat, rapid breathing, chest pressure, or difficulty breathing. If you are experiencing any of these symptoms, stop going up, drink some water and catch your breath. Do the symptoms resolve after 15 minutes? If not, head down and seek medical attention.

HAPE is pretty spooky but his big brother will kill you quick. Can you think of an area in your body that is filled with as much blood as your lungs or your heart and would feel kinda bad if all the vessels started leaking and popping? High altitude cerebral edema is the same process of blood vessel popping but instead of your lungs it’s happening in your brain. Confusion, slurred speech, difficulty walking or using your hands, sudden vomiting, hallucinations, or changes in vision are all warning signs that something is going very bad. If you experience any of these symptoms go down as fast as you can. Got a radio? Call a chopper. HAPE can go from bad to dead in an hour.

Aside from going down quickly the only treatment for HAPE is using IV dexamethasone (a potent steroid) in conjunction with a Gamow bag. That’s an awesome portable hyperbaric chamber you can put a single person in and increase the ambient pressure. At around $25000 for Gamow bag, I’m not getting one unless I climb Denali. If the injury is acute enough it may be necessary to put you in an actual hyperbaric chamber with a provider and a crash cart to dive with you.

The baby sister of HACE and HAPE may not be as scary but it is much more common. Acute mountain sickness (AMS) happens to a lot of people visiting Denver from lower elevations. Headache, fatigue, hangover or flu-like symptoms are common complaints for recent arrivals from below. It may feel like a little cold that you can walk off but don’t get too crazy. AMS is often a precursor to HACE or HAPE and should not be ignored. If you have AMS don’t ascend yet. Wait a day or two in Denver and let your body adjust. The best way to deal with it is to drink water like it’s going out of style. Avoid alcohol, caffeine, and recreational drugs. That’s hard to do around here.

-Richard Hammack