My buddy could have died!!!!

[TSandM]

The tetanus organism is a bacterium, and like low-oxygen environments. I honesty don't know if it can survive in water, or salt water, but it is typically found in soils. It is standard practice to update tetanus immunizations for anyone with an open wound who is found to be out of date, even if the wound is not a tetanus-prone wound (like a simple slice with a kitchen knife). Tetanus still carries about a 50% mortality rate, even with modern medicine, and it's 100% preventable.

 

[Bronson]

Thanlks for this post. Glad that your buddy is recovering.

 

[ba_hiker]

I've seen it mentioned not to use anything on the wound, except to clean and irrigate it with water and that using peroxide or alcohol can actually damage tissue and slow healing.

Hopefully one of the MDs on this site will chime in on this, but in my first aid classes, we were told to only use 1 of 2 topical antiseptics on an open wound, either Povidone-iodine or Quaternary ammonium compounds (such as benzethonium chloride, found in Bactine). All such compounds will cause some tissue damaged, but these two have good antiseptic properties and cause little tissue damage if used correctly.

They should be used after cleaning and rinsing the wound. Povidone-iodine is the preferred antiseptic, and can be diluted (to a light pink color) with water and used to flush a wound. Hydrogen peroxide and alcohol cause more significant tissue damage and may delay healing, they should be avoided. Antiseptic ointments should be avoid for deep injuries (more than superficial damage).

These are first aid treatments and do not substitute for proper medical care, particularly if the wound is deep, particularly ragged, contaminated, or any of the symptoms TSandM mentioned develop. As soon as possible consult a doctor for any but completely superficial wounds incurred diving.

Whether either of these will be effective depends on several factors, including the actual organisms involved, the depth and condition of the wound, and the general health of the victim. a MD can assess these after the dive. in the water or in tropical locations subsequent infection should be considered very likely.

 

[OnceLoyal]

Hopefully one of the MDs on this site will chime in on this, but in my first aid classes, we were told to only use 1 of 2 topical antiseptics on an open wound, either Povidone-iodine or Quaternary ammonium compounds (such as benzethonium chloride, found in Bactine). All such compounds will cause some tissue damaged, but these two have good antiseptic properties and cause little tissue damage if used correctly.

They should be used after cleaning and rinsing the wound. Povidone-iodine is the preferred antiseptic, and can be diluted (to a light pink color) with water and used to flush a wound. Hydrogen peroxide and alcohol cause more significant tissue damage and may delay healing, they should be avoided. Antiseptic ointments should be avoid for deep injuries (more than superficial damage).

These are first aid treatments and do not substitute for proper medical care, particularly if the wound is deep, particularly ragged, contaminated, or any of the symptoms TSandM mentioned develop. As soon as possible consult a doctor for any but completely superficial wounds incurred diving.

Whether either of these will be effective depends on several factors, including the actual organisms involved, the depth and condition of the wound, and the general health of the victim. a MD can assess these after the dive. in the water or in tropical locations subsequent infection should be considered very likely.

You hit the nail on the head. This is the advice to follow

Although I must say if I have peroxide on the boat and nothing else I will take my chances with destroying a little extra tissue.

 

[carrielsal]

onceloyal,
Any idea what the two living organisms were?

Carrie

 

[OnceLoyal]

One was actually a shrimp of some sort. I will try and get in touch with him later today and see if I can get the specifics..

 

[cgvmer]

In sept 2006 my leg went through a floor board of the local high school football stands. After being extracted from the hole, the Ambulance squad arrived (they were onsite for the a football game), they cleaned the wound which was a surface scratch. No blood, just a scratch. I put ice on the foot, my ankle was a little swollen, but I didn't think it was broken so I turned down transport to the hospital. The next day I went my doctor, where the foot/ankle was xrayed and the scratch was cleaned. No break, and told to keep the wound covered and use a bacitracin type cream on it. 3 weeks later I go back to the doctor, my foots fine, but my scratch doesn't feel right. The doctore see's it, leaves the room, then comes back in 10 minutes with an appoinment to a local hospital wound care office.
I then spent 6 weeks on daily IV antibiotics, which they had to change a couple times to cover the spectrum of infections that they found in my wound. With the IV was twice weekly debriedments of the wound, culminating in a surgical debriedment then attachment of a vacumn pump. By Feb 2008 I was finally had the wound healed, 5 months for a scratch.

I don't care if your diving or just walking down the street, clean the wound.

 

[AfterDark]

Puncature wound, squezze hard ASAP, keep squezzein hard for awhile, clean and see a MD.

 

[sunapeebob]

I am a hand surgeon, and these infections can be hard to diagnose and treat. Some of the organisms are slow to grow, so treatment has to be prolonged. For example, I assume that not too many of you are diving in a fresh water fish tank, but I have had two patients with infections from cleaning the fish tank at home. The organism is mycobacterium Marinum. Treatment lasts about 3-6 months with 2-3 different oral agents.
TSandM's comments are right on. The actual topical agents are often a choice. I am actually a fan of 1/2 strength peroxide. I use it all the time on wounds - table saws, snowblowers, etc. I find that it is actually less toxic to early healing tissue, cleans out some of the debris and allows the wound to dry and form a stable eschar(scab). Betadine is toxic to tissues. Diluted betadine is a bit better. I am not a fan of ointments of whatever type. I find that when this is applied, the wound stays wet and will not form that stable eschar that allows the normal skin to heal underneath.
The most important thing is early recognition and early treatment. For example, my son and I were dismantling a climbing wall at home. He stabbed his hand with a piece of old plywood. He cleaned it and dressed it. The next day it was a little redder and had some early purulent drainage (pus). He started soaking it with the peroxide, I made sure there was nothing in there and he started some Keflex. It is a broad spectrum antibiotic that does not cover everything, but it does pretty well for common organisms. We will keep an eye on this and make sure that it settles down. Hope this helps

Bob

 

[TSandM]

Really, what the literature supports is that the best way to clean a wound is copious irrigation. "The solution to pollution is dilution" is an old surgical adage. Clean water, squirted onto a wound with enough force to wash off any blood or clot, has been shown to be very effective in reducing infection. And it doesn't have to be sterile saline -- clean tap water is just as good.

Puncture wounds are difficult, because it's essentially impossible to get effective irrigation to their base, so they are considered high risk wounds and we often treat people with prophylactic antibiotics because of that, especially for puncture wounds in the feet that go through tennis shoes (which, as you can imagine from their aroma, grow some VERY interesting bugs).