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Old 06-16-2010, 12:44 AM   #11
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Baja Medical Emergency, Hooked in to Help

Good job. My personal preference is almost always to push any large hook through, though as you found out it is usually best to leave the shank on until the barb is through. If you're an advanced level provider, I would recommend Lidocaine as a part of your kit . . . It's too useful to be without in situations like that.

Something to keep in mind, you're almost always "out of your scope" doing anything in the backcountry. You have to work to your comfort level. I would also not recommend doing anything you aren't proficient with on a stranger. Obviously, you have a more ideal background then most, but for anyone who isn't as comfortable with procedures, frequently your best advice in a non-emergency is to send them to the appropriate destination.

That being said, any training is good, but if you have the opportunity back the training up with some experience by volunteering with an ambulance or something similar.


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Old 06-16-2010, 01:27 AM   #12
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Re: Baja Medical Emergency, Hooked in to Help

Originally Posted by cellularSTEVE
Hey Lance,
1. Can you please elaborate on what the next steps would be and how soon would you recommend getting to a hospital?

2. If the hook wasn't rusty and it was the same type of wound, would the hospital follow up be required (I am just thinking that sometimes I go to remote areas and could see getting hooked. Do you cancel your plans and drive to a hospital)?
Like I told the father, get her to a doctor for a tetanus shot asap, it isn't the same drive like a madman rush if she still had the hok in, but it is something to be done that day.
Here is a little blurb off the web:
Mortality rates reported vary from 40% to 78%. In recent years, approximately 11% of reported tetanus cases have been fatal. The highest mortality rates are in unvaccinated people and people over 60 years of age.[2]

The incubation period of tetanus may be up to several months but is usually about 8 days.[3][4] In general, the further the injury site is from the central nervous system, the longer the incubation period. The shorter the incubation period, the more severe the symptoms.

So get the girl to a doctor for a shot, keep the wound clean, watch for any other S&S of infection (redness, heat, puss, pain moving the hand).

Rust isn't the issue as much as you would think....the bad bugs can live just as well on a shinny new hook.
The issues are:
1) it is a deep pocket wound that is tough to wash/clean
2) pocket wounds can get infected and become abcesses that have to be opened up...ouch
3) bits of the rust can break off inside and even without tetanus can cause infection and problems
4) remote area with limited access to doctors & med supplies meant leaving them as much as I could and still worrying.

Oh and Austin, yeah I am thinking I will start taking xylocaine jelly with me as a topical from now on.

Go out and play in the dirt!
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Old 06-17-2010, 05:33 PM   #13
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Re: Baja Medical Emergency, Hooked in to Help

<Insert John Hughes style slow clap here.>


Nice job Lance! Sometimes you have to do the best with what you have and you were the best thing going for that girl at the time!
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Old 06-18-2010, 07:22 AM   #14
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Re: Baja Medical Emergency, Hooked in to Help

Fantastic response and write-up Lance! Now I have to dig out that big Adventure Medical kit from the Sporty and see if I can remember how to use all the stuff there. Time for a first aid refresher course I think.

At work as a cartographer, I produce evacuation maps to hospitals or clinics from remote job sites that our environmental cleanup crews work in. I have started doing this for our Sportsmobile Expeditions as well, so that we always know where the closest medical help is. You can easily do this for non-commercial purposes using Google Maps, or any of the similar web mappings. I put the printed maps in our trip binder, along with trip info on campgrounds, trails, tourist sites and grocery stores. it really helps having everything in one place.

Of course in Baja, you are a much longer way from most hospitals or clinics. Thanks again for this amazing write-up.
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Old 06-22-2010, 01:18 AM   #15
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Re: Baja Medical Emergency, Hooked in to Help

+1 on lidocaine in a remote medicine kit. A radial nerve block would be ideal in this case or similar cases.
I have used my trauma kit more on friends and family members than I ever envisioned. Another crowd pleaser in the kit is miracles on the right cuts. You can find it on eBay within expiry dates.

Nice work here, fish hooks are designed to stay put and you did a great job dislodging it. There is no easy way around it in the field. Especially on a little girl with her father watching.

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Old 06-22-2010, 04:58 PM   #16
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Re: Baja Medical Emergency, Hooked in to Help

Thanks for the comments guys...
Funny how as an ICU RN and all the big shinny toys I get to play with in a huge urban hospital and yet I am often jealous of the Paramedics I know as their skills play better in remote areas.
I am currently a Wilderness EMT but I want to up my training a bit more through a place called Remote Medical Institute, they have great classes.

Topical Xylocaine and some other numbing agents, and a few other choice meds will be going into my kit before my next outing.
It is always great to hear from other medical folks, keep your stories coming also, it is a great way for everyone to learn.
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Old 06-23-2010, 02:17 PM   #17
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Re: Baja Medical Emergency, Hooked in to Help

I have a hook removing device that is a stainless steel wire loop that hooks to a handle which looks like the pull starter on a lawnmower. I won it in a bass tournament. I wondered how well it would work until one day I had to use it on a fishing partner. We discussed the push through method but decided to try using the hook remover tool. It worked great. I told him I'd yank on 3 but lied to him and pulled just before 2. He never knew what hit him. I still wonder what the correct method is, so when you find out please post the correct method. When I was an EMT I was always told not to disturb undamaged flesh but that was a long time ago when we did pericardial thumps. Im sure things have changed since then but I also understand each situation can vary.
BTW nice Job.

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