Author Topic: Road Rash?  (Read 7457 times)

hoodedfalcon

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Road Rash?
« on: September 23, 2013, 11:40:28 AM »
I took a tumble on my bike over the weekend and ended up with a pretty nasty case of road rash, mostly on my palms and forearm. I made it home, thanks to a nice passerby with a pickup truck. I think I was pretty lucky - no broken bones and no broken bike. I will never again go out for a ride, no matter how leisurely, without gloves. Please, all you cyclists! Learn from my mistake and go get some gloves! Having the skin violently scraped from your palms is not very fun, especially when it could have been avoided.

So, here I am two days later and I've spent too much time on the internet trying to figure out the best way to treat this road rash. With all the cyclists on this board, I thought I would ask what sort of road rash treatment has worked best for you in the past? The squeamish may want to skip the rest of this...My basic technique was to rinse well with water, squirt it clean with hydrogen peroxide (there are mixed feelings on the internet about the use of HP, but it was the best I had at my disposal). I cut off the larger flaps of skin, but I could have probably removed more flappy skin. Any thoughts on going back two days later and removing the skin? Some folks seem to think it's best to remove all the skin you can so the new skin can grown in more uniformly I guess? I've been keeping it covered with antibiotic cream and non-stick absorbent pads, and I am trying not to let a scab form for now. It doesn't look infected but it also sorta looks like a zombie has been chewing on my hands, if that makes sense...

Thoughts? What has worked for those of you unfortunate enough to experience road rash?

matchewed

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Re: Road Rash?
« Reply #1 on: September 23, 2013, 12:05:47 PM »
As corny as they can be the wikihow on treating road rash is quite accurate. I'd remove any dead skin from the area, if you've got the large pieces you should be fine.

Matt K

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Re: Road Rash?
« Reply #2 on: September 23, 2013, 12:11:57 PM »
Talk to a medical professional. Forums like this are a very poor way to get good medical advice. If you can find an ER nurse they'll be able to tell you everything you could want to know.

However since you've asked here, I'll try to offer something useful.

Look at how ERs treat motorcycle road rash; First they scrub every last bit of grit out of the wound (and this hurts like hell - they are far more concerned with diggin that shit out than they are with not causing further damage). Then wash it out. Then apply ointments of some variety (I believe antiseptic, but I don't know what other functions the ointments may provide). Then wrap it in sterile bandages. Wash the wound and replace the bandages & ointment as needed - which is daily for a motorcycle accident - until a fresh lays of skin is formed, at which point bandage replacement slows down but doesn't stop.

It helps to understand that in the motorcycle community there is only one injury called Road Rash. In the bicycling community there are two.

In the motorcycling community road rash is not a typical scratch, it is a friction burn. That is why it is treated so seriously, the risk of serious infection is very high (just as it is in any bad burn). The injuries extend well below the visible scrapped up tissue.

In the bicycling community, we often have guys who crash at 10mph, scratch themselves up, and then call it road rash. It is a different scale of injury from what happens at higher speeds (which btw, bicycles definitely get into - if you go down at 35mph on a bicycle, you should probably visit a hospital). It hurts, it sucks, but it is essentially a bigger version of the scraped knee you had when you were five, and risk of serious infection is much much lower. If you keep it clean it out well, and change your dressing every day or two, you'll be fine.

I find the idea of cutting off skin unsual. Again I'm not a medical professional, I don't know that it is wrong, just not something I've seen done on any of my injuries. Normally skin is left on (especially in the case of blisters and burns), as it provides another layer of protection for the damaged tissue.

Abe

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Re: Road Rash?
« Reply #3 on: September 23, 2013, 12:15:02 PM »
Hi, here is information on burn/minor skin trauma treatment. This should not be construed as professional medical opinion, as mentioned above that is not possible on a forum. If you are concerned at all about your injuries, see a doctor as hand injuries can become infected and quite serious.

1. remove the dead/devascularized skin (looks like you've done that). This reduces the risk of infection of the underlying skin. We do not normally leave skin on the burns, unless it is a superficial burn with no skin tears on the blister. It was thought before that this helped with wound healing, but studies have shown it increases risk of infection if the skin has already been traumatized, as in your case.
2. Don't use hydrogen peroxide anymore. Just wash with regular soap and water to remove dirt.  Hydrogen peroxide is quite toxic to replicating skin cells and will delay healing.
3. Cover the wound with neomycin ointment or any generic triple-antibiotic ointment. It is effective for small burns/abrasions of the hands and face.
4. Wrap the hands with dry gauze. Scabs will form and that is fine. Avoid trauma from removing them as this will also delay wound healing.

Things to watch for: increasing pain over time, greenish tinge or pus-like material building up. These are signs of infection, and hand infections can quickly become very serious if not treated aggressively. I would advise going to a doctor if this occurs, or the wound is not healing within a few days. I hope you get better soon!
« Last Edit: September 23, 2013, 12:20:55 PM by Abe »

Russ

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Re: Road Rash?
« Reply #4 on: September 23, 2013, 12:19:35 PM »
you've got the most important parts already: keep it clean, covered, and ointment-ed. Scabs won't kill ya but they're a pain in the ass, so I've always tried to avoid them by keeping everything good and wet. I've never cut off flappy skin, but I've never had any that flappy to speak of so I might not be the best person to talk about that. I guess go with the real doctor's opinion on that one.

For next time, the only thing I didn't see was scrub scrub scrub (seems like everyone is mentioning this, which is good). You really want to get out every bit of dirt, gravel, and asphalt you can before it heals up at all. It will hurt, but that's part of the fun. Two days might be too late though, and it seems like you've done well enough anyway.

hoodedfalcon

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Re: Road Rash?
« Reply #5 on: September 23, 2013, 12:38:27 PM »
Thanks for the replies everyone!

I do think I could have scrubbed a little more. I get pretty lightheaded when I see my own blood, so I probably called it quits a little early on the scrubbing part. Hopefully I did good enough. I will keep it clean from here on out and watch out for infection. No more hydrogen peroxide.

Luckily I wasn't going full speed at the time of the crash and I didn't hit my head. I am also lucky that I didn't get hit by a car. I did look up and saw some morons driving by who apparently thought watching someone crash on their bike was the funniest thing ever.

This is the sort of information that is good to have before you need it, ya know?

matchewed

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Re: Road Rash?
« Reply #6 on: September 23, 2013, 01:15:17 PM »
This is the sort of information that is good to have before you need it, ya know?

I have a few medical professionals in the family so I've had advantages that others haven't, also I was a first responder at work and got free training. However brushing up on first aid is always a good thing, I prefer the free study method but others may not have that drive. And certification courses at Red Cross don't really cost much. The great thing about the classroom is that you can get as specific with questions related to the risks you encounter.

Mr.Macinstache

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Re: Road Rash?
« Reply #7 on: September 23, 2013, 01:32:21 PM »
I like using HP to clean wounds. It also reduces inflammation. After it dries, use plenty of triple antibiotic ointment...but eave the bandages off once in awhile to let it breath as well.

mandydean

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Re: Road Rash?
« Reply #8 on: September 23, 2013, 01:36:17 PM »
My husband really liked the Tegaderm bandages the first time he got road rash - they're uniquely breathable, see-through (so you're not tempted to remove the bandage just to check on it), and water-safe so you can shower in them. They're kind of pricy though, so I'm not sure how Mustachian they are. This last time he just used regular non-stick pads and lots of antibiotic cream (after cleaning of course). I agree that it should be kept moist and covered until you see a good bit of healing. If it scabs over too quickly, you run the risk of it all pulling away and having a fresh wound again.

hoodedfalcon

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Re: Road Rash?
« Reply #9 on: September 23, 2013, 01:42:08 PM »
This is the sort of information that is good to have before you need it, ya know?

I have a few medical professionals in the family so I've had advantages that others haven't, also I was a first responder at work and got free training. However brushing up on first aid is always a good thing, I prefer the free study method but others may not have that drive. And certification courses at Red Cross don't really cost much. The great thing about the classroom is that you can get as specific with questions related to the risks you encounter.

I always thought I'd be pretty cool to be an EMT or something. Even though I get grossed out by my own blood, I am completely fine with other people's blood. And I'm really calm in a crisis as long as it isn't my crisis. But when I am the injured person, I get stupid.

matchewed

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Re: Road Rash?
« Reply #10 on: September 23, 2013, 01:52:04 PM »
This is the sort of information that is good to have before you need it, ya know?

I have a few medical professionals in the family so I've had advantages that others haven't, also I was a first responder at work and got free training. However brushing up on first aid is always a good thing, I prefer the free study method but others may not have that drive. And certification courses at Red Cross don't really cost much. The great thing about the classroom is that you can get as specific with questions related to the risks you encounter.

I always thought I'd be pretty cool to be an EMT or something. Even though I get grossed out by my own blood, I am completely fine with other people's blood. And I'm really calm in a crisis as long as it isn't my crisis. But when I am the injured person, I get stupid.

I've always wanted the training. I was always worried that even a month of seeing people in pain and worse would probably not be great to my head. But I can agree with keeping a cool head when things go bad. I'm lucky enough that I don't get too rattled if it's myself (unless I've hit my head) but bike injuries and other things haven't really shook me too hard (except for that piece of my thumb that got lopped off, that pain was excruciating).

imustachemystash

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Re: Road Rash?
« Reply #11 on: September 23, 2013, 07:48:11 PM »
Yikes!  I'm sorry that happened.  Thanks for the heads up on wearing gloves.  I hope you can recover on your own, but if it gets worse make sure you see a doctor.

hoodedfalcon

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Re: Road Rash?
« Reply #12 on: September 23, 2013, 08:05:54 PM »
So, I started to worry that my lack of scrubbing was going to cause me problems sooner or later. So just a little while ago I decided to do what I could to clean out the wound even more. I soaked my hand for a good ten minutes or so to loosen up the skin, and then got some tweezers and fingernail scissors and got busy, and I am glad I did. I will spare everyone the details, but I did find some dirt that needed to go away, and now that I am slathered with antibiotic cream and some nice fresh non-stick bandages, my hand actually feels much much better. And my brain feels better knowing I've done everything I could to give it the best shot (short of going to the doctor). I'm really not an anti-doctor kind of person at all, but I generally try to DIY the consequences of my failures when prudent. I think I am an okay judge of where prudent ends and folly begins.

But seriously. Gloves, y'all.

Russ

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Re: Road Rash?
« Reply #13 on: September 23, 2013, 08:57:07 PM »
Oh man that's hardcore, good job. IANA doctor, but I doubt they would've done much different. Glad your hand feels better now.

FuckRx

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Re: Road Rash?
« Reply #14 on: September 23, 2013, 10:52:52 PM »
Hi, here is information on burn/minor skin trauma treatment. This should not be construed as professional medical opinion, as mentioned above that is not possible on a forum. If you are concerned at all about your injuries, see a doctor as hand injuries can become infected and quite serious.

1. remove the dead/devascularized skin (looks like you've done that). This reduces the risk of infection of the underlying skin. We do not normally leave skin on the burns, unless it is a superficial burn with no skin tears on the blister. It was thought before that this helped with wound healing, but studies have shown it increases risk of infection if the skin has already been traumatized, as in your case.
2. Don't use hydrogen peroxide anymore. Just wash with regular soap and water to remove dirt.  Hydrogen peroxide is quite toxic to replicating skin cells and will delay healing.
3. Cover the wound with neomycin ointment or any generic triple-antibiotic ointment. It is effective for small burns/abrasions of the hands and face.
4. Wrap the hands with dry gauze. Scabs will form and that is fine. Avoid trauma from removing them as this will also delay wound healing.

Things to watch for: increasing pain over time, greenish tinge or pus-like material building up. These are signs of infection, and hand infections can quickly become very serious if not treated aggressively. I would advise going to a doctor if this occurs, or the wound is not healing within a few days. I hope you get better soon!

i think i'm gonna cut and paste this and hand it to my patients from now on for future road rash injuries! :)

Abe

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Re: Road Rash?
« Reply #15 on: September 25, 2013, 08:06:01 PM »
No problem!  We give handouts to patients to similar effect, but I can't find the copy on my hospital computer. I wanted to include a picture of an infected burn for the patient's reference, but others argued it would violate HIPAA (which isn't true, but some things you can't win). We basically just have them call if they have any concerns, those with camera phones text us pictures.

Diamondpick

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Re: Road Rash?
« Reply #16 on: September 25, 2013, 09:14:32 PM »
I agree with mashori:
Hi, here is information on burn/minor skin trauma treatment. This should not be construed as professional medical opinion, as mentioned above that is not possible on a forum. If you are concerned at all about your injuries, see a doctor as hand injuries can become infected and quite serious.

1. remove the dead/devascularized skin (looks like you've done that). This reduces the risk of infection of the underlying skin. We do not normally leave skin on the burns, unless it is a superficial burn with no skin tears on the blister. It was thought before that this helped with wound healing, but studies have shown it increases risk of infection if the skin has already been traumatized, as in your case.
2. Don't use hydrogen peroxide anymore. Just wash with regular soap and water to remove dirt.  Hydrogen peroxide is quite toxic to replicating skin cells and will delay healing.
3. Cover the wound with neomycin ointment or any generic triple-antibiotic ointment. It is effective for small burns/abrasions of the hands and face.
4. Wrap the hands with dry gauze. Scabs will form and that is fine. Avoid trauma from removing them as this will also delay wound healing.

Things to watch for: increasing pain over time, greenish tinge or pus-like material building up. These are signs of infection, and hand infections can quickly become very serious if not treated aggressively. I would advise going to a doctor if this occurs, or the wound is not healing within a few days. I hope you get better soon!

Additions: if you use hydrogen peroxide...mix it 1/2 with water. I don't like neomycin unless you get it off each day and apply a fresh application. Silvadene works well on road rash too but again you have to keep it clean once or twice a day.

Good luck

hoodedfalcon

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Re: Road Rash?
« Reply #17 on: September 25, 2013, 09:26:35 PM »
I wanted to give everyone an update since you were all so helpful!

After going back and cleaning it some more the other day, it has felt like a million bucks. Or, as much like a million bucks that raw skin can feel like. I have kept it covered 23 hours a day. I wash it morning and night with soap and water, apply new antibiotic cream and re-wrap it. I am pretty certain there is no infection. The skin is bright pink as you might imagine (but not red and not hot), and it looks like it's starting to heal or at least think about it. There is no scab forming on the parts that were more severely injured, probably because I am keeping it covered. My elbow/forearm has scabbed up but that wasn't the worst hit.

I am really grateful for the SCRUB comments. I think if I had left it the way it was, I would be in way worse shape. Thank you everyone! I am probably a few weeks away from being able to ride again, but I will get there.