Barnacles

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plank

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I am at home, in Ft. Lauderdale, and I just got a call from my friend who got a pretty mean cut from a barnacle while docking his boat. Although in my previous life as a Floridian this was commonplace among my friends and myself, I have to say I have never seen this as a med student in the Northeast. Does anyone know specifics about this type of wound (i.e., organisms, infection rates, close vs. not to close, etc.)?

Thanks for any help.

P.S. I advised him to see a doctor since he has "no freakin' idea" when he last had a tetanus shot.
 
By the way, "saltwater necrotizing fasciitis" that I was referring to above is caused by a different organism than regular nec fasc. Saltwater nec fasc is caused by Vibrio species, whereas most nec fasc is caused by Strep, Haemophilus, and Staph (usually co-infections).
 
plank said:
I am at home, in Ft. Lauderdale, and I just got a call from my friend who got a pretty mean cut from a barnacle while docking his boat. Although in my previous life as a Floridian this was commonplace among my friends and myself, I have to say I have never seen this as a med student in the Northeast. Does anyone know specifics about this type of wound (i.e., organisms, infection rates, close vs. not to close, etc.)?

Thanks for any help.

P.S. I advised him to see a doctor since he has "no freakin' idea" when he last had a tetanus shot.
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what southern doc said. Also DO NOT CLOSE and get any debris out. These wounds get infected very fast.
 
BKN said:
what southern doc said. Also DO NOT CLOSE and get any debris out. These wounds get infected very fast.
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One of the internal medicine residents where I went to medical school cut his leg on his boat while returning from a dive. It was a saltwater wound. He ended up with saltwater nec fasc and almost lost his leg. He was cut at 3 pm, noticed it starting to get red at 8 pm (but did nothing about it - dumbarse), and was awakened at 3 am by excruciating pain. 12 hours was all it took for him to present with nec fasc!
 
These cuts do happen in the NE, as it happened to me in NY when I fell onto a barnacle-covered pole that was supporting a dock. They're very sharp! My mom drenched me in hydrogen peroxide and it foamed up like I've never seen before. I fortunately had no problems following that episode.
 
You also have to watch for mycobaterium marinum. It's like the TB of the sea. On my derm rotation we actually saw a guy with it from cleaning out his fish tank and scrapping his elbow. It looks like a brown or purple nodule that doesn't go away with regular antibiotics. It apparently is really often misdiagnosed based on the skin presentation until someone finds out that the patient has a fishtank or scraped themself on barnacles. Left untreated it can get pretty nasty. hope this helps.
 
Hydrogen peroxide, the favorite medicine of moms!! 👍
 
Paws said:
Hydrogen peroxide, the favorite medicine of moms!! 👍
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Excuse my ignorance but I thought hydrogen peroxide wasn't as favoured anymore because of its cytotoxicity to granulation tissue and healthy cells that are healing?
 
driedcaribou said:
Excuse my ignorance but I thought hydrogen peroxide wasn't as favoured anymore because of its cytotoxicity to granulation tissue and healthy cells that are healing?
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An Optho resident was showing me how he uses it on minor surgeries to stop bleeding. We had a BB pellet in the orbit, and he happened to be there, so I let him take it out. From what I could see the peroxide did a good job at stopping the bleeding. If you can use it around the eye, I'd say it's safe for most other body parts.
 
GeneralVeers said:
. If you can use it around the eye, I'd say it's safe for most other body parts.
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Cool- thanks for the reply.

I don't doubt that it is safe- it's just that I heard it wasn't 'best practice' anymore.

I had some time to look up MD Consult and they still recommended hydrogen peroxide for this 'fish hook' injury scenario they had.

I have read articles against using hydrogen peroxide and heard it from some clinicians but I have yet to see a journal article about it...

I have also seen company handbooks telling you to use their product over hydrogen peroxide but I think we all know how biased that is......


edit:

I found this article :
http://www.findarticles.com/p/articles/mi_qa3977/is_200403/ai_n9366189


Which is against using it..
' * hydrogen peroxide had little effect on wound healing or bacterial control, but its effervescent effect may be useful in cleansing or debriding wounds. Hydrogen peroxide is usually diluted to one-half strength, then rinsed off with saline.'

But the opinion is funded by a company that makes a commercial antiseptic solution..

and this article:

http://www.worldwidewounds.com/2004/february/Cooper/Topical-Antimicrobial-Agents.html

Which is more neutral about using it.
 
Thanks for all your replies. I thought you would like some follow-up.

After speaking with me that day, my friend called his mother to say he was going to the emergency room. As any good mother does, she told him to wait and instead called her plastic surgeon (aka "South Florida PMD"). The surgeon told my friend to meet him in his office, where he cleaned out the cut, put a couple of stitches in, and gave him some Cipro. As it turns out, my friend had a tetanus booster pretty recently. After speaking with him on the phone today, he says that he is doing well and that everything seems to be healing nicely.

I asked him not to dive off the side of boats into seawalls to save cameras anymore, but I'm not holding my breath.
 
Why do you think the peroxide stopped the bleeding? Because it causes localized tissue destruction.

I don't think that peroxide is the Wound Care Devil, and it can be quite helpful in removing a large amount of caked on clot which is obscuring your exploration of a wound. However, things which may potentially cause further tissue destruction (including excessive exposure to full strength povidone iodine [betadine]) are not good for wounds, as devitalized tissue predisposes to infection.

GeneralVeers said:
From what I could see the peroxide did a good job at stopping the bleeding.
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plank said:
Thanks for all your replies. I thought you would like some follow-up.

After speaking with me that day, my friend called his mother to say he was going to the emergency room. As any good mother does, she told him to wait and instead called her plastic surgeon (aka "South Florida PMD"). The surgeon told my friend to meet him in his office, where he cleaned out the cut, put a couple of stitches in, and gave him some Cipro. As it turns out, my friend had a tetanus booster pretty recently. After speaking with him on the phone today, he says that he is doing well and that everything seems to be healing nicely.

I asked him not to dive off the side of boats into seawalls to save cameras anymore, but I'm not holding my breath.
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Unless this wound was gaping wide open, suturing it would have been the last thing on my mind.
 
southerndoc said:
Unless this wound was gaping wide open, suturing it would have been the last thing on my mind.
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$$$ Probably big bucks for the plastics guy to do a cutaneous repair! Kinda like an orthopod buddy taping a couple of fingers and billing $800 for 'fracture care'. 😱
 
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