With Dr. Joshua Rankin

After Richard Holt’s dog attack incident I’ve been thinking a lot about what I would have done if I were in that situation. Or how would I have responded if someone I was riding with was severely injured. What are the things I need to be thinking about when someone/myself is injured while riding? What are those first steps I should take? I checked in with Dr. Rankin for tips on first aid for cyclists.

OCA: Road rash, abrasions and broken bones come with the territory. How should a cyclist initially address these types of injuries?
Josh: Obviously, this depends on the severity of the injury. I’ll start by saying if someone crashes and there is any loss of consciousness, they really need to be seen immediately (preferably at a facility where a CT of the head can be performed, such as the ER). If you sustain an open fracture (i.e. a bone sticking out of the skin), this requires immediate ER evaluation and probably surgery. A closed fracture, while painful, most likely can be at least initially evaluated at your primary care physician’s office or urgent care clinic. However, if you suspect a larger bone or joint is dislocated due to the injury (especially a shoulder, elbow, foot, or hip), you’re probably better off going to the ER as the relocation of these will probably require some type of IV sedation.

With regard to injuries limited to the skin, the main things to consider are blood loss, preventing infection, and improving the rate of healing. If there is a large, deep wound, it probably would be best to first apply pressure to limit blood loss, and then get somewhere where the wound could be thoroughly cleaned & possibly sutured closed to prevent further blood loss and reduce the chance of infection. Most minor abrasions and road rash can be treated with topical antiseptics and non-adherent dressings. I’d also point out that it’s a good idea to make sure your tetanus immunization is caught up for any wounds other than minor/clean wounds.

OCA: If someone has had a heavy impact should they be concerned about spinal injury?
Josh: Unfortunately a lot of crashes typically sustained in cycling and races can involve significant blunt force. As I mentioned above, any loss of consciousness is concerning not just because of concussion but for the possibility of intracranial hemorrhage (bleeding in/around the brain). This can be fatal in severe cases if not treated quickly. Spinal injuries are also quite possible in cycling.  What I’d be most concerned about is a spinal cord injury that could cause neurologic impairment ranging from limb paralysis (the degree of which depends on at what spinal level the injury occurred) all the way to a high cervical (neck) injury which could prohibit someone from breathing on their own. For these reasons, if someone you’re riding with ever has an injury like this and they are unconscious, it’s best not to move them excessively in order to reduce the possibility of worsening their injury. Obviously, however, if someone is unresponsive and not breathing, CPR should be started immediately as EMS is being called, but spinal precautions (which involve moving the patient in a specific manner to minimize further spinal cord injury) should be instituted. Other injuries to the spine which do not involve the spinal cord can also occur which include fractures of the vertebral bodies or their projections. These can be quite painful, and sometimes may require surgical or procedural interventions to heal properly. But I’d say most of these type fractures heal on their own, although the patient may be placed in a back brace to limit movement while the healing occurs.

OCA: What about something more severe like what Richard experienced. What should a person be thinking about immediately?
Josh:  In Richard’s case, (speaking specifically in reference to his bite wounds) with those deep puncture wounds in a highly vascular area, the first thing to assess is the degree of blood loss. I’m not sure if he had any large artery tears or not, but the pictures showed just how much blood can be lost even without a major artery tear. It looked like there was blood everywhere, and the deep tissues of his leg were clearly visible. Those deep tissues (like muscle) can still bleed profoundly even though they don’t have the full weight of your blood pressure like a major artery does that could cause even more rapid blood loss.  In his scenario, I think he & JV did the best they could with what they had to limit as much blood loss as possible. What you’re trying to limit in this situation is loss of blood to the point that there’s just not enough blood to pump to your brain and other vital organs (what we call hypovolemic shock). In most cases when there’s not an obvious major arterial bleed, the first thing to do is apply pressure to stop the bleeding. An arm warmer or other article of clothing could be used for that. Obviously, EMS and ER care should be called immediately to clean and perhaps close the wounds (although sometimes dog bites aren’t closed). But if there is a major arterial bleed like with visible pulsations of blood from the wound (sorry if too graphic), more advanced measures may be needed to control the blood loss until EMS arrives. This is the scenario where application of a tourniquet would have to be considered, especially if the patient is already feeling faint/dizzy. Things like an arm warmer, belt, or even an inner tube from your pack could be used for this purpose until help arrives.

To see the previous post on Steering Clear of Hypothermia with Dr. Rankin click here.

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Dr. Joshua Rankin
FirstCare Family Doctors – Tontitown, a MANA Clinic
171 N. Maestri Rd.
Springdale, AR 72762
479-361-1020