Medicine of Cycling: Road Rash
*originally published on LifeBalance
By Paul Engler, RN, BSN
Cycling has many health benefits. However, there is always a risk of injury or medical issues. As a cyclist, a nurse and event volunteer, I find myself helping injured cyclists, doing medical assessments and giving treatment. I wanted a new resource to educate myself on injuries, prevention, improving care and educating the public. My solution was to attend the yearly conference in Colorado Springs presented by Medicine of Cycling™. It turned out to be wonderful resource for medical professionals who are involved in the sport. The Medicine of Cycling™ mission is prevention of crashes with injuries and rehabilitation with performance to help cyclists across the country get better care and help them achieve their goals.
This organization is affiliated with USA Cycling and is made up of a panel of sports doctors from around the country and teaching universities. Professional team doctors from Cannondale Garmin and Team Type 1 sit on the panel and were present and ran lab simulation. They were excellent teachers and presenters. If you’re a bicycle racer, USA Cycling would be familiar as the organizing and sanctioning body for bicycle racing in the United States. MOC looks at evidence-based research and methods to treat or prevent cycling related medical problems. This year’s focus covered a number of areas with experts across the nations. If you are wanting to know more, see the MOC website https://www.medicineofcycling.com/.
This is the first of a few articles on what I learned at MOC and I hope you find interesting and useful. I shall keep them brief and to the point and start with the least serious to the most serious injuries to follow in the coming months. Most crashes will have abrasions or lacerations. Studies at the this conference showed around 60-70% of all injuries from the skinned knee of a child to the full body road rash of the back, shoulder, hip and knee of the crit racer. “Road rash” is the common term and the most common injury, and is very painful.
Event planners such as race directors or large ride leaders can stock up their first aid kits. Clubs and race teams should keep a well-stocked first aid kit in their trailers. It’s a nice service to add to a rider’s membership. Also make sure they are covered under the club’s or USAC insurance policy and get the paperwork filled out. It’s best to buy supplies on online as the selection is greater and the cost is affordable. A formal medical plan should be part of your event to respond and treat injured cyclists.
Road Rash Treatment
This is assuming bumps and bruises with minor swelling, no fractures, lacerations or head injuries which have been well ruled out. If you have more serious injuries, road rash issues are the least of your worries. If any doubts have them driven to urgent care or activate EMS.
1. Dirty wound with possible contamination? Gravel, glass, cow poop (this happened in the Dirty Kanza gravel ride this year leading to secondary infection) or wet, slippery, muddy conditions increase the risk for infections. Elbows and knees are more at risk as the organism will get inside the bursa of the joint where it can grow and is not easily washed out. Go to step 2 for a dirty wound. If NOT, skip 2. and go to step 3. Hydrogen Peroxide is very good at killing germs but it kills live tissue as well so you need to use good judgment.
For a cow poop wound while on gravel or trail, scrub the wound bed really well. Mountain Bikers get into dirt and rocks. Goose poop may be found on lake trails. With wet, slippery, or muddy pavement, a cyclist will lose traction and fall down.
2. A. Irrigate with normal saline or store bought bottled water. Normal saline reduces some of the sting while washing out a wound.
B. Use sterile scrub brush with hydrogen peroxide and scrub out wound and remove all foreign bodies.
Hate to say it but it’s going to hurt a lot. However, a $1500.00 day hospital bill while they treat you for infection for not cleaning out the wound properly is going to hurt more. If you cannot get all the crud out, go to the ER as they have tools such as VERSAJET hydro-surgery system which enables a surgeon to precisely select, excise and evacuate nonviable tissue, bacteria and contaminants from wounds and soft tissue injuries. Stronger anti-infectives and antibiotics can be prescribed with sedation to reduce the pain of the procedure.
4. Pat the wound dry and use triple antibiotic cream, then a
non-stick bandage such as Tegaderm. This provides a good barrier and healing environment. You can buy BSN Tegaderm on the internet in rolls to place in club or first aid bags.
5. For the second layer, apply a 4×4 gauze over Tegaderm as padding and base for final compression layer.
6. Compression bandages are used to hold the bandage in place. Shoulders, elbows and knees are hard areas to hold the bandage in place. Cover-Roll® Stretch is good product to use on shoulders as well as general areas of the forearm. Coban can be used as well. These products come in rolls to be cut to length and can be kept in first aid bags. Cover-Roll® Stretch runs about $10-$14 dollars a roll. The sock or tube bandages are very nice too. Either place over the CoverRoll or over the gauze as shown below.
Removal is done in the shower. The bandage will fall off easier with minimal sticking to the wound causing less discomfort. Wash the wound out gently and with shower water and then allow drying and re-bandaging starting with step 4 above.
Signs of infection include increased pain with swelling redness or streaking, yellow or white drainage, or not healing. Go to urgent care or doctor for assessment. Crashing in wet conditions increase the risk for secondary infection on knees and elbows. Infection may lead to hospital admission so it’s good to catch early. If you are a race or event director, send extra bandages in a plastic bag with the person to take home till they can get to the drug store or their doctor.
Paul Engler, BSN, RN has been working in medicine for 25 years. A cyclist for more than 30 years, he has enjoyed riding for recreation, racing, and gravel grinding. Paul is a member of the Lawrence Bike Club, Kaw Valley Bike Club, Medicine Of Cycling, and USA Cycling.