The Altons at Doom and Bloom Medical have an article about what to do When a Person Faints. I once fainted while standing in early morning PT formation in the Army, probably from a combination of low blood sugar and low hydration. Well, I vomited and then fainted, so I hit at least one of the warning signs which the Altons mention. I think I also hit “momentary lack of attention.” After questions from a medic and a drink of water, I was able to continue with PT as usual with no further issues. Anyone can faint, but sometimes more rest is better.
We often write about medical strategies when a society collapses, but, sometimes, an individual may collapse as a result of fainting (also called “syncope”). It usually occurs when a drop in blood pressure (“hypotension”) doesn’t allow enough oxygenated blood to reach the brain.
Someone who has fainted must be differentiated from the person who has “seized” from epilepsy. Fainters won’t exhibit jerky movements as in a Grand Mal seizure or stare into space as in a Petit Mal seizure. Also, a person who has had a seizure tends to be difficult to rouse for a period of time. This is called a “post-ictal” state and may last for 30 minutes or so before it resolves on its own. Most people who have only fainted will regain alertness relatively soon after the episode.
(Note: Grand Mal and Petit Mal are no longer used in the latest nomenclature of seizures. They changed the whole system in 2017, but most people still know them by these names.)
There are a few signs that a person is close to fainting:
Cold, clammy skin
Nausea or vomiting
Complaints of feeling lightheaded or weak
A sensation of spinning
Tunnel vision or blurriness
Momentary lack of attention
(Note: More than once, I’ve had a surgical intern or other assistant faint dead away during a grueling and long surgical procedure.)
Survival scenarios almost guarantee the medic will be confronted with a person who has fainted at one point or another. Simple activities of survival, such as long hikes to retreats, work sessions in hot weather, and hiding out in hot shelters without climate control, can make certain group members prone to syncope. In addition, skipped meals and dehydration will put many of your people at risk.
Low blood sugar and various other medical conditions can cause fainting. Good hydration and appropriate dietary intake will prevent most episodes. Glucose or honey packets, for example, can help raise a person’s blood sugar that has gone dangerously low. Have some in your kit. Others may pass out due to irregular heart rhythms, extreme stress, or even pregnancy.
If someone feels as if they are about to collapse, they should sit down and put their head down between their knees to increase blood flow to the brain. If you see someone who is fainting from a standing position, hold and gently lower them to the ground on their back. In normal times, of course, you would have someone call emergency medical services as soon as possible.
If help isn’t coming, it’s up to you to quickly evaluate the victim. If the patient fell to the floor, there is always the possibility of a head injury. Evaluate for obvious wounds and rule out concussion.
A person who has had a simple fainting spell will usually be breathing normally and have a steady, regular pulse. Raise their legs about 12 inches off the ground and above the level of their heart and head. This position will help increase blood flow to the brain. Assess the patient for evidence of trauma, bleeding, or signs of a seizure. If bleeding, apply direct pressure to the wound. If no pulse or breathing, begin CPR.
After the first few seconds, you have determined that the victim is breathing, has a pulse, and is not bleeding. Tap on their shoulder (some say to gently shake) and ask in a clear voice “Can you hear me?” or “Are you OK?”. Loosen any constricting clothing and make sure that they are getting lots of fresh air by keeping the area around them clear of crowds. Look for a medical alert bracelet that may give clues as to their health issues. If you are in an area that is hot, fan the patient or carefully carry them to a cooler area. Cool compresses may be helpful.
If you are successful in arousing the patient, ask them if they have any pre-existing medical conditions such as diabetes, heart disease or epilepsy. Stay calm and speak in a reassuring manner. People oftentimes are embarrassed and want to brush off the incident, but be aware they are still at risk for another fall.
Once the victim is awake and alert (Do they know their name? Do they know where they are? What year it is?), you may have the patient sit up slowly if they are not otherwise injured. Don’t let them get up for 15 minutes or so, even if they say that they are fine. If you are not in an austere setting, emergency medical personnel are on the way; wait until they arrive before having the patient stand up. Off the grid, however, you will have to make a judgment as to whether and when the victim is capable of returning to normal activities. A period of observation would be wise.
As dehydration and low blood sugar are possible causes, some oral intake may be helpful during recovery. This is appropriate only if it is clear that they are completely conscious, alert, and able to function. Test their strength by having them raise their knees against the pressure of your hands. If they are weak, they should continue to rest. Close monitoring of the patient will be very important, as some internal injuries may not manifest for hours.
Asthma is a chronic condition that limits your ability to breathe. It affects the tubes that transport air to your lungs, collectively known as the “airways”. Asthma affects 20 million Americans and is the most common cause of chronic illness in children. Off the grid, increased stress and exposure to new substances will only makes things worse. The family medic must know how to recognize and treat symptoms with limited supplies.
When people with asthma are exposed to a substance to which they are allergic (an “allergen”), airways become swollen, constricted, and filled with mucus. As a result, air can’t pass through to reach the part of the lungs that absorbs oxygen (the “alveoli”).
During an episode of asthma, you will develop shortness of breath, tightness in your chest, and start to wheeze and cough. This is referred to as an “asthma attack”. In rare situations, the airways can become so constricted that a person could suffocate from lack of air.
Here are common allergens that trigger an asthmatic attack:
Pet or wild animal dander
Dust or the excrement of dust mites
Mold and mildew
Pollutants in the air
Yes, you can trigger an asthmatic attack with exercise. This doesn’t mean you shouldn’t stay in shape. Exercise strengthens lungs, which helps improve asthma control.
There are many other myths associated with asthma; the below are just some:
Asthma is contagious. (False)
You will grow out of it. (False; it might become dormant for a time but you are always at risk for it re-emerging.)
It’s all in your mind. (False; although may trigger it, it’s very real.)
If you move to a new area, your asthma will go away. (False; it may go away for a while, but eventually you will become sensitized to something else and it will likely return.)
Asthma should only be treated when an episode occurs. (False; asthma is best treated with constant medication to reduce frequency and severity of attacks. Encourage your asthmatic group members to stockpile meds.)
You will become addicted to your asthma meds. (False; inhalers and oral asthma drugs aren’t addictive. It’s safe to use them on a regular basis.)
Here’s are two “true” myths: Asthma is, indeed, hereditary. If both parents have asthma, you have a 70% chance of developing it compared to only 6% if neither parent has it. Also, asthma does have the potential to be fatal, especially if you are over 65 years old.
(Note: In the 1980s, I treated a pregnant patient who had the worse type of asthma attack, called “status asthmaticus.” Once she improved somewhat, she insisted on going home against my advice to care for her other children. She returned that night in an irreversible state of oxygen loss. Both mother and baby perished.)
PHYSICAL SIGNS AND SYMPTOMS OF ASTHMA
Asthmatic symptoms may be different from attack to attack and from individual to individual. Some of the symptoms are also seen in heart conditions and other respiratory illnesses, so it’s important to make the right diagnosis. Symptoms may include:
Shortness of Breath
Wheezing (usually of sudden onset)
Chest tightness (sometimes confused with coronary artery spasms/heart attack)
Rapid pulse rate and respiration rate
Besides these main symptoms, there are others that are signals of a life-threatening episode. If you notice that your patient has become “cyanotic”, they are in trouble. Someone with cyanosis will have a blue/gray color to their lips, fingertips, and face.
You might also notice that it takes longer for an asthmatic to exhale than to inhale. As an asthma attack worsens, wheezing may take on a higher pitch. As the attack worsens, the patient suffers a lack of oxygen that makes them confused and drowsy; they may possibly lose consciousness.
Asthma vs Heart Attack
As an asthma attack may resemble a heart attack, the medic should know how to tell the difference. For Asthma is usually improved by using fast-acting inhalers, a strategy that doesn’t offer relief from a heart attack or other cardiac events. Cardiac patients often have swelling of the lower legs, also called “edema.” This is rarely seen with asthma. Asthmatic also don’t have arm and jaw pain that is often seen with heart attacks. Those with a history of cardiac chest pain improve with the angina drug nitroglycerin.
Although both may be associated with shortness of breath, few will confuse the symptoms of COVID-19 with asthma, but suffice it to say that COVID-19 is associated with fever and loss of taste or smell.
On physical exam, use your stethoscope to listen to the lungs on both sides. Make sure that you listen closely to the bottom, middle, and top lung areas as described in the section on physical exams.
In a mild asthmatic attack, you will hear relatively loud, musical noises when the patient breathes. As the asthma worsens, less air is passing through the airways and the pitch of the wheezes will be higher and perhaps not as loud. If no air is passing through, you will hear nothing, not even when you ask the patient to inhale forcibly. This person may become cyanotic.
Sometimes a person might become so anxious (a “panic attack”) that they become short of breath and may think they are having an asthma attack. To resolve this question, you can measure how open the airways are with a simple diagnostic instrument known as a peak flow meter. A peak flow meter measures the ability of your lungs to expel air, a major problem for an asthmatic. It can help you identify if a patient’s cough is part of an asthma attack or whether they are, instead, having a panic attack or other issue.
To determine what is normal for a member of your group, you should first document a peak flow measurement when they are feeling well. Have your patient purse their lips over the mouthpiece of the peak flow meter and forcefully exhale into it. Now you know their baseline measurement. If they develop shortness of breath, have them blow into it again and compare readings.
In moderate asthma, peak flow will be reduced 20-40%. Greater than 50% is a sign of a severe episode. In a non-asthma related cough or upper respiratory infection, peak flow measurements will be close to normal. The same goes for a panic attack; even though you may feel short of breath, your peak flow measurement is still about normal.
TREATMENT OF ASTHMA
The cornerstones of asthma treatment are the avoidance of “trigger” allergens, as mentioned previously, and the maintenance of open airways. Medications come in one of two forms: drugs that give quick relief from an attack and drugs that control the frequency of asthmatic episodes over time. In panic attacks, however, these medicines are ineffective; treatment for anxiety is discussed elsewhere in this book.
Quick relief asthma drugs include “bronchodilators” that open airways, such as Albuterol (Ventolin, Proventil), levalbuterol (Xopenex HFA), among others. These drugs should open airways in a very short period of time and give significant relief. These drugs are sometimes useful for people going into a situation where they know they will exposed to a trigger, such as before strenuous exercise. Don’t be surprised if you notice a rapid heart rate on these medications; it’s a common side effect.
If you find yourself using quick-relief asthmatic medications more than twice a week, you are a candidate for daily control therapy. These drugs work, when taken daily, to decrease the number of episodes and are usually some form of inhaled steroid. There are long-acting bronchodilators as well, such as ipratropium bromide (Atrovent HFA). Another family of drugs known as Leukotriene modifiers prevents airway swelling before an asthma attack even begins. These are usually in pill form and may make sense for storage purposes. The most popular is Montelukast (Singulair).
Often, medications will be used in combination, and you might find multiple medications in the same inhaler. The U.S. pharmaceutical Advair, for example, contains both a steroid and an airway dilator. Remember that inhalers lose potency over time. Expired inhalers, unlike many drugs in pill or capsule form, have less effect than fresh ones. Physicians are usually sympathetic to requests for extra prescriptions from their asthmatic patients.
NATURAL TREATMENT OF ASTHMA
In mild to moderate cases of asthma, you might consider the use of natural remedies. Some involve breathing exercises:
Pursed-lip breathing: This slows your breathing and helps your lungs work better. Breathe in slowly through your nose for two seconds. Then position you lips as if you were whistling, and breathe out slowly through your mouth for four seconds.
Abdominal breathing: Similar to pursed-lip breathing but focuses on using the diaphragm more effectively. With your hands on your belly, breathe as if you were filling it with air like a balloon. Press down lightly on the belly as you slowly exhale.
There are also a number of substances that have been reported to be helpful:
Ginger: A study published in the American Journal of Respiratory Cell and Molecular Biology indicates that ginger is instrumental in inhibiting chemicals that constrict airways. Animal tests find that extracts of ginger help ease asthmatic symptoms in rodents. Use as a tea or extract twice a day.
Ginger and Garlic Tea: Add three or four minced garlic cloves in some ginger tea while it’s hot. Cool it down and drink twice a day. Some report a benefits from just the garlic.
Other herbal teas are thought to help: Ephedra, Coltsfoot, Codonopsis, Butterbur, Nettle, Chamomile, and Rosemary all have been used in the past to relieve asthmatic attacks.
Caffeine: Black unsweetened coffee and other caffeine-containing drinks may help open airways. Don’t drink more than 12 ounces at a time, as coffee can dehydrate you. Interestingly, coffee is somewhat similar in chemical structure to the asthma drug Theophylline.
Eucalyptus: Essential oil of eucalyptus, used in a steam or direct inhalation, may be helpful to open airways. Rub a few drops of oil between your hands and breathe in deeply. Alternatively, a few drops in some steaming water will be good respiratory therapy.
Honey: Honey was used in the 19th century to treat asthmatic attacks. Breathe deeply from a jar of honey and look for improvement in a few minutes. To decrease the frequency of attacks, stir one teaspoon of honey in a twelve-ounce glass of water and drink it three times daily.
Turmeric: Take one teaspoon of turmeric powder in 6-8 ounces of warm water three times a day.
Mustard Oil Rub: Mix mustard oil with camphor and rub it on your chest and back. There are claims that it gives instant relief in some cases.
Gingko Biloba leaf extract: Thought to decrease hypersensitivity in the lungs; not for people who are taking aspirin or ibuprofen daily, or anticoagulants like warfarin (Coumadin).
Lobelia: Native Americans actually smoked(!) this herb as a treatment for asthma. Instead of smoking, try mixing tincture of lobelia with tincture of cayenne in a 3:1 ratio. Put 1 milliliter (about 20 drops) of this mixture in water at the start of an attack and repeat every thirty minutes or so
Further research is necessary to determine the effectiveness that some of the above remedies have on severe asthma, so take standard medications if your peak flow reading is 60% or less than normal.
Don’t underestimate the effect of diet on the course of asthma. Asthmatics should:
Replace animal proteins with plant proteins.
Increase intake of Omega-3 fatty acids and vitamin D.
Eliminate milk and other dairy products.
Eat organically whenever possible.
Eliminate trans-fats; use extra-virgin olive oil as your main cooking oil.
Always stay well-hydrated; more fluids will make your lung secretions less viscous.
Finally, various relaxation methods, such as taught in Yoga classes, are thought to help promote well-being and control the panic response seen in asthmatic attacks. Acupuncture is thought by some to have some promise as well.
I’m sure you have your own home remedy that might work to help asthmatics. If so, let us know!
As we head into the colder part of the year, I thought I’d talk about the dangers of exposure to cold. On or off the grid, if you don’t take environmental conditions into account, you have made Mother Nature your enemy, and she is a formidable one, indeed.
Hypothermia is a condition in which body core temperature drops below the temperature necessary for normal body function and metabolism. The normal body core temperature is defined as between 97.5-99.5 degrees Fahrenheit (36.0-37.5 degrees Celsius). Symptoms related to cold exposure occur once the core temperature dips below 95 degrees (35 degrees Celsius).
HOW THE BODY LOSES HEAT
Besides simply breathing out warm air, the body loses heat in various ways:
Evaporation: The body perspires (sweats), which releases heat from the core. Heat loss through evaporation increases in dry, windy weather conditions.
Radiation: While the body makes efforts to maintain normal body temperatures, the body loses heat to the environment when the ambient (surrounding) temperature is lower than about 68 degrees F. Much lower temperatures cause heat loss more quickly.
Conduction: The body loses heat when its surface is in direct contact with cold temperatures, as in the case of someone falling from a boat into frigid water. Water, being denser than air, removes heat from the body much faster.
Convection: Heat loss where, for instance, a cooler object is in motion against the body core. The air next to the skin is heated and then removed, which requires the body to use energy to re-heat. Wind Chill is one example of air convection: If the ambient temperature is 32 degrees F but the wind chill factor is at 5 degrees F, you lose heat from your body as if it were actually 5 degrees F.
A surprising amount of heat is lost from the head area, due to its large surface area and tendency to be uncovered. Direct contact with anything cold, especially over a large area of your body, will cause rapid cooling of your body core temperature. When the Titanic sank in 1912, hundreds of people fell into near-freezing water. Within 15 minutes, they were probably beyond medical help.
GENERAL SYMPTOMS OF HYPOTHERMIA
The body, when it is exposed to cold, kicks into action to produce heat once the core cools down below 95 degrees F. The main mechanism to produce heat is shivering. Muscles shiver to produce heat, and this will be the first symptom you’re likely to see. As hypothermia worsens, more symptoms will become apparent if the patient is not warmed.
The diagnosis of hypothermia may be difficult to make with a standard glass thermometer because it doesn’t register below 94 degrees Fahrenheit. Unless you have a thermometer that can measure low ranges, it may be difficult to know for certain that you’re dealing with this problem. You should assume that anyone with altered mental status encountered in cold weather is hypothermic until proven otherwise.
Aside from shivering, the most noticeable symptoms of hypothermia will be related to mental status. The victim may appear confused and uncoordinated. As the condition worsens, speech may become slurred. The patient will appear apathetic, lethargic, and uninterested in helping themselves; they may fall asleep. This occurs due to the effect of cooling temperatures on the brain; the colder the body core gets, the slower the brain works. Brain function is supposed to cease at a body temperature of about 68 degrees Fahrenheit, although there have been exceptional cases where people (usually children) survived even lower temperatures.
Some sources differentiate different levels of hypothermia body temperature:
MILD: (93-97 degrees F; 33.9-36.1 degrees C)
A person with mild hypothermia will usually still be awake and alert, but shivering. Hands and feet will be cold, and they may complain of pain or numbness in the extremities. Loss of dexterity is often noted.
MODERATE: (90-93 degrees F; 32.2-33.9 degrees C)
In moderate hypothermia, you’ll see all of the above, but mental status begins to alter and efforts to produce heat by shivering may decrease or even stop.
SEVERE HYPOTHERMIA: (82-90 degrees F; 27.8-32.2 degrees C)
The severely hypothermic person will stop shivering and mental status changes become clearly apparent. Expect to see confusion, lethargy, and memory loss. The victim’s muscles appear less flexible; they will be uncoordinated and speech will be slurred. An unusual apathy or denial regarding the seriousness of the situation is often noted.
CRITICAL HYPOTHERMIA (less than 82 degrees F (27.8° C))
Once less than 82 degrees F, the victim will likely be unconscious. Respirations will be impaired and the pulse slow and difficult to feel. Skin will be cold and cyanotic (blue) and muscles will be rigid. Pupils may be dilated.
Individual cases may vary somewhat.
Immediate action must be taken to 1) prevent further heat loss and 2) reverse the ill effects of hypothermia. Important measures to take are:
Get the person out of the cold. Transport as soon as possible to a warm, dry location. If you’re unable to move the person out of the cold, shield them as much as possible. Be sure to place a barrier between them and the cold ground.
Exercise to produce heat in mild cases: In alert victims who can move without difficulty, mild exercise can help raise body temperature (as long as they stay dry). Avoid exertion in those with moderate hypothermia or worse, however, and in anyone with altered mental status.
Monitor breathing. A person with severe hypothermia may be unconscious. Verify that the patient is breathing and check for a pulse. If none, still assume the patient is revivable and begin CPR. Elevate the feet as you would for anyone in shock.
Take off wet clothing. If the person is wearing wet clothing, remove them gently. Ignore pleas of “leave me alone!” Cover them with layers of dry blankets, including the head, but leave the face clear (see image above).
Share body heat. There may be circumstances when it’s necessary to warm the person’s body by removing your clothing and making skin-to-skin contact. Then, cover both of your bodies with blankets. Some people may cringe at this notion, but it’s important to remember that you are trying to save a life. Gentle massage or rubbing may be helpful, but vigorous movements may cause unnecessary trauma.
Give warm oral fluids. If the affected person is alert and able to swallow, provide a warm, non-caffeinated beverage to help warm the body. Despite the image of St. Bernards saving alpine mountaineers with casks of brandy around their necks, alcohol is a bad idea. Alcohol may give you a “warm” feeling, but it actually causes your blood vessels to expand; this results in more rapid heat loss from the surface of your body and negates the body’s efforts to stay warm. Alcohol and recreational drugs also cause impaired judgment: Those under the influence might clothe inadequately for cold weather.
Use warm, dry compresses. First-aid “shake and break” warm compresses or warm (not hot) water in a plastic bottle will effectively apply heat to the body core if placed on the neck, chest wall or groin. Don’t use hot water, a heating pad or a heating lamp directly on the person. The extreme heat can damage the skin, cause strain on the heart, or even lead to cardiac arrest.
PREVENTION OF HYPOTHERMIA
An ounce of prevention is worth a pound of cure. To prevent hypothermia, you must anticipate the climate that you will be traveling through, including wind conditions and wet weather. Condition yourself physically to be fit for the challenge. Travel with a partner if at all possible, and have enough food and water available for the entire trip.
It may be useful to remember the simple acronym C.O.L.D. This stands for: Cover, Overexertion, Layering, and Dry.
Cover: Protect your head by wearing a hat. This will prevent body heat from escaping from your head. Instead of using gloves to cover your hands, use mittens. Mittens are more helpful than gloves because they keep your fingers in contact with one another, conserving heat.
Overexertion: Avoid activities that cause you to sweat a lot. Cold weather causes you to lose body heat quickly; wet, sweaty clothing accelerates the process. Rest when necessary; use rest periods to self-assess for cold-related changes. Pay careful attention to the status of your elderly or juvenile group members. Diabetics are also at high risk.
Layering: Loose-fitting, lightweight clothing in layers do the best job of insulating you against the cold. Use tightly woven, water-repellent material for wind protection. Wool or silk inner layers hold body heat better than cotton does. Some synthetic materials, like Gore-Tex, Primaloft, and Thinsulate, work well also. Especially cover the head, neck, hands and feet.
Dry: Keep as dry as you can. Get out of wet clothing as soon as possible. It’s very easy for snow to get into gloves and boots, so pay particular attention to your hands and feet.
If left untreated, hypothermia leads to complete failure of various organ systems and death. People who develop hypothermia due to cold exposure are also vulnerable to other cold-related injuries, such as frostbite and immersion foot. We’ll discuss those and some specific clothing strategies in the near future.
If germs invade the soft tissues below the superficial level of the skin (the “epidermis”), they can rapidly infect the main layers of soft tissue below. These include the deep layer of the skin (the “dermis”), the subcutaneous fat, the muscle layers, and various blood vessels and nerves.
Cellulitis may be easy to deal with in normal times, but it will be an epidemic in the aftermath of a major disaster. This is not because it’s contagious; it isn’t unless you have an open wound yourself or exchange bodily fluids. Expect cases simply because of the sheer number of injuries incurred from performing activities of daily survival in less than sanitary conditions.
Without antibiotics, infections can spread to lymph nodes and the bloodstream, rapidly becoming life-threatening. The end result might affect the entire body, referred to as “sepsis.” Once sepsis develops, inflammation of deep structures like the spinal cord (“meningitis”) or bone marrow (“osteomyelitis”) can further complicate the situation. In the past, sepsis was usually fatal.
The bacteria that can cause cellulitis are on your skin right now. Normal inhabitants of the surface of your skin include Staphylococcus and Group A Streptococcus. They do no harm until the skin is broken and they enter deeper tissues where they don’t belong. In recent years, a resistant bacterium called MRSA (Methicillin-Resistant Staphylococcus Aureus) has arisen which causes cellulitis resistant to the usual antibiotics.
As an aside, Cellulitis has nothing to do with the dimpling on the skin called “cellulite”. The suffix “-itis” simply means “inflammation”, so cellul-itis simply means “inflammation of the cells.”
Heat in the area of the infection compared to non-affected areas
Redness, usually spreading towards torso
Swelling in the area of infection (often appearing shiny and causing a sensation of tightness)
Drainage of pus or cloudy fluid from the area of the infection
Foul odor coming from the area of infection
Hair loss at the site of infection (less common)
Joint stiffness caused by swelling of the tissue over it (less common)
Cellulitis commonly occurs in an extremity, such as a leg. In these cases, it’s helpful to keep the limb elevated. Other strategies include warm or cool compresses or soaks to the affected area, and the use of ibuprofen (Advil) or acetaminophen (Tylenol) to decrease pain, discomfort, and fever.
As most cases of cellulitis are caused by bacteria, they should improve and disappear during a 7-14-day course of therapy with medications in the Penicillin, Erythromycin, or Cephalosporin (Keflex) families. Amoxicillin and ampicillin are particularly popular. MRSA cellulitis can be treated with clindamycin and the sulfa drug combination of sulfamethoxazole/trimethoprim (SMX-TMP). It’s important to complete the full course of therapy.
-Penicillin, amoxicillin, cephalexin, or ampicillin 250-500 mg orally four times a day for 7-14 days (Amoxicillin also comes in 875 mg).
-Clindamycin 150-300 mg orally three times a day for 7-10 days.
-SMX 800 mg-TMX 160 mg orally twice a day for 7-10 days.
Those allergic to penicillins can still take clindamycin or SMX-TMP. It should be noted that not all sources will recommend the same dosage, frequency, and duration of therapy for a particular drug. In resistant infections like MRSA, combination therapy with SMX/TMP and Cephalexin 500 mg orally four times a day for 7-14 days may be necessary.
All the drugs mentioned above are available in veterinary equivalents (at least at present). In a survival situation, however, antibiotics will be precious commodities. You, as medic, should dispense them only when absolutely necessary. The misuse of antibiotics, along with their excessive use in livestock, is part of the reason that we’re seeing an epidemic of antibiotic resistance in this country.
Your tonsils are glands on each side of the back of the throat. Their job is to help trap bacteria and other germs that cause infections. Sometimes, however, they can become infected themselves, a condition known as “tonsillitis“. Most cases of tonsillitis are caused by viruses, but bacteria may also be the culprit. The average age is between 5 and 15 years old.
Once, tonsils were commonly removed (known as “tonsillectomy”) in young children at the first sign of infection. In the 21st century, the procedure is much less common. Recurrent bacterial infections or severe symptoms may still require removal, a simple procedure (see link) in the hands of an experienced provider, but difficult for the family medic. The best option, therefore, in austere settings is identifying and treating as early as possible.
(Note: I had my tonsils removed at age 5. At least they gave me some ice cream afterwards! Joe Alton, MD)
Use of a tongue depressor helps visualize the area. Common signs and symptoms of tonsillitis include:
• Red, swollen tonsils
• White or yellow coating or patches on the tonsils
• Sore throat
• Difficult or painful swallowing
• Enlarged, tender glands (lymph nodes) in the neck
• A scratchy, muffled or throaty voice
• Bad breath
Since tonsillitis is often seen in children too young to give a good history, look for:
Loss of appetite
difficult or painful swallowing
Drooling or difficulty breathing (signs of a severe case)
Treating someone with tonsillitis can include some of the following:
A soft diet
Acetaminophen or ibuprofen is helpful for pain, but aspirin should be avoided in children due to Reye’s Syndrome.
Although viral tonsillitis isn’t improved with antibiotics, Penicillin or amoxicillin works for bacterial infections if taken by mouth for ten days. If Penicillin is not an option due to allergy, azithromycin may be substituted. These drugs are available in veterinary equivalents at fishmoxfishflex.com.
Amoxicillin 500-875 mg orally twice a day or 250-500 mg orally every 8 hours for 10 days
Penicillin V 500 mg orally twice a day for 10 days or 250 mg orally four times a day for 10 days
Azithromycin 500 mg orally once a day for 5 days
Penicillin V 25-50 mg/kg/day divided by four and given every 6 hours for 10 days
Amoxicillin 50 mg/kg/day orally in 2 or 3 divided doses for 10 days
According to published research, reported in the October 2017 issue of the Journal of the American Medical Association (JAMA)), the average response time in the US from the time of a 911 call to arrival of EMS on scene was seven minutes. This increased to more than 14 minutes in rural settings. A person can bleed out from a severed femoral artery in less than five minutes. You do the math.
In an active shooter or terrorist incident, emergency personnel won’t reach victims until the threat has been neutralized. During the Paris attacks on 13 November 2015, it was over 160 minutes from the time the terrorists fired the first shots in the Bataclan theater until the responding emergency personnel were able to reach those inside the venue.
The reality is that you’re going to be your own first responder. Bystanders will always be first on the scene, whether it be terrorism or other criminal act or an accident. In the Boston Marathon bombing on 15 April 2013, bystanders employed improvised tourniquets to save lives. Time consuming and inefficient, but it was all that they had. Don’t plan to improvise if the need arises. Always have a real tourniquet.
Data from the Boston Marathon Bombing found that six of the rubber and improvised type tourniquets had to be subsequently replaced with C-A-T® tourniquets. Additionally, the most common EMS tourniquet on scene consisted of rubber tubing and a Kelly clamp.
Roughly 80% of combat deaths and 50% of civilian trauma deaths are attributable to hemorrhage. It’s the most preventable cause of death in compressible injuries. The proper use of tourniquets saves lives.
Time is of the essence. Hypovolemic shock occurs where there is an acute fluid or blood loss in the body. It’s a life-threatening emergency. Hypovolemic shock is most often secondary to rapid blood loss (hemorrhagic shock). It causes inability of the heart to pump the essential blood needed to the body, resulting in multiple organ failure due to inadequate cellular oxygenation. There are four stages of hypovolemic shock.
Stopping the blood loss before patient goes into Stage II shock, ie., blood volume loss up to 15% (~750 mL), keeps survivability at around 94%. If blood loss continues and the patient is in Stage II (30% or ~1500 ml) or greater, the survivability goes down to 14%, without any blood being administered. These figures are based on a US Army Institute of Surgical Research (USAISR) study conducted in 2006 and 2007.
While I recommend that everyone carry a trauma kit, a tourniquet (and gloves) needs to become part of your everyday carry (EDC) at the at the very minimum. Tourniquets have emerged as the standard of care in the tactical environment due to their ease of use, rapid application, and complete stoppage of blood loss. Current protocol considers the tourniquet an initial lifesaving intervention to control massive hemorrhage from an extremity.
The old dogma of “save a life, lose a limb” has been proven to be false. A tourniquet can safely remain in place for up to two hours. Thousands of combat veterans are walking around today with all their limbs because their lives were saved by tourniquet use.
The use of tourniquets on the battlefield isn’t new. As far back as Alexander the Great’s military campaigns in the fourth century BC, tourniquets were used to staunch the bleeding of wounded soldiers. The term “tourniquet” dates from the 17th century and originated from the French “tourner” meaning “to turn”. .
Tourniquets lost popularity after the US Civil War, having been blamed for complications that resulted in amputation. This misunderstanding has unfortunately persisted, especially as it pertains to tourniquet use in civilian settings.
Although there have been several studies in the past that have looked at tourniquet use in civilian settings, the survival benefit for patients has been unclear. However, new research shows that for civilian patients with peripheral vascular injury, prehospital tourniquet use is associated with dramatically improved odds of survival.
The study, titled “Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury,” was published 29 March 2018 and reported in the May 2018 issue of the Journal of the American College of Surgeons (JACS). This study was a multi-institutional retrospective review of all patients sustaining peripheral vascular injuries admitted to all 11 urban Level I trauma centers in the state of Texas from January 2011 to December 2016.
The study found that “Although still underused, civilian prehospital tourniquet application was independently associated with a 6-fold mortality reduction in patients with peripheral vascular injuries. More aggressive prehospital application of extremity tourniquets in civilian trauma patients with extremity hemorrhage and traumatic amputation is warranted.” Simply put, tourniquets save lives.
Popular commercial tourniquets include the Combat Application Tourniquet® (C-A-T®), SOF® Tourniquet, RevMedx® TX® Series Ratcheting Medical Tourniquet -Tactical™ (RMT-T™), SAM Extremity Tourniquet (SAM-XT™), Tactical Mechanical Tourniquet™ (TMT™), SWAT-T® and Rapid Application Tourniquet System®® (R.A.T.S.®) / Rapid Tourniquet. Each has its pros and cons. All are capable of occluding blood flow when properly applied.
As of this writing, the C-A-T, RMT-T, SAM-XT, SOF Tourniquet (SOFTT-W), TMT and TX Series (TX2 and TX3) are the only US military Committee on Tactical Combat Casualty Care (CoTCCC) recommended non-pneumatic limb tourniquets. It’s important to keep in mind that the CoTCCC, a division of the DoD Joint Trauma System, is looking at tourniquets for use on adults in combat by trained military personnel. not for use by civilians with limited training or for use on children.
The C-A-T, RMT-T, SAM-XT, SOF Tourniquet, TMT and TX Series are windless/ratcheting tourniquets. The SWAT-T (Stretch, Wrap and Tuck Tourniquet®) and R.A.T.S. are elastic wrap tourniquets.
A plus to elastic wrap tourniquets is that they pack down into a significantly smaller size, making them easier to carry. They’re also considerably less expensive than windless/ratcheting tourniquets. On the downside, elastic wrap tourniquets require a wider range of motion to apply. The latter can make self-application more difficult.
The SWAT-T and R.A.T.S. can be be employed for higher axillary and groin applications than windless tourniquets. They may also be employed for pediatric and K-9 applications, where standard windlass tourniquets cannot. A study of commercial tourniquets conducted in Israel, and reported in a paper submitted to the 2018 NAEMSP Scientific Assembly, found that the SWAT-T and R.A.T.S. were the best tourniquets for use on children.
It should be noted that North American Rescue states that the C-A-T has been shown to be effective on limbs as small as five inches in circumference. It should also be noted that the TX Series ratcheting tourniquet is available in a pediatric model designed specifically for children.
The SWAT-T is a versatile medical multi-tool that may be employed not only as a tourniquet, but also as pressure dressing, occlusive device, elastic bandage, sling and swathe, used to secure a splint, and more. If the SWAT-T is employed as a pressure bandage or dressing, it’s important to check for a distal pulse after application. Although not a CoTCCC-recommended tourniquet, the SWAT-T has been the subject of several studies which demonstrated it’s efficacy.
PHLster Flatpack Tourniquet Carrier
No tourniquet does you any good if you don’t have it with you when you need it. I have found the PHLster Flatpack® Tourniquet Carrier from PHLster Holsters to be a great, low-profile way to EDC a windlass tourniquet for easy, one-hand deployment. Designed for versatility, it allows you to carry a folded and staged windlass tourniquet on your belt, in a pocket or with MALICE CLIPS® for MOLLE/PALS mounting..
Having the necessary tools is only part of the equation. Equipment is only as good as your training. Basic emergency medical training should cover the entire spectrum of lifesaving skills. And like shooting, they’re perishable skills.
Emergency medical training should be part of the basic skill sets of every firearms owner. In fact, it should be part of the basic skill sets of everyone. The time to learn isn’t when someone is bleeding out.
Dark Angel Medical also offers an outstanding two-day Direct Action Response Training (D.A.R.T.) course at various locations around the country. All participants receive BCON (Bleeding Control) certification from the American College of Surgeons. It also provides 16 hours of CEU’s, per CECBEMS, to NREMT EMT-Basics/Advanced and Paramedics. I have taken the D.A.R.T. course and highly recommend it. Dark Angel Medical is also a great source for trauma kits and components. I have taken the course and highly recommend it. Idid an article on the D.A.R.T. course recently for Spotter Up.
The online learning platform Deployed Medicine is also valuable resource. It’s used by the Defense Health Agency (DHA) “to trial new innovative learning models aimed at improving readiness and performance of deployed military medical personnel.” Learning assets include the standardized Tactical Combat Casualty Care All Service Members (TCCC ASM) Course curriculum developed by the Joint Trauma System, which is part of the DHA. You don’t have to be a member of the military to take advantage of its resources.
Some Final Thoughts
Preparedness requires the proper mindset, training, and tools. It doesn’t just happen. It’s a way of life and takes some effort. And it’s about preparing for possibilities, not just probabilities.
Carry a proven tourniquet. Not all tourniquets are created equal. I recommend carrying at least two tourniquets. This will leverage your capability. I carry a C-A-T as my primary EDC tourniquet and a SWAT-T as my secondary/backup tourniquet
Buy from a reputable source. If you try to save a few bucks you may wind up with poorly made counterfeit. Counterfeit tourniquets are a growing problem. They can cost lives. The life you save may be your own or that of a loved one.
Practice with the tourniquet in situations that are similar you may encounter. Get a spare/training tourniquet for this purpose. Don’t use the actual tourniquet that you will be counting on in an emergency. Practice both strong and support side applications.
This post is on Amputation. What first aid and also post aid needs to be done.
NOTE: Some of the images at the end of this are graphic. They are of my son’s finger and the wound.
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Normally when I write a blog post its from current events, past experiences both civilian and or military. This time I am using my youngest son as our topic. This past week (Tuesday the 4th of August) he had a pretty normal day at work. He works at a motorcycle accessory shop. Sells gear and he is about the most requested tire man in the city.
People bring him tires to mount that they bought from all over. From the store he works at to mail order The reason he is so requested is he cares for the customer and the motorcycle. Never scratches or damages a rim. He recently did a set of tires that the rims cost 2 grand each. Personally requested by the bike owner. Not bad for a 19 year old young man. Today’s post ties in to one from may on one we did years ago on Emergencies
Where did my finger go?
He and his manager were moving out the old tire machine for the brand new one the store bough. As they were lifting it on the pallet the old one came on, the bead breaker slipped out of position, dropped down and amputated his lift index finger between the 3rd knuckle and the nail bed. (Knuckles are counted from nearest to the hand to the finger tip. Think of drawing and angle from the cuticle backwards from that point at a 45 degree angle to the 1st knuckle. If folks have taken my classes or shooting classes from some of my friends, you have heard me say that a traumatic injury is not a painful as it looks. For a while at least.
According to Ryan it felt like he pinched his finger. Not to bad. He went to keep lifting and he looked down and saw the blood covering the floor and tire machine. His mechanic glove was torn and the end of it was missing. The body has amazing self preservation tools. I’ve know gunshot victims who were shot, walked down a flight of stairs with a suspect in custody, put them in the patrol car and then died.
STOP THE BLEEDING! This cannot be stressed enough STOP THE BLEEDING. Even an injury like my son Ryan has can be dangerous if the bleeding is not stopped. When blood is spilled on the floor it looks 5 times as much as it is.
The blood loss Ryan had was about ¼ a cup 60 cc more or less. It looked like more. MUCH more. 2 fluid ounces is not much in the grand scale of the body. An adult will have approximately 1.2-1.5 gallons (or 10 units) of blood in their body. The average us 1.2 gallons or 5 liters
Now the scary part. The ½ cup of blood he lost was in the first minute! And it was not pure arterial flow. It was a mixed flow. The finger tips do not have large arteries in them The vessels are about 1/32nd of an inch in diameter (.79 mm). DIRECT PRESSURE.
Ryan has been trained extensively in first aid. Well he HIS my and his mom’s son. Growing up in a medical family has advantages. He squeezed below the wound and yelled he needed something to help hold it. His manager and the vendor grabbed shop towels and put pressure on it. Sat him down with his hand higher than his heart and called 911.
If at all possible retrieve the amputated part, wrap in clean cloth or sterile bandage material, place in a baggie, and place that baggie into one containing ice. This gives the surgeons the best chance of re-attachment.
To tourniquet or to not tourniquet.
There is a sorted history on the tourniquet. Lets go back to the 1980’s As an old medic, when we had a wound that needed a tourniquet, we put it on, marked a “T” on the patients forehead with date and time of application. If your patient was going to be with you for a few hours, every hour or so we would loosen the tourniquet for a short time to allow blood to the part below the tourniquet. The reapply it.
This did not work as well as expected. For a tourniquet to work it has to be tight. TIGHT. When it is applied correctly. Tissues will be damaged. When tissue is damaged there is swelling. We call it edema. So when we let off the tourniquet, let some blood down, then re applied it, the bleeding would stop and all was good in the world. Until the patient bled out. What happened was when the tourniquet was re-applied, it compressed the edema, and stopped the flow. But once the edema had been moved, the tourniquet was now loose…(continues)
Throughout history, people have used essential oils for a variety of applications.
In Ancient Egypt, they were used for religious ceremonies. The Greeks and Romans used them aromatically. And ever since, they’ve been integrated into society.
Today many people use essential oils daily, for several different purposes. Let’s take a quick look at what essential oils are, which ones are good for beginners, and how you can use them.
What Are Essential Oils?
Essential oils come from plants. After harvesting, the plant material is distilled down, creating a pure compound. It’s very aromatic and powerful. These oils are then bottled, so you can store them for use. They evaporate quickly, so always make sure your lids are on tight.
Because essential oils are so concentrated, they need to be diluted before using. This means the tiny bottles you purchase end up lasting quite a while. You only use a few drops at a time.
Top 10 Essential Oils for Beginners
Name a plant, and you can probably find essential oil from it. There are so many types available. You can also mix your oils, to create combinations.
It’s best to start small. If you are new to essential oils, don’t feel like you must buy them all at once. Pick a couple you think you can get the most benefit from. Then slowly add to your collection.
Here are the top ten essential oils I recommend for beginners. These are the ones that are in my cupboard, and the ones I frequently use. I list the common name and the scientific name for each of them.
I also share a couple of benefits of each. This is not even close to being an inclusive list, just a quick guide to get you started.
Finally, you’ll find a link to one scientific study for each of the oils I recommend. You can dive into the research on your own and see just how beneficial essential oils can be.
1. Peppermint (Mentha x piperita)
Peppermint is revitalizing! It helps improve exercise performance. This essential oil has been shown to help with nerve pain, stomachaches, and bruising.
2. Sweet Orange (Citrus sinensis)
The sweet smell of orange is calming. Sweet orange essential oil is used to reduce anxiety, reduce inflammation, and provide antiseptic properties.
3. Lemon (Citrus limonum)
Lemon essential oil helps relieve stress. It also supports the digestive system and is thought to improve circulation.
4. Eucalyptus (Eucalyptus globulus)
This oil has a unique, almost woodsy scent. It’s very strong. Eucalyptus has been used as a natural antibiotic throughout history. Many people use it for respiratory problems, and to relieve pain from arthritis.
5. Tea Tree (Melaleuca alternifolia)
You can use tea tree oil to help treat head lice. It’s also thought to fight bacteria and help relieve shock.
6. Lavender (Lavandola angustifolia)
One of the most popular essential oils, lavender has many therapeutic uses. It’s soothing and can help relieve stress. It’s thought to help relieve migraines and stabilize moods. Lavender also has antimicrobial properties.
7. Oregano (Origanum heracleoticum)
Oil of oregano is used to treat wounds. It has anti-inflammatory properties, making it a good choice for skincare products. It also is an immune booster.
8. Clary Sage (Salvia sclarea)
Clary sage is a natural antimicrobial agent. It can help lift the spirits and reduce stress. Many women use it to help with menstrual cramps.
9. Rosemary (Rosmarinus officinalis)
You can use rosemary essential oil to boost your memory. It’s shown beneficial as part of a treatment plan for patients with Alzheimer’s. Additionally, rosemary is thought to relieve pain and improve circulation.
10. Ginger (Zingiber officinale)
Ginger helps relieve inflammation in the body. It helps alleviate nausea and can be used to help digestion.
Where to Buy Essential Oils
There are different qualities of essential oils. You always want to read the ingredients before you purchase, and make sure you are happy with what’s in the bottle you’re purchasing. You don’t want any fillers or artificial oils added to them.
You can find decent essential oils on Amazon. There are several beginner packages that are a good place to start. I do recommend going with organic essential oils.
Alternatively, you can purchase from a direct sales company. There are several of those.
I’m not going to tell you which kind to buy. Find one you like and go with it. You can always change later.
How to Use Essential Oils
Once you have your essential oils, what can you do with them? Let me show you some of my favorite ways to use them.
Perhaps the easiest way to get some benefits from your essential oils is to simply unscrew the cap and breathe deeply. You can add a drop or two to a cotton ball and keep in your pocket. Then whenever you need a mental boost, you can pull it out and inhale.
Add to a Bath
You can add a few drops of essential oil to a warm bath.
Looking for a simple way to experience some benefits of essential oils? Pick up a diffuser and select an oil. Let the diffuser release the scent into the air and take a deep breath…(continues)
Sam Coffman from The Human Path (an herbalism and survival school in Austin and San Antonio, Texas) explains the most fundamental concepts around creating and using your own herbal first aid kit. Sam’s experience as a former Special Forces Medic, while blending that world with herbalism, gave him some unique insights into making and using herbal first aid kits that are highly effective in a variety of situations. He uses the herbal first aid kit that The Human Path sells, as the starting point for talking about the packs, the containers, the herbs, the practicality of what works and what doesn’t, and why you would want to use an herbal first aid kit in the first place.
Bill White at Survivopedia writes about some of the numbers that aren’t being talked about much related to the current coronavirus pandemic – people with permanent damage who didn’t die – Are We Looking At The Wrong Numbers?
As the second wave of COVID-19 continues sweeping the nation, it is becoming even more politically polarized than ever before.
This is sad to me, that we can’t unite over something that is really not a partisan issue but is affecting us all. Our focus, all of us, should be on doing what is best for the people of our county; and that includes both protecting their health and protecting their ability to provide for their needs, financially speaking. The two are not mutually exclusive.
But that’s not what’s happening. Those on the political left are trying to use the pandemic to make Trump and Republican governors look bad, focusing on the rise in cases, as we wade through the second surge. It doesn’t matter that this second surge was part of the plan all along, as the original lockdowns were just about flattening the curve, in their narrative, the surge has to be because of some grave error in judgment on the part of their political enemies.
Then we’ve got the political right, many of whom are focusing on how the left-leaning media is overreacting and overstating the danger of the current situation. Sadly, they aren’t serving us any better, when they’re saying that we shouldn’t have to be wearing masks. Yes, I understand their position that the government is infringing on our liberty, but at the same time, I’ve got to say that there’s enough evidence that masks help save lives, that it makes sense to do so.
The argument that’s being used is that only one percent of the people die of COVID-19. But just what do they mean by “one percent?” If they’re talking 1% of the people who come down with it, the numbers don’t jive. We’ve had 4,170,000 people come down with the disease and 147,342 deaths as of this writing. That works out to 3.53% of total cases ending up in death.
But we need to realize that 3.53% is a low number. Even if nobody else comes down with the disease, some of the 2,042,559 active cases will result in death. We just don’t know how many. If we divide the number of people who have died by the total number of closed cases, we get 6.9%. That’s probably too high. When all is said and done, the death toll will probably end up being somewhere between those two percentages; we just don’t know where.
On the other hand, if they’re talking about one percent of the total population dying from COVID-19, then we’re talking 3.31 million people. Since we have no idea of how many total people are going to come down with the disease, that number is not outside the realm of possibility. I personally don’t think it will get that bad, but I can’t discount the possibility…
o start with, for every person who dies of COVID-19, there are 19 others who require hospitalization. That’s a hard number, which can be substantiated by hospital records. So the 147,342 people who have died become 2.8 million who have been hospitalized. Unfortunately, I can’t find any data to substantiate that; as everyone is reporting hospitalizations on a weekly basis, not a cumulative total; and I can’t just add those up, because we don’t know how long any of those people have been in the hospital.
So let’s use that 2.8 million number for now. Supposedly for every person who dies of COVID-19:
18 people will have to live with permanent heart damage
10 people will have to live with permanent lung damage
3 people will end up having strokes
2 people will have to live with chronic weakness and loss of coordination due to neurological damage
2 people will have to live with a loss of cognitive function due to neurological damage
Granted, I’m sure these numbers are preliminary and they will be modified in the future, as our medical community gains more information. But we’re talking about the potential for all of those 2.8 million people having to live with some sort of permanent or semi-permanent disability. And that number is only going to go up, as we’re nowhere near the end of this pandemic if an end actually even exists.
If we take the viewpoint that one percent of the population is going to die of COVID-19, as some are saying, then we’re looking at a total of:
59,598,000 with permanent heart damage
33,110,000 with permanent lung damage
9,933,000 who have strokes
6,622,000 with permanent weakness and lack of coordination
6,622,000 with permanent loss of cognitive function
Obviously, we can’t afford that as a nation. While I’m sure that there will be a considerable amount of overlap, with people having more than one of those symptoms, that just means that those who do have long-term effects will be in that much worse shape. And before you say it will just be old people, I know people in their 20s who have come down with COVID and are still battling these sorts of long-term symptoms two to three months later.
When I say we can’t afford that, I’m referring to the loss in our labor force. While a large percentage of the people who have serious problems with COVID-19 and die are elderly people with underlying health problems, more and more younger people are having serious problems with the disease. Are those young people going to become disabled and end up needing public assistance their whole lives? (continues)
Chuck Hudson, a friend of Daisy Luther of The Organic Prepper, who works at Roper St. Francis Healthcare, Roper Hospital in South Carolina takes time to write about what it is like to work in a COVID ward there. Because some people still believe that COVID-19 is entirely a hoax without any patients or full hospitals, Daisy had to preface with the article with her statement about Chuck being a personal friend of hers, so that people don’t think it’s some kind of planted fake story.
Editor’s Note: This article was written by a personal friend of mine. This isn’t some stranger who wrote to me to share some story that may or may not be true. This is a man I’ve known for years who has dedicated his entire career to caring for the health of others. In this essay, he shares an average day in the COVID ward of the hospital where he works. ~ Daisy
COVID virus has turned the world upside down. From the economy of the planet to pitting neighbor against neighbor and friend against friend. Never mind the violence destroying our cities. We are all dealing with this virus with totally unbelievable numbers, huge numbers of infected people, and a rising death toll.
Yet, I look out my living room window and see green grass, flowers blooming and some kids down the street playing basketball.
And then, I go to work.
The area where our day patients come in is called 2HVT. All 14 rooms of 2HVT are now negative pressure rooms. (Also called isolation rooms, negative pressure rooms help prevent airborne diseases from escaping the room and infecting others.) All the rooms of the old Cardiac ICU, which is attached to our cath lab by a short hall, are now negative pressure rooms. 4 South on the 4th floor is now a COVID unit. 6 south, an old Ortho ward, and 5 South have been converted as well. All these conversions are in the downtown hospital alone. All patient areas of the 3, newer hospitals in the system have been converted to handle COVID patients.
Watching the news here in my new home state of South Carolina, no matter the station, it is the same thing: doom and gloom. More and more infected people from testing, talking heads pointing the finger of blame, and numbers being sensationalized. After all, “If it bleeds it leads.” It’s gotten so bad that I turn on the news just long enough to catch the weather and traffic for the morning drive from Summerville to Charleston.
But enough of that. Let me tell you what it is really like in the COVID step-down unit. This unit is for people not sick enough to need high flow O2 or intubation, yet too sick to go to a “regular” floor. (Like there is a regular COVID floor!) As with any floor, the “permanent “ nurses and techs get morning reports from their night shift counterparts. After getting the reports we start our rounds with the patients.
Wait…no, we don’t just walk into a COVID room.
It takes about 3-5 minutes to gear up before entering a room.
Step 1 put on a set of gloves.
Step 2 Put on impermeable gown.
Step 3 Put on N95 mask.
Step 4 Put on face shield. ( We 3D print the frames for these. And use pieces of acetate we get from Staples. )
Step 6 Put on 2nd set of gloves.
Step 7 Triple check that everything is sealed and in order.
Now…we can go in the room.
We try to allow only 1 person at a time in the room, unless something demands that 2 people are needed. The nurse or tech who goes in the room does not leave the room until they have completed all tasks. If the nurse or techs needs something this is where I come in. If I am not assigned a patient, I run and get things. We are runners. We run and get whatever is needed.
What about emergencies?
We have Mayday bags stapled to the wall in front of each room. Each of these Mayday bags contains the following:
2 N95’s: small and regular
Face shield (We 3D print face shields in-house)
6 pairs of separately bagged gloves (sm, med, lg)
All of this must be put on prior to entering a room. It is mandatory. Even if the patient is dying.
Very little is talked about…so much to tell.
Even the little things that the patients and the staff endure take a huge toll on us.
A majority of our patients have lost their sense of taste and smell. Some can only sense texture and temperature. This makes it difficult and frustrating for our patients and staff. The food delivered to our COVID patients is left at the “Airlock”. In normal rooms, insulated containers can be used for the food, keeping it hot. However, food in the COVID areas must be served using only paper plates, paper cups, paper serving trays and plastic ware. We have to use a microwave to heat the food just before it goes in the room.
In normal rooms a tech, nurse or CNA brings the food to the patients. In our world, only the assigned nurse or tech brings the food. And it may be a LONG wait due to having to microwave the food just prior to going in. We have to coordinate routine care to keep the number of times a room is entered to a minimum. (I have become an expert at microwaving paper plates of hospital grade food!)
One thing the virus does that many people outside of the medical field don’t know is it interferes with the blood clotting cascade. Believe you me, as a former Medical Lab Tech (MLT) I would LOVE to go over in mind-numbing detail the 12 steps of clotting. The intrinsic and extrinsic pathway that lead to a fibrin strand…”OUCH!” (My wife just tossed a crafts magazine at me. I started describing the steps. In detail.)
So, in addition to damaging the lungs, COVID can cause deep vein thrombosis. It also causes DIC (Disseminated Intravascular Coagulation.) Post mortem exams have revealed up to 30% of early COVID patients had elevated D-Dimer, C-reactive protein and lactate dehydrogenase. All markers for clotting system problems, which has led to death by stroke, even in young people.
Some patients are in denial until the last moment.
Recently, I was helping to discharge a fairly young patient, about the mid to late 40s. As I was getting his history and gathering information on his experience, I asked how he ended up in ICU and then in my area.
He told me he thought he had a summer cold. He thought the whole virus was a hoax and refused to wear a mask. When his wife brought him in he thought it was a bad cold AND an ulcer. He complained of stomach pain, severe diarrhea, and shortness of breath. He was admitted to our COVID floor, still in denial. What he had believed was a stuffed up nose was actually him losing his sense of smell. Then he crashed.
The anesthesiologist did what is called rapid sequence intubation. The patient is given sedative and paralytic drugs. That’s it. Once they are intubated, they are put out.
He told me when they jerked his head back and he saw that the young doctor looking scared though his protective gear he knew then it wasn’t a hoax.
Good news: we ARE saving more than we lose.
Here in Charleston where I work, our average patient stay is 4 days. If they go to the ICU their stay is about double that. In the last 3 weeks we have dropped from 44% to 31% of our inpatients being in for COVID. Our percentage of positive COVID tests is at about 21%. We test EVERY PATIENT that comes in the hospital.
We have a game plan:
Plasma antibodies from COVID survivors
Intervene and intubate
ECMO: Extracorporeal membrane oxygenation (to treat some patients)
We have a long way to go. We still have shortages of protective gear, but we improvise, adapt and overcome. Up to 170 or so of our teammates, young and not so young, have been out with COVID. Some ended up in the ICU. Our hospital is finding ways to use senior management. A large group of nurses that haven’t been bedside in years are filling in as runners, housekeepers, and patient transport.
This is part of a corporate email from this past week. (Patient sensitive information has been removed.)
Roper St. Francis Healthcare has tested and confirmed that 46 more patients since Tuesday have COVID-19, bringing our total to 3,806 since the beginning of the pandemic.
Once each week, we will provide additional information about our testing and which segments of the population are most affected by the virus.
In the past seven days, 19 percent of our 3,014 COVID-19 tests have been positive, which is down from our 22 percent positive rate during the past 14 days. Our overall positive rate since we started COVID-19 testing is 15 percent. We have 949 tests pending.
Of those testing positive in the past seven days,
– 19 percent are under 29 years old
– 15 percent are 30-39 years old
– 12 percent are 40-49 years old
– 17 percent are 50-59 years old
– 16 percent are 60-69 years old
– 20 percent are over 70 years old
Thirty four percent of those patients have been white, 44 percent have been Black, 5 percent have been Latino and 16 percent have been other.
The areas where we’ve seen the largest number of new cases are North Charleston, Charleston and Summerville.
There have been 3,882,167 cases nationally with a total of 141,677 deaths, according to the federal Centers for Disease Control and Prevention. South Carolina has had 73,101 confirmed cases and 1,203 deaths.
Hero’s? Nah…We signed up for this because we wanted to help.
I’m not going to berate, belittle, or bully anyone over their choice when it comes to personal protective equipment. I am going to ask that you be careful. You do not want someone like me or my old Ranger bud Johnny doing CPR on you. You will end up with damaged ribs.
I’m pretty blessed to be working at Roper St. Francis Healthcare, Roper Hospital. We show up to work each day to care for our patients, and we go home to rest up a little before doing it again the next day. Some of us, myself included, don’t care much for the term “hero”. It is MY job to take care of YOU if you end up in OUR hospital. It is YOUR job to stay healthy, be careful, and be smart about this virus.
Summer is here with a vengeance and parts of the Midwest and Southern U.S. are experiencing record high temperatures in major heat waves. Officials predict a high-risk situation for 200 million citizens as places as far north as Buffalo, NY hit 90 degrees Fahrenheit for a week straight, while Pheonix, Arizona will have multiple days in the 110s. The air temperature in Death Valley, California may reach as high as 125 degrees.
Even in places where the air temperature isn’t as high, the “heat index” is surpassing the 90s, 100s, and the 110s. The heat index is a measure of the effects of air temperature combined with high humidity. Above 60% relative humidity, loss of heat by perspiration is impaired and exposure to full sun increases the reported heat index by as much as 10-15 degrees F. All this increases the chances of heat-related illness such as heat stroke and heat exhaustion.
In the next few weeks, we can expect the power grid to be challenged by tens of millions of air conditioning units set on “high”. Major health issues may arise if the electricity goes out and people have to fight the heat with hand fans, like they did in the “good old days”.
Things are even worse in the city. Buildings and roads replace open land and vegetation. Concrete and asphalt surfaces in the sun become much hotter than air temperature, resulting in a “heat island” effect in large populated areas. Rural areas are more moist and cool, leading to less heat-related emergencies.
Another factor may increase the risk of heat-related emergencies. Homes without air conditioning will not only become sweatboxes, but many people cooped up in closed environments are a recipe to increase the number of COVID-19 cases (so much for the summer giving us a break from the pandemic).
HEAT WAVES ARE NATURAL DISASTERS
You might not consider a heat wave to be a natural disaster, but it most certainly is. Heat waves can cause mass casualties, as it did in Europe when tens of thousands died of exposure (not in the Middle Ages, but in 2003). India, Pakistan, and other underdeveloped tropical countries experience thousands of heat-related deaths yearly.
HOW HEAT KILLS
So how exactly does heat kill a person? Your body core regulates its temperature for optimal organ function. When core body temperature rises excessively (known as “hyperthermia”), inflammation occurs, cells die, and toxins leak. Fatalities can occur very quickly without rapid intervention. Even with modern technology, hyperthermia carries a 10% death rate, mostly in the elderly and infirm. Those who are physically fit, however, are not immune.
HEAT EXHAUSTION AND HEAT STROKE
The ill effects due to overheating are called “heat exhaustion” if mild to moderate; if severe, these effects are referred to as “heat stroke”. Heat exhaustion usually does not result in permanent damage, but heat stroke does; indeed, it can permanently disable or even kill its victim. It’s a medical emergency that must be diagnosed and treated promptly.
Simply having muscle cramps or a fainting spell doesn’t necessarily signify an imminent heat-related medical emergency. You will see “heat cramps” often in children that have been running around on a hot day. Getting them out of the sun, massaging the affected muscles, and providing hydration will usually resolve the problem.
Heat exhaustion’s signs and symptoms include:
Nausea and vomiting
Temperature elevation up to 105 degrees F
If no action is taken to cool the victim, they could easily progress to heat stroke. In addition to all the possible signs and symptoms of heat exhaustion, heat stroke will manifest as loss of consciousness, seizures or even bleeding (seen in the urine or vomit). Breathing becomes rapid and shallow. Shock and organ malfunction may ensue, possibly leading to death.
In heat stroke, the skin is likely to be red and hot to the touch, but dry; sweating might be absent. Once the body core hits 105 degrees or more (it varies from person to person), thermoregulation breaks down and the body’s ability to use sweating as a natural temperature regulator fails. In heat stroke, the body core can rise as high as 110 degrees Fahrenheit or more.
(Aside: The highest body temperature ever recorded was 115 degrees: On July 10, 1980, 52-year-old heatstroke victim Willie Jones of Atlanta was admitted to the hospital with a temperature of 115 degrees Fahrenheit. He spent 24 days in the hospital and recovered.)
In some circumstances, the victim’s skin may actually seem cool. Despite feeling “clammy” to the touch, it’s important to realize that it is the body core temperature that’s elevated. You could be misled unless you take readings with a thermometer to reveal the patient’s true status.
When overheated patients are no longer able to cool themselves, it is up to their rescuers to do the job. If hyperthermia is suspected, the victim should immediately:
Be removed from the heat source (for example, out of the sun).
Have their clothing removed.
Be drenched in cool water (with ice, if available)
Have their legs elevated above the level of their heart (the shock position)
Be fanned or otherwise ventilated to help with heat evaporation
Have moist cold compresses placed in the neck, armpit and groin areas
Why the neck, armpit and groin? Major blood vessels pass close to the skin in these areas, and cold packs will more efficiently cool the body core. Recent studies by the military suggest that cold packs to feet and hands are also helpful.
Oral rehydration is useful to replace fluids lost, but only if the patient is awake and alert. If your patient has altered mental status, he or she might “swallow” the fluid into their airways; this is known as “aspiration” and causes damage to the lungs.
Heat stroke is preventable in many cases. The Arizona department of health recommends the following:
Drink at least 2 liters (about a half-gallon) of water per day if you are mostly indoors and 1 to 2 additional liters for every hour of outdoor time. Drink before you feel thirsty, and avoid alcohol and caffeine.
Wear lightweight, light-colored clothing and use a sun hat or an umbrella to deflect the sun’s rays. Use sunscreen if available.
Eat smaller, more frequent meals instead of large ones.
Avoid strenuous activity.
Stay indoors as much as possible.
Take regular breaks if you exert yourself on warm days.
In a heat wave, it’s important to check on the elderly, the very young, and the infirm regularly and often. These people have more difficulty seeking help, and you might just save a life if you’re vigilant. You can bet there’ll be more than one heat wave this summer, so know the warning signs and how to help those with hyperthermia.
In my recent article “Suture Basics For The Off-Grid Medic “, I gave some thoughts on suture materials, especially as they apply to closing skin lacerations. Your skin is your armor, and anything that breaches it can cause a life-threatening infection.
Although the decision to close a wound should never be automatic, simple skin lacerations can often be cleaned and closed successfully by the off-grid medic. Sutures are just one of a number of ways to accomplish this goal and allow acceleration of the healing process. Today, we’ll discuss the qualities of suture needles.
(Note: This article is for educational purposes only. If the medical system in your area is intact, seek it out to treat lacerations or other medical issues!)
Suture needles are made of a corrosion-resistant stainless steel alloy that is sometimes coated with silicone to permit easier tissue penetration.
A suture needle has three sections: the point, the midportion or body, and the swage. The swage is the “end” of the needle and is where the thread is attached. The midportion is usually curved at an arc, and the point is, well, pointy.
Before about 1920, suture needles had “eyes” and string was separate; the surgeon had to thread the eye of the needle. Since then, sutures became a single continuous unit. This process of connecting suture needle and string is called “swaging”.
Swaging dealt with a number of disadvantages associated with using separate needles and thread. In the old method, two lengths of string were formed on either side of the eye. Passage of a double strand of suture through tissue led to more tissue trauma and, perhaps, a higher risk of infection. Also, the suture string was more likely to become unthreaded or frayed.
THE IDEAL SUTURE NEEDLE
Suture needles perform based on a number of qualities, including strength and sharpness. The strength of a needle refers to its resistance to deformation during use, limiting the amount of trauma to tissue. Sharpness measures the ease of penetration into tissue and is dependent on factors involving not only the point, but the shape of the body of the needle.
Just as suture thread has ideal characteristics, the effective suture needle would be:
Made of high-quality stainless steel
The smallest diameter possible
Stable in the grasp of the needle holder
Capable of running suture material through tissue with minimal trauma
Sharp enough to penetrate tissue with minimal resistance
Sterile and corrosion-resistant to prevent introduction of microorganisms or foreign materials into the wound
Rigid enough to go through tissue, but flexible enough to bend before breaking
Not all suture needles meet the above criteria, but will suffice for the basic needs of the medic.
There are a number of different needle types variations at the point, body, and swaged end:
Cutting Needles: The shape of the suture needle on cross-section may vary dependent on the particular need. The point of this shape to have more cutting edges. On cross section, it appears triangular. These needles are effective in penetrating thick, firm tissue, like skin.
There are two common types of cutting needles. “conventional” and “reverse”. Conventional cutting needles have the third edge of the “triangle” on the inner surface of the needle. Reverse cutting needles have the third edge of the triangle on the outer surface of the needle’s arc. The reverse edge is even stronger and able to penetrate tendons and other tough tissues, while decreasing the amount of trauma during the procedure.
Tapered Needles: These needles are round on cross-section and can pass through tissue by stretching more than cutting. A sharp tip at the point becomes round, oval, or square shape as you approach the swage. The taper-point needle minimizes trauma in delicate and easily-penetrated tissues such as organs or intestinal lining.
Blunt Needles: These don’t come to a sharp point, but are rounded at the end. These are best used for suturing liver, kidney, and other delicate organ tissue without causing excessive bleeding.
The body of a needle is important for interaction with the needle holder instrument and the ability to easily transfer penetrating force to the skin. A needle must be stable in the jaws of the needle holder to give maximum control and prevent bending.
The midportion comprises most of the needle’s length and is commonly curved into a 3/8 circle arc for skin or 1/2 circle for close spaces. Of course, other curvatures are available. Straight needles may be used if dealing with easy-to-reach tissues such as certain types of skin closures.
Next time, we’ll discuss the instruments you’ll use when closing a laceration with sutures.
Chuck at The Medic Shack has an article about Less Than Lethal Rounds, what damage they do and how to treat the wounds in the field. If you’re particularly squeamish to wound pictures, there are a couple of photos in the article which may disturb you.
Last time we were here, we talked about Chemical Defense. The week we move to things that can make a hole in you. This week its all about Less than lethal rounds.
What is the Rubber Bullet
The so called rubber bullet is not non lethal. It is a less lethal bullet. It has and will cause death if not used correctly or with malice.
A rubber bullet (LL round) is normally blunt to a flat tip. When it hits think of getting hit with a golf ball at close range. It will hurt like hell. Also it will cause massive bruising around the area of impact.
If fired at close range it will penetrate and act like a low velocity pistol bullet. It’s wound channel is wide and can cause severe damage to tissue, tendons, nerves and blood vessels.
If a person is taking blood thinners rubber bullets can cause severe bleeding under the skin which can be dangerous.
In 2016 a study was performed on the damage caused by rubber bullets. The results were eye opening to say the least. All images in this section are taken from the study
One thing noticed was when a LL round was fired at close range its wound channel was much larger than the bullet diameter. It was found that on impact a large portion of these rounds skewed sideways and a few tumbled a few times after impact…
As seen in the above image the wound is oblong, not round as one would expect. This tissue damage is seen though the wound channel.
Should You Remove a Rubber Bullet? Disclaimer
Before we go any further…
Use of the information on this site is AT YOUR OWN RISK, intended solely for self-help, in times of emergency, when medical help is not available, and does not create a doctor-patient relationship. We here can not diagnose, prescribe medication or treatments. We are not doctors, NP’s or PA’s
The information on this site is meant to be used only during times when improvisational, last-ditch efforts are all that is possible. When writing posts, the author often assumes that if anyone uses the advice, the person will have no access to regular medical equipment or supplies. This author always assumes that the person will not have access to professional medical care. DO NOT USE THIS INFORMATION WHEN YOU CAN GET MORE TRADITIONAL OR PROFESSIONAL CARE.
First off, see the disclaimer above. /\
Problems with Removing a Rubber Bullet
With that out of the way, the big question is, “Do I or Do I NOT remove the rubber bullet?”
Blindly probing around in a wound is dangerous. You can cause extreme bleeding by dissecting and/or damaging a blood vessel, such as an artery or a large vein. This can cause your patient to bleed out. It doesn’t take long.
You can also cause permanent and crippling damage to the person.
In the modern world when a bullet is removed, we take X-rays and CT scans. Ultrasound is also used to guide the surgeon to the object. It is NOT the toss the Bowie Knife on the fire and take a slug of whiskey and start digging.
Even in the worst of times I would usually clean the wound and then pack and dress it and let the docs with a MD degree or who came out of Ft. Sam Houston take out the bullet.
An old friend and mentor of mine who passed away about 15 years ago from pancreatic cancer taught me a lot about surgery. He told me that the best surgical instrument ever made was the index finger. He also said that the sharpest object one should ever put in the human body is, you guessed it, your index finger.
There were (and will be) times when a DUSTOFF was unable to come, or it was not in our best interests to go to a civilian hospital. If it was not in a dangerous area, I would remove one. Notice, I said I would remove one. I was trained in the best facility on the planet for combat medicine. The United States Army Medical Department and School, Fort Sam Houston Texas. as a 91B40.
However that is something that is too involved to cover safely and responsibly in a blog post. You really want to learn? Let’s get a class together and I’ll do a live, in person one. It is dangerous to do. And, without the proper training, you’d be a menace to your patient.
What we will go over is the first aid needed to treat these in the field and let the professionals do the fixing.
Treating a Rubber Round Injury In the Field
In a SHTF situation, the treatment of this is flushing the wound with copious amounts of saline. Water can be used, but an isotonic saline solutionis much more effectiveand a bit less painful than water. As a combat medic, I would flush a wound like this with a mixture of 500cc ( ½ quart) of saline and 30 cc ( 1 ounce) of Betadine. Using a 60 cc syringe or a turkey baster style bulb syringe
This is from a advanced class I taught on gunshot wounds, showing how I flushed the wound track in the tissue, (pork shoulder).
Let’s look at some real life wounds from the Kashmir report, linked to above…
LL rounds are NASTY. They HURT, and a lot of people after being shot with one refuse advanced medical care.
So lets talk about GSW care, MINUS the removal.
First you will need a REAL first aid kit. No not the 5.99 one from Walmart. A true blow out kit. These are a 1 time use kit that has only the items you need to stop the bleeding of a GSW (Gun Shot Wound).
This Kit, Everlit Emergency Trauma Kit is a decent kit. It has everything you need to treat a variety of traumas. This stuff is not cheap. The trauma kit with chest seal will set you back 70 bucks or so. And, it is a one time use.
Yes, there are cheaper. And, there are much more expensive. This set up is a mid-range kit that fills your needs. You will see kits with many different style of tourniquets. This one comes with the industry standard. the Combat Action Tourniquet (CAT). In my opinion there is none better.
Train with Your Kit
So you have this kit. Pop Quiz Medic. What do you do with it?