Strokes (CVAs) On and Off The Grid

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Strokes (CVAs) On and Off The Grid

STROKES ON AND OFF THE GRID

Often, medics in remote areas are confronted with a major challenge. Some of these challenges relate to wilderness exposure, or perhaps, an accident while performing activities of daily survival. Give me an axe and set me to chopping wood and you’ll probably see what I mean.

Sometimes the challenge faced by the medic isn’t from some external trauma, but internal; problems so severe that, even in normal times, there are limits to the options available for treatment. One issue that fits this description is the Cerebro-Vascular Accident (CVA), also known as a “stroke”.

Although modern medicine can do more for stroke victims than the pioneer medic, it’s important for an off-grid healthcare provider to recognize the signs and symptoms of a stroke and to act quickly to improve a victim’s chances of survival.

WHAT IS A STROKE?

A CVA, or stroke, is a medical event in which a blood vessel that supplies the brain with oxygen becomes blocked or leaks blood. The effect is that tissue served by that blood vessel becomes starved of oxygen. Within a few short minutes, the region affected begins to die, and functions controlled by that part of the brain are lost or impaired.

Uncontrolled high blood pressure is considered to be a major risk factor for a stroke. Other predisposing factors include diabetes, tobacco, obesity, and some heart irregularities. In a sizable number of cases, however, no obvious cause is ever identified.

According to the Centers for Disease Control and Prevention, stroke is the fifth leading cause of death in the United States, with about 800,000 cases a year. Of those that survive a stroke, many are left with significant permanent disability; a percentage do not survive more than a year afterward.

TYPES OF STROKES

The failure to provide oxygen-carrying blood to the brain could happen in one of two ways:

  • A blood clot obstructs a blood vessel that is needed to maintain circulation (“perfusion”) to the brain. This is called an “ischemic” stroke and is the most common type.
  • Blood from an artery, vein, or an abnormal structure leaks into brain tissue or the space between the brain and the membranes that cover it. This can happen due to trauma, blood-thinning medication, or other causes, and is known as a “hemorrhagic stroke”.

Sometimes, hemorrhage can occur in the area of an ischemic stroke, blurring the line between the two types.

ISCHEMIC STROKES

Ischemic strokes can be caused by a number of issues, including:

  • Thrombosis: A blood clot forms locally, causing obstruction.
  • Embolism: A blood clot forms elsewhere in the body and travels through the circulation to lodge in the brain.
  • Systemic Hypoperfusion: An inadequate amount of blood gets to the brain due to, say, severe bleeding, as in hemorrhagic shock.

HEMORRHAGIC STROKES

When blood leaks into brain tissue, it places pressure on sensitive brain cells, causing significant damage. Hemorrhagic strokes can be caused by uncontrolled high blood pressure or, less commonly, by a malformation of a blood vessel known as an “aneurysm”. An aneurysm is a weakness in a vessel wall that looks like a tiny balloon; if it bursts, a catastrophic bleed into brain tissue can occur.

Certain medications that suppress blood clotting may increase the risk of CVA. I mention this as a nod to my father, who survived a heart attack only to have a hemorrhagic stroke from blood thinners given to him in the aftermath. He died a few weeks later.

Hemorrhagic strokes can occur:

In the brain tissue itself: This is known as an “intracerebral” hemorrhage and is the most common hemorrhagic stroke.

Between the brain and the thin membranes that surround it: This type, albeit less common, can accumulate a significant amount of blood and cause severe pressure on brain tissue.

TRANSIENT ISCHEMIC ATTACKS (TIAs)

Occasionally, the medic may encounter a short-term event called a “Transient Ischemic Attack (TIA)”. Sometimes referred to as a “mini-stroke”, a TIA can present as minimal or significant symptoms, which are, well, transient in nature. In a classic TIA, symptoms will disappear for the most part within two hours or so.

Despite this, it is impossible to know whether you’re dealing with a major stroke or a TIA when first presented with the victim. Those who experience a TIA, even if all symptoms disappear, will be at higher risk for a major stroke in the near future.

Click the link below to read an account by a real person of her TIA experience:

https://www.cdc.gov/stroke/survivor_stories/blanche.htm

IDENTIFYING A STROKE

The CDC has compiled a list of symptoms that point the medic to the diagnosis of a stroke. By learning these (often unmistakable) signs, quick action may lead to lives saved and function restored. Stroke victims will often exhibit the sudden onset of:

  • Severe headache
  • Numbness or weakness affecting (usually) one side of the face, arm, or leg.
  • Trouble speaking or inability to understand speech.
  • Difficulty with vision in one or both eyes
  • Confusion or dizziness
  • Trouble walking
  • Loss of coordination

The CDC recommends the memorization of “F.A.S.T.”, a simple way to help with stroke diagnosis and treatment:

Face: Smile. Does one side of the face sag?

Arms: Raise both of the victim’s arms and see if one droops.

Speech: Have the victim say a common phrase: Does it sound strange or slurred?

Time: Call 9-1-1 right away if you notice any of these symptoms (of course, this won’t be an option off the grid).

It’s important to note when symptoms started and when the victim was last seen well. The longer the time frame between wellness and debilitation, the more likely there’ll be long-term consequences.

TREATING A STROKE

The presentation of a stroke victim is oftentimes quite striking and an observant medic will make the diagnosis quickly. Rapid action may help preserve function and even life.

The majority of CVAs are ischemic in nature. In normal times, a patient with this type of stroke can be treated with a powerful IV therapy called tPA that helps break up clots (must be given within three hours). Procedures can also be performed that might be successful in removing the clot that’s blocking the circulation.

In the absence of modern medical facilities, blood thinners like aspirin may be of use. If no aspirin is available, Salicin from the underbark of willow trees will have a similar effect.

It should be noted that a hemorrhagic stroke may actually worsen with the use of blood thinners like aspirin. As many of these are caused by elevated blood pressures, anti-hypertensive meds may help to reduce damage caused. Blood pressure is usually at its lowest if the patient is placed on their left side. If caused by an aneurysm, surgical procedures may be necessary.

Recovery from a stroke is not impossible. The National Stroke Association reports 10% will experience almost complete recovery, with another 25% with minor impairments. Reports suggest that most recovery occurs soon after a stroke, but improvement may still occur over a longer period of time, especially with rehabilitation.

With the lack of modern medical facilities in the aftermath of a disaster, the hard reality may be that major medical events like strokes may be very difficult to deal with. The medic’s motto may have to be: “Do what you can, with what you have, where you are.”

Joe Alton MD

Learn about 150 medical issues and how to deal with them when the ambulance is not just around the corner, by checking out The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon or on this website.

Video: Volcano Preparedness?

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Video: Volcano Preparedness?

VIDEO: VOLCANO PREPAREDNESS?

Being prepared certainly increases your chances of surviving and staying healthy in a lot of disaster settings, but can you prepare for a volcanic eruption like we’re seeing at Mount Kilauea in Hawaii? A volcano can form a river of lava, molten rock at 750-1250 degrees, plus shoot out rocks the size of boulders onto the landscape. Over time, falling ash can cause roofs to collapse. Sure, most of the country isn’t at risk for a volcanic eruption, or is it? Yellowstone National Park is home to a huge “caldera” where superheated gases cause geysers like Old Faithful. It exploded 640,000 years ago, and we’re due, some geologists say, for another event (in the next 40,000 years or so).

While you can’t protect your home from a wall of lava, there might be some actions that could give you a fighting chance to survive the event. In this video, Joe Alton, MD explores your options and offers some thoughts on what might make a difference and what might not for a volcanic eruption.

To watch, click below:

Wishing you the best of health in good times or bad,

Joe Alton MD

Learn more about natural disasters and medical issues you might confront in one in the award-winning Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.  Also, check out some of Nurse Amy’s medical kits for off-grid scenarios at store.doomandbloom.net.

Survival Medicine Hour: Emerging Infectious Diseases, Malaria

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Survival Medicine Hour: Emerging Infectious Diseases, Malaria

SURVIVAL MEDICINE HOUR PODCAST

e. coli bacteria

e. coli bacteria

Joe Alton MD and Amy Alton ARNP often  talk about infectious diseases on the Survival Medicine Hour, a number of which are called emerging infectious diseases.

Emerging infectious diseases are infections that have recently appeared within a population or those whose frequency or geographic range is increasing or likely to increase in the near future. They say there’s nothing new under the sun, so how is this possible? Emerging infections can be caused by:

  • Previously undetected or unknown infectious agents (SARS, MERS)
  • Known agents that have spread to new geographic locations or new populations (Zika, Ebola, Chikungunya)
  • Previously known agents whose role in specific diseases has previously gone unrecognized. (like some viruses now being thought responsible for certain illnesses)
  • Re-emergence of agents whose incidence of disease had significantly declined in the past but whose incidence of disease has reappeared, say measles. This group is known as re-emerging infectious diseases.
Asian Tiger Mosquito

Asian Tiger Mosquito

The World Health Organization warned in its 2007 report that infectious diseases are emerging at a rate that has not been seen before. Since the 1970s, about 40 infectious diseases have been discovered, including SARS, MERS, Ebola, chikungunya, avian flu, swine flu and, most recently, Zika.

More information on emerging infectious disease can be heard on this episode of the Survival Medicine Hour!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2018/05/11/survival-medicine-hour-emerging-infectious-disease

Wishing you the best of health in good times or bad,

Joe and Amy Alton

The Altons

The Altons

E. Coli Contamination

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E. Coli Contamination

E. COLI CONTAMINATION

Romaine Lettuce

Romaine Lettuce

The Centers for Disease Control and Prevention reports that food poisoning from romaine lettuce harboring the bacteria E. Coli spread recently to 29 states and sent at least 150 people to the hospital. The areas involved include all parts of the country from Florida to North Dakota to California, and new cases are making it the worst E. Coli outbreak nationally since 5 people died and 200 were hospitalized in 2006.

Although E. Coli is a common inhabitant of the intestinal tract, some strains, especially O157:H7,  produce a toxin known as “Shiga” that causes bloody diarrhea, nausea and vomiting, dehydration, and other symptoms. Victims range from 1 to 88 years old, and a number are experiencing kidney failure, which has killed one person so far. Several E. Coli varieties are common causes of urinary tract infections.

E. Coli

E. Coli

Sources of Shiga-toxin producing E. Coli may include:

·       Contaminated water (even swimming in it may cause infection)

·       Undercooked ground beef

·       Unpasteurized milk or juice

·       Cheese made from raw milk

·       Raw fruits, vegetables, and sprouts

·       Contact with animals and their enclosures

·       Feces of those infected

After the organism enters the system, it usually takes several days for symptoms to appear. Unlike many infections, E. Coli tends not to cause high fevers, but the abdominal pain, diarrhea, and vomiting can be severe. Dehydration can cause decreased urine production, dark urine, weakness, and fatigue.

Rehydration is the main treatment

Rehydration is the main treatment

Re-hydration support during the illness will help support the victim for the 6-8 days it takes most to get over the infection. Antibiotics are rarely indicated, as it usually goes away by itself; it is even thought that taking anti-diarrheal medicines may slow the recovery process by preventing the elimination of the organism through bowel movements. Dairy products or items with high fat content or fiber can make your symptoms worse.

If it occurs, kidney damage will begin to become apparent after the first week.

Simply avoiding bagged lettuce at the grocery store is not enough, as many of those made ill ate the lettuce in salads served in restaurants. It is not yet known where in the chain from farm to consumer that the contamination with the bacteria took place. A farm in Yuma, Arizona may be involved.

Prevention involves avoiding poorly prepared food and water.  Use different cutting boards for raw fruits and vegetables than you would for raw meat.  

The most important factor in preventing E. Coli outbreaks is strict diligence applied to washing hands before cooking, after caring for animals and their environments, and diapering infants or otherwise disposing of human waste. 

Eating salads is a healthy option for most, but always be sure to make yours with freshly-washed hands and vegetables.

Joe Alton MD

Dr. Alton

Dr. Alton

Find out more about E. Coli contamination and 150 other medical issues when the ambulance may not be just around the corner! Check out a copy of the award-winning Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the way, available at Amazon or at doomandbloom.net. Also, be sure to find a medical kit that will help keep your people healthy in good times or bad: Check out store.doomandbloom.net

The Third Edition

The Third Edition

Can You Prepare For A Volcano?

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Can You Prepare For A Volcano?

Can You Prepare For A Volcano?

Uh oh...

Uh oh…

There are a number of disasters, natural or man-made, where a great deal of preparation greatly increases your chances of survival. Then there are others, like volcanic eruptions or asteroid strikes, where your option are, to say the least, more limited. You might not consider a volcano as the most likely event to ruin your day, and you’d be right. Still, it makes sense to know about them and what you might be able to do to prevent being a victim of one.

A volcano is a rupture in the crust of the earth which allows lava (molten rock at 750-1250 degrees Fahrenheit), ash, and gases to escape from deep below the surface. The violence of volcanic eruptions is so great that boulders can come raining down from the sky to flatten houses and, perhaps, you.

Most have the impression that a volcano is a conical mountain with smoke and fire spewing from the top, such as you see today in Hawaii. In actuality, however, most volcanos can be active without displaying physical signs for thousands of years.

Volcanoes can also take a number of forms: In Yellowstone National Park, a huge dormant super-volcano looks more like flat land than a cone. Indeed, it takes some observation to know you’re walking on top of it. Geysers like ‘Old Faithful” exist as evidence that there’s still a great deal of pressure and molten rock below the surface.

Old Faithful Geyser

 

One doomsday scenario includes the eruption of this huge land feature, which is called a “caldera” (meaning “cauldron” or “cooking pot”). This disaster last happened 640,000 years ago, but it’s thought to be an event that is likely to occur again “soon”. In geologic time, “soon” means in the next 40,000 years or so.

If you live in a volcanically active area, there are a few things that you can do to decrease the chance of becoming a victim. Monitor volcanic activity reports via NOAA radios and evacuate the area if authorities believe an eruption is imminent. Have a plan in place to get the family together via texting, email, social media, etc.

Know several routes out of the area; roads may be blocked by fire, thick ash, or lava flows. Visibility and breathing might become difficult, so respirator masks and goggles should be worn by every member of the group.

That's not snow, it's volcanic ash!

That’s not snow, it’s volcanic ash!

Ash can also damage engine parts and stall escape vehicles, so be prepared to go on foot if necessary. Any equipment with moving parts that must remain outside as your evacuate should be covered with tarps.

The most intelligent decision is to hit the road, Jack, and take a good amount of supplies with you. There are circumstances, however, where you might be unable to leave your home. While you can’t expect even the most solid house to be much protection from a wall of lava, you might still be able to achieve protection from volcanic ash:

·       Close all windows and doors

·       Block chimneys

·       Stay under the sturdiest part of the roof (ash can be very heavy)

·       Have food and water stored in quantity

It imperative to have at least several days supplies packed and ready to go at a moment’s notice. I call this a “G.O.O.D.” bag (Get Out Of Dodge!).

It’s also important to have a good kit to deal with medical issues. You’ll need materials that that treat burns and orthopedic injuries as well as masks, goggles, and flashlights for every member of the family. You might not consider these items to be medical in nature, but they’ll help you breathe and see even if the ash is falling thickly, and you’ll be in better physical shape and more likely to survive.

Masks

Masks

No masks and no shelter? Place a damp cloth over your nose and mouth and cover your skin as much as possible. Of course, protection in the form of work gloves, sturdy high-top boots, and head coverings (a hard hat even seems prudent here) will decrease your chance of injury as you escape the area. Avoid low-lying areas that might be a natural conduit for lava. Stay clear of areas downwind of the volcano; ash and flying debris will be thickest there.

Don't let this happen!

Don’t forget the pets

Don’t forget your pets: Have a “G.O.O.D.” bag for them as well. Here’s the Red Cross’s recommendations for emergency pet kits and a plan of action that will increase your animals’ safety in times of trouble:

http://www.redcross.org/get-help/how-to-prepare-for-emergencies/pet-disaster-preparedness#Pet-Emergency-Kit

You might not always have a lot of options in a disaster, but you can always improve your chances of surviving even in the worst situations.

Joe Alton MD

Dr. Alton

Dr. Alton

Find out more about disaster preparedness and 150 medical topics you might face off the grid in the award-winning Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. Plus, fill those holes in your medical supplies at store.doomandbloom.net!

Third Edition

Third Edition

ASIDE: Can you stop a lava flow? Here’s some ways they’ve tried:
https://www.msn.com/en-us/news/us/people-have-tried-to-stop-lava-from-flowing-this-is-why-they-failed/ar-AAwVk3t?ocid=spartanntp

Malaria: Important Things To Know

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MALARIA

World's most dangerous creature?

World’s most dangerous creature?

The world is full of dangerous critters, and we’re lucky not to run into the grand majority of them during our daily lives. Animals that present a threat to humans usually live in habitats that are in the wilderness or the deep ocean, where population densities of people are low and encounters infrequent.

You might consider the Great White Shark to be the most dangerous animal in the world, but you’d be wrong. It’s not the black mamba snake of Africa, nor the cone snail of tropical waters; Indeed, in terms of the sheer number of human deaths, a creature much smaller is involved: The lowly mosquito, which puts Jaws and all the classic creatures from our nightmares to shame.

Mosquitoes, especially those in the Anopheles, Aedes, and Culex families, are responsible for more deaths than any other animal (humans excluded). According to the World Health Organization, mosquito bites are the cause of one million deaths every year. But a mosquito bite is a direct way of getting a disease indirectly; the mosquito itself isn’t the cause, it’s a “vector”, a way-station for a microbe on its way to its eventual host. These organisms are rarely, if ever, fatal to the mosquito they live in, but can be to their eventual host: Warm-blooded animals that the mosquito bites, like humans.

MALARIA

Life Cycle of Malaria

Life Cycle of Malaria

The majority of deaths from infectious diseases transmitted by mosquitoes are caused by a disease known as malaria. It was originally thought that the disease came from foul marsh air, thus came to be known as  “mal aria” or “bad air”.

The World Health Organization believes that 300-500 million cases of malaria occur every year, with 1 million deaths. 1700 cases are reported to the Centers for Disease Control and Prevention (CDC) annually in the United States, mostly by those traveling outside the country.

Malaria is caused by one of four species of microbe called “plasmodium“, of which p. falciparum seems to be the worst. Plasmodium lives in the gut of mosquitoes. When female mosquitos (only females bite humans) of the anopheles species inject these micro-organisms into a human body, they colonize organs such as the liver. Once there, they travel through your circulation to damage blood cells and other organs.

modern range of malaria organisms

modern range of malaria organisms

Looking at the map of the current range of anopheles mosquitoes, you would think the United States is immune to issues relating to malaria. This is primarily due to the common availability of air conditioning systems, drained swamp areas, and improved health care in modern times. Malaria was thought, however, to be a significant problem, especially in the South, in the 18th and 19th centuries; even today, a remote homestead or a community off the grid due to a major disaster might still be vulnerable to an outbreak.

It should be noted that, besides anopheles, other species of mosquitoes carry micro-organisms that invade and cause damage to organs. One instance that created a sensation recently was the aedes mosquito that transmitted Zika virus to the brains of fetuses in Brazil in a 2015-16 epidemic.

SYMPTOMS OF MALARIA

Plasmodium organism under the microscope

Plasmodium organism under the microscope

Symptoms of Malaria appear flu-like and present as periodic chills, fever, and sweats.  The classic appearance includes:

High fever (often reaching up to 104° F or more)
Chills
Shaking
Extreme sweating
Fatigue
Discomfort (known as “malaise”), joint, and body aches
Headache
Nausea, vomiting, and diarrhea

Some develop jaundice, a yellowing of the skin and eyes due to liver damage.

Although most people begin to experience symptoms 10 days to 4 weeks after infected, it is possible to be without symptoms for up to 1 year after you are infected. Bouts of severe symptoms every two or three days is common.

Some types of malaria can lead to repeat bouts of sickness. The parasites can go dormant in the liver for a period of time after infection. When they become active again, the person gets sick again, known as a “recurrence”.

Over time, the patient becomes anemic as blood cells are lost to the infection. With time, periods between episodes become shorter and permanent organ damage may occur.

DIAGNOSIS AND TREATMENT

Malaria can be treated and controlled

Malaria can be treated and controlled

Diagnosis of malaria cannot be confirmed without a microscope, but anyone experiencing relapsing fevers with severe chills and sweating should be considered candidates for treatment.  The medications used for Malaria include Chloroquine, Quinine, and Quinidine; other, later-generation drugs, are also available.

Sometimes, an antibiotic such as Doxycycline or Clindamycin is used in combination with the above. Physicians are usually sympathetic towards prescribing these medications to those who are contemplating trips to places where mosquitos are rampant, such as tropical climates. These drugs are also available as veterinary equivalents in avian or aquatic form.

MOSQUITO CONTROL

Of course, the fewer mosquitos near your retreat, the less likely you will fall victim to one of these diseases. You can decrease the population of mosquitos in your area and improve the likelihood of preventing illness by:

  • Looking for areas of standing water that could serve as mosquito breeding grounds. Drain all water that you do not depend on for survival.
  • Monitoring the screens on your retreat windows and doors and repairing any holes or defects.
  • Being careful to avoid outside activities at dusk or dawn. This is the time that most mosquitos are most active.
  • Wear long pants and shirts whenever you venture outside.
  • Have a good stockpile of insect repellants. If you are going to use sunscreen, apply it first and then apply the insect repellant.

Some insect repellants are meant to be applied to clothing only, such as Permethrin. DEET, however, is acceptable for exposed skin; those areas not covered with clothing.  DEET is acceptable for pregnant and breastfeeding women when used correctly (and, preferably, at 35% or less concentrations).

Many are reluctant to use chemical repellants, and there are EPA-accepted natural remedies. Plants that contain Citronella may be rubbed on your skin to discourage bites.  Lemon balm has been recommended in the past, but, despite having a fragrance similar to citronella, does not have the same bug-repelling properties.

When you use an essential oil to repel insects, re-apply frequently and feel free to combine oils as needed. Besides Citronella oil, you may consider:

  • Lemon Eucalyptus oil
  • Cinnamon oil
  • Peppermint oil
  • Geranium oil
  • Clove oil
  • Rosemary oil

A large amount of damage can occur to humans as a result of small insects. Knowing how to recognize major insect-borne diseases, along with a program of systematic control of bug populations can decrease the number of people that have to deal with signficiant illnesses.

Joe Alton MD

Joe Alton MD

Joe Alton MD

Lear more about malaria and many other infectious diseases in austere settings by checking out the award-winning Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. Also, consider becoming more medically prepared with supplies and kits from Nurse Amy’s entire line at store.doomandbloom.net.

Survival Medicine Hour: Spring Camping Safety, Snakebite, More

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Camping Safety

Camping Safety

School is winding down, and families are starting to think about that camping trip to the mountains or shore. Camping safety is important, and a lot of factors need to be considered like weather, gear, and more to make a camping trip memorable (and I mean in a good way, not a bad way). What you need to do to deal with common injuries, supplies you’ll need, and even a little about snakebite, since those critters are waking up from their cold-weather slumbers.

venomous snake bite

venomous snake bite

all this and more on the Survival Medicine Hour with Joe Alton MD and Amy Alton ARNP!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2018/04/27/survival-medicine-hour-spring-camping-safety-snakebites-more

Wishing you the best of health in good times or bad,

Joe and Amy Alton

The Altons

The Altons

Follow us on Twitter @preppershow  YouTube at drbones nurseamy channel

Facebook at our Survival Medicine Group DrBones NurseAmy or Doom and Bloom pages

Check out our kits and books at store.doomandbloom.net

 

Appendicitis Off The Grid

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Appendicitis Off The Grid

Blocked appendix

Blocked appendix

After a disaster or at a remote homestead, the medic may not have ready access to modern medical technology. As such, many conditions that are commonly identified with ultrasounds or CAT scans may be more challenging to diagnose. One of these challenges is abdominal pain. There are various medical issues that cause it, with the classic example of an abdominal emergency being appendicitis. Over 300,000 Americans have their appendix removed every year.

The Appendix

The “vermiform appendix”, as it is formally known, is a hollow tubular organ a few centimeters long and a centimeter wide. It looks like a worm (vermiform means worm-like).  Attached at the entrance to the large intestine (the “cecum”), it resides in the lower right portion of the abdomen in almost all people. Inflammation of the appendix can become a medical emergency quickly; if ignored, it may represent a life-threatening situation.

ASIDE: When the appendix (or any other organ, for that matter) is inflamed, the suffix “-itis” is added; thus, inflammation of the appendix is called “appendicitis”.

What purpose does the appendix serve? Charles Darwin believed it was a left-over from an earlier time, as horses and some other animals have larger ones that help them digest vegetation. Today, it is thought by many that it serves an immune function for fetuses and children. It is also thought to be a reservoir for good gut bacteria. After a bout of, say, dysentery or cholera, it may help repopulate the gastro-intestinal tract with beneficial micro-organisms.

Having said that, there seems to be no major ill effects from having an appendix removed, although some studies suggest a small increase in diseases, such as Crohn’s Disease.

What Happens in Appendicitis

A grossly inflamed appendix

A grossly inflamed appendix

Appendicitis is related to an obstruction of the organ by, usually, calcified feces; it some cases, blockage can be caused by foreign objects, trauma, or even intestinal worms.  How does this lead to a possibly life-threatening situation?

Once blocked, the mucus produced by the appendix is unable to drain into the cecum. The organ swells as a result. Once swollen enough, the ensuing pressure on the appendix walls prevents the circulation necessary to keep tissue alive. The dying tissue causes the appendix to fill with pus and, without treatment, will be either walled-off by the body’s defenses or will burst (a “ruptured appendix”).

Once ruptured, an inflammation of the lining of the entire abdomen called peritonitis occurs. From there, it can progress to an infection throughout the body (sepsis) if untreated. Death may be the final outcome.

How to Identify Appendicitis

Many illnesses will be difficult for the medic to diagnose in austere settings. Although ultrasounds and CAT scans help confirm suspicions, appendicitis can be identified with some reliability based on physical signs and medical history.

Classic signs and symptoms that suggest appendicitis as the cause of abdominal pain include:

  • Pain starting at or around the belly button, usually dull and aching
  • Loss of appetite, followed by nausea and vomiting
  • Abdominal swelling
  • Fever
  • Inability to pass gas
  • Pain evolving to become sharper and migrates to the lower right abdomen

The pain tends to localize to a specific spot one-third of the way from the hip bone to the belly button, an area known as “McBurney’s Point”.

McBurney's Point

McBurney’s Point

Once an appendix has ruptured, the pain becomes general throughout the abdomen in many cases. The belly may appear stiff and swollen, with tenderness on exam, both on pressing down (“guarding”) and when letting go (“rebound tenderness”, often worse).

It should be noted that other symptoms may present in a significant minority of patients. Cramping may occur, with some complaining of painful or otherwise difficult urination. As with any condition, signs and symptoms may vary from person to person.

Mimics of Appendicitis

Causes of abdominal pain by area

Causes of abdominal pain by area

Other conditions may lead you to erroneously suspect appendicitis when, in actuality, something entirely different is going on. Urinary infections, right-sided tubal pregnancies or ovarian cysts, diverticulitis, Crohn’s disease or ulcerative colitis, and pelvic inflammatory disease may mimic an inflamed appendix to one extent or another and must be ruled out. These topics will be discussed in future articles.

Treatment of Appendicitis

Appendicitis is the most common cause of abdominal pain treated by surgery today, and the procedure is usually curative. The earlier the surgery is performed, the faster the recovery and the less likely scarring will occur. Below is a video of a (bloodier than usual) open removal of a swollen appendix:

Appendectomy can be performed, using a very small incision, under sedation and local anesthesia off the grid. This procedure is not without difficulty for the inexperienced surgeon, as there is intervening small intestine and other structures that must be moved out of the way to visualize the inflamed area. Of course, patient discomfort is a major obstacle.

Recent studies have explored the possibility of using antibiotics to nip early appendicitis in the bud. The patient should be placed on bedrest and restricted to small amounts of clear liquids as soon as you make the diagnosis.

Intravenous treatment is the preferred way to deliver antibiotics to treat appendicitis, but may not be an option off the grid. In that case, a combination of Ampicillin (veterinary equivalent Fish-Cillin) and either Clindamycin (veterinary equivalent Fish-Cin) or Metronidazole (veterinary equivalent Fish-Zole) might be useful. In cases of Penicillin allergy, Ciprofloxacin (veterinary equivalent Fish-Flox) may be a suitable alternative to Ampicillin.

Look for other common causes of abdominal pain to be examined in future articles.

Joe Alton MD

Dr. Alton

Dr. Alton

Find out more about appendicitis and conditions that mimic it in the Third Edition of the award-winning Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the way, available at Amazon or along with an entire line of medical supplies at store.doomandbloom.net.

The Third Edition

Survival Medicine Hour: E. Coli Outbreak, Mudslides, Water Disinfection, More

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SURVIVAL MEDICINE HOUR #386

MUDSLIDES

MUDSLIDES

Spring has sprung, and snowmelt plus heavy rains may increase the risk of mudslides, aka debris flows, in many areas. Find out more about this dangerous natural phenomenom which is akin to a river of wet concrete, plus some early warning signs that you property is at risk. Joe and Amy, aka Dr. Bones and Nurse Amy, also discuss a new E. Coli outbreak that is hitting several states across the country but is still mysterious in its origin, plus their recommendations for water disinfection and how it compares to official EPA directives.

bacterial outbreak in 7 states

bacterial outbreak in 7 states

Also, some examples as to when the medic has to make tough decisions in survival settings, like giving medicines to someone who is really sick but claims to have an allergy to the only drug or natural option you’ve got in your medical supplies.

All this and more in the latest Survival Medicine Hour with Joe Alton, MD and Amy Alton, ARNP!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2018/04/13/survival-medicine-hour-e-coli-outbreak-mudslides-disinfection-more

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Joe and Amy Alton

Joe and Amy Alton

 

Follow Joe and Amy on twitter @preppershow; Facebook at Doom and Bloom, and on Youtube at drbones nurseamy channel!

Find the award-winning third edition of The Survival Medicine Handbook at Amazon.com

Survival Medicine Hour: Allergies, More

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Survival Medicine Hour #385

all about allergies

all about allergies

In certain seasons, like Spring, pollens and other substances are at high levels. For most, it’s a great time of year to be outside, but for allergy sufferers, well, not so much. Joe Alton, MD,aka Dr. Bones, and Amy Alton, ARNP, aka Nurse Amy, go into detail to tell you the history of allergies (the word didn’t even exist in the year 1900!), what exactly happens in your body during an allergy attack, and how to identify it from, say, a simple adverse reaction to a medicine.

Also, a little about severe allergic reactions and your treatment options in good times or bad, plus why most people that tell their doctor they’re allergic to something may actually not have an allergy at all!

All this and more on the latest Survival Medicine Hour with Joe and Amy Alton!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2018/04/06/survival-medicine-hour-allergies-more

Wishing you the best of health in good times or bad,

Amy and Joe Alton

The Altons

The Altons

Follow the Altons on twitter @preppershow, Facebook at Doom and Bloom(tm), and YouTube at DrBones NurseAmy Channel! Drget to get a copy of their 2017 Book Excellence 1st Place Award winner in medicine, The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, and medical kits and supplies at store.doomandbloom.net.https://store.doomandbloom.net/

The Survival Medicine Handbook, Third Edition

The Survival Medicine Handbook, Third Edition

Survival Medicine Hour: Wound Closure in Survival Settings, More

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SURVIVAL MEDICINE HOUR #382

wound closure

Important factors when deciding to close a wound off the grid

Injuries occur in disaster and other off-grid settings, and some of those break the skin or even go into deeper layers, like subcutaneous fat and muscle. When do you close a wound and when is it wiser to keep it open? Also, if you’re going to close it, what materials should you use and why? Joe Alton MD and Amy Alton ARNP, aka Dr. Bones and Nurse Amy, take you through the decision making process and much more in this episode devoted to wound closure in survival situations.

Suture Training is important, but so is open wound care

Suture Training is important, but so is open wound care

Follow Joe and Amy on Twitter @preppershow, plus their YouTube Channel at drbones nurseamy, and Facebook on their Doom and Bloom(tm) page!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2018/03/30/survival-medicine-hour-wound-closure-in-survival

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Amy's garden

Amy’s garden

Fill those holes in your medical supplies with kits and individual supplies at store.doomandbloom.net.

The Survival Medicine Handbook, Third Edition

The Survival Medicine Handbook, Third Edition

 

Survival Medicine Hour: Wound Cleaning, Medical Backpacks, More

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SURVIVAL MEDICINE HOUR #380

dealing with open wounds

dealing with open wounds

The right equipment is important for anyone to do a job efficiently. You wouldn’t expect a steak knife to cut a tree down better than a saw, or see a hunter have the same success with a catapult as opposed to a rifle. The same goes for the containers you put supplies in, especially one you have to carry with you while bugging out or away from your retreat. The right medical backpack allows you to work effectively as a medic, while giving you the ability to have plenty of materials and minimizing back problems. Dr. Bones and Nurse Amy discuss what goes into choosing a good medical backpack.

A loaded first aid kit with medical supplies for trauma,burns, sprains and strains and other medical issues

Picking the right medic bag

Plus, some basics of wound cleaning off the grid. In normal times, you can pass off a person with a wound to a hospital, but after a disaster, it’s your responsibility to see the wound to full recovery. That means diligent and strict attention to wound cleaning. We talk about some strategies for wound care off the grid that will decrease the risk of wound infections and increase the chances for survival.

All this and more on the Survival Medicine Hour with Joe and Amy Alton!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2018/03/16/survival-medicine-hour-would-cleaning-medical-backpacks-more

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Dr Bones/Nurse Amy

Dr Bones/Nurse Amy

Follow us on Twitter @preppershow, Facebook at Doom and Bloom’s page, and YouTube at DrBones NurseAmy channel

Plus, get a copy of the Survival Medicine Handbook’s award-winning Third Edition at Amazon.com

2017 Book Excellence Award Winner in Medicine

2017 Book Excellence Award Winner in Medicine

Medical Backpacks

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Things To Consider When Choosing a Medical Backpack

A loaded first aid kit with medical supplies for trauma,burns, sprains and strains and other medical issues

Stomp Supreme bag by Doom and Bloom

For anyone to do their job properly, they’ll need the right equipment.  Imagine a carpenter having to use a steak knife as a saw, or a hunter using a catapult instead of a rifle.  The same goes for the medic.  The successful survival caregiver has spent a lot of time and energy (and some money) on accumulating a stockpile of medical supplies.  The more the better, since you don’t know how long you might have to function without access to modern medical care.

It’s important to note that the value of many medical supplies depends largely on the knowledge and skill that the user has obtained through study and practice. A blood pressure cuff isn’t very useful to someone who doesn’t know how to take a blood pressure. Concentrate first on obtaining items that you can use effectively, and then purchase more advanced equipment as you learn more skills.

Don’t forget that many items can be improvised; a bandanna can serve as a sling, an ironing board as a stretcher, or thin fishing line and a sewing needle as suturing equipment.  A careful inspection of your own home would probably turn up lots of items that can be adapted to medical use.  Look with a creative eye and you’ll be surprised at the medical issues you are already equipped to deal with.

The Medic Bag

Prepper Medical Supply Kit

Items should be clearly visible and accessible

If you are going to be the medical caregiver for your family or community in times of trouble, you will, hopefully, have accumulated a significant number of medical supplies. You’ll find many articles that tell you what to put in a medical kit, but few ever talk about a basic piece of medical equipment that everyone needs: the medical bag that will contain all these supplies.

Without a place to put your medical supplies, they will, most likely, be strewn about in a way that prevents you from accessing the stuff you need when an emergency arises.  This wastes precious time when someone’s life may hang in the balance. Organization is key; if you’re disorganized, you’re not going to be effective at the time you’re most needed.

Choosing the Right Medic Bag

One important aspect of choosing a bag that fits your needs is size.  Size matters; you should assess your needs to determine which size bag is right for you.  The factors that go into this decision include:

  • Are you staying in place or on the move?
  • How many people are you responsible for?
  • How long will you be the medical resource for your family or group?
  • Are you in an area that is potentially dangerous?
  • What climate should you be prepared for?
  • What medical issues will you be most likely to encounter?
  • Can you depend on clean water?
  • How many medical supplies do you have?

Larger bags are made more versatile if they are M.O.L.L.E. compatible. M.O.L.L.E. is a military acronym; it stands for Modular Lightweight Load-carrying Equipment.  These bags have what look like horizontal straps sown on the outside of a pack which allow additional items to be secured by attaching them to the loops that are created by the stitching or webbing.

Which medical supplies should every member of your family carry in case you get separated? What are the more advanced supplies that the medic should carry? You might start by having members of your group carry an IFAK (Individual First Aid Kit) whenever they’re away from base camp.  The family medic carries the advanced items in a larger bag.

IFAK bag and supplies by Doom and Bloom

IFAK bag and supplies 

The best medic bags, in my opinion, have lots of clear or mesh pockets. These have everything you’ll need in an emergency in plain sight if packed right, and will avoid the question you never want to ask yourself if someone’s injured: “Where’d I put the tourniquet?”, or “Where’d I put the burn dressings?”  Closed pouches in the bag could be used for non-emergency items, like certain medicines, water filters, etc. Putting your items in groups based on the issues they deal with is also a great idea.

Avoiding Backpack-Related Injuries

The American Occupational Therapy Association has some general tips on preventing backpack mishaps like back injuries. They target students, but their advice makes sense for the survival medic as well. They include:

  • Choose a backpack with a padded back panel and adjustable padded shoulder straps. Chest straps will also help stabilize the pack.
  • Always distribute weight evenly in your pack.
  • Load heaviest items closest to your back; balance materials so that you can easily stand up straight.
  • For large packs, a hip belt is important. It provides balanced support and takes strain off sensitive neck and shoulder muscles.
  • Whether the bag is short or tall, has an internal frame or is soft are important factors to determine comfort and utility.

The key is to have the medical kit make sense for you. Many medical kits, like you can find at our website, come already packed with supplies. This might mean deconstructing it and moving things around so that the arrangement seems natural for your purposes.

A medical bag doesn’t have to be commercially produced; if you’re staying in place, a tool box or other item that sets up your supplies in an organized way is all that is needed.

Choosing the right bag for the right job is as important as having the right medical items. Do a little research to see what your options are; you’ll be glad you did.

Joe Alton MD

That ol' Dr. Bones

That ol’ Dr. Bones

See a wide selection of bags, packed kits, and individual supplies at Nurse Amy’s shop at store.doomandbloom.net.

Some medical kits by Doom and Bloom

Some medical kits by Doom and Bloom

Survival Medicine Hour: All about Arthritis, Mass Recall, Anosmia

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Survival Medicine Hour #379

Rheumatoid is just one kind of arthritis

Rheumatoid is just one kind of arthritis

 

What if you had to function with joint pain in the aftermath of a major disaster? In the latest Survival Medicine Hour with Joe Alton MD, aka Dr. Bones, and Amy Alton ARNP, aka Nurse Amy, our hosts tell you all about arthritis: The different types, signs and symptoms, how to tell one type from another, treatment both natural and conventional, plus much more.

mass fire extinguisher recall includes ours!

mass fire extinguisher recall includes ours!

A mass recall of fire extinguishers going all the way back to 1973 is in the news after a fire rescue team couldn’t save a victim due to the failure of the all-important device. Is your device affected? Listen to Nurse Amy give an account of the Consumer Product Safety Commission’s report.

Plus, a listener who has lost his sense of smell; could it be allergies? could it be a chronic medical condition. Listen to his story and Dr. Alton’s thoughts.

To listen in, click here:

http://www.blogtalkradio.com/survivalmedicine/2018/03/09/survival-medicine-hour-arthritis-mass-recall-anosmia

All this and more on the Survival Medicine Hour with Dr. Bones and Nurse Amy!

The Altons

The Altons

 

Don’t forget to check out the Survival Medicine Handbook Third Edition on Amazon!

Follow Dr. Bones and Nurse Amy on twitter @preppershow, facebook at Doom and Bloom, and YouTube at drbones nurseamy channel!

Survival Medicine Hour: Pregnancy, Labor and Delivery Off The Grid

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Survival Medicine Hour #378

Birthing a Baby Off The Grid

Birthing a Baby Off The Grid

It may not be the wisest move to be fruitful and multiply in the early going after a disaster. You need all your people at 110% efficiency, and that isn’t part of the deal with pregnancy, with all that fatigue, discomfort, nausea, and other symptoms. The best plans of mice and men often go awry, however, and you might find yourself taking care of a pregnancy and, eventually, delivering a baby.

Old Dr. Bones, retired obstetrician, and Nurse Amy, retired nurse-midwife, give you their perspectives on how to make labor and delivery manageable and result in a healthy baby and healthy mother. There’s more to it that we can fit in a one hour podcast, but you’ll learn a lot I’ll bet your didn’t know!

All this and more on the latest Survival Medicine Hour with Joe Alton MD and Amy Alton ARNP…

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2018/03/02/survival-medicine-hour-labor-and-delivery-off-the-grid

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Joe and Amy Alton

Don’t forget to fill those holes in your medical kit at store.doomandbloom.net. You’ll be glad you did.

Video: Amputation in Survival Settings

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Amputation in survival settings

Amputation in survival settings

One of the worst injuries that can occur in a disaster or other off-grid setting is the traumatic amputation. In the Civil War era. amputations on the battlefield or later in the field hospital resulted in 1/4 to 1/2 of the victims succumbing to their wounds. In an EMP attack, we could easily be thrown back to that era medically, and we should consider what can be done for those injured so horrifically.

Joe Alton MD attempts to tackle this delicate subject that others won’t touch in this video, knowing the limitations on the medic and the lack of sterility in most instances. See him explain his thoughts and rationale on what can and can’t be done, and some tips on what to do when confronted with the traumatic amputation.

To watch, click below:

Wishing you the best of health in good times or bad,

Joe and Amy Alton MD

Dr. Bones and Nurse Amy

Amy and Joe Alton

Fill those holes in your medical supplies with individual kits and supplies from Nurse Amy’s entire line at store.doomandbloom.net.

three compact first aid kits great for hiking and camping made by Amy Alton of store.doomandbloom.net

Survival Medicine Hour: Nosebleeds, Pregnancy Complications, Flu Recurrence, More

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SURVIVAL MEDICINE HOUR PODCAST

 

Cauterization with silver nitrate sticks

Cauterization with silver nitrate sticks

You might not think it’s possible, but there are enough different flu viruses circulating this season that you could actually get the flu again before Spring! H3N2 is the most common form around this year, but late season flus like Influenza B could bring you down again before things warm up. Joe and Amy talk about their recovery from a nasty case of the flu and give you some important advice.

Plus, how to deal with nosebleeds with limited supplies. Nosebleeds, also known as epistaxis can occur in young or old, and for a dozen different reasons. Learn all you need to know about this common, but scary, medical problem.

pregnancy complications off the grid

pregnancy complications off the grid

Also, survival settings require your people to be at 100% efficiency, but what happens when people get pregnant? Back pain, nausea and vomiting, and much more can intervene to take out a productive member of your crew. Dr. Alton tells you about some of the issues that might complicate what is usually a normal and natural process.

All this and more in the latest Survival Medicine Hour Podcast with Amy Alton, ARNP and Joe Alton MD!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2018/02/09/survival-medicine-hour-nosebleeds-flu-recurrences-pregnancy-complications

Wishing you the best of health in good times or bad,

Joe and Amy Alton

The Altons

The Altons

To learn more about survival medicine, get a copy of the award-winning Third Edition of the Survival Medicine Handbook!

Third Edition

Third Edition

Video: Adding Natural Remedies to First Aid Kits

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natural remedies

natural remedies

If you’re putting together a solid first aid kit, you have to decide if that kit is going to have to perform in long-term survival settings. You can put together a decent kit or even consider one of our specially-designed kits, but what if a disaster turns out to be a long-term event that knocks you off the grid for months, maybe longer?

It’s pretty clear you’ll eventually run out of standard medicines and other supplies quickly, especially if you’re taking care of an extended family. That’s why it’s not only important to have more materials than you think you’d need for the group, but also have some natural remedies like essential oils, herbal teas, and maybe even a medicinal garden.

Here’s a video that discusses the topic in detail. It’s something you might want to consider if you believe some long-term disaster could one day affect your area.

To watch, click below:

Wishing you the best of health in good times or bad,

Joe Alton MD

Dr, Alton

Dr, Alton

Read more about natural remedies, plus 150 other medical topics, in the award-winning Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. Plus fill those holes in your medical storage with kits and individual items from Nurse Amy’s store at store.doomandbloom.net.

Nosebleeds

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HOW TO STOP A NOSEBLEED

Trauma is a common cause of nosebleeds

Trauma is a common cause of nosebleeds

A common, often minor, problem that causes significant anxiety for both the patient and the caregiver is the nosebleed, also known as “epistaxis”. More than 50% of the population will experience a nose bleed during their life, although only about 10% will require medical aid to stop it. Most significant bleeds will occur either at a very young age (2-10 years) or much later (50-80 years of age).

NASAL ANATOMY

Nasal Anatomy (common area of nosebleed origin circled)

Nasal Anatomy (common area of nosebleed origin circled)

The lining of the nose is supplied richly with blood vessels. When this lining is eroded, bare veins and arteries have a tendency to “leak” in a constant ooze.

About 90% of the time, the hemorrhage is coming from the front of the nose (“anterior”), near the cartilage-bearing septum. This location, known as “Little’s Area” or “Kiesselbach’s Plexus” contains numerous small arteries and veins where bleeding can originate. Bleeding comes from one nostril only in the grand majority of cases.

In a small percentage of cases, bleeding starts in back of the nose (“posterior”) where other arteries are located. These nosebleeds have a tendency to occur more often in the elderly, be heavier in volume, and more difficult to stop. The diagnosis is usually made when the usual measures for an anterior nosebleed have failed. A posterior nosebleed may be suspected by heavy bleeding from both nostrils or by blood draining down the back of the throat.

where posterior nosebleed originate (compare with anterior illustration above)

where posterior nosebleed may originate (compare with anterior illustration above)

WHY NOSEBLEEDS OCCUR

Epistaxis may occur for a number of reasons. Of course, trauma to the nose and face is a common cause. This trauma may be caused by anything from a blow to the face to excessive nose-picking. Other risk factors include:

  • Exposure to dry air, especially if very cold or very warm (say, from space heaters in winter)
  • Sinusitis and other infections affecting the nasal cavity
  • Foreign objects in the nose
  • Excessively forceful nose-blowing
  • Allergies
  • Nasal septum abnormalities or complications from surgery to correct them
  • Use of drugs inhaled through the nose. These can be recreational, such as cocaine, or therapeutic, such as afrin (oxymetazoline) or neo-synephrine. Note that Afrin and neo-synephrine are habit-forming!
  • Blood clotting disorders
  • Liver or kidney disease
  • Chronic alcohol abuse
  • Tumors in the nasal cavity
  • Non-inhaled medications that “thin” the blood, like coumadin, aspirin, plavix, nsaids, etc.

High blood pressure (Hypertension) is associated with nosebleed, but it is uncertain which is the “chicken” and which is the “egg”. Is the elevated pressure causing the bleeding or does anxiety associated with seeing blood cause the blood pressure to rise?

SIGNS OF EXCESSIVE BLEEDING

Nosebleeds rarely cause life-threatening hemorrhage, but some signs may tip you off to excessive blood loss, including:

  • Weakness
  • Fainting
  • Dizziness
  • Confusion
  • Rapid heart beat
  • Bleeding from any place other than the nose
  • The presence of fever

If modern medical facilities are available, persons with these symptoms should present there for care.

FINDING AND TREATING THE NOSEBLEED

Luckily, few nosebleeds will cause heavy bleeding and most can be treated at home by following a few general steps:

  • First and foremost, stay calm. Anxiety will speed the pulse and cause more rapid bleeding.
  • Sit up but not back; leaning forward will more effectively prevent blood from flowing down the back of your throat.
  • Using your index finger and thumb, apply pressure by tightly pinching the area of cartilage below the bony part of the nose (pinching the bony part does little to stop the bleeding). Pinch towards the face. A commercial nasal clip is available for the purpose (see image below).
  • Breathe through your mouth while holding pressure for 10 minutes.
  • If the bleeding successfully stops, don’t blow your nose, bend over, or strain for the next day.
  • If bleeding doesn’t stop, blow out residual clots and consider a spray like Afrin with 5-10 more minutes of pinching the nose.
Nasal Clip for nosebleeds

Nasal Clip for nosebleeds

If these simple instructions fail to achieve the desired result, a more thorough evaluation is warranted. To determine the location of the bleed, caregivers may spray a decongestant or saline solution into the nostrils. This will constrict the blood vessels, make visualization easier, and may even stop the bleeding. An instrument called a nasal speculum is then placed into the nostril to look inside.

using a nasal speculum and silver nitrate to cauterize an anterior bleed

using a nasal speculum and silver nitrate to cauterize an anterior bleed

If the bleeding is from an easily-seen blood vessel towards the front of the nostril, it may be cauterized with a swab stick containing a chemical called silver nitrate.

PLACING A NASAL PACK

If this fails to stop bleeding, a packing with petroleum jelly may be required to apply pressure to the leaking vessel. Other packing materials contain blood-clotting agents like Celox, which comes in a ribbon option, or drugs like oxymetazoline (Afrin) or neo-synephrine to help stop the bleed (beware of elevating blood pressures with the last two). Sometimes, synthetic sponges (Merocel) and balloons are needed to stop bleeding, especially posterior bleeding.

Placing an anterior pack

Placing an anterior pack with a “bayonet” forceps

To place a simple anterior packing into the nose, gauze impregnated with petroleum jelly is gripped with a “bayonet” forceps and inserted into the anterior nasal cavity.  The first packing layer is inserted straight back along the floor of the anterior nasal cavity, not at an upward angle. Additional layers of packing are then added in accordion-fold fashion. A nasal speculum (pictured in a previous image) can be used to hold the positioned layers down while a new layer is inserted.  Packing is continued until the nasal cavity is filled. Be aware that you could traumatize the nasal cavity if placement is poorly performed.

It should be noted that nasal packing is an uncomfortable procedure usually performed in the emergency room. Significant pressure is usually required to be effective and the packing must stay in place for a good 48 hours or so.

A true posterior bleed may be difficult to stop without specialized equipment like balloon catheters such as the Rhino-Rocket, The Epistat catheter, or the Simpson Plug. A urinary Foley catheter balloon may also be an option to apply pressure to a posterior bleed.

The "Rhino Rocket" balloon catheter

The “Rhino Rocket” balloon catheter

Although cold temperatures are known to constrict blood vessels, it is unlikely that an ice pack would effectively deliver enough cold to the origin of the hemorrhage while at the same time allowing the application of pressure to the area. Given the choice, applying pressure is more important. Having said that, ice packs are important in nasal trauma cases to decrease swelling.

Here’s a useful video on various ways to stop a nosebleed:

PREVENTING NOSEBLEEDS

Once you’ve had a significant nosebleed, you’ll do everything possible to not have another one. Here are some strategies that will decrease the chances of a recurrence:

  • Prevent nasal dryness. Moisten your nasal cavity with petroleum jelly or antibiotic ointment. Use a cotton swab to gently smear a thin layer inside several times a day, especially before going to sleep. Alternatively, use a saline nasal product. Spraying it in your nostrils helps keep the inside of your nose moist.
  • Use a humidifier to increase the humidity in your home during winter.
  • Don’t smoke. Smoking can dry out the inside of your nose.
  • Don’t pick your nose or allow your child to do so.
  • Don’t blow your nose forcefully.
  • Keep fingernails short so as not to traumatize the lining (if you must pick).
  • Avoid excessive use of decongestants and allergy medications, which can dry out your nose.
  • Discuss other medicines you take with your health care provider to make sure they aren’t a factor in your nosebleeds.

Nosebleeds can be scary, but most can be dealt with successfully with limited supplies, even in an austere environment. With some materials and knowledge, they can be a bump on the road, not the end of the road for the prepared individual.

Joe Alton MD

Joe Alton MD

Joe Alton MD

Learn more about nosebleeds and 150 other medical topics in the Third Edition of the Survival Medicine Handbook, the 2017 Book Excellence Award winner in medicine! Also, fill those medical holes in your survival supplies by checking out Nurse Amy’s entire line of kits and individual items at store.doomandbloom.net.

Avalanche Survival

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Avalanche!

Avalanche!

An avalanche, also called a “snowslide”, is a mass of snow, ice, and debris sliding rapidly down a mountainside, and is a risk to any winter hiker. Just as a snowball rolling down a hill picks up more snow as it goes, an avalanche can achieve significantly more volume and mass as it travels.

Although they rarely make the news, avalanches cause an average of 28 deaths a year. This event may seem like a rare occurrence, but it happens a lot more often than you’d think; certainly more than, say, shark attacks (which get a lot more press).

Snowslides are part and parcel of the winter wilderness experience, and it pays to know what to do if you’re caught in one.  If you’re not prepared to deal with issues associated with your environment, then you have made it your enemy.  This is not just good advice for skiers or backcountry hikers; anyone driving on mountain roads in winter could get in caught in an avalanche if not prepared.

Avalanches may be caused by simple gravity, a major snowfall, seismic tremors, or human activity. The speed and force of an avalanche may depend on whether the snow is “wet” or “dry powder”. Powder snow avalanches may reach speeds of 190 miles per hour. Wet slides travel slower, but with a great deal of force due to the density of the snowpack.

What Kills An Avalanche Victim?

These members of the 1912 Scott Expedition froze to death, but avalanche victims more likely succumb to trauma or suffocation.

These members of the 1912 Scott Expedition froze to death, but avalanche victims more likely succumb to trauma or suffocation.

You might assume that the main cause of death in this circumstance is freezing to death. There are other ways, however, that are more likely to end the life of an avalanche victim:

Trauma:  serious injury is not uncommon in an avalanche, and not just due to the weight of the snow. Debris, such as rocks, branches, and even entire trees, can be carried along in the cascade and cause life-ending traumatic wounds.

Suffocation:  When buried in the snow, asphyxiation is a major risk.  Densely packed snow is like concrete; many victims may find themselves immobilized and unable to dig themselves out of trouble.

Hypothermia: Hypothermia is, surprisingly, the cause of death of only a small percentage of avalanche victims. It’s much more likely that they will perish due to traumatic injury or suffocation before they freeze to death.

Factors involved in deciding your fate include:

  • The density of the snowpack
  • The presence of air pockets for breathing (or the lack of them)
  • The position of the body in the snow (if not upright, you’ll be disoriented)
  • Traumatic injuries sustained
  • The availability of rescue equipment at the scene

Important Avalanche Survival Basics and Equipment

On any wilderness outing, it makes sense to go prepared. Appropriately warm clothing for the weather is, of course, a basic concern in winter. Food, water, heat packs, spare dry clothing, and a cell phone are just some of the items you should take with you if you’re attempting a mountain hike in January.

In avalanche country, space yourselves out

In avalanche country, space yourselves out

Most backcountry expeditions are best attempted in a group. That goes for avalanche country, as well, except for one thing: Space yourselves out far enough so that there’s not too much weight on any one area of snow. If a member of your party is buried in the snow, know that you have to act quickly to find them and dig them out. It’s unlikely that going for help will end in a successful rescue. Therefore, it’s especially important to have some specialized items in avalanche country.

Recommended gear (besides warm clothing) would include:

PIEPS avalanche beacon

PIEPS avalanche beacon

An avalanche beacon:  A device that emits a pulsed radio signal.  Everyone in the group carries one. If a member gets buried in an avalanche, the rest of the party picks up the signal from under the snow. The receivers interpret the signal into a display that aids the search.

An avalanche shovel:  Lightweight short aluminum shovels that fit inside your backpack and help chop and remove snow and debris on top of a buried hiker. These shovels usually have telescoping shafts. Shovels with D-shaped grips can be used with mittens.

rescue team with avalanche probes

rescue team with avalanche probes

An avalanche probe: Essentially, a stick that helps you pinpoint the exact location of an avalanche victim and see how far down he/she is. 2 meters or more in length, you can use the probe to tell a victim under the snow from the ground; the victim will feel “softer”.

A helmet: Many fatalities occur due to head trauma from rocks and debris flung around by the snow.

Skier’s Air Bags:  Relatively new, these brightly colored air bags auto-inflate with a trigger; they work like a lifejacket to keep you buoyant and, therefore, closer to the surface and easier to find.

Ortovox Skier Air Bags

Ortovox Skier Air Bags

avalanche air bags in action

avalanche air bags in action

What To Do As The Avalanche Starts

83% of avalanches in recreational settings are triggered by the victim. To survive, quick thinking and rapid action will be needed:

Yell: Let everyone in your group know that you’re in trouble. At the very start of the slide, wave your arms and shout as loud as you can to alert as many people as possible to your location.

Move. If you started the avalanche, you may notice a crevice forming in the snow.  Jump uphill of it quickly and you might not get carried off.  If this isn’t an option, run sideways as fast as you can away from the center of the event, which is where the snow will be moving fastest and with the most force.

Get Lighter. Heavier objects sink in snow, so jettison unnecessary heavy equipment so that you’ll be closer to the surface. Throwing off something light isn’t a bad idea either: A loose glove or hat on top of the snow could signal rescuers to your general location and save precious time.  Deploy your avalanche air bag if you have one.

Hug a tree (or rock). If the avalanche is relatively small, you could grab the nearest immobile object and hold on for dear life.  In a very large avalanche, trees and rocks may not be safe anchors; trees can be uprooted by the force of the snowslide.

"Swimming" in an avalanche

“Swimming” in an avalanche

Swim!  To survive an avalanche, the key is to stay as close to the top of the snow as possible. Increase your surface area by spreading your legs (feet downhill) and raising your hands. While in this position, swing your arms while trying to stay on your back (it’s easier to breathe if face up), similar to swimming backstroke.  With any luck, this strategy will keep you towards the surface of the snow.

What To Do If You’re Buried In The Snow

You did your best, but still got completely buried in the snow.  You’ve got maybe 15-30 minutes, on average, before you suffocate.  Snow may be porous, but warm breath melts the snow which then refreezes as solid ice.  This makes breathing difficult.

As the snow slows: The larger the air pocket you have, the longer you’ll survive.  As the snowslide slows to a stop, put one arm in front of your face in such a way as to form a space that will give you the most air. If possible, raise the other arm straight up toward the avalanche surface.  Your glove might signal your location to rescuers.  Expand your chest by inhaling deeply so that you have more room to breathe once the snow has settled.

Once buried: Once you are completely buried, the snowpack may be so dense as to prevent you from moving. Stay calm, in order to use up less oxygen.  If you’re not sure which way is up, spit.  The spit will go towards the ground due to gravity.  If you can move, work to make a bigger air pocket in the direction of the surface.

You’ll only have a second or two to act to avoid most avalanches.  Rapid action, and some basic rescue equipment, may prevent you from being the harsh winter’s latest victim.

Joe Alton MD

Joe Alton MD

Joe Alton MD

Find out about how to survive avalanche and just about every other kind of natural disaster, plus much more, in the 700 page Third Edition of the Survival Medicine Handbook!

Winner of the 2017 Book Excellence Award in Medicine

Winner of the 2017 Book Excellence Award in Medicine

Diseases Caused By Food And Water Contamination

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Even healthy-looking fruit can contain contaminants

Even healthy-looking fruit can contain contaminants

The primary necessity for survival is the availability of air. Once you have air to breathe, water, food, and shelter become the next requirements for your continued existence on the planet; that is, clean water and properly prepared food.

Even in normal times, there are many instances where an outbreak of infectious disease occurs due to water of poor quality. Ingesting food that was incompletely cooked caused the deaths of medieval kings in medieval times and may even have sparked the Ebola epidemic in 2014.

Epidemics caused by organisms that cause severe diarrhea and dehydration have been a part of the human experience since before recorded history. If severe enough, dehydration can cause hypovolemic shock, organ failure, and death. Indeed, during the Civil War, more deaths were attributed to dehydration from infectious diseases than from bullets or shrapnel.

More soldiers died from infectious disease than from bullets or shrapnel in the Civil War

More soldiers died from infectious disease than from bullets or shrapnel in the Civil War

Off the grid, water used for drinking or cooking can be contaminated by anything from floods to a dead opossum upstream from your camp. This can have dire implications for those living where there is no access to large amounts of IV hydration.

Therefore, it stands to reason that the preparation of food and the disinfection of drinking water should be under supervision. In survival, this responsibility should fall to the community medic; it is the medic that will (after the patient, of course) be most impacted by failure to maintain good sanitation.

Many diseases have disastrous intestinal consequences leading to dehydration. They include:

Cholera: Caused by the marine and freshwater bacterium Vibrio cholera, Cholera has been the cause of many deaths in both the distant and recent past. It may, once again, be an issue in the uncertain future.

Cholera toxins produce a rapid onset of diarrhea and vomiting within a few hours to 2 days of infection. Victims often complain of leg cramps. The body water loss with untreated cholera is associated with a sixty per cent death rate. Aggressive efforts to rehydrate the patient, however, drops the death rate to only one per cent. Antibiotic therapy with doxycycline or tetracycline seems to shorten the duration of illness.

This is the bowel movement of someone with Cholera

This is the bowel movement of someone with Cholera

Typhus: A complex of diseases caused by bacteria in the Rickettsia family, Typhus is transmitted by fleas and ticks to humans in unsanitary surroundings, and is mentioned here due to its frequent confusion with “Typh-oid” fever, a disease caused by contaminated, undercooked food.

Although it rarely causes severe diarrhea, Typhus can cause significant dehydration due to high fevers and other flu-like symptoms. Five to nine days after infection, a rash begins on the torso and spreads to the extremities, sparing the face, palm, and soles. Doxycycline is the drug of choice for this disease.

Typhoid: Infection with the bacteria Salmonella typhi is called “Typh-oid fever”, because it is often confused with Typhus. Contamination with Salmonella in food occurs more often than with any other bacteria in the United States.

In Typhoid fever, there is a gradual onset of high fevers over the course of several days. Abdominal pain, intestinal hemorrhage, weakness, headaches, constipation, and bloody diarrhea may occur. A number of people develop a spotty, rose-colored rash. Ciprofloxacin is the antibiotic of choice but most victims improve with rehydration therapy.

Dysentery: An intestinal inflammation in the large intestine that presents with fever, abdominal pain, and severe bloody or watery mucus diarrhea. Symptoms usually begin one to three days after exposure. Dysentery, a major cause of death among Civil War soldiers, is a classic example of a disease that can be prevented with strict hand hygiene after bowel movements.

Shigella

Shigella dysenteriae

The most common form of dysentery in North America and Europe is caused by the bacteria Shigella and is called “bacillary dysentery”.  It is spread through contaminated food and water, and crowded unsanitary conditions. Ciprofloxacin and Sulfa drugs, in conjunction with oral rehydration, are effective therapies.

Another type is caused by an organism you may have read about in science class: the amoeba, a protozoan known as Entamoeba histolytica. Amoebic dysentery is more commonly seen in warmer climates. Metronidazole is the antibiotic of choice.

Traveler’s Diarrhea: An inflammation of the small intestine most commonly caused by the Bacterium Escherichia coli (E. coli). Most strains of this bacteria are normal inhabitants of the human intestinal tract, but one (E. coli O157:H7) produces a toxin (the “Shiga” toxin) that can cause severe “food poisoning”. The Shiga toxin has even been classified as a bioterror agent.

In this illness, sudden onset of watery diarrhea, often with blood, develops within one to three days of exposure accompanied by fever, gas, and abdominal cramping. Rapid rehydration and treatment with antibiotics such as Azithromycin and Ciprofloxacin is helpful. The CDC no longer recommends taking antibiotics in advance of a journey, but does suggest that Pepto-Bismol or Kaopectate (Bismuth Subsalicylate), two tablets four times a day, may decrease the likelihood of Traveler’s Diarrhea.

Campylobacter: The second most common cause of foodborne illness in the U.S. after Salmonella, this bacteria resides in the intestinal tract of chickens and causes sickness when meat is undercooked or improperly processed. It’s thought that a significant percentage of retail poultry products contain colonies of one variety, Campylobacter Jejuni. It is characterized as bloody diarrhea, fever, nausea, and cramping which begins two to five days after exposure. Although controversial, Erythromycin may decrease the duration of illness if taken early.

Trichinosis: Trichinosis is caused by the parasitic roundworm Trichinella in undercooked meat, mostly from domesticated pigs. Trichinosis causes diarrhea and other intestinal symptoms, usually starting one to two days after exposure. Fever, headache, itchiness, muscle pains, and swelling around the eyes occur up to 2 weeks later. Recovery is usually slow, even with treatment with the anti-helminthic (anti-worm) drugs Mebendazole and Albendazole (Albenza).

Giardia Lamblia

Giardia Lamblia

Giardiasis: The most common disease-causing parasite in the world is the protozoa Giardia lamblia. It has even been found in backcountry waters in many national parks in the U.S. Symptoms may present as early as one day after exposure, although it more commonly presents in one to two weeks. Patients complain of watery diarrhea, abdominal cramping, violent (often called “projectile”) vomiting, and gas. Metronidazole is the drug of choice in conjunction with oral rehydration.

There are many other pathogens that can cause life-threatening dehydration if untreated. Although we have mentioned common antibiotic treatments where applicable, most of the above will resolve on their own over time with strict attention to oral (or intravenous) rehydration. Many antibiotics (Cipro is an example) are associated with adverse effects that can be worse than the illness they’re designed to treat, so use judiciously.

It should be noted that some of these illnesses may be mimicked by viruses that are completely unaffected by antibiotics, such as Norovirus. Norovirus has been implicated in many of the outbreaks you read about on cruise ships.

Air, food, water, and shelter is necessary for survival. Bad air, food, water, and shelter leads to the next requirement, and that is medical supplies. Have a good medical kit and know how to use all its components. If you can accomplish this goal, you’ll be an effective medic if things go South.

Joe Alton MD

Joe Alton MD

Joe Alton MD

Find out more about infectious disease and 150 other survival medical topics in the award-winning “Survival Medicine Handbook“, now in its 700-page Third Edition. Plus, fill those holes in your medical supplies with kits and individual items from Nurse Amy’s store at store.doomandbloom.net.

Survival Medicine Hour: Cold Weather Issues On The Trail, In The Car, At Home

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Dang, it's cold!

Dang, it’s cold!

It’s January, and bitter cold has already engulfed much of North America, with heavy snowfall and high winds causing all sorts of issues that might be hazardous to your health. Nurse Amy and Dr. Bones (Joe Alton MD and Amy Alton ARNP) go over a myriad of cold weather issues like hypothermia, winter car survival if stranded, and more. .

We pleased to announce that KYAH in the great state of Utah is now carrying our show on land-based radio!

We wish you the best of health in 2018!

Joe and Amy Alton

The Altons

The Altons

For medical kits, individual supplies and our books/dvds, go to store.doomandbloom.net

Survival Medicine Hour: Cellulitis, Spirituality of and Realities for the Medic, More

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SURVIVAL MEDICINE HOUR #369

spirituality and survival

spirituality and survival

In this episode of the Survival Medicine Hour, Joe Alton MD and Amy Alton ARNP discuss the role of spirituality in survival, and the role hope plays in keeping people resilient in the face of adversity. Also, some hard realities the medic must confront in long-term survival scenarios and the role natural plant products will play in keeping people healthy when the medications run out.

Cellulitis: An epidemic off the grid?

Cellulitis: An epidemic off the grid?

Plus, a discussion of one of the most common issues that will attend injuries in survival settings: cellulitis, or soft tissue infections. People performing activities of daily survival get injured and those injuries can get infected. How do you recognize these infections, and what can you use to treat them?

All this and more in the Doom and Bloom(tm) Survival Medicine Hour with Joe and Amy Alton!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/12/22/survival-medicine-hour-spirituality-and-survival-cellulitis-medic-realities

 

Wishing you the best of health in good times or bad (and a Merry Christmas)!

Have a Corgi Christmas!

Have a Corgi Christmas!

Follow us on Twitter @preppershow; on Facebook @Doom and Bloom(tm);on Youtube’s DrBones NurseAmy channel!

Don’t forget the award-winning Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, as well as the kits and supplies at Nurse Amy’s store at store.doomandbloom.net.

 

Essential Oils As Medical Tools

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ESSENTIAL OILS

Essential Oils As Survival Tools

Essential Oils As Survival Tools

Recently, I wrote an article about the use of herbal teas for their medicinal benefits. For the medic who is concerned about long-term survival scenarios, a hard reality is that stored pharmaceuticals will run out over time. This leaves them with only natural options, such as the plants that grow in their own backyard. These were used with skill by our ancestors, who had little else to treat sickness and injury.

While teas are the simplest way to utilize your medicinal herbs, many swear by essential oils as a storage option with other medical supplies. These items have much more longevity than fresh plants and can include those that don’t naturally grow in the area.

Essential Oils Contain Various Compounds

Essential Oils Contain Various Compounds

An essential oil is distilled from whole plant material, not a single ingredient; therefore, each one has multiple compounds that might be medically useful. To take an example, English lavender has about 20 different chemicals, including esters, ketones, and terpenes. These combinations make each oil unique. Oils may be produced from leaves, bark, flowers, resin, fruit or roots. For example, Lemon oil comes from the peel, Lavender oil from flowers, and Cinnamon oil from bark.

Although you might not realize it, you’ve been using essential oils all your life in soaps, furniture polishes, perfumes, and ointments. Previous generations of conventional physicians commonly included them in their medical bags. Indeed, many standard medical texts of the past were really instruction manuals on how to use these products.

Distilling Essential Oils Requires Equipment

One Way To Make Essential Oils: Distillation

Essential oils aren’t easy to produce without distillery equipment. Although it only takes a few leaves of peppermint to make a tea, you would need 5 pounds of leaves to make 1 ounce of essential oil. One source states that it takes an entire acre of peppermint to produce just 12 pounds of oil. The same source says that 12,000 rose blossoms are required to produce a tablespoon of rose oil. These concentrated versions are the ones you see marketed in small, dark bottles. Unless you intend to buy distilling materials, you should accumulate essential oils in quantity but use them sparingly.

The strength or quality of the oil is dependent on multiple factors, including soil conditions, season harvested, subspecies of plant, rainfall, and, in some cases, even the time of day. This is akin to the conditions that determine the quality of a particular vintage of wine. It also explains the significant variance you’ll see in the effects of the same oil from year to year.

You might be surprised to learn that the Food and Drug Administration only requires 10% essential oil in the bottle for it to be marketed as “Pure Essential Oil”. Beware of claims of FDA certification; the FDA has no certification or approval process for these products.

Making Essential Oils

The manufacture of essential oils, known as “extraction”, can be achieved by various methods:

Distillation Method: Using a “still” like old-time moonshiners, water is boiled through an amount of plant material to produce a steam that travels through cooled coils. This steam condenses into a “mixture” of oil and water from which the oil can be extracted

Pressing Method: The oils of citrus fruit can be isolated by a technique which involves putting the peels through a “press”. This works well only with the oiliest of plant materials, such as orange skins.

Maceration Method: a fixed oil (sometimes called “carrier” oil) or lard may be combined with the plant part and exposed to the sun over time, causing the fixed oil to become infused with the plant “essence”. Oftentimes, a heat source is used to move the process along. The plant material may be added several times during the process to manufacture stronger versions. This is the method by which you obtain products such as “garlic-infused olive oil”. A similar process using flowers is referred to as “Enfleurage”.

Solvent Method: Alcohol and other solvents may be used on some plant parts, usually flowers, to release the essential oil in a multi-step process.

As each essential oil has different chemical compounds in it, it stands to reason that the medicinal benefits are also different. An entire alternative medical discipline has developed to find the appropriate oil for the condition that needs treatment. The method of treatment may differ, as well. Common methods are:

1) Inhalation Therapy: This method is also known as “aroma- therapy”. The simplest  way to perform direct inhalation therapy involves putting 2 or 3 drops of essential oil on your hands, rubbing them together, and inhaling.

Steam inhalation therapy utilizes the addition of a few drops of the essential oil in a bowl of steaming water (distilled or sterilized), which is then inhaled. This method is most effective when placing a towel over your head to catch the vapors.

Many people will place essential oils in potpourri or use a “diffuser” to spread the aroma throughout the room. This technique probably dilutes any medicinal effects, however.

2) Topical Application: The skin is an amazing absorbent surface, and using essential oils by direct application is a popular method of administration. The oil may be used as part of a massage, or directly placed on the skin to achieve a therapeutic effect on a rash or aching muscle.

It’s wise to always test for allergic reactions before using an essential oil in this manner: Even though the chemical compounds in the oil are natural, you could still exhibit an allergy to it or be irritated by it (case in point: poison ivy).

A simple test involves placing a couple of drops on the inside of your forearm with a cotton applicator. Within 12-24 hours, you’ll notice redness and itching if you’re allergic. Mixing some of the essential oil with a “carrier” oil such as olive oil before use is a safer option for topical use. Another concern, mostly with citrus oils applied to the skin, is “phototoxicity” (an exaggerated burn response to sun exposure).

Although we have seen many sources recommend applying essential oil over the location of an internal organ, some reservations exist about whether such an application will really have an effect on that organ. It is much more likely to work on skin issues or, perhaps, underlying muscle tissue.

3) Ingestion: Direct ingestion is unwise for many essential oils, and this method should be used with caution. Professional guidance is imperative when considering this method, except for a very few instances. A reasonable alternative to consider is a tea made with the dried herb. This is a safer mode of internal use, but the effect may not be as strong.

Hard Data?

Hard Data on Oils is Not Always Easy To Find

Hard Data on Oils is Not Always Easy To Find

Essential oils have been used as medical treatment for a very long time, but it’s difficult to provide definitive evidence of their effectiveness for several reasons. Essential oils are difficult to standardize, due to variance in the quality of the product based on soil conditions, time of year, and other factors that we mentioned above.

In addition, there are many subspecies of plants that may differ in their effects. An essential oil of Eucalyptus, for example, may be obtained from Eucalyptus Globulus or Eucalyptus Radiata; these plants may have their own unique properties. These factors combine to make scientific study problematic.

In most university experiments, a major effort is made to be certain that the substance tested caused the results obtained. As essential oils have a number of different compounds and are often marketed as blends, which ingredient was the cause of the effect? If the oil is applied with massage, was the effect related to the oil itself or from the physical therapy?

The majority of studies on essential oils have been conducted by the cosmetics and food industries. Others have been conducted by individuals or small companies with a vested interest in the product.

Definitive studies of possible medicinal benefits are usually performed in universities sponsored by the pharmaceutical industry. Unfortunately, they generally have little interest in herbal products because they are hard to patent. Therefore, serious funding is hard to find because of the limited profit potential.

Commonly Used Essential Oils

There are many types of essential oils

There are many types of essential oils

Despite the lack of hard data, essential oils have various reported beneficial effects, mainly based on their historical use on thousands of patients by generations of healers. Although there are many essential oils, a number of them are considered mainstays of any herbal medicine cabinet. Here are some of the most popular:

purple colored lavender flowers smell really good and they have medicinal properties

Lavender is a very popular oil

Lavender Oil: An analgesic (pain reliever), antiseptic, and immune stimulant. It is thought to be good for skin care and to pro- mote healing, especially in burns, bruises, scrapes, acne, rashes and bug bites. Lavender has a calming effect and is used for insomnia, stress and depression. It has been reported effective as a decongestant through steam inhalation. Lavender oil may have benefit as an antifungal agent, and has been used for athlete’s foot or other related conditions.

Eucalyptus Oil: An antiseptic, antiviral, and decongestant (also an excellent insect repellent), Eucalyptus oil has a “cooling” effect on skin. It aids with respiratory issues and is thought to boost the immune system. Consider its use for flus, colds, sore throats, coughs, sinusitis, bronchitis, and hay fever. Eucalyptus may be used in massages, steam inhalation, and as a bath additive. Although eucalyptus oil has been used in cough medicine, it is likely greatly diluted and should not be ingested in pure form.

Melaleuca (Tea Tree) Oil: Diluted in a carrier oil such as coconut, Tea Tree oil may be good for athlete’s foot, acne, skin wounds, and even insect bites. In the garden, Tea Tree oil is a reasonable organic method of pest control. In inhalation therapy, it is reported to help relieve respiratory congestion. Studies have been performed which find it effective against both Staphylococcus and fungal infections. Some even recommend a few drops in a pint of water for use as a vaginal douche to treat yeast. Tea Tree oil may be toxic if ingested or used in high concentrations, around sensitive areas like the eyes.

Peppermint Oil: This oil is said to have various therapeutic effects: antiseptic, antibacterial, decongestant, and anti-emetic (stops vomiting). Peppermint oil is claimed to help for digestive disorders when applied directly to the abdomen. Some herbalists prescribe Peppermint for headache; massage a drop or two to the temples as needed. For achy muscles or painful joints, massage the diluted oil externally onto the affected area. As mentioned previously, definitive proof of topical application effects on deep organs is difficult to find.

Lemon Oil: Used for many years as a surface disinfectant, it is often found in furniture cleaners. Many seem to think that this disinfecting action makes it good for sterilizing water, but there is no evidence that it is as effective as any of the standard methods, such as boiling. Lemon oil is thought to have a calming effect; some businesses claim to have better results from their employees when they use it as aromatherapy. Don’t apply this oil on the skin if you will be exposed to the sun that day, due to increased likelihood of burns.

Clove Bud Oil Is A Dental Anesthetic

Clove Bud Oil Is A Dental Anesthetic

Clove Oil: Although thought to have multiple uses as an anti-fungal, antiseptic, antiviral, analgesic, and sedative, Clove oil particularly shines as an anesthetic and antimicrobial. It is marketed as “Eugenol” to dentists throughout the world as a natural painkiller for toothaches. A toothpaste can be made by combining clove oil and baking soda. When mixed with zinc oxide powder, it makes a temporary cement for lost fillings and loose crowns. Use Clove oil with caution, however, as it may have an irritant effect on the gums if too much is applied.

Arnica Oil: Arnica oil is used as a topical agent for muscle injuries and aches. Thought to be analgesic and anti-inflammatory, it is found in a number of sports ointments. As a personal aside, we have tested this oil on ourselves and found it to be effective, though not very long lasting. Frequent application would be needed for long term relief. Although some essential oils are used as aromatherapy, Arnica oil is toxic if inhaled.

Chamomile Oil: There are at least two versions of Chamomile oil, Roman and German. Roman Chamomile is a watery oil, while German Chamomile seems more viscous. Both are used to treat skin conditions such as eczema as well as irritations due to allergies. Chamomile oil is thought to decrease gastrointestinal inflammation and irritation, and is thought have a calming effect as aromatherapy, especially in children.

Geranium Oil: Although variable in its effects based on the species of plant used, Geranium oil is reported to inhibit the production of sebum in the skin, and may be helpful in controlling acne. Some believe that it also may have hemostatic (blood-clotting) properties, and is often recommended for bleeding from small cuts and bruising. When a small amount of oil is diluted in shampoo, it may be considered a treatment for head lice.

Helichrysum Oil: Thought to be a strong analgesic and anti-inflammatory, Helichrysum is used to treat arthritis, tendonitis, carpal tunnel syndrome, and fibromyalgia as part of massage therapy. It has also been offered as a treatment for chronic skin irritation

Rosemary is a versatile oil

Rosemary is a versatile oil

Rosemary Oil: Represented as having multiple uses as an antibacterial, anti-fungal, and anti-parasitic, Rosemary oil is proven to control spider mites in gardens. Use a few drops with water for a disinfectant mouthwash. Inhalation, either cold or steamed, may relieve congested or constricted respiration. Mixed with a carrier oil, it is used to treat tension headaches and muscle aches

Clary Sage Oil: One of the various chemical constituents of Clary Sage has a composition similar to estrogen. It has been used to treat menstrual irregularities, premenstrual syndrome, and other hormonal issues. Sage is also believed to have a mild anticoagulant effect, and may have some use as a blood thinner. Clary Sage also is thought to have some sedative effect, and has been used as a sleep aid.

Neem Oil: With over 150 chemical ingredients, the Neem tree is called “the village pharmacy” in its native India. Many Ayurvedic alternative remedies have some form of Neem oil in them. Proven as a natural organic pesticide, we personally use Neem Oil in our garden. Reported medicinal benefits are too numerous to list here and seem to cover just about every organ system. It should be noted, however, that it may be toxic when the oil is taken internally.

Wintergreen Oil: A source of natural salicylates, Wintergreen oil is a proven anticoagulant and analgesic. About 1 fluid ounce of Wintergreen Oil is the equivalent of 171 aspirin tablets if ingested, so use extreme caution. It may also have beneficial effects on intestinal spasms and might reduce elevated blood pressures.

Frankincense Oil: One of the earliest documented essential oils, evidence of its use goes back 5000 years to ancient Egypt. Catholics will recognize it as the incense used during religious ceremonies. Studies from Johns Hopkins and Hebrew Universities state that Frankincense relieves anxiety and depression in mice (we’re unsure how, exactly, this was determined, but it probably involved a cat). Direct application of the oil may have antibacterial and antifungal properties, and is thought to be helpful for wound healing. As a cold or steam inhalant, it is some- times used for lung and nasal congestion.

Blue Tansy Oil: Helpful in the garden as a companion plant for organic pest control, Blue Tansy is sometimes planted along with potatoes and other vegetables. The oil has been used for years to treat intestinal worms and other parasites. One of its constituents, Camphor, is used in medicinal chest rubs and ointments. In the past, it has been used in certain dental procedures as an antibacterial.

Oregano Oil: An antiseptic, oregano oil has been used in the past as an antibacterial agent. It should be noted that Oregano oil is derived from a different species of the plant than the Oregano used in cooking. One of the minority of essential oils that are safe to ingest, it is thought to be helpful in calming stomach upset, and may help relieve sore throats. Its antibacterial action leads some to use the oil in topical applications on skin infections when diluted with a carrier oil. Oregano Oil may reduce the body’s ability to absorb iron, so consider an iron supplement if you use this regularly.

Thyme Oil: Reported to have significant antimicrobial action, diluted Thyme oil is used to cure skin infections, and may be helpful for ringworm and athlete’s foot. Thyme is sometimes used to reduce intestinal cramps in massage therapy. As inhalation therapy, it may loosen congestion from upper respiratory infections.

“Thieves’ Oil”: Many essential oils are marketed as blends, such as “Thieves’ Oil”. This is a combination of clove, lemon, cinnamon bark, eucalyptus, and rosemary essential oils. Touted to treat a broad variety of ailments, studies at Weber State University indicate a good success rate in killing airborne viruses and bacteria. Of course, the more elements in the mixture, the higher chance for adverse reactions, such as phototoxicity.

I’m sure I missed some of your favorites. There are as many oils as there are species of plants.

Many oils aren't proven safe in pregnancy

Many oils aren’t proven safe in pregnancy

Some important caveats to the above list should be stated here. Many of the essential oils listed are unsafe to use in pregnancy, and some may even cause miscarriage. Also, allergic reactions to essential oils, especially on the skin, are not uncommon; use the allergy test we described earlier before starting regular topical applications.

Even though essential oils are natural substances, they may interact with medicines that you may regularly take or have adverse effects on chronic illness such as liver disease, epilepsy, or high blood pressure. Thorough research is required to determine whether a particular essential oil is safe to use.

Having said that, essential oils are a viable option for many conditions. Anyone interested in maintaining their family’s well-being, especially off the grid, should regard them as another weapon in the medical arsenal. Learn about them with an open mind, but maintain a healthy skepticism especially about “cure-all” claims.

Joe Alton MD

Dr. Alton

Dr. Alton

Learn more about natural remedies and 150 other topics on survival medicine with the 2017 Book Excellence Award winner in medicine, “The Survival Medicine Handbook: The Essential Guide For When Medical Help is Not on the Way”.

Herbal Teas as Medicinal Tools

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HERBAL TEAS

herbal teas

herbal teas (image by pixabay)

In a long-term disaster setting where you are knocked off the grid, medical supplies expended and medicines dispensed over time may not be easily replaced. When confronted with dwindling access to the tools needed by the survival medic to keep people healthy, it becomes clear that knowledge of natural remedies is important.

Every medic must determine whether they believe a long-term survival scenario is a possibility. If this is their concern, they must not only have a sizable amount of supplies and medicine, but also a realization that they eventually must turn to the plants in their own backyard that may have medicinal benefit.

For long term storage, the preparedness community has turned primarily to essential oils as a natural alternative. These are, indeed, some of the best natural products the medic can stockpile due to their longevity. Producing new supplies of them, however, is problematic. Without distilling equipment and a large amount of plant material, you will not be able to replenish oils in any significant quantity.

purple colored lavender flowers smell really good and they have medicinal properties

It takes a lot of lavender to make an oil

A more realistic option for sustainable herbal medicines is using fresh or dried plant materials in teas. These require little more than a garden and some knowledge regarding each herb.

It should be noted that the term “tea” is incorrect: The word actually refers to various drinks made from the leaves of one species, Camellia sinensis. Green, black, white, and oolong teas are made from the same plant; only the processing differs. The proper term for a drink made by steeping herbs in hot water would be an “herbal infusion” or “tisane”. For simplicity’s sake, though, we’ll call them teas.

Standard teas from Camellia Sinensis, like green, black, white, and oolong, are high in antioxidants with many health benefits ascribed to them for various medical issues. These include heart disease, type 2 diabetes, liver dysfunction, and more.

Making a tea is one of the simplest ways to prepare medicinal herbs. If you can boil water, you can brew tea. You just:

  • Bring some water to a roiling boil in a pot or other container. Crush the herb leaves, roots, and/or flowers.
  • Pour the boiled water over 1 teaspoon of herbs and let steep for about five or ten minutes
  • Keep a cover on while steeping.
  • Unless using a tea bag or “bob”, place a strainer over a cup, and pour.
  • Use honey or lemon to add flavor if desired.

A tea doesn’t have to be ingested to be of benefit: Some may be used as an eye wash, an irrigation solution for wounds, or in cold or warm compresses.

There are many herbs that can be made into a tea. Although some of the information below lacks hard scientific data, these are just some of the teas made by your ancestors for medicinal purposes.

Alfalfa: The seeds and leaves contain vitamins A, C, E, and K, as well as calcium, phosphorous, iron, and potassium. It has been used as a diuretic to help urine flow and for upset stomachs. There are claims that it helps arthritis pain and may lower cholesterol. Use 1 to 2 teaspoons of dried leaves, steeped in 1 cup of boiling water, for 10-20 minutes.

Burdock: The dried root has been used in teas to help clear acne and to treat psoriasis. Use 2 tablespoons of fresh grated root or 1 tablespoon of well-dried root in 3 cups of boiling water.

Catnip: Leaves and flowers are used to treat intestinal cramping, indigestion, diarrhea, and other stomach ailments. Also thought to treat respiratory infections like the common cold. A substance in catnip called nepetalactone is thought to produce a mild sedative effect. Use 1 teaspoon of dried leaves or 1 tablespoon of fresh leaves per cup.

Chamomile: This popular tea contains the amino acid Tryptophan, which gives it a sedative and relaxing effect. As such, it may help treat anxiety and insomnia. Antioxidants in chamomile may help slow down progression of visual, kidney, and nerve damage in diabetics. Use 2-3 teaspoons of dried flowers per cup.

Chicory: When supplies of coffee ran out, soldiers in the Civil War used the root of this common plant as a substitute. It doesn’t have caffeine, though, and has more of a sedative than stimulant effect in large amounts. Chicory root has an effect against intestinal worms, and has been shown in animal studies to improve calcium absorption and bone mineral density. Scrape the “bark” off the root before drying; use 1 teaspoon to 1 cup of water. Tea made from leaves has a laxative effect.

dandelion tea

dandelion tea

Dandelion: You might be surprised to know that the common dandelion contains vitamins and minerals. Indeed, it’s thought to have more beta-carotene than a similar serving of carrots. Young flowers and leaves make a good tea for constipation (steep for 20 minutes). Roasting the roots produces a coffee-like drink; use 2 teaspoons of dried chopped root in 1 cup of water.

Echinacea: Well-known to decrease the duration of colds and flus, Echinacea boosts the immune system and may have some antiviral activity. Steep 1-2 teaspoons of leaf, flower, or ½ teaspoon of root to 1 cup of boiling water.

Elder: Elderberry flowers make a tea that is used for many upper respiratory infections such as sinusitis, colds, flus, and laryngitis. Applied in a compress, the tea may be helpful for wound healing and some skin conditions.

The blue or purple berries are high in antioxidants and may be made into a juice or syrup: Put two pounds of elderberries and four cups of water and bring to a boil, then simmer for a half hour. Use a fine mesh strainer to press out the juice. Sugar may be added under medium heat to make a syrup.

Eucalyptus: Tea made from eucalyptus leaves offers relief from asthma as well as respiratory infections, mostly by opening airways and loosening thick mucus. It may have antibacterial and antiviral effects. Steep ½ teaspoon of dried or fresh leaves in 1-2 cups of water.

ginger rhizome

ginger rhizome

Ginger: The underground stems, or rhizomes, of Ginger are used to treat nausea of all types from morning sickness to motion sickness. Slice one inch of the rhizome into small pieces and simmer in two cups of water on low heat for 15 minutes. Then strain. ¼ – ½ teaspoon of ginger powder is another option.

Ginseng: Both Asian and American Ginseng root can be made into herbal teas that are thought to lower blood sugar levels, a useful benefit for those with diabetes. Simmer three to six teaspoons of the root for 45 minutes in three or four cups of water, then strain.

Lavender: Used in aromatherapy, lavender may improve nausea and other digestive symptoms when drunk as a tea. It’s thought to decrease migraine headaches and possibly limit convulsions and muscle spasms. Use 1 tablespoon of dried herb in 1 cup of water.

Lemon Balm: An herb with antiviral effects, it’s a member of the mint family. A tea made from lemon balm leaves and flowers was used in the past to treat mouth, throat, and dental infections like gingivitis and herpes sores. It’s also thought to decrease anxiety, aid sleep, and may help improve intestinal spasms and nausea. Add 1 teaspoon of dried herb or 5-6 fresh leaves to one cup of boiling water.

Licorice: Better known as an ingredient in candy, its coating properties may help with sore throats, coughs, and heartburn. Licorice can, however, raise blood pressure and should be avoided during pregnancy. Add 1-2 teaspoons of chopped root to 2 cups of boiling water. Drink ½ cup at a time.

Passionflower: Tea made from passionflower has a beneficial effect on anxiety and may serve as a sleep aid if taken regularly. Boil 1-2 teaspoons of herb (avoid the root) in 2 cups of water for 5-10 minutes.

Peppermint: A long-standing herbal remedy, tea made from peppermint calms the stomach and helps Irritable Bowel Syndrome (IBS), but can worsen heartburn. The tea helps thin respiratory mucus and relieves nasal congestion. Put 1 teaspoon of dried herb or 6-8 fresh leaves over 1 cup of boiling water.

rose hips

rose hips

Rose: Rose “hips” make a tea with vitamin C, as well as calcium, selenium, zinc, manganese, and others. It boosts the immune system and is thought to be beneficial for the adrenal gland, responsible for the stress hormone cortisol. Boil 1 teaspoon of dried rose hips in water and steep for 20 minutes.

Sage: Sage leaf tea is a time-honored remedy for sore throat as well as the common cold as a tea or gargle. It may also aid digestion, decrease cramping, and may even improve memory. Steep 1 teaspoon of dried leaves in one cup of water.

Stinging Nettle: Stinging nettle root is thought to have benefits as a diuretic to improve urine flow, even in those with enlarged prostates. The leaves may decrease the pain of arthritis in joints. Use 1 teaspoon dried leaves in 1 cup boiling water or boil 5 grams of dried root in 2 cups of water for 5-10 minutes.

St. John’s Wort: One of the few herbs that has known activity against minor depression, it has been called “herbal Prozac”. Beware of interactions with prescription drugs, however. Pour 1 cup of boiling water over 1 teaspoon of herb.

Thyme: Teas made from thyme will loosen thick phlegm and may help coughs. It’s known to inhibit bacteria, viruses, and fungi, including many that cause respiratory infections. Steep 1 to 2 teaspoons of fresh or dried leaves in 1 cup of water.

Turmeric: This herb contains curcumin, an anti-inflammatory compound that may treat Crohn’s disease and other digestive tract issues. As well, it may have beneficial effects on joint pain due to rheumatoid arthritis and other disorders.

Valerian

Valerian

Valerian: The dried roots of this plant have been utilized for centuries to deal with anxiety and insomnia. It may even decrease the frequency of seizures in patients with epilepsy. Its mild sedative effect eases pain and promotes sleep. Avoid taking with alcohol or sedative drugs.

Willow: The green underbark of willow trees contain salicin, the original ingredient used to produce aspirin. It is especially useful for muscle aches and joint pain. Simmer 1 teaspoon of bark in 1 cup of water for 10 minutes.

There is much research to be done to confirm all of the effects of these plants, and there may be other benefits not mentioned. Many other plants have medicinal effects other than the ones in the list above. These, however, are easily made into teas that can be produced even while on the move.

I’m sure you have your own herbal teas that have helped with various medical issues. The bottom line: Learn how to grow your own medicinal herbs. You may find they are all you have to keep people healthy in the long run. Using all the tools in the medical woodshed will make you a more effective medic.

Joe Alton MD

Dr. Alton

Dr. Alton

Learn more about natural remedies in the 2017 Book Excellence Award winner in Medicine “The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way”.

Survival Medicine Hour: Acid Reflux, Colds vs Flus, Medical Barter Items, More

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Survival Medicine Hour #366

Colds vs. Flus

Colds vs. Flus

Joe Alton MD and Amy Alton ARNP, aka Dr. Bones and Nurse Amy, discuss a number of topics, including honey as a treatment for burns, how to tell colds vs. flus, medical barter items, acid reflux, using glues to close wounds, and much more!

Honey, if raw and unprocessed, has antibacterial effect and may be useful to treat burns in situations where modern medical care is not a possibility.

Honey as a treatment for burns

Honey as a treatment for burns

Do you have a cold or the flu? Here’s some tips on how to tell the difference.

Most survivalists consider ammunition to be the most important barter item, but how about items that could heal, instead of cause, wounds? Dr. Alton bets that medical supplies would be important barter items in a post-disaster economy.

Glue in place

Glue in place

Medical glues and even Super-glue, may be valuable items for closing wounds. Here’s how to use glue to close a wound (remember, that it’s more important to know when a wound should be closed and when it should remain open!).

acid reflux

acid reflux

How many people do you know that have problems with stomach acid? In a disaster, those people will still be there, and they need your help. Dr.Alton tells you everything you need to know about gastroesophageal reflux disease (G.E.R.D.).

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/11/30/survival-medicine-hour-acid-reflux-medical-barter-items-colds-vs-flus-more

Wishing you the best of health in good times or bad,

Joe and Amy Alton

The Altons

The Altons

Follow us on twitter @preppershow, Facebook at Doom and Bloom(tm), and YouTube at DrBones NurseAmy channel.

Fill those holes in your medical supplies with kits and individual items from Nurse Amy’s store at store.doomandbloom.net!

 

 

 

 

Survival Medicine Hour: Natural Burn Remedies, Ingrown Nails, Lone Wolves

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Survival Medicine Hour Podcast #365

lone wolf

Lone Wolf?

Does the “lone wolf” have an advantage or disadvantage in situations where you’re knocked off the grid and long term survival is not a sure thing? Joe Alton MD and Amy Alton ARNP discuss the importance of community in tough times, even if it’s just an extended family.

3rd degree burn

3rd degree burn

Plus, after discussing first and second degree burns last week, Dr. Alton, aka Dr. Bones, tackles third degree burns, a difficult challenge for the survival medic, as well as natural burn remedies that might help speed recovery for some of the injured.

off grid ingrown toenail strategy

off grid ingrown toenail strategy

Lastly, minor conditions like ingrown toenails may not seem like much to those who watch The Walking Dead, but they’re a major impediment to work efficiency. Not being able to take a step without pain isn’t likely to increase your chances for survival. Dr. Alton talks about what can be done to prevent and treat this condition off the grid.

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/11/25/survival-medicine-hour-natural-burn-remedies-ingrown-nails-lone-wolves

Wishing you the best of health in good times or bad!

Joe and Amy Alton

The Altons

The Altons

Hey, follow us on twitter @preppershow, YouTube at DrBones NurseAmy channel, and Facebook at Doom and Bloom. And check out the Third Edition of the Survival Medicine Handbook on Amazon!

Third Edition

Third Edition

 

 

 

 

 

G.E.R.D. (Severe Acid Reflux) Off The Grid

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Acid Reflux Off The Grid

G.E.R.D.

Acid Reflux

In this high-stress world, you probably know someone who suffers from G.E.R.D. (Gastroesophageal Reflux Disease). “Gastro-“ refers to your stomach; “-esophageal” refers to the tube that runs from it to your throat. Acid “reflux” is essentially acid that escapes the stomach and can go all the way up to your throat. G.E.R.D. is a severe form of acid reflux that can ruin a person’s quality of life.

Normally, an area called the “lower esophageal sphincter” (LES) is what separates the contents of the very acidic stomach from entering the esophagus. In G.E.R.D., the LES allows food to enter the stomach but fails to close tightly enough to keep juices from going back up, causing what we call “heartburn” and other symptoms.

Up to 20 per cent of the U.S. population suffers from some form of G.E.R.D., which means that it’s likely that the medic will eventually encounter this issue in a remote setting or survival scenario. Off the grid, we won’t have the stress that goes with the modern rat race, but there will be more basic issues just as concerning like “where’s my next meal coming from?”.

hiatal hernia

Hiatal Hernia

G.E.R.D. may occur in those with a “hiatal hernia”. This condition occurs when the top of the stomach moves up through a weak area in the diaphragm (the muscle that separates chest from abdomen and helps you breathe). As such, acid can more easily leave the stomach.

Although the stomach has a lining that can handle acidic environments, the esophagus becomes inflamed when exposed to too much. The lining becomes weakened and can erode, a condition known as an “ulcer”. Ulcers can occur in the esophagus, stomach, and upper part of the small intestine.

To make the diagnosis of ulcer or acid reflux disease as opposed to, say, chest pain from heart issues, the timing of the discomfort is important. Ulcer and acid reflux discomfort occurs soon after eating but is sometimes seen several hours after a meal. It can be differentiated from other causes of chest pain in another way: it gets better by drinking milk or taking antacids. As you can imagine, this wouldn’t do much for heart problems. Also, it often worsens when lying down or eating acidic foods. In the worse cases, such as with ulcers, blackish stools may be seen or vomiting may occur that looks like coffee grounds. This is a sign of bleeding high up in the GI tract.

ulcers

ulcers

Certain lifestyle changes are often helpful for people with G.E.R.D. Eating smaller meals (say, 5 a day) and avoiding acidic foods before bedtime may help prevent reflux. Give your stomach at least 3 hours to empty before you lie down or add a pillow or two behind your shoulders, head, and neck.

You would think chewing gum would increase stomach acid; chewing gum, however, produces saliva: Saliva acts to buffer acid.  Also, you swallow the saliva, which might force some of that acid further down the esophagus.

Spicy foods may worsen G.E.R.D.

Spicy foods may worsen G.E.R.D. (image by pixabay)

Your patient may benefit from avoiding certain foods. These commonly include:

  • Acidic fruit (for example, oranges or other citrus)
  • Fatty food
  • Coffee
  • Certain teas
  • Tomatoes
  • Onions
  • Peppermint
  • Chocolate
  • Alcohol
  • Spicy foods

Medicines like aspirin, ibuprofen, and others may also cause stomach issues. As well, smoking is thought to worsen G.E.R.D.

One thing about milk: although it may be helpful as a treatment, avoid regular milk intake and stick with low-fat, as high levels of fat ingestion may actually increase stomach acid. Obese individuals seem to suffer more from this problem:  Excess abdominal fat can press against the stomach, forcing acids up into the esophagus. Weight loss may help, something that’s likely in survival scenarios.

Medications that commonly relieve acid reflux include calcium, magnesium, aluminum, and bismuth antacids such as Tums, Maalox, Mylanta or Pepto-Bismol, as well as other medications such as Ranitidine (Zantac), Cimetidine (Tagamet), and Omeprazole (Prilosec). These medications are available in non-prescription strength and are easy to accumulate in quantity.

In modern times, G.E.R.D. can be definitively identified by procedures such as upper G.I. endoscopy, X-ray tests like an upper GI series, and other high technology. Of course, off the grid, these aren’t an option.

There are many alternative remedies reported to be helpful to deal with G.E.R.D. Home remedies for acid reflux include:

Organic apple cider vinegar: Mix one tablespoon in four ounces of water, drink before each meal.

Aloe Vera juice: Mix one ounce in two ounces of water before a meal.

Baking soda: Mix one tablespoon in a glass of water and drink right away when you begin to feel heartburn

Glutamine: An amino acid that has an anti-inflammatory effect and reduces acid reflux. It can be found in milk and eggs.

Melatonin might be useful  for some (more study is needed on this one).

I’m sure you have some home remedies of your own.

Off the grid, many stoic individuals in the preparedness community may be unlikely to tell the medic about something they consider trivial, like heartburn. Someone in pain, however, loses sleep and work efficiency. Always question these people to find out what their symptoms are. You might be able to help.

Joe Alton MD

Dr. Alton

Dr. Alton

Find out more about G.E.R.D. and 150 medical issues in tough times by checking out the 2017 Book Excellence Award winner in medicine “The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way”.

Ingrown Toenails Off The Grid

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Ingrown Toenails

In the typical zombie apocalypse movie or TV show, you’ll see gunshot wounds and broken bones. Off the grid, however, minor conditions can be a major detriment to the performance of many activities of daily survival. One of these is the ingrown toenail, also known as Onychocryptosis.

You rugged individualists out there might think toenail problems are no big deal, that is, until you have one. When you have to be at 110% efficiency just to survive, you don’t want to be in pain every time you take a step. In the worst scenarios, ingrown nails can cause skin ulcers, blood infections (also called “septicemia”), or even total loss of circulation (“gangrene”).

Your fingernails and toenails are made up of a protein called keratin. It is the substance that forms the claws (and covering of horns and hooves) of animals. When we refer to issues involving nails, we refer to it as “ungual” (from the latin word for claw: unguis).

 

The nail consists of several parts. They include:

The nail plate: this is the hard covering of the end of your finger or toe; what you consider to be the nail.

The nail bed: the skin directly under the nail plate. Made up of dermis and epidermis just like the rest of your skin, the superficial epidermis moves along with the nail plate as it grows. Vertical grooves attach the superficial epidermis to the deep dermis. In older people, the nail plate thins out and you can see the grooves if you look closely. Blood vessels and nerves run through the nail bed.

The nail (or “germinal”) matrix: the portion or root at the base of the nail under the cuticle that produces new cells for the nail plate. You can see a portion of the matrix in the light half-moon (the “lunula”) visible at the base of the nail plate. This determines the shape and thickness of the nail; a curved matrix produces a curved nail, a flat one produces a flat nail.

An ingrown toenail occurs when the edge of the nail grows downward and into the skin of the toe. It can occur for a number of reasons, but poorly fitting shoes and poorly trimmed toenails are the most common causes. The big toe is usually affected, but any toenail can become ingrown.

Symptoms of an Ingrown Toenail

The skin along the edge of a toenail that is ingrown may appear:

  • Red
  • Swollen
  • Painful
  • Warm to the touch

These are signs not only of pressure on the skin, but also the beginning of an infection. If not treated, the condition worsens, possibly even leading to the drainage of pus.

Ingrown Toenails and Your Shoes

Shoes that are either too tight or too loose can cause ingrown toenails. If too loose, it causes continual pounding of your big toe against the inside due to movement within the shoe as you walk. With shoes that are too small for your foot (or even high heels), extra pressure is placed on your toes which prevents normal nail growth.

Improper Trimming

Nails that are not trimmed properly can also cause ingrown toenails. This happens when your toenails are trimmed too short or you cut your toenails in a rounded fashion instead of straight across. Rounded cuts are appropriate for fingernails, but not toenails. The edges of the nails will tend to curl downward and grow right into the skin.

Other Causes

While the above problems can be rectified, some less avoidable factors like heredity, injuries, or medical conditions may also cause ingrown toenails. Some people are born with nails that are curved and naturally tend to curve inward. Injuries to the nail bed can also cause ingrown toenails, especially if it affects the germinal matrix, the living part of the nail that produces new cells.

People with diabetes or other illnesses that cause poor circulation are also at higher risk for these problems. A diabetic, for example, may experience nerve damage and not realize that excessive pressure is being applied to the toes by ill-fitting shoes. They may not even notice that the nail is growing into the skin.

Badly ignored ingrown nail

Badly ignored ingrown nail

Of course, in normal times, there are doctors like podiatrists or orthopedic specialists you should visit to deal with the problem. Off the grid, however, here’s some tips on how to treat an ingrown nail:

  • Soak the foot in warm water with Epsom salts 3 to 4 times a day. In between soaks, keep the toe dry.
  • Use an antiseptic to decrease the bacterial count in the area
  • Place a small piece of moist cotton, waxed dental floss, or other material  under the nail to help it grow away from the skin.
  • Consider wearing sandals until improved.
conservative management of ingrown nail

conservative management of ingrown toenail

Aggressive Treatment

At some point, you may have no choice but to intervene more aggressively. In these circumstances, you may have to remove the offending segment of nail.

Wedge resection of Ingrown Toenail

Wedge resection of Ingrown Toenail

Take the ingrown curved side, about 1/5 of the nail plate width or less. You may have to cut all the way down to the base in some cases. This procedure is more easily done after injecting some numbing medicine into the area, such as lidocaine. Avoid lidocaine with epinephrine; it may compromise the circulation and possibly lead to gangrene. If you have plain lidocaine, consider establishing a “digital block”, seen below:

After Ingrown Toenail Removal

If the toe is infected, antibiotics might be appropriate. Triple antibiotic ointment may be helpful here, but oral antibiotics, such as Keflex (fish-flex), Clindamycin (Fish-Cin) and Amoxicillin (fish-mox forte) may be necessary.  For more information about antibiotics, go here for the first of a 4 part series.

If a portion of the nail is cut off, patience is required as it will take months for the nail to regrow. If you have a genetic tendency toward ingrown toenails, be prepared to deal with recurrences.

Wearing properly-fitted and protective shoes, managing medical conditions, and teaching appropriate foot grooming methods will make sure that the steps on your journey to medical preparedness won’t be painful ones.

For my youtube video on this topic, click below:

Joe Alton MD

Find out more about ingrown toenails and 150 other medical topics when help is not on the way in “The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way”, now in its award-winning Third Edition.

Video: Using a SteriPen

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the SteriPen

the SteriPen

Learning how to make water safe to drink is important in any backcountry or disaster scenario. One method that is gaining popularity is using an ultraviolet light handheld water purifier. Outdoor activities, like hiking, can make having a portable water purifier a lifesaver. In this video hosted by Amy Alton, ARNP of https://www.doomandbloom.net/ , she demonstrates the item and its use in the backdrop of the Great Smoky Mountains National Park.

How does it work? Ultraviolet germicidal irradiation (UVGI) uses short-wavelength ultraviolet (UV-C) light to kill or inactivate bacteria and parasites by disrupting their DNA, leaving them unable to perform the functions needed to survive.

To watch, click below…

Wishing you the best of health in good times or bad,

Amy Alton MD

Amy Alton

Amy Alton

Hey, fill those holes in your medical supplies by checking out Nurse Amy’s entire line of medical kits and supplies at store.doomandbloom.net. You’ll be glad you did.

Award-Winning Survival Medicine Handbook (third edition)

Award-Winning Survival Medicine Handbook (third edition)

Video: Disaster Supply List

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disaster items

disaster supplies

In this video with Nurse Amy, she goes over some of the most important items that should be in your storage and GO bag in times of trouble. Having supplies is key to survival, but the right ones with greater increase your chances of success, even when everything else fails. Amy goes over various categories and demonstrates some of her favorites. Water, Food, Medical, and much more are covered.

To watch, click below:

Wishing you the best of health in good times or bad,

Amy Alton ARNP

Amy Alton

Amy Alton ARNP

Be sure to fill those holes in your medical storage with kits and individual items from Nurse Amy’s entire line at store.doomandbloom.net.

Survival Medicine Hour: Plague, Hepatitis, Pain Issues

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SURVIVAL MEDICINE HOUR #361

Plague Doctor

Plague Doctor

An outbreak of plague in Madagascar has killed 124 people and infected 1200. Although not an uncommon occurrence in the rural areas, this epidemic has hit the larger cities in the island nation, and is the deadlier version called “pneumonic plague“. Pneumonic plague can be cured if found very early but if not, invariably results in death. Dr. Alton tells you all about bubonic, pneumonic, and septicemic plague and what the off-grid medic could do to prevent this terrible infectious disease from running rampant.

ascites

hepatitis damage

Also, inflammation of the liver, called “hepatitis“, is caused by various viruses which are harder to cure than a bacteria like what causes the plague. There are several types of hepatitis, and it’s important to know what to do to avoid becoming a victim of it. Symptoms, diagnosis, and prevention are discussed by our hosts Joe Alton MD and Amy Alton ARNP.

Plus, we start a series on pain issues, discussing different types of pain and also the government’s categorization of drugs into “schedules” from 1-5.

All this and more in the latest episode of The Survival Medicine Hour with Joe and Amy Alton!

To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/10/27/survival-medicine-hour-plague-hepatitis-pain-issues

Follow us on Twitter @preppershow/Facebook: Doom and Bloom/YouTube: DrBones NurseAmy Channel

Wishing you the best of health in good times or bad,

Joe and Amy Alton

The Altons

The Altons

Fill those holes in your medical supplies with kits and individual items from Nurse Amy’s entire line at store.doomandbloom.net!

We’re pleased to announce that the Third Edition of The Survival Medicine Handbook has been named the 2017 winner of the Book Excellence Award in Medicine!

Survival Medicine Hour: Mudlslides, OTC Drugs, More

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SURVIVAL MEDICINE HOUR PODCAST #360

A loaded first aid kit with medical supplies for trauma,burns, sprains and strains and other medical issues

Your medic kit should contain various OTC meds

Your survival medicine cabinet should have plenty of different meds that can handle pain, inflammation, fever, respiratory infections, stomach upset, diarrhea, and many more of the common issues that the survival medic will confront off the grid. Here’s a good list and explanation of why you should have these medicines in your storage.

mudslide

mudslide

Plus, Living in a cliffhanging home on Ski Mountain in Gatlinburg, TN, gateway to the Smokies, puts ol’ Dr. Bones and the lovely Nurse Amy at risk for a mudslide, especially since the 2016 wildfire, destroyed so many trees that were preventing erosion in the area. What are warning signs of future mudslides and what can you do to prevent becoming a victim?

All this and more in the Latest Survival Medicine Hour with Joe Alton MD and Amy Alton ARNP!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/10/20/survival-medicine-hour-mudslides-otc-drugs-more

Wishing you the best of health in good times or bad,

Joe and Amy Alton

The Altons

The Altons

We’re pleased to announce that the Survival Medicine Handbook’s 700 page Third Edition has won the 2017 Book Excellence Award in the category of medicine. Earlier editions are out there, so make sure get the latest edition!

Survival Medicine Hour: Labor and Delivery, Wildfire, More

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off grid labor and delivery

off grid labor and delivery

In any long-term survival situation involving a group or community, eventually the issue of pregnancy and childbirth arises. The medic for the group should know basics about pregnancy and childbirth. Childbirth is a natural process that usually doesn’t require a doctor or even a midwife to manage, as long as some simple steps are followed. Joe and Amy Alton, aka Dr. Bones and Nurse Amy, take you through a typical labor and delivery process.

Calilfornia wildfires

Calilfornia wildfires

Also, wildfires are raging through Northern California, with 40 killed and hundreds unaccounted for. What should you do to prepare for wildfires from both a personal and a property perspective? Dr. Alton gives you some common sense recommendations that could save life, limb, and location in a conflagration.

All this and more on the latest Survival Medicine Hour with Joe Alton MD and Amy Alton ARNP!

To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/10/13/survival-medicine-hour-labor-and-delivery-wildfires-more

Wishing you the best of health in good times or bad,

Joe and Amy Alton

the Altons

the Altons

Find out more about wildfire safety and much more with the Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, 2017 winner of the Book Excellence Award in the medical category.

Plus, don’t forget to check out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net.

8 Health Benefits of Cloves

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Health Benefits of Clove

Dried Clove Buds

Dried Clove Buds

Our readers often ask us to comment on various natural remedies. Face it, medics can stockpile all the drugs they can, but if a disaster event lasts long enough, medicine and supplies will be expended. Unless society restabilizes pretty darn quickly, commercial medical items and drugs will be hard to find unless your retreat is the local hospital.

That leaves you with whatever’s in your back yard that might have medicinal benefits. Therefore, you’d be smart to start planting an herb garden in normal times. Once you get over the learning curve, you’ll figure out what plants do well in your grow zone. These plants will comprise your survival medicine cabinet.  Once you get through a good season, you can experiment a little with teas, tinctures, or other ways that plants are processed into medicines. Your ancestors did just that, and had this plant or that plant in the garden not because it was food necessarily, but to treat illnesses and injuries.

Many medicinal plants are herbs that are mostly used in cooking, but also have uses for the medic. Today, let’s talk about cloves.

Clove Tree

Clove Tree

Cloves, (syzygium aromaticum) are one of the spices native to Asia. You can find them in places like the Maluku islands in Indonesia, where it might have originated, but also in India, Pakistan, and even areas of East Africa. They are a popular spice used in a variety of ways in Asian cuisine. In fact, cloves form the basis of a lot of the food in a number of different nations.

Cloves have an interesting history. During the 13th and 14th centuries, they were transported all the way from Indonesia to pretty much all over the known world. I would think Marco Polo shipped some cloves to Italy and other European nations. During this time, cloves were very expensive, so much so that they were the subject of wars for monopoly over their production, distribution, and the islands where they came from. Dutch traders emerged victorious and held the Maluku islands for some time.

When we talk about natural plants, we usually talk about using leaves, roots or flowers, but with cloves, it’s the flower buds that are used as a spice and for most of its medicinal purposes. These look like miniature nails from your tool box. They are processed in a number of ways; for example, we use the essential oil in some of our kits.

Clove bud

Clove bud

Cloves are antioxidant powerhouses. Minerals in cloves include calcium, iron, magnesium, phosphorous, potassium, sodium, and zinc. The vitamins found in them include vitamin C, thiamin, riboflavin, niacin, folate, vitamin B6, vitamin B12, vitamin A, vitamin E, vitamin D, and vitamin K. They are also a source of Omega-3 fatty acids (the good kind).

Cloves are reported to have many health benefits, some of which include providing aid in digestion, having antimicrobial properties, fighting against cancer, protecting the liver, boosting the immune system, controlling diabetes, preserving bone quality, as well as fighting against oral diseases and headaches, while also, at least the Chinese say, displaying aphrodisiac properties. Which takes me to, how do I know if cloves are effective against this problem or that problem? I’ll admit that hard scientific data is hard to come by, so you have to understand that the reports aren’t always proof, and effects may be very individual, some may receive these health benefits in full, others, not so much.

What makes Clove buds a useful part of your off-grid medicine cabinet? The health benefits include beneficial effects on pain and inflammation, but also a negative effect on bacterial, viruses, fungi, and more. Like many herbs, Clove have a number of different compounds that may have medical uses, but the most well-known is called “Eugenol”.

Here are eight benefits that cloves may impart to your off-grid patients:

  1. Pain relief: We supply clove oil in all our dental kits because of its anesthetic and antiseptic effect in damaged teeth. Mixing 2 drops of clove oil with some zinc oxide powder can produce improvised temporary cement, useful for lost fillings and other oral issues. It may also relieve gum discomfort, but beware of using too much or too often; it can cause irritation.
  2. Breath issues: It may be hard to distill oil, but teas are easy to make right from the garden (and after drying in many cases). Gargling some tea made with cloves is thought to be a great way to eliminate bad breath.
  3. Respiratory ailments: Clove in its various forms is reported to be helpful for respiratory system complaints due to antimicrobial, anti-inflammatory, and expectorant effects. It’s been used for colds, sore throat, bronchitis, sinusitis, and more. Warm tea is a good way to access these benefits but better, perhaps, is adding clove oil to hot water and inhale steam.
  4. GI problems: Nausea and vomiting might be improved with direct inhalation of clove oil in a cloth. Mix some powdered clove buds with honey to decrease gas. It’s possible that cloves improve the production of digestive enzymes and help relax irritated intestinal lining, which might help stomach ache, diarrhea, and other GI discomforts.
  5. Ear infections: Clove has anesthetic and antimicrobial oral properties, but these also pertain to the ear canal. A combination of clove oil and sesame oil soaked in a cotton ball (best if warm) can relieve earache and treat infection. Alternatively, make an infusion with crushed cloves and olive oil, let sit for an hour, strain well, and put a few warm drops in the affected ear.
  6. Skin blemishes: Acne may be improved with Cloves due to its antibacterial effect. Mix clove oil with coconut oil (ratio 1:10) and apply to affected skin with a Q-tip two or three times daily until improved.
  7. Headaches: Due to it pain-relieving properties, massaging Clove oil mixed with coconut oil into the forehead or other area can relieve headache discomfort. Alternatively, place a few drops of clove oil on a warm cloth and apply to where the pain is.
  8. Joint Pain: Massaging aching joints with the above mixtures may work the same way on joint pain. Alternatively, a warm clove compress to the joints may be helpful.

It should be noted that clove oil is pretty strong stuff, and must be used sparingly. It can cause irritation, as mentioned above, but also has ill effects on the body’s cells when used excessively. It may also slow blood clotting, and, hence, not used prior to surgery. Having said that, used correctly in small amounts by diluting with carrier oils or liquids, clove oil is generally considered to be safe. You can expect whole dried clove buds to last 3-4 years if stored properly.

With clove oil and other natural plant oils, teas, tinctures, infusions, and balms, the quality of the product and medicinal benefits may vary due to a number of reasons. Soil conditions, seasonal temperatures, rainfall, and time of harvest are just some of the factors involved in determining the end product when it comes to herbal products. Many of these remedies also vary from individual to individual.

The off-grid or homestead medic should have a stockpile of commercial medicines, but also a sustainable supply of plants with medicinal properties for use in good times or bad. Use all the tools in the woodshed and you’ll be a more effective caregiver in austere settings.

Joe Alton

Dr. Alton

Joe Alton MD

Find out more about cloves, other natural remedies, and much more with the Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, 2017 winner of the Book Excellence Award in the medical category.

Plus, don’t forget to check out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net.

You’ll be glad you did!

 

The Effective Survival Medic

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THE EFFECTIVE SURVIVAL MEDIC

 

Amy Alton ARNP

Nurse Amy

(This article first appeared in American Survival Guide, a great magazine for backcountry, short-term, or long-term survival. Each issue is so packed with great information, I can’t bear to let go of them!)

 

After water, food, and shelter, many consider personal defense to be the most important priority in a long-term disaster. They’ve got the beans and bullets, but what many of these rugged survivalists don’t realize, however, is this: You can have all the beans and bullets there are, but it won’t mean a hill of beans, and you’ll just shoot yourself in the foot, unless you have the bandages.

Few in your group will be accustomed to performing activities of daily survival like, say, chopping wood for fuel. This fact will lead to injuries, burns, infections, and other medical issues that must be treated. Someone, therefore, has to assume the role of survival medic. This person might have to be you, an average citizen with little formal medical training. In a circumstance where the ambulance is no longer just around the corner, you may be the only medical asset left to your family or group.

When you become the end of the line, medically, for your people, how can you be certain that you’ll be an effective caregiver? This is a question that I’m often asked as I travel the country speaking on disaster medical preparedness. The success of the survival medic depends on the accumulation of three things: knowledge, training, and supplies. These can be obtained, over time, with effort and dedication.

One thing that isn’t easy for an inexperienced medic to obtain is the ability to avoid feeling squeamish at the sight of blood. A response similar to the “fight or flight” mechanism, it’s a natural fear reaction that causes blood vessels to dilate, blood pressure to drop, and slowing of the heartbeat, all leading to lightheadedness and nausea.

Of course, repeated exposure to blood is one way to become accustomed to it. One medical center director says that his students learn to compartmentalize fear reactions by repeating words or numbers in their head, rocking side to side, tensing and relaxing leg muscles, or even drinking a sugary caffeinated beverage to raise blood pressure, stay hydrated, and avoid low glucose levels (called “hypoglycemia”) that make them feel faint.

(As an aside, coffee is commonly thought to be dehydrating, but it doesn’t cause you to lose more fluids than you ingest in the drink.)

The designated medic must assume a number of roles besides that of chief medical officer. These include sanitation supervisor, dental technician, medical quartermaster, counselor, and archivist.

As sanitation supervisor, it is your duty to ensure that water is purified, food is prepared properly, and human waste is disposed of appropriately. Failure to, for example, construct an effective latrine could cause infectious disease to run rampant among your people.

If you are worried about a week without power due to a storm, you won’t have to deal with a lot of dental issues. In long-term survival, however, people start having dental issues like broken teeth, abscesses, and toothache that threaten their work efficiency, if not their life. Dental supplies become as important as medical supplies in this scenario.

Let’s say you’ve prepared and have a lot of medical supplies. Who determines when these precious items, many of which will be scarce after a disaster, are dispensed? Who gets the last course of antibiotics? That decision must be clearly defined as yours to make.

In the aftermath of a life-changing catastrophe, anxiety and depression will be more likely to be daily issues than gunfights at the OK corral (I hope). You must be a calm, understanding, confidential presence to keep your people focused on staying alive and productive.

Finally, you must be the archivist for the group. It’s your job to know the history of those for whom you are medically responsible: their illnesses, medications taken, past hospitalizations, allergies, and more. If you anticipate the likely problems you will confront as medic, you can stockpile supplies accordingly.

Speaking of supplies, you will need more than you have currently. How can I know this, not having seen your kit? Because you will responsible for more people that you think. You may be preparing to care for the number of people in your mutual assistance group, but be certain that they will bring relatives or that you will find additional survivors that have skills that would increase your chances for survival. These folks may be useful but will cause additional strain on your medical resources.

Lack of enough supplies for the number of people in your group is the biggest mistake made by the survival medic. You can never have enough; any extras would be valuable barter items. Be wary of kits that claim to be sufficient for 25 or 50 people, as they are often advertised: Just one major hemorrhage can take up the entirety of the bandages in these products. If you doubt this, empty a liter or two of fluid onto the floor and see how many bandages are needed to absorb it.

Although I suggest that medical supplies may be useful for barter purposes, I believe it is best to conserve them while freely offering to help all who are in need of medical help. Once it is known that you have skills, supplies, and a willingness to help, you’ll become so valuable to others in your community that they will expend resources to protect you.

Another mistake made by the medic is preparing for traumatic injuries while ignoring the lesser issues that can affect work efficiency. Toothaches, foot fungus, and hemorrhoids are just some of the problems that can plague group members and make them less productive.

Still another is the failure of the medic to know what plants and other natural substances in their area might have medicinal benefits. Aloe plants can be helpful for burn care. The green underbark of willow trees and others contain Salicin, the original ingredient in the first aspirins. Eventually, commercial products will be expended; it’s important to learn what’s in your own backyard that can help you keep your people healthy. Use all the tools in the medical woodshed.

It’s important to realize that, as the survival medic, you may not have the luxury of stabilization and evacuation to modern medical facilities. That means that you are responsible for wound care and infectious illness from beginning to end, something even experienced paramedics may not be ready to handle. You must enter the mindset that you are the highest medical resource left, and must deal with issues without the hope of transport for the foreseeable future. It’s important to set up a reasonable sick room or hospital tent to care for your patients.

What medical conditions will the medic be most likely to confront in long-term survival? Here are some you can expect:

Trauma

  • Minor Musculoskeletal injuries (sprains and strains)
  • Minor trauma (lacerations, abrasions, etc.)
  • Major traumatic injury (fractures, occasional knife and/or gunshot wounds)
  • Burn injuries

Infections

  • Respiratory infections (pneumonia, bronchitis, influenza, common colds)
  • Diarrheal disease (sometimes a community-wide outbreak)
  • Infected wounds
  • Minor infections (for example, urinary infections, “pinkeye”)
  • Lice, Ticks, Mosquitoes, and the diseases they carry

Allergic reactions

  • Minor (bees, bed bugs, or other insect bites and stings)
  • Major (anaphylactic shock)

Dental

  • Toothaches
  • Broken or knocked-out teeth
  • Lost fillings
  • Loose crowns or other dental work

Women’s issues

  • Pregnancy and delivery
  • Miscarriage
  • Birth control

Your environment will also factor into your effectiveness as a medic. At various times of the year, issues such as heat stroke or exhaustion, hypothermia, and dehydration may be encountered. If you don’t take into account the environment, you have made it your enemy, and it’s a formidable one.

All of the issues I mention here can quickly take up everything you have stored to help you function as the medic. Therefore, it just makes common sense to consider preventative measures to avoid headaches and, perhaps, heartaches. An ounce of prevention is worth a pound of cure, and that old saying is never more true than in survival.

It’s important to enforce the use of protective gloves, boots, and eyewear in any situation where injuries might occur. Clothes should be appropriate for the climate at your location. You might not consider these items to be medical supplies, but they can prevent a lot of problems that will take up your time and resources.

Personnel that carry firearms and knives must be trained in their safe use. Prevention extends not only to injuries, but also to infectious disease. When you suspect a group member of being ill, you must make sure that they are isolated from those that are healthy. These concepts may seem obvious to you, but you’ll be surprised (unpleasantly) at how many will forget to take precautions to avoid injuries and infection.

There is one last essential characteristic of the successful survival medic: a strong instinct for self-preservation. Although you might want to rush to the aid of the sick and injured, even in the face of hostile fire, you must realize that you are an indispensable asset to your group. If you frequently place yourself in harm’s way, you will eventually find yourself as the patient more often than you or anyone else would like. Always determine first if you can care for a victim without placing yourself at undue risk. You must abolish all threats; if someone has a gunshot wound, it stands to reason that there’s a guy with a gun out there. Don’t become the next casualty.

The Survival Library

For more resources on becoming an effective caregiver, consider these books for your survival library:

The Survival medicine handbook Third Edition 2016

The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way: Now in its 700 page third edition, our book covers 150 different medical issues that you might face after a disaster eliminates the option of modern medical care. Includes lists of recommended medical supplies and a guide to veterinary antibiotics in post-disaster settings.

(As an aside, The Survival Medicine Handbook’s Third Edition won the medical category of the 2017 Book Excellence Awards)

The Physician’s Desk Reference (Amazon Link): No longer available in print form, this guide to drugs, their uses, dosages, and side effects is still around on Ebay and elsewhere. Includes pictures of individual drugs to help identify unknown meds. Find an edition that’s a year or two old for your survival library.

Where There Is No Doctor and Where There Is No Dentist (Amazon Links): Guides for medical and dental care in underdeveloped countries.

Gray’s Anatomy (Amazon Link): The classic textbook of human anatomy

The Merck Manual (Amazon Link): Classic handbook for diagnosis and treatment

Davidson’s Principles and Practice of Medicine: Standard medical textbook

This is, by no means, a complete list of every book that might be useful in survival situations, but it’s a good start.

DISCLAIMER: Be aware that, where there is an existing modern medical system, the practice of medicine or dentistry without a license is illegal and punishable by law. If modern medical professionals and facilities exist, seek them out.

Joe Alton MD

joe alton md

joe alton md

While you’re checking out American Survival Guide don’t forget to get the 2017 Gear Guide, where we’re privileged to have a number of our medical kits featured. For all Nurse Amy’s kits and individual supplies, check out her store at store.doomandbloom.net.

 

Survival Medicine Hour: Off-Grid Pregnancy Care, Cloves, Bleeding Kits

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The Survival Medicine Hour Podcast #357

off-grid pregnancy care

off-grid pregnancy care

What if you had to care for a pregnancy off the grid? Would you identify it as early as you should without pregnancy tests and ultrasounds? How can you assure the well-being of mother and baby during the pregnancy. Joe Alton MD and nurse-midwife Amy Alton, ARNP discuss how to keep an eye on that pregnant lady in your group from beginning all the way to 9 months (labor and delivery coming next time).

Amy's multi-person bleeding kit

Amy’s multi-person bleeding kit

Also, what would be the items you’d want in a kit for a public venue where a gunman could cause multiple casualties? Nurse Amy discusses what’s in her multi-person kit specifically meant for bleeding wounds at schools, churches, workplaces, etc.,  and how it could be a lifesaver in active shooting incidents and other disaster settings.

Plus, natural remedies are important in good or bad times, but especially when modern medicines aren’t being produced, such as in survival scenarios. Joe Alton MD discusses the health benefits of cloves and why you should have some in your survival medicine cabinet.

All this and more in the latest episode of the Survival Medicine Hour with Joe and Amy Alton!

To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/10/06/survival-medicine-hour-pregnancy-management-cloves-bleeding-kits

all the best,

Joe and Amy Alton

Joe and Amy Alton

Joe and Amy Alton

We’re pleased to announce that the third edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way has won its category (medical) in the 2017 Book Excellence Awards! Thanks to all for their support.

Survival Medicine Hour: Earthquake, Birthing Supplies, Hemorrhage, More

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Survival Medicine Hour #355

earthquake damage

earthquake damage

What would you have done if you were in Mexico City during the recent earthquakes? Is there anything that might have increased your chances of survival? In this episode of the Survival Medicine Hour, hosts Joe Alton MD and Amy Alton ARNP talk about earhtquakes in general and give you safety tips that could save a life.

birthing supplies

birthing supplies

Plus, what supplies would you need for delivering a baby and caring for a pregnancy in tough times? Nurse Amy put on her Expert Council hat from Jack Spirko’s Survival Podcast to answer a listener’s question. In addition, one of our readers sends us an entertaining story about her son’s hornet sting and some natural remedies she uses for her allergy-prone family.

Direct Pressure on Bleeding Wound

Bleeding wound

Lastly, is it time to add a 4th R to Reading, ‘Riting, ‘Rithmetic in school curriculums? Should Reduce hemorrhage classes be talk in view of the risk of injury during natural disasters, shooter events, even car crashes? Sounds crazy, but would it save a life?

All this and more in the latest episode of The Survival Medicine Hour with Joe and Amy Alton, aka Dr. Bones and Nurse Amy! To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/09/22/survival-medicine-hour-earthquakes-first-aid-hornets-birthing-supplies

 

BTW, you can follow us at twitter @preppershow, YouTube at DrBones NurseAmy channel, and Facebook at our Doom and Bloom page or our survival medicine group “survival medicine dr bones nurse amy”

Thanks!

Don’t forget to check our medical kits and supplies at store.doomandbloom.net, plus our latest edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon and on this website.

The Survival medicine handbook Third Edition 2016

The Survival Medicine Handbook Third Edition

Survival Medicine Hour: Post-Irma, Floods, Shoulder Dislocation

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Survival Medicine Hour #354

wildfire

close shave #1: Gatlinburg, Nov. 2106

This Survival Medicine Hour 9/15: Hurricane Irma has wreaked havoc on Florida, Georgia, and South Carolina, and our hosts Joe and Amy Alton, aka Dr.Bones and Nurse Amy have now had two different homes survive destruction in a year: Their place in Gatlinburg on Ski Mountain, where 100 homes burned to the foundation last November as part of a huge human-set wildfire, and now their home in South Florida from Hurricane  Irma’s winds. We’ll talk about flood survival and give you some tips on what to do in the aftermath of storms like Harvey and Irma.

hurricane winds

close shave #2: Irma

Also, your shoulder is the most flexible of your joints, but also the least stable and most likely to be dislocated by trauma. Find out more about how to recognize and treat this painful but common wilderness and off-grid injury.

shoulder joint: most flexible, least stable

shoulder joint: most flexible, least stable

To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/09/15/survival-medicine-hour-irma-floods-shoulder-dislocation

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Nurse Amy and Dr. Bones

Nurse Amy and Dr. Bones

We’d like to announce that we’ll be holding an 8 hour class on 10/21 near Knoxville, TN, where they’ll impart a lot of knowledge and teach a lot of hands-on skills! Check doomandbloom.net’s classes page to find out more!

Don’t forget to follow us on Twitter @preppershow, Facebook at Doom and Bloom(TM), and YouTube at DrBones NurseAmy!

7 Serious Infections from Contaminated Food and Water

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7 Serious Infections from Contaminated Food and Water

Just Hanging Out (and I mean just hanging out)

Just Hanging Out (and I mean just hanging out)

 

Recently, I watched a few episodes of “Naked and Afraid“, a series that puts two individuals in extreme environments with few supplies and, for some reason, no clothes. In this program, many of the participants come down with various infections; some of which cause bowel disturbances. Life then becomes, well, even more miserable than walking around for three weeks naked in the jungle.

Epidemics characterized by diarrhea and dehydration have been a part of the human experience since before recorded history. Cholera is an example of one particularly dangerous infection that was epidemic in the past. It and other bacterial diseases, many of which are now rare, may once again become a problem in the uncertain future.

Off the grid, water quality is questionable and may lead to misfortune if not properly purified. Using bad water to cook food in a remote setting can also lead to major problems that manifest as diarrhea, and later, dehydration. When dehydration is not treated, deaths may occur.

typical bacteria

typical bacteria

Many diseases with diarrhea as the main symptom are caused by poor sanitation. These including the following:

Cholera: Caused by CTX, a toxin produced by the marine and freshwater bacterium Vibrio cholera. Cholera toxins produce a rapid onset of diarrhea and vomiting within a few hours to 2 days of infection. This was a major issue in Haiti after the earthquake there several years ago.

The diarrhea caused by cholera looks like water after rice has been cooked in it. In addition, victims complain of nausea, leg cramps, and other symptoms. The body water loss with cholera is so severe that it is associated with a sixty per cent death rate if untreated. Aggressive efforts to rehydrate the patient, however, drops the death rate to only one per cent. Antibiotic therapy with doxycycline or tetracycline seems to shorten the duration of illness.

typhus rash (brittanica.com)

typhus rash (brittanica.com)

Typhoid (and Typhus): Salmonella typhi is a bacterium of the Enterobacteriaceae family that is found in contaminated and undercooked food. The illness it causes is called “typh-oid fever” because it often confused with Typhus.

Typhus is a complex of diseases caused by bacteria in the Rickettsia family that is transmitted, not by contaminated food and water, but by fleas and ticks in unsanitary surroundings. Although it rarely causes severe diarrhea, Typhus can cause severe dehydration due to high fevers and other flu-like symptoms. Five to nine days after infection, a rash begins on the torso and spreads to the extremities, sparing the face, palm, and soles. Doxycycline is the drug of choice for this disease.

Typhoid rash

Typhoid rash (emergencymedicinecases.com)

Contamination with Salmonella in food (leading to typhoid fever) occurs more often than with any other bacteria in the United States, with a major outbreak in turkey meat causing more than 100 hospitalizations in 2011. In Typhoid fever, there is a gradual onset of high fevers over the course of several days. Abdominal pain, intestinal hemorrhage, weakness, headaches, and bloody diarrhea may occur. A number of people develop a spotty, rose-colored rash, hence the confusion with typhus. Ciprofloxacin  is the antibiotic of choice, but most victims improve just with rehydration therapy.

Dysentery: Caused by a number of different pathogens (disease-causing organisms), dysentery is an inflammation of the large intestine that presents with fever, abdominal pain, and severe bloody or watery diarrhea. Symptoms usually begin one to three days after exposure. Dysentery was a major cause of death among Civil War soldiers. It is a classic example of a disease that can be simply prevented with strict hand hygiene after bowel movements.

civil war hospital

civil war hospital

The most common form of dysentery in North America and Europe is caused by the bacteria Shigella and is called “bacillary dysentery”.  It is spread through contaminated food and water in crowded unsanitary conditions. Ciprofloxacin and Sulfa drugs, in conjunction with oral rehydration, are effective therapies.

Another type of dysentery is caused by an organism you may have read about in science class: the amoeba, a protozoan known as Entamoeba histolytica. Amoebic dysentery is more commonly seen in warmer climates. Metronidazole is the antibiotic of choice.

Traveler’s Diarrhea: An inflammation of the small intestine most commonly caused by the Bacterium Escherichia coli, commonly known as E. coli. Most strains of this bacteria are normal inhabitants of the human intestinal tract, but one (E. coli O157:H7) produces a toxin (the “Shiga” toxin) that can cause severe food poisoning. The Shiga toxin is so potentially dangerous that it has been classified as a bioterror agent.

In this illness, sudden onset of watery diarrhea, often with blood, develops within one to three days of exposure accompanied by fever, gas, and abdominal cramping. Rapid rehydration and treatment with antibiotics such as Azithromycin and Ciprofloxacin is helpful. The CDC no longer recommends taking antibiotics in advance of a journey, however, but does suggest that Pepto-Bismol or Kaopectate (Bismuth Subsalicylate), two tablets four times a day, may decrease the likelihood of Traveler’s Diarrhea.

Campylobacter: The second most common cause of foodborne illness in the U.S. after Salmonella, this bacterium resides in the intestinal tract of chickens and causes sickness when meat is undercooked or improperly processed. It’s thought that a significant percentage of retail poultry products contain colonies of one particular variety, Campylobacter jejuni. Symptoms include bloody diarrhea, fever, nausea, and cramping which begins two to five days after exposure. Although controversial, Erythromycin may decrease the duration of illness if taken early.

Trichinosis: Trichinosis is Caused by the parasitic roundworm Trichinella in undercooked meat, mostly from domesticated pigs. Trichinosis causes diarrhea and other intestinal symptoms one to two days after exposure. Fever, headache, itchiness, muscle pains, and swelling around the eyes occur as much as 2 weeks later. Recovery is usually slow, even with treatment with the anti-helminthic drugs Mebendazole and Albendazole (Albenza).

beautiful but could harbor giardia

beautiful, but could harbor giardia

Giardiasis: The most common disease-causing parasite in the world is the protozoa Giardia lamblia. It has even been found in backcountry waters in many national parks in the U.S. Symptoms may present as early as one day after exposure, although it more commonly presents in one to two weeks. Patients complain of watery diarrhea, abdominal cramping, violent (often called “projectile”) vomiting, and gas. Metronidazole is the drug of choice in conjunction with oral rehydration.

There are many other pathogens that can cause diarrheal disease and dehydration if untreated. Although we have listed antibiotics in this article (many of which you can read about in this website), most of the above will resolve on their own over time with strict attention to oral (or intravenous) rehydration. Without hydration support, however, the situation may become life-threatening in some cases.

An important point is that some of these illnesses may be mimicked by viruses that are unaffected by antibiotics, such as norovirus, so employ them only when absolutely necessary. The U.S. is in the midst of an epidemic of antibiotic resistance that is partly due to overuse in humans. You might be surprised when I say “partly”; close to 80% of antibiotics in the U.S. are given, not to humans, but to food-producing livestock.

recipients of most antibiotics

recipients of most antibiotics

If you see post-apocalyptic disaster movies, you’ll see a lot of gunfights at the OK corral. Certainly, this may occur in the aftermath of a major catastrophe. The most deaths will occur, however, due to failure to assure that water is clean, food is prepared properly, and human waste is safely disposed. The medic for a survival group must understand this and enforce good sanitary practices. If he/she is successful, the group will have a better chance of staying healthy even in the worst of situations.

Joe Alton MD

Joe Alton MD

Joe Alton MD

 

Find out more about infectious disease and much more with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net.

a small first aid kit with items shown such as a tourniquet, gauze, mini compression dressings, ace, scissors and more

Motorcycle and hiking first aid kit

How to Handle Dental Emergencies In Survival Situations

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Video: How To Apply A SOFT-T Tourniquet

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Direct Pressure on Bleeding Wound

Bleeding wound

The Special Operations Forces Tactical Tourniquet (SOFT-T) is one of the most popular tourniquets made, with many selecting it as their item of choice to control severe extremity bleeding. The SOFT-T is reliable, sturdy, and easy to apply, especially when only one hand is available to the casualty. The US Army Institute of Surgical Research reports a 100% effectiveness rate in stopping hemorrhage.

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Tourniquets like the SOFT-T are used in a life-threatening situation, and its ease of application is a major advantage when no time is available for training purposes. Having said that, it’s important to become acquainted with the use of every item in your medical kit.

The SOFT-T particularly shines during transport, with a screw that that can be fastened to prevent accidental release during the jostling that can occur during evacuation to a modern medical facility or, in a survival scenario, to your sick room or hospital tent.

Here’s Nurse Amy to show you the method of application of the SOFT-T.

For 10 critical principles of tourniquet use, check out her video on the subject here:

<iframe width=”560″ height=”315″ src=”https://www.youtube.com/embed/1zI5j5a1VL8″ frameborder=”0″ allowfullscreen></iframe>

Wishing you the best of health in good times or bad,

Amy and Joe Alton

Dr. Bones and Nurse Amy

 

For a review of several popular tourniquets (and much more), check out the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net. You’ll be glad you did.

Just some of our kits and supplies

Just some of our kits and supplies

Learn how to stop bleeding in emergencies

Herbal Teas from Medicinal Gardens

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HERBAL TEAS IN AUSTERE SETTINGS

medicinal herbs

Herbal Products as Medicine

In long-term disaster settings, even prepared medics may end up using their entire supply of commercially-made medicines. As such, caregivers should consider the medicinal benefits of the plants in their own backyard as additional tools in the medical woodshed.

 

Due to their longevity, essential oils are probably some of the best natural products the medic can stockpile. Producing them, however, requires knowledge, experience, and equipment. In addition, you’ll need a lot of plant material. It takes 250 pounds of lavender flowers to make 1 kilogram of essential oil, and that’s if you have the right variety, soil conditions, weather conditions, and other factors in place.

lavender field

It takes a lot of lavender to make a little essential oil

In the long haul, a more realistic option for sustainable herbal medicines is using fresh or dried plant materials in teas. These require little more than a garden and some knowledge regarding each herb, the parts of the plant used, and the medicinal effect.

 

It should be noted that the term “tea” is incorrect: The word actually refers to various drinks made from the leaves of one species, Camellia sinensis. Indeed, green, black, white, and oolong teas are made from the same plant; only the processing differs. The proper term for a drink made by steeping herbs in hot water would be an “herbal infusion” or “tisane“. For simplicity’s sake, though, we’ll call them teas.

 

Standard teas from Camellia Sinensis, like green, black, white, and oolong, are high in antioxidants with many health benefits ascribed to them. These include heart disease, type 2 diabetes, liver dysfunction, and more.

 

Making Teas

making tea

It’s easy to make tea

Making a tea is one of the simplest ways to prepare medicinal herbs. If you can boil water, you can brew tea. You just:

 

  • Bring some water to a roiling boil in a pot or other container.
  • Crush leaves, flowers, and/or roots, depending on the plant.
  • Pour the boiled water over 1 teaspoon of herbs and let steep for about five or ten minutes.
  • Keep a cover on while steeping.
  • Place a strainer over a cup and pour (alternatively, use a tea bag or “bob”).
  • Use honey or lemon to add flavor if desired.

 

A tea doesn’t always have to be ingested to be of benefit; some may be used as an eye wash, an irrigation solution for wounds, or in cold or warm compresses.

 

There are many herbs that can be made into a tea. Although some of the information below lacks hard scientific data, these teas were used by your ancestors for their medicinal benefits:

 

Alfalfa: The seeds and leaves contain vitamins A, C, E, and K, as well as calcium, phosphorous, iron, and potassium. It has been used as a diuretic to help urine flow and for upset stomachs. There are claims that it helps arthritis pain and may lower cholesterol. Use 1 to 2 teaspoons of dried leaves, steeped in 1 cup of boiling water, for 10-20 minutes.

 

Burdock: The dried root has been used in teas to help clear acne and to treat psoriasis. Use 2 tablespoons of fresh grated root or 1 tablespoon of well-dried root in 3 cups of boiling water.

catnip

catnip

Catnip: Leaves and flowers are used to treat intestinal cramping, indigestion, diarrhea, and other stomach ailments. Also thought to treat respiratory infections like the common cold. A substance in catnip called nepetalactone is thought to produce a mild sedative effect. Use 1 teaspoon of dried leaves or 1 tablespoon of fresh leaves per cup.

 

Chamomile: A favorite tea of many, it contains the amino acid Tryptophan, which gives it a sedative and relaxing effect. As such, it may help treat anxiety and insomnia. Antioxidants in chamomile may help slow down progression of visual, kidney, and nerve damage in diabetics.  Use 2-3 teaspoons of dried flowers per cup.

 

Chicory: When supplies of coffee ran out, soldiers in the Civil War used the root of this common plant as a substitute. It lacks caffeine, though, and has more of a sedative than stimulant effect in large amounts. Chicory root has an effect against intestinal worms, and has been shown in animal studies to improve calcium absorption and bone mineral density. Scrape the bark off the root before drying; use 1 teaspoon to 1 cup of water. Tea made from leaves has a laxative effect.

 

Dandelion: You might be surprised to know that the common dandelion contains vitamins and minerals. Indeed, it’s thought to have more beta-carotene than a similar serving of carrots. Young flowers and leaves make a good tea for constipation (steep for 20 minutes). Roasting the roots produces a coffee-like drink; use 2 teaspoons dried chopped root in 1 cup of water.

echinacea

echinacea

Echinacea: Well-known to decrease the duration of colds and flus, Echinacea boosts the immune system and may have some antiviral activity. Steep 1-2 teaspoons of leaf, flower, or ½ teaspoon of root to 1 cup of boiling water

 

Elder: Elderberry flowers make a tea that is used for many upper respiratory infections such as sinusitis, colds, flus, and laryngitis. Applied in a compress, the tea may be helpful for wound healing and some skin conditions.

 

The blue or purple berries are high in antioxidants and may be made into a juice or syrup: Put two pounds of elderberries and four cups of water and bring to a boil, then simmer for a half hour. Use a fine mesh strainer to press out the juice. Sugar may be added under medium heat to make a syrup.

 

Eucalyptus: Tea made from eucalyptus leaves offers relief from asthma as well as respiratory infections, mostly by opening airways and loosening thick mucus. It may have antibacterial and antiviral effects. Steep ½ teaspoon of dried or fresh leaves in 1-2 cups of water.

 

Ginger: The underground stems, or rhizomes, of Ginger are used to treat nausea of all types from morning sickness to motion sickness. Slice one inch of the rhizome into small pieces and simmer in two cups of water on low heat for 15 minutes. Then strain. ¼ – ½ teaspoon of ginger powder is another option.

ginseng root

ginseng root

Ginseng: Both Asian and American Ginseng root can be made into herbal teas that are thought to lower blood sugar levels, a useful benefit for those with diabetes. Simmer three to six teaspoons of the root for 45 minutes in three or four cups of water, then strain.

 

Lavender: Used in aromatherapy, lavender may improve nausea and other digestive symptoms when drunk as a tea. It’s thought to decrease migraine headaches and possibly limit convulsions and muscle spasms. Use 1 tablespoon of dried herb in 1 cup of water.

 

Lemon Balm: An herb with antiviral effects, it’s a member of the mint family. A tea made from lemon balm leaves and flowers was used in the past to treat mouth, throat, and dental infections like gingivitis and herpes sores. Also thought to decrease anxiety and aid sleep. Lemon balm may help improve intestinal spasms and nausea. 1 teaspoon of dried herb or 5-6 fresh leaves to one cup of boiling water makes a fine tea.

 

Licorice: Better known as an ingredient in candy, its coating properties may help with sore throats, coughs, and heartburn. Licorice can, however, raise blood pressure and should be avoided during pregnancy. Add 1-2 teaspoons of chopped root to 2 cups of boiling water to make a decoction. Drink ½ cup at a time.

 

Passionflower: Tea made from passionflower has a beneficial effect on anxiety and may serve as a sleep aid if taken regularly. Boil 1-2 teaspoons of herb (avoid the root) in 2 cups of water for 5-10 minutes.

 

Peppermint: A long-standing herbal remedy, tea made from peppermint calms the stomach and helps Irritable Bowel Syndrome (IBS), but can worsen heartburn. The tea helps thin respiratory mucus and relieves nasal congestion. Put 1 teaspoon of dried herb or 6-8 fresh leaves over 1 cup of boiling water.

 

Rose: Rose “hips” make a tea with vitamin C, as well as calcium, selenium, zinc, manganese, and others. It boosts the immune system and is thought to be beneficial for the adrenal gland, responsible for the stress hormone cortisol. Boil 1 teaspoon of dried rose hips in water and steep for 20 minutes.

Sage leaves

Sage leaves

 

Sage: Sage leaf tea is a time-honored remedy for sore throat as well as the common cold as a tea or gargle. It may also aid digestion and decrease cramping, and may even improve memory. Steep 1 teaspoon of dried leaves in one cup of water.

 

Stinging Nettle: Stinging nettle root is thought to have benefits as a diuretic to improve urine flow, even in those with enlarged prostates. The leaves may decrease the pain of arthritis in joints. Use 1 teaspoon dried leaves in 1 cup boiling water or boil 5 grams of dried root in 2 cups of water for 5-10 minutes.

 

St. John’s Wort: One of the few herbs that has known activity against minor depression, leading it to be called “herbal Prozac”. Beware of interactions with prescription drugs, however. Pour 1 cup of boiling water over 1 teaspoon herb.

 

Thyme: Teas made from thyme will loosen thick phlegm and may help coughs. It’s known to inhibit bacteria, viruses, and fungi, including many that cause respiratory infections. Steep 1 to 2 teaspoons of fresh or dried leaves in 1 cup of water.

 

Turmeric: This herb contains curcumin, an anti-inflammatory compound that may treat Crohn’s disease and other digestive tract issues. As well, it may have beneficial effects on joint pain due to rheumatoid arthritis and other disorders.

 

Valerian: The dried roots of this plant have been utilized for centuries to deal with anxiety and insomnia. It may even decrease the frequency of seizures in patients with epilepsy. Its mild sedative effect eases pain and promotes sleep. Avoid alcohol or sedative drugs.

 

Willow Bark: The green underbark of willow trees contain salicin, the original ingredient used to produce aspirin in the late 19th century. It is especially useful for muscle aches and joint pain. Simmer 1 teaspoon of bark in 1 cup of water for 10 minutes.

 

There is much research to be done to scientifically confirm all of the effects of these plants, and there may be other benefits not mentioned or yet discovered. As well, many other plants have medicinal effects other than the ones in the list above; you might know of some yourself. The herbs above, however, are easily made into teas that can be produced even while on the move.

 

In any case, learning the use of natural substances for their medicinal benefits will make the off-grid medic an effective provider even in the most remote settings.

 

Joe Alton MD

Joe Alton MD

Joe Alton MD

 

Find out more about disasters (natural and man-made) with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net.

stomp supreme

The Stomp Supreme Medical Kit, ideal for large groups, camps, outfitters, and much more (available in various colors)

Skin Problems and Their Treatments

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SKIN PROBLEMS AND TREATMENTS

Dermatitis Herpetiformis is not actually associated with herpes virus

Treating medical problems in a remote homestead or after a disaster won’t always be about gunshot wounds and broken bones.  Sometimes, little things can make people miserable and affect their ability to contribute to group efforts. Skin inflammation, called “dermatitis“, is one of the issues that a caregiver can’t ignore if the group is going to function at 100% efficiency.

This condition has various causes and varies in appearance from case to case, although most present with redness and itchiness, sometimes with swelling. You might not consider itchiness to be a problem worth the medic’s attention, but continuous scratching traumatizes the skin, your natural armor, and may lead to a type of infection called “cellulitis“ once the skin is broken. Cellulitis has nothing to do with “cellulite”.

TYPES OF DERMATITIS

skin rashes can be caused by contact with allergens

contact dermatitis

Contact dermatitis is caused by physical contact with allergy-causing substances called “allergens”. The allergen involved is so varied as to include almost everything, including:

  • laundry soap and detergents
  • Household cleaning products
  • Rubber or latex
  • Perfumes, makeup, deodorants
  • Metals, such as nickel
  • Preservatives
  • Weeds, such as poison ivy, oak or sumac

Usually, the first exposure only produces antibodies but not major skin reactions. Once antibodies exist against a certain substance, the next exposure can cause significant irritation (or worse general reactions such as anaphylaxis).

Once the allergen is identified, avoidance is the best way to prevent contact dermatitis. Corticosteroid creams and cool moist compresses are the cornerstones of treatment. Use these only until the rash is improved. Antihistamines such as Benadryl or Claritin will help relieve itching.

Atopic Dermatitis may be associated with hay fever or food allergies

Atopic Dermatitis

Atopic Dermatitis or Eczema is a chronic itchy rash that can be found in various areas at once (oftentimes, the face) that may be accompanied by hay fever or asthma. Dust mites, animal dander, and food allergies are possible causes. Atopic dermatitis sometimes flares up in cold weather.  Treatment is similar to contact dermatitis.

seborrheic dermatitis

Seborrheic dermatitis is a condition that affects areas that contain oil-rich glands called sebaceous glands. It is characterized by scaling, redness, and itching. The most common version of this is dandruff or, in infants, “cradle cap”. The area near the nose and lips is another place where you might see this type of dermatitis.

Scalp irritations caused by Seborrhea may be treated by shampoos that contain tar or pyrithione zinc (Head and Shoulders). It also can be treated by the anti-fungal ketoconazole, which supports the belief that yeast plays a part in the development of this condition.

neurodermatitis

Lichenification

Neurodermatitis is a type of dermatitis that manifests as chronic itchy and raised patches, sometimes red and sometimes just darker than normal skin. The cause is unknown, although insect bites, tight clothing, dryness, and even anxiety have been implicated as possibilities. A vicious cycle of itching and scratching leads to thick, scaly, and leathery skin called “lichenification”.

Treatment includes Antihistamines such as diphenhydramine (Benadryl) and steroid creams, especially at night when some people scratch irritated areas without knowing. Injections of corticosteroids are given into the affected area in severe cases. Anti-anxiety medications are given to those who scratch out of nervousness.

Herpes Zoster

Shingles (Herpes Zoster)

Shingles is also known as herpes zoster, and is seen in people who have previously been infected with Chicken Pox. The dormant chickenpox virus, called varicella zoster, becomes active in nerves and appears as a blistering rash with itching, burning, and pain, usually localized to the distribution of a particular nerve.

Shingles usually resolves after a very uncomfortable 2-4 weeks but may be treated with anti-viral agents, such as Acyclovir, Valtrex, or Famvir (but not by the anti-viral Tamiflu, a commonly used antiviral for influenza).

dermatitis herpetiformis is not actually associated with herpes virus

dermatitis herpetiformis

Shingles is sometimes confused with dermatitis herpetiformis, a chronic skin condition characterized by blisters that is actually not associated with herpes virus.

stasis dermatitis is associated with poor circulation

stasis dermatitis

Stasis dermatitis appears as an inflamed area caused by fluid and poor blood flow under the skin. It is commonly seen on the lower legs of individuals with varicose veins.  Rarely seen in those under 50, poor circulation is a major factor although trauma damaging the circulation may be a factor. To deal with dermatitis related to poor circulation, you may have to use support stockings and mild steroids. In normal times, varicose veins may be dealt with surgically or with other high technology. See our article on varicose veins.

what causes rosacea

rosacea

Rosacea is an extremely common condition that manifests as a reddened area on the face that is caused by swollen blood vessels, usually in fair-skinned individuals beginning in middle age. It is accompanied by spider veins, flushing, and, sometimes, a markedly red nose and an appearance like acne. It is not acne, however, and will not respond to over-the-counter acne medicine. Antibiotics are sometimes used, and Vitamin A-related medications like Accutane may help.

What does psoriasis look like?

Psoriasis

Psoriasis is a series of thickened patches of reddened skin with silvery flaking.  The most common areas affected are the elbows, knees, scalp, armpits, scalp, and lower back. An auto-immune condition, Psoriasis causes the buildup of new skin cells where the body mistakenly thinks an injury has occurred. Moisturizers as well as corticosteroids and coal tar ointments are helpful; Psoriasis responds to sunlight, so phototherapy using special lamps are used for this type of dermatitis.

Natural supplements that improve dermatitis are numerous and often involve Omega-3 fatty acids, which have an anti-inflammatory effect.  Used with evening primrose oil, it is especially effective. Chamomile cream is thought to be as potent as a mild hydrocortisone. Calendula has skin-soothing properties and may protect against contact dermatitis. Be aware that it may trigger an allergic reaction on broken skin. I’ll bet you have your own home remedies for various skin problems as well.

MEDICAL SUPPLIES FOR SKIN

Clearly, the medic will need to include some skin treatments in their medical kit. Some useful items, some with links to medical issues we’ve covered before,  include:

Hydrocortisone Cream: Various mild steroid creams are useful in decreasing inflammation in an area of the skin that is inflamed.

Clotrimazole (Lotrimin in the U.S.): Helpful in the treatment of skin yeast infections, including athlete’s foot, ringworm, and others.

What can treat athlete's foot

Athlete’s foot

Triple Antibiotic Cream: Helpful in preventing infections in areas of minor scrapes and cuts.

Insect Repellant: These are useful in preventing insect bites, which may prevent more serious medical problems such as malaria, Lyme disease, and severe allergic reactions.  Commercial products usually contain DEET. Natural products, like lemon eucalyptus, lemongrass and citronella, also serve to repel insects and can be grown in many areas.

Fels-Naptha soap: This time-honored item helps to remove toxins from poison ivy, oak, and sumac from both skin and clothes. Studies show pre-bathing with Fels-Naptha may decrease effects of these rash inducing plants.

What does poison ivy rash look like

severe poison ivy rash

Permethrin shampoos/lotions (NIX, Elemite in the U.S.):  Helpful in the treatment of lice and mite-related issues (head lice, scabies, etc.)

Sunscreen:  Often overlooked as a medical supply, sunscreen will help prevent many skin problems down the road.

Aloe Vera:  Natural product useful in treating burns. Others which may be effective include vinegar, witch hazel, diluted lavender and tea tree essential oils, etc.

Non-stick gauze dressings (e.g., Telfa brand dressing):  these dressings have a shiny non-stick surface and are especially used for burns and other raw skin areas to prevent removal of healing tissue during dressing changes.

Diphenhydramine (Benadryl in the U.S.): Useful for suppressing minor reactions to bug bites and allergy-causing agents such as hives, redness, or swelling, but can cause drowsiness. Claritin and Zyrtec are milder antihistamines, but do not usually cause severe sleepiness like Benadryl can.

Epi-Pens: A self-contained prescription injection of epinephrine (adrenaline outside the U.S.) that will improve severe allergic reactions, also referred to as anaphylactic shock.  Few physicians would deny you a supply of this important item, especially if they are aware that you are often outdoors.

Soothing rash ointment with oatmeal called Stop the sting

Colloidal Oatmeal Ointment to treat insect bites and stings.

Natural Remedies: Vinegar, witch hazel, diluted lavender and tea tree essential oils,used as a compress is calming to rashes and burns. Baking soda or an oatmeal paste or bath are both very soothing to irritated or itchy skin. Apply raw honey to open skin areas for healing and infection prevention, and cover with non-stick dressings.

Other Natural Remedies: Balms containing Arnica are useful for pain relief in many people. French green clay paste used as a pack or mask has been studied for it’s healing properties. Warm tea bags (especially Chamomile) or a tea leaves poultice, (add raw honey for extra healing) contains tannins that help calm irritated skin. Just like the French green clay, cornstarch paste can be used as a soothing pack.

Joe Alton MD

Joe Alton MD, survival medicine writer

Dr. Alton

Find out more about poisonous plants and 150 other medical topics in the survival mindset with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net!

motorcycle medical kit

New Biker/Hiker Kit

Survival Medicine Hour: Nuclear Blasts, Water Safety, Eclipse Eye Safety

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SURVIVAL MEDICINE HOUR #353

Solar Eclipse (via Wiki)

In this episode of the Survival Medicine Hour, Joe Alton MD, aka Dr. Bones and Amy Alton, ARNP, aka Nurse Amy discuss the types of nuclear weapons and the damage they cause in the form of shock and heat waves. Plus, the different types of radiation emitted by detonations of nuclear bombs: Alpha, Beta, Gamma, X-ray, and Neutron radiation. Also, what are the damage zones for, say, a Hiroshima type bomb and what are the chances you’ll survive?

Plus, it’s still pretty hot out and the kids will want to be at the pool, lake or beach. Here’s 12 water safety tips that can prevent a near-drowning mishap, the second most common cause of death in those 14 years old and under by injury. Find out what actually happens when you drown (hint: it’s not all screaming and thrashing around).

Prevent Drowning

Lastly, how to safely view the coming solar eclipse. Did you know that old eclipse glasses more than three years old no longer give you protection, and that homemade filters or sunglasses will not do the job?

All this and more on the latest Survival Medicine Hour with Joe and Amy Alton! To listen in, click the link below:

http://www.blogtalkradio.com/survivalmedicine/2017/08/18/survival-medicine-hour-nuclear-blasts-water-safety-eclipse-eye-safety

 

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Amy and Joe Alton

Follow us: Twitter @ preppershow, Facebook at Doom and Bloom(tm), and YouTube at drbones nurseamy channel

Don’t forget to check out Nurse Amy’s entire line of medical kits and supplies at store.doomandbloom.net. You’ll be glad you did.

 

 

 

 

 

 

Types of Nuclear Weapons and Their Effects

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TYPES OF NUCLEAR WEAPONS AND THEIR EFFECTS

Ground Blast with Fireball

Given the fragile state of affairs on the Korean peninsula, fears of a nuclear incident are higher than at any time since the Cold War. With good reason, most people associate use of nuclear weapons with devastating outcomes. Few, however, know much about the different types and their actual effects.

(by the way, It’s pronounced “noo-clee-ar”, not “noo-cu-lar”)

TYPES OF NUCLEAR WEAPONS

Until the recent missile launches by North Korea, most people were concerned about the use of “dirty bombs“ by terrorists. A dirty bomb is not technically a nuclear weapon. It uses conventional explosives to disperse radioactive material in the general area. Usually, the effect of the explosion causes more damage and casualties than the radioactive elements.

Our concept of an “atomic bomb“ as developed by the Manhattan Project in the 1940s is one that uses “nuclear fission”. The explosion is caused by a chain reaction that splits atomic nuclei. The result is a wave of intense heat, light, pressure, and kinetic energy equaling thousands of tons (also called kilotons) of TNT. This is followed by the release of radioactive particles in a cloud that resembles a mushroom (if a ground blast). Mixed with dirt and debris, the particles fall back to Earth, contaminating crops, animals, and people. This will happen in the area of the detonation, but will also be blown elsewhere by the prevailing winds.

Atomic bombs gave way to hydrogen bombs, which are best described as “thermonuclear” weapons due to the generation of extreme heat during detonation. H-Bombs use a process known as nuclear fusion, which takes two light nuclei and forms a heavier one, using variations of hydrogen atoms called “isotopes”. This fusion process requires high temperatures and usually involves a fission reaction as discussed above to initiate. H-Bombs don’t just generate power in the kilotons; they can reach levels in the megatons (millions of tons) of TNT.

Another type of thermonuclear weapon is the “neutron bomb“, which generates much less kinetic energy and thermal damage, but much more radiation. Enhanced radiation weapons like the neutron bomb generate a fusion reaction that allows neutrons to escape the weapon with only a limited blast. Originally designed by the United States to counter massive Soviet tank formations, the neutron bomb is an example of a tactical nuclear weapon. The effect is to leave infrastructure mostly intact while wiping out human targets due to massive radiation.

Blast and Heat Waves cause more % damage than radiation in a fission bomb detonation

DAMAGE CAUSED BY A NUCLEAR ATTACK

The impact of a nuclear bomb is dependent on its “yield”, a measure of the amount of energy produced. The Hiroshima A-Bomb had a yield of 15 kilotons, while the “Tsar Bomba” detonated by the Russians in 1961 had a yield of 51 megatons (51,000 kilotons!). Most of the weapons stockpile of the U.S. and Russia consist of bombs in the 100 to 500 kiloton range, much stronger than Hiroshima and much weaker than Tsar Bomba. This is because they are meant to be fired at major cities in clusters rather than one large bomb, which would be easier to intercept than, say, 20 smaller ones.

Damage is caused by:

  • Blast effects (kinetic energy) – damage due to the explosion and resulting shock wave
  • Heat (thermal energy) – damage generated by extreme heat
  • Radiation (initially and later via fallout) – both local and, later, far-reaching
  • Electromagnetic pulses (EMPs) – disrupts telecommunications, infrastructure

You can expect a generally circular pattern of local damage, but various factors come into play besides the yield of the weapon. The altitude of the explosion, weather, wind conditions, and nearby geologic features play a role. The U.S. government estimates the distribution of damage for fission bombs to be distributed in the following manner:

  • 50% shockwave
  • 35% heat
  • 5% initial blast radiation
  • 10% fallout radiation

Hiroshima Burn Victim

(Note: I don’t have the data in front of me, but it stands to reason that H-bombs would likely cause a higher percentage of heat damage while Neutron bombs would cause more radiation damage than the above model for a standard fission bomb.)

The atom bomb dropped on Hiroshima in 1945 flattened buildings over a roughly 4 square mile area and killed 60,000 people immediately. Another 90,000-140,000 succumbed later to injuries and radiation exposure. Although this represents a total of 150,000 to 200,000 fatalities, the entire population did not perish. At the time of the explosion, there were about 350,000 people in Hiroshima, including 43,000 soldiers. This shows that, although horrific in its effects, that distance from ground zero and other factors play a role in a nuclear weapon’s lethality, as does the power of the bomb itself.

A 50 megaton H-Bomb like the Russian “Tsar Bomba“, however, would cause a much larger circle of devastation than the Hiroshima bomb, with widespread fatalities at least 20 miles from ground zero and third-degree burns 50 miles away. Windows were reported shattered from the test detonation as far away as Norway and Finland.

You might think there isn’t anything you can do in a nuclear attack, and if you’re at ground zero at the moment of detonation, you’re right. But your chances of survival, given some time, distance, and protection, may be better than you think. Well talk about’ what you can do to increase your chances of survival in future articles.

Joe Alton MD

Joe Alton MD

 

Find out more about disasters (natural and man-made) with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net.

Doom and Bloom(tm) Med Kits

Radiation Sickness

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RADIATION SICKNESS

Radiation sickness

Many consider a nuclear attack an outlandish scenario to which only conspiracy theorists subscribe. Unfortunately, the threat of a nuclear incident, accidental or purposeful, exists, perhaps more than in recent years, due to recent developments in the Korean peninsula.

Atomic weapons can decimate a population from thermal blasts, but it also causes illness and death due to exposure from radiation. Although populated areas have experienced detonations only twice, (Hiroshima and Nagasaki in 1945), nuclear reactor meltdowns and other events have occurred from time to time since then, such as in Fukushima in 2011 and Chernobyl in 1986.

In an atomic explosion, radiation is just one of the possible causes of casualties; heat effects and kinetic energy damage near the blast will cause many deaths and injuries. Radiation released into the atmosphere, however, can have devastating effects far from “ground zero”.

A nuclear event produces “fallout”.  Fallout is the particulate matter that is thrown into the air by the explosion. It can travel hundreds (if not thousands) of miles on the prevailing winds, coating fields, livestock, and people with radioactive material.

The higher the fallout goes into the atmosphere, the farther it will travel downwind.  This material contains elements that are hazardous if inhaled or ingested, like Radioiodine, Cesium, and Strontium. Even worse, fallout is absorbed by the animals and plants that make up our food supply. In large enough amounts, it can rapidly become life-threatening. Even in small amounts, it is hazardous to your long-term health.

A nuclear power plant meltdown is usually less damaging than a nuclear blast, as the radioactive material doesn’t make it as high up in the sky as the mushroom cloud from an atomic bomb. The worst effects will be felt by those near the reactors. Lighter particles, like radioactive iodine, will travel the farthest, and are the main concern for those far from the actual explosion or meltdown. The level of exposure will depend on the distance the radioactive particles travel from the meltdown and how long it took to arrive.

RADIATION SICKNESS

The medical effects of exposure are collectively known as “radiation sickness” or “Acute Radiation Syndrome”. A certain amount of radiation exposure is tolerable over time, but your goal should be to shelter your group as much as possible.

To accomplish this goal, we should first clarify what the different terms for measuring the quantities of radiation mean.  Scientists use terms such as RADS, REMS, SIEVERTS, BECQUERELS or CURIES to describe radiation amounts. Different terms are used when describing the amount of radiation being given off by a source, the total amount of radiation that is actually absorbed by a human or animal, or the chance that a living thing will suffer health damage from exposure:

Marie and Pierre Curie

BECQUERELS/CURIES – these terms describe the amount of radiation that, say, a hunk of uranium gives off into the environment. Named after scientists who were the first to work with (and die from) radioactivity.

RADS – the amount of the radiation in the environment that is actually absorbed by a living thing.

REMS/SIEVERTS – the measurement of the risks of health damage from the radiation absorbed.

This is somewhat confusing, so, for our purposes, let’s use RADS.  A RAD (Radiation Absorbed Dose) measures the amount of radiation energy transferred to some mass of material, typically humans.

Some effects of radiation exposure (wiki commons)

An acute radiation dose (one received over a short period of time) is the most likely to cause damage.  Below is a list of the effects on humans corresponding to the amount of radiation absorbed. For comparison, assume that you absorb about 0.6 RADs per year from natural or household sources.  These are the effects of different degrees of acute radiation exposure on humans:

  • 30-70 RADS: Mild headache or nausea within several hours of exposure.  Full recovery is expected.
  • 70-150 RADS: Mild nausea and vomiting in a third of patients.  Decreased wound healing and increased susceptibility to infection. Full recovery is expected.
  • 150-300 RADS: Moderate nausea and vomiting in a majority of patients.  Fatigue and weakness in half of victims.  Infection and/or spontaneous bleeding may occur due to a weakened immune system. Medical care will be required for many, especially those with burns or wounds.  Occasional deaths at 300 RADS exposure may occur.
  • 300-500 RADS: Moderate nausea and vomiting, fatigue, and weakness in most patients.  Diarrheal stools, dehydration, loss of appetite, skin breakdown, and infection will be common.  Hair loss is visible in most over time.  At the high end of exposure, expect a 50% death rate.
  • Over 500 RADS: Spontaneous bleeding, fever, stomach and intestinal ulcers, bloody diarrhea, dehydration, low blood pressure, infections, and hair loss is anticipated  in almost all patients.  Death rates approach 100%.

The effects related to exposure may occur over time, and symptoms are often not immediate. Hair loss, for example, will become apparent at 10-14 days.  Deaths may occur weeks after the exposure.

PROTECTION AGAINST EXPOSURE TO RADIATION

radiation dosimeter

In the early going, your goal is to prevent exposures of over 100 RADS. A radiation dosimeter will be useful to gauge radiation levels and is widely available for purchase.  This item will give you an idea of your likelihood of developing radiation sickness.

There are three basic ways of decreasing the total dose of radiation:

1) Limit the time unprotected. Radiation absorbed is dependent on the length of exposure. Leave areas where high levels are detected and you are without adequate shelter.  The activity of radioactive particles decreases over time.  After 24 hours, levels usually drop to 1/10 of their previous value or less.

2) Increase the distance from the radiation. Radiation disperses over distance and effects decrease the farther away you are.

3) Provide a barrier. A shelter will decrease the level of exposure, so it is important to know how to construct one that will serve as a shield between your people and the radiation source. A dense material will give better protection that a light material.

DIFFERENT MATERIALS AS BARRIERS

Radiation burns post-Hiroshima bombing

The more material that you can use to separate yourself from fallout, the more likely you won’t suffer ill effects. Barrier effectiveness is measured as “halving thickness”. This is the thickness of a particular shield material that will reduce gamma radiation (the most dangerous kind) by one half.  When you multiply the halving thickness, you multiply your protection.

For example, the halving thickness of concrete is 2.4 inches or 6 centimeters.  A barrier of 2.4 inches of concrete will drop radiation exposure by one half.  Doubling the thickness of the barrier again (4.8 inches of concrete) drops it to one fourth (1/2 x 1/2) and tripling it (7.2 inches) will drop it to one eighth (1/2 x 1/2 x 1/2), etc.  Ten halving thicknesses (24 inches of concrete) will drop the total radiation exposure to 1/1024th that of being out in the open.

Here are the halving thicknesses of some common materials:

  • Lead:   4 inches or 1 centimeter
  • Steel: 1 inch or 2.5 centimeters
  • Concrete: 4 inches or 6 centimeters
  • Soil (packed): 6 inches or 9 centimeters
  • Water:  2 inches or 18 centimeters
  • Wood:  11 inches or 30 centimeters

 

By looking at the list above, you can see that the same protection is given with 1/6 the thickness of lead plating as that of concrete.

TREATING RADIATION SICKNESS

Eliminating external contamination with fallout “dust” is important before absorption occurs. This can be accomplished d with simple soap and water. Scrub the area gently with a clean wet sponge. Safely dispose of the sponge and dry the area thoroughly.

Internal contamination is a more difficult issue. Emergency treatment involves dealing with the symptoms.  Once the diagnosis is made, methods that may help include antibiotics to treat infections, fluids for dehydration, diuretics to flush out contaminants, and drugs to treat nausea.  In severely ill patients, stem cell transplants and multiple transfusions are indicated but will not be options in an austere setting.  This hard reality underscores the importance of having an adequate shelter to prevent excessive exposure.

Protection is available against some of the long term effects of radiation. Potassium Iodide (known by the chemical symbol KI), taken orally, can prevent radioactive Iodine from damaging the specific organ that it targets, the thyroid gland. The usual adult dose is 130 mg daily for 7-10 days or for as long as exposure is significant. For children, the dosage is 65 mg daily. KI is available in a FDA-approved commercial product called Thyrosafe.

Thyrosafe (Potassium Iodide)

Taking KI 30 minutes to 24 hours prior to a radiation exposure will prevent the eventual epidemic of thyroid cancer that will result if no treatment is given. Radiation from the 1986 Chernobyl disaster has accounted for more than 4,000 cases of thyroid cancer so far, mostly in children and adolescents. Therefore, if you only have a limited quantity of KI, treat the youngsters first.

Although there is a small amount of KI in ordinary iodized salt, not enough is present to confer any protection by ingesting it.  It would take 250 teaspoons of household iodized salt to equal one Potassium Iodide tablet.

Pets may also be at risk for long-term effects from radioactive iodine. It is recommended to consider 1/2 tablet daily for large dogs, and 1/4 tablet for small dogs and cats.

ALTERNATIVE REMEDY FOR RADIATION EXPOSURE

Don’t depend on supplies of the drug to be available after a nuclear event. Even the federal government will have little KI in reserve to give to the general population. In recent power plant meltdowns, there was little or no Potassium Iodide to be found anywhere for purchase

Betadine Solution

If you find yourself without any KI, consider this alternative:  Povidone-Iodine solution (brand name Betadine). “Paint” 8 ml of Betadine on the abdomen or forearm 2-12 hours prior to exposure and re-apply daily. Enough should be absorbed through the skin to give protection against radioactive Iodine in fallout.

Betadine as an alternative for KI

For children 3 years old or older (but under 150 lbs or 70 kg), apply 4 ml. Use 2 ml for toddlers and 1 ml for infants. This strategy should also work on animals. If you don’t have a way to measure, remember that a standard teaspoon is about 5 milliliters. Discontinue the daily treatment after 3-7 days or when Radioiodine levels have fallen to safer levels.

Be aware that those who are allergic to seafood will probably be allergic to anything containing iodine. Adverse reactions may also occur if you take medications such as diuretics and Lithium. It is also important to note that you cannot drink tincture of iodine or Betadine; it is poisonous if ingested.

Although many don’t view a nuclear event as a likely disaster scenario, it’s important to learn about all the possible issues that may impact your family in uncertain times.

Joe Alton MD

Dr. Alton

Find out more about survival medicine with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net.

Medical Kits by Doom and Bloom

7 Antiseptics For Your Medical Kit

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Betadine is a Iodophor-type antiseptic

I’ve often said that, in a major disaster, we may be thrown back to a bygone era where modern medicine is not an option. Indeed, we can expect civil war-era statistics with regards to major abdominal and chest trauma outcomes, but we will still be ahead of our ancestors even if we’re thrown off the grid. That’s because of modern knowledge of antisepsic techniques.

The word antiseptic comes from the greek words anti (against) and septikos (putrid or rotten).  Antiseptics are substances with antimicrobial properties applied to living tissue to reduce the possibility of infection. Antiseptics, it should be noted, are not antibiotics. Antibiotics are meant to destroy bacteria within the body. Antiseptics are also different from disinfectants, which destroy germs found on non-living objects. All of these are important supplies for the survival medic.

Infected wound

We have a number of videos on this website that discuss antibiotics and what your options are in a survival scenario. If you haven’t been here before, use the search engine and you’ll find there are more than you think. We haven’t, however, talked a lot about antiseptics. Let’s discuss the most popular types on the market that might be candidates for your survival medical kit.

Iodophors: Iodophors like Betadine contain iodine, a substance that can also be used to purify water, but is combined with a solubilizing agent, povidone, which makes it, unlike pure iodine, relatively nonirritating and nontoxic to living tissue. Iodophors work against a broad array of microorganisms and don’t need to be heavily diluted. I will admit that I do dilute my Betadine if I use it on open wounds for regular dressing changes.  Iodophors are effective in killing microbes within just a few minutes.

Chlorhexidine

Chlorhexidine Gluconate: This substance, perhaps better known by its brand name “Hibiclens”, is helpful  against many types of germs, although it’s not very effective against fungal infections. It’s relatively long-lasting, however, compared to some other antiseptics. For this reason, Hibiclens is popular as a way to prepare areas for surgery and for healthcare providers to scrub their hands before patient encounters.

Alcohol: Ethyl Alcohol (also called ethanol) is another tried and true antiseptic product. It, along with isopropyl alcohol, kills many different types of microbes and is fact acting and inexpensive. The problem is that alcohol has a drying effect on skin, the oral cavity, and vagina. It has a tendency to inhibit the development of new cells, so use it for an initial wound cleaning but not for regular care.

Benzalkonium Chloride: BZK is a mild antiseptic and is easily tolerated by most people. One of the most popular first aid wipes or sprays, some say that it has a special effect against the rabies virus, but there’s little hard data supporting this claim.

Hydrogen Peroxide: Hydrogen peroxide is used to clean wounds and reacts with blood to form an impressive foam. This is because blood and most cells contain an enzyme called catalase. Catalase reacts with hydrogen peroxide, converting it into oxygen and water. This effect makes it popular for household first aid in common mishaps like abrasions, but not a great candidate for regular dressing changes due to its drying effect on new cells. It can be used as a mouth rinse in the oral cavity, however, making it a candidate for a survival dental kit.

PCMX (Parachlorometaxylenol or chloro-xylenol for short): Available in more brand names than you can count, this substance is effective against most germs. It’s less potent, though, than chlorhexidine and iodophors, although the antiseptic effect lasts longer. PCMX can be irritating, so don’t use it on mucous membranes like the oral cavity and vagina.

Bleach and baking soda added to just-boiled water in the right proportions can make an effective antiseptic solution

Bleach: Bleach can be found as either a sodium hypochlorite (Clorox) solution or can be improvised with calcium hypochlorite granules, also known as “Pool Shock”. Used more as a disinfectant than an antiseptic, bleach in very dilute solutions (0.5% or less) can make Dakin’s solution, a time-honored method to clean wounds. Be sure to watch our recent two-part video on this website that shows you how to make it easily and affordably.

I’m sure you know of more products that can serve as antiseptics for your survival sick room. Armed with these items, your chances of succeeding when everything else fails, at least as a medic, go up exponentially. Be sure to get the supplies and knowledge that will save lives in times of trouble.

Joe Alton MD

Joe Alton MD

Find out more about stopping hemorrhage and 150 other medical topics in the survival mindset with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net!

Video: 10 Critical Principles of Tourniquet Use

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Video: 10 Critical Principles of Tourniquet Use

SOF-T Tourniquet

In this video, Nurse Amy steps in front of the camera to discuss important principles with regards to tourniquet use to stop massive hemorrhage.  Besides the imperative to apply pressure to stop the bleeding, Amy discusses the concept of pressure loss, the length of time the tourniquet should be placed, and when to transition the tourniquet to a pressure dressing with hemostatic agents. Nurse Amy (an advanced registered nurse practitioner) gives you strategies that will help prevent rebleeds, and other factors that make tourniquet use appropriate and generally safe.

To watch, click below:

Wishing you the best of health in good times or bad,

 

Amy and Joe Alton

Amy Alton ARNP

Find out more about stopping hemorrhage and 150 other medical topics in the survival mindset with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net!

Survival Medicine Hour: Poison Plants, Setting a Fracture, More

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various fracture types; note open fracture 2nd from left

SURVIVAL MEDICINE HOUR #349

In the this episode of the Survival Medicine Hour with Joe Alton MD and Amy Alton ARNP, aka Dr. Bones and Nurse Amy, our hosts discuss what you would do with a fractured bone off the grid or after a disaster where modern medicine is just not an option. Dr. Alton’s take on the subject might shock modern medical professionals, but you have to do what you can, with what you have, where you are, in tough times. Topics including placing a cast, open fractures, re-aligning bones (known as “reductions”) and more.

typical rash of poison ivy

Also, the Altons talk about what to do when you’re outdoors and surrounded by poison plants like poison ivy, oak, and sumac. How to identify plants, diagnose and treat the rash, plus natural remedies that might help.

All this and more on the latest Survival Medicine Hour with Joe and Amy Alton! To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/07/28/survival-medicine-hour-poison-plants-setting-a-fracture-more

Hey, do us a big favor and follow us on twitter @preppershow, Facebook: Doom and Bloom or join our group at Survival Medicine Dr Bones Nurse Amy, and YouTube at DrBonesNurseAmy!

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Joe and Amy Alton

 

 

Find out more about poisonous plants, fractures, and 150 other medical topics in the survival mindset with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net!

Grab and Go Deluxe First Aid Trauma Kit

Grab N Go Medical Kit

Poison Ivy, Oak, and Others

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POISON IVY AND SIMILAR PLANTS

From Left: Poison Ivy, Poison Oak, Poison Sumac, Poisonwood (UFAS)

Whether you’re outdoors due to a major disaster or just on a wilderness hike, it’s possible that you’ll run afoul of poisonous plants. If you live in the continental United States, expect to find poison ivy, poison oak, poison sumac, and others in the environment.  350,000 cases of poison ivy alone are recorded in the United States every year.

POISON IVY AND SIMILAR PLANTS

Poison Ivy

The typical “tri-foliate” appearance of poison ivy and another poisonous plant, poison oak, has led to the saying: “Leaves of three, let it be”. Poison ivy’s leaves appear almond-shaped, while poison oak looks like, well, oak leaves. There are various subtypes: Some are vinelike, others short and shrubby, still others appear as ground cover.

Poison Oak

There are, of course, plants that are perfectly harmless that come in “leaves of three”. Other poisonous plants, like poison sumac, have a different look. Poison sumac has 7-13 pointy leaflets and can grow into a small tree upwards of 20 feet in height. Poisonwood is a relative that prefers subtropical areas like the Florida Keys. It is thought that inhaling smoke from burning sumac and poisonwood can cause life-threatening respiratory distress.

Poison Sumac

WHAT CAUSES POISON IVY RASH

Poison Ivy rash can appear “streaky”

The common factor that makes all of the above plants dangerous is the compound “urushiol”. Urushiol is an oily resin that can be found on just about every part of the plant, including vines, leaves, and roots. The chemical irritant sticks to the skin on contact and causes symptoms in 85% of those exposed.

As poison ivy rash is essentially an allergic reaction, it is not, in and of itself, contagious. However, any clothing or body parts that have urushiol on them can cause symptoms when touched by others.

As an aside, the presence of urushiol in poison ivy and other plants appears not to be a defense mechanism; instead, it serves to help them retain water. Deer, birds, and other wildlife can eat poison ivy without ill effects.

DIAGNOSIS AND TREATMENT

Poison Ivy, Oak, and Sumac rash is caused by the compound “Urushiol”

 

The rash of poison ivy, oak, and sumac causes itching and a red, bumpy rash within a day or two of exposure. The rash continues to spread for a few days and lasts for up to three weeks (more in some cases). Breaks in the skin from itching can cause secondary infections that can become serious.

It’s sometimes difficult to make the diagnosis. Most don’t  realize they were exposed during their time outdoors.   Exposure may also occur indirectly, for example, by petting the fur of a pet that has been outside. The rash might appear in winter and confuse health providers, but even plants that are dormant can cause reactions.

Therefore, a red, bumpy, itchy rash in anyone who has been in the Great Outdoors or near others who have (including pets) should raise your suspicions. Either poison oak, ivy, or sumac exist just about everywhere in North America except perhaps mountaintop and desert environments. As such, it should always be on the list of possibilities in wilderness settings.

Touching kids and pets that have been outside could cause exposure to poison plant toxins

Once you have determined that there has been exposure to poison ivy, it’s important to wash the exposed area and clothing with soap and water as quickly as possible. Urushiol isn’t easy to remove, however, so you might consider soaps that are effective against resins or oil, such as Fels-Naptha or Tecnu.

Common treatments for poison ivy, oak, and sumac rashes include hydrocortisone cream, calamine lotion, capsaicin cream, and antihistamines like diphenhydramine (Benadryl). Some recommend the use of rubbing alcohol on the exposed areas. Cool compresses may are thought to be soothing.

There are many home remedies that are also thought to be effective to treat poison ivy rash. Here are just a few:

  • Apple cider vinegar (burns at first)
  • Baking soda paste
  • Epsom salt or oatmeal baths.
  • Chamomile tea bag compresses
  • Aloe Vera gel mixed with various essential oils, such as tea tree, lemon, lavender, peppermint, geranium, and chamomile.
  • Jewel weed (mash and apply)

There are many others. Natural or commercial creams and ointments should be dabbed on as opposed to rubbed, which may cause more irritation and slow healing. In the worst cases, prescription medications like Medrol (Methylprednisolone) may be needed to speed recovery and prevent complications.

The good news is that, even if you don’t treat the rash, it will go away by itself over 2-3 weeks in most cases.

PREVENTION

Long pants and sleeves will help prevent contact with poison plants

The best prevention is to avoid getting the toxin on your skin. If you can’t avoid exposure, make sure to wear long pants, long-sleeved shirts, work gloves, and boots if you’re doing work in areas known to harbor poison plants.

Some recommend an over-the-counter lotion called IvyX as a preventative. Apply it like you would a sunblock to likely areas of exposure. Theoretically, it prevents the oil from being absorbed by your skin.

The effects of poison ivy, oak, or sumac can make you miserable and even cause secondary infections, something that will decrease your work efficiency in the Great Outdoors. If you know how to identify these plants and be aware of your surroundings, you’ll have less headaches off the grid.

Joe Alton MD

Joe Alton MD

Find out more about poisonous plants and 150 other medical topics in the survival mindset with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net!

Video: Making Dakin’s Solution, Part 2

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Video: Making Dakin’s Solution, Pt. 2

Open wounds are prone to infection

In this video (part 2 of 2), Amy Alton ARNP, aka Nurse Amy, demonstrates how to make Dakin’s solution for the care of open wounds, followed by some comments by Joe Alton MD, aka Dr. Bones, on how to vary the strength from full (5% sodium hypochlorite) down to 1/8 strength, how long it last when stored properly, and some other important things to know about this additional tool for the medical woodshed in survival settings.

To watch, click below:

In case you missed it, here’s Part 1 of the video:

Video: Making Dakin’s Solution, Part 1

https://www.doomandbloom.net/video-making-dak…-solution-part-1/

Wishing you the best of health in good times or bad,

Joe and Amy Alton

The Altons

You can make Dakin’s solution with regular household items, but for medical supplies you can’t make on your own, check out Nurse Amy’s entire line of kits and individual items at store.doomandbloom.net. You’ll be glad you did.

Video: Making Dakin’s Solution, Part 1

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Video: Making Dakin’s Solution for Wound Care, pt. 1

open wound care

In this video, Joe Alton MD and Amy Alton ARNP take turns in front of the camera to discuss and demonstrate Dakin’s solution, a 100 year old recipe that is still used today by some practitioners as a way to treat and prevent infections in open wounds. Dakin’s solution is simple to make with affordable ingredients and is a useful tool in the medical woodshed for those that are off the grid due to a disaster or remote location. Part 1 of 2.

Wishing you the best of health in good times or bad,

 

Joe Alton MD and Amy Alton ARNP

You can make Dakin’s solution on your own, but when you need medical kits or commercially-made individual items, check out Nurse Amy’s entire line of supplies at store.doomandbloom.net. You’ll be glad you did.

All About Urinary Tract Infections

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Urinary Tract Infections

Urinary Anatomy

Medics in survival scenarios have to deal with major injuries and serious infections, Sometimes, infections aren’t serious to begin with, but worsen if not treated. Some of these infections involve the urinary tract.

Urine directly from the bladder is generally sterile, but most women have experienced a urinary tract infection (UTI) at one point or another.  The areas most commonly contaminated are the bladder, which holds the urine, and the urethra, the tube that drains the bladder.  Although men can also get bladder infections (called “cystitis”), their urethra is much longer and bacteria are much less likely to reach the bladder.

If untreated, bladder infections may ascend to the kidneys via tubes called ureters, causing an infection known as “pyelonephritis”.  Once in the kidneys, it can make its way to the bloodstream and lead to shock or worse.

Symptoms of UTIs

 

Each type of UTI manifests in more or less specific signs and symptoms, depending on which part of the urinary tract is infected.

Inflammation of the urethra (urethritis) may be caused by E.Coli, Gonorrhea, Herpes, and other bacteria and viruses. Sufferers will feel a burning sensation with urination; males may also have a urethral discharge, while women with certain sexually transmitted infections may notice a foul discharge from the vagina.

Bladder infections are characterized by pelvic pressure, lower abdominal pain, and frequency of urination. Some people may feel an urgent need to go without warning (urgency) but notice that the stream of urine is slow to start (hesitancy). The urine itself may be cloudy or red-tinged with blood and have a strong smell.

Kidney Infections signs include one-sided flank pain with fever

Once the infection reaches the kidney (pyelonephritis), other signs and symptoms will become apparent.  Fever and chills are common, with pain on the flank (the side of your back). Normally, it will be noticeable only on one side by tapping the flank lightly at the level of the lowest rib with the side of a closed first. This will elicit no response in a healthy patient, but someone with an infection will grimace and flinch. Kidney stones may be mistaken for a kidney infection, as they also cause tenderness in this region. They are, however, less likely to cause fever.

Treating a UTI

Treatment revolves around the vigorous administration of fluids.  Lots of water will help flush out the infection by decreasing the concentration of bacteria in the affected organs.  Some feel relief with a heating pad or compress in the area of discomfort.

various antibiotics work to treat UTIs

Antibiotics are another standard of therapy. The following are commonly used for UTIs (brand names and veterinary equivalents in parenthesis):

  • Sulfamethoxazole-trimethoprim (Bactrim, Septra, Bird-Sulfa, Fish-Sulfa)
  • Amoxicillin (Amoxil, Fish-Mox)
  • Ampicillin (Fish-Cillin)
  • Cephalexin (Keflex, Fish-Flex)
  • Azithromycin (Zithromax, Z-Pak, Aquatic Azithromycin)
  • Doxycycline (Vibramycin, Bird-Biotic)
  • Ciprofloxacin (Cipro, Fish-Flox)

For dosages, days taken, side-effects, and warnings, use the search engine on this website for the particular antibiotic.

To eliminate the pain that occurs with urination in UTIs, stockpile over-the-counter medications like Phenazopyridine (also known as Pyridium, Uristat, Azo, etc.).  Don’t be alarmed if your patient’s urine turns a reddish-orange color; it is an effect of the drug and is only temporary.

Natural Remedies for UTIs

There are a number of natural remedies to treat someone with a urinary infection. Vitamin C supplements, for example, are thought to reduce the concentration of bacteria in the urine.

Others include:

  • Garlic or garlic oil (preferably in capsules).
  • Echinacea extract or tea.
  • Goldenrod tea with vinegar (1 to 2 tablespoons),
  • Uva Ursi (1 tablet).
  • Cranberry tablets (1 to 3 pills).

Take any one of the above remedies three times per day.

Another home remedy is to take one Alka-Seltzer tablet and dissolve it in 2 ounces of warm water. Pour directly over the urethral area.

One more alternative that may be helpful is to perform an external massage over the bladder area with 5 drops of lavender essential oil (mixed with castor oil) for a few minutes. Then, apply a gentle heat source over the area; repeat this 3 to 4 times daily. The combination of lavender/castor oil and warmth may help decrease bladder spasms and pain.

I’m sure you have a tried-and-true strategy of your own. As with many home remedies, however, your experience may vary. In normal times, consult your physician.

Preventing UTIs 

Preventative medicine plays a large role in decreasing the likelihood of urinary tract infections.  Basic hygienic method, such as wiping from front to back after urinating, is important for women.  Also, emptying the bladder right after an episode of sexual intercourse is a wise choice.

Wear cotton undergarments to allow better air circulation in areas that might otherwise encourage bacterial or fungal growth. Adequate fluid intake, especially cranberry juice if available, is also a key to flushing out bacteria and other organisms.  Lastly, never postpone urinating when you feel a strong urge to go.

Off-grid medics may have to deal with gunfights at the OK corral, but it’s how well they handle everyday problems like UTIs that gauges their day-to-day contributions to their community.

Joe Alton, MD

Joe Alton MD

Learn about UTIs and 150 other medical topics in the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.

Survival Medicine Hour: Wilderness Safety, Snake Bite, More

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Survival Medicine Hour #347

wilderness safety

In this episode of the The Survival Medicine Hour with Joe Alton, MD, aka Dr. Bones, and Amy Alton, ARNP, aka Nurse Amy, discusses how to make those summer outdoor outings with your family, as well as off-grid survival scenarios, safer for all involved. To make a wilderness experience memorable (in a good way), you’ll need to know what factors will make the environment friendly or not-so-friendly, with injuries as the end result. Amy and Joe tell you what you need to bring in your medical kit.

Pit vipers!

One thing you might not bring is that old snake bite kit! Dr. Bones talks about current thinking regarding the old standard, and what to do if you have a group member suffer a venomous snake bite when modern facilities are not an option.

All this and more on the latest Survival Medicine Hour with the Altons! To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/07/14/survival-medicine-hour-wilderness-safety-snake-bites-more

 

Hey, do us a huge favor and….

Follow us on: Twitter @Preppershow      Facebook at DoomandBloom(tm)     YouTube at DrBones NurseAmy     Instagram at DoomandBloomMedical

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Nurse Amy and Dr. Bones

Find out more about snake bites and 150 other medical topics in times of trouble by getting a copy of the 700 page Third Edition of The Survival Medicine Handbook, now available on Amazon! And don’t forget to get a solid medical kit from Nurse Amy’s often-imitated, never-equaled entire line of supplies at store.doomandbloom.net! You’ll be glad you did.

Snake Bites in Austere Settings

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rattlesnake (image by wiki)

Off the grid, you will find yourself outdoors a lot, with activities like gathering wood for fuel, foraging, and hunting required to keep body and soul together. In warm weather, you just might find yourself face-to-face (or maybe face-to-ankle) with a snake.

Most snakes aren’t poisonous, but a few are, including some species common in North America. The term “poisonous snake” is probably incorrect, as venoms and poisons are not the same thing. Poisons are absorbed in the gut or through the skin, but venom must be injected into tissues or blood via fangs or a stinger. Interestingly, it’s usually not dangerous to drink snake venom unless you have a cut or sore in your mouth. Having said that, please don’t test this out at home.

Venomous snake bites have a distinct appearance due to the hollow fangs at the front of the mouth. This differs from non-venomous snakes, which have a more uniform appearance.

Since snakes are most active during the summer, most bite injuries occur then. Not every bite from a venomous snake transmits toxins to the victim, however; indeed, 25-30% of these bites will be “dry” and show little or no ill effects.  This could be due to the short duration of time the snake has its fangs in its victim or whether the snake had bitten another animal shortly beforehand. Many other snake bites are only slight “envenomations” and resolve without major intervention.

In most cases, it’s not hard to tell whether there’s venom in the bite. Snake bites containing venom tend to cause a painful burning sensation almost immediately. Swelling at the site may begin as soon as five minutes afterwards, and may travel up the affected area towards the body core.

Venomous Snakes in North America: Pit Vipers and Elapids

Many snakes have enough venom to deliver more than one bite

The two to worry about in North America are the pit vipers and the elapids. Of these, the pit vipers are responsible for the grand majority of venomous bites in the United States.

Pit vipers like rattlesnakes and water moccasins are identified by the presence of a heat-sensing “pit” organ between the eye and nostril on both sides of the head. They are, perhaps, more easily recognized by their triangular-shaped heads and slit-like eyes.  Rattlesnakes will, of course, have rattles that make noise when they’re threatened.

Pit viper bites tend to cause bruising and blisters at the site of the wound.  Numbness may be noted in the area bitten, or perhaps on the lips or face.  Some victims describe a metallic or other strange taste in their mouths. Serious bites might cause spontaneous bleeding from the nose or gums, irregular heart rhythms, or difficulty breathing.

Red touches yellow, kill a fellow…

The elapids include cobras and mambas, but the main North American representative is the colorful coral snake. Coral snakes appear very similar to their look-alike, the non-venomous king snake.  They both have red, yellow, and black bands and are commonly confused with each other. The old saying goes: “red touches yellow, kill a fellow; red touches black, venom it lacks”.  In other words, if the red band is next to the yellow band, it’s a deadly coral snake. If the red band touches the black band, it’s a non-venomous king snake. It should be noted that this old saying only applies to coral snakes in North America.

red touches black, venom it lacks…

Coral snake bites are “neurotoxic” and will cause mental and nerve issues such as twitching, confusion, and slurred speech.  Later, nerve damage may cause difficulty with swallowing and breathing, followed by total paralysis.  Luckily, only 73 coral snake bites were reported in the U.S. in 2013.

Preventing Snake Bites

Wear high tops in snake country

An ounce of prevention, they say, is worth a pound of cure.  High-top boots and long pants are always a sound strategy when hiking in the wilderness. It’s important to be aware of where you’re putting your hands and feet.  Be especially careful around areas where snakes might like to hide, such as hollow logs, under rocks, or in old shelters. Wearing sturdy work gloves would be a wise precaution if you can’t avoid these places.

If you let snakes know you’re near, they tend to leave the area. Snakes have no outer ear, so treading heavily creates ground vibrations much more easily “heard” by them than, say, shouting.

In warm weather, many snakes like to be active at night. This means that nocturnal outdoor activities are inadvisable without a good light source.

Treating a Snake Bite in Austere Settings

Pit viper bites often have bruising, sometimes blisters

The standard treatment for a venomous snake bite is “anti-venin”, also called “anti-venom”. Anti-venin is an animal or human serum with antibodies capable of neutralizing a specific biological toxin. Any hospital will have it, but in survival scenarios, this product will be a scarce commodity. If there’s no help coming, consider these steps:

  • Keep the victim calm. Stress increases blood flow, thereby endangering the patient by speeding the venom into the system.
  • Stop all movement of the injured extremity. Movement transports the venom into the circulation faster, so do your best to keep the limb still.
  • Clean the wound thoroughly to remove any venom that isn’t deep in the wound.
  • Remove rings and bracelets from an affected extremity. Swelling is likely to occur.
  • Position the extremity slightly below the level of the heart; this slows the transport of venom.
  • Wrap with clean, loose bandages further up the limb than usual. Pressure bandaging is thought to be helpful for elapid bites, but may be risky for pit viper bites, as it may cause tissue damage.In any case, keep the wrapping somewhat less tight than when dressing a sprained ankle. If it is too tight, the patient will reflexively move the limb, and spread the venom around.
  • Avoid tourniquets, which do more harm than good.
  • Draw a circle around the affected area. As time progresses, you will see the area shrink if it improves or grow if it worsens. By the way, this is a good strategy to follow for any local reaction, infection, abscess, or hematoma.

The limb should then be rested and, perhaps, immobilized with a splint or sling.  The less movement there is, the better. Keep the patient on bed rest, with the bite site lower than the heart, for 24-48 hours. This strategy also works for bites from venomous lizards, like Gila monsters.

Snake bite kits aren’t always recommended anymore

It is no longer recommended to make an incision and try to suck out the venom with your mouth.  The amount of venom removed is thought to be very little and oral bacteria could introduce an infection. Snake bite kits are available for your backpack, but are out of favor with most wilderness medical professionals. The Sawyer Extractor (a syringe with a suction cup) is modern and compact, but ineffective in eliminating more than a fraction of the venom. These methods fail, mostly, due to the speed at which the venom is absorbed by the body.

You may wonder why I haven’t suggested antibiotics as a treatment for snake bite. Interestingly, snake bites don’t cause infections as frequently as bites from cats, dogs, or humans.  As such, antibiotics are used less often.

Parting Thoughts on Snake Bite

A snake doesn’t always slither away after it bites you.  It’s likely that it still has more venom that it can inject, so move out of its territory or abolish the threat in any way you can. To many, this entails killing the snake. Even severing the head from the body may not render it harmless, however: it can reflexively bite for a period of time.

Elapids and pit vipers may respond differently to an encounter with a human. Coral snakes are not as aggressive as pit vipers and prefer fleeing to attacking.  Once they bite you, however, they tend to hold on. Rattlesnakes prefer to bite and let go quickly. Unlike elapids, though, pit vipers may be reluctant to relinquish their territory to you, so leave the area as soon as possible.

Snakes can be dangerous, but they want to avoid you as much as you want to avoid them. Keep an eye out, wear decent gear, and both you and the snake will be the happier for it.

 

Joe Alton MD

Ol’ Doc Bones

Fill those holes in your medical supplies by checking out Nurse Amy entire line of kit and individual items at store.doomandbloom.net!

 

 

Survival Medicine Hour: Wound Debridement, Shock Treatment, More

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THE SURVIVAL MEDICINE HOUR #345

Wound Debridement

In this episode of The Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy, discuss the Wilderness Medical Society’s special edition on combat casualty care guidelines applied to survival settings, where they coincide and where they diverge. Also, some basics on an important part of wound care, wound debridement, the removal of dead skin from a healing open wound. Studies show that antibiotics are important to prevent and treat wound infections, but debriding dead tissue from a wound is important to aid recovery as well.

People in shock lose heat quickly

Also, more on the different types of shock, and what to do if you have to treat someone deteriorating rapidly from some of the various types. All this and more on the latest Survival Medicine Hour with Joe Alton MD, and Amy Alton ARNP!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/07/07/survival-medicine-hour-shock-wound-debridement-more

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

Nurse Amy and Dr. Bones

Hey, fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and individual items at store.doomandbloom.net. You’ll be glad you did. And don’t forget, the 700 page third edition of the Survival Medicine Handbook: The Essential Guide for when Medical Help is Not on the Way is the most comprehensive book you’ll find written on medical care in times of trouble!

Survival Medicine Hour: Dakin’s Sol’n, Shock, HPV, Garlic

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Survival Medicine Hour #344

Direct Pressure on Bleeding Wound

Bleeding wounds need long-term care. Are you ready?

In this episode of the Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy, tackles a number of tough topics like, what can you put in an open wound to prevent and treat infection if a disaster happens and all you have is household items? Here’s how to use bleach and baking soda to make Dakin’s solution, used for over 100 years to prevent death from infected wounds.

Also, Nurse Amy discusses the uses of garlic, it’s not just for cooking! It’s got great antibiotic properties and more…

garlic

Plus, there are a variety of types of shock, and we’re not talking about the emotional kinds. Dr. Bones discusses hypovolemic, hemorrhagic, and cardiogenic shock in this ongoing series about dealing with a life-threatening event.

Finally, Joe Alton MD answers a question for the Survival Podcast’s expert council about whether the HPV exam is worthwhile to give to preteens. Find out more about this virus and the controversy surrounding it.

All this and more on the Survival Medicine Hour! To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/06/29/survival-medicine-hour-dakins-solution-garlic-shock-hpv-more

 

Wishing you the best of health in good times or bad,

Joe and Amy Alton

The Altons

Hey, fill those holes in your medical storage by checking out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net. You’ll be glad you did!

Video: Dental Abscesses

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dental abscess

In this companion video to a recent article, Joe Alton, MD, aka Dr. Bones, discusses the importance of dental preparedness in long-term survival settings. Perhaps you don’t need a dental kit when the power’s out for a few days, but when you’re stuck in primitive conditions and not likely to get out anytime soon, dental supplies are an important part of being an effective medic.

Let’s face it, pain in your mouth can make you miserable, so miserable that your work efficiency suffers as much as you do. One cause of dental discomfort may be a tooth abscess, which is a serious issue that can turn life-threatening. But what if there is no dentist? Learn what a tooth abscess may look and feel like, plus some possible emergency treatment methods during long-term disasters where there is no dental care available. Hosted by Joe Alton, MD of https://www.doomandbloom.net/

Wishing you the best of health in good times or bad,

 

Joe Alton, MD

 

Benadryl as a Local Anesthetic in Survival?

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Benadryl as a Local Anesthetic in Survival?

diphenhydramine (Benadryl)

A major obstacle in the ability of the survival medic to deal with the issue of wound closure is the lack of an easily available (and stockpile-able) form of anesthesia. With the most popular local anesthetic, lidocaine, a prescription item, it may be difficult to obtain enough to adequately fill the need in long-term disaster scenarios.

We often mention in our podcast that we learn as much (really, more) from our readers and listeners than they do from us. Now, we are informed that diphenhydramine (Benadryl) may serve, in its injectable form, as a reasonable alternative for local anesthesia.

You won’t find this information at drugs.com or other general medical information sites. Ordinarily, you’ll read that diphyenhydramine (DPH) is an antihistamine that reduces the effects of natural chemical histamine in the body. Diphenhydramine is used to treat sneezing, runny nose, itching, watery eyes, rashes, and some cold or allergy symptoms. It also serves as a remedy for motion sickness, a hypnotic (sleep-inducer), and even to treat certain aspects of Parkinson’s disease.

Benadryl comes in oral form as well as an injectable solution. Although controversial, the injectable has been used as a local anesthetic since 1956. It has been used in minor skin, dental, and podiatric procedures, especially in those allergic to lidocaine. This comment from a pharmacist’s emergency medicine blog:

“In one validation study for its use as a dermal anesthetic, a prospective, randomized, double-blind, placebo-controlled study was conducted to assess both the degree of anesthesia (in square millimeters) and pain associated with injection in 24 subjects who received 0.5-mL injections of 1% DPH, 2% DPH, 1% lidocaine, and 0.9% sodium chloride placebo. Subjects who received 1% DPH achieved equivalent level of anesthesia relative to 1% lidocaine (p = 0.889); in addition, 1% DPH more effective in this outcome compared to 2% DPH. However, subjects did experience greater perception of pain at injection with both concentrations of DPH relative to 1% lidocaine (more pain perceived with 2% DPH), with some subjects experiencing persistent discomfort in the injected area for up to three days following injection. In another study evaluating other concentrations of  DPH for local anesthesia, although a concentration of 0.5% DPH was deemed similar in perception of pain by patients upon injection compared to 1% lidocaine and a viable alternative to 1% lidocaine in maintaining local anesthesia, it was less effective than lidocaine when used for repairing minor skin lacerations in the face. In other head-to-head comparisons of 1% DPH and 1% lidocaine, similar levels and depths of local anesthesia were achieved.”

Like all drugs, there are possible adverse effects. The use of DPH as a local anesthetic may be associated with local necrosis (tissue death) at the site of injection. This usually occurs from the use of excessively high concentrations of the medication. As such, you will see it contraindicated as a local anesthetic on most medical websites. At normal dosages, sedation may be noticed, as well as local soreness. Be aware that it might burn as it is administered and that its safety is not confirmed in distal areas like fingers, toes, ears, and nose.

Injecting local anesthetic

The recipe is as follows, again from our pharmacist’s blog:

“Steps:

Draw up entire contents of vial containing 50 mg/mL diphenhydramine into the syringe. This should measure to a volume of 1 mL.

Dilute the contents of the syringe with 4 mL of 0.9% sodium chloride to yield a final volume of 5 mL.

Clearly label the contents of the syringe with the medication label as “Diphenhydramine 1% (10 mg/mL).”

Usually, the appropriate effect can be achieved with 2 ml or so of the injectable Benadryl. Use as little as possible to achieve the desired effect.

From the standpoint of availability, I was able to order the product as a private citizen (as opposed to a physician) from at least one veterinary website. That doesn’t mean that it is widely available, however.

The survival medic’s job is a difficult one. Searching for additional tools in the medical woodshed isn’t easy, but necessary if the medic is to be effective in an austere off-grid setting. Of course, in normal times, seek modern and standard medical care from qualified professionals.

 

Some additional support from conventional medical journals for the anesthetic effect of diphenhydramine:

Green SM, Rothrock SG, Gorchynski J: Validation of diphenhydramine as a dermal local anesthetic. Ann Emerg Med 1994; 23:1284-1289.

Ernst AA, Marvez-Valls E, Mall G, et al. 1% Lidocaine versus 0.5% diphenhydramine for local anesthesia in minor laceration repair. Ann Emerg Med 1994; 23:1328-1332.

Dire DJ, Hogan DE. Double-blinded comparison of diphenhydramine versus lidocaine as a local anesthetic. Ann Emerg Med 1993; 22:1419-22.

Ernst AA, Anand P, Nick T, et al. Lidocaine versus diphenhydramine for anesthesia in the repair of minor lacerations. J Trauma 1993; 34:354-7.

 

Joe Alton, MD

Joe Alton MD

Fill those holes in your medical storage by checking out Nurse Amy’s entire line of medical kits and supplies at store.doomandbloom.net. You’ll be glad you did.

some of Nurse Amy’s kits

Survival Medicine Hour: Survival Navigation w/Glen Martin, Thyroid Issues

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by Glen Martin

In this episode of the Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy, welcome Glen Martin, owner and founder of the 50-show strong Preppers Broadcasting Network to talk about his journey and to discuss his new book on Amazon, Prepper’s Survival Navigation. One way to put your health in jeopardy is not knowing where the heck you are, so listen in as Amy finds out secrets on how to stay grounded and pointed in the right direction in the wilderness.

Effects of low thyroid levels on left, normal on right

Also, a question about thyroid problems with the Expert Council with Jack Spirko, with Joe Alton MD answering questions about what to do about thyroid issues in survival scenarios. All this and more on the Survival Medicine Hour!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/06/16/survival-medicine-hour-survival-navigation-with-glen-martin-thyroid-issues

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Amy and Joe Alton

follow us on twitter @preppershow, on YouTube at drbones nurseamy, and Facebook at Doom and Bloom!

Also, don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and items at store.doomandbloom.net!

 

Survival Medicine Hour: Nailbed Injuries, Wound Closure, Mass Casualties

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American Survival Hour #340

Nailbed Injuries

In this episode of the Survival Medicine Hour, Joe and Amy Alton discuss small injuries like those to the nail bed, and large, massive injuries like those seen in mass casualty events. What do you do if you’re the first on the scene of a bombing or other multi-injury event? These days, as the recent events in England have taught us, a mass casualty incident (MCI) can occur anytime and anyplace there’s a crowd.

Plus, Joe and Amy talk about  the factors to consider before deciding to close a wound. Wounds should only be closed in certain circumstances in off-grid settings. Find out how to use the best judgment in this week’s Survival Medicine Hour with Dr. Bones and Nurse Amy!

When to close a wound?

To Listen in, click the link below:

http://www.blogtalkradio.com/survivalmedicine/2017/06/02/survival-medicine-hour-nailbed-injuries-wound-closure-mass-casualties

 

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Dr. Bones and Nurse Amy

Joe and Amy Alt

Don’t forget to check out Nurse Amy’s entire line of medical kits and individual items at her store at store.doomandbloom.net. You’ll be glad you did!

 

By the way, do us a Yuge favor and follow us on:

Twitter:@preppershow

Facebook:  drbonesand nurseamy     Facebook Group: Survival Medicine Group

Youtube: DrBones NurseAmy channel

 

 

 

 

To Close or Not to Close a Wound

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To Close or Not to Close a Wound?

typical laceration

typical laceration

When a laceration occurs, our body’s natural armor is breached and bacteria, even species that are normal inhabitants of our skin, get a free ticket into the rest of our body.  Microbes that are harmless outside the body could be life-threatening inside the body.

It only makes common sense that we want to close a cut (also known as a “laceration”) to speed healing and prevent infection. There is controversy, however, as to whether or not a wound should be closed.  When and why would you choose to close a wound, and what method should you use?

A laceration may be closed either by sutures, tapes, staples or medical “superglues” such as Derma-Bond or even industrial “Super-Glue” (the prescription product tolerates getting wet better).

After rendering first aid, which includes controlling the bleeding, removing any debris, flushing debris out of the wound (known as “irrigation”), and applying antiseptic, you will have to make a decision.

What are you trying to accomplish by closing a wound?  Your goals are simple.  You close wounds to repair the defect in your body’s armor, to eliminate “dead space” (pockets of air/fluid under the skin which could lead to infection), and to promote healing.  Although less a consideration in normal times, a well-approximated wound also has less scarring.

It sounds, you’d think, as if all wounds should be closed. Unfortunately, closing a wound that should be left open can do a lot more harm than good, and could possibly put your patient’s life at risk. Take the case of a young woman injured some years ago in a fall from a “zipline”:  She was taken to the local emergency room, where 22 staples were needed to close a large laceration. Unfortunately, the wound had dangerous bacteria in it, causing a serious infection which spread throughout her body.  She eventually required multiple amputations (including her hands!).

We learn from this an important lesson: Namely, that the decision to close a wound is not automatic but involves several considerations. The most important of these is whether you’re dealing with a clean or a dirty wound.

Most wounds you’ll encounter in an off-grid setting will be dirty.  If you try to close a dirty wound, such as a gunshot, you have sequestered bacteria, bits of clothing, and dirt into your body.  Within a short period of time, the wound may show signs of infection. An infected wound appears red, swollen, and hot. In extreme cases, an abscess may form, and pus will accumulate inside. The infection may spread to the bloodstream, a condition known as “septicemia”, and become life-threatening.

wound infection

wound infection

It may be difficult to fight the urge to close a wound. Leaving the wound open, however, will allow you to clean the inside frequently and directly observe the healing process.  It also allows inflammatory fluid to drain out of the body.  The scar isn’t as pretty, but it’s the safest option in most cases. In addition, if you’re truly in a long-term survival scenario, the suture material or staples you have aren’t going to be replaced. It’s important to known when a closure is absolutely necessary and when it’s not.

Other considerations when deciding whether or not to close a wound are whether it is a simple laceration (straight thin cut on the skin) or whether it is an avulsion (areas of skin torn out or hanging flaps).  If the edges of the skin are so far apart that they cannot be stitched together without undue pressure, the wound should be left open.

avulsion

avulsion

Another reason the wound should be left open if it has been open for more than 6-8 hours. Why? Even the air has bacteria, and there’s a good chance that they have already colonized the injury by that time.

Let’s say that you’re certain the wound is clean. It’s less than 8 hours old. Here are some other factors that would suggest that closure is appropriate:

  • The laceration is long or deep. The exception would be a puncture wound from an animal bite. These bites are loaded with bacteria and should be kept open in austere settings, in my opinion.
  • The wound is located over a joint. A moving part, such as the knee, will constantly stress a wound and prevent it from closing in by itself.
  • The wound gapes open, but loosely enough to suggest that it can be closed without undue pressure on the skin.
sutures

An item unlikely to be found after the you-know-what hits the fan

It’s important to realize that you will only have a limited supply of staples and sutures. Feel free to mix different closure methods like alternating sutures and Steri-Strips, or even adding duct tape improvised into butterfly closures when you’ve run out of medical supplies. You’d be surprised to see what qualifies as medical supplies when the chips are down.

If you are unsure, you can choose to wait 48 to 72 hours before closing a wound to make sure that no signs of infection develop.  This is referred to as “delayed closure”.  Some wounds can be partially closed, allowing a small open space to prevent the accumulation of inflammatory fluid.

Penrose Drain

Penrose Drain

Drains, consisting of thin lengths of latex, nitrile, or even gauze, might be placed into the wound for this purpose. Although these can get quite expensive, “Penrose” drains are a reasonably priced version of these that are still used in some operating rooms. Drains have a tendency to leak, so place a dressing over the exposed area.

Many injuries that require closure (and some that don’t) also should be treated with antibiotics in oral or topical form to decrease the chance of infection.  Natural substances with antibiotic properties, such as garlic or raw, unprocessed honey, may be useful in survival scenarios.

The decision to close a wound involves developing sound judgment, something that takes some training and experience. For that reason, we’ve taught wound care classes throughout the country, not just to teach the mechanics of how to “throw” a stitch, but to impart the knowledge of just what makes for a “close-able wound”.

Injuries are part and parcel of survival. Make sure that you can handle them, as well as infectious disease and all the other problems that will confront the medic in times of trouble.

Joe Alton, MD

dr. bones

Joe Alton, MD

Find out more about wound closure and 150 other off-grid medical topics in the third edition (700 pages!) of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available here or at Amazon.com.

Mass Casualty Triage Basics

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mass casualty incidents

Given the horrific events surrounding the Ariana Grande concert in Manchester, UK, we have come to realize that we may never be safe in today’s world. The bombing is new evidence, however, that no target is off limits to the terrorists in our midst. We can expect more episodes of terror in the western world in the future, and many will involve mass casualties.

The Mass Casualty Incident

The responsibilities of a caregiver is usually one-to-one; that is, the healthcare provider will be dealing with one ill or injured individual at a time.  This encounter usually falls within their expertise and resources.  There may be a day, however, when you find yourself confronted with a scenario in which multiple people are injured.  This is referred to as a Mass Casualty Incident (MCI).

A Mass Casualty Incident is any event in which your medical resources are inadequate for the number and severity of injuries incurred.  MCIs can be quite variable in their presentation.

Types of Mass Casualty Incidents

MCIs can be quite variable in their presentation:

  • Doomsday scenario events, such as a nuclear weapon detonation
  • Terrorist acts, such as occurred in Manchester
  • Consequences of a storm, such as a tornado or hurricane
  • Consequences of civil unrest or battlefield injuries
  • Mass transit mishaps (train derailment, plane crash, etc.)
  • A car accident with, say, four people injured (and only one ambulance)

 Responding to a Mass Casualty Incident

The effective medical management of any of the above events required rapid and accurate triage.  Triage comes from the French word for “to sort” (trier) and is the process by which medical personnel can rapidly assess and prioritize a number of injured individuals and do the most good for the most people. Note that I didn’t say: “Do the best possible care for each individual victim”.

Let’s assume that you were at the concert in Manchester, the Christmas market in Berlin, or the Boston Marathon when a bomb went off.  You are the first one to arrive at the scene, and you are alone.  There are twenty people on the ground, some moaning in pain.  There were probably more, but only twenty are, for the most part, in one piece.  The scene is horrific.  As the first to respond to the scene, you are “Incident Commander” until someone with more medical expertise arrives on the scene.  What do you do?

Your initial actions may determine the outcome of the emergency response in this situation.  This will involve what we refer to as the 5 S’s of evaluating a MCI scene:

  • Safety
  • Sizing up
  • Sending for help
  • Set-up of areas
  • START – Simple Triage And Rapid Treatment

Safety Assessment:  An insidious strategy on the part of terrorists when they target crowds is to set off primary and secondary bombs.  The main bomb causes the most casualties, and the second bomb is timed to go off or is triggered just as the medical/security personnel arrive.  This may run counter to your instinct to help, but your primary goal is your own self-preservation. Keeping the medical personnel alive is likely to save more lives down the road.  Therefore, you do your family and community a disservice by becoming the next casualty.

As you arrive, be as certain as you can that there is no ongoing threat.  Do not rush in there until you’re sure that the damage has been done and you and your helpers are safe entering the area.  In the immediate aftermath of the 1995 Oklahoma City bombing, various medical personnel rushed in to aid the many victims.  One of them was a heroic 37-year-old Licensed Practical Nurse who, as she entered the area, was struck by a falling piece of concrete.  She sustained a head injury and died five 5 days later.

Scene at the Boston Marathon bombing

Sizing up the Scene:  Ask yourself the following questions:

  • What’s the situation?   Is this a mass transit crash?  Did a building on fire collapse?  Was there a bomb?
  • How many injuries and how severe?  Are there a few victims or dozens?  Are there “walking wounded” that could assist you?
  • Are they all together or spread out over a wide area?
  • What are possible nearby areas for treatment/transport purposes?
  • Are there areas open enough for vehicles to come through to help transport victims?

Sending for Help:  If modern medical care is available, call 911 and say (for example):  “I am calling to report a mass casualty incident involving a multi-vehicle auto accident at the intersection of Hollywood and Vine (location).  At least 7 people are injured and will require medical attention.  There may be people trapped in their cars and one vehicle is on fire.”

In three sentences, you have informed the authorities that a mass casualty event has occurred, what type of event it was, where it occurred, an approximate number of patients that may need care, and the types of care (burns) or equipment that may be needed.

Set-Up:  Determine likely areas for various triage levels (see below) to be further evaluated and treated.  Also, determine the appropriate entry and exit points for victims that need immediate transport to medical facilities, if they exist.  If you are blessed with lots of help at the scene, assign triage, treatment, and transport team leadership roles.

S.T.A.R.T.:  Triage uses the acronym S.T.A.R.T., which stands for Simple Triage and Rapid Treatment.   The first round of triage, known as “primary triage”, should be fast (30 seconds per patient if possible) and does not involve extensive treatment of injuries.  It should be focused on identifying the triage level of each patient.  Evaluation in primary triage consists mostly of quick evaluation of respirations (or the lack thereof), perfusion (adequacy of circulation), and mental status.  These are known as “RPMs” and are a (very) basic indication of the level of injury.

Other than controlling massive bleeding and clearing airways, very little treatment is performed in primary triage. Controlling hemorrhage is best done with commercial tourniquets, for example, the SOF-T, CAT, or SWAT. It’s a sad sign of the times that I recommend carrying one of these if you have to go to areas where there are large crowds and little security. Tourniquets can be improvised with belts, bandannas, and other items, but are more difficult to apply effectively.

Although there is no international standard for this, triage levels in the U.S. are usually determined by color:

Immediate (Red tag): The victim needs immediate medical care and will not survive if not treated quickly.  (for example, a major hemorrhagic wound/internal bleeding) Top priority for treatment.

Delayed (Yellow tag): The victim needs significant medical care within 2-4 hours. Injuries may become life-threatening if ignored, but can wait until Red tags are treated. (for example, an open fracture of the femur without major hemorrhage)

Minimal (Green tag): Generally stable and ambulatory “walking wounded”, but may need some medical care. (for  example, broken fingers, superficial burns)

Expectant (Black tag): The victim is either deceased or is not expected to live.  (for example, a large open fracture of cranium with brain damage, multiple penetrating chest wounds

Patients may be identified with colored tape or triage casualty cards, but you’re unlikely to have these on hand. In that case, simply mark the victims’ foreheads with the numbers 1,2,3, and 4 indicating the priority for urgent care

casualty card produced by sos products

Knowledge of this system allows a patient marking system that easily allows incoming medical personnel to understand the urgency of a patient’s situation.  It should go without saying that, in a power-down situation without modern medical care, a lot of red tags and even some yellow tags will become black tags.  It will be difficult to save someone with major internal bleeding without surgical intervention.

The surviving victims of the Manchester bombing were “fortunate”, if I may use the word, that emergency personnel were on the scene in minutes. Although the death count is currently at 22, many more of the 60 wounded would not have survived without their assistance and transport to modern medical facilities.

We live in a more dangerous world these days, something I call “The New Normal“. In the New Normal, increased vigilance and situational awareness will be needed if you want to stay safe in crowds. In future articles, we’ll explore further how to deal with mass casualty incidents as a medical asset, and also how to avoid becoming a victim of those who want to disrupt civilized society.

Joe Alton, MD

Dr. Alton

Learn more about mass casualties, active shooter, terror events, and 150 other medical topics in times of trouble in the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.

Survival Medicine Hour: Eye Issues, Fractures, TENS units

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THE SURVIVAL MEDICINE HOUR: EYE ISSUES, FRACTURES, TENS UNITS

Pink Eye, aka Conjunctivitis

In this episode of the Survival Medicine Hour, Joe Alton, MD and Amy Alton, ARNP, aka Dr. Bones and Nurse Amy, discuss how to deal with various eye issues that can confront a medic in an off-grid survival setting, like Pink Eye, foreign objects, styes, and more. Plus, our hosts impart some basics on how to deal with broken bones.

Ouch!

Dr. Bones also answers a question from Jack Spirko’s Survival Podcast Expert Council, of which he’s a member, regarding the potential for use in survival scenarios of TENS units. TENS units are battery-powered items that deliver electrical stimulation to muscles and nerves to help with pain relief.

All this and more in the latest Survival Medicine Hour! To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/05/19/survival-medicine-hour-eye-issues-fractures-tens-units

Hey, do ol’ Dr. Bones a big favor and follow us on twitter @preppershow, YouTube at DrBones NurseAmy, and Facebook at Doom and Bloom(tm). You can also join our Facebook group at Survival Medicine DrBones NurseAmy!

Joe and Amy Alton

Joe and Amy Alton

Find out more about survival eye issues, fractures, and much more in the 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon. Also, check out Nurse Amy’s entire line of kits and individual supplies for the survival medic at store.doomandbloom.net!

Video: Azithromycin as Survival Antibiotic

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veterinary equivalents for Azithromycin

One of the most commonly prescribed antibiotics is Azithromycin, known in the U.S. as Z-Pak, is now in a new veterinary version known as Bird-Zithro. In survival situations where you’re off grid and there no modern medical care for the foreseeable future, the medic for the family must stockpile medical supplies, and this includes antibiotics.

See how Azithromycin in the form of “Bird-Zithro” might fit into you survival plans to treat your, well, sick birds. Uses, dosages, precautions, and more are more are discussed in this video by medical preparedness writer Joe Alton, MD.

To watch, click below:

Wishing you the best of health in good times or bad,

 

Joe Alton MD aka “Dr. Bones”

Joe Alton MD

 

Hey, learn more about Azithromycin, survival antibiotics, and 150 other medical issues in the Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available on this website and at Amazon.com. Also, check out Nurse Amy’s entire line of medical kits and supplies at store.doomandbloom.net. You’ll be glad you did.

Study: Expired EpiPens Still Effective

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Study: Expired EpiPens Still Effective

EpiPen and EpiPen Jr.

An expiration date is defined as the last day that a medicine is warranted to be safe and effective when stored properly. I’ve written for years that this date is often arbitrarily determined, and that the idea all medicines somehow “spoil” very soon after their expiration dates is incorrect.

I’m not alone in this opinion: A new study now reports that an important medical product that prevents deaths from severe allergic reactions (also called”Anaphylaxis“) can still be used effectively years after the expiration date on the package.

The California Poison Control System in San Diego tested 40 unused, expired Epipens and found that all (yes, all) of them retained at least 80% active epinephrine, the main ingredient.  This was true even for Epipens that closed in on the four-year expired mark. The least potent device was found to be at 81 percent 30 months past its expiration date. Most were at 90% or above.

Epipens are expensive items that are sometimes in short supply. F. Lee Cantrell, lead researcher of the California study, concludes that those unable to replace the product should hold onto it for use past the expiration date.

“There’s still a dose that would be therapeutic in there…” Cantrell also said: “if an expired EpiPen is all that I have, I would use it.” He suggests that it might be appropriate for the FDA (Food and Drug Administration) and Mylan, the company that distributes Epipen, to consider adjusting the expiration dates. Currently, the drug”expires” 12-18 months from the date of manufacture.

Of course, in normal times, the recommendation is to replace expired EpiPens. This new information, however, if of use to those who cannot afford to replace Epipen often and, also, to those in the preparedness community who store medical items in case of disaster.

The recommendation given by the California Poison Control System is a rare departure from standard conventional medical wisdom, which states that drugs should be disposed of as soon as they become expired. However, even the Department of Defense has determined that many medicines are 100% effective and safe to use even if expired. This data can be found in the July 2006 issue of the Journal of Pharmaceutical Sciences.

many drugs remain potent after expiration

The “Shelf Life Extension Program” (SLEP), which initially evaluated 122 drugs commonly stored for use in peacetime disasters, determined that most drugs in pill or capsule form were therapeutically effective for 2 to 10 years beyond the written expiration date. This led to the government issuing “emergency use authorizations” for various expired medicines when a shortage occurred. One example is the antiviral drug Tamiflu: During the 2009 Swine Flu epidemic, existing supplies of Tamiflu were authorized for use up to five years after the expiration date.

Drugs in liquid form did not fare as well in SLEP studies, which makes the Epipen (which uses a liquid solution of epinephrine) data so interesting. Granted, 100% potency would have been better, but 80-90% would still have a beneficial effect on an allergic reaction.

Given the 2016 Mylan scandal where the company increased the price from about $100 per two-pack to $600, an extended shelf life would be welcome news. (Mylan recently released a “generic” version for $300 per two-pack).

It should be noted that potency of a drug is affected by storage conditions. Most medicines should be stored in dry, cool, dark conditions. Allowing Epipens to be exposed to high heat or freezing could adversely affect effectiveness.

Many physicians are greeting the study’s findings skeptically, but I consider it more evidence that expiration dates are sometimes artificially determined, and that those storing medications for use in disaster settings might get more longevity out of their supply than expected. Get fresh medicine if available, but think twice before throwing out your last Epipen. Sometimes, something is better than nothing.

Joe Alton, MD

Dr. Alton:

Find out more about expired drugs, anaphylactic shock, and 150 other medical topics in austere settings with the 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon. (Be aware that the Second Edition can still be found there; be sure to get the latest edition or just order from store.doomandbloom.net.

An “UpTick” in Lyme Disease

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Deer Tick Bites and Lyme Disease

deer blacklegged tick

Blacklegged or Deer Tick

Whether you’re a hiker, camper, or survivalist, you’ll be spending a lot of time in the Great Outdoors.  During your off-grid adventures, you’ll be exposed to all sorts of critters that want a piece of you (watch an episode of “Naked and Afraid” to see what I mean). One of these is the lowly tick.

Ticks are eight-legged spider-like “arachnids” that exist in various species throughout the United States. They latch onto the skin of a host for a meal of blood and transmit various disease-causing microbes (“pathogens”) to humans and animals through infected saliva.

These diseases include:

  • Lyme Disease (also called “Lyme Borreliosis”)
  • Babesiosis
  • Anaplasmosis
  • Tularemia
  • Rocky Mountain Spotted Fever
  • Ehrlichosis
  • Relapsing Fever

In this article, we’ll concentrate on Lyme Disease. Lyme Disease is caused by the corkscrew-shaped bacterium known as Borrelia burgdorferi, commonly transmitted by the tiny blacklegged tick, also known as the deer tick.

borrelia bacteria

Borrelia Burgdorferi

Experts are expecting more cases of Lyme Disease due to recent mild winters and bumper acorn crops, which have increased the populations of animals that ticks like to feed upon. These include mice, a favorite of baby ticks, and deer, popular targets for adults. Because of the abundance of host animals, the Centers for Disease Control and Prevention (CDC) are estimating 300,000 cases of Lyme Disease this year, which is three times the number reported 20 years ago.

In case you’re wondering, Lyme disease has nothing to do with limes. It was first diagnosed in the town of Old Lyme, Connecticut in 1975. Since then, Lyme has become the most common tick-borne illness in the Northern Hemisphere.

tick stages

Deep Ticks in various stages of development

HOW TICKS SPREAD LYME DISEASE

Ticks have a life cycle that can last two-three years and includes egg, larva, juvenile (also called “nymph”), and adult stages. For a larva to develop into a nymph or for a nymph to develop into an adult, a blood meal in needed. It appears that the nymphs cause the most cases of Lyme. The CDC estimates that about 30% carry the disease in the Northeast and Upper Midwest.

To pass along Borrelia burgdorferi to an animal or human, ticks must first find their hosts. They do this in a number of ways: By detecting smells, sensing body heat, or feeling vibrations with movement. Usually, they hang on grasses and bushes, holding on with their back pairs of legs and latching onto passersby with their front pair(s). When the tick finds a favorable place to feed, its mouth parts pierce the skin and start extracting blood.

how to remove a tick

Tick Removal

A thorough examination of the entire body for ticks is warranted within two hours of returning after a day outdoors. This is most easily accomplished during a shower. Look behind the knees, in armpits, behind the ears, even the belly button.

If the tick is found, it may be possible to just brush it off. If that doesn’t work, a number of commercial products are available to remove it. It is reasonable, however, to simply use fine-tipped tweezers to grasp it as close to the skin’s surface as possible, and pull straight upward in an even manner. Twisting or jerking as you pull may cause the mouth parts to remain in the skin.

Thoroughly clean the wound area with isopropyl (rubbing) alcohol and apply antibiotic ointment. Wash hands afterwards. As an added precaution, launder clothing in hot water and dry in high heat. If all this is done soon after the bite occurs, infection is highly unlikely.

DETECTION OF EARLY LYME DISEASE

Sometimes, however, the bite goes unnoticed. Once bacteria are passed to the host by the tick (a process that often requires 24-48 hours), symptoms can become apparent anywhere from 3 days to a month afterwards. You will usually see the following: :

  • Rash
  • Fever and chills
  • Muscle aches
  • Fatigue
  • Joint pain
ticklymerash

Tick feeding

In 70 per cent of patients, the rash occurs before the fever and starts as redness in the area of the bite. It often then develops into a red circular “bull’s-eye” that feels warm to the touch. Usually, very little pain or itching is associated. This pattern, which spreads over time, is called “erythema migrans” and may be enough to confirm the diagnosis. Lyme Disease, however, may be missed or misdiagnosed if symptoms are mild or, especially, if the tick bite was missed by the examiner.

 

erythema migrans bulls eye pattern

erythema migrans

 

When a bite from a blacklegged tick is newly identified, preventative antibiotics may prevent Lyme Disease. A single dose of two 100 mg. doxycycline (Bird-Biotic) may suffice.

For early infection, as evidenced by the presence of erythema migrans, rapid treatment usually results in a cure. Symptoms, however, may last for a time after treatment.

Doxycycline (veterinary equivalent; Bird-Biotic) 100 mg. twice a day for 14-28 days is indicated, or in children (must be over 8 years old) 4mg/kg twice a day for 14-28 days (max of 100 mg.) Avoid doxycycline in pregnant or breastfeeding women.

Alternatively, Amoxicillin (veterinary equivalent: Fish-Mox) can be used in pregnant or breastfeeding women at dosages of 500 mg 3x/day for 14-28 days. 50 mg/kg is the dose for children younger than eight years of age (maximum 500mg 3x/day). Azithromycin (Bird Zithro) has been mentioned as a second alternative and can be used in those allergic to Penicillin-family drugs.

LATE STAGE OR CHRONIC LYME DISEASE

Late stage infections with Borrelia burgdorferi result in a more diverse set of Lyme symptoms, some quite different from those seen early. These may occur months after the tick bite and include:

  • Neck pain and stiffness
  • Severe headaches
  • Multiple rashes away from the site of the bite
  • Joint pain and swelling in knees and other large joints
  • Bell’s palsy (nerve damage that causes drooping on one side of the face)
  • Heart problems such as irregular heartbeats
  • Dizziness
  • Shortness of breath
  • Inflammation of the spinal cord (called “meningitis”)
  • Shooting pains, numbness, or tingling in the hands, feet, or face
  • Memory loss

Many of the above symptoms may persist for long periods. As of yet, there is not a proven cure for chronic or late stage Lyme disease, but a vaccine is now in development. We’ll discuss  some strategies are to deal with this debilitating condition in a future article.

Boots1

Don’t forget the high-tops!

PREVENTING LYME DISEASE

An ounce of prevention is, they say, worth a pound of cure, and this old saying is particularly relevant when it comes to infections caused by tick bites. For prevention, consider:

  • Long pants and sleeves on the trail
  • Thick socks and high-top boots (tuck your pants into them)
  • Walking in the center of trails
  • Using insect repellants like DEET (20% or greater) on skin (oil of citronella or lemon eucalyptus are natural alternatives)
  • Applying Permethrin 0.5% insecticide to clothing, hats, shoes, and camping gear 24-48 hours before using (proper application will even withstand laundering)
  • Thorough exams after a day outdoors; pay special attention to children and dogs
permethrin clothing

0.5% Permethrin for clothing

Paying close attention to the little things, especially ticks, will make sure that your outdoor activities are healthy and memorable (in a good way).

Joe Alton, MD

AuthorJoe

Dr. Alton

Survival Medicine Hour: John Steinbaugh of Xstat, Wound Packing, Obesity

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cover celox with roller gauze

Packing a Bleeding Wound

In this episode of The Survival Medicine Hour with Joe Alton, MD and Amy Alton, ARNP, aka Dr. Bones and Nurse Amy, we welcome John Steinbaugh of RevmedX to discuss his XStat product (which we previously mentioned was not an ideal product for the preparedness community), plus new products that his company has to help stop hemorrhage in wounds. Learn about the XGauze and Parabelt, plus some realities about TCCC guidelines and the issues that companies go through getting new technology to the public.

obesity fat

extra weight will decrease chances for survival

Plus, a question for Dr. Bones as a member of Jack Spirko’s popular Survival Podcast Expert Council, this time about what to do with obese group members once the trigger event occurs for a SHTF situation.

Lastly, Dr. Alton talks about how to pack wounds effectively, and some recommendations from a doctor-paramedic team’s recent article in the Journal of Emergency Medical Services.

All this and more in the latest episode of The Survival Medicine Hour with Joe and Amy Alton. To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/04/28/survival-medicine-hour-wound-packing-obesity-john-steinbaugh-of-xstat

 

Follow us on Twitter @preppershow

YouTube: DrBonesNurseAmy channel

Facebook: Doom and Bloom

 

Wishing you the best of health in good times or bad,

Joe and Amy Alton

AmyandJoePodcast400x200

Dr. Bones and Nurse Amy

Learn more about bleeding wounds and 150 other survival medicine topics in the Third Edition (700 pages!) of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon.

How To Pack A Bleeding Wound

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bleeding wound

Bleeding Wound

The failure to control hemorrhage is a common cause of death in trauma situations. With the increased number of active shooter events in the United States, the average citizen should have knowledge of basic methods to stop heavy bleeding. The government’s Stop The Bleed Initiative is attempting to foster awareness of the importance of this type of education.

In the April 2017 issue of the Journal of Emergency Medical Services (JEMS), Dr. Peter Taillac and EMT-P associates Scotty Bolleter and A.J. Heightman put forth their recommendations for the packing of hemorrhagic wounds with plain and/or hemostatic gauze such as Quikclot, Celox, and others. In addition, they reinforce the principles of direct pressure and tourniquet use to control bleeding and save lives.

In 2012, The American College of Surgeons (of which I’m a retired Fellow) and other organizations formed a joint commission to improve survival in heavily bleeding injuries. While endorsing direct pressure as a primary technique to reduce hemorrhage, the commission reviewed evidence for the use of hemostatic gauze, finding it to be an effective tool in 90% of cases.

Packing of wounds is useful in many situations, but not all. Wounds of the neck are problematic, for instance, due to the risk of compressing airways. Packing injuries in the abdomen, pelvis, and chest may not be effective due to the deep nature of the bleeding vessels. This is one reason why, in an off-grid setting, the death rate (called “mortality”) from these wounds is so high. Statistics from the Civil War put mortality rates for major injuries in these regions at close to 70 per cent, a figure that might be expected in long-term survival scenarios.

CeloxHemostatics

Celox Gauze is approved by the TCCC

Tactical Combat Casualty Care guidelines approve hemostatic gauze as dressings of choice for severe bleeding. These products use materials that enhance or produce clotting. QuikClot uses Kaolin, an original ingredient in Kaopectate; Celox and Chitogauze use Chitosan, a product made from the shells of crustaceans. XStat, made by RevMedX, is preferred by TCCC for hemorrhage in areas like the axilla (armpit) and groin. A new product, Xgauze, was recently described to us by John Steinbaugh of RevMedX as an effective item to control bleeding without kaolin or chitosan, using instead expanding sponges built into the dressing itself.

xgauze by revmedx

Xgauze by RevmedX

According to Dr. Taillac’s team, proper packing of wounds with plain or hemostatic gauze include the following steps:

  • Quickly and aggressively apply direct pressure with a gloved hand, clean dressing or cloth, or even the knee or elbow while breaking out your supplies. Explore the wound with your fingers to find the source of bleeding, using nearby bones, if possible, to increase the effectiveness of pressure.
  • Tightly (and I mean, tightly) pack the wound cavity as deeply as you can while continuing to apply pressure on the bleeding vessel. Pack directly onto the vessel itself. Although hemostatic gauze is effective, sufficient pressure with plain gauze may be enough.
  • Maintain pressure on the packed wound for at least 3 minutes.
  • Place a tight pressure dressing (Israeli Battle Dressing, Olaes Bandage, etc.) over the whole thing.
  • Splinting the wound will immobilize it and help prevent re-bleeds during transport.
Direct Pressure on Bleeding Wound

Direct pressure with a gloved hand and cloth barrier

The above method, along with appropriate use of tourniquets, should be effective in controlling hemorrhage. If the dressings become saturated, however, it may be necessary to use more packing or to start over. A second tourniquet may also be needed. In normal times, this might best be done during transport to a modern medical facility. In long-term survival settings, get the victim to where the bulk of your supplies are.

It is thought that 1 in 5 deaths from hemorrhage may be prevented by rapid action. Know the procedure and, have no doubt, you will save lives in disasters or other times of trouble.

 

Joe Alton, MD

AuthorJoe

Joe Alton, MD

 

Learn more about hemorrhage and over 100 other survival medicine topics  in the 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon. Plus, check out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net.

 

Survival Medicine Hour: Black Scout, Pt. 2, Azithromycin, Sick Room Set-Ups

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TentMEDIUM

Setting up a sick room

In this episode of The Survival Medicine Hour with Joe Alton, MD and Amy Alton, ARNP (aka Dr. Bones and Nurse Amy), we welcome back Jack of Black Scout Survival’s popular YouTube channel, who discusses a wide range of topics in part 2 of his interview with Amy.

Plus, Joe Alton, MD examines Azithromycin as a survival antibiotic. Thomas Labs has released a new bird drug, Bird-Zithro. Is Bird-Zithro a possible candidate for treating sick birds in your aviary after a disaster? Find out all you need to know about this important drug.

bird zithro 30 count azithromycin

Azithromycin for sick birds

Lastly, when an infectious disease epidemic comes to your town, would you be able to set up an effective sick room that will help the infected recover while keeping the healthy from getting sick? Joe and Amy go over what factors will make for an effective area to deal with infectious disease off the grid.

All this and more on The Survival Medicine Hour with Dr. Bones and Nurse Amy. To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/04/21/survival-medicine-hour-black-scout-pt-2-azithromycin-sick-rooms

Follow us on Twitter @preppershow                YouTube: DrBones NurseAmy Channel                  Facebook: Doom and Bloom

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

AmyandJoePodcast400x200

Dr. Bones and Nurse Amy

Don’t forget to get a copy of the new 700 page third edition of The Survival Medicine Handbook: The essential guide for when medical help is not on the way, available at Amazon or at www.doomandbloom.net

Setting Up A Survival Sick Room

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medicaltent

A hospital tent

In normal times, we have the luxury of modern medical facilities that can isolate a sick patient from healthy people. In a survival scenario, however, most organized medical care will no longer exist, placing the average citizen into the position of medic for his/her family or community.  

Although we may be thrown back to the 19th century medically by a disaster, we have the benefit of knowing about infections and hygiene.  The knowledge of how contagious diseases are spread and how to sterilize supplies give us a major advantage over medical personnel of bygone eras.

Using this knowledge, it should be possible for a medically prepared person to put together a “sick room” or “hospital tent” that will minimize the chance of infectious disease running rampant through the community. The cornerstone of care is to deal effectively and humanely with the sick while keeping the healthy from becoming infected.

In the face of a looming catastrophe, you must first make the decision to either stay in place or get out of Dodge. If you’re staying in place, choose a room where the sick will be cared for. That room should be separate from common areas, like the kitchen. It must have good ventilation and light, and preferably, a door or other physical barrier to the rest of the retreat.

If the wiser choice is to leave the area, shelter is an issue that may be addressed with, for example, tents. Choose a tent as the sick room and place it on the periphery of the camp. Again, good ventilation is important to allow air circulation.

With sick rooms in a retreat or camp, it is important to designate them before a disaster occurs. For groups where a number of people are living together, procrastinating will cause someone to lose their room or tent for “the greater good”. This invariably breeds resentment at a time when everyone needs to pull together.

Sometimes, you may find that there isn’t a spare room or tent to assign as a sick room. If you only have a common area to work with, raise a makeshift barrier, such as a sheet of plastic, to separate the sick from the healthy. Even if you have a dedicated sick room, keep group members with injuries separate from those with infectious diseases such as influenza. Although wounds will sometimes become infected, they won’t likely be as contagious as epidemic illnesses.

tent joe's kids

The injured should be separate from the infected, if possible

A sick room in a retreat with air conditioning won’t qualify as decent ventilation when the power’s down. In this case, air ducts are actually more a danger than a benefit. Microbes passing through the air ducts in the sick room to other areas may present a risk for transmission of disease. Cover with duct tape. Keep windows or tent flaps open, however, except in particularly bad weather. Screening may be necessary in areas with lots of insects, or netting provided over the beds.

Furnishings should be minimal, with a work surface, an exam area, and bed spaces. In mild weather, some of these bed space can be outside, as long as shade is provided via a canopy or other means. Hard surfaces are preferable to fabric upholstery, as cloth can harbor disease-causing organisms. Even bedding might best be covered in plastic. The more areas that can be disinfected easily, the better.

It’s important to have a way to eliminate waste products of bedridden patients, even if it’s just a 5-gallon bucket and some bleach. Containers with lids should be made available to put used sick room items that need cleaning.

shutterstock_209173573

Keep a basin with soap and water at the entrance to the sick room

A station should be set up near the entrance of the sick room or hospital tent for caregivers’ masks, gloves, gowns, aprons, and other personal protection items (have a good supply of these items). You’ll should also have a basin with water, soap, or other disinfectant. Thermometers should be dipped in alcohol.

Many consider medical supplies to consist of gauze, tourniquets, and battle dressings, but you must also dedicate sets of sheets, towels, pillows, and other items to be used in the sick room. Keep these items separate from the bedding, bathing, and eating materials of the healthy members of your family or group.

Having a lot of these may seem like overkill to you, but there can never be enough dedicated medical supplies. Expect to care for more people that you’ve planned for. There will always be additions that weren’t planned, and medical items will be expended much faster than you’d expect.

Cleaning supplies should also be considered medical preparedness items. You’ll want to clean the sick room thoroughly on a daily basis. Hard surfaces should be regularly cleaned with soap and water, or use other disinfectants such as a 1:10 bleach solution. Don’t forget to disinfect the doorknobs, tables, sinks, toilets, counters, and even toys.

Wash bed sheets and towels frequently; boil them if you have no other way to clean them. As these items may carry disease-causing organisms, wash your hands after use. The same goes for plates, cups, etc. Any equipment brought into the sick room should stay there.

One additional item that will be important to your sick room patients: Give them a whistle or other noisemaker that will allow them to alert you when they need help. This will decrease anxiety and give them confidence that you will know when they are in distress.

The duties of a medic involve more than how to control bleeding or splint an orthopedic injury. Medical problems involving infectious disease may take a heavy toll on your people if the sick aren’t isolated from the healthy. Knowing how to put together an effective sick room will go a long way towards helping the sick get healthy and the healthy stay that way.

 

Joe Alton, MD

AuthorJoe

Joe Alton MD

Find out more about dealing with infectious disease in times of trouble in our 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon or on this website.

The Survival medicine handbook Third Edition 2016

The Survival Medicine Handbook 2017 Third Edition

Survival Medicine Hour: Jack of Black Scout Surv., Gallstones, Fish Hooks, More

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jack richland black scout

Jack of Black Scout Survival

In this episode of the Survival Medicine Hour podcast, Joe Alton, MD and Amy Alton, ARNP, aka Dr. Bones and Nurse Amy, welcome back Jack of Black Scout Survival‘s popular YouTube channel to talk about his work and other important issues. Plus, Dr. Bones tells you all you need to know about gall bladder stones, a condition that affects 10-15 percent of the populations, and certainly would be an issue for the medic taking care of a large mutual assistance group.

gall bladder stones

Lastly, some ways to remove a fish hook from an outdoor mishap.

fishhookremoval

All this and more on the latest Survival Medicine Hour with Joe and Amy Alton!

 

To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/04/14/survival-medicine-hour-jack-of-black-scout-survival-gallstones-fish-hooks

 

 

Some of the items mentioned in today’s interview with Jack of Black Scout Survival:

Benchmade SOCP

https://www.amazon.com/Benchmade-Dagger-Combo-Sheath-Skelentonized/dp/B008NBBTAS

BENCHMADE SOCP MEDICAL EDITION

https://www.amazon.com/gp/aw/d/B06XD3J9LR/ref=pd_aw_sbs_200_2?ie=UTF8&refRID=H44CQTRPYXX6XPD852DR&dpPl=1&dpID=51a-lo20aYL

FELLHOELTER TIBOLT PEN

http://fellhoelter.com/shop/

Zebra pen f701

https://www.amazon.com/Zebra-Stainless-Ballpoint-Retractable-29411/dp/B002L6RB80

 

Wishing you the best of health in good times or bad,

Joe and Amy Alton

joe and amy radio

Dr. Bones and Nurse Amy

 

Fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and individual items at store.doomandbloom.net

MedBag-ADpic

The family medical bag and just some of its conten

Foot Fungus Diagnosis, Treatment, and Prevention

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athletes-foot-large

Tinea Pedis

The medic in austere settings may have to deal with major medical issues; there are minor issues, however, that don’t threaten your patients’ lives, but can seriously affect their quality of life or work efficiency.  In times of trouble, you’ll need your people at 110%, and many issues, such as toothaches or foot infections, can become a nuisance or worse.

One problem that is very common (and will be more so off the grid) is foot and toenail fungus, also called “Athlete’s Foot”.  When your dogs (by that, I mean your feet) are howling because you aren’t able to change socks often, Athlete’s Foot might be the cause.  Expect this to be particularly relevant in scenarios where you’re constantly on the move.

Athlete’s Foot

Athlete’s foot (also known as “tinea pedis”) is an infection of the skin caused by a type of fungus known as Trychophyton. A fungus is a microscopic organism that likes dark and humid conditions.

This condition may be a chronic issue, lasting for years if not treated. Neglect can lead to its spread from between the toes to hands and groin.

It’s important to know that fungal infections are likely to be contagious. They can be passed by sharing shoes or socks and even from wet surfaces such as shower floors.  Those affected by Athlete’s Foot may also find themselves with other fungal conditions like Ringworm or Jock Itch (“Tinea Cruris”).

What Are Risk Factors For Athlete’s Foot?

 

Any fungal infection is made worse by moist conditions. People who are prone to Athlete’s foot commonly:

  • Spend long hours in closed shoes
  • Keep their feet wet for prolonged periods
  • Have had a tendency to get cuts on feet and hands
  • Perspire a lot
  • Are male
  • Are older or have chronic medical conditions like diabetes

What Does Foot Fungus Look Like?

athletes-foot

typical appearance of tinea pedis

To make a diagnosis, look for whitish flaky skin between the toes or fingers., which often appear red and raw. The nails may be yellowed, thickened, and “crumbly”.  Toenails may even separate from the underlying nail bed. Itching and burning in the affected areas is common and sometimes becomes severe. If the skin has been traumatized by scratching, you might see some fluid drainage.  Often, the damage caused by scratching is worse than the infection itself, leading to secondary bacterial infections like cellulitis.

Although toenails will appear yellowish in Athlete’s Foot, dark spots (brown, blue, or black) under the nail may be just debris or could be related to other issues. After an injury, a collection of blood under the nail (called a “hematoma”) will be dark and, often, painful. Less often, a tumor such as a cancer called “melanoma”, may first present with a dark or mottled appearance.

Treatment of Foot Fungus

If the condition is mild, keeping your feet clean and dry may be enough to allow slow improvement of the condition. Oftentimes, however, topical antifungal ointments or powders such as miconazole or clotrimazole are required for relief.  In the worst cases, oral prescription antifungals such as fluconazole (Diflucan) or terbinafine (Lamisil) are needed.

Although creams and ointments cover the skin between the toes more thoroughly, don’t use them too often; excessive moisture may delay healing.

In the worse cases, an infected nail may require removal. If so, it may take a year to grow back.

Patience is a virtue when monitoring the healing process, which may take more than a month for a significant case of Athlete’s Foot to resolve. In the meantime, disinfect shoes with antifungal powders on at least a weekly basis.

Home Remedies

vinegar

cloudy vinegar useful for relief

A favorite home remedy for Athlete’s Foot involves placing Tea Tree Oil liberally to a foot bath and soaking for 20 minutes or so.  Dry the feet well and then apply a few drops onto the affected area. Repeat this process twice daily. Try to keep the area as dry as possible otherwise. For prevention of future outbreaks of Athlete’s Foot, apply tea tree oil once a week before putting on socks and shoes.

5% Apple cider vinegar foot soaks (2-4 cups) may work as well. The acid will kill the fungus, as well as soften and break down the skin changes it causes. Use a washcloth to gently scrub the infected areas. If you notice irritation from the bath, dilute with water.

Others recommend soaks with other items, such as black tea, cinnamon, betadine, or Epsom salts.

Long-term therapy with Snakeroot extract may help. Apply every third day for the first month, and once a week thereafter for two to three months. Alternatively, dip a cotton ball in the vinegar and hold to affected areas for several minutes.

Vicks Vap-o-Rub, applied with a swab, shows partial important in more than half of cases.

One method that doesn’t work is urinating on your feet in the shower. Although there is ammonia in urine that might kill germs, it’s not strong enough to kill the Athlete’s foot fungus.

You might have your own home remedy for foot fungus. If so, feel free to post it in the comments section.

 

Joe Alton, MD

AuthorJoe

Joe Alton, MD

Find out more about foot fungus and other minor and major medical issues related to survival, check out a copy of our Third Edition (700 pages) of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at amazon.com and here at store.doomandbloom.net.

Survival Medicine Hour: Sulfa Drugs, Uva Ursi, Quicklime, More

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OLYMPUS DIGITAL CAMERA

Sulfa Drugs

In this episode of the Survival Medicine Hour, Joe Alton, MD (Dr. Bones) and Amy Alton, ARNP (Nurse Amy) examine Sulfa drug antibiotics as an option in survival settings. One of the first antibiotics, sulfa has been credited with saving the lives of tens of thousands in WWII, including Winston Churchill himself, and still has applications today in good or bad times.

Also, the herb Uva Ursi may have some use in urinary tract infections, one of the medical issues that sulfa drugs are effective for. Find out more about this herb in Nurse Amy’s segment on natural remedies.

Uva ursi

Uva Ursi

Plus, Dr. Bones discusses what disasters are most responsible for the most deaths in the U.S. over the last 40 years. The answers will definitely surprise you! Plus, some guidelines on disposal of dead bodies in post-apocalyptic times.

All this and more on the latest Survival Medicine Hour with Joe and Amy Alton!

To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/04/07/survival-medicine-hour-sulfa-drugs-uva-ursi-quicklime-more

 

Wishing you the best of health in good times or bad,

Joe and Amy Alton

joe and amy radio

The Altons

Please follow us on Twitter @ Preppershow, and don’t forget to check out Nurse Amy’s entire line of medical kits at store.doomandbloom.net!

Sulfa as a Survival Antibiotic

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Fish Sulfa Forte = Bactrim/Septra

In survival settings, it’s reasonable to assume that you’ll be performing activities that aren’t part of your routine in normal times, like, say, chopping wood for fuel. When you’re doing chores to which you’re not accustomed, injuries can occur. Of course, an ounce of prevention is worth a pound of cure. Using protective eyewear, gloves, and boots may prevent an injury that could become life-threatening off the grid.

It might be difficult to envision that a simple cut could turn lethal, but in survival, many of these wounds are “dirty”; that is, they’re contaminated with bacteria or other microbes. Today, the use of drugs called antibiotics can nip infections in the bud. in any situation where modern medicine isn’t available, however, these wounds can become problematic. If an infection enters the bloodstream (a condition called “septicemia”), things can go downhill quickly.  

A while ago, I did a series of articles and videos on antibiotics, and talked about popular drugs like amoxicillin, doxycycline, Cipro and others that you can find in aquarium and avian versions. Available in capsules and tablets that are essentially identical to those provided for human use (even down to identification numbers), the wise medic should have some of these tools in the medical woodshed for when the you-know-what hits the fan.

Quick disclaimer: This doesn’t mean that you should be using them in normal times. Remember that it’s illegal and punishable by law to practice medicine without a license. If modern medical professionals exist, seek them out.

Today we’ll talk about a family of antibiotic called sulfonamides, or sulfa drugs. Sulfonamides act to inhibit an enzyme involved in folate synthesis, an important part of the production of bacterial DNA. Sulfonamides are bacteriostatic, which means that they don’t directly kill bacteria. They do, however, significantly inhibit growth and multiplication, which leads to eventual elimination of bacteria from the body.

Sulfonamides were available even before Penicillin, and are credited with saving the lives of tens of thousands during WWII, including that of Winston Churchill. Soldier’s first aid kits even came with sulfa pills or powder.

bird sulfa

Bird Sulfa

A specific version, Sulfamethoxazole 400mg/Trimethoprim 80mg (veterinary equivalent: Bird- Sulfa or Fish-Sulfa) is a combination of two medications in the Sulfa family. This drug is well-known in the U.S. by its brand names Bactrim and Septra. Our British friends may recognize it by the name Co-Trimoxazole. The two antibiotics work synergistically, which means that, together, they are stronger in their effect than alone.

Sulfamethoxazole/Trimethoprim is effective in the treatment of the following:

·        Some upper and lower respiratory infections (chronic bronchitis and pneumonia)

·        Kidney and bladder infections

·        Ear infections in children

·        Cholera

·        Intestinal infections caused by E. coli and Shigella bacteria (a cause of dysentery)

·        Skin and wound infections, including MRSA

·        Traveler’s diarrhea

·        Acne

The usual dosage in adults is sulfamethoxazole 800-mg/Trimethoprim 160mg twice a day for most of the above conditions for 10 days (5 days in traveler’s diarrhea).

The recommended dose for pediatric patients with urinary tract infections or acute otitis media (ear infection) is  40 mg/ kg sulfamethoxazole and 8mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours, for 10 days. 1 kilogram equals 2.2 pounds. This medication should not be used in infants 2 months old or younger.

In rat studies, the use of this drug was seen to cause birth defects; therefore, it is not used during pregnancy.

silvadene

Silvadene cream

Another sulfa drug, Sulfadiazine, is combined with Silver to make Silvadene, a cream useful for aiding the healing process in skin wounds and burns. Cover completely twice a day.

Sulfamethoxazole/Trimethoprim and other Sulfonamides are well known to cause allergic reactions in some individuals. These reactions to sulfa drugs are almost as common as Penicillin allergies, and usually manifest as rashes, hives, and/or nausea and vomiting. Worse reactions, however, can cause blood disorders as well as severe skin, liver, and pancreatic damage. Those with conditions relating to these organs should avoid the drug.

Although an allergy to Sulfa drugs may be common, it is not the same allergy as to Penicillin. Those allergic to Penicillin can take Sulfa drugs, although it’s possible to be allergic to both.

It’s important to understand that antibiotics aren’t candy: they must be used wisely and only when absolutely necessary. The overuse of antibiotics (mostly in livestock) is responsible for an epidemic of antibiotic resistance. Having them in your medical storage, however, can prevent the medic from experiencing headaches, and heartaches, if things go South.

Joe Alton, MD aka Dr. Bones

JoeAltonLibrary3

Joe Alton, MD

Learn more about antibiotics and 150 other medical topics related to survival by checking out a copy of our 700 page Third Edition of The Survival Medicine Handbook: THE Essential Guide for When Medical Help is Not on the Way.

The Survival medicine handbook Third Edition 2016

The Survival Medicine Handbook 2016 Third Edition

The Preparedness Dental Kit

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Dental Fracture

(This article first appeared in Gaye Levy’s Back Door Survival website)

Many of our readers are surprised that “The Survival Medicine Handbook: The Essential Guide for when Medical Help is Not on the Way” devotes a portion of its pages to dental issues. Indeed, few who are otherwise medically prepared seem to devote much time to dental health. Poor dental health can cause issues that affect the work efficiency of members of your group in survival settings. When your people are not at 100% effectiveness, your chances for survival decrease, and anyone who has experienced a toothache knows how it effects work performance.

A survival medic’s philosophy should be that an ounce of prevention is worth a pound of cure. This thinking is especially apt when it comes to your teeth. By enforcing a regimen of good dental hygiene, you will save your loved ones a lot of pain (and yourself a few headaches).

This article will discuss procedures that are best performed by someone with experience. Unfortunately, you’re probably not going to have a dentist in your party. The information here will give you a basis of knowledge that may help you deal with some basic issues

The Prepared Family’s Dental Kit

dental kit

some components for a dental kit

The prepared medic will have included dental supplies in their storage, but what exactly would make sense in austere settings? You would want the kit to be portable, so dentist chairs and other heavy equipment wouldn’t be practical.

We’ve mentioned that gloves for medical and dental purposes are one item that you should have in quantity. Don’t ever stick your bare hands in someone’s mouth! Buy hypoallergenic nitrile gloves instead of latex. For additional protection, masks should also be stored and worn by the medic.

Other items that are useful to the survival “dentist” are

  • Dental floss, dental picks, toothbrushes, toothpaste or baking soda
  • Dental or orthodontic wax as used for braces; even candle wax will do in a pinch. Use it to splint a loose tooth to its neighbors.
  • A Rubber bite block to keep the mouth open. This provides good visualization and protection from getting bitten. A large-sized pink eraser would serve the purpose.
  • Cotton pellets, Cotton rolls, Q tips, gauze sponges (cut into small squares)
  • Commercial temporary filling material, such as Tempanol, Cavit, or Den-temp.
  • Oil of cloves (eugenol), a natural anesthetic.It’s important to know that eugenol might burn the tongue, so be careful when touching anything but teeth with it.  Often found in commercial preparations.
  • Red Cross Toothache Medicine (85% eugenol)
  • DenTemp Toothache Drops (benzocaine )
  • Zinc oxide powder; when mixed with 2 drops of clove oil, it will harden into temporary filling cement.
  • Spatula for mixing (a tongue depressor will do)
  • Oil of oregano, a natural antibacterial.
  • A bulb syringe to blow air and dry teeth for better visualization, and as a diagnostic tool to elicit discomfort in damaged teeth.
  • A 12cc Curved irrigation syringe to clean areas upon which work is being done.
  • Scalpels (#15 or #10) to incise and drain abscesses
  • Dental probes, also called “explorers”.
  • Dental tweezers
  • Dental mirrors
  • Dental scrapers/scalers to remove plaque and probe question- able areas
  • Spoon excavators. These instruments have a flat circular tip that is used to “excavate” decayed material from a tooth. A powered dental drill would be a much better choice, but not likely to be an option off the grid.
  • Elevators. These are thin but solid chisel-like instruments that help with extractions by separating ligaments that hold teeth in their sockets. #301 or #12B are good choices. In a pinch, some parts of a Swiss army knife might work.
  • Extraction forceps. These are like pliers with curved ends. They come in versions specific to upper and lower teeth and, sometimes, left and right.
dental_extraction_forcep

dental extractor

There are more types of dental extractors than there are teeth, you should at least have several. Although every dentist has their preferences, you should consider including the following in your dental kit:

-#151 or #79N for lower front teeth

-#150A or #150 for upper front teeth.

-#23, best for lower right or left molars

-#53R, best for upper right molars

-#53L, best for upper left molars

  • Blood-clotting Agents: There are a number of products, such as Act-Cel, that help control bleeding in the mouth after extractions or other procedures. Act-Cel comes in a fabric square that can be cut to size and placed directly on the bleeding socket or gum.
  • Sutures: A kit consisting of a needle holder, forceps, scissors, and suture material is helpful for the control of bleeding after extraction or to preserve the normal contour of gum tissue. We recommend 4/0 Chromic catgut as it is absorbable and delicate enough for the oral cavity but large enough for the non-surgeon to handle. Don’t forget a small scissors to cut the string. More information on suture materials can be found later in this book
  • Pain medication and antibiotics. Medications in the Penicillin family are preferred if not allergic. For those allergic to Penicillin, Erythromycin can be used. For tooth abscesses, Clindamycin is a good choice. Antibiotics are discussed in detail in our book and in various sections of our website at doomandbloom.net

The Survival Dental Exam

Because your hands and your patient’s mouth are colonized with bacteria, every exam should begin with hand washing and the donning of gloves. All instruments should have been thoroughly cleaned or sterilized between exams. If an instrument has touched blood, consider using heat in the form of boiling water (or steam from a pressure cooker) as previously described in this book. Alcohol or bleach solution may be sufficient in cases where there was no blood involved.

Have your patient open their mouth so that you can investigate the area. A dental mirror and dental probe, also called an “explorer”, are good tools to start with. Does the patient have any problems opening and closing their mouth? Are there sores at the corner of their mouths (sometimes seen in vitamin B2 and other nutritional deficiencies)?

Evaluate the cheek linings, roof of the mouth, the tongue, tonsils, and the back of the throat. Are the gums pink, or are they red and swollen? Do they bleed easily when lightly touched by the probe?

Are there “canker” or “cold” sores? Contrary to popular opinion, these are not the same thing. Cold sore, or fever blisters, start off as small blisters and are caused by Herpes type I virus. They mostly affect the hard gums and the roof of your mouth. Canker sores are less certain in origin. They are shallow ulcers that affect soft parts like the inside of your lips and cheeks, the floor of the mouth, and the underside of the tongue.

Other soft tissues to check out include the tonsils. Are they enlarged? Are they or the back of the throat reddened and dotted with pus? These can be signs of tonsillitis or Strep throat.

Once you have checked the soft tissues inside the mouth, it’s time to examine the teeth. Using your dental explorer, carefully look around for any obvious cavities. A cavity will appear as a dark pit where bacteria has demineralized the enamel. Search for fractures, missing fillings, or other irregularities. Even if there is nothing visible, however, there may still be serious decay between teeth or below the gums. Patients with this issue may have pain, otherwise known as “toothache”. You’ll find information on how to deal with toothache, broken and “knocked-out” teeth, and other dental issues in The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way and in specialty books like “Where There is No Dentist”. We’ll discuss specific issues and how to treat them in future articles.

Once you’ve identified the problem area, you can do your best to deal with the problem. With the items above, you’ll be more prepared for survival dental 99.9% of the population. Our dental kit is designed to have the materials necessary to function in a survival setting and even comes with a free copy of “Where There is No Dentist”. That doesn’t mean that, in normal times, you shouldn’t seek out a qualified dentist; whenever and wherever modern dental care is available, take advantage of it.

Amy Alton, ARNP

NurseAmyBook

Amy Alton, ARNP

 

Find out more about dental issues and 150 other topics in our 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.

Video: All About Dysentery

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Shigella boydii

Shigella bacteria

In this video, Joe Alton, MD, aka Dr. Bones of DoomandBloom.net, discusses the issue of infectious diseases as the main causes of avoidable deaths in survival scenarios. In particular, he talks about dysentery, a disease that is transmitted by bacteria in contaminated food and water. Here’s all you need to know about this killer in past and future times of trouble. Companion video to a previous article on the same topic.

To watch, just click below:

Wishing you the best of health in good times or bad,

 

Joe Alton, MD

JoeAltonLibrary3

Joe Alton, MD

Find out more about dysentery and 150 more medical issues in the latest 700 page edition of the Survival Medicine Handbook: THE Essential Guide for When Medical Help is Not on the Way, available at store.doomandbloom.net or Amazon.com!

 

Survival Medicine Hour: Blood Clotters, Wound Closure, More

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stabwound

In this episode of the Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy discuss improvised tourniquets and some TCCC guidelines regarding hemorrhage under fire or in normal times. Blood clotting agents are introduced and Quikclot/Celox are compared. Plus, when should a wound be closed and when should it be treated as a open wound from beginning to full recovery?

celox

Celox hemostatic agent

All this and more from a Survival Medicine Hour on the road, this time in Chicago, Illinois!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/03/17/survival-medicine-hour-blood-clotters-wound-closure-more

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

AmyandJoePodcast400x200

Dr. Bones and Nurse Amy

Survival Medicine Hour: Dental Exams, Bleeding Control, Tourniquets

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dentalcare

The basic dental exam

The Survival Medicine Hour, on March 11, 2017, is hosted by Joseph Alton, MD aka Dr. Bones and Amy Alton, ARNP, aka Nurse Amy of https://www.doomandbloom.net/. In today’s show, Dr. Alton reviews the steps of a dental exam for those who find themselves in a remote area or post-disaster and who need to care for someone with an immediate dental issue. Expect more segments on individual dental problems that might confront the medic in remote or post-disaster settings.

soft-t tourniquet

The Sof-T tourniquet

Accidents happen everyday and you may find yourself as the person responsible for saving a life of someone who’s hemorrhaging. Severe injuries with bleeding can be scary to non-medical persons. Knowing some basic steps to stop bleeding are important to understand and share with your family members. Plus, a review of different tourniquets that might be useful for your medical kit.

 

All this and more on the Survival Medicine Hour! To listen in, click below:

 

http://www.blogtalkradio.com/survivalmedicine/2017/03/10/survival-medicine-hour-dental-exam-bleeding-and-tourniquets

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

AmyandJoePodcast400x200

Dr. Bones and Nurse Amy

If you’re concerned about a disaster taking you off the grid long term, have you thought of putting some dental supplies in that medical kit? Check out Nurse Amy’s dental kit at store.doomandbloom.net! Compare it with any other and you’ll know it’s the essential kit for long-term survival settings.

Dysentery in Survival Settings

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bacteria

dysentery may be caused by bacteria or parasites

 

In survival scenarios, many believe that trauma from gunfights at the OK corral will cause the most deaths. The truth, however, is that many avoidable losses will occur due to more basic issues, such as dehydration from infectious diarrheal diseases. These most often occur from failure to assure the sterilization of water, proper preparation of food, and safe disposal of human waste. One of the many duties of the medic in austere settings is to supervise these activities.

 

I’ve written about some of these diseases before, such as Cholera, but I haven’t discussed dysentery in much detail. The World Health Organization (WHO) defines dysentery as diarrhea in which blood is present in loose, watery bowel movements. Unlike Cholera, dysentery is a diarrheal disease that can be caused by several different organisms. It can be spread from human to human or, less commonly, from animals to humans.

 

Most cases of diarrhea are mild and easily treated with fluids and avoidance of certain food products, like dairy. Dysentery, however, is a more serious form where inflammation of the large intestine causes watery stools mixed with blood, pus, and mucus.

 

There are two types of dysentery:

 

Bacillary: Most often caused by several variants of the bacteria family Shigella, but E. Coli, Salmonella, and Campylobacter may also be involved.

 

Amoebic: A parasite, Entamoeba Histolytica, is more commonly seen in tropical and subtropical climates.

 

Dysentery was the cause of death of many soldiers in the Civil War. In total, infectious diseases like Cholera, Typhoid, and others killed more men than bullets or shrapnel.

 

SIGNS AND SYMPTOMS OF DYSENTERY

cholera 1

Nausea and vomiting can be seen in dysentery and other diarrheal diseases

 

About 2-10 days after infection, the patient will begin to show symptoms. Some will experience mild effects but others will progress to more severe disease. Beside frequent watery stools mixed with blood and mucus (sometimes 20-30 times a day!), you may see:

 

·        high fevers

·        abdominal pain and bloating

·        Excessive gas

·        Loss of appetite

·        Weakness and fatigue

·        Urgent need to evacuate

·        Vomiting

 

All of the above leads to significant dehydration, which is complicated in severe bacillary dysentery by erosion of the lining of the gut, leading to ulcers that cause bleeding from the rectum. Combined with the effect of bacterial toxins, death may occur quickly without antibiotic therapy and IV fluids. Amoebic dysentery may follow a similar course or be more prolonged in nature, leading to a weakened system and the formation of pockets of pus in the liver.  

 

TREATING DYSENTERY

oralrehydrationpack

oral rehydration salts

 

As you can imagine, any form of this disease will greatly decrease the chance for survival off the grid. As the well-prepared medic can intervene early with certain medicines, a high index of suspicion will decrease avoidable deaths.

 

For bacillary dysentery like that caused by Shigella, antibiotics like ciprofloxacin (Fish-Flox) or azithromycin (Aquatic Azithromycin) are used as treatment.  Amoebic dysentery can be treated with an anti-parasitic drug such as metronidazole (Fish-Zole). Dosing can be found in our book “The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way” or in various articles at doomandbloom.net. Loperamide (Imodium) and Pepto-Bismol (Bismuth Subsalicylate) are additional items that will be useful tools in the medical woodshed.

 

Of course, it’s especially important to rehydrate victims aggressively. Oral rehydration salts contain electrolytes that will more effectively aid recovery. These can be purchased commercially or improvised using the following formula:

 

To one liter of water (2 liters for children), add:

·        6-8 teaspoons of sugar

·        ½-3/4 teaspoons of salt

·        ¼-1/2 teaspoons of salt substitute (used by people who can’t use regular salt. This item has potassium, an important electrolyte, and can be found wherever regular salt is found.)

·        A pinch of baking soda for bicarbonate

 

PREVENTION

 

vegetables wash

prevent infectious disease with thorough washing

Prevention of dysentery requires understanding of how it’s spread. Transmission often occurs by infected individuals who handle food without washing first or use unsterilized water. Some people may carry the organisms and show no symptoms, at least for a time. As contamination with human feces is a big factor, the medic has to closely supervise the building and use of latrines and other facilities.

 

Dysentery is just one of the issues that can cause headaches and heartaches for the survival medic. With some knowledge and supplies, you’ll have a better chance to keep your family safe in times of trouble.

 

Joe Alton, MD

JoeAltonLibrary3

Joe Alton, MD

Fill those holes in your medical storage by checking out Nurse Amy’s entire line of often-imitated, never-equaled kits and supplies at store.doomandbloom.net!

Anaphylaxis: Causes, Diagnosis, and Treatment

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dandelion allergy

Allergies

In a disaster or any other situation that takes us off the grid, we will expose ourselves to insect stings and poison ivy, as well as strange food items that we aren’t accustomed to. Allergic reactions may ensue in susceptible individuals. When we develop an allergic reaction, it might be mild or it might be severe. If severe enough, we refer to it as anaphylaxis or anaphylactic shock. Anaphylaxis is the word used for serious and rapid allergic reactions involving one or more parts of the body which can become life-threatening.

Anaphylactic reactions were first identified when researchers tried to protect dogs against a certain poison by desensitizing them with small doses. Instead of being protected, many of the dogs died suddenly the second time they got the poison. The word used for preventative protection is “PROphylaxis”. Think of a condom, also known as a prophylactic. A condom protects you from sexually transmitted diseases. The word “ANAphylaxis”, therefore, means the opposite of protection. The dog experiment allowed scientists to understand that the same can happen in humans, and had application to asthma and other immune responses.

Severe allergic reactions may cause body-wide reactions called anaphylaxis that can be life-threatening. Anaphylaxis has become a timely issue because of the increased numbers of cases being reported throughout the world. When drugs are the cause, the explanation is likely that we are simply using a lot of them these days. Why foods should be causing anaphylaxis more often, however, is more perplexing. Is genetic manipulation of food crops to blame? Could contaminants be an issue, or perhaps pollution in general? In any case, the cause of many anaphylactic events is never identified; most are lumped into the “idiopathic” category (another word for “unknown”).

The likely causes of anaphylaxis are:

• Drugs: dyes injected during x-rays, antibiotics like Penicillin, anesthetics, aspirin, ibuprofen, and even some heart and blood pressure medicines
• Foods: Nuts, fruit, seafood
• Insects stings: Bees and Yellow Jacket Wasps, especially
• Latex: rubber gloves mad of latex, especially in healthcare workers
• Exercise: often after eating
• Idiopathic: This word means “of unknown cause”; a substantial percentage of cases

Fumes from chemicals like Chlorine gas and other toxins can be dangerous in their own right without causing an immune or anaphylactic reaction.

anaphylaxis symptoms

signs and symptoms of anapylaxis (wiki commons)

Although few die from simple allergic reactions, anaphylaxis is much more severe and, without intervention, the victim can die from respiratory or cardiac arrest. Body-wide swelling and rashes far from the site of a bee sting, for example, would be an example of an anaphylactic reaction. Other symptoms are exaggerated versions of typical allergies symptoms, with perhaps the addition of lowered blood pressure and fainting. In some cases, abdominal tract symptoms like cramping or diarrhea could be seen.

anaphylaxis

signs/symptoms of anaphylaxis

 

Treating Anaphylaxis

The treatment for anaphylactic shock is straightforward: epinephrine via injection. Other methods of delivery, such as oral doses of antihistamines, are generally too slow in their effect to be of much use.

Known as adrenaline in Europe. Epinephrine is given via auto-injector, with the most popular being the Mylan Corporation’s “Epi-Pen”. The process is simple with a dose delivered to the upper outer thigh. Once given, epinephrine narrows blood vessels and opens airways in the lungs. These effects can reverse hives, swelling, severe wheezing, low blood pressure, severe skin itching, and hives.

epi-pen

The “Epi-Pen”

A recent 600% price hike from the company that makes the Epi-Pen may put the drug out of the financial reach of many. If the auto-injector isn’t an option, vials or ampules of epinephrine are available (by prescription).

1:1000 epinephrine solution contains 1mg of drug per milliliter or cc of solution. For a person weighing 30 kg, 66 pounds, or greater, give 0.3 to 0.5 mg (0.3 to 0.5 mL) into the anterolateral thigh about the level of the bottom of your Jeans pocket. Repeat the dose every 5 to 10 minutes, alternating left and right thighs until improvement is noted (one dose if often sufficient). Remember that epinephrine will cause a fast heartbeat, nervousness and, perhaps, a number of other side effects. Of course, get the victim to modern medical care as soon as possible.

THE HYGIENE HYPOTHESIS

dog-and-kid-pixabay

It’s okay to get a little dirty!

The increased number of allergies seen in the modern world may actually be the product of “good parenting”. Our efforts to keep our children with their noses wiped and their hands clean are helpful to stop colds and flus but may be a factor in making them more prone to allergies and infections later on.

In 1989, researcher Dr. David Strachan suggested the hypothesis that the failure of children to be exposed to infectious bugs and parasites may be responsible for the epidemic of allergic conditions like asthma. This was called the “Hygiene Hypothesis”. The lack of exposure to microbes have since been tied to other diseases ranging from hay fever to multiple sclerosis.

When most of us lived on farms or in less-than-pristine cities, we were exposed to plenty of germs from a young age due to time spent outside with animals or with lots of other people. Now the majority of kids aren’t motivated to go outside or, certainly, get dirty. In the final analysis, never getting dirty as a child may be hazardous to your future health.

Here are some things you might consider:

Avoid antibiotics: The medical profession may have been remiss in over-prescribing antibiotics, but there are antibiotics in food as well. Indeed, 70-80% of antibiotics are given to livestock, not to treat infection, but to make they grow faster and get them to market sooner. Stick with antibiotic-free eggs, milk, and meats.

Avoid anti-bacterial soaps: Triclosan, the active antibiotic ingredient in many brands, has recently been banned by the FDA due to the risk of antibiotic resistance and the lack of evidence of any medical benefit. Use regular soap and water for washing.

Tailor Handwashing Strategies to the Situation:  If you’re in a city where open sewers run through the streets and people are tossing buckets of excrement out the window, have your kids wash their hands conscientiously. In clean environments where there isn’t a raging epidemic, however, don’t freak out over dirty hands.

Don’t Bathe Every Day: Not only should your kids be exposed to dirt to develop their immune system, but bathing too often might do more harm than good. Daily showers removes protective skin oils and causes drying and irritation. You’re also washing away the good bacteria that lives on your skin.

Get Your Kid a Pet: Not every kid has the good fortune of living on a farm, but they’ll benefit from a furry pet. Dogs seem to give more resistance to colds and allergic skin conditions like eczema than cats, but early cat exposure might give more protection against asthma. Why not have both?

Get your kids outside when they’re young: In these days where we have legitimate concerns about children’s safety, you might be reluctant to let your kids go outside by themselves. Here’s an idea: Go out with them, to parks, wilderness areas, and other places where both adults and kids can reap real benefits. How about helping them plant and manage a garden?

The more you encourage outdoor activities early, the more they become part of the next generation’s culture; let the kids get a little dirty, and you might give them a healthier future.

 

Joe Alton MD

AuthorJoe

 

Learn more about your immune system, allergic reactions, and over 100 other topics in our Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.

Survival Medicine Hour: Allergies, pt.2, Water Issues

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water

Safe Water

The Survival Medicine Hour this week, with your hosts, Joe Alton MD, aka Dr. Bones, and Amy Alton, ARNP, aka Nurse Amy, discusses water pollutants and part 2 of the series on Allergies. Your hosts request feedback on the show and other topics you may like to hear in future episode. They would also like to have any suggestions you might have about outdoor sport or activity first aid supplies and what you might experience as first aid incidents during those activities. Write to drbonespodcast@aol.com anytime!

 

Water contaminants are many and are reviewed in this episode. A guest post at https://www.doomandbloom.net/guest-post-10-things-you-didnt-know-were-in-your-drinking-water/ , by Jennifer Moran from https://theberkey.com/ is discussed and expanded upon in detail. Pollutants like lead, fluoride, BPA (Bisphenol A), iron and arsenic are just a few covered during this show.

 

In this part 2 series on allergies, Dr. Alton reviews a few allergies from the last show and continues with drug allergies, atopic dermatitis, food allergies, and toxin allergies. Helpful medications that relieve specific symptoms can include Afrin (beware of too much, and you will learn why), antihistamines, and oral meds.  A few natural remedies to relieve symptoms, like a Neti Pot, are reviewed. One important hint when using a Neti Pot, always make sure the water or saline is a sterile solution, or you could get sick from the contaminated solution.

 

To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/02/10/survival-medicine-hour-water-pollutants-allergies-pt2

 

Wishing you the best of health in good times or bad,

 

Amy and Joe Alton

Amy Alton Everglades Close up 400 x 600

Amy Alton, ARNP

 

Learn about allergies, water safety, and 150 more topics in off-grid settings with the 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. You’ll be glad you added it to your survival library.

 

Hey! Like board games? Well, check out our fun survival board game SURVIVAL! at survivalboardgame.com!

20130606-DBS_gameplay_mockup_KS

Doom and Bloom’s SURVIVAL! board game unboxed

Dang, It’s Cold! Treating and Preventing Hypothermia

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shutterstock_90110446

hypothermia (and bad judgment)

This winter has already seen deadly cold snaps where people have found themselves at the mercy of the elements. Whether it’s on a wilderness hike or stranded in a car on a snow-covered highway, the physical effects of exposure to cold (also called “hypothermia”) can be life-threatening.

 

Hypothermia is a condition in which body core temperature drops below the temperature necessary for normal body function and metabolism. Normally, the body core is between 97.5-99.5 degrees Fahrenheit (36.0-37.5 degrees Celsius). Cold-related illness occurs once the core temperature dips below 95 degrees (35 degrees Celsius).

 

When it is exposed to cold, the body kicks into action to produce heat. 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.

 

Aside from shivering, the most noticeable symptoms of hypothermia will be related to mental status. The person may appear confused, uncoordinated, and lethargic. As the condition worsens, speech may become slurred; the patient will appear apathetic, uninterested in helping themselves, and may lose consciousness. These effects occur 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 about 68 degrees Fahrenheit, although there have been exceptional cases where people (usually children) survived even lower temperatures.

 

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; include windy and wet weather into your calculations. Condition yourself physically to be fit for the challenge. Travel with a partner if at all possible, and have more than 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. Your head has a significant surface area, so prevent heat loss by wearing a hat. 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 those rest periods to self-assess for cold-related changes. Pay careful attention to the status of the elderly and the very young. Diabetics are also at high risk.

 

Layering. Loose-fitting, lightweight clothing in layers trap pockets of warm air and 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, 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.

st. bernard

Pet the Dog, Skip the Booze

One cold-weather issue that most people don’t take into account is the use of alcohol. 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.

 

Alcohol and recreational drugs also cause impaired judgment. Those under the influence might choose clothing that might not protect them in cold weather.

 

Treating  Hypothermia

 

If you encounter a person who is unconscious, confused, or lethargic in cold weather, assume they are hypothermic until proven otherwise. Immediate action must be taken to reverse the ill effects of hypothermia. Important measures to take are:

 

Get the person out of the cold. Move them into a warm, dry area as soon as possible. If you’re unable to move the person out of the cold, be sure to place a barrier between them, the wind, and the cold ground.

 

Monitor breathing. A person with severe hypothermia may be unconscious. Verify that they are breathing and check for a pulse. Begin CPR if necessary.

 

Take off wet clothing. If the person is wearing wet clothing, remove gently. Cover the victim with layers of dry blankets, including the head, but leave the face clear.

 

Share body heat. To warm the person’s body, remove your clothing and lie next to the person, making skin-to-skin contact. Then cover both of your bodies with blankets. Some people may cringe at this controversial notion, but it’s important to remember that you are trying to save a life. Gentle massage or rubbing may be helpful. Avoid being too vigorous.

 

Give warm oral fluids if awake and alert. If, and only if, the affected person is alert and able to swallow, provide a warm, nonalcoholic, non-caffeinated beverage to help warm the body. Coffee’s out, but how about some warm apple cider?

 

Use warm, dry compresses. Use a first-aid warm compress (a fluid-filled bag that warms up when squeezed), or a makeshift compress of warm, not hot, water in a plastic bottle. Apply to the neck, armpit, and groin. Due to major blood vessels that run close to the skin in these areas, heat will more efficiently travel to the body core.

 

Avoid applying direct heat. Don’t use hot water, a heating pad or a heating lamp directly on the victim. The extreme heat can damage the skin, cause strain on the heart, or even lead to cardiac arrest.

 

Joe Alton, MDAuthorJoe

Find out more about cold-related injuries in our Third Edition of the Survival Medicine Handbook, now at 700 pages! Also, fill those holes in your medical supplies at Nurse Amy’s store at store.doomandbloom.net. You’ll be glad you did.

Choosing Sutures

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Sutureneedleholder1

As we go around the country teaching the art of suturing pig’s feet to aspiring porcine podiatrists, we are often asked about how to choose the appropriate suture needles and material for different types of injuries.  There are a wide variety of choices and, today, we’ll discuss what is available and what is most effective for different types of wounds.

 

First, let’s identify some of the qualities of the optimal suture.  The suture should:

 

·        Be sterile

·        Be easily worked with

·        Be strong enough to hold wound edges together while they heal

·        Be unlikely to cause infection, tissue reaction or significant scar formation

·        Be reliable in its everyday use with every type of wound

 

It is rare, if not impossible, to find a single suture type that meets all of the above criteria, but there are many that will serve if chosen properly.

 

In the United States and many other countries, a standard classification of suture has been in place since the 1930s.  This classification identified stitches by type of material and the size of the “thread”.  Suture diameters most commonly used in humans (and pigs, I would think) is measured in zeroes, much like buckshot.  2-0 (00) suture, for example, is thicker than 5-0 (00000) suture. The more zeroes, the finer the “thread”. Finer sutures have less tissue reaction and heal faster, but are more difficult to handle for those without experience.

 

In addition to size, sutures are classified as absorbable and non-absorbable.  An absorbable suture is one that will break down spontaneously over time but not before the tissue has had sufficient time to heal.  Absorbable sutures have the advantage of not requiring removal after healing has taken place. This type of suture is commonly used in deep layers, such as muscle, fat, organs, etc.  A classic example of this is “catgut”, actually made from the intestines of sheep or cows.

 

(Aside: Catgut was once also used in the manufacture of stringed musical instruments and tennis racquets.)

 

Catgut is usually found in “plain” and “chromic” varieties. When dipped in a chromic acid salt solution, catgut lasts longer in the body while remaining absorbable.

 

Although still popular, catgut has been replaced by synthetic absorbables for many applications. examples of synthetic absorbable suture include “Vicryl” (polyglycolic acid), “PDS” (polydiaxanone), and others. These tend to last longer than catgut sutures, but will eventually be absorbed by the body.

suturenylon

Nylon suture package depicting size, needle shape, and length of “thread”

Nonabsorbable sutures are those that retain their character for a very long time, and will stay in the body until removed.  As such, normal immune response will cause the development of scar tissue, sometimes called “encapsulation”, around these sutures if used in internal body structures. 

 

Nonabsorbable sutures are best used in skin closures and situations that require prolonged tensile strength. They include monofilaments (such as “Nylon” and “Prolene”) and braided multifilaments (such as ”Surgical Silk”). Monofilaments like Nylon are useful because of less likelihood of harboring bacteria, whereas braided multifilaments have nooks and crannies for these organisms to hide. Monofilament also glide more easily through tissue. In trade, braided Silk is somewhat easier to handle than Nylon for many and often used for teaching purposes.

 

I recommend Nylon in most survival situations, with 2-0 or 3-0 Nylon ideal for those new to the suturing skill.  This size “thread” is easy to handle and useful for aspiring medics to learn surgical knot-tying.

 

The size of the “thread” you’ll use depends on the area of the body being repaired. Slowly healing tissues such as skin and tendons require nonabsorbable sutures; wounds in rapidly healing areas such as the inside of the cheek and vagina (childbirth) are best repaired with absorbables. 

 

In survival settings, cosmetic results are less important, but surgeons generally use smaller sutures in delicate areas such as areas on the head and face.  5-0 or 6-0 Nylon would normally be the choice here, but require more skill in handling.  Skin sutures should be placed, in my opinion, about 1/2 inch or so apart in most instances. This will allow drainage while keeping the wound together.  Areas over joints or other moving parts should be closer together. In wounds not near joints, say, the forearm, the sutures may be further apart and could be interspersed with Steri-Strips or butterfly closures.

suture needles

typical suture needles (chromic catgut)

 

The type of needle is also an important factor in choosing suture material. Needle that are less traumatic to sensitive tissues, like the lining of the bowel and other deep structures, are round on cross-section. These are known as “atraumatic” or “tapered”. Needles that are best on tough areas like skin are triangular in shape on cross-section and are referred to as “cutting” needles. Most suture needles that are useful for skin form a 3/8 circle; needles for deep work are often ½ circle in shape.

 

Having said all of the above, the choice of suture needles and material will vary depending on the user. Each surgeon will have his or her preferences based on their experience.

 

How long skin sutures remain in place before removal is dependent on the body part repaired.  Face wound sutures are usually removed relatively soon (5 days) compared to, say, a forearm wound (7-10 days).  Thicker skins, such as the sole of the foot should stay in somewhat longer.   Sutures placed over the knee or other joints should remain in place longer, 2-3 weeks, in my opinion.

 

Remember that the act of suturing is more traumatic than using butterfly closures, Steri-Strips, surgical glue, and others due to the fact that you are making more punctures in an area of skin already injured.  Each extra “hole” you create could allow the entry of bacteria into the wound. 

 

One last relevant point:  When you practice suturing on your pig’s foot, you are learning a skill, not a trade.  The practice of medicine without a license is illegal and punishable by law; as long as modern medical care exists, seek it out.

 

We’ll talk about staples, medical glues, and Steri-Strips/butterfly closures in future articles.

 

To see me suture in real time, here’s my YouTube video:

Joe Alton, MD

joealtonlibrary4Find out more about wound closure and 150 other topics in our 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for when Medical Help is Not on the Way“. Find suture kits and individual sutures at Nurse Amy’s store.

When to Close a Wound

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laceration2

There are many injuries that a medic will face in a survival scenario, and a common and potentially life-threatening one occurs whenever the skin is broken. Your skin is your body’s armor; when it is breached, infectious organisms enter a highway which can transport them to just about any part of the body. Therefore, it makes common sense that you’d want to close that breach to speed healing and lock out infection. Indeed, that’s exactly what happens thousands of times daily in emergency rooms in normal times.

The off-grid medic has a dilemma, however: Most wounds in survival will be dirty, and providing a sterile environment for a surgical procedure is a difficult challenge. You could make the work area as clean as possible, but sterile? Not likely. As such, you should wisely choose what wounds should be closed and what wounds should be left open.

Many medics can’t imagine not closing a tear or cut in the skin (called a “laceration”), but it’s a reasonable way to deal with contaminated wounds in situations where you can’t assure a sterile, or even clean, field on which to work. Lacerations that are kept open must be dressed and cleaned regularly until they’re fully healed.

Open wounds heal through a process called “granulation”, where new tissue forms at the base and sides until the defect in the skin is fully healed. Essentially, “from the bottom up”. This tissue is somewhat granular in appearance, hence the name.

hamlet-wiki

To Close or Not to Close?

To paraphrase Hamlet, “To close or not to close? That is the question!” To answer this questions, we must examine what our goals are in closing a wound. Among other reasons, you close wounds to:

  • Repair the defect in the body’s armor, thus preventing infection in a clean wound.
  • Accelerate the healing process. Wound edges that are touching heal faster than those that aren’t.
  • Decrease scarring. Scarring is less of an issue in survival, unless the scar would, say, limit the range of motion of a joint in extremity.

A note about bleeding: Although closing a wound may apply pressure to bleeding areas, it is not a substitute for hemorrhage control, also known as “hemostasis” before closure. Consider the application of direct pressure first on the bleeding area, a method that succeeds in many cases. Also, for major blood loss, have tourniquets, hemostatic agents like Celox or Quikclot, and pressure dressings as part of your medical storage.

So what factors come into play when deciding to close a wound or to keep it open? Consider keeping the wound open in these circumstances:

The wound is dirty. Are the circumstances suspicious for contamination? In survival scenarios, the answer is often yes. In austere environments, even WHO (the World Health Organization) agrees that the safest course of action is to keep it open.

infectedcut

Candidate for closure IF clean

Here are some circumstances where wounds should be kept open:

  • The wound is infected. Infected wounds have a certain appearance: They are red, swollen (sometimes appearing “shiny”), warm to the touch, and may drain pus.
  • The wound is colonized (infected but not yet showing signs). Even the air has bacteria; you can expect a wound to be colonized within 6-8 hours or so.
  • There is dead tissue in the wound. This tissue won’t bleed when it is cut and often appears discolored or black. No closure should be performed without removing dead tissue first (a procedure known as “debridement”).
  • Puncture wounds, especially from mammalian (including human) bites have lots of bacteria and shouldn’t be closed. Interestingly, snake bites become infected less often than, say, cat or dog bites, but don’t close them either.
  • The wound edges are so far apart that closing them would cause undue pressure. This occurs with injuries like “avulsions”, where entire areas of tissue are missing.
infected-cut

wound infection

Here are situations where you should consider closing the wound:

  • You’re certain the wound is clean. This usually requires witnessing the injury as it happens.
  • The wound has been open less than 6-8 hours.
  • The laceration is long or deep enough to penetrate the entire thickness of the skin. A deep wound would allow you to see underlying tissue such as subcutaneous fat.
  • The wound is located over a joint. A moving part, such as the knee, will constantly stress a wound and prevent it from closing in by itself.
  • The wound gapes open loosely, suggesting that it can be closed without undue pressure on the skin (and won’t close at all without your intervention).

In future articles, we’ll explore wound closure materials, techniques, and theory.

Joe Alton, MD

AuthorJoe

Joe Alton, MD

Learn all about wound care and wound closure methods via our DVD or in the Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.  View our entire line of medical kits and supplies at store.doomandbloom.net