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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ellis2contempclindent.org_

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

Survival Medicine Hour: Respiratory Infections, pt. 3, Foot Care, More

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colds

Respiratory Infections

The Survival Medicine Hour, November 25, 2016, with Joe Alton, MD aka Dr. Bones, and Amy Alton, ARNP aka Nurse Amy explore various respiratory infections and their symptoms. We classify respiratory infections as upper and lower. Upper respiratory infections invlove the troat, nasal passages, sinuses and larynx. Lower respiratory infections invlove the trachea (wind-pipe), bronchi and lungs.

Discover the common treatments and medications commonly used to treat these infections, and some special tips to help prevent them. What do you do with your toothbrush after you recover from a respiratory infection? Are you still using anti-bacterial soap to wash your hands? Find out what you should be doing to stay healthy and why.

Boots1

Pick the right shoes!

Christmas holidays are the time for shopping and lots of walking. Wear the wrong shoes and you may be in a world of hurt. Nurse Amy shares some good advice on what kind of shoes to wear on long walks and how to pick the right shoes for your feet.

To Listen in, Click below:

http://www.blogtalkradio.com/survivalmedicine/2016/11/25/survival-medicine-respiratory-infections-pt3-foot-care-happy-thanksgiving

 

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

 

Joe and Amy Alton, MD

 

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Doom and Bloom’s SURVIVAL! board game

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game miniatures (an added bonus!)

Survival Medicine Hour: Epipens, Hurricanes, Kratom, Chamomile

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epi-pen
The Survival Medicine Hour hosted by Joe Alton, MD aka Dr. Bones and Amy Alton, ARNP, aka Nurse Amy, are bringing you another episode of exciting and thrilling (well very entertaining and useful at least) survival information. Don’t miss out! Folks we have another hurricane on the horizon, Matthew is churning up the seas and is now a level 3 Hurricane with the possibility of hitting the USA in a few days time. Get prepared and learn what you need to do now to stay safe. Storm safety for all kinds of storms is vital knowledge.
What’s up with the Epipen crisis? What will you do if you don’t have or can’t afford the epipen, or even the still expensive ($606 for 2 pack) generic version? Dr. Bones shares a method of administering an alternative in the face of an emergency.
Kratom is being made into a schedule 1 drug, which is the same level as Heroin. This herb is blamed for 15 deaths, but only one of those deaths was the person found with only Kratom onboard. Many Kratom users herald it as the reason they were able to stop using other drugs, like heroin and pain meds. The users and their families contacted their congress members and a call to delay the change of Kratom to a schedule 1 drug has been made by the supportive congress members. More research should be done to accurately determine the effects of Kratom before a hastily decision is made. We discuss this issue and give you the 411.
Chamomile is a wonderful herbal medicine. It has been used safely for thousands of years. It is know to calm digestive issues and calm nervous disorders. Nurse Amy discusses this awesome herbal remedy and how to use it.
To listen in, click below:
Joe and Amy Alton
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Amy Alton, MD

 

Find out how to deal with medical issues in disaster/survival settings with the brand new 700 page Third Edition of the Survival Medicine Handbook: The essential guide for when medical help is not on the way.

Survival Medicine Hour: Kratom Ban, Dental Trauma, Medical Uses for Rosemary

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kratom

Kratom

In this episode of the Survival Medicine Hour with Dr. Bones and Nurse Amy (Joe Alton MD and Amy Alton ARNP), Dr. Bones discusses the upcoming ban on the useful but, perhaps, addictive herb Kratom, a Southeast Asian herb used for centuries to treat chronic pain and depression, and used by some today to replace addictions to opiates. Also, Nurse Amy discusses the many medical uses of Rosemary, and Dr. Bones discusses dental trauma, and what to do about that loose or knocked-out tooth in a survival setting.

dental-trauma

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/09/16/survival-medicine-hour-kratom-ban-dental-trauma-rosemarys-uses

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

 

Joe and Amy Alton

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The Dynamic Duo

Survival Medicine Hour: Hurricanes, Zika Update, Bee Deaths

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zika virus

Zika Virus

In this episode of the Doom and Bloom Survival Medicine Hour with Joe Alton, MD and Amy Alton, ARNP, a Florida landfall occurs for a hurricane for the first time in more than a decade. Were you ready? What should you do to prepare for the next one? Plus, Dr. Bones discusses new tragedies for the native bee population in the U.S. What will be the straw that break’s the bee’s, I mean, camel’s back? With every third bite of food you put in your mouth coming as a result of some bee pollinating a plant, you should be invested in this topic!

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A hurricane’s storm surge

Plus, we haven’t talked about Zika for a while, but that’s not because there hasn’t been a lot of news about it. Nurse Amy and Dr. Bones follow the globetrotting pandemic to a new outbreak in Singapore, talk about outbreaks that might not be reported due to lack of testing, and the effects that could occur on zika-infected newborns that are born looking perfectly normal.

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More bad news for bees

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

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/09/04/survival-medicine-hour-more-bad-news-for-bees-hurricanes-and-a-zika-update

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

Joe and Amy Alton

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The Altons

13 Safety Tips For Floods

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Mid Atlantic Coast Prepares For Hurricane Sandy

Storms often bring flooding

The recent Louisiana floods which claimed 11 lives and damaged 40,000 homes show how easily low-lying areas can be devastated by bad weather. Floods can occur even in normally dry areas and are so common that they represent 75% of presidential disaster proclamations. They are often seen in conjunction with other disasters like hurricanes and other storms.

 

You’d have to live on a mountaintop to avoid a flood but, even then, you’re still at risk for mudslides as a result of heavy rains. In view of this, we recently added flood and mudslide preparedness as chapters to the new Third Edition of “The Survival Medicine Handbook”. Clearly, floods are a disaster that can happen, and you should know how to keep your family safe.

 

TYPES OF FLOODING

 

A flood is defined as an overflow of water that submerges land which is normally dry. In the United States, there are various causes for flooding, including:

 
Flash Floods: Flash floods usually develop shortly after a nearby heavy rain. I say nearby because it doesn’t have to be raining at your location for rising water to endanger you. These floods create a rapid rise of water, especially in low-lying areas like floodplains. Causes of flash flooding include heavy rain, ice jams, and levee or dam failures. This is especially common in the western United States where normally dry areas next to steep terrain might fill with rushing water.

River Flooding: River flooding can be caused by heavy rainfall, dam failures, rapid snowmelt and ice jams. Normally flow can become turbulent rapidly as in a flash flood. In other cases, water levels may rise slowly but steadily. Either way, the result threatens structures and populations along its course.

Storm Surges: Tropical (or even non-tropical) storm systems can bring heavy winds, but most damage occurs as a result of flooding due to the storm surge. Storm surge is the rise in water generated by the storm above normal tide levels. When the storm approaches the coast, high winds cause large waves that can inundate structures, damage foundations, and cause significant loss of life.

Burn Scars: The Western U.S. has had significant wildfire activity, most recently in California. After a fire, the bare ground can become so hardened that water can’t be absorbed into the ground. This is known as a “burn scar”. Burn scars are less able to absorb moisture, leading heavy rains to accumulate water wherever gravity takes it.

Ice Jams: Northern areas of the continental U.S. and Alaska may have flooding as a result of ice jams. When moving ice and debris are blocked by an obstruction, water is held back. This causes flooding upstream. When the obstruction is finally breached, flash flooding occurs downstream. Many ice jams occur at bends in a river.

Snowmelt: Snowmelt flooding is common in mountainous Northern U.S. states. Snow is, until temperatures rise above freezing, just stored water. When it gets warmer, the snowmelt acts as if it were rain and flooding can occur.

Barrier Failures: When a dam or levee breaks, it can be due to excessive rainfall, erosion, landslides, earthquakes, and many other natural causes. Some dams fail as a result of man-made issues, such as negligence, improper maintenance, and even sabotage. As a result, water level can overflow the barrier or water can seep through the ground.

 

 

FLOOD PREPAREDNESS



Most people have heard of hurricane or tornado watches and warnings, but the U.S. weather services also tries to warn the populace of flooding. A “flash flood watch” means that flash flooding is possible in the near future; a “flash flood warning” means that flooding is imminent in the area.

 
If you live in a low-lying area, especially near a dam or river, then you should heed warnings when they are given and be prepared to evacuate quickly. Rising flood waters could easily trap you in your home and you don’t want to have to perch on your roof waiting for help.

 

FLOOD SAFETY TIPS

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Flood water may not recede quickly

 

To make it safely through a flood, consider the following recommendations:

 
Hit The Road Early
Make the decision to leave for higher ground before flooding occurs and roads are blocked. Having a NOAA weather radio will keep you up to date on the latest advisories. When the authorities tell you to leave, don’t hesitate to get out of Dodge.
Be Careful Walking Through Flowing Water
Drowning is the most common cause of death during a flood, especially a flash flood. Rapidly moving water can knock you off your feet even if less than a foot deep. Most vehicles can be carried away by water just two foot deep.
Don’t Drive Through a Flooded Area
In a flood, many people drown in their cars as they stall out in moving water. Road and bridges could easily be washed out if you waited too long to leave the area. Plan before a flood occurs to see if there is a “high road” to safety.

Beware Of Downed Power Lines
Watch for downed power lines; electrical current is easily conducted through water. You don’t have to touch the downed line to be electrocuted, only step in the water nearby. There are numerous instances of electrocutions occurring as a result of rescuers jumping into the water to try to save victims of a shock.
Don’t Drink The Water
Water, water everywhere, but not a drop to drink: Flood water is not clean water. It is contaminated by debris and water treatment plants may even have been compromised by the disaster. Have a reliable way to purify water and a good supply of clean water stored away. 12-16 drops of household bleach will sterilize a gallon of water (a teaspoon for 5 gallons), but a filter might also be needed to eliminate debris. Wait 30 minutes after sterilization to drink.
Have Supplies Handy
Flood waters may not recede quickly. Besides water as mentioned above, have non-perishable food, bottled water, heat and light sources, batteries, tools, extra clothing, a medical kit, a cell phone, and a NOAA weather radio among your supplies.
Turn Off The Power

If you have reason to believe that water will get into your home, turn off the electricity. If you don’t and the water reaches the level of the electric outlets, you could easily get electrocuted. Some warning signs might be sparks or strange sounds like crackling, popping, or buzzing.

Beware of Intruders
Critters that have been flooded out of their homes may seek shelter in yours. Snakes, raccoons, insects, and other refugees may decide your residence is now their territory. Human intruders may also be interested to see what valuables you left behind.
Watch Your Step
After a flood, watch where you step when you enter your home; there will, likely, be debris everywhere. The floors may also be covered in mud, causing a slip-and-fall hazard.
Check for Gas Leaks
Don’t use candles, lanterns, stoves, or lighters unless you are sure that the gas has been turned off and the area is well-ventilated.
Avoid Exhaust Fumes
Only use generators, camping stoves, or charcoal grills outside. Their fumes can be deadly.
Clean Out Saturated Items Completely

If cans of food got wet in the flood, their surfaces may be covered with mud or otherwise contaminated. Thoroughly wash food containers, utensils, and personal items before using.

 

Don’t use appliances or motors that have gotten wet unless they have completely dried. You might have to take some apart to clean debris out of them.

 

Use Waterproof Containers for Important Stuff

Waterproof containers can protect food, personal items, documents, and more.  If your area is at risk for flooding, have the important stuff protected by storing them correctly.

 
Floods are just one of the many natural disasters that can endanger your family and turn your home into a ruin. With planning and some supplies, however, you’ll be able to keep your loved ones safe and healthy.

 

 

Joe Alton, MD

JoeAltonLibrary4

Dr. Alton

Flood and mudslide survival are just some of the new chapters in the 700 page new Third Edition of the Survival Medicine Handbook: The Essential Guide For When Help Is Not On The Way. Get a copy for your survival library!

 

 

 

 

 

 

 

The Formula For Penicillin

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madscientist

The Penicillin Formula

As you might know, I write mostly about how to deal with medical issues in situations where modern medical facilities and care don’t exist. Accumulating medications for disaster settings may be simple when it comes to finding aspirin and other non-prescription drugs, but prescription drugs will be hard to get for those who can’t write their own prescriptions or don’t have a relationship with an understanding physician.  Antibiotics are a case in point.

I consider this a major issue because there will be a much larger incidence of infections when people have to fend for themselves. In a long-term survival setting, they will perform activities to which they are not accustomed and injuries are likely.  Simple cuts and scratches from, say, chopping wood can begin to show infection, in the form of redness, heat, and swelling, within a relatively short time.

The History Channel, some years ago, aired a special called “After Armageddon”, where a family gets out of Dodge after a collapse-level catastrophe and eventually makes their way to a village of survivors. Integrating into the community, the father (a paramedic) takes to gardening and other survival-type activities. He suffers a cut which quickly becomes infected. Unfortunately, no antibiotics are available and he slowly succumbs to the infection despite knowing exactly what’s happening to him.

Treatment of infections at an early stage improves the chance that they will heal quickly and completely.  However, many rugged individualists would most likely ignore the problem until it gets worse. This is unwise, as an infection can become life threatening if not treated. Having antibiotics readily available would allow them to deal with the issue until medical help (if available at all) arrives.

ANTIBIOTIC OPTIONS IN SURVIVAL SETTINGS

Years ago, I wrote the first physician article about aquarium and avian antibiotics as a way to stockpile medications for the uncertain future.  Since the only ingredient in certain of these medications is the antibiotic itself, it’s a reasonable alternative. There are some veterinary antibiotics, like Fish-Mox, that are only produced in human dosages and appear identical to human pharmaceuticals, down to the identification numbers on the capsules. For more information, see my series of articles on the subject.

This is not to say you should treat yourself in normal times. When modern medical care is available, seek it out. The practice of medicine without a license is illegal and punishable by law.

Once in a while, I get someone who wants to know how to make penicillin (isn’t it just bread mold?).  It’s true that penicillin is a by-product of a fungus known as penicillium, which, indeed, grows on bread and fruit.  It was originally discovered by Alexander Fleming in 1929. In 1942, a moldy cantaloupe in Peoria, Illinois was found to have a strong version of it.  Most of the world’s supply of penicillin in the 1940s came from cultures of the fungus on that cantaloupe.

There is a formula for making penicillin at home. It’s next to impossible, honestly, to get all the chemicals needed to produce it safely. Besides the legal issues, home laboratories are dicey at best (just ask a local Meth dealer). To illustrate a point, however, here it is:

THE FORMULA FOR PENICILLIN

penicillin mold

Penicillium Notatum mold

Penicillin is a by-product of the Penicillium fungus, but the thing is, it’s a by-product of a Penicillium fungus that’s under stress.  So you have to grow the fungus, and then expose it to stresses that will make it produce Penicillin.

First you need to produce a “culture” of the penicillium fungus. – A microbiological culture is a method of multiplying microscopic organisms by letting them reproduce in a certain environment under controlled conditions.

One of the most important things to know is that it is easy for other microbes to contaminate your penicillium culture, so use sterile techniques at all times or you will likely wind up with something entirely different (and, possibly, harmful).

NIH penicillin process

general penicillin production process (from NIH)

STEP 1

Expose a slice of bread or citrus peel or a cantaloupe rind to the air in a dark place at 70 deg. F until a bluish-green mold develops.

Cut two fresh slices of whole wheat bread into ½ inch cubes and place in a 750ml Erlenmeyer flask with a non-absorbent plug. One thing you might not know is that a lot of bakeries put a substance called a mold inhibitor on bread.  This suppresses fungal growth so you should probably use bread that you baked yourself.

Sterilize the flask and contents in a pressure cooker for at least 15 minutes at 15 psi. An alternate method is to place in an oven at 315 degrees Fahrenheit for one hour.

In a sterile fashion, transfer the fungus from the bread or fruit peel into the flask containing the bread cubes. Allow the cubes to sit in the dark at 70 degrees for 5 days. This is called incubation.  That’s the easy part.

STEP 2 

This is where it gets complicated. Prepare one liter of the following solution:

Lactose Monohydrate                    44.0 gm

Corn Starch                                      25.0 gm

Sodium Nitrate                                3.0 gm

Magnesium Sulfate                         0.25 gm

Potassium MonoPhosphate          0.50 gm

Glucose Monohydrate                   2.75 gm

Zinc Sulfate                                      0.044 gm

Manganese Sulfate                        0.044 gm

You’ll obviously need a scale that measures very small amounts. These are called gram scales and you can find them online.  The above ingredients can be found at chemical supply houses, but you’ll have to buy a significant amount.

Dissolve the ingredients in the order listed in 500ml of cold tap water and then add more cold water to complete a liter (1000 ml).

Adjust the pH to 5.0-5.5 using HCL (hydrochloric acid). You’ll need a pH test kit like those found at pet shops and garden supply stores. Fill glass containers with a quantity of this solution. Only use enough so that when the container is placed on its side the liquid will not touch the plug.

Sterilize the containers and solution in a pressure cooker or stove just like you did before. When it cools, scrape up about a tablespoon of the fungus from the bread cubes and throw it into the solution.

Allow the containers to incubate on their sides at 70 degrees for seven days. It’s important that they are not moved around.  If you did it correctly, you’ll have Penicillin in the liquid portion of the media. Filter the mixture through a coffee filter or something similar, plug the bottles, and refrigerate immediately.

STEP 3

To extract the penicillin from the solution:

Adjust the cold solution to pH 2.2 using (.01 %) HCL. Mix it with cold ethyl acetate in a “separatory funnel” (that’s a funnel with a stopcock; you can find all these items at chemistry glass suppliers) and shake well for 30 seconds or so.

Drain the ethyl acetate (which should be on the bottom) into a beaker which has been placed in an ice bath and repeat the process. Add 1% potassium acetate and mix. You want the ethyl acetate to evaporate off. This can be induced by a constant flow of air over the top of the beaker, say from a fan.  When it dries, the remaining crystals are a mixture of potassium penicillin and potassium acetate.

There you have it, you have put together a laboratory and made Penicillin!  You are now officially a mad scientist.

REALITY

It’s clear that making penicillin at home is beyond the ability of non-chemists.  However, it does make a point.   If there’s a major long-term disaster, there isn’t a way that anyone will be able to produce reliably safe and effective antibiotics at home. You might read about producing penicillin teas, but the issue is that you might have contamination by other molds that could be hazardous to your health.

If you are concerned about a collapse-level event, it may be wise to consider stockpiling some veterinary equivalents. At present, no prescription is necessary nor is there a limit to quantities purchased. This may eventually change as the CDC has declared that an increased “stewardship” of animal antibiotics will be necessary to combat the issue of antibiotic resistance. This is a reasonable concern, but restrictions will probably involve drugs for food animals first.

You can find lists of useful antibiotics, their veterinary equivalents, and much more in The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, now in its 700 page Third Edition. The book is available on Amazon or at DoomandBloom.net.

If you don’t want to buy fish medicine, at least grow plants that might have some antibacterial action. Garlic, for example, has scientifically proven antibacterial properties, as do some other herbs.  Honey, in its raw and unprocessed state, is also consider to be antibacterial. More on various herbal options in a future article.

Joe Alton, MD

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Dr. Alton

 

Video: Heat Wave Safety

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heat stroke 1

Man, it’s hot! In this video on Joe Alton, MD and Amy Alton, ARNP‘s YouTube channel, Dr. Bones discusses a natural disaster: Heat Waves. You might not consider the heat to be a natural disaster, but it can be deadly to a community as it was when a major one hit Europe in 2003, causing tens of thousands of deaths. Find out how to identify, treat, and prevent heat-related complications like heat exhaustion and heat stroke, and you might just save a life this summer!

To watch, click below:

 

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

 

Joe and Amy Alton

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Fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and individual items at store.doomandbloom.net.

Survival Medicine Hour: Tom Martin of APN, Shooter Issues, Summer Germs, Natural Remedies

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Summer Germs

In this episode of the Survival Medicine Hour with Joe and Amy Alton, aka Dr. Bones and Nurse Amy, Tom Martin of American Preppers Network joins us to talk about his new show, plus a serious look at the recent shooter events and when violence is the answer to stop the fatalities. Also, places you’ll be this summer that could make you seriously sick if you’re not careful. Nurse Amy continues her discussion of natural remedies that will help for orthopedic injuries. Dr. Bones also talks about what the medic’s priorities should be when under fire in hostile survival scenarios. All this and more on the latest Survival Medicine Hour.

DBS_character_hunter

 

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/07/08/survival-medicine-hour-shooters-summer-germs-tom-martin-of-apn-more

 

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

 

Joe and Amy Alton

joe and amy radio

Don’t forget to check out our brand new Third Edition of the Survival Medicine Handbook, as well as our Zika Virus Handbook, both available on Amazon. And fill those holes in your medical supplies at Nurse Amy’s store!

Survival Medicine Hour: Sprains/Strains, Heat Wave Safety, Brazil’s Zika Woes

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sprained-ankle

In this episode of the Survival Medicine Hour with Dr. Bones and Nurse Amy (Joe Alton, MD, and Amy Alton, ARNP), we discuss how a heat waves is a major natural disaster which commonly causes deaths, sometimes on a large scale, and how you can stay safe and avoid, identify, and treat heat stroke and other heat-related illness. Also, how to deal with orthopedic injuries like sprains and strains, plus some natural remedies from Nurse Amy that might be helpful to speed healing. We also discuss Brazil’s many woes, of which Zika virus is just one. Brazil is suffering from economic and political turmoil, and you can expect issues with security that may cause some injuries and deaths on top of the risk of infection. All this and more in this week’s Survival Medicine Hour!

heat stroke 1

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/07/01/survival-medicine-hour-sprainsstrains-heat-waves-brazils-zika-woes

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

 

Joe and Amy Alton, aka Dr. Bones and Nurse Amy

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Don’t forget to check out our brand new 700 page Third Edition of the Survival Medicine Handbook, now available at amazon.com!

Survival Medicine Hour: Urban Survival, Slowly Healing Wounds

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In this episode of the Doom and Bloom(tm) Survival Medicine Hour, Joe Alton, MD and Amy Alton, ARNP discuss what it takes to be an effective medic in an urban survival setting. From dealing with contaminated water to controlling a bleeding wound, there are special considerations that must be taken into account when surviving in place in the town or city. Find out what items you should have and how to approach the bleeding wound. Plus, Dr. Alton answers a question from “rancher”, a member of Jack Spirko’s Survival Podcast audience, about how to deal with thinning skin as you age and spend time in the outdoors. Conventional and natural remedies are discussed to help wounds in fragile skin heal faster.

Also, the new 2016 Third Edition of the Survival Medicine Handbook has hit Amazon, and it’s 670 pages of plain English advice on what to do in a disaster when the hospital is far away or just plain no longer exists. Get a copy today for your survival library.

To listen in to the podcast, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/06/12/survival-medicine-hour-urban-survival-slowly-healing-wounds

 

Wishing you all the best in good times or bad,

 

Joe and Amy Alton

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Announcing The NEW Third Edition Survival Medicine Handbook

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The Survival medicine handbook Third Edition 2016

The Survival Medicine Handbook 2016 Third Edition

Well, we’ve returned from an awesome week in the great state of Oregon and got to look at the final proof of the Third Edition, which arrived while we were away. It looks good on review, so we hit the publish button and it’s now available at Amazon.

 

For those who don’t know us, the third edition of The Survival Medicine Handbook is not your standard first aid book: Unlike other medical books (even some outdoor and “survival” medicine books), it assumes that a disaster, natural or man-made, has removed all access to hospitals or doctors for the foreseeable future; you, the average person, are now the highest medical resource left to your family.  It’s also for the family that lives or is traveling in rural areas where the ambulance is more than a few minutes away, or where there isn’t cell phone service.

 

To let you know what’s in the book, most of the topics are below. Every chapter has been revised to some extent. We’ve greatly increased the content on hemorrhagic wounds, adding chapters on active shooters, tourniquets, gunshot and knife wounds, discussions of ballistic trauma and body armor, and even the medic under fire. Food/water contamination, pandemic diseases, rodent issues, and disease-causing microbes also added as individual discussions. The section on respiratory infections is completely reworked as is the section on physical exams. Additional natural disaster preparedness topics include blizzards, avalanches, survival when lost at sea, mudslides, and more. Nurse Amy has added a lot of material to the medical supplies section, plus how to sterilize supplies, choosing a medic bag, and more. Soft tissue wound care and patient transport have been expanded. As always, we discuss alternative remedies wherever they may be helpful.
Here are just some of the over 150 topics (175 illustrations) covered in our 670 page book:

PRINCIPLES OF MEDICAL PREPAREDNESS-HISTORY OF PREPAREDNESS-USING ALL THE TOOLS IN THE WOODSHED-SPIRITUALITY AND SURVIVAL-MODERN MEDICINE VS. SURVIVAL MEDICINE-THE IMPORTANCE OF COMMUNITY-HOW TO BECOME AN EFFECTIVE MEDIC-LIKELY MEDICAL ISSUES YOU’LL FACE-MEDICAL SKILLS YOU’LL WANT TO LEARN-MEDICAL BAGS, KITS, AND SUPPLIES-HOW TO STERILIZE MEDICAL SUPPLIES-NATURAL REMEDIES, LIKE OILS, TEAS, TINCTURES, AND SALVES-THE MEDICAL HISTORY AND PHYSICAL EXAM-THE MASS CASUALTY INCIDENT-THE ACTIVE SHOOTER EVENT-PATIENT TRANSPORT-HYGIENE-RELATED MEDICAL ISSUES-LICE, TICKS, AND WORMS-DENTAL ISSUES AND PROCEDURES-RESPIRATORY INFECTIONS-GUIDE TO PROTECTIVE MASKS-FOOD AND WATER-BORNE ILLNESS-WATER STERILIZATION-DIARRHEAL DISEASE AND DEHYDRATION-DEALING WITH SEWAGE ISSUES-RODENTS AS DISEASE VECTORS-FOOD POISONING-PATHOGENS (DISEASE-CAUSING ORGANISMS)-HOW INFECTIONS SPREAD-APPENDICITIS AND OTHER ABDOMINAL INFECTIONS AND CONDITIONS-HEPATITIS-URINARY TRACT INFECTIONS-INFECTIONS CAUSED BY YEAST-CELLULITIS-ABSCESSES-TETANUS-MOSQUITO-BORNE ILLNESSES-PANDEMICS-THE SURVIVAL SICK ROOM -HYPERTHERMIA (HEAT STROKE)-HYPOTHERMIA-FROSTBITE/IMMERSION (TRENCH) FOOT-COLD WATER SAFETY-FALLING THROUGH THE ICE-AVALANCHE PREPAREDNESS-ALTITUDE SICKNESS-WILDFIRE PREPAREDNESS-SMOKE INHALATION-TORNADO PREPAREDNESS-HURRICANE PREPAREDNESS-EARTHQUAKE PREPAREDNESS-FLOOD PREPAREDNESS-MARITIME SURVIVAL-NEAR-DROWNING-VOLCANO PREPAREDNESS-ALLERGIC REACTIONS-ASTHMA-ANAPHYLACTIC SHOCK-POISON IVY, OAK, AND SUMAC-RADIATION SICKNESS-BIOLOGICAL WARFARE-INJURIES TO SOFT TISSUES- MINOR WOUNDS-HEMORRHAGIC WOUNDS-PHYSICAL EFFECTS OF BLOOD LOSS-HEMORRHAGE CONTROL-TOURNIQUETS-COMMERCIAL BLOOD-CLOTTING AGENTS-KNIFE AND BULLET WOUNDS-BODY ARMOR-THE MEDIC UNDER FIRE-SOFT TISSUE CHRONIC WOUND CARE-HOW TO SUTURE SKIN-HOW TO STAPLE SKIN-LOCAL NERVE BLOCKS-BLISTERS, SPLINTERS, AND FISHHOOKS-NAIL BED INJURIES-BURN INJURIES-ANIMAL BITES-SNAKE BITES-INSECT BITES AND STINGS-HEAD INJURIES-SPRAINS AND STRAINS-DISLOCATIONS-FRACTURES-PNEUMOTHORAX-AMPUTATION-THYROID DISEASE-DIABETES-HIGH BLOOD PRESSURE-HEART DISEASE-ULCER AND ACID REFLUX DISEASE-SEIZURE DISORDERS-JOINT DISEASE-KIDNEY AND GALL BLADDER STONES-SKIN RASHES-VARICOSE VEINS-HEMORRHOIDS-AIRWAY OBSTRUCTION-TRACHEOTOMY-CPR IN THE UNCONSCIOUS PATIENT-HEADACHE-EYE TRAUMA AND INFECTIONS-NASAL TRAUMA-EAR INFECTIONS-PREGNANCY AND DELIVERY-ANXIETY AND DEPRESSION-SLEEP DEPRIVATION-OVER THE COUNTER DRUGS-PAIN RELIEF-ANTIBIOTICS (and how to use them)- EXPIRATION DATES

 

We hope you’ll consider the Third Edition of the Survival Medicine Handbook for your library.

 

Joe and Amy Alton

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Joe Alton, MD and Amy Alton, ARNP

 

Food Contamination

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We’ve talked a lot about sterilizing water to make it safe for drinking, but a few things in the news lately got me thinking about food safety, another responsibility for the survival medic. Let’s start with some news of the weird:

Two supermarkets in Great Britain were closed by police after a man allegedly sprayed foul-smelling “urine” on the produce. The motive for this act is unknown, but if it’s a terror event, he certainly gets credit for creativity. In any case, authorities claim little if any risk to public safety (unless you shop at those markets, I guess).

While the above is a rare case of food contamination, outbreaks of bacteria found on food seem  to be becoming more frequent. Besides highly publicized problems at restaurants like Chipotle Mexican Market, a number of food companies have announced recalls of a wide variety of products. CRF frozen foods, who products are carried at Safeway, Wal-Mart, Trader Joe’s, and prepper favorite COSTCO, is recalling a total of 358 different items sold under 42 brands(!).

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These items were found to contain a bacteria known as Listeria, and at least seven people were hospitalized with 2 deaths. Organic and non-organic versions of carrots, broccoli, squash, peaches, raspberries, strawberries, and blueberries are among the many and varied products involved. All affected items have sell by dates between 4/26/16 and 4/26/18.  The US FDA website has a list of every brand.

So what’s listeria? Listeria monocytogenes is a member of a family of bacteria named after a founding father of modern sterile surgery, Joseph Lister; his name is also on various types of surgical instruments. It causes a relatively rare bacterial disease called listeriosis, a serious infection caused by eating food contaminated with the bacteria. The disease especially affects pregnant women, newborns and toddlers, adults with weakened immune systems, and the elderly. In these folks, the death rate from sepsis and a nervous system infection, meningitis, is about 20%.

A person with listeriosis usually has fever, muscle aches, diarrhea, and other intestinal symptoms. Listeria starts in the GI tract, but frequently invades different organ systems, often varying from patient to patient.

Pregnant women infected with Listeria can expect a higher incidence of miscarriage, stillbirth, premature delivery, and neonatal (newborn) infections. Others, such as the very young and the very old, may experience confusion, stiff necks, loss of coordination and balance, and seizures.

Although there are some differences in opinion, the antibiotic Ampicillin is generally thought to be a drug of choice. Other penicillins are considered acceptable by many. If allergic to Penicillins, other antibiotics like Sulfa drugs may be an option, although no specific alternative is officially recommended.

So how do you prevent infections with Listeria, and really, any bacteria that causes food poisoning? The below recommendations come from the Food and Drug Administration:

  • Rinse raw produce, such as fruits and vegetables, thoroughly under running tap water before eating, cutting, or cooking. Even if the produce will be peeled, it should still be washed first. If you touch the peel, and then the peeled fruit or vegetable, it can get contaminated with bacteria.
  • Scrub firm produce, such as melons and cucumbers, with a clean produce brush.
  • Dry the produce with a clean cloth or paper towel.
  • Separate uncooked meats and poultry from vegetables, cooked foods, and ready-to-eat foods.

It’s important to consider food storage and preparation surfaces. The FDA recommends:

  • Wash hands, knives, countertops, and cutting boards after handling and preparing uncooked foods.
  • Listeria monocytogenes can grow in foods in the refrigerator. Use an appliance thermometer, such as a refrigerator thermometer, to check the temperature inside your refrigerator. The refrigerator should be 40°F or lower and the freezer 0°F or lower.
  • Clean up all spills in your refrigerator right away–especially juices from hot dog and lunch meat packages, raw meat, and raw poultry.
  • Clean the inside walls and shelves of your refrigerator with hot water and liquid soap, then rinse.

Without thoroughly cooking meats, you put yourself at risk for infection. You should be sure that food is cooked evenly. It is thought that Ebola may have started in West Africa from partially-cooked bat meat. Each type of meat has its own recommended temperature to eliminate pathogens (disease-causing organisms). To see these, click the link below:

http://www.foodsafety.gov/keep/charts/mintemp.html

You might wonder how long meats are safe to eat even if stored in the refrigerator? The USDA has firm opinions on this:

  • Use precooked or ready-to-eat food as soon as you can. Do not store the product in the refrigerator beyond the use-by date; follow USDA refrigerator storage time guidelines:
    • Hot Dogs – store opened package no longer than 1 week and unopened package no longer than 2 weeks in the refrigerator.
    • Luncheon and Deli Meat – store factory-sealed, unopened package no longer than 2 weeks. Store opened packages and meat sliced at a local deli no longer than 3 to 5 days in the refrigerator.
  • Divide leftovers into shallow containers to promote rapid, even cooling. Cover with airtight lids or enclose in plastic wrap or aluminum foil. Use leftovers within 3 to 4 days.

In a survival scenario, it may be difficult to avoid bacterial contamination unless you closely monitor food preparation. In normal times, it’s easier, but only if you pay attention to good practice of food hygiene.

 

Joe Alton, MD

Survival Medicine Hour: New Normal, Zika Handbook, More

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Joe and Amy Alton announce their latest book, “The Zika Virus Handbook“! It’s the first book on everything you need to know about the infection written by an MD. It’s concise at 138 pages, but still way more information than the other books on Amazon. You’ll find out how to identify, prevent, and treat the disease, all about the mosquito that transmits it, and every measure you can take to protect your family. You’ll also hear about what our government is doing about it, plus some alternative theories about why so many cases are occurring on this side of the Atlantic. Zika’s this year’s pandemic, and with warm weather approaching, you should know about it.

Also, are people who prepare for disasters normal? Are “normal” people who don’t prepare for disasters normal? Well, in the New Normal, they might be, but normal sure doesn’t mean “sane”. Dr. Bones and Nurse Amy discuss the difference between “normal” and “sane” and why it’s even more important, given recent events, for people to wake up and get together knowledge and supplies that might help in times of trouble.

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17-year Cicada

Also, it’s time for the 17 year cicadas to come out! Will it be a plague of biblical proportions, and do you have anything to worry about? All this and more on the Survival Medicine Hour with Doom and Bloom’s Joe Alton, MD, and Amy Alton, ARNP.

To lIsten in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/04/24/survival-medicine-hour-the-new-normal-zika-handbook-more

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

 

Joe and Amy Alton

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Videocast: Around The Cabin #22

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In collaboration with the good folks at aroundthecabin.com/campfire, Joe and Amy Alton host a live videocast where they can demonstrate things live, like how to lance a boil, control bleeding, and other medical issues you might encounter in remote or survival settings. Here’s the latest episode, always fun and alway informative!

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This week’s guest star!

 

To watch, click below:

http://aroundthecabin.com/show-archives/wednesdays/

 

 

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

 

Joe and Amy Alton

 

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The Lovely Nurse Amy

 

 

 

Survival Medicine Hour: Altitude Sickness, Radiation, Zika, Survival Skills

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Nurse Amy was asked by Ballistic magazine to pick three survival skills she considers most important from a lengthy list, guess which one she thought would help her most in times of trouble? Also, Joe Alton, MD, aka Dr. Bones talks about how to identify and treat altitude sickness, and some important considerations to protect your family in case of a radiation event. Plus, the results of a recent poll of US citizens on Zika virus, a possible issue when mosquitoes swarm later this spring and summer. All this and more in the latest episode of the Survival Medicine Hour podcast!

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To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/04/11/survival-medicine-hour-radiation-altitude-sickness-zika-survival-skills

 

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

 

Joe and Amy Alton, aka Dr. Bones and Nurse Amy

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Video: Brown Recluse Spider Bites

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In this companion video to the article on the same subject, Joe Alton, MD discusses what he believes to be a brown recluse spider bite incurred by his wife Amy Alton, ARNP while tending to her medicinal and vegetable garden. Learn all about Brown Recluse Spiders, how to recognize their bites, and how to treat injuries caused by spider venom. And don’t worry, Amy is slowly but surely recovering.

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To watch, click below:

 

 

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

 

Joe and Amy Alton, aka Dr. Bones and Nurse Amy

 

Brown Recluse Spider Bites

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Brown Recluse wiki

Brown Recluse Spider (wikipedia)

You might have seen our articles and videos on snakebite, but in a survival scenario, and really, everyday life, you will see a million insects for every snake; so many, indeed, that you can expect to regularly get bitten by them. Insect bites usually cause pain with local redness, itching, and swelling, but are rarely life-threatening, although some fleas and mosquitoes can transmit some pretty nasty diseases.

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Nurse Amy

This time, we’ll talk about spider bites, and for a very specific reason. My lovely wife, Nurse Amy, has what we suspect is a brown recluse bite. As you know, we’re big on gardening and Amy spends a lot of time putting her green thumb to work growing some food. Well, there are bugs in any garden, and wouldn’t you know it, Amy got bitten by something. It started off as a blister, but then eroded the skin before stabilizing, and is now slowly healing.

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adult brown recluse (wikipedia)

Although tarantulas and other large spiders cause painful bites, most spider bites don’t even break the skin.  In temperate climates, two spiders are to be especially feared:  The black widow and the brown recluse. Today, we’ll talk about the brown recluse.

 

The brown recluse spider is, well, brown, and has legs about an inch long.  Unlike most spiders, it only has 6 eyes instead of 8, but they are so small that it’s difficult to identify them from this characteristic.

 

Victims of brown recluse bites report them to be painless at first, but then may experience these symptoms:

 

  • Itching
  • Pain, sometimes severe, after several hours
  • Fever
  • Nausea and vomiting
  • Blisters

 

The venom of the brown recluse is thought to be more potent than a rattlesnake’s, although much less is injected in its bite. Substances in the venom disrupt soft tissue, which leads to local breakdown of blood vessels, skin, and fat. This process, seen in severe cases, leads to “necrosis”, or death of tissues immediately surrounding the bite. Areas affected may be quite extensive. The same venom that acts to liquefy an insect’s innards for consumption causes the “flesh rotting” effect in human wounds.

Brown Recluse Bite

Amy’s spider bite

A common appearance of a brown recluse bite is the formation of a reddish blister, surrounded by a bluish area, with a narrow whitish separation between the red and blue, giving a “bull’s-eye” pattern. In some people, however, very little effect is noted or the appearance can be quite variable, as seen in the above image of Nurse Amy’s bite.

 

Once bitten, the human body activates its immune response as a result. Immune reactions can go haywire, destroying red blood cells and kidney tissue, and sometimes hampering the ability of blood to clot appropriately.  These effects can lead to coma and, eventually, death.  Almost all deaths from brown recluse bites are recorded in children.

 

The treatment for spider bites includes:

 

  • Washing the area of the bite thoroughly
  • Applying ice to painful and swollen areas
  • Pain medications such as acetaminophen
  • Enforcing bed rest in severe cases
  • Warm baths for those with muscle cramps due to black widow bites, but stay away from applying heat to the area with brown recluse bites
  • Antibiotics to prevent secondary bacterial infection

 

Home remedies include making a paste out of baking soda or aspirin and applying it to the wound. The same method, using olive oil and turmeric in combination, is a time-honored tradition. Dried basil has also been suggested; crush between your fingers until it becomes a fine dust, then apply to the bite. One naturopath uses Echinacea and Vitamin C to speed the healing process.  Be aware that these methods may be variable in their effect from patient to patient.

 

There are various vacuum devices and kits available that purport to remove venom from bite wounds. Unfortunately, these suction devices are generally ineffective in removing venom from wounds. Tourniquets are also not recommended and may be dangerous.

 

Although antidotes known as “antivenins” exist and may be life-saving for venomous spider and even scorpion stings, these will be scarce in the aftermath of a major disaster. Luckily, most cases that are not severe will subside over the course of a few days, but the sickest patients will be nearly untreatable without the antivenin.

 

Now, brown recluses are relatively new in Florida, but have been frequently reported recently in Florida, usually in the North. In the year 2000 alone the Florida Poison Control Network had recorded nearly 300 alleged cases of brown recluse bites in the state. Having said that, other infections or bites may appear similar, and some doctors feel that the brown recluse is often blamed for reactions that have nothing to do with it. other insect bites and some infections may also be the culprit.

 

Amy’s bite is getting better, but it’s important to know that spiders exist and to keep a close eye out for them as you tend to your survival garden.

 

Joe Alton, MD

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Are you ready to deal with medical issues you might encounter in a disaster? With our #1 Amazon bestseller The Survival Medicine Handbook and Nurse Amy’s entire line of medical kits and supplies, you’ll get a head start on keeping it together, even if everything else falls apart.

Video: Bleeding Control Kit

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In her latest video, Nurse Amy shows off her recently designed Bleeding Control Kit for active shooter or terrorist events. Packaged in highly visible mylar, it’s meant to be kept anywhere there are crowds that might be a tempting target for those who would do us harm. Especially useful for workplaces, schools, malls, arenas, and other locations, but also works for homes or vehicles. See it by clicking the video link below:

 

 

 

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

 

Amy Alton, ARNP
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Antioxidants and Survival, Part 2

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Last time, we talked about what antioxidants are and how they work to eliminate free radicals and strengthen your resistance to disease. We made clear the importance of having a variety of  antioxidant sources in your diet. It turns out that eating a healthy diet (and providing good nutrition for family and group members) is the best way to keep it together, even when everything else is falling apart.

 

 

Antioxidant Food Sources

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You can buy antioxidants by the bottle at the store but, to tell the truth, you should get most of your antioxidants not from supplements, but from your diet. A diet of fresh, raw, unprocessed foods (especially fruits and vegetables) is loaded with them. You should eat fresh, organically-produced food whenever possible, which underscores the importance of learning how to produce food on your own property or by “guerrilla gardening“. Check out  resources through your state’s agricultural extension office, such as The Master Gardener Program. Even in survival scenarios, the ability to access fresh food will supplement stored non-perishables and, certainly, provide more antioxidant support.

 

 

Foods that are high in antioxidants include:

 
• Vegetables. Most of the vegetables you eat, especially green leafy ones, are loaded with plant compounds that act as antioxidants. Kale, mustard greens, and spinach, for example, are good sources of vitamin E and other antioxidants. Remember that to maximize the antioxidants in vegetables, you have to eat them in a raw, unprocessed, and fresh state.

Fruit. Fresh berries like raspberries, blueberries, and cranberries are good antioxidant sources. They contain lots of vitamin C and carotenoids, as well as  iron, zinc, calcium, magnesium, and potassium.

 
Nuts. Raw Pecans, walnuts, almonds, and hazelnuts have antioxidants that can boost your heart and overall health. It should be noted that some grocery store nuts are  irradiated to prevent germination and should be avoided. Also, you should know that peanuts aren’t on this list. They aren’t even really a nut! They’re legumes, and related more to beans and peas.

 

 

Green tea. Green tea has compounds that lower your risk for heart attack and stroke, plus much more.

 

Herbs and spices. Consider putting together a herb garden to go along with those veggies. Herbs and spices are an abundant source of antioxidants. Some options are ginger, garlic, cloves, cinnamon, and turmeric,. Look for fresh products, as they are have higher antioxidant levels than processed and powdered versions. The antioxidant activity of fresh garlic is stronger than dry garlic powder, for example.

 

 

Sprouts are great sources of antioxidants.  Live in a high-rise and can’t grow a garden? Well, if you have about a little spare counter space in your kitchen, you can be a successful sprout farmer. You can even grow them in jars.

 
What about all those supplements you’ll find online and at the store? The name (“supplement”) is the key, they’re there only to add to a diet and shouldn’t be a sole source.  Certainly, it isn’t easy  to eat healthily due to today’s hustle and bustle lifestyle. If you choose to take supplements, consider CoQ10, moderate, not high, levels of Vitamin C and E, and acai berry as some options.

 

Antioxidant-Friendly Lifestyle Changes

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                                Get some sleep!

 

And, speaking of lifestyle, change yours to decrease the number of free radicals that your body has to deal with.

 
Decrease the amount of sugar  in your diet. Less sugar in your diet can help the antioxidants you have to work better and last longer. Food items with high-fructose corn syrup like many sodas are especially bad.

 
Exercise. Exercise in moderation can boost your body’s antioxidant production.

 
Manage your stress. Stress can worsen  inflammation  caused by free radicals. Studies have found links between psychological stress and numerous health issues. Even the Centers for Disease Control (CDC) says that most diseases have a psychological component.

 
Avoid smoking.  Smoking forms free radicals in your body, which accelerates the aging process, especially in your skin. Oh, by the way, it also has more carcinogens than you can shake a stick at.

 
Get some sleep! Sleep deficits can cause severe health problems. Seven to eight hours of sleep per night is the recommended amount for most adults, maybe a little less for oldsters.

 

Although antioxidants are considered to be part of the alternative philosophy of healthcare, many Western practitioners believe they have an important role (especially via diet) in keeping your body functioning at 100% efficiency. In a survival setting, that’s where you’ll have to be to stay healthy.

 

 

Joe Alton, MD

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To learn some strategies for handling medical issues in survival settings, look up our 3 category Amazon bestseller “The Survival Medicine Handbook“, with over 275 5-star reviews!  Also, fill those holes in your medical supplies by checking out our entire line of kits and supplies at store.doomandbloom.net.

Understanding Asthma

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Asthma is a chronic condition that limits your ability to breathe. It affects the airways, which are the tubes that transport air to your lungs. When people with asthma are exposed to a substance to which they are allergic (an “allergen”), airways become swollen and filled with mucus. As a result, air can’t pass through to reach the part of the lungs that absorbs oxygen (the “alveoli”).

During an episode of asthma, you will develop shortness of breath, tightness in your chest, and start to wheeze and cough. This is referred to as an “asthma attack”. In rare situations, the airways can become so constricted that a person could suffocate from lack of air.

Here are common allergens that trigger an asthmatic attack:

• Pet or wild animal dander
• Dust or the excrement of dust mites
• Mold and mildew
• Smoke
• Pollen
• Severe stress
• Pollutants in the air
• Some medicines
• Exercise

There are many myths associated with asthma; the below are just some:

• Asthma is contagious. (False)

• You will grow out of it. (False; it might become dormant for a time but you are always at risk for it returning)

• It’s all in your mind. (False)

• If you move to a new area, your asthma will go away. (False; it may go away for a while, but eventually you will become sensitized to something else and it will likely return)

Here’s a “true” myth: Asthma is, indeed, hereditary. If both parents have asthma, you have a 70% chance of developing it compared to only 6% if neither parent has it.

Physical signs and symptoms of asthma

Asthmatic symptoms may be different from attack to attack and from individual to individual. Some of the symptoms are also seen in heart conditions and other respiratory illnesses, so it’s important to make the right diagnosis. Symptoms may include:

• Cough
• Shortness of Breath
• Wheezing (usually sudden)
• Chest tightness (sometimes confused with coronary artery spasms/heart attack)
• Rapid pulse rate and respiration rate
• Anxiety

Besides these main symptoms, there are others that are signals of a life-threatening episode. If you notice that your patient has become “cyanotic”, they are in trouble. Someone with cyanosis will have a blue/gray color to their lips, fingertips, and face.

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cyanosis of the fingertips

You might also notice that it takes longer for them to exhale than to inhale. As an asthma attack worsens, wheezing may take on a higher pitch. Once the patient has spent enough time without adequate oxygen, they will become confused, drowsy, and possibly lose consciousness.

To make the diagnosis, use your stethoscope to listen to the lungs on both sides. Make sure that you listen closely to the bottom, middle, and top lung areas.

In a mild asthmatic attack, you will hear relatively loud, musical noises when the patient breathes for you. As the asthma worsens, less air is passing through the airways and the pitch of the wheezes will be higher and perhaps not as loud. If no air is passing through, you will hear nothing, not even when you ask the patient to inhale forcibly. This person may become cyanotic.

Here’s what wheezing sounds like when using a stethoscope:

Sometimes a person might become so anxious that they become short of breath and  think they are having an asthma attack. To resolve this question, you can measure how open the airways are with a simple diagnostic instrument known as a peak flow meter. A peak flow meter measures the ability of your lungs to expel air, a major problem for an asthmatic. It can help you identify if a patient’s cough is part of an asthma attack or whether they are, instead, having a panic attack or other issue.

To determine what is normal for a member of your group, you should first document a peak flow measurement when they are feeling well. Have your patient purse their lips over the mouthpiece of the peak flow meter and forcefully exhale into it. Now you know their baseline measurement. If they develop shortness of breath, have them blow into it again.

In moderate asthma, peak flow will be reduced 20-40%. Greater than 50% is a sign of a severe episode. In a non-asthma related cough or upper respiratory infection, peak flow measurements will be close to normal. The same goes for a panic attack; even though you may feel short of breath, your peak flow measurement is still about normal.

In our next article, we’ll discuss conventional and alternative ways to treat asthma.

 

Joe Alton, MD

AuthorJoe

Learn about asthma and other respiratory problems in the Amazon bestseller “The Survival Medicine Handbook“, with over 275 5-star reviews!

Traumatic Brain Injuries

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Most head injuries cause superficial damage and are not life-threatening. Indeed, most head injuries amount to only a laceration of the scalp, a black eye, or a painful bump. These wounds, however, can hide damage inside the cranium, the part of the skull that contains the brain. Injuries that affect the brain are called traumatic brain injuries (TBIs). It’s important for the medic to recognize when trauma to the skull has caused damage that is more than superficial.

 

 

Concussions are the most common type of TBI. A concussion is associated with a variety of symptoms that are often immediately apparent. The presentation differs from one individual to the next. Although you might expect a loss of consciousness, the victim may remain completely alert. Headache is actually the most commonly seen symptom. Other symptoms include:

 

 

• Dizziness
• Confusion
• Nausea
• Loss of motor coordination
• Blurred or double vision
• Slurred speech
• Ringing in the ear (also called “tinnitus”)
• Difficulty focusing on tasks at hand

 

 

A person with trauma to the head may be knocked unconsciousness for a period of time. In most cases, they will “wake up” in less than 2 minutes. You can expect them to be “foggy” and behave inappropriately (put me in, coach!). They may not remember the events immediately prior to the injury.

 

 

Loss of consciousness is a serious concern. If the victim is “out” less than two minutes, the patient will merit close observation for the next 48 hours. You should examine for evidence of superficial injuries and determine that the patient has regained normal motor function. Make sure they can move all their extremities with normal range and strength.

 

 

Rest is prescribed for the remainder of the day. When your patient goes to bed, it will be appropriate to awaken them every two or three hours, to make sure that they are easily aroused. In most cases, a concussion causes no permanent damage unless there are multiple episodes of head trauma over time, as in the case of boxers or other athletes in contact sports.

 

 

It should be noted that a physical strike to the head is not necessary to suffer a concussion. A particularly jarring football tackle or the violent shaking of an infant can cause a concussion or worse traumatic brain injury. This is because the brain “bounces” against the walls of the cranium. When injury occurs at the site of a blow to the head, it’s called a “coup” injury. Just as often, it can occur on the opposite site of the head, known as a “contrecoup” injury.

 

 

In many cases, evidence of direct trauma to the skull is visible. An “open” head injury means that the skull has been penetrated with possible exposure of the brain tissue. If the skull is not fractured, it is referred to as a “closed” injury. An indentation of the skull is clear evidence of a fracture and the outlook may be grim, due to the likelihood of bleeding or swelling in the brain. A closed injury may still become life-threatening for the same reasons.

 

 

The brain requires blood and oxygen to function normally. An injury which causes bleeding or swelling inside the skull will increase the intracranial pressure. This causes the heart to work harder to get blood and oxygen into the brain. Blood accumulation (known as a “hematoma”) could occur within the brain tissue itself, or between the layers of tissue covering the brain.

 

 

Without adequate circulation, brain function ceases. Pressure that is high enough could actually cause a portion of the brain to push downward through the base of the skull. This is known as a “brain herniation” and, without modern medical care, will almost invariably lead to death.

 

 

There are a number of signs and symptoms which might identify those patients that have a serious TBI. They include:

 

 

• Prolonged loss of consciousness
• Convulsions (Seizures)
• Worsening headache over time
• Nausea and vomiting
• Bruising (around eyes and ears)
• Bleeding from ears and nose
• Worsening confusion/Apathy/Drowsiness
• One pupil more dilated than the other
• Indentation of the skull

 

 

If the period of unconsciousness is over 10 minutes in length, you must suspect the possibility of significant injury. Vital signs such as pulse, respiration rate, and blood pressure should be monitored closely. The patient’s head should be immobilized, and attention should be given to the neck and spine, in case they are also damaged. Verify that the airway is clear and breathing is regular. In a collapse, this person is in a life-threatening situation that will have few curative options if consciousness is not regained.

 

 

Other signs of a traumatic brain injury are the appearance of bruising behind the ears (Battle’s sign) or around the eyes (raccoon sign). This indicates internal bleeding in the cranium, despite the impact not occurring in those areas. Bleeding from the ear itself or nose without direct trauma to those areas is another indication. The fluid that drains out may be clear; this may represent spinal fluid leakage.

 

 

In addition, intracranial bleeding may cause pressure that compresses nerves that lead to the pupils. In this case, you will notice that your unconscious patient has one pupil more dilated than the other.

 

 

A severe consequence of bleeding in the brain is a stroke, (also known as a cerebrovascular accident or CVA). It represents damage to the brain caused by lack of blood supply. This could occur in a head injury due to a blockage of blood flow to a portion of the brain. This blockage could be due to a clot, a hemorrhage, or anything else that compromises the circulation in the area. Another possibility is a defect in a blood vessel known as an “aneurysm” which could rupture even in the absence of a traumatic event.

 

 

Whatever functions are associated with the part of the brain affected will be lost or impaired. These patients often present with an inability to speak, partial or complete blindness, and paralysis or weakness of one side of the body and face. The stroke is usually heralded by a sudden severe headache.

 

 

Strokes may also occur due to other reasons as well, such as uncontrolled high blood pressure. Although it may not be difficult to diagnose a major CVA in an austere setting, few options will exist for treating it. Blood thinners might help a stroke caused by a clot, but worsen a stroke caused by hemorrhage. It could be difficult to tell which is which without advanced testing.

 

 

Keep the victim on bed rest; sometimes, they may recover partial function after a period of time. If they do, most improvement will happen in the first few days.

 

 

Trauma to the head may have negligible consequences, or it could have life-threatening consequences. In some circumstances, there may be little that you, the medic, can do in a long-term survival situation.

 

 

Joe Alton, MD

 

Learn more about traumatic brain injury and over 100 other medical topics in austere settings in our Amazon bestseller “The Survival Medicine Handbook“, with over 270 5-star reviews!

Video: The Medic Under Fire

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In Joe Alton, MD’s latest video, he examines the issue of providing medical care in hostile encounters, including some thoughts on the role of the medic. What should your strategy be when there’s a threat to be abolished? To all combat medics: You have my utmost respect for your dedication and courage…

 

 

To watch, click below:

 

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

 

Joe Alton, MD

 

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Close those holes in your medical storage by checking out Nurse Amy’s entire line of medical kits and supplies at store.doomandbloom.net

The SWAT Tourniquet

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SWAT tourniquet

The SWAT-T

In these dangerous times, any trip to the mall (or anywhere there are crowds) could be a ticket to an active shooter event. In our recent article on what to do in these circumstances, we specifically mentioned that you shouldn’t attend the wounded until the threat is abolished, and that is still your best strategy; you aren’t doing anyone any good by becoming the next casualty. Even law enforcement won’t treat the injured until the gunman is neutralized.

 

 

ABCDE vs. CABDE

 

 

It stands to reason that those sustaining wounds are going to be bleeding. If emergency medical personnel are not on the way, you will have to take action.

 
The initial field assessment of a victim usually involves the mnemonic ABCDE:

 
• Airway: Is the airway open?
• Breathing: Is the victim breathing?
• Circulation: Is the victim bleeding?
• Disability: Can the victim feel and move extremities? Can they respond appropriately to questions?
• Expose: Can you see the full extent of the injury or injuries?

 

 

This sequence changes in the actively bleeding wound to CABDE. In these circumstances, the cause of death is more often hemorrhage, which must be abated quickly. The determination of airway, breathing, and mental status can often be done simultaneously with bleeding control, as many patients will be conscious and talking.

 
Direct pressure with a gloved hand is still the most successful method of bleeding control. However, there are many instances where pressure alone won’t deal with the issue. More aggressive methods such as tourniquets were, however, discouraged due to the risk of “necrosis” (tissue death due to lack of blood flow), nerve damage, and more.

 
Despite the legitimacy of these issues, the military, through its experience in the Middle East, began to change its thinking. They found that a percentage of preventable deaths were related to inadequate measures to control bleeding. As such, the Tactical Combat Casualty Care (TC3) guidelines for our armed forces now actively promote the use of tourniquets as the first step to stop severe hemorrhage.

 
This has carried over to civilian emergency care, especially in events like the Boston Marathon bombings and the San Bernardino shootings. Injuries at remote locations, like homesteads where rapid transport is difficult, make tourniquets a required item in the family medical kit.

 

The SWAT-T

SWAT tourniquet

SWAT tourniquet

We’ve talked about tourniquets in the past, but we haven’t mentioned what might be an ideal tourniquet for the average citizen: the SWAT-T. SWAT-T stands for Stretch, Wrap, and Tuck Tourniquet, and the instructions are, essentially, all in the name. You can see the simplicity of application in the video below:

The SWAT tourniquet is a wide elastic band that can serve as a compact, lightweight, and inexpensive tourniquet or pressure dressing. It’s very simple to use, especially with two hands: Stretch it, wrap (at least 2 inches) above the area of bleeding on the extremity, and tuck the end into itself. That’s pretty much all there is to it.

 
Some tourniquets are difficult or impossible to place effectively around the thin arms of children, but the SWAT-T gives you the ability to apply it on just about anyone’s extremities, regardless of size.

 
The SWAT-T is often carried as a backup to other tourniquets due to its versatility: It can be used as a pressure dressing as well as a tourniquet, or even just as a covering for other dressings without any significant pressure at all.  Other non-tourniquet uses include stabilizing a splint or ice pack for orthopedic injuries, holding an abdominal dressing in place, and even as a sling for an injured arm or shoulder.

 
For the medic, having a supply of tourniquets is important to save lives that would otherwise be lost due to bleeding. Even if you have other tourniquets, consider adding the versatile and lightweight SWAT-T to your medical storage.

 

 

Joe Alton, MD

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Learn more about controlling hemorrhage (or just about any other issue you’ll face in times of trouble) by getting a copy of our 3 category #1 Amazon Bestseller The Survival Medicine Handbook.

Survival Medicine Hour: New Sterilization Method, Skin Infections, Ginger

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woundinfection

One big issue in remote locations is the sterilizations of instruments and dressings. Now, the U.S. Army Medical Research Institute for Infectious Disease has tested a new method that claims 100% sterilization using portable items that won’t break the bank. Joe Alton, MD explains the procedure and talks about infections you’ll find in soft tissues as a result of poor disinfecting practices and dirty wounds. Also, Amy Alton, ARNP talks about one of her favorite natural remedies: Ginger. All on the latest Survival Medicine Hour with Dr. Bones and Nurse Amy.

To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/01/11/survival-medicine-hour-new-methods-of-sterilization-ginger-skin-infections

Nurse-Amy-Ginger

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

 

Joe Alton, MD and Amy Alton, ARNP

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The Survival Dental Kit

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dentist

Over the years, we have written hundreds of articles on medical preparedness for short or long-term disasters. Many now include medical kits and supplies to add to survival food storage and items for personal protection. Yet, 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.

History tells us that problems with teeth take up a significant portion of the medic’s patient load. In the Vietnam War, medical personnel noted that fully half of those who reported to daily sick call came with dental complaints. In a long-term survival situation, you certainly will find yourself as dentist as well as nurse or doctor.

Anyone who has had to perform a task while simultaneously dealing with a bad toothache can attest to the effect on the amount and quality of work done. If your teeth hurt badly, it’s unlikely that your mind can concentrate on anything other than the pain. Therefore, it only makes sense that you must learn basic dental hygiene, care, and procedures to keep your people at full work efficiency. It could easily be the difference between success and failure in a collapse.

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. You would want it to be easily distinguished from the medical kit.

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different masks

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.

We’ve researched dental items that should be in the dental kit of those that would be medically responsible in a long-term survival community. After consulting with a number of preparedness-minded dentists, we have put together what we believe will be a reasonable kit that can handle a number of dental issues. Items that would be practical for  the survival “dentist” include:

• Dental floss, dental picks, toothbrushes, toothpaste or baking soda.

• Dental or orthodontic wax as used for braces. Wax can be used 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 eraser would serve the purpose.

• Cotton pellets, Cotton rolls, Q tips, gauze sponges (cut into small squares).

• Compressed air cans or a bulb syringe for drying up saliva on teeth.

• Commercial temporary filling material, such as Tempanol, Cavit, or Den-temp.

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• Oil of cloves (eugenol), a natural anesthetic. Often found in commercial preparations such as:

-Red Cross Toothache Medicine (85% eugenol)
-Dent’s Toothache Drops (benzocaine in combo with eugenol)

It’s important to know that eugenol might burn the tongue, so be careful when touching anything but teeth with it.

• other oral analgesics like Hurricaine or Orajel (Benzocaine)

• Zinc oxide powder; when mixed with 2 drops of clove oil, it will harden into temporary filling cement.

Here’s a video of the procedure:   https://www.youtube.com/watch?v=I3rTF4c26Po

• 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 can of compressed air may be an alternative.

• An irrigation syringe to flush areas upon which work is being done

• Scalpel #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 questionable areas.

• Spoon excavators. These instruments have a flat circular tip that is used to “excavate” decayed material from demineralized areas of 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.

dental_extraction_forcep

• Extraction forceps. These are like pliers with curved ends. They come in versions specific to upper and lower teeth and, sometimes, left and right.

Although 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 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. It comes a fabric square that can be cut to size and placed directly on the bleeding socket or gum.

chromic catgut

Chromic Catgut Suture

• Sutures: A kit consisting of a needle holder, forceps, scissors, and suture material is helpful for the control of bleeding or to preserve the normal contour of gum tissue. We recommend 4/0 Chromic catgut as it is absorbable. It’s small 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. These antibiotics are discussed in detail in the section dedicated to them in this book.

Just as obtaining knowledge and training on medical issues likely in a disaster is important, the study of dental procedures and practices is essential for the aspiring survival medic.

Joe Alton, MD

JoeAmyPortrait2013

Nurse Amy has expanded her dental preparedness kit to include almost all the items you see in the list above. Check our her dental kit, and many other kits and supplies for survival medical issues, at her store at store.doomandbloom.net.

 

Survival Medicine Hour: Tornadoes, Lice, Dental Issues

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More deaths from late season tornadoes in Texas makes us ask this question: Do you know how to keep your family safe if you were in the path of a twister? Find out what to do to decrease the risk of injury. Also what part does hygiene play in survival success. Dr. Alton talks about a common issue in good times or bad: LICE. Plus, some thoughts on the part dental hygiene plays in the duties and responsibilities of the survival medic, all in this episode of the Survival Medicine Hour with Dr. Bones and Nurse Amy.

 

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2015/12/28/survival-medicine-hour-tornadoes-lice-dental-hygiene-in-austere-settings

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

 

Joe and Amy Alton

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dr. bones and nurse amy

FLUAD, The Next Generation Vaccine?

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virus

One thing you can count on seeing every winter is a flu outbreak. Influenza is a viral respiratory illness that has been the cause of worldwide epidemics (“pandemics”). In 1918, the Spanish Flu spread throughout the globe and killed close to 100 million people.

 
Even non-pandemic influenza can turn deadly in some cases. The Centers for Disease Control and Prevention have limited information on official death counts from flu each year, but it can be anywhere from a few thousand to fifty thousand in the U. S., mostly among those over 65.

 

So many people get the flu yearly (one in five to one in twenty in recent years) that modern medicine has worked diligently to try and prevent it. This has led to the development of vaccines. Vaccines work by exposing you to the previous year’s virus in the hope that you will develop immunity to this year’s version. Now, the Food and Drug Administration has approved a new type of flu vaccine with a “booster” meant to improve the immune system, especially in the elderly. This new vaccine, called Fluad, claims to translate into better outcomes among older people.

fluvaccine

 

Fluad’s main target is people over 65 years of age. The elderly typically do worst if they get the flu, so much so that influenza has been called the “Old Man’s Friend” because it ends their suffering, and I mean permanently. According to an FDA spokesperson: “Immunizing individuals in this age group is especially important because they bear the greatest burden of severe influenza disease and account for the majority of influenza-related hospitalizations and deaths…”

 

Fluad contains MF59, a mixture that includes squalene, an oily nutrient produced by the liver but also seen in sharks, certain birds, and amaranth seeds (it also includes some preservatives). When incorporated into vaccines, MF59 increases the number of immune cells that are activated.

 

From a pandemic standpoint, there’s another benefit: Adding MF59 can help extend vaccine supplies. People might need a lower dose of vaccine, thus allowing more to receive it.

 

The government actually considered using MF59 when the Swine Flu arrived in the U.S. in 2009. But, although vaccine supplies were short, MF59 wasn’t used due to the expected resistance to the new ingredient.

 

U.S. government officials have been wary about using MF59 in vaccines because of public suspicion of new ingredients in medical treatments in the U.S. Fluad, however, has been in use in Europe and Canada for close to 20 years; the FDA now declares it to be safe and effective.

 

Vaccine effectiveness is a big issue, because last year’s vaccine was only around 20% effective in preventing the flu in those who took it. Normally, you want a flu vaccine to be 60% effective or more.

 

There are two reasons why last year’s vaccine failed, relatively speaking. The formulation may not be effective against a particular virus if the virus mutates or a new virus arrives. Also, if the vaccine doesn’t activate a person’s immune response, it won’t work to produce antibodies against the virus.

Tests show Fluad works at least as well as the vaccines already on the market, and may boost a senior’s protection from H3N2, one of the currently circulating strains of influenza.

 

(DID YOU KNOW: Type A (the most common) Influenza viruses are categorized by certain proteins on their surface called HA (Hemaglutinins) and NA (Neuraminidases). For example, Swine Flu is H1 N1.)

 

The CDC recommends that everyone over 6 months of age receive the vaccine. Despite this, only 148 million doses get distributed in the United States, a country with a population of more than 300 million. This is because of concerns on the part of many of adverse reactions. Some believe that reluctance is also due partly to the injection required, so a nasal mist was developed. Unfortunately, shortages are commonly reported.

 

Another concern is the possibility of  an adverse reaction to something in the vaccine. Ill effects of flu vaccine can be minor or major. Minor problems following a flu shot include pain, redness, and swelling at the site of injection, plus flu-like symptoms. If these occur, they usually last 1 or 2 days.

 

This doesn’t mean, however, that serious problems can’t occur with vaccines. One in a hundred thousand to a million people may develop a disorder called Guillain-Barre syndrome, which can cause long-term damage to nerves. Children may, rarely, experience seizures due to high fever from a flu shot. Of course, anyone could be allergic to a component of the vaccine, causing a mild to serious reaction. Major reactions seems to occur in one in a million cases.

 

You won’t find Fluad on pharmacy shelves this year but it should be available next year. Will it decrease flu-related deaths among older citizens in the U.S.? We’ll have to wait until 2016 to find out.

 

Joe Alton, MD

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To find out more about influenza, check out our classic 4 part series of articles, or get a copy of our bestseller The Survival Medicine Handbook, with over 250 5-star reviews.

And, if you’re looking for a Christmas gift for that older child, check out our board game Doom and Bloom’s SURVIVAL!, a great way to have a fun family game night (and think about tough decisions you’d make in a survival scenario). Now with a full set of 8 custom miniatures, our survival medicine DVD, and a SURVIVAL! nylon mini-backpack free with your purchase!

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Antibiotic-Resistant Superbugs

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cellulitismoderate

The wise medic will store antibiotics to deal with infections in survival scenarios, but what happens when a bacteria becomes resistant to them? In other words, a “Superbug”?

In the U.S., 2 million people are infected annually with bacteria resistant to standard antibiotic treatment. At least 23,000 of these will die as a result. In an increasingly overburdened health system, resistant microbes are responsible for a huge increase in the cost of caring for the sick.

This article will discuss antibiotics and the epidemic of resistance that has spawned a growing number of superbugs.

Antibiotics

Antibiotics are medicines that kill micro-organisms in the body. Amazingly, the first antibiotic, Penicillin, was discovered entirely by accident in 1928 when Alexander Fleming returned to his lab from a vacation. He noticed that a lab dish with a bacterial culture had developed a mold known then as Penicillin Notatum. Around the mold, an area had developed that was clear of bacteria. Further study proved the potent germicidal effect of the compound processed from the mold.

By the 1940s, penicillin was in general use and credited with saving many lives during WWII. Since then, more than 100 different antibiotics have been identified and developed into medicines.

Antibiotic Overuse

The huge success that antibiotics had in eliminating bacterial infections caused them to be used excessively. Liberal employment of antibiotics is a bad idea for several reasons:

  • Overuse fosters the spread of resistant bacteria.
  • Allergic reactions can occur, sometimes severe.
  • Antibiotics given before a diagnosis is confirmed may mask some symptoms and make identifying the illness more difficult.

Antibiotics will kill many bacteria, but they will not be effective against viruses, such as those that cause influenza or the common cold. They are also not meant as anti-fungal agents.

 

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Viruses are largely unaffected by antibiotics

 

Most will be surprised to hear that almost 80% of the antibiotics used in the U.S. don’t go to people, but to livestock. This is not to treat sick livestock but to make healthy livestock grow faster and get to market sooner. No one knows for sure why antibiotics have this effect, but the gross overuse on food animals is a big reason for the epidemic of resistance seen today.

The Superbug List Grows Longer

The Center for Disease Control and Prevention has compiled a list of close to 20 bacteria that have shown a tendency towards antibiotic resistance. They include various organisms that cause severe diarrheal disease, respiratory issues, wound infections, and even sexually transmitted disease.

The CDC’s list:

  • Clostridium difficile
  • Carbapenem-resistant Enterobacteriaceae (CRE)
  • Drug-resistant Neisseria gonorrhoeae
  • Multidrug-resistant Acinetobacter
  • Drug-resistant Campylobacter
  • Fluconazole-resistant Candida
  • Extended spectrum β-lactamase producing Enterobacteriaceae (ESBLs)
  • Vancomycin-resistant Enterococcus (VRE)
  • Multidrug-resistant Pseudomonas aeruginosa
  • Drug-resistant Non-typhoidal Salmonella
  • Drug-resistant Salmonella Typhi
  • Drug-resistant Shigella
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Drug-resistant Streptococcus pneumoniae
  • Multidrug-resistant tuberculosis
  • Vancomycin-resistant Staphylococcus aureus (VRSA)
  • Erythromycin-resistant Group A Streptococcus
  • Clindamycin-resistant Group B Streptococcus

 

There have been no effective treatments identified for some of the above microbes, as in the case of multidrug-resistant Tuberculosis. MRSA, Methicillin-Resistant Staph. Aureus, was responsible for more deaths than AIDS in recent years.

 

Although this is the CDC’s list of superbugs that affect the United States, they aren’t the only ones. A new type of Malaria, a very common parasitic disease of warmer climates, is turning up that is resistant to the standard drugs.

 

Viruses are “resistant” to antibiotics by nature (in other words, they are unaffected by them) and include Influenza A, Swine Flu, Ebola, Bird Flu, SARS, and Middle East Respiratory Syndrome (MERS). These will be discussed in detail in a future article.

 

An Effective Strategy

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Strategy #1

 

Many believe that antibiotic-resistant Superbugs listed are exotic diseases that could never affect their community. With the ease of commercial air travel, however, cases of antibiotic-resistant diseases from afar can easily arrive on our shores.

 

Recently, a case of multi-drug resistant Tuberculosis was identified and then isolated at the high level isolation unit at the National Institute of Health in Maryland. Although we have increased our capacity for handling this type of patient significantly since the arrival of Ebola in the U.S. last year, it wouldn’t take much to overwhelm our facilities.

 

 

Therefore, the medic must have a plan to decrease the chances for antibiotic-resistant infections. The main strategy is to hold off on dispensing that precious supply of antibiotics until absolutely necessary, but other strategies include:

 

  • Establishing good hygiene practices: Everyone should be diligent about washing hands with soap and hot water or hand sanitizers. Good respiratory hygiene includes coughing or sneezing into tissues or the upper arm, but never the bare hands.
  • Supervising sterilization of water, preparation of food, and disposal of human waste and trash. Contaminated water and food will lead to many avoidable deaths in survival scenarios. Make sure that food preparation surfaces (counter tops, etc.) are disinfected frequently.
  • Dedicating personal items: Personal items like towels, linens, utensils, and clothing may be best kept to one person in an epidemic setting.
  • Cleaning all wounds thoroughly and covering with a dressing. Skin is the body’s armor, and any chink in it will expose a person to infection.
  • Social distancing: When a community outbreak has occurred, limiting contact with those outside the family or survival group may be necessary to stay healthy.
  • Keeping a strong immune system: Getting enough rest, eating healthily, and avoiding stress will improve a person’s defenses against disease. Unfortunately, it may be difficult to achieve these goals in times of trouble.
  • Going natural: Allicin, a compound present in garlic, is a natural antibiotic that is thought to have an effect against some resistant bacteria like MRSA. Crush a clove and eat it.

 

 

Preventing the spread of infections, especially antibiotic-resistant ones, is important to maintain the viability of a survival community. If you’re the medic, have antibiotics in your storage but use them wisely. If you do, you’ll help prevent not only resistance, but a lot of heartache if things go South.

 

Joe Alton, MD

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Videocast: Bear attacks, E. Coli, more

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black bear

bear

What would you do if you came upon a full-grown bear on the trail? There’s black bears all over the place here in the Great Smokies, and you should know how to stay safe in a encounter with one of these beautiful, but potentially dangerous, animals. Also, Joe and Amy Alton discuss the latest E. Coli outbreak, this time originating in some Northwest Chipotle restaurants.

squirrel

Not a bear

 

To watch, click below:

 

 

http://aroundthecabin.com/show-archives/wednesdays/

 

 

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

 

 

Joe and Amy Alton

2015 Birdhouse Inn Mountain Paradise View!

Video: Metronidazole as a Survival Antibiotic

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antibiotics1

Antibiotics will be a key but scarce commodity that could be a major weapon in the survival medic’s arsenal. In this part of our continuing series on antibiotics, Joe Alton, MD,aka Dr. Bones, explores the potential of  Metronidazole (Flagyl, Fish-Zole) for use in austere settings. To watch, click below:

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

 

Joe Alton, MD

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Fill those holes in YOUR medical storage by checking out Nurse Amy’s entire line of medical kits and individual items at store.doomandbloom.net.

Bear Attacks

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black bear

Black Bear

The Great Outdoors is, well, great, but there’s also danger in them thar hills, and it pays to know what to do when you encounter it.

 

 

I’ve talked about animal bites in videos, but I haven’t shown you any actual animals. Although we’re here at the Birdhouse Inn, the best bird’s eye view of the mountains in the Great Smokies, we’re not talking about birds today. We’re talking about bears.

 

 

Bears are mammals of the family Ursidae, and I’ll bet you don’t know what their closest living relative is: It’s seals. There are a number of species of bear but the one around here is the American black bear. 1800 bears live in the Smoky Mountains and many of them have become very accustomed to humans.

 

 

There are several in the area around this property, mostly youngsters that have decided that Halloween pumpkins are a tasty treat. I guess we should have known, because bears, indeed, eat more plant matter than meat, taking in opportunistically whatever they can find, like acorns. Poor crops of such foods, called mast, result in bears moving out of their back country territory to look for alternative food sources, like your trash. Even though black bears are only 8 ounces when they’re born, males (also known as boars) can wear 500 pounds or more. This puts you in danger, no matter how “cute” you think these critters are.

newborn black bears

Newborn black bears

 

To prevent injuries from bear encounters, situational awareness is the order of the day. Watch for disturbed trash, fresh tracks, and of course, actual bears.

bear droppings

Probably from an actual bear…

Some basic advice: Don’t hike alone. Whenever possible you should hike in groups, 90% of people injured by bears (mostly grizzlies, I suspect) in Yellowstone National Park were alone or with only one other hiking partner.

 

 

Avoid hiking at dawn, dusk, or at night, times that bears are out in warm weather months. You’re just as likely to come upon a bear as it is to come upon you.

 

 

You might think it’s not too smart to yell “Hey, Bear!” or sing “The Star Spangled Banner” on the trail but, actually, bears don’t like noise and it’s actually a pretty good strategy, especially when traveling near babbling brooks or other settings where normal hiking noises might be muffled. Just don’t do it with a hamburger or hot dog in your hand.

 

 

When you encounter a bear, it will, hopefully, be at a distance: If so, and the bear doesn’t see you, keep out of sight and go slowly behind and downwind of the bear. If the bear does see you, slowly retreat the way you came. A bear in defensive mode will huff, hiss, or slap the ground with its paws, telling you that you’re too close. So put some distance between you and the bear. However, don’t run, it might activate a chase response in the animal.

 

 

If the bear follows you quietly, ears erect, and its attention is clearly directed at you, it is likely in predatory mode and not acting defensively. Make yourself appear larger, louder, and threatening. Groups should stay together to look like a bigger threat. A bear that is initially curious or testing you may become predatory if you appear meek. A deterrent like pepper spray, at least, or other items of personal defense will become very handy. Pepper spray is most effective at close range, say 5-10 feet.

 

 

If the bear attacks, don’t run. You can’t outrun a black bear. Don’t climb a tree unless you’re a squirrel, you’re not 10 years old anymore, it takes longer than you think, and your pursuer is a very good climber. Use your deterrent and fight for your life, because that’s what’s at stake. Kick, punch or hit the bear on the face, eyes, nose, with whatever you have.

squirrel

Probably a better tree climber than you

You also should not play dead. Bears will feed on carrion like deer carcasses, so why pretend to be one? If you do, however, keep your backpack on, lie face down and clasp your hands over the back of your neck with your elbows protecting the sides of your face. A bear that’s just protecting its cubs may decide you’re no longer a threat.

 

 

Which leaves you with bite and claw injuries that may be bleeding, so make sure that backpack has dressings, tourniquets, antiseptics, and other supplies needed for treating wounds. Here’s an article on dealing with animal bites and one on active bleeding

 

 

http://www.doomandbloom.net/treating-an-animal-bite/

 

 

http://www.doomandbloom.net/stab-wound-management/

 

 

Studies have shown that bears accustomed to humans never live as long a life as truly wild bears. Bear lose their fear of people by being fed by them. As a result, many of these are hit by cars or end up euthanized. Remember this: A bear that’s fed is a bear that’s dead.

 

 

Joe Alton, MD

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Can’t bear to be without a good medical kit? Check out Nurse Amy’s entire line over at store.doomandbloom.net!

 

 

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Video: Glue as a Wound Closure Method, Part 2

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dermabond in place

In part 2 of his series on skin adhesives, Joe Alton, MD, aka Dr. Bones, compares skin glues to traditional sutures/staples as a method of skin closure, the procedure to apply glue to a wound, and about how commercial super glue compares to the much more expensive (10-15 times or more) medical glues. To watch, click below:

 

 

Here’s wishing you the best of health in good times or  bad,

 

 

Joe Alton, MD

AuthorJoe

 

 

Video: Glue as a Wound Closure Method, Part 1

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skin glue applied

There are lots of ways to skin a cat, but how many ways can you close a cat’s skin? Well, just about as many as you can close a human’s skin! Joe Alton, MD, aka Dr. Bones, co-author of the Survival Medicine Handbook, talks about the benefits of skin adhesives as a wound closure method and their limitations. Part 1 of a 2 part series corresponding to a recent article on the same topic.

 

 

 

 

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

 

 

Joe Alton, MD

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Metronidazole as a Survival Antibiotic

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Antibiotics

Antibiotics are an important part of any medical arsenal in tough times. Many infections easily treated today would possibly be life-threatening in an off-grid survival setting. Indeed, if such a thing occurred, you can bet that these drugs would no longer be produced. There would be a lot of otherwise avoidable deaths due to simple cuts that become infected or dehydration from diarrheal disease. We only have to look at mortality statistics from pre-antibiotic times like the Civil War to know that this is true. More soldiers died then from infectious disease that from bullets or shrapnel.

 

 

This article is part of a series on antibiotics and their use in survival settings. Today we’ll talk about an antibiotic that would be useful to deal with some organisms that can cause a number of major problems. Metronidazole (aquatic equivalent: Fish-Zole) 250mg is an antibiotic in the Nitroimidazole family that is used primarily to treat infections caused by anaerobic bacteria and protozoa.

 
“Anaerobes” are bacteria that do not depend on oxygen to live. “Protozoa” have been defined as single-cell organisms with animal-like behavior. Many can propel themselves randomly from place to place by the means of a “flagellum”; a tail-like “hair” they whip around that allows them to move.

 

giardia

Giardia (Protozoal Parasite)

 
The antibiotic Metronidazole works by blocking some of the functions within bacteria and protozoa, thus resulting in their death. It is better known by the U.S. brand name Flagyl and usually comes in 250mg and 500mg tablets. Metronidazole (Fish-Zole) is used in the treatment of these bacterial diseases:

 

 

• Diverticulitis (an intestinal infection seen in older individuals)
• Peritonitis (an inflammation of the abdominal lining due to a ruptured appendix, ruptured cysts, and other causes)
• Certain pneumonias (lung infections)
• Diabetic foot ulcer infections
• Meningitis ( an infection of the spinal cord and brain lining)
• Bone and joint infections
• Colitis due to a bacterial species known as Clostridia (sometimes caused by taking Clindamycin!)
• Endocarditis (a heart infection)
• Bacterial vaginosis (a very common vaginal infection)
• Pelvic inflammatory disease (an infection in women which can lead to abscesses, often in combination with other antibiotics)
• Uterine infections (especially after childbirth and miscarriage)
• Dental infections (sometimes in combination with amoxicillin)
• H. pylori infections (a bacteria that causes peptic ulcers)
• Some skin infections

 
And those are just the bacterial infections that metronidazole can deal with. It also works with these protozoal infections:

 
• Amoebiasis: dysentery caused by Entamoeba species (contaminated water/food)
• Giardiasis: infection of the small intestine caused by Giardia Species (contaminated water/food)
• Trichomoniasis: vaginal infection caused by parasite which can be sexually transmitted

 
Amoebiasis and Giardiasis can be caught from drinking what appears to be the purest mountain stream water, and these infections are seen right here in the Great Smoky Mountains and elsewhere. Never fail to sterilize all water, regardless of the source, before drinking it.

 
Metronidazole is used in different dosages to treat different illnesses. You’ll find detailed information in our book “The Survival Medicine Handbook” and in other standard medical references such as the Physician’s Desk Reference. You’ll also find this information at drugs.com or rxlist.com.

 
Here are the dosages and frequency of administration for several common indications:

 
• Amoebic dysentery: 750 mg orally 3 times daily for 5-10 days. For children, give 35 to 50 mg/kg/day orally in 3 divided doses for 10 days (no more than adult dosage, of course, regardless of weight).

 
• Anaerobic infections (various): 7.5 mg/kg orally every 6 hours not to exceed 4 grams daily.

 
• Clostridia infections: 250-500 mg orally 4 times daily or 500-750 orally 3 times daily.

 
• Giardia: 250 mg orally three times daily for 5 days. For children give 15 mg/kg/day orally in 3 divided doses (no more than adult dosage regardless of weight).

 
• Helicobacter pylori (ulcer disease): 500-750mg twice daily for several days in combination with other drugs like Prilosec (Omeprazole).

 
• Pelvic inflammatory disease (PID): 500 mg orally twice daily for 14 days in combination with other drugs, perhaps doxycycline or azithromycin.

 
• Bacterial Vaginosis: 500mg twice daily for 7 days.

 
• Vaginal Trichomoniasis: 2 g single dose (4 500mg tablets at once) or 1 g twice total.

 
All drugs have the potential for side effects, also known as adverse reactions. These are different from allergies, where your body actually mounts an immune response to a drug, such as in a penicillin allergy.

 
One particular side effect has to do with alcohol: drinking alcohol while on Metronidazole will very likely make you vomit.

 

Metronidazole should not be used in pregnancy. but can be used in those allergic to Penicillin.

 
Having antibiotics will give you an additional tool in the medical woodshed that just might, one day, save a life. They’re not toys, however, and should only be used when absolutely necessary.

 

Joe Alton, MD

joe bleachLearn more about antibiotics and their use in survival settings in our book “The Survival Medicine Handbook“, with over 250 5-star reviews on Amazon.

Airway Obstruction and Tracheotomy

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shutterstock_19078906

CPR classes are important for everyone to take, but standard chest compressions and breaths are most helpful in normal times, when there are ICUs and respirators readily available. One thing  CPR class teaches you that does have relevance to off-grid survival is how to deal with an airway obstruction.

 

An airway obstruction may happen for several reasons, but most commonly occurs as a result of food lodging in the back of the throat. This blockage, if complete, cuts off respiration and is life-threatening, but  can be treated successfully with knowledge and limited supplies. Early diagnosis and quick action is the key.

 

Some signs of an airway obstruction are:
• Difficulty breathing
• Noisy breathing, sometimes called “stridor“.
• Inability to talk; you need air to speak.
• Inability to cough for the same reason.
• The patient’s skin turning blue (called “cyanosis,” which is due to lack of oxygen circulating in the blood)
• Decreasing level of consciousness as oxygen levels drop.

cyanosis

cyanosis around the mouth

Photo by Jim Bryson

 

THE CONSCIOUS VICTIM
If you see a conscious adult in sudden respiratory distress, ask quickly: Are you choking? If they can answer you, there is still air passing into their lungs. If it’s a complete blockage, they will be unable to speak. They’ll be clearly agitated and holding their throat, but they’ll hear you and (frantically) nod their head “yes”. This is your signal to act.

shutterstock_19078906

Heimlich Maneuver

So what should you do for an adult in this situation? Quickly tell the victim that you’re there to help them and immediately get into position for the Heimlich maneuver, otherwise known as an “abdominal thrust”. Get behind the victim and make a fist with your right hand. Place your fist above the belly button and below the breastbone (also called the sternum); then, wrap your left arm around the patient and grasp the fist. Make sure your arms are positioned just below the rib cage. With a forceful upward motion, thrust your fist abruptly into the abdomen. You might have to do this multiple times before you dislodge the foreign body.

 

In old movies, you might see someone slap the victim hard on the back; this is not as likely to dislodge a foreign object as the abdominal thrust and might waste precious time. If you have to use a blow to the back. do it right in the center of the upper back with the victim bent over so that the torso is parallel to the ground. In this way, gravity might help the foreign object drop out of the mouth. Back blows are considered more effective in an infant: place the baby over your forearm (facing down) as if holding a football and apply several blows with the heel of your hand to the upper back.

 

 

infant airway obstruction

THE UNCONSCIOUS VICTIM

 

If your patient loses consciousness and you are unable to dislodge the obstructive item, place the victim flat on their back and straddle them across the hips. Open their mouth and make sure that the object can’t be removed manually. If not, give several, say five, upward abdominal thrusts with the heels of your palms (one above the other) and check the oral cavity again; you might have partially dislodged the foreign object.

 

If abdominal thrusts fail in a person that is unconscious, you may have to resort to more extreme measures to save that person’s life. It’s important to realize that the person is unconscious due to oxygen deprivation, and further delay may lead to brain damage or death.

 

PERFORMING  A TRACHEOTOMY TO SAVE A LIFE

 

An extreme method that can be used to open an airway is the “tracheotomy”. This procedure, also called a cricothyroidotomy, involves cutting an opening in the windpipe below the level of an obstruction. Tracheotomy should be performed only when an airway obstruction completely prevents the ability to breathe and all other methods have proved unsuccessful.

 

To perform a tracheotomy, you will need a sharp blade and some sort of tube, such as a firm plastic straw. Of course, a good first aid kit is always good to have, but there might not be time for antiseptics; you are performing this procedure because someone becoming cyanotic and will die in the next few minutes.

 

(Aside: It should be noted that there are syringe sets manufactured for this purpose available by prescription and a number of improvisations that also exist.)

 

In austere settings, the procedure goes as follows:

 

Place a towel under the shoulders. This will tilt the head into a position that makes it easier to define structures.

 

Start at the Adam’s apple, also known as the laryngeal prominence, on the front of the neck. It’s seen easily in men, less so in women. Move about 1 inch down the windpipe until you feel a second bulge. This is the cricoid cartilage.

 

Make a vertical incision through the skin with your knife or a razor blade in the crease between the laryngeal prominence and the cricoid cartilage. This incision can be about an inch or so long, and is superior (in my opinion) to a horizontal incision in that it can be extended upwards or downwards in case you entered the skin at the wrong location. A vertical incision will also avoid cutting nerves on either side that help control speaking and swallowing.
A curved Kelly clamp or a finger could be used to stretch the skin incision for better visualization of the structures beneath. Separate the tissue underneath and you’ll find the greyish cricothyroid membrane. Make a horizontal incision through it no more than half an inch deep. Once opened, there may be a audible rush of air or a “pop” as the incision is made.

 

It should be noted that some make a vertical or cross-shaped incision below this level to make a larger opening through more of the windpipe. It’s harder, however, to cut through cartilage than membrane. In any case, the incision should allow passage of air into the lungs.

tracheotomy from zuidelma 1985

tracheotomy incision illustration from Zuidema et al 1985

Be careful not to cut too deeply or widely into the membrane. Much more than 1/2 inch deep and you may penetrate the back of the airway, cutting the esophagus underneath the windpipe and trapping air in the soft tissues of the neck. The base of the scalpel can be used to make the slit opening larger. Don’t remove your scalpel from the incision until you’ve placed an open tube in the trachea. There normally isn’t a great deal of blood with this procedure and should be controllable with direct pressure.

trach tube

“Trach” Tubes

To maintain a clear airway, place something hollow in the opening. A “trach” tube would be great, but a plastic straw might do in a pinch. Thread it 1-2 inches down the windpipe; doing this makes it less likely to fall out (commercially-made tubes can be tied around the neck to secure it in place).
If the patient fails to breathe on their own despite a successful tracheotomy, you may need to perform CPR rescue breaths through the tube you inserted.

 

I don’t have to tell you that this is a difficult and dangerous procedure. A lot can go wrong and your equipment will likely be inferior to what is really needed. Remember, however, that the patient is dying and is already unconscious from lack of oxygen; it may be your last resort.

 
Only consider performing a tracheotomy when help is not forthcoming and you have tried every other option first. Even a successful emergency tracheotomy is only good for a short period of time before a more permanent solution is needed. You’ll need a system to keep the opening clear of mucus, etc. That’s only one of the hard realities that the medic must face in times of trouble.

 

 

(Final Note: For those that aren’t acquainted with my work, I focus on what to do when there are no modern medical personnel or facilities available, as in a wilderness or survival setting. In normal times, seek modern and standard medical care whenever and wherever it exists.)

 

 

Joe Alton, MD

 

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Learn more about how to deal with medical issues in disasters and epidemics with a copy of the 3 category #1 Amazon bestseller “The Survival Medicine Handbook“, with over 250 5-star reviews!

Preventing a Cold: Myths vs. Facts

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colds

We often talk about infections that would cause avoidable deaths in disasters, but minor illnesses that negatively affect work efficiency in times of trouble are also major problems for the family medic. When everyone has to be at 110% just to survive, anything that limits the ability to perform activities of daily survival puts the whole group at risk.

 
One of these issues is the common cold. Known variously as a head cold, naso-pharyngitis, coryza, or just a cold, it is the most common illness on the planet, and 75-100 million Americans present to a medical professional for treatment every year. A small percentage of these people go on to have secondary respiratory infections such as pneumonia, which can lead to a life-threatening condition.

viruslarge

typical virus

The common cold is an infection caused, usually, by a virus in the Rhinovirus or Coronavirus family, although a number of others have been implicated. Affecting the upper respiratory system (nose, throat, sinuses), it’s a (very) rare individual that hasn’t dealt with a cold at one point or another.

 
Like many viral illnesses, there is no cure for the common cold, and attention should be paid to methods that might prevent it. Many people have their own strategies for prevention, but some of these methods are ineffective and have little basis in fact. Here are time-honored (but false) ways that you can (can’t) prevent a cold:

 
Dress warmly and you won’t get sick: Dressing warmly for cold weather is a smart move to prevent hypothermia, but it won’t prevent colds. A cold is an infectious disease caused by a virus. Regardless of what you wear, you can be infected in any type of weather.

 

 

Stay inside during the winter to avoid catching a cold: Staying inside actually increases your chances of getting infected. Enclosed spaces can expose you to a higher concentration of the virus.

 

 

Take antibiotics to prevent colds: Antibiotics kill bacteria. Colds are caused by viruses, an entirely different organism. Therefore, antibiotics are ineffective against them as a preventative or a cure. Although many people ask their doctors for antibiotics to prevent or treat colds, this is a practice that has contributed to an epidemic of resistance in the U.S. Indeed, one out of three Americans leave their doctors’ offices with a prescription for antibiotics to treat an illness that is completely unaffected by them.

shutterstock_90110446

 

Keep your head dry. A wet head will cause a cold: Having a head full of wet hair is thought by some to predispose you to a cold, but it just isn’t so. You may feel a chill, but it won’t make you more likely to catch a virus.

 
A weakened immune system will cause a cold: Certainly, having a strong immune system is a good thing, but even the healthiest person can catch a cold if exposed to the virus.

 

 

Vitamin C will prevent colds: Although supplements like Vitamin C and Zinc may decrease the duration of a cold, they don’t do anything to prevent your catching one.

 
Turning down the heat in the house will prevent a cold: Many feel that central heating causes the nose to dry up and make them more susceptible to a cold. A virus can colonize the mucus membranes, regardless of the level of humidity.

shutterstock_87791806
Prevention is only an issue in the winter. You can only catch colds then: In reality, colds occur most often in the Spring and Fall. Many viruses actually become dormant in cold weather.

 
Wearing Garlic or other herbs will prevent your getting sick: What? Wearing garlic may repel vampires (and everyone else), but its health benefits mostly derive from being ingested.

 
Avoid kissing to prevent colds: Interestingly, relatively small quantities of virus reside on the lips or in the mouth. Most of it is found in the nasal cavity. Then again, it’s hard to be kissed without being breathed on as well.

 
Those are some myths, but here’s a fact: Hand washing is an effective way to decrease your chances of catching a cold. Viruses are transmitted less often if hands are washed regularly and frequently throughout the day. This is especially true if you want to prevent colds in children. Instill hand-washing as a part of daily routine in kids, just as you would teach toilet training.

 

 

Natural remedies would include one of my favorites: Green tea with Lemon and Honey.  Drinking the tea and breathing in steam helps the hair follicles in the nose to drain germs out. Lemon is known to thin out mucus and honey is a great natural antibacterial agent.

 

 

Don’t forget that viruses can live on surfaces for a period of time, so have some disinfectant around to clean countertops, work surfaces, and doorknobs.

 
There are as many myths about treating a cold as there are about preventing one. “Feed a cold, starve a fever” is one. We’ll discuss these in detail in a future article.

 

 

Joe Alton, MD

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Skin Glue in Survival

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laceration2

 

There are many ways to skin a cat, but how many ways are there to close a cat’s skin? Pretty much, the same number of ways that you can close a human’s skin. Sutures, staples, and tape butterfly closures like steri-strips are common methods, but there’s another one: topical skin adhesive glues.

 

Topical glues have been around since the 1940’s, but it took more than 3 decades for them to be approved for human use. Since that time, they have become the favorite method of closure for some surgical procedures.

 

This article will discuss the properties and uses of skin adhesives, especially as they apply to survival scenarios. Therefore, we will forego a discussion of cosmetic results, as they would be less important in austere settings.

 

Topical skin adhesives (or glues) are liquids made from a mixture of cyanoacetate and formaldehyde called cyanoacrylate. These glues become solid upon contact with skin, thus holding wound edges together.

 

The original cyanoacrylates (methyl-cyanoacrylate) comprise what is now industrial Super Glue. Medical versions were then developed (octyl- and butyl-cyanoacrylate) that were meant specifically for human skin. Some brands include Dermabond, Surgiseal, Liquiband, and others. These are mostly by prescription only, and are roughly ten times the cost of regular Super Glue.

 

Benefits of Topical Skin Adhesives

 

Topical skin adhesives are useful in a number of specific circumstances, and have some benefits not seen with some other methods of wound closure:

 

• They are quick to apply.
• They are a relatively painless method of closure.
• They don’t leave the “hatch marks” seen with sutures and staples.
• They don’t require removal. Skin glues slough off by themselves spontaneously after 5-10 days.
• They don’t require anesthetic injections, which makes them less problematic to use in children or those afraid of needles.
• They create an environment which speeds healing.
• They decrease the risk of wound infections with certain bacteria (gram-positive like Staph).

 

Indications for skin closure with glue

 

Topical skin adhesives are best used for simple cuts such as some traumatic lacerations. Use them for:

 

• Wounds that are completely dry (no longer bleeding).
• Areas where there is no skin tension (not difficult to pull together manually).
• Hair-free areas .
• areas not inside the mouth.
• children, to avoid pain of local anesthetic injection.
• Short-medium length lacerations

 

Topical adhesives are not helpful or may be dangerous if used:

 

• Inside the mouth or other internal cavity.
• In other high-moisture areas such as the groin or armpit.
• Around the eyes without extreme caution.
• On joints (unless immobilized with splints).
• Very long lacerations
• On avulsions (areas where skin flaps have been torn off due to trauma) or very jagged lacerations.
• Infected wounds.
• Wounds with dead tissue, like gangrene.
• In those with known hypersensitivity to the chemical compound.

 

Comparing skin adhesives to sutures and staples

Sutureneedleholder1

 

Traditional methods of skin closure include sutures and staples. The following are considerations when comparing these to topical skin glues:

 

• The wound strength with glues is less than with staples or sutures, probably only 10 per cent or so in the early going. After several days, the healed skin strength with glue is nearly equal to other methods, especially if used in conjunction with butterfly closures.
• Although anti-bacterial ointments can be applied on top of suture/staple closures, they weaken the strength of skin adhesives.
• Blood or fluid may collect under the adhesive. Although drainage from the wound is acceptable with suture or staple closures (and may be preferable to collection under the skin), infection risk may be increased with glues or even prevent skin healing.

 

 

How to use topical skin adhesive glue:

skin glue applied

 

Before using any method of skin closure, meticulous care must be taken to completely flush out debris and bacteria in the open wound. This should be done with an antiseptic solution like betadine or sterile saline. Any bleeding must be completely controlled. If deep layers are needed to close dead space, sutures can be used for this purpose as well as to decrease any tension on the wound edges.

 

When you are ready to close the skin:

 

• Approximate the wound edges carefully (best done by an assistant).
• Gently brush the glue over the laceration, taking care not to push any below the level of the skin.
• Apply about three layers of the adhesive over the wound, preferably widening the area of glue to increase strength of closure.

 

• Once completely dry, consider adding steri-strips to increase the strength of the closure.

 

It should be noted that some people experience a sensation of heat to the area when the glue is first applied. Encourage your patient to avoid picking at the closure or scratching it.

 

 

What about Super Glue for skin closure?

super glue

 

Many underdeveloped countries may not be able to afford the expensive medical glues. In some, like Cuba, emergency rooms have had to resort to industrial Super Glue. As a closure method, it is comparable, but it should be noted that Super Glue closures must be kept dry as they may break down more easily that medical glue.

 

 

Some people will experience skin irritation or even mild burns from the industrial version. You can test for this beforehand by having those in your group place a drop of Super Glue on the inside of their forearm. If there is a significant reaction such as redness or itching, avoid this method of closure on that person, or use the prescription version.

 

 

In my experience, gel versions of Super Glue are easier to handle due to less dripping.

 

 

Of course, standard medical texts will tell you to avoid Super Glue altogether. In a survival setting, you will have to make decisions based upon what you have available. The medic will often have to “make do” with suboptimal methods and equipment, but something is better than nothing. It will be easier to stockpile commercial glue than the more expensive medical skin adhesives.

 

 

As the survival medic, you should know how to use all the tools in the medical woodshed. If you learn the pros and cons of every method of skin closure, you’ll be better able to succeed, even if everything else fails.

 

Joe Alton, MD

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Survival Medicine Hour: Amputation, Insomnia, more

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fracture

 

What if you were the medic in a long-term survival scenario and came upon an injury that won’t get better with the usual treatment? What if you had to make an extreme decision like whether to perform an amputation? Joe Alton, MD steps out on a limb to talk about considerations that would be necessary in these circumstances. Also, Amy Alton, ARNP, discusses a common problem and how to deal with it: Insomnia! All this and more in the latest Survival Medicine Podcast.

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To listen in, click below:

 

 

http://www.blogtalkradio.com/survivalmedicine/2015/09/28/survival-medicine-hour-amputation-insomnia

 

 

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

 

 

Joe and Amy Alton, aka Dr. Bones and Nurse Amy

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Celox and Quikclot to Control Bleeding

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medic-in-action

 

No matter what survival scenario you envision, few come without a real risk of major trauma, and with it, bleeding. One of the most important medical supplies to have on hand in times of trouble would be those items that can help you control hemorrhage. In studies of casualties in the recent wars, 50% of those killed in action died of blood loss. 25% died within the first “golden hour” after being wounded. Indeed, with many injuries, a “platinum 5 minutes” may determine life or death.

 
The battle to prevent deaths from hemorrhage has been waged throughout history. The Egyptians mixed wax, barley, and grease to apply to a bleeding wound. The Chinese and Greeks used herbs like bayberry, stinging nettle, yarrow, and others for the same purpose. Native Americans would apply scrapings from the inside of fresh animal hides mixed with hot sand and downy feathers. These treatments would sometimes save a life, sometimes not.

 
In modern times, the control of major hemorrhage rightly belongs to the emergency physician, paramedic, trauma surgeon, and other trained medical personnel. Our focus, however, is when you find yourself without access to modern medical care. In these circumstances, you may be the highest medical asset left, and it pays to have some tools that will help you stop bleeding. In a recent article, we discussed one of these tools: tourniquets and their use in survival situations. Today, we’ll discuss compounds produced specifically to produce clotting.

 

 

HEMOSTATIC AGENTS

 

CeloxHemostatics

 

In the last decade or so, there have been advancements in clotting agents (also known as “hemostatic agents”). Knowledge of their appropriate use in an emergency will increase the injured patient’s chance of survival. These products are used in conjunction with direct compression on the bleeding wound. Ideally, a hemostatic agent should:

 

 

  • Stop a major hemorrhage within two minutes of application
  • Be applicable through pools of blood
  • Be packaged ready to use
  • Simple to use
  • Store well for extended periods of time
  • Be affordable
  • Have little risk of infection or embolism (blood clots that travel to other areas of the body)

 
Although there are a number of hemostatic agents available on the market for your medical storage, the two most popular are Quikclot and Celox. They are two different substances that are both available in a powder or granule form and a powder-impregnated gauze.

 

quikclot
Quikclot originally contained a volcanic mineral known as zeolite, which effectively clotted bleeding wounds but also caused a reaction that burned the patient and, sometimes, the medic. As a result, the main ingredient was replaced with another substance that does not burn when it comes in contact with blood.

 
The current generation of Quikclot is made from Kaolin, a naturally-occurring mineral that was the original ingredient in Kaopectate. It does not contain animal, human, or botanical components.

 
Contact between kaolin and blood immediately initiates the clotting process by activating Factor XII, a major player in hemostasis. The powder or impregnated gauze is applied directly to the bleeding vessel along with pressure placed on the wound for several minutes. Quikclot is FDA-approved and widely available; the gauze dressing is easier to deal with than the powder, but can be relatively expensive. Quikclot has a shelf life of 3 years or so, less if the packages are left out in the sun. It’s uncertain exactly what effect the passage of time has on the product.

 
One negative with Quikclot is that it does not absorb into the body and can be difficult to remove from the wound. The material is known to become hard when left in too long and bleeding may restart when removed. This occurs less often if you use the gauze dressing.

 
In the The Journal of TRAUMA® Injury, Infection, and Critical Care , (Volume 68, Number 2, February 2010), the kaolin gauze was found to be as safe as standard surgical gauze.

 

celox

Celox is the other popular hemostatic agent, and it is composed of Chitosan, an organic material taken from purified shrimp shells. Despite this, the manufacturer states that it is safe to use in those allergic to seafood. This product is made up of high surface area flakes. When these tiny flakes come in contact with blood, they bond with it and form a clot that appears as a gel. Like Quikclot, it also comes in impregnated gauze dressings, which are, again, relatively expensive.

 
Unlike Quikclot, Celox will cause effective clotting even in those on anti-coagulants like Heparin, Warfarin or Coumadin without further depleting clotting factors. Chitosan, being an organic material, is gradually broken down by the body’s natural enzymes into other substances normally found there. Like Quikclot, Celox is FDA-approved. This study by the U.S. government compares Celox favorably to some other hemostatic agents: http://www.ncbi.nlm.nih.gov/pubmed/18211317

 
Both Quikclot and Celox gauze dressings have been tested by the U.S. and U.K. military and have been put to good use in Iraq and Afghanistan. The US Department of Defense’s Committee on Tactical Combat Casualty Care (CoTCCC) has added CELOX™ Gauze to its guidelines for control of hemorrhage as approved hemostatic agents for military use. The Rapid version significantly cuts down the amount of compression time required. Expiration dates are similar to Quikclot.

 
One additional benefit of Celox gauze is that it serves as a reasonable gel-like burn dressing when moistened with water or saline solution.

 
To see both Quikclot and Celox in action (warning: graphic in nature):

 

 

“Celox demonstration”

 

 

“Quikclot demonstration”

 
Although effective, you shouldn’t use these items as a first line of treatment in a bleeding patient. Direct pressure, elevation of a bleeding extremity above the heart, gauze packing and tourniquets should be your strategy here. If these measures fail, however, you have an effective extra step towards stopping that hemorrhage. Be sure to include one or both in your medical supplies.

 
It’s important to make certain to avoid getting hemostatic powders into a patient’s eyes or airways. Also, removal from the wound  is usually recommended no longer than 24 hours after application.

 
Let’s not forget natural remedies that may help stop mild-moderate bleeding. Certainly, if a disaster has long-standing consequences, the supply of commercial hemostatic agents will diminish, and it’s important to know what plants may provide medicinal benefits.

 
Cayenne Pepper powder at levels above 35,000 Scoville (heat) Units has a coagulant (clotting) effect, although it may cause a burning sensation. Too much stronger, however, and it can get into the medic’s eyes and cause irritation. Black pepper has also been used in the past to help control hemorrhage. Apply either of these in a good quantity to the bleeding area and apply pressure with a gauze dressing. For major hemorrhage, however, the commercially produced products like Celox or Quikclot are superior.

 

 

The medic is most effective when they have the right tools. Accumulate a supply of hemostatic agents now and you’ll succeed, even if everything else fails.

 

 

Joe Alton, MD

JoeAltonLibrary4

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