Using Antibiotics Wisely

Rourke: This post was originally published HERE over at DoomandBloom.net.

 

Antibiotics are essential tools for success in long-term survival, but the government, the food industry, and some physicians and patients are fostering widespread resistance to many of the standard drugs. More than 2 million diagnosed cases of antibiotic resistance were reported in the United States in 2013, leading to 23,000 deaths and costing 30 billion dollars.

 

 

As a physician, I was often asked by patients in my practice for antibiotic prescriptions for certain ailments, some of which these medications really weren’t useful for. Antibiotics deal mostly with bacteria, and many respiratory and other infections are caused by other disease-causing organisms such as viruses. I was always very cautious when it came to prescribing these medications, and as a caregiver, you should be also.

 

 

This doesn’t mean that I think that antibiotics aren’t useful, especially in survival scenarios. In situations where modern medical care isn’t available, they will prevent many avoidable deaths. You should have a good supply of these drugs in your storage.
If you use antibiotics for every minor ailment that comes along, you will run out very quickly and may contribute to an epidemic of antibiotic resistance caused by overuse. In survival, the medic is also a quartermaster of sorts; you will want to wisely dispense that limited and, yes, precious supply of life-saving drugs. You must walk a fine line between observant patient management (doing nothing) and aggressive management (doing everything).

 

 

Liberal use of antibiotics is a poor strategy for a few reasons:

where most antibiotics go…

where most antibiotics go…

 

Overuse can foster the spread of resistant bacteria, as you might remember from the salmonella outbreak in turkeys in 2011. Millions of pounds of antibiotic-laden turkey meat were discarded after 100 people were sent to the hospital with severe diarrheal disease. The food industry is responsible for 80% of the antibiotic use (overuse) in the U.S. This is not to treat sick livestock but to make healthy livestock grow faster and get to market sooner. According to National Geographic magazine, only 7 per cent of some 400 antibiotics given to livestock have received review by the Food and Drug Administration.

 

 

Another reason to use antibiotics sparingly is that potential allergic reactions may occur that could lead to anaphylactic shock. Frequent exposure to antibiotics increases the likelihood of developing an allergy to one or more of them.

 

 

Lastly, being trigger-happy with antibiotics may make diagnosing an illness more difficult. If you give antibiotics BEFORE you’re sure what medical problem you’re actually dealing with, you might “mask” the condition. In other words, symptoms could be temporarily improved that would have helped you know what disease your patient has. This could cost you valuable time in determining the correct treatment.
You can see that judicious use of antibiotics, under your close supervision, is necessary to fully utilize their benefits. In survival settings, discourage your group members from using these drugs without first consulting you. In normal times, seek a qualified medical professional.

 

 

Joe Alton, MD

joe-video-tent

 

To find out more about antibiotics and their usage in survival settings, get a copy of our 3 category amazon bestseller, the Survival Medicine Handbook, a great way to succeed, even if everything else fails.

Anaphylactic Shock In Austere Settings

Rourke: This article can be seen here in its original format.

In a disaster or any other situation that leaves 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 anaphylaxisor 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.

 

WHAT ARE THE CAUSES OF ANAPHYLACTIC SHOCK?

This allergic reaction can be caused by drug exposure or pollutants, but even ordinary foods such as peanuts can be culprits. Our immune system sometimes goes haywire when it acts to protect our body from an invading substance. In extreme circumstances, a person could go into shock.
Anaphylaxis has become an timely issue in because of the increased numbers of people that are experiencing the condition. Why the increase? When medicines are the cause, the explanation is likely that we are simply using a lot of drugs these days. Why foods should be causing anaphylaxis more often, however, is more perplexing. Could pollutants be an issue? For whatever reason, allergies such as asthma, food allergies and hay fever are becoming epidemic all over the world.

 

peanuts
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 can be dangerous in their own right without causing an immune or anaphylactic reaction.

 

SYMPTOMS OF ANAPHYLAXIS

 

anaphylaxis
It’s important to recognize the signs and symptoms of anaphylaxis because the faster you treat it, the less likely it will be life-threatening. You may see:
• Swelling: can be generalized, but sometimes isolated to the airways or throat
• Breathing difficulty: wheezing is common as in asthmatics
• GI symptoms: diarrhea, nausea and vomiting, or abdominal pain
• Loss of consciousness: The patient may appear to have fainted
• Strange sensations on the lips or oral cavity: especially with food allergies
• Shock: Blood pressure drops, respiratory failure leading to coma and death

 

anaphylaxis symptoms

 

 

FAINTING VS. ANAPHYLAXIS

 

Indonesia Independence Day
Fainting is not the same thing as anaphylactic shock. You can tell the difference in several ways:
• Someone who has fainted is usually pale in color, but anaphylactic shock will often present with the patient somewhat flushed.
• The pulse in anaphylaxis is fast, but a person who has fainted will have a slow heart rate.
• Most people who have just fainted will rarely have breathing problems and rashes, but these will be very common signs and symptoms in an anaphylactic reaction.

 

 

WHY ANAPHYLACTIC SHOCK OCCURS
In food allergies, victims often notice the effects very rapidly; their life may be in danger within a few minutes. People who have had a serious anaphylactic reaction should be observed overnight, as there is, on occasion, a second wave of symptoms. This can happen several hours after the exposure. Some reactions are mild and probably not anaphylaxis, but a history of mild symptoms is not a guarantee that every reaction will be that way.
Why does our immune system go awry in anaphylactic situations? Anaphylaxis happens when the body makes an antibody called immunoglobulin E (IgE for short) in response to exposure to an allergen, like food or a medication. IgE sticks to cells, which then release substances that affect blood vessels and air passages. The second time you are exposed to that allergen, these substances drop your blood pressure and cause soft tissue swelling. The airways, however, can tighten and cause respiratory difficulty.
Histamine is a substance released in this situation. Medications which counteract these ill effects are known, therefore, as antihistamines. These drugs may be helpful in mild allergic reactions, but tablets, like Benadryl, take about an hour to get into the bloodstream properly; this isn’t fast enough to save lives in serious reactions. If it’s all you have, chew the pill to get it into your system more quickly. Other antihistamines, like Claritin, come in wafers that melt on your tongue, and get into your system more quickly, although the effect is also mild.
The same cells with IgE antibodies release other substances which may cause ill effects, and antihistamines do not protect you against these. As such, we look to another medicine that is more effective: Adrenaline, known in the U.S. as Epinephrine.

 

ADRENALINE (EPINEPHRINE)

 

epipen
The Epi-pen is the most popular of the various available injectable kits to combat anaphylaxis. It’s important to learn how to use the Epi-Penproperly. Click the link in the last sentence for a video on the subject.

 

 

You can cause more harm than good if you fail to follow the instructions. For example, Adrenaline (Epinephrine) can constrict the blood vessels if injected into a finger by mistake, and prevent adequate circulation to the digit. In rare cases, gangrene can set in. Also, remember that the Epi-Pen won’t help you if you don’t carry it with you or have it readily accessible.
Since it’s a liquid, Adrenaline (Epinephrine) will not stay effective forever. Be sure to follow the storage instructions. Although you don’t want to store it someplace that’s hot, the Epi-pen shouldn’t be kept in any situation where it could freeze, which will damage its effectiveness significantly. Store in dry, dark, cool conditions.
When is it appropriate to inject Epinephrine? An easily remembered formula is the Rule of D’s:
Definite reaction: Your patient is obviously having a major reaction, such as a large rash or difficult breathing.
Deterioration: Use the Epi-pen before the condition becomes life-threatening.
Danger: Any worsening of a reaction after a few minutes.
Imminent danger is probably most likely if your patient has difficulty breathing or has lost consciousness. If you are ever in doubt, go ahead and give the injection. The earlier you use it, the faster a person will resolve the anaphylaxis. One injection is usually enough to save a life, but have more than one handy, just in case. This is especially pertinent when you are away from your base of operations.
Some people may not be able to take Adrenaline (Epinephrine) due to chronic heart conditions or high blood pressure. Make sure that you consult with your doctor now to determine that it is safe to receive an injection. Have the medicine available, learn the signs and symptoms, and you’ll stay out of trouble.

 

Joe Alton, MD

 

JoeAltonLibrary4

 

Learn more about anaphylactic shock and 100 other medical issues you might encounter in a disaster in our Amazon bestselling book “The Survival Medicine Handbook“, now with over 195 5-star reviews.

 

Also, check out Nurse Amy’s entire line of medical kits and supplies at our store at store.doomandbloom.net.

 

 

….On practical IFAKs

 

There is a dearth of useful information out there on practical useful IFAKs(Individual First Aid Kit). Most of what is offered amount to a “Boo-Boo” kit. They do not remotely address the most common of life threatening wounds encountered in a combat situation.

Outside of EMS/EMT training there is minimal information on the use and application of the equipment and materials required to address these wounds. There are a few DVDs available (Doc Spears) and some equipment manufacturers have made some useful you-tube videos on the use of their equipment (NARP, ARS).

A list of mandatory supplies:(most purchased IFAKS have few of these.)

Chest seal (Bolin, Halo, Hyfin, ARS, Asherman)

Chest decompression needle, 14ga, 3.25” (NAR ARS)

Tourniquet (CAT, NARP)

Battle dressing (OLAES, ISRAELI, H&H)

Hemostatic Z fold gauze (Celox, Quick clot)

Powdered Quick clot or Celox

Naso-Pharyngeal tube w/lube (RUSCH)

Nitrile gloves

Bandage scissors

Scalpel w/blade

Hemostat

Pen light

Beta-dine wipes

Waterproof marker

Tourniquets can be improvised from belts, straps etc, and compression bandages can be made from Kotex pads and ace bandages in a pinch.

These are the minimum of supplies needed to address the wounds discussed below. Proper use of these items with training, will allow you to:

Stop extremity arterial bleeding

Relieve a tension pneumo-thorax (collapsed lung, pressure on heart)

Seal a chest wound to prevent lung collapse

Provide a clear airway

Evaluate, stop bleeding and pack/bandage most other wounds

Cut away clothing and clean the site.

Debride the wound if necessary

Mark the casualty with time of tourniquet placement or other vital information

 

The following is informational only and is not to be taken as medical training, seek out a qualified medical instructor.

The below listed wounds are the top 4 combat wound killers if not treated in a timely manner. These wounds should be addressed by yourself or another, AFTER you have gained fire superiority or can be removed to a safe area. Other wise continue the fight.

Rule #1 is scene safety. Do not become a casualty yourself. Best way to do that is to return fire and and eliminate the threats to safety. Do not begin casualty care until you can do it safely.

There have been changes to the ABCs of wound care. Now it’s Circulation, Airway, Breathing, Circulation. Stop all major bleeding first and foremost as that is what is going to kill folks after a firefight.

 

 

Wound: Sucking chest wound [Tension pneumo-thorax (collapsed lung)]

Presents as: Entry hole the size of projectile in lung. May or may not also have a larger exit wound. Wound will make a sucking sound and/or blow blood bubbles. Look for Tracheal deviation, hyper- expanded chest, bulging neck veins. Patient in respiratory distress.

Treatment:Inspect for exit wound. Treat for shock if indicated. Clean wound(s) with beta-dine wipe, Place chest seal on entrance and exit wound per package instructions. Monitor for pneumo-thorax. If indicated, clean area in line with nipple vertically and between the 2nd and third rib down from the clavicle (collar bone) with beta-dine. Feeling for the top of the 3rd rib with your weak hand, place the decompression needle vertically just above the rib. If resistance is felt, angle the needle slightly away from the rib and fully insert flush. You should feel and or hear air escape. The wounded party should experience almost immediate improvement in breathing. Treat for shock. Monitor for blockage of needle. An additional needle may need to be placed next to the first one.

 

 

Wound: Arterial bleeding of extremities (arm/leg)

Presents as: Bright red pulsing, forceful bleeding. Elevated pulse.

Treatment: Apply CAT (combat application tourniquet) two inches above the wound. Apply Celox or quik clot granules. Tighten tourniquet until bleeding stops.(this will hurt, that is natural). If bleeding does not stop, apply an additional tourniquet above the first. Write time on injured forehead or tourniquet. Remove any visible debris and clean with beta-dine.(follow this treatment up with the next wound treatment.)

 

Wound: Puncture, stab, projectile penetration (single or thru and thru)

Presents as: wound smaller than two fingers, no arterial bleeding or has been addressed above.

Treatment: clean wound with beta-dine and bandage with gauze compress and tape. If excessive bleeding apply celox/quikclot and compression bandage.

Presents as: wound the size of two fingers. Moderate bleeding or arterial bleeding has been addressed

Treatment: Clean with beta-dine. Wrap a couple turns of Z-fold celox/quick clot gauze around two fingers and start packing gauze at the bleed site. Continue to feed in gauze working around the wound until full. Ball up additional gauze atop the wound and then apply a compression bandage.

 

 

Wound: Injured is unconscious and not breathing.

Presents as: Air way blocked for one reason or another. Difficulty breathing, unconscious.

Treatment: With injured on back , head supported, lubricate nasopharyngeal tube. Place the tube with the bevel against the inside wall of the nose and insert straight in (not up toward the eyes) It should follow the path of the hard palate. Twist up, with the bevel to the rear to clear the back of the tongue. If resistance is felt try the other nostril. (some people have one occluded nostril, but not both) Push the airway flush. Injured should start breathing through the tube. Place injured on his side in the recovery position.

This article has very briefly covered the skills and tools required to be a “combat lifesaver”. This is not in any way training to be a corpsman or EMT. Its intention is to allow basic, emergency, in the field, temporary, self or buddy treatment of the most statistically deadly combat wounds in a SHTF situation.

In the interest of correctness I submitted this article to an active duty LTC. medical combat, surgical nurse for review. I have added his few recommendations.

Please follow this up with additional study and training, if you feel that you or yours life is worth the additional skill set. What I have presented here are the mere basics and should not be construed as medical training, only advice in an area that you may not know, but should.

The life you save may be mine.

 

Included below is my outline for the CLS class I teach my Tactical Carbine students. It may be of use to you in training your friends and family.

CLS TRAINING MODULE FOR RANGE EMERGENCIES

Teaching aids:

Bolin chest seal

ARS decompression needle

Z-fold gauze

Israeli battle dressing

CAT

Naso tube

IFAK contents

alcohol wipes

 

Denim wrapped raw pork loin with gunshot wound,.223

Denim wrapped raw pork loin with large gunshot wound.

Denim wrapped raw slab of ribs with gunshot wound, .223

 

DECOMPRESSION NEEDLE (see ….on IFAKS notes)

Demonstration and then student practice of placement of chest decompression needle on a raw slab of ribs contained in saran wrap.

Use of volunteer to show correct location of needle placement.

Have students find location. And simulate with marker pen.

 

CHEST SEAL(S) (see notes)

Demonstration and then student practice of placement of chest seal on

slab of ribs with gunshot wound.

 

CELOX Z-FOLD GAUZE (see notes)

Demonstration and then student practice of packing and compression bandaging of pork loin with large gunshot wound.

 

CAT (see notes)

Demonstrate application of CAT.

Pair up students and have them apply CAT and check pulse to determine effectiveness of CAT and also experience the pain of a proper CAT application while monitored.

 

ISRAELI BATTLE DRESSING

Demonstrate and then student practice of application of compression bandage.

 

NASOPHRENGEAL TUBE (see notes)

Perform a non-invasive demo of tube placement.

Have students talk through a non invasive explanation of insertion.

 

BUDDY SIMULATION SCENARIOS

Set up scenarios and have buddied students simulate and explain the various treatments.

 

Regards, D.

 

*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *

ModernSurvivalOnline.com Survival & Preparedness Guest Post Contest

 

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The Right Way to Treat a Wound

By Dave from PreppingPlans.com

We’ve all put on a band-aid sometime or other; but that’s not really wound treatment. In a survival situation, you’re probably going to be faced with much more serious wounds than that, requiring much more thorough wound treatment. Whether due to gunshot wounds or working with tools that most of us aren’t accustomed to using, the likelihood of serious wounds is much higher.

The other problem is that medical services will be overloaded. This happens in any crisis situation, with hospitals and clinics becoming overcrowded and medical personnel working round the clock to take care of those with needs. Just getting medical care will be a challenge.

Doctors say that the faster a person receives treatment, the better. Quick treatment lowers the amount of blood loss, as well as reducing the chance of infection. Being able to take care of wounds yourself can literally save someone’s life, by getting them the care they need before it is too late.

The Importance of Cleanliness

Doctors and other medical professionals always wash before and after having any contact with a patient. There’s a good reason for that; it’s to avoid infection. We always have bacteria in and on our bodies. As long as they stay in the areas where they belong, they really don’t cause us any problem. However, if they get into other parts of our bodies, some can be lethal.

The skin acts as part of our immune system in that it protects us from infection. Bacteria and other pathogens can’t easily penetrate our skin. However, if we have a cut or other opening in our skin, they can enter the body easily.

So this means that one of the places a victim can be infected from is you, while you are attempting to treat them. Washing your hands and putting on sterile gloves is merely a manner to help prevent that from happening.

5 Steps to Care for a Wound

Every wound needs to be cared for in the same way. While the amount of bleeding is a concern, at least from the viewpoint of preventing the patient from losing too much blood, that isn’t an indication of the seriousness of the wound. Some wounds bleed more than others, simply because of their location. Cutting a vein or artery will cause a wound to bleed a lot, whereas a wound 1/2 inch away won’t.

Clean the wound

Irrigating the wound is part of cleansing it, specifically that of removing any foreign particles from the wound. It consists of running enough of a sterile solution over the wound to rinse it out. That sterile solution could be water, alcohol or hydrogen peroxide. If water is clean enough to safely drink, then it’s clean enough to safely irrigate a wound.

If available, an irrigation syringe should be used. This is a 30cc syringe with an extended plastic nozzle, rather than a needle. The plastic nozzle allows you to get the irrigating solution into the wound area. If the wound is open, where you can actually see inside the body, then place the end of the nozzle inside the body; otherwise, keep it close to the surface.

In addition to cleaning out the wound itself, the area around the wound should be cleaned. This can be done by pouring on alcohol or hydrogen peroxide, or by using alcohol towlettes. The idea is to kill any bacteria on the surface of the wound and skin, while also providing a clean skin surface for the bandage’s adhesive to stick to.

Stop the bleeding

If a wound is bleeding profusely, there’s a chance that a vein or artery was cut in the injury. It will be necessary to get the wound to stop bleeding so much, before it can be fully treated. Examine the wound and see if you can determine exactly where the blood is coming from. There are a few different ways of stopping or at least slowing bleeding. They can be used in conjunction with each other.

  • Pressure – Applying pressure to the wound is usually the first means of slowing bleeding. Place a sterile pad, such as one of gauze, over the wound and press down on it. Maintain pressure until the bleeding slows to a reasonable level.
  • Apply a tourniquet – a tourniquet is a pressure band placed between the wound and the patient’s heart, when a wound is on a limb. The pressure reduces the blood flow to that limb, allowing it to clot. When a tourniquet is applied, it should always be a temporary measure, along with other measures. Loosen after 15 minutes to see if the bleeding has slowed.
  • Suturing – If the patient were in a hospital emergency room, this is probably what they’d try to do. However, suturing a wound is difficult and should only be attempted if you know what you are doing.
  • Hemostats – In the case of a severed or partially severed limb, closing off the blood vessels may be the only way of stopping the bleeding. However, there is a risk when this is done, as it totally blocks off blood flow to the limb. This will probably cause tissue to die, so it should only be used when absolutely necessary.
  • Clotting agent – A clotting agent is something which speeds up the blood’s normal ability to clot. There are several brands of this on the market, which are available in a crystal form or embedded into a bandage.

Apply antiseptic

No matter how well you clean a wound, you can’t see bacteria, so you don’t know if you’ve cleansed it thoroughly enough. Antiseptic ointments are there to kill any bacteria, helping to prevent any infection from taking hold. Apply liberally to the whole wound and the area around it.

Close the wound

If the wound is open, the edges of the skin need to be brought together so that they can heal closed. This is normally done by suturing. However, you can do just about as good a job by using butterfly sutures. These are like adhesive bandage strips, without the center portion that has the gauze pad. Instead of a gauze pad, it has a thin strip of plastic to hold the two adhesive sides together.

To use butterfly closures, start by opening the packages of however many butterflies you’ll need. Peel off the protector from one of the adhesive pads and stick it lightly to your glove. Once you have the closures ready, pull the skin together with the hand that has the closures stuck to the glove, so that the edges come into contact with each other. If necessary, wipe or blot off any water or blood. Then take the butterfly and stick the adhesive pad to the far side of the wound. Pull it, remove the protective cover off the other adhesive pad and attach it to the near side. Repeat for all butterflies.

Protect the wound

The purpose of bandaging a wound is to protect it from dirt and other impurities that can carry infection. Always use a bandage that’s bigger than the wound, so that the entire wound area will be covered by one bandage. Place the bandage centered over the wound and tape it in place. If the bandage is self-adhesive, then use the adhesive strips provided. However, larger bandages rarely have any adhesive on them, so you must use medical tape.

The new cohesive medical tape is much better than the older adhesive type. The cohesive tape is stretchy rubber. To apply it, one pulls on the roll as they are going around the limb. The tape does not stick to the skin. Rather, once the first revolution is complete, the tape sticks to itself. This prevents it from pulling loose hair and makes it much less painful to remove.

Change bandages whenever they get dirty to prevent infection. At a minimum, they should be changed once per day.

 

Dave is a 52 year old survivalist; father of three; with over 30 years of survival experience.

He started young, learning survival the hard way, in the school of hard knocks. Now, after

years of study, he’s grey-haired and slightly overweight. That hasn’t dimmed his interest in

survival though. If anything, Dave has a greater commitment to survival than ever, so that

he can protect his family. You can learn more about Dave on his site, PreppingPlans.com

My philosophy on preparedness, and an MD perspective on wound closures

The following article was originally published on April 12th, 2012 and won 1st Place in a past MSO Guest Post Writing Contest. It can be seen in its original format HERE.

 

When I reflect on what drives me to prep, I realize that this motivation was born long before I actually started prepping. In fact, it was something that was forged through my life experiences beginning as early as childhood. My parents divorced when I was young, and with that I spent the good portion of my life experiencing what it is like to be financially limited. Although difficult, I never felt like my situation was hopeless or that I was powerless to change my surroundings. This was in part due to my mother acting as an example of strength and determination that kept hope and optimism alive. It was not just her encouragement but also her sacrifices to do things like send me to private school even though we were living six people in a two bedroom apartment in the ghetto of Los Angeles.  Now, as a young resident family medicine physician with a wife and three very young sons, this motivation to prepare for the worst is even stronger. The burden of caring for my family is something that I carry with me every day; and the knowledge that when things go bad, I will need to protect and care for them, drives me to learn more about preparedness and defense every single day. This is the preface for my current outlook on life, and what I would like to share with you.

 

The most important lesson that I have ever learned is that whatever your goal is, there is always a way, but that way may be of great resistance, and the resistance is simply your own subjective perception of inconvenience. Granted, there are very concrete obstacles to any goal in life, but those obstacles can still be surmounted with determination – essentially the basic mechanism through which we accomplish all things in life.

 

Unfortunately, our society has become sorely deficient in the core values that distinguish us as Americans. The political machine that is our government has, over time, fashioned a dependent populous that has become so dysfunctional and de-conditioned that we now have an entitlement pandemic with no cure in sight. The democratic system was designed to be a fair and balanced way to elect public servants. Presently, that system has been maligned by politicians seeking power which can only be granted by the masses, so social infrastructure has been put in place to divide the American people into those who have, and those who have-not. This addresses the key component to why I worry about our future as a functional society if we were to ever have a lapse in rule-of-law.

 

I’m no Nostrodamus, but as I see what is going on currently in our world, the most likely “doomsday” scenario plays out something like this: Since oil is the Achilles heel of our economy, when – not if, we become engaged in another major Middle East conflict (most likely with Iran), we will be wishing for $5.00 per gallon gas prices. Subsequently, a shockwave of inflation will affect every single person in America. When this happens, those without financial reserve will become even more strained. Unknown is whether this is a relatively slow or abrupt event. When we cross that threshold into societal breakdown, the current way of life we now enjoy will be gone. No more push button world that we currently enjoy, and the only person you can rely on is yourself, and the only certainties are those preps that we have done, despite mocking or questioning from people around us. It will be a time when you now have to worry about keeping yourself safe from those who will want to take advantage of a scenario like this.

 

Now insert a spouse and kids into this picture. It is not something we want to imagine having our family exposed to, but is essentially the main motivation for why I prep. Single, I’d still prep, but my family gives me even greater passion, and even more than that, responsibility,  to prep, and to broaden my mindset to prep in anticipation of helping others with the skill sets that I have been blessed with having and learning.  Some would ask, in a survival scenario, why utilize your preps or aid those who have failed to prepare? Well, the short answer is that as preppers we need to be the beacons of recovery. I know I would not want to be perpetually stuck in a state of survival and high stress existence, and restoration of order can only be achieved as a community.Therefore, to aid others is to thyself, and it is an investment in the future if our world were to change for the worse. Saving myself and my family isn’t enough; I have a commitment as both a human and a doctor to heal and help. Preparedness is essential to being ready to fulfill that commitment when things go bad. Preparedness isn’t a hobby for me. It isn’t a sport. It’s a necessary piece of life; something that is as essential for the future as breathing. Because my family won’t be breathing long if I’m not prepared to care for them in every possible way. I work in my career field learning to be a better doctor and helping care for people. I work to earn the money to care for my children in the Today, but I also work on the means of preparing to care for my children in the Tomorrow that I fear is coming. If I am coming into the “game” – so to speak – a bit late, I am coming into it with passion, determination, and the will to succeed. Every day, I work on learning, collecting, securing the tools and information I will need for the future, whether it’s a spare suture kit, antibiotics, UHTP milk for the kids, baby wipes, or wilderness medicine techniques. Every day, I am bettering myself as a productive human, and I am preparing to care for my family and my community in every way that I can. So, why do I prep? I prep because it’s my duty to my family, to my community, and to my country. It’s our job and prerogative to care for ourselves. After all – no one – cares more about the survival of ourselves and our families than we do. Preparedness can only help, not hurt, so there’s no reason not to and every reason why I should.  I’m glad to be a part of the prepper community knowing there are others out there with the same mentality and mindset. Although my experience is limited, I do have some information to share with the community that I hope is helpful in regards to simple wound closure since in a SHTF scenario, injuries will become more frequent due to the increased demand on ourselves for physical labor, maintenance, and altercations we may be involved in. The following is intended to give you a brief summary of the approach I take when considering wound closure in the emergency department or clinic, and also to stimulate your own learning on how to improve your own techniques and skills to have during a SHTF scenario. Any comments or suggestions for improvement are always welcome.

 

SIMPLE WOUND CLOSURE 101:

 

***DISCLAIMER: Whenever you require medical attention, unless you are a trained medical professional, I would seek out medical help. This information is intended for application during a less ideal situation where medical attention may not be readily available and you need to treat yourself or your loved ones in an emergency.

There are essentially two ways to heal a wound:

1)      Primary intent: bringing the wound edges together via bandage, suture, or glue.

2)      Secondary intent: allowing the wound to heal “as is” when primary intent is not indicated (such as a very contaminated, dirty wound with multiple deep entry points).

It’s important to close a wound by primary intent for several reasons:

1)      Hemostasis (stopping bleeding): because if you lacerated a vessel with your injury, you will need to ligate it somehow. Granted, if you lacerate a major artery, you will just need to apply pressure because ligating it may compromise blood flow to whatever body area it feeds.

2)      Infection prevention: since our skin provides a barrier to bacteria, this is pretty obvious why closing a wound is important to restoring that barrier. There are, however, exceptions to this rule when the wound is fairly contaminated, and by closing the wound you may actually trap bacteria under the skin and cause a deeper infection. I will explain how to minimize this chance.

3)      Cosmesis:  if you have a deep laceration in an area where “looking good” or “not looking like Frankenstein” is important, then repair is indicated.

REPAIR MATERIALS: *Any suture kit will include a needle driver, forceps, and scissors.

1)      Tape / Bandage closure: butterfly and steri-strips are excellent ways to close a wound for the simple reason that they require no anesthetic to employ. Their downfall is that they cannot always establish good hemostasis with deeper wounds.

2)      Dermabond: a synthetic bio-glue that differs from krazy glue in that it won’t cause tissue damage on contact. Also an excellent choice since it can be used without anesthetics, and can close deeper wounds than bandages alone since you can place it inside the crevices of wounds to get a deeper closure. Again, like bandages, you cannot guarantee hemostasis with this method. Never put a bandage over it, and be careful around the eyes since you can glue an eye shut. This material will dissolve within about 48-72h depending on moisture exposure.

3)      Staples: great for quick closure of the skin. Not for use in deeper layers since you never want to have any non-absorbable materials permanently under the skin when you do a wound closure.

4)      Sutures: there are different types depending on 2 major parameters:

  1. Type: Non-absorbable vs. absorbable – important because surface skin closures for skin repair will be non-absorbable and hence will need to eventually be removed. Absorbable sutures are used for deeper layer closures if you require closure of a deeper layer (if you have a deep wound, you always want to try and repair each layer that was injured such as muscle, fascia, subcutaneous fat, and then skin).
  2. Thickness: 0-7.0, 0 being the thickest, 7.0 being very fine (for vascular repairs). Depending on the area of the body you are repairing, you will use different thicknesses like thicker to provide mechanical support over a high stress area like a joint or thinner to reduce scar formation and get finer approximation of the skin edges. For example, on the face you would use a fine thickness like 5.0 or 6.0.

REPAIR TYPE AND LOCATION:

SCALP: Staples or 3.0 non-absorbable suture

FACE: 5.0 (or 6.0 for children’s faces or eyelid), LIP/MOUTH/TONGUE: 4.0 absorbable suture

BODY: 4.0 for most areas

OVER JOINTS (KNEE/ELBOW): 3.0

HANDS: 4.0 – *Make sure in any type of hand laceration repair you stay very SUPERFICIAL to avoid tendon/nerve/vessel damage since there is not much subcutaneous tissue to protect those underlying structures.

REPAIR TECHNIQUE: Simple interrupted suturing technique will never fail you for any skin closure, and is the easiest/most reliable to learn. When I started learning I learned on hot dogs, chicken breasts, any type of meat really. There are lots of You-tube videos out there describing this technique as well as how to tie the knots with instruments.

Since a lot of people will be storing antibiotics as a component of their medical supply kit, it’s important to remember that unless you develop a skin infection (cellulitis – which is red, tender, warm skin after a skin wound), you do not need to routinely give antibiotics after a wound since copious irrigation with simple tap water is sufficient to ensure clean healing. We routinely put bacitracin over the wound once we close it, and that is OK because it is something that can easily be obtained unlike antibiotics. Neosporin is something more common but contains neomycin (antifungal), which some people can get allergic reactions to which is why we use bacitracin in the emergency department and clinic.

I will work on an antibiotic usage guide and my recommendations for the top antibiotics I would store up for an impending collapse of society in order to be prepared to treat simple bacterial infections that, in a SHTF scenario, would be life threatening untreated – stay tuned!

-Doc Morgan

 


smalllogcabinFrom the Supply House: Here are a few popular survival & preparedness items available at deep discounts on Amazon. Many items are available with Free Shipping on orders over $35. 

BaoFeng UV-5R 136-174/400-480 MHz Dual-Band DTMF CTCSS DCS FM Ham Two Way Radio: This radio continues to be a bargain and super popular as people look for low cost longer-range communication solutions.

Mountain House “Just in Case” Classic Bucket: At under $60.00 with Free Shipping this a great deal if you are looking to add freeze dried food to your food storage system. Great way of buying and trying – or for storing.

11” x 50’ Foodsaver Bag Material/roll: The cheapest Foodsaver-type bags I have found online.

WaterBOB Emergency Water Storage System: Excellent expedient method to store a large amount (100 gallons) of water

Emergency Fishing Kit: Inexpensive and durable emergency fishing kit sealed in a compact can.

Agenda: Grinding America Down – Documentary available on DVD that really gives some interesting insight on what has been and is going on in this country. High recommended.