Monday, August 2, 2010

Hormones: the Bane of Woman's Existence

If hormones aren't the curse of women, I don't know what is.

It's not like our lives are hard enough with high heels, anorexic super models, childbearing, but we also have to get a high does of hot flashes, bloating, cramps, and PMS.

I blame it all on Eve. She just had to listen to that nasty snake and eat that forbidden apple... Fine! Well at least, she got a good taste of fruit. But what about the rest of us? Yeah, we get night sweats and problems sleeping and mood swings, all for nothing! I feel gypped. (Image taken from http://christophermattix.wordpress.com/category/food-for-thought/page/3/)

But I do have to hand it to God for providing women with means of coping: chocolate, ice cream, support groups, sappy romance flicks, and those video games where a woman character can beat up men.

Yep, for some reason taking female hormone issues out on men has a gratifying sense to it. For instance: Where do you think the idea that men should take out the garbage came from? Come on don't give me that look. You know it as well as I do. Think about it: Who else would come up the idea that men should cart stinky crap outside into the heat?

Anyway, let's talk about Progesterone. I know, men complain about estrogen all the time. Yeah, well women complain about testosterone. But no one should complain about progesterone; it's the feel good hormone. It's the one that we should all come to love and enjoy. It's the hormone that helps women get some sleep, avoid hot flashes, have better memories, and just plain feel peaceful. Well, that is when it is in balance.

Okay, if you are a man reading this: No, I don't suggest that you run out and buy your woman progesterone to keep her from getting mood swings. Just stick to the chocolate. It's safer and more romantic.

You return with a paper bag of progesterone instead of a box of chocolate, and taking out the garbage will be the least of your worries. [Note: some women, like me, are allergic to chocolate and would prefer the progesterone.]

What's the big deal about Progesterone?

Progesterone is a hormone produced by the ovaries, placenta, and adrenal glands. It not only is involved in the menstrual cycle, female sexual development, and pregnancy, but it also plays a major role in the development of cortisol (one of the body's stress hormones).

I am going to skip over progesterone's role in pregnancy: I figure that the detailed labor and delivery post covered enough of the fear factor that I don't want to re-engage the post-traumatic stress in by mentioning the physiology of pregnancy. I know, the flashbacks were horrific. ;).

Other effects of progesterone:
  • Involved in synthesis of fat into energy (It's one of "The Biggest Loser" hormones.)

  • Participates in blood clotting

  • Acts as a diuretic. (No progesterone and you bloat up like the Stay-puft Marshmellow Man.)

  • Stimulates bone building, thus preventing osteoporosis

  • Helps regulate blood sugar levels

  • Acts on oxygen levels in cells

  • It's part antidepressant on its mother's side.

What are some of the expected levels of progesterone?
This is when you hijack a medical lab and ask them to take your blood progesterone level. Or you could always visit your health professional and have them check your level for you, but where's the fun in that.

Reproductive years: 8-10 ng/ml

Menopause (lows): 0.1-8 ng/ml

Menopause (highs): 10-16 ng/ml

Post-menopause: 1 ng/ml

Durning pregancy: 16 ng/ml

Normal ovulation: 20 ng/ml
(Image and data from www.natural-hormones.net ; and Speroff, et al. (1989). Clinical Gynecologic Endocrinology and Infertility. 4th ed. Baltimore: Williams & Wilkins.)

And why do we care about the stupid numbers? Well, WE don't. But it's those psycho anal physicians that are so addicted to numbers, that we have to feed them lab results at least once or twice a week in order to prevent them from having withdrawl symptoms.

Either that or those mad scientists with data fetishes. Sometimes, I can't tell which. (Image from http://www.arronbailiss.co.uk/).

Down on Your Luck: Low Levels of Progesterone

Symptoms of low progesterone are those that involve the men running sreaming and the women wanting to beat the living tar out of them. Either the woman's progesterone is low or the man was caught cheating. Either way the woman is irritable, sweaty, and ready to break something.

Low Progesterone Signs and Symptoms:
  • Irritability
  • PMS/ Mood swings
  • Difficulty concentrating
  • Memory deficiencies: memory loss, lack of mental acuity, brain fog which is not to be confused with brain freeze. That is derived from drinking huge amounts of Slushies too fast. [And yes, if you were wondering, low hormones have been linked to Alzheimer's disease*. ]
  • Insomnia
  • Hot flashes/ Night sweats
  • Anxiety/ panic attacks
  • Depression
  • Irregularity of menstrual cycle
  • Abnormal/ excessive uterine bleeding
  • Uterine fibroids
  • Uterine cancer
  • Strong cramps during menustration
  • Greater presence of blood clots during menstruation
  • Vaginal dryness/ irritation
  • Joint pain/ muscle pain
  • Breast tenderness
  • Frequent urinary tract infections
  • Headaches, Dizziness
  • Weight gain
  • Edema /bloating (water retention)
  • Fatigue
  • Dry skin
  • Low blood sugar levels
  • Deficiency of Magnesium ( This kind of has the chicken vs the egg dilema about it.)
  • Thyroid malfunction
  • Gallbladder disease
  • Infertility/ difficulty with conception
  • Lack of libido (Men tend to mourn this aspect.)

I do have to state here that low thyroid (or hypothyroidism) can mimic many of the signs and symptoms of low progesterone and vice versa. It is especially important that you contact your healthcare provider when you experience any of the above.

Granted, in the case of dizziness, fatigue, and headache, these symptoms are very ambiguous for medical practitioners. They are like the needle-in-the-haystack: You have the needle, but now you have to figure out which haystack it was in and how it got there.

In my next post, some natural and medical methods of relieving the symptoms of low progesterone will be discussed.

References list:
*Carroll, J.C., et al. (2007). Progesterone and estrogen regulate Alzheimer-like neuropathology in female 3xTg-AD mice. The Journal of Neuroscience, 48: 13357-13365.

Simpkins, J.W., et al. (1997). Role of estrogen replacement therapy in memory enhancement and the prevention of neuronal loss associated with Alzheimer's disease. The American Journal of Medicine, 103:19S-25S.

Vongler, J.M and Frye, C.A. (1999). Progesterone in Conjunction with estradiol has neuroprotective effects in an animal model of neurdegeneration. Pharmacology Biochemistry and Behavior, 64: 777-785.

Other links regarding low progesterone:

http://www.diagnose-me.com/cond/C8779.html

http://www.tarunaoils.com/articles/low-progesterone-levels-signs-symptoms.asp









Tuesday, July 13, 2010

Mandrakes, Mallots, Malts: Natural Anesthetics?

Okay, I am writing two separate posts at the same time. Do you realize how brain fogging that is? ;) It's like listening to a bunch of Irishmen after they downed 20 Guinness, while eating snapper candy. It just shouldn't be done. ;)

Just for fun, I want to state here a few of my favorite questions:

Why are most politicians evil? Because in the job description it says, "several years of experience in evil-doing, lying, cheating, and stealing required for employment in this position". ;)

Why are evil dark overlords politicians in training? Because everyone has to have retirement plans. See required politician experiences.

What do storm troopers wear under their uniforms? Smiley face boxers and t-shirts that say "I love carebears." It's totally obvious. (image taken from http://www.shutterpoint.com/Photos-ViewPhoto.cfm?id=184251)

But the question of the day is:

What are some natural anesthetics?
This was the great inquiry made by a wonderful blog follower that I decided to write this post in response to. (I'm biased: I love my blog followers.)

So let's start with a little medical history. Okay, I think I just lost half of my viewers with the "history" comment.

Historical Natural Anesthetics:

Now, I am not an expert on the natural ways of numbing, so I grabbed my knapsack, couple of bottles of generic filtered tap water that I was charged a buck a piece for, and went on an epic journey to research natural pain killers. [First, I looked at historical analgesics. You know, there is something to be said about some wives' tales: just not the ones that told knights that they needed to be sewn into their armor for good luck. Funny, but so wrong on so many levels.]

Anyway, after that search, I discovered many things. One, Harry Potter was right: people did actually believe that mandrake plants killed you with their screams. (Please enjoy this refresher video of Mandrakes. Mandrake - Harry Potter and The Chamber of Secerets).

And two, our ancestor's were whacked out of their gord.

I am not kidding, this is the first time that I can honestly say, "what the heck were our ancestors were thinking?!"

Seriously, I wonder how any of them survived long enough to create the next generation.

Most of the "numbing methods" they applied centered around doping themselves up enough hallucinogens to ride magic carpets (now, we know why they have those freaky fairy tales), hitting each other in the head with massive hammers, downing keggers of beer, and eating plants that are lethal.

Well, that explains a lot of historical events.

Hitler being voted in. Definitely a bunch of people on natural pain drugs. The voter cards looked blurry under the flying spots and fairies. They mistook Hitler for "hit here." (Actually, "hier" in German, but eh, details, details.)

The Third Crusade. It was all in the mead. Who else but drunks would head into the hottest, nastiest area of the world wearing heavy armor and start a war?

Atlantis. They took the Bugs Bunny approach to numbing methods and beat each over the head with mallots, then became lunatics thinking they could take over the world. Why else did God send their island into the ocean?

Easter Island. Self-explanatory. The entire population ate their weight in lethal mandrakes.

At any rate, the ancient methods for pain reduction were in fact:

1. Halluciongenics such as opium, and cocaine
2. Alcohol (largely whiskey and wine)
3. Striking the patient in the head (either by placing a helmet over the person's head and hitting them with a mallot or by giving them a good punch to the jaw. They lost a couple teeth, but hey, they were unconscious during surgery).
4. Mandrakes (a potentially lethal plant from the nightshade family)

Well, we can't knock them for trying. In all honesty, we pretty much use the a few of the same things for pain relief.

The analgesics Lortab and Vicodin are semi-synthetic derivatives of the opioid family. (Codeine and thebaine are two of the naturally occurring opiates used in the creation of these drugs.)

And come on, I know there are a few of you out there that wanted to deck that guy that was screaming in pain. (Please see reasons why not to go into medicine).

Anyway, let's discuss mandrakes (Mandragora officinarum). These are members of the nightshade plant family (Solanaceae) and genus Mandragora. [Included in the nightshade family are potatoes, tomatoes, peppers, and eggplant.]

The genus Mandragora, on the other hand, realistically should be included in the hallucinogens category, but I want to give them their own attention.

The mandrake contains alkaloids such as scopolamine, atropine, and hyoscyamine. These are potentially deadly substances. So it wasn't the screaming that killed them, it was the alkaloids.

Atropine is used as a treatment for organophosphate poisoning (pesticides) and used to resuscitate patients with severe bradycardia. (For more information see: http://www.cvpharmacology.com/antiarrhy/atropine.htm and http://en.wikipedia.org/wiki/Atropine).

Not only are the Mandragora potentially deadly, they actually promote inflammation and pain. They produce a number of alkaloid chemicals that can range from irritating to lethal.

So why am I telling you this? What is this historical lesson good for?

One, our ancestors were a bunch of neanderthals when it came to medicine. But... although crude, the doping, drinking, and clobbering approaches, were actually affective.

Two, mandrakes, instead of being used for pain relief, can be used to treat organophosphate poisoning which is a life-threatening condition.

Three, for chronic pain or headache suffers, avoiding the nightshade family altogether (tomatoes, potatoes [especially the green and sprouted spots on potatoes], sweet and hot peppers, eggplant, tomatillos, tamarios, pepinos, pimentos, and paprika), actually does help lessen chronic pain symptoms. (For more information please see http://www.whfoods.com/genpage.php?tname=george&dbid=62. and see also, http://naturalmedicine.suite101.com/article.cfm/nightshades)

Lastly, I am still looking for natural anesthetics that are safe and available for disaster medicine kits. Sorry. I wish I could have found something more helpful. Apparently, the best things that we can store up are the prescription analgesics and local anesthetics.

So far, I have been unable to find any natural ones that have been scientifically proven to be safe and to actually work. For the sake of my viewers, I will keep looking.

TTFN.





Tuesday, June 22, 2010

Wound Closure: Up-close and Personal

Okay, so I have been ditching my posting duties. It has been a few months and you haven't heard one lick from me. I know, I know. You were wondering if I was abducted by aliens. Well, they did land in my backyard: I offered them lemonade, and sent them on their way, but inadvertently, no abductions. (Image taken from http://noliesradio.org/archives/1954)

Sorry, I know you're disappointed: I have no alien anal probe experiences to share, but I can tell you about a lot of colonoscopies I have assisted in if you're interested. Man, there were some colons that would reek so bad that--. Wait, you want me to talk about wound closure instead? Are you sure? I mean I can really give you a riveting story about the day that the Sick Colon Struck Back.

Oh, alright. Fine. Be that way. See if I ever tell you about colons again. ;)


Wound Care: Anesthesia

Since we have past the medieval ages, we have ways of numbing wounds. When I was looking up videos for lidocaine injections, I found a great site that gave the following list of subjects:

1. Inject insulin
2. Inject local anesthetic into a wound
3. Pick locks with a strategically placed bump key
4. Prepare an insulin syringe to inject a diabetic cat.
(Image derived from http://www.watercure2.org/pet_testimonials.htm)

Yes, that is the actual list. Hmmm, so let's ask: which of these doesn't belong? The picking locks or the diabetic cat? I think I will go with the cat. (please see: http://www.wonderhowto.com/topic/inject-lidocaine/). (Image taken from http://thegreatgeekmanual.com/blog/motivational-poster-lock-picking)

Back to the blog at hand: Last time we discussed wound irrigation and the different types of antiseptics. So I am going to leave that out of this discussion, except to say: Please irrigate and clean the wound before administering anesthetic.

Okay. Okay. There are a bunch of whiners out there that couldn't handle a wound cleaning if their life depended on it. So in their case, just sterilize your injection site first then give the local anesthetic then clean them. Whine whine complain.

But for everyone else:

1. Irrigate

2. Clean

3. Prep the area with an antiseptic.

4. Prepare a 27 or 30-gauge STERILE UNUSED needle synringe with around 3 cc of anesthetic. (Wipe the top of the anesthetic bottle with alcohol pad before inserting the needle. Draw out 3 cc or more solution.)

5. Infiltrate the skin (epidermis) at the edge of the wound with the needle bevel side up.

6. Create a skin wheal by slowly injecting approximately 0.5 cc of anesthetic into the area. (Note: To all the trigger fingers out there, refrain from turning the injection into a Nascar race. Rapid injection produces painful swelling of the tissues.)

7. Redirect the needle within the wheal if needed. Once the first wheal is created, you can always redirect the needle within it towards a different direction and add an additional 1 cc of local into the dermis. If needing to re-enter the skin for further injections, try to re-enter a site that is already blanched or part of the wheel you made previously. This will prevent further pain, because you will be entering a site that is more likely to be numb.

8. Go get a hamburger. Enjoy a good movie. No, just kidding, but you can afford to wait a couple minutes for the anesthetic to take affect. A good injection will leave a thick wheal line around the edges of the wound and take into account its depth.

9. Gently poke the wound area that you intend to suture with a sterile needle (you can use the one you injected them with). Now, this doesn't mean go for the gold and poke 'em like you mean it. Gently means gently.

The patient should feel pressure but nothing sharp. If they feel something sharp, one they may slug you; and two, you need to add more local to the area.

Anyway, I promised you that I would discuss lidocaine. Truthfully, I thought about running to South America before giving the lidocaine interview, but alas, the border patrol saw I was an Amercan with out papers and I got deported. :)

Lidocaine vs. Bupivicaine

This is the "Tastes great. Less filling" debate of wound care. You may see the anesthetic protests and WWF smackdowns at a local hospital if you are lucky. I think I saw a surgeon take out an ER doc over this once.

These two are the most commonly used local anesthetics. Lidocaine being the very most common. In fact, it is widely used for the majority of cases, but Bupivicaine is used in situations that needed a longer duration of coverage. Those type of situations generally involve complex wounds that would require a greater amount of time to close.

I have been known to make a Lidocaine-Bupivicaine cocktail. Mix in a little epinephrine and some Sodium Bicarbonate and my patients love it. Shaken not stirred.

Lidocaine with epinephrine (the most popular, kind of like the Homecoming Queen of anesthetics) generally lasts 2-6 hours.

Bupivacaine (Marcaine) with epinephrine generally lasts anywhere from 3 hours to 7 hours.

Note: if you want to be nice to your patient and you have it on stock, add some Sodium bicarbonate to the mixture. You just draw enough Sodium bicarb to cause the clear solution to turn cloudy. That is the chemical reaction of the Sodium bicarb neutralizing the acidity of the anesthetic, thus relieving the burning sensation of the acidic local.

So, let's take the ' why epinephrine?' quiz:

Why do you want to include epinephrine?

A. Because the pharmaceutical companies told you so.

B. It blanches the skin, helping you to better identify which areas that have been numbed.

C. Because it decreases bleeding. Nothing says, blood go away like epinephrine.

D. It increases the maximum dose of local you can apply to the area. It vasoconstricts blood vessels thus preventing systemic absorption of the anesthetic.

E. All of the above.

F. B,C, D and forget about A

The answer is F. Sorry to all those that chose A. I know, you were tempted to break down the pharmaceutical company doors for forcing you to add epinephrine to local anesthetics, but we must refrain.

When considering whether or not to use a mixture with epinephrine in it, please remember one important rule:

Epinephrine should NEVER be used in the following areas: Ears, Nose, Fingers, Toes and male anatomical parts.


Top Five reasons why you don't want systemic absorption of lidocaine:

1. Wastes lidocaine. Hello, you're in the middle of a disaster. Is the pharmacy going to be open. ;)

2. Aliens don't approve.

3. Your mother told you not to.

4. Because the cows might attack. Udderly terrifying. (Image taken from http://www.robmillard.com/archives/cat-off-the-wall-insights.html)

5. Lidocaine is used to treat disturbances in heart rhythms and can stop a normal working heart.

I don't know, I think number 4 is the most important. ;) Those cows can be dangerous.

Interestingly enough, lidocaine decreases the sensitivity of cardiac muscle to electrical impulses. No. We don't want insensitive hearts. We need sensitive hearts to cry, to love, and to live.

Lidocaine acts by slowing the conduction of electrical signals within heart muscle. Thus, it helps restore the heart's rhythm in conditions such as irregular and incresed contraction of the ventricles (ventricular tachyarrhythmias). (please see http://www.netdoctor.co.uk/medicines/100001501.html for more information on lidocaine and heart arrythmias, and also http://en.wikipedia.org/wiki/Lidocaine)


Here are a few good sites providing more information on anesthetics:

Local Anesthetic

How Anesthetics work and their History

Why you shouldn't go Butt-crazy in administering local anesthetics


The following are some really great videos further explaining the administration of local into a wound as well as the basics of suturing. Yes, I'm being lazy. If there is a good video out on the subject, why should I have to write it? Besides, the aliens say no more writing until the mind probe is activated.

So until next time. TTFN.


Injecting a local anesthetic into a wound:



Basic Suture Technique:



Suture Technique Part 2

Saturday, March 20, 2010

There is More Than One Way To Sterilize a Wound

I know. I know. If I steer away from the beloved alcohol post, you won't be able to enjoy the bitter beer face anymore. Don't cry, moving on is an important part of life.

Yes, the sensational appeal of an old scary man bringing his bottom lip up high enough to swallow his whole head just brings tears to our eyes, but... No more beer for you! ;)

Since, alcohol is such a volatile substance to be pouring on any wound, I'm going to move to more gentler and practical means of sterilizing and cleaning wounds.

Cleaning wounds:

Everyone loves having their wounds cleaned, especially when we have to take a wire scrubbing brush to them just to clean out the debris and dirt.

In a different post, I will discuss the need for analgesics and the favorite question of how to administer lidocaine. Although, if you were wondering, it would be good to have 1% Lidocaine and topical Lidocaine gel in your trauma kit. Otherwise, your patient, if they are still conscious when you start messing with their wound is going to beat you like a red-headed stepchild in a drunk family.

So moving on to wound irrigation and cleaning. I, personally have a dozen lactate ringers, three dozen normal salines, and a bunch of contact lens cleaner (works just as good) in my personal kit for wound irrigation. But I like irrigating wounds, it's fun to watch big chunks of crap fly out an open wound to hit your assistant.

Rule one of proper wound irrigation: Aim the irrigation so that it sprays and hits your partner. It never gets old.

Tap water also can be used to clean a wound as long as there has been no earthquake or radiation in the area. Tap water is obviously not as good as sterile saline, but oh, well... if you're not a wound cleaning junkie like me, then you might not have the solutions on hand.

But just for the heck of it, a good home solution for wound cleaning is tap water and Johnson & Johnson Baby Shampoo.

People always ask me about Hydrogen Peroxide (H2O2) in connection with it being an antiseptic, because they see it a lot be mixed with water and used to flush out some wounds, especially things within the ear. It's a good cleaner, just as water is a good cleaner.

Yet, unfortunately, H2O2 isn't that great as an antiseptic, because it has only minimal bactericidal effects, especially the dilutions of less than 3%, but it does make cleaning the infection funner... ahem, I meant easier.

Ever wondered why hydrogen peroxide foams: Cells contain an enzyme known as catalase, which floats around in wounds and also many bacteria are catalase formers. When catalase and peroxide come in contact with each other, they react to form water (H2O) and Oxygen (O2). The bubbles that you see are oxygen being released from the liquid.

A good way to test this is to put hydrogen peroxide on a cut potato. Cut potatoes are rich in catalse.

So all in all, it really doesn't do jack, but watching it bubble makes us feel better.

So you clean the wound by hosing it down with enough saline to hydrate a dehydrated camel (yes, they too can get dehydrated), and remove all of the debris.

Anyway back to the real reason why I wrote this post: Antiseptics.

There are many great antiseptics out on the market today, most of which have been tried and tested in clinical studies.

According to the Wound Health Society, the best antiseptics would be Chlorhexidine, Cadexomer iodine, Ethacridine Lactate, Polyhexanide, and Betadine (which is 10% Provodine Iodine).

I prefer Cadexomer then Chlorhexidine then Ethacridine (for topical wounds) and Polyhexanide (name brand is Pronotosan, and is good for wound cleansing). The effects of betadine are not lasting and it has to be applied without re-introducing more bacteria to the area. (Note: On the other hand, the shelf life of betadine is one of the longest.)

I want to add to this list also a gentle antiseptic benzethonium chloride which is a great antibacterial solution for children that can be also used as a hand sanitizer. (Note: alcohol based hand sanitizers can be used as well for would disinfection, but like the regular alcohol: they will burn like a Biggest Loser workout.)

Benzethonium Chloride can be found in products from a company called Pureworks. www.buypureworks.com.

On the natural end of things, I would say 10% Calendula officinalis (pot marigold) and Manuka Honey.

Here are a couple links scientifically comparing many of the different types of antiseptics and wound treatments, just for the fun of it:


Antiseptics on Wounds, Part 1

Antiseptics on Wounds, Part 2


Emerging Treatments in Diabetic Wound Care


What? You thought I would write more? Eh, I'm being lazy today.

But I will leave you with this wonderful add put out by some very well meaning individuals. Enjoy:




Sunday, March 7, 2010

To Booze or Not To Booze: Alcohol as an Antiseptic


Disclaimer: I am not promoting the drinking of alcohol: I personally think it is devil's urine. The stuff eats through livers like the government does tax payer dollars. (Image taken from: myrightword.blogspot.com)

Yet, there have been many questions concerning alcohol being used as a wound antiseptic. So, I thought this might be a good subject to post on. (To all my American Preppers followers, I have already posted the majority of this under the Little Doc section).

Myth Busters: Alcohol and Wounds

There are better forms of disinfection than cracking out a cocktail, but to some extent, it is true that certain liquors do in fact treat wound infections. They burn like a monkey beating, but they do work. (Image taken from: Closebutsofar.com).

It is true, there have been actual cases where men have been mauled and bitten by wild animals, such as bears, and icing them with Toddy saved their lives. So it is definitely not a myth that spirits saves lives.

[Man, can you believe this kung-fu-monkey kicking the crap out of that guy? It's seriously giving him a Jackie Chan smackdown. Like a Chuck Norris chimp kind of thing.

So, I'm assuming that the guy might have needed some antiseptic after that punk-slapping.]

Anyway, while in the field and there is no other source of disinfectant available, liquor is a great alternative to field water. Granted, your buddy will want to kill you as you pour that firewater on his open wound, but think on the bright side... he's injured and you can run faster.

There is one problem though. Alcohol can, unfortunately, work too well and cause tissue damage due to its ability to penetrate and lyse cells. Hence, the reason for its effectiveness against bacteria.

You pour moonshine on an open wound... bye bye bacteria, but also many good cells go down with it. It's like Rambo saying, "I'm taking you all down! And your little dog too!"


The 'Proof' is in the Pudding.

Anyway, on a more scientific note, it is the alcohol content that determines the hooch's antiseptic abilities.

When you see an old drunk in a western movie down some diesel fuel and make a face like he's dying. Then he chokes out a barely audible gasp with satisfied smile, "Now, that's the good stuff." You know he's talking about at least 35% alcohol by volume (ABV) or 70% proof. See and you thought old westerns weren't scientific.

And that type of liquor is the "good stuff"

In order to cleanse a wound, the drink must be at least 35% alcohol (ETOH) or it's disinfecting capabilities are practically nil. Not at least 35% ABV then you might as well pour apple juice on the wound.

Anyway, let's see how some sauce's measure up:

Beer 3-12% ABV. Sorry guys, your beer isn't worth Jack.

Wine 9-16% ABV. Ladies, the romantic films where the woman pours a bottle of wine on her dying hero's wound to save his life, are liars! Woman pours wine. The bacteria remain and cause sepsis. Hero dies, end of story.

Next!

Fortified wines. (aka port, madeira, sherry, etc.) 15.5-20% ABV. Only good for cooking.
Brandy 36-60% ABV. Brandy does well against infections.

Pure vanilla extract. The poor man's ponto. >35% ABV. What do you know! You can totally sterilize a wound and smell like vanilla at the same time.

Vodka. I understand the Nazi German's used this substance to turn Russian prisoners into human flame throwers. Yikes.

Is it potent crap? Rating in at 32-80% ABV, yes it is! (Pure Russian brands coming in at closer to 80%... Go Russians, they can sterilize wounds and kill livers at the same time.

Rum and Gin 40-80% ABV.

Whisky. 40-55% ABV. Like you were expecting Whisky to score lower.

Raki. 42-86% ABV. I have never heard of this paint before. I wonder if it is related to Saki, on it's mother's side?

Poten. 60-95% ABV. I love this one's name, especially because it is one of the most potent.

Neutral grain spirit or moonshine 95% ABV. We have a winner. That's practically ethyl alcohol! It might as well be sold in the pharmacy section of Walmart with a sign on it saying, "Moonshine, it's medical grade."

So now all you have to do is open up moonshine businesses in your back yards and when the cops come to bust you, you can tell them that you're running a medical supplies company specializing in antiseptics.

One more word of warning: Do NOT drink and clean wounds at the same time. None of that: "One for the wound, one drink for me. One shot for the wound, two shots for me." Not good. Bad idea.

And remember, "Friends don't let friends drink and do wound care."

The next post will be about better and more appropriate wound antiseptics. TTFN

Here is the site of today:

General Wound care

Just for he heck of it, here are a few more monkey pictures, from zomporo.com and everydaynodayoff.com.

This one is just too funny. Scary, but funny. I think this monkey was ripping the guy a new one one about wound care and booze.



And I couldn't help, but go "awww how cute!" when seeing this picture from EverydayNoDayOff.com.



Thursday, March 4, 2010

Superglue: It Burns Us! It Burns Us!

It is amazing how mankind strives for the unattainable treasure, works for the impossible dream, labors to overcome all obstacles... Wait, who am I kidding, we look for the easy way out.

It's all about convenience. Heck everything has a drive through nowadays. Fast food, pharmacies, grocery stores, weddings in Vegas. Yeah, it's true: you don't even have to get out of your car to say your "I do"s. See: Convenient.

It all started back when some misguided, drunk aliens crash landed their UFOs on Earth and mixed their genes within society, creating a techno-savvy but lazy generation that doesn't care about the consequences as long as the effort is minimal and the execution is fast. ;) It also explains why a vast majority of people drink enough alcohol to kill their livers, but that's another story.

Don't worry: the well-paid government scientists in Area 51 are working hard to this day to find a cure for the laziness gene. Unfortunately their efforts are thwarted by undercover aliens who created the Clapper, remote controls, those reaching sticks with the pinchers on the end, and superglue.

And as we all well know: the easy way is not always is the best way.

Fast food. Result: Coronary artery Disease.

The Clapper. Result: A bigger pant size and annoyed spouses.

That hot dog stand on the side of the road. Result: A bacteria so vicious that it beats your insides with a mace.

Superglue. Result: A myth about its use in wound care.

The highly classified alien project superglue leaked out of Area 51 because some punk paid off a guard, and the glue landed in the hands of medical personnel in the Vietnam War.

Medic 1: "Now that's a biggin'! I don't want to suture wound. What about you, Bob?"

Medic 2: "Nope, too much work. Heck, with all the gunfire raining down over our heads, who has the time. But, look I've got some alien superglue."

Hence the discovery of superglue for wounds.

Seriously though, during the Vietnam war, medics did find that superglue was made of a substance called Cyanoacrylate, which made a great wound adhesive. When the substance comes in contact with liquids, it forms a plastic mesh, thus sealing off wounds.

Now, I can really see the benefit of sealing up a wound at lightning speed, especially when bullets and mortars are your surgical background music. But over a time, they discovered that superglue had some side effects and decided that it shouldn't be used all the time. Unfrotunately, the rest of society are struggling with the lazy gene and believe superglue is good for everything.

When it comes to wound care, my little three year old niece believes that the only cure to anything is to put a band-aid on it. You scrape your knee; put a band-aid on it. You bump your head; put a band-aid on it. You fall down the stairs; put a band-aid on it. You knock your car bumper off by hitting that trash can that came out of nowhere; put a band-aid on it.

And now, superglue has become the 21st century prepper's* version of the "band-aid." I don't think I have heard of a disaster preparedness kit yet, that doesn't have superglue in it attached to the belief that one can put superglue on pretty much any type of wound that needs suturing.

I hate being a myth buster. I love myths. The myth about a dorky nerd flying on Pegasus to chop the head off a chick so ugly that looking at her turns you to stone is a great myth... that I can believe. But the myth about superglue being a great wound adhesive is just going too far.

The superglues out on the market today also contain a chemical called methyl alcohol, which releases energy in the form of heat during the formation of the adhesive. Therefore, because of this exothermic reaction, the good periwound tissue receives a chemical burn that destroys the granulation buds, thus preventing correct wound healing.

I figure this is what happened when Golum started screaming, "It burns us! It burns us!"

What you didn't see was that in a earlier edited scene Golum fell on his buck-naked butt, getting a wound the size of Gibraltor on his scrawny cheek.

Then a wise guy said, "Let's put superglue on it." That's when you see Golum running around, "It burns us! It burns us!" It's in the unofficial director's cut.

To prevent this chemical burn a medical grade superglue (tissue glue) that it is also a form of cyanoacrylate has been developed. This glue has no exothermic reaction and has added ingredients possessing bacteriocidal effects, such as either butyl, octyl, or isobutyl derivatives.

Now, I'm not saying that you have to dig through your gia-normous, end of the world trauma kit and throw out your superglue. You can still use it, if you don't mind the burning sensation...

Provided you follow a few simple rules:

NEVER use superglue on a wound that is deep into the body... seriously bad idea to chemical burn deep tissue. Healing will be delayed on a whole new level.
Don't glue your finger to your patient. That's not good in the wilderness. It can be laughed at in the hospital, but in the wilderness, you might end up pulling a Coyote Ugly.

The Minor Leagues are better. If you are going to use superglue to close a wound, you should probably use it on a minor wound that is straight and of which the skin flaps easily close back together.

Well, I better end my blogging for today. TTFN.

If you have any further questions, please feel free to email me or post a comment.

*Prepper: Person involved in preparedness.


Friday, February 26, 2010

Blood, Guts, and No Worries: Woundcare in the Wild

In the event of a zombie attack... wait, oh, that's right, there are no zombies attacking these days. Just the Taliban. ;) Seriously though, have you noticed that there are a good number of zombie attack preparedness sites out there in blogger space?

I mean come on ...they're slow and falling apart like my uncle's Chevy. That thing can't even get out of the driveway without losing it's oil pan. I'd be more afraid if there was an attack of rabid old people: they have canes. And they can spit their dentures out at you from a mile away. Think about it, their walkers scraping the ground as they stalk towards you, mole hairs waving in the wind. Some carrying rolling pins, shouting, "In my day we didn't have internet!" Now that's scary.

But whatever slow moving decrepit thing, whether it be zombies or rabid fossils, is attacking in the apocalypse, you need to prepared. Dude, but if you can't out run either of them, you deserve getting bit.

Now I can't train you to fight off a zombie, but I can teach you how to handle wound care in the wilderness. I can't tell you how happy I am to finally get to the wound care series of these posts.

I couldn't wait to post this so much that I have already posted some of this on a wonderful site, called American preppers. So to all my Preppers buddies: Sorry for the repeat.


First Aid on the Frontline

In all medical situations, even those within the hospital setting, any medical professional must act according to a certain order of important principles because of their lifesaving nature.... the ABCs.

A - Airway
B - Breathing

C - Circulation

D - Disability


Airway: Basically, you make sure that they have an open trachea (windpipe) or an open way to breathe. No open airway: No way they can breathe. (Image taken from: California White Water Rafting and First Aid. This is a site specializing in training wilderness medicine hands-on.)

Breathing: You look, listen, and feel for their breathing. This is also where rescue breathing comes in. Give two breaths. Refer to Rescue Breathing Video.

Circulation: The bleeding. Here is where you treat the wounds. You wait until you know that they have an open airway and are breathing before even attempting to take care of their bleeding.

Handling their airway and breathing can be quite simple in many circumstances. If they are screaming, talking, complaining, or swearing at you like they're a drunken sailor than they have an open airway and they are breathing. See. Simple.

Disability: This step is where you check to see if they can move all four extremities and splint broken bones. If they are waving a bird at you, then they can move that extremity.

Now for the good stuff...


Blood, Guts, and Gore...

Okay, so only a little blood, no guts, and well, the gore is up to your perspective.

When faced with wounds, there are a few goals that you need to focus on, especially out in the boonies.

1. Control the Bleeding: The whole point of the Circulation portion of the ABCs.
2. Clean the wound and prevent infection

3. Reduce discomfort and promote healing

4. Minimize the loss of function
(we're dipping into the disability stage here, but still we need to mention it.)
5. Perform correct care and transport of patient


Before I get into the nuances of wound care, I would like to stress here that you need to attempt some form of body-substance-isolation (BSI) first. BSI is a full body cover-up kit. And I seriously doubt that any of you are carrying a surgeon's gown mask, and surgeon's gloves in your backpack. So let's make one with stuff you might be already wearing.

Eye cover: Ski goggles or sunglasses or even regular glasses (not as great as those ski goggles, but hey, it's coverage).

Gloves: Any water barrier gloves or barrier material, such as those Ziploc sandwich bags your PBJ is sitting in, or the plastic grocery bag that you are carrying to put your trash in.

Body cover: Because some of these wounds can make Old Faithful look like a weak geyser. Parka. Ski Jacket. Big garbage bag with holes for arms. Or that "Kiss the Cook" apron works too.

Alright, you're covered up and you throw a tarp down for your poor bleeding patient to lay on.

Now you're ready to deal with the Slasher flick before you.

CONTROL BLEEDING


How do we control bleeding?
Pressure. Pressure. Pressure.

Literally, you apply pressure to the wound. Get your gloves in there, if you don't have gauze, and apply some direct pressure to the wound. (Be one with the oozing wound... Ohmmmm).

Direct pressure, elevation of the body part, and packing with a moist sterile dressing or clean cloth (if sterile is unavailable) will stop most hemorrhaging.

I, personally, like to add to my wilderness kit a little hemostatic qauze or agents like Celox, Gelfoam, Surgicel, or Jello (non-sterile)... there's always room for Jello. These speed up the clotting process considerably.

Stop the bleeding and pad with sterile gauze or clean cloth... or you could even use one of your Ziploc sandwich bags minus the PBJ to dress the wound... than affix it with roller gauze, surgical tape, or that duct tape that you know you tie around your ski poles or walking sticks. Duct tape is your friend.

CLEAN WOUND AND PREVENT INFECTION


Irrigation is more than just a farming tool.
Basically, you take sterile water and spritz down the wound, washing debris, soil, foreign bodies, etc from the wound. Well, you forgot to shove that liter of sterile fluid in your backpack, but you do have your sports water bottle or canteen.

Remember your goggles... they come in handy right at this point. You spritz them, they spritz back.

In situations where you don't have irrigation available, use a ziploc bag filled with clean water, put a pin-sized hole in it, and spray the wound clean.

Visible debris can be removed with sterile forceps or if you don't have them, tweezers dipped in alcohol.

You know, also contact eye solution can be used to irrigate a wound. Not only is it a clean isotonic solution, but it also has some minor elements of bacteriocides within it.

You can use honey or sugar as a natural antiseptic. Except with the honey, avoid putting the honey on the good intact skin, just put it in the wound then cover it with a sterile or clean dressing. With the sugar, just pour it in. Your patients will say that you're sweet for treating them so wonderfully. I will discuss the benefits of honey later in a different post.

REDUCE DISCOMFORT


There's more to do than just knock them out with a tree log.

Stabilize the extremity with the wound. Strips of duct tape can be used to close a wound in place of steri-strips if you don't have them on hand. Dermabound and its non-sterile cousin, tissue glue can work as well. Be careful with super glue... it can cause chemical burns. (I will discuss superglue in a different post.)

PERFORM CORRECT CARE AND TRANSPORT


Lastly, if it's wounded, get rid of it.
No, you don't shoot them... although there are some whiners out there that might tempt you to do so.

Seriously, if a person has been wounded, evacuate them. They need to get proper medical care.

The following is a list of "wound" situations where evacuation of the patient should be as rapid as possible:

-Infected wounds, deep penetrating wounds, impaled objects, wounds with ligaments, joints, tendons, or bones exposed

-Animal or human bites. (Yes, human bites can happen. Some people get awful hungry in the wilderness.)

-Severe blood loss

Next time, we will talk about using natural antiseptics.

TTFN.

If you have any further questions, feel free to email me or post a comment and I will get back to you as soon as I can.

(UPDATE: I do want to thank a reader that has enlightened me on my typos. Remind me never to speed through a blog without grammar checking it first. ;).

Also, I have been informed that there are an epidemic of "fast zombies"... I would have thought those were medical students rushing of campus after a week of exams, but apparently, there are other types of fast zombies.

I would like to express my appreciation for the reader that helped me realize all this. Thank you :). )

Thursday, February 25, 2010

Don't Know Jack Forst: How to Handle Hypothermia

You know I have been debating whether or not to write more about hypothermia. It has no guts, no glory, no raving zombies you have to fight off. It is just Jack Frost taking a chunk out of your hiney then calling it a day. What kind of criminal locks a person in a refrigerator and just leaves whistling like Frosty the Snowman? The boring kind, that's who.

See that's why I like writing about wilderness wound care. Because no bear smacks you upside the head then leaves; they finish you off. Then gnaw on you for a few more days. Now, that's civil.

But mean old Jack, he just sits there on his cold-hearted balloon-knot and blows frosty mist in your face. But we, weak, mortal non-mutated humans tremble under his ice cold breath. (We shiver.) Then being the rough and tough rumbler John Wayne-wannabees, we still get in Jack's face and say, "You want a peice of me, you icy beast-ard!" (We get irritable.)

And of course, we dance around like Mohammid Ali with butterflies in our pants. By this time we're looking like insane bunnies on crack. (We start to get an altered mental status.) Jack just sits there and yawns. He's got all winter. But sooner or later Jack tires of us and gives us the cold shoulder, so we freeze into a human-sicles, and he leaves. (That's when spring comes and some park ranger finds a defrosting human-sicle in the wilderness.) That's it. Where's the excitement in that?

So, I thought long and hard about this, contemplating the universe without zombies but instead with frost bite. Yes, the debate was heartfelt. It lasted all of but three seconds. So here I am writing more on hypothermia.

The Three Stages of Defeat:

When God created Adam and Eve, and they were naked in the Garden of Eden... God make heck of sure that the temperature was an ambient 72-74 degrees fahrenheit, otherwise we would have had two frostbitten first parents. The human body is designed to handle moderate temperatures being bare-buck-naked, and Heavenly Father knew that. Life was paradise before that nappy serpent introduced the forbidden fruit. Stupid snake.

Now, being in the lone and dreary world, we have to bundle up or our core body temperature drops fast... because not every day is going to be paradise. (If you're in medical school, than no day is paradise... because you're living in a literal hell. ;).)

Mild Hypothermia

This starts when the body's core temperature drops below 95 degrees fahrenheit (35 degrees Celsius), but is still above 90 degrees.

This is where we start shivering, our extremities become numb, and we experience a reduction in manual dexterity. Remember the last post: 'drop of 1 degree Celsius' and we turn into 'mean drunks'? Well, here we are. Mean shivering drunks. Complex skills become difficult. We become tired, can't throw a snowball to save our lives, and forget about cooperating with anything or anyone.

Here's a mnemonic device developed by Giesbrecht and Wilkerson in their book, "Hypothermia, Frostbite, and Other Cold Injuries":

Fumbles
Stumbles
Tumbles
Mumbles
Grumbles

Moderate Hypothermia

This is the stage that happens when either we are kidnapped by the abominable snowman to be his snowbride and can't get away, or we are too irritable and argumentative to listen to our friends about going inside somewhere warm.

The core body temperature drops below 90 degrees Fahrenheit (32 degrees Celsius), yet is still above 82 degrees.

The signs and symptoms are as follows:

Violent shivering to No Shivering (the shivering is progressively inhibited until it stops)
Loss of muscle control
Loss of ability to make rational decisions

(I know what you're thinking: there are some people out there that are so irrational that they must be hypothermic in 120 degree weather. Those people don't count. They would already have been eaten by abominable snowman for irritating him.)

Staggering Gait
Profoundly altered mental status
(Think a fifth of vodka and a billy club to the head)
Apathetic attitude
Urinate in Clothing
Paradoxical Undressing (You might get a strip show)
Finally, consciousness will be lost

The line between moderate and severe hypothermia gets blurred.

You know what, all this talk about cold and hypothermia made me want to make myself some hot chocolate... well, actually, hot vanilla, because I am allergic to the cocoa plant. Since I like my drinks robust, I got this hazelnut flavoring product just to add more calories.

After putting two tablespoons of it in my drink, I noticed on the side of the hazelnut powder a warning label that says: 'Warning: Don't store near open flame. May combust.' And I thought to myself: It may combust, but we can still eat it. How is that supposed to be healthy?

Then I suddenly remembered as I almost burnt my tongue on the hot vanilla that hot beverages can give you esophageal cancer. Yes, while studying for the board exams, I discovered that fact. So I added whip cream to it. Mmmmm, extra calories. But they're cold calories so they combat the esophageal cancer.

So here's to spontaneous combustion and esophageal cancer. Bottoms up. Mmm... hazelnut-chemical-induced-hot vanilla-water-that-has-been-nuked-in-a-microwave. Yummy!

Severe Hypothermia: Human Popsicle

Core temperature below 82 degrees fahrenheit. At this point, the heart is at risk of going into ventricular fibrillation.

Loss of Consciousness
Pupils fixed and dilated
Rigid and unresponsive
Can't feel their pulses
No respirations
Not yet dead

Here's a deal in prehospital medicine: The person is not dead until they are warm and dead. So here you have two EMTs debating whether or not the caveman trapped in a block of ice was still alive or not.

Treatment of Hypothermia: Handle with care

Let me put it this: manhandling a hypothermic patient is a very bad thing. You rustle them too much, you can cause them to have a heart attack.

1. Remove the patient from the cold and keep them laying down.

2. Remove wet and/or constrictive clothing. Constrictive clothing, especially boots, should be removed to reduce the risk of frostbite.

3. Wrap them in warm/insulating layers. Preferably two layers or more. (Protect the insulation from getting wet as well.) No water for you! [Note: Fabrics such as fleece, wool, or polyesters, actually retain their insulating capabilities, even when wet.]

Insulate from snow, ground, wind, etc. If it's cold, keep it out.

4. Add a vapor barrier to eliminate evaporation. Saran wrap. Just kidding, but a water barrier such as a space blanket would work.

5. A fire should be built with a reflective surface behind it to direct the heat at the victim. I'm thinking a mirror or a log with aluminum foil over it.

Keep in mind that a fire itself does not effectively rewarm a hypothermic patient. And whatever you do, don't put them to close to the fire. You're trying to rewarm them, not flambe them.

If Mild Hyperthermia:

6. Give the patient warm high-energy drinks like my hazelnut-combustible-hot-vanilla-nuked-water. No alcohol. Chicken noodle soup works as well.

(Warning: before you start shoving liquids and food down the patient, make sure they can swallow without choking.)

7. Use external heat sources. Preferably in their armpits and on their chest.

Don't rub their extremities! Rubbing them sends cold blood back to their heart and actually lowers their core body temperature.

Heat sources can include: hot water bottles, warming blankets, blow by heaters, and/or chemical or charcoal heat packs. Don't apply the heat sources directly to their skin, but over thin layer of cloth.


If Moderate-Severe Hypothermia: Think slow cooking.

Field warming can be a very slow process. Just check your turkey thermometer every hour... 24 hours or more may be needed in order to rewarm them.

8. All of the above. Except don't give an unconscious patient drinks.

Don't use hot water or a heating pad on them. Instead apply warm compresses to their neck, chest wall, armpits, and groin.

And cut off their wet/constrictive clothing to avoid moving them too much.

9. Add warm and humidified oxygen.

I know what you are thinking: You're out in the wild, where would you get an oxygen tank. So if one is not present, don't think that you have to sit there and blow in their face.

This is not a major means of warming the patient.

10. DO NOT immediately initiate chest compressions in a moderately-severely hypothermic patient with no pulse. First, do rescue breathing for three minutes, then take another sixty seconds to assess their pulse.

CPR should only be preformed if there are no signs of life present in the victim.


If you have anymore questions concerning hypothermia and its treatment, please feel free to email me.

Saturday, January 23, 2010

Hypothermia: Jack Frost's idea of a Sick Joke, the Beastard

The start of 2010 brings with it streamers, noisemakers, happy people singing, and a busload of freaking-cold weather.

We look outside and see that pretty white stuff glistening in what could barely be deemed sunshine, and we think, 'wow, it would be so much fun just to roll around in that making angel figures because I want to freeze my butt off.'

See that's what the snow wants you to think. It's sending out subliminal messages: "Play in me, I'm soft and fluffy. You'll love it. Don't mind the frozen extremities; they'll grow back." It's evil, I tell you. Pure evil!

So, knowing this, you do what any sane person would do: You take the sled out with the kids and get completely iced over. At the same time, Jack Frost is waiting out there, stalking your noses like a polar bear does a herd of seals.

In a perfect world, we'd have built in heating pads. Okay in a perfect world, we'd all have killer bodies and own mansions. But we're not in a perfect world: we're in a world of chapped lips, runny noses, and frostbite. Yes, as you can see, I am a-cup-is-half-full-kind-of-girl. The chapped lips thing is making me bitter. ;)

I'm going to plug a very good book at this point, and the sad thing is that the authors aren't paying me a lick of doe for it. I know, I know, you're feeling great sympathy for my plight. Thank you, I appreciate every tear on my behalf. :)

In all seriousness, Hypothermia, Frostbite, and Other Cold Injuries: Prevention, Survival, Rescue, and Treatment by Gordon G. Giesbrecht, Ph.D. and James A. Wilkerson, M.D. (www.mountaineersbooks.org) is a very good book for this time of year, especially if you have children.

My brother has seven kids, which includes two sets of twins. Can you ever imagine wrangling two 2 years and two infant babies at the same time? He and his wife have got their hands full. One afternoon their eight year old girl came home crying of her feet being so cold they were numb. So as any knowing parent would, my brother said, "Well, if your toes fall off, you'll remember that I told you to come straight home and not to play out in the snow."

Let's talk about numb toes and red noses, or in other words, hypothermia: The cold's and water's evil love-child.

Just in case you were wondering: "Hypo" means under and "thermia" is Greek for heat or temperature. (I feel like that father on My Big Fat Greek Wedding; "Show me a word, any word and I will show you the Greek root of the word.")

Hypothermia occurs when the body's core temperature drops below 35 degrees Celsius or 95 degrees Fahrenheit. That's not a lot of leeway considering the normal human body temperature is around 37 degrees C (98.5 degrees F).

You see our bodies are stubborn: they hate change. Any change and they decide to shut down. It's like some sort of mutiny. "You wanna drop my temp a couple of degrees, huh? Well, I'll show you!" It's like a living Union.

Truth be told, in acclimated populations, the human physiology has incredible mechanisms that tolerate severe cold. For instance, the aboriginals of Australia can easily sleep on frozen ground without shivering. (See Giesbrecht and Wikerson's book) The women of Tiera del Fuego can breast feed during a blizzard without discomfort. Inuit men can easily work with their bare hands in sub-freezing temperatures for extended periods of time. Well, good for them. Let's give them a medal. As for the rest of us, we have a hard time adjusting to falling temperatures. Hence, we develop hypothermia

The worst part about it is that we are bull-headed enough that during the first stage of hypothermia that we deny the fact that we even are cold. Then we get irritable if anyone dares suggest that we bundle up or put on gloves. Yes, it's true. One good dose of hypothermia and we become like the Exorcist. Our heads start spinning, and we smack-talk to anyone trying to help us.

For instance, just the drop of 1 degree C in core temperature causes impaired judgment and slows our reaction time by half. If our temperature falls below 35 degrees C, then we lose the ability to make rational decisions. We become, well... like mean drunks. I can just see the TV ads now: "Friends don't let friends drive under the influence of hypothermia." Or the support groups: "My name is Joe and I am a hypothermic."

Temperature drops below 32 degrees and our only innate heating system of shivering stops. At that point, we are two steps away from laying down and becoming a human icicle.

Here's a question for all the parents out there: Who tends to get hypothermia worse, you or your kidlets? Unfortunately, the kidlets do. Actually, babies, children, and elderly are most at risk. But for the purposes of this post, we'll focus on children, since the elderly are more likely to stay indoors during this time of year. They don't seem to find the joy in freezing their butts off. Go figure.

Anyone remember the little brother on "A Christmas story" being bundled up to look like the Michelin man? Now that mother was smart, she knew about this kid-care fact. Forget about her child's social life, she prevented his hypothermia.

Okay, so maybe she went overboard. I mean really look at him, the boy looks like he can barely waddle. That's a sure ticket to getting your kid beat up. And then you'll have to deal with taking care of broken bones and bloody noses... but that is a totally different blog.

Now, we don't have to go to that much of an extreme. But we can take into consideration that the manifestations of hypothermia in children don't present in the same manner as in adults. Due to this fact, hypo- and hyperthermia are very common ailments in children.

All on their own, children are interesting little rug rats. Just like my brother's little girl, kids get so engrossed in playing that they tend to forget they even have bodies. Whereas an adult would say, "Heck with this, I'm cold. I'm going inside." A child would say, "What those are fingers turning into ice chunks? Who cares, just one more turn on the sled."

In addition to that, children lose heat more quickly than adults do, mostly through their head. And you wondered if they stored anything up there at all.

You know, I was studying the causes of hypothermia in children and one of the most common causes was alcohol ingestion.

Now, I just want to know: Who goes about giving alcohol to kids? "Hey, Billy, I know you are five, but I think it's high time that you start drinking if you want to fit into with the rest of Mickey's club house." What the heck?!

Granted, the ingestion of alcohol could be due to taking OTC cold medicines like Nyquil, but who in their right mind would send a kid with a head cold out and doped up on medicine into the snow?

(Just FYI, alcohol causes vasodilation of blood vessels, preventing the body's natural defense against hypothermia of shunting blood away from the extremities and skin.)

Anyway, I'll step off my soap box and get back to this post.

Other common reasons why children are more susceptible to getting hypothermia than adults:

*Children have smaller body masses, relative to their surface areas, leading to increased heat loss.

*Children have limited glycogen stores to support increased heat production in response to cold.

*Very young infants don't have the ability to increase body heat through shivering.

Also, once children develop hypothermia, they are less likely to turn into mean drunks like adults do, despite having more severe hypothermia.

The following is a list of things which you can do to prevent hypothermia when outdoors:

-Use a weatherproof outer layer. In sub-freezing temperatures, use a breathable nylon fabrics with an insulating layer of fiberfill like Lamilite.

-Avoid Cotton. Wool base layers are essential, and most importantly avoid wearing cotton under clothes.

-Don't over layer. When playing or working, people sweat. I know, I know: it's hard to believe, but the little sweat fairies wave their magic wands over your pits and boom! Beautiful, glistening, saline comes oozing out of your pores.

Now, what happens is that people get hot under too many layers while playing or working, so they sweat. Then, they unzip the layers and the sweat evaporates, cooling them down. They zip their layers back up. Yet, they still are damp underneath and thereby their core temperature drops even more, and pretty soon, they are hypothermics.

-Instead, layer when not active. When you are working or playing, wear only enough layers so that you're a little cold. When you sit down to rest, add on more layers. When you get back up to play, remove the extra layers.

-Items to Bring. Hat (extremely important). Gloves. Bandanna or hankerchief. Extra socks.

-Stay Dry. Don't get wet inside your clothes or outside your clothes.

-Eat high energy snacks. Snickers bars do come in handy. ;). Actually, eating things like granola and apples can help a lot.

Next time, the clinical manifestations of hypothermia will be discussed and how to treat it.



Here are the links of the day:

http://www.osteopathic.org/index.cfm?PageID=you_frostbite This link is for information on how to fight frostbite.

http://www.emergency.cdc.gov/disasters/winter/staysafe/hypothermia.asp

http://www.nia.nih.gov/HealthInformation/Publications/hypothermia.htm

http://www.outdoors.org/recreation/hiking/hiking-hypothermia.cfm

Thursday, January 21, 2010

Incoming: Eminent Delivery, Part 1

::::::WARNING: Due to the graphic nature of some of the images and videos of, there is some medical and anatomical details that may be not appropriate for children.:::::::::::

Then again, if you're a medical crazy person like me than you wouldn't mind your children learning this kind of stuff. (Image taken from www.babybumpdiaries.com)

Alright, here we go. Get out your full body armor, because we're about to take on blood bath.

Actually, the process of birth can be a quite beautiful thing. This is where women come as close to what it feels like bring life into this world. It's the great blessing from the Lord that allows us a chance to take part in creation. I say epidurals are great blessings too, but that's just me.

The first thing you must remember is to: STAY CALM and DON'T PANIC!

You may think it's funny, but I've seen grown men faint at the thought of their wives going into labor. You wouldn't beleive how many unconscious fathers that I have had to scrape up off the hospital floor.

The next thing to do is to get a birthing area set up. The area has to be level and flat, with lots of light and warmth. Believe it or not, but the baby, just after being born, is bare-butt-naked and wet. It's kind of like being a nudist in Florida and immediately being transported to the arctic circle for the little tikes.

Don on barrier gloves (preferably sterile), goggles, and gown.

Next take the chuk from your birthing kit, and place it under the mother's pelvis with the cotton-side up. remember cotton-side up.

When the mother looks at you like you're insane and yells, "What the heck are you doing?!" (Note: women in labor are less likely to censor their words.)

You can calmly say, "Don't worry, mam; I know what I'm doing: I read a blog."

Now as for the positioning of the mother, I have provided a video clip of a vaginal birth for you to have an idea of how things should be during the delivery.

Graphic Childbirth video



The following steps are to be considered during heavy labor:

1. Breathing. Yes you should breathe, but actually it is important to breathe. Have the mother take deep breaths, concentrating on her breathing when she is inbetween contractions.

2. Crowning. The baby's head appearing at the vaginal opening is known as crowning. At this point during contractions, instruct the mother to push, while two assistants push her bent knees back at her chest. (Having assistants push the mother's knees back towards her, opens up the mother's pelvis making delivery easier.) The mother should NOT push in between contractions.

Instruct the mother to take a deep breath and hold it for at least ten seconds while she pushes. The idea of pushing is similar to that of bearing down to go to the bathroom... I know the guys can relate to this one. They have their newspaper and spend hours bearing down.

Warning: because the mother is pushing, most times the baby is not all that is 'delivered', so don't be surprised if a bowel movement precedes the baby's delivery. Just place another chuk or towel over the feces and continue with the birth.

3. Assist the head. Place your hand against the area below the vaginal opening and gently apply pressure during each contraction.

I had an OB preceptor that liked to used his knuckle here and dig in hard, because he could get his knuckle under the baby's chin through the perineal tissue. But since emergent deliveries are natural (non-epidural) deliveries, I highly suggest that you gently place your palm there... that is, if you want to live.

4. Appearance of entire head. As the baby's head is being delivered, gently support it with your hands. The baby's head, in most deliveries will appear chin down, then as the body turns to reconstitute, so that the shoulders can deliver, the baby's head will then turn to the side.

As soon as the head is out, tell the mother to stop pushing. Because at this point, you need to clean out the baby's nose and mouth.

5. Cleaning out the mouth and nose. The bulb syringe in your kit is essential for this step. Suction out the baby's mouth then nose. Use a clean towel if no syringe is available. (Images and videos taken from: Bookside press)

video

6. Nuchal Cord. If the umbilical cord is wrapped around the baby's neck, DO NOT attempt to cut the cord. Instead, place a finger under the cord to slip it off over the head.

If the cord will not slip over the baby's head, keep a couple fingers bracing it from tightening further around the baby's neck during delivery.

Normally, OBs cut and clamp the cord, but it takes experience to be able to effectively perform it. So I would highly suggest avoiding cutting the cord at this point in the delivery.

7. Head is delivered. The rest of the body should deliver with ease. Some baby's are with such ease that they literally slip out, others have broader shoulders and take some work.

The upper shoulder should present first, help it along by guiding the baby's head downward while the mother pushes. Once the top shoulder has delivered, then help guide the baby's head up when the mother pushes. (And I seriously mean guide, not pull on.) Then the bottom shoulder will deliver and then all baby's pop out at this point. So be prepared to catch.

8. Baby is out. Wrap the baby in a clean, dry and preferably warm towel or blanket. The baby should cry. Then place the baby on the mother's stomach.

If the baby doesn't cry or isn't breathing, keep the baby at the level of the mother's vagina. Place the baby's head lower than its feet. Stimulate the baby by rubbing its back. If still not breathing, give two quick gentle puffs of air into the infant's nose and mouth.

(Further resuscitation measures, should be left for a different discussion.)

Once baby is crying and breathing, place baby on mother's stomach. Skin to skin is the best.

DO NOT pull on the umbilical cord.

9. Cutting the cord. There should be two plastic, sterile clamps in your OB kit, or two kelly clamps. If you don't have either available then tie a clean shoelace or thick string, firmly around the umbilical cord, no closer than 4 inches from the baby's navel. (DO NOT use thread: it will cut through the cord.)

Tie another shoelace or thick string a few inches away from the first tie towards the mother's side of the umbilical cord. Make sure that both ties are secure, then using a sterile pair of scissors or scalpel cut the cord in between the ties.
video

10. Placenta. The placenta normally delivers itself. Usually a gentle kneading on the mother's belly helps the process, but I am going to leave the details of delivering the placenta to the following video. As for after the placenta is delivered, place it in an airtight container to take to the hospital with the mother.

video

11. Clean up. Gently (and I mean GENTLY!!!) wipe the blood off the mother with gentle soap and water. (Baby shampoo is a very good form of soap for wounds.) Fill a thick, feminine napkin pad with a little ice and place over the vagina.

12. Get to the Hospital. If you cannot get to medical help at all, then keep both mom and baby dry and warm. Keep the mom hydrated and watch the both of them closely for signs of shock.

13. Now you can Relax. Well, either that or pass out, because you just delivered a baby.



Since there is so much material concerning emergency births, I was unable to cover it all. Please refer to the following sources for more information on emergent deliveries:

ParasolEMT.com

Babypartner

Planbaby.com

Healthopedia.com

AHealthyme.com