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.

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 :). )

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.

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

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)

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.

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.

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

Delivering Babies: So Grizzled

Delivering babies can be a grizzled job. How grizzled?

Let's just say that the field of Obstetrics (OB) is kind of a Wes Craven meets the Care Bears situation: Blood, guts, gore, and cute little baby butts.

So there's a very good reason why obstetricians prepare like nuclear fallout specialists to deliver a baby. They have to fend against an all-out military airstrike with the baby as the Drill Sergeant: "Alright you bodily substances, you better hit 'em with everything you've got! Darned, if they make me come out into the world! So bring on the rain!" Then hence starts the artillery.

During one of the last deliveries that I performed, the umbilical cord sought its revenge and sprayed my face like Old Faithful. It was not pretty; kind of like the aftermath of the movie Carrie. I think I heard the dad scream.

For instance, cesarean section yields enough blood to make a general surgeon cry, "oh mommy!", but then the OB doc pulls out a tiny baby buttocks out of the gaping abdominal wound and everyone in the room goes, "Ahhhhhh! Isn't that cute!"

Now, you are probably wondering, why I would bother to talk about baby butts in a disaster and wilderness medicine blog. But that's just the point, just like in the world of OB, anything can happen. And you just might find yourself needing to deliver a baby.

First, in this post I am going to discuss the things that you should have on hand in order to perform an emergent delivery. (Emergent delivery: if you are in a situation where in you can't contact 911 or are unable to get the laboring mother to a hospital in time.)

In the next post, I will describe how to perform an emergent delivery. This is not to replace the work of medical professionals, instead it is designed to help you handle an imminent situation where appropriate medical help can not be obtained. (Image obtained from www.lifemedicalsupplier.com.)

As for gear, many companies offer pre-made OB kits which you can purchase online, which I personally prefer, because I'm too lazy to make my own. Or you can purchase the products separately and build your own. Lazy way is better.


The following is a list of items that should be contained in any Ob kit:

*One pair or more of sterile exam gloves. These are the gloves that are generally worn by OB docs in order to perform sterile cervix exams. I suggest having more than one pair.

*One disposable plastic apron or surgical gown. I'd personally go with the surgical gown, more coverage. You know, from a disaster perspective, I would stock up on disposable surgical gowns, but that's just me and I am biased towards having more medical supplies.

*One 17" x 24" under pad. In the medical arena, we call these "chux pads". These are plastic on one side and cotton plush on the other. The closest thing out in grocery stores to them are puppy pads, but I wouldn't suggest using a puppy pad for delivering a baby.

*Disposable Absorbent Towels. I would stock up on these. They are good for any medical emergency dealing with body fluids.

*Biohazard bag. Again, good for any medical emergency where instruments can become contaminated with fluids.

*Plastic Drape sheet. Okay, I have to admit that lots of blood equals need for lots of plastic coverage, whether it be in the wilderness or in your home.

*One heavy duty feminine pad and Ice. I personally like the ones that you can either fill with ice or can open enough to shove ice in them. The ice helps alleviate the pain that occurs post-partum in the perineum. The pad itself absorbs the post-partum blood.

*At least Four Sterile 4 x 4" guaze sponges. Really, if you don't have these in your emergency medical kit already than you have a very poor quality kit.

*One Sterile Scalpel. Preferably a #10. (Image taken from www.canfsupply.com)

*One Sterile 2 oz bulb syringe. I think this should be in any emergency kit notwithstanding whether the kit is designed for baby delivery or not.

*Alcohol Prep pads. Okay, these are a must regardless.

*At least two Sterile Umbilical Cord Clamps. Or you can use Kelly Hemostats. (To sterilize the hemostats: Place hemostats in water that has been brought to rolling boil for at least 15 minutes. Note: water sterilization kills most bacteria and inactive viruses, but doesn't kill prions which are the cause of Bovine Spongiform Ecephalopathy [also known as Mad cow disease] or Creutzfeldt-Jakob disease. But most likely, you won't encounter Prions on clean medical equipment.) The sterile clamps are the cream colored plastic pieces seen in the picture.

If you are unable to obtain these things, or they are not on hand when an emergency birth takes place. Get out your boiling water, toss a sharp blade in and some shoelaces. Boil for 15 minutes.

In a later post, I will describe the different types of sterilization techniques.

Next time, we'll discuss how to perform an emergent delivery when birth is imminent and medical help is unavailable.

If you have any questions or comments, please feel free to email me at disaster_medicine@yahoo.com.

Until next post,

Christine

Pigs in Your Blanket: What to Do When H1N1 is in Your House

Alert! The swine flu has marched its coughing army of viral genetics into your safe haven... it has blown its way into your home.

The porky enemy has infiltrated your territory. The siege is over and the swine have broken through your defenses. Your walls are breached and your pants are down. There are piglet particles everywhere.

Some of your team have been compromised, maybe even your second-in-command (your spouse). What do you do? Are you going to give up? Are you going to throw in the towel and run out screaming, 'the piggies are coming, the piggies are coming'? No! Heck, no!

You are one tough mommy! You don't fall weak at the sight of puke and pustules. You are supermom or superdad. Your motto is: 'Never give up! Never surrender!' Okay, so that's the motto from Galaxy Quest, but you borrowed it and tattooed it on your buttock.

So now that you have built up the resolve to take down the enemy swine, what do you do next? You do what any normal military person would do, you hedge off the areas that have been compromised, tend to the wounded, and do your best to keep from becoming a military casualty yourself.

At this point in the war on H1N1, you know that the time for bellyaching and fear-mongering is over. Now is the time for buckling down, rolling back your sleeves, and heading N95 mask first into the pig pen.

You remember all those old movies about the crusty old army sergeant that forges back into the line of fire to save a fallen comrade: well, that crusty old sergeant is you. This is your moment; you have trained for it and you are going to kick some swine flu butt. You stand in front of your sickly family and shout, "Are you with me?!"

Okay, so your family looks at you as if you are the village fruitcake. Maybe the two-year-old applauds, but they all return to their beds moaning and you are left to tackle the flu on your own.

Well, you're not entirely on your own; the CDC has established some steps to lessen the spread of flu in the home. They have offered you the almighty handbook of "Security Lock-Down 101."

Rule 1: Solitary confinement. The CDC suggests keeping the sick person away from the other members of the household as much as possible, especially those that are high risk for complications from the novel H1N1.

I have to say here, how in the heck is that supposed to work if you have children sharing a room and the only other room in your house is the only last safe haven you have from children, or at least it is until 3 am when your toddler comes jumping into bed with you because the boogie man set up shop in their closet.

But anyway, the CDC suggests that you keep the sick person or persons in a room separate from the common areas of the house. ("For example, a spare bedroom with its own bathroom.") And keep the designated sick room shut at all times.

Oh yeah, a three year old child is going to love the solitary confinement while they feel like crap. How many three-year-olds do you know of that enjoy being absolutely alone when they need comfort from mommy or daddy? And I doubt the six-year-old sick child is going to stay put.

The curious thing about children is that they can and will play up until they are so sick that they can hardly stand. At that time, they begin to shows signs of lethargy and confusion. At that time, they should be visiting ye ol' emergency room, sporting a face mask. While we adults, the first moment we feel ill, we're done playing. (I'll talk about this phenomena more in my posts on hypo- and hyperthermia.)

Rule 2: Careful Transport of the Compromised. The CDC suggests that if the sick person does have to walk through they should wear a mask.

Rule 3: Hedge off the Enemy, Don't Allow it to Compromise Other Bases. Try to keep visitors to a bare minimum. Children when sick can transmit the virus up to two weeks after the last symptoms have gone. So if their friends come over to visit, there is a high likelihood that they can catch the disease and bring it home to their own families. And I'm sorry, misery shouldn't like company.

Rule 4: Keep Yourself From Becoming a Military Casualty. When holding your sick child to comfort them, hold them so that their chin is over your shoulder and turn your head away when they cough. If you come down sick then who cares for your loved ones.

Also, if possible try to wear protective gear to prevent the spread of infection. When leaving the patient's room, remove the protective gear to a designated location and wash your hands.

Rule 5: Clean the Barracks. Laundry should be washed with hot water and bleach if possible. Don't hug laundry to yourself when placing it in the washing machine. Use a laundry basket and gloves. After handling laundry, wash your hands and wipe the area with disinfectant.

In the kitchen, designate a specific set of dishes and utensils for your sick loved one to use. And wash those dishes in hot water in a dishwasher, if possible. Try to keep those dishes separate from the rest of your family's dishes.

Wipe down surfaces, bathrooms, door knobs, etc. with disinfectant sprays constantly.

Rule 6: Call in for Backup When the Enemy Becomes to Powerful. I have listed a series of signs in past blogs of when to go to the ER. Keep in mind that the H1N1 comes on fast. It doesn't wait for a few days to gather its strength, it hits you like a ton of bricks on the fastlane.

A lot of primary care providers are concerned, because of the possibility that patients can come into their offices with seemingly harmless symptoms and within less than 24 hours are in deep distress with full-blown H1N1.

On a single day, a particular hospital reported that there were 50 admissions for H1N1 with 19 of them being transferred to intensive care. The majority of these cases appeared at first looking like they had the common cold.

Recognize when to cut your losses and go to seek professional assistance.

Rule 7: Like all Things, This too Shall Pass. The truth is that I have seen many cases of H1N1 in this last week, where the family has recovered together. Careful planning and attention to warning signs will help you and your family stay safe this flu season.

On a serious note, please keep hydrated. Please get enough rest and vitamins. And for the love of Miss Piggy, please seek medical attention when you start feeling an illness come on quickly.

If you have any more questions concerning H1N1, please utilize the comments section of this blog. I will try to reply to your questions as soon as possible.