Ten unconventional additions to your emergency medical kit

Okay, I am sure you all have a medical kit to be proud of, you've got all the bandages, the slings, the ointments and creams, but sometimes, just sometimes, the most mundane items can make life simpler, especially if you need to move fast, or find yourself in a situation where you need to improvise, or, the stuff you have just isn't right for the job in hand. Here are a few ideas, and examples of what to use them for.

AN OLD CREDIT CARD/ATM CARD


These are great for a good deal more than stuffing in a hole in the wall of your bank. Scraping out a sting with the edge of a plastic card is preferable to fingernails or tweezers, both of which, just by the pinching action pump the last bit of venom from the sting into the skin.

Cut into strips they are excellent splints for broken fingers, and the gaps between the strips allow for swelling. Position either side of the finger and tape into place.

Used whole they can help inflate a deflated lung caused by a sucking chest wound. Put over the hole and tape on three sides only, the card acts as a flutter valve, preventing air from entering the wound but allowing air outside of the lung but inside the chest cavity to escape as the lung inflates.



DUCT TAPE

I love duct tape, it needs to be good tape, not a cheapo one that is not very sticky. Use to secure the card to the chest as described above. It can be used to hold splints on limbs in place, to secure pressure dressings,and even to make a makeshift stretcher to carry a casualty if wrapped around two poles and stuck to itself across the gap between them. There are dozens of uses for this stuff.





A DOZEN MIXED SIZE CLEAR PLASTIC BAGS



Clear plastic bags form a great barrier between a wound and the air, preventing pathogens from getting into the body. They are great for wounds and burns on hands and feet and are carried in ambulances for this reason. Duct tape into place and the wound will stay clean until you can deal with it. This is particularly beneficial if you are near water and you want to prevent contamination.

Use as a flutter valve on large sucking chest wounds. Fix on three sides as described for the card method above.

SANITARY PADS

Sanitary pads make really good pressure dressings. Put over the wound and tape tightly down covering the whole pad with tape, extend the tape a good distance from all edges of the pad to make sure the pressure is maintained.

HALF A DOZEN STRONG TEA BAGS

Tea leaves contain tannin which has anti-inflammatory and vaso-constrictor properties. To wash out an eye make as you would tea, leave to cool and lean forward so the liquid in the container reaches the eye and open and close the eye whilst in the liquid. The tea bag can be placed on the eye afterwards, to reduce any swelling and irritation.

Tannin is a vasoconstrictor, it causes blood vessels to contract and therefore slows blood loss. It would be no use at all for anything major, but for nosebleeds, traumatic tooth extractions and minor cuts and abrasions, it works well. Put just enough boiling water on the tea bag to make it swell to its maximum size and show a little liquid leaking from it, then when it has cooled sufficiently apply it to the tooth socket, cut etc. for nose bleeds roll the bag as small as you can and plug the nostril with as much of it as you can, you can cut it in half if need be and roll so as the cut edge is on the inside of the roll. There is no worry about sterility with a nose bleed.

STRONG SMELLING VAPOUR RUB

There are times when the smells around you are almost too much to bear. Infected wounds, corpses, human waste all give off gut-wrenching odours and dabbing vapour rub under your nose helps a great deal.

I have heard occasionally that a dab under the nose of someone having an asthma attack, who does not have an inhaler with them, helps open the airways a little making breathing somewhat easier. I have no experience of this and therefore cannot vouch for it. Having said that an asthma sufferer without an inhaler will not come to any harm by trying this.

A SECTION OF BICYCLE TYRE INNER TUBE

The inner tube from a bicycle tyre is very stretchy and it makes an excellent tourniquet. It is also possible to use it as a fire starter, and it will burn even when it is pouring with rain, and it burns for a long while, often long enough to dry out a little damp tinder placed very near it.

A SUPER ABSORBANT DRYING CLOTH

These microfibre cloths are very light weight and take up almost no space. They are excellent for drying around wounds so that dressings and tapes stick more easily. As they hold a good amount of liquid, one dunked in water and lightly squeezed out is useful for giving a casualty that cannot sit properly sips of water, they just suck on the cloth.

AN EMPTY SODA BOTTLE

Cut off the top and bottom and then cut it along it's length. This gives you a sheet of strong plastic that rolls back into a tube when you let it go. These make great splints, keeping clothing etc away from a wound or helping to immobilise a broken bone. Unroll, place around the limb and gently let it go back into its tube shape. Then, very gently, close the plastic up, one edge will slide under the other with little effort. Fix in place with a piece of tape. To store, roll it up tight and secure with a rubber band. We used this method in hospitals to stop babies and toddlers ripping off their dressings, works very well.

A PAIR OF ADULT OVER THE KNEE SOCKS


Get an adult pair of knee high socks and force them over a large, full soda bottle to stretch them. When stretched for a couple of days, roll them down the bottle so what you end up with resembles a donut, store them in this shape so that they can be rolled onto a limb rather than forced up over it causing pain and possibly more injury. They are great for holding a leg dressing in place, and make a good sling for arm injuries. Roll onto the arm, position the arm comfortably and safety pin to the patients clothing in a couple of places, beats messing about with a triangular bandage if you are in a hurry. If they have long sleeves, position the arm and pin the sleeve to the body of their clothing.

Well there you have it, a few coventional items with a few unconventional uses.

Take care

Lizzie

Cleaning necrotic wounds in an emergency situation

Necrotic wound debridement...the sight of those three words was enough to fill me with dread when I saw them on my operating list. Unpleasant, often disgusting and always extremely foul smelling, these were the cases you really did not want right before going home for your evening meal. Always done at the end of the list so as to avoid the possibility of contaminating a 'clean' case, you have to believe me when I say some of these wounds were the stuff of nightmares.

Imagine for a moment, dealing with a foul smelling wound, full of dead and dying tissue, without the backup of an operating theatre and the equipment and staff that goes with it. Not good eh?

Necrotic tissue is dead tissue, and when tissue dies it starts to rot, to decompose, and that smells, it smells awful, it is a smell you will NEVER forget. It does not always occur through neglecting a wound, a simple scratch, something that you would not have considered going to the doctor or hospital about, can turn necrotic over night if the right bugs get into it. Necrotising fasciitis is an extreme but prime example of this. Necrotic tissue is soft and spongy to the touch, there is no form to it. It may be black in colour, but any shade of green and/or yellow is quite common. The wound will probably be oozing pus and fluid, and it will stink to high heaven. This decaying tissue has to be removed from the wound as soon as possible to avoid overwhelming infection.

It goes without saying that if you have antibiotics they should be given immediately, providing the patient has no allergy to the drug.

Those who live a long distance from medical assistance, or who find themselves embroiled in a situation where medical assistance is no longer a viable option would do well to know how to deal with such wounds.

AUTOLYTIC DEBRIDEMENT


This is simply allowing the body to resolve the situation itself, such as allowing a frost bitten finger or toe to drop off on its own without intervention. The digit is wrapped in a damp dressing, and kept damp until the situation resolves.

MECHANICAL DEBRIDEMENT

Mechanical debridement is the simplest way to try and get the dead and dying tissue out of the wound. Water under pressure is the simplest way of doing this. Clean sterile or boiled and cooled water if forced into the wound, flushing the dead tissue out. This can be done via a large syringe if available. An acceptable substitute is a squeezey ketchup or mayo bottle that has been cleaned and treated with bleach prior to being filled with clean water to be used on the wound. The water should be forced into one end of the wound, working systematically towards the other end of the wound. This may need to be done many times in order to remove as much decayed tissue as possible. If chlorhexidine or iodine scrub solutions are available they can be used, well diluted to assist in cleaning the wound.

Opinion varies on what should be done next. Years ago the wound was packed with a large, sterile, wet to dry pack, which was left to soak up any exudate and then allowed to dry. This was then pulled out of the wound, bringing necrotic, and healthy tissue with it. This is very painful. I do not favour this but it was/is a recognised practice depending on where you live and the availability of ongoing care.

My choice would be to remove the bulk of the decaying tissue with pressurised water as described, and then do it again with salt water. The wound should be checked every few hours and the treatment repeated, with salt water as often as is needed. This may need to be done for several days, several times a day until the wound no longer smells and is no longer purulent(producing pus). These wounds should not be sutured as the smallest amount of decaying tissue left behind will fester inside the closed wound. The wound should be covered with a clean non-adhesive, damp, lint free dressing and checked twice daily for signs of regression. If you are fortunate enough to have a supply of alignate or hydrogel type dressings or packs these should be used in preference to other types of dressings.

CHEMICAL DEBRIDEMENT

Certain chemicals contain enzymes that can target necrotic tissue whilst leaving healthy tissue undamaged. These chemicals are not available other than in a hospital setting, they are target specific components of decaying tissue depending on the type of wound. Some articles state that chlohexidine and iodine are suitable for chemical debridement, they are not as they contain no enzymes. They are useful for wound cleaning if available but that is all.

SHARP DEBRIDEMENT





This simply means removal of necrotic tissue with a sharp instrument, preferably with a scalpel being held by a qualified surgeon.

BIOLOGICAL DEBRIDEMENT

This may also be called larval therapy. Maggots are used to clean the wound. In hospitals the maggots are bred in the lab, but a maggot is a maggot and if left to do what they do best they will clean out a necrotic wound very effectively. As much dead and decaying tissue as possible should be removed with washouts and then several maggots should be put into the wound. A damp dressing should be used to cover the wound and the maggots left to do their job. Obviously the maggots will need to be removed before they turn into flies, so having a steady supply would be advisable. A small amount of meat product in a damp jam jar will allow flies to lay eggs and ensure your maggot supply.

Many people will have a psychological aversion to larval therapy, and this is understandable. The patient should be warned that they will feel the maggots moving around, but the maggots prefer decaying tissue and will choose it over healthy tissue if given the choice. It is not in any way painful and really does give the wound an excellent chance of healing as they are very effective cleaning machines.

Once the wound is clean, it will start to granulate, new cells will form and eventually the wound will close. This can, depending on the size of the wound take a considerable time. The use of alignate dressings or hydrogel will speed the process considerably. If not using these dressings keep the dressings you are using slightly damp with either pre-packed or home made saline solution, this will aid the healing process. Antibiotics should be continued for at least five days.

It goes without saying that the decision always has to be to seek qualified medical help if it is available. Dealing with these wounds is difficult and the outcome can never be predicted. Treating wounds yourself should only ever be the first choice if there is NO other choice.


Lizzie.

Iron deficiency anaemia

First of all the science bit. Blood is made up of plasma, a straw coloured liquid that is composed of four components;

Red blood cells that transport oxygen around the body

White blood cells that help fight infection

Platelets that clot the blood

Proteins and other chemicals that are essential for normal functioning

Red blood cells are made in the bone marrow, and millions are released into the bloodstream every day. These cells carry a chemical called haemoglobin,which binds to oxygen, and is transported from the lungs to every cell in the body. It is haemoglobin that gives blood it's red colour. To maintain this constant supply of red cells and haemoglobin, the bone marrow needs to be rich in iron, iron folate and vitamin B12, all of which we obtain from the food we eat.

Should our diet diminish in these essentials, it will diminish in haemoglobin, which in turn will reduce the amount of oxygen travelling around inside us. The body uses this oxygen in the combustion of sugars and fats, and this is what provides us with energy. Without this process working at the right capacity, energy levels diminish rapidly, and the body struggles to make up the deficit. A continued lack of these essentials leads to anaemia.

The symptoms of simple anaemia are approximately the same in all those who suffer from it, varying degrees of tiredness, lethargy, which can be quite profound, pale skin, headaches, dizziness and sometimes faintness. If left untreated the condition will progress, worsening over time, leading to altered taste sensations, tinnitus ( ringing in one or both ears)severe headaches and palpitations.

If it is left untreated beyond this point the constant over working of the heart to pump what available oxygen there is around the body, can lead to both cardiac and lung problems. On occasions this can lead to coma and very occasionally death can result. It should be noted that other, more serious forms of anaemia do exist, and that they have a much higher morbidity and mortality rate than simple iron deficiency anaemia.

The tiredness caused by anaemia can be profound, enough that the sufferer can only stay awake for short periods of time, the urge to rest and/sleep becoming overwhelming to them. This is not something you want to be dealing with in a critical situation when you need to be alert to everything,including the subtleties, of what is going on around you.

In addition to anaemia being caused by dietary deficiency, pregnancy, heavy menstrual bleeding,growth spurts in children, particularly if they are fussy eaters, and any internal bleeding, such as from kidney stones or ulcers, can cause anaemia.

Iron folate can also be called folic acid, this and vitamin B12 as well as iron may become more difficult to obtain in a post-collapse environment. How difficult depends entirely on what caused the collapse, and how that event affects growing seasons or the ability of people to grow the required food that is rich in these essentials.

Some foods inhibit your ability to absorb iron, excess tea and coffee,whole grains,calcium, antacids and proton pump inhibitor drugs all have an effect on iron absorption, as does smoking. On the other side of the coin, eating food rich in vitamin C alongside iron rich foods increases the amount absorbed by your body.

Over-the-counter iron supplements, folic acid supplements and vitamin B12 are all widely available. They store well and toxicity is not a issue but their efficiency after lengthy storage may well be diminished.

Below is a very basic list of foods rich in each of these basic nutrients. It is by no mean exhaustive and researching for yourself what grows best in your geographical area and/or climate is recommended.

IRON RICH
Dark green leafy vegetables
Beans-fresh or dried
Nuts
Red meat
Apricots
Prunes
Raisins
Blackstrap molasses


B12 RICH
Cheese
Clams
Fish
Lamb
Eggs
Liver

FOLIC ACID RICH
Citrus fruit
Cauliflower
Beans-dried
Dark green leafy veg
Lentils
Beets
Seeds
Corn

I hope this was of some use

Take care

Lizzie

Bugging out or staying put...Hantavirus doesn't mind which you do.

Hantavirus has been around for a long, long time, it is endemic in South-east Asia but was first discovered in the New World in 1993, in New Mexico. A dozen healthy individuals of the Navajo Nation, in the Four Corners area, developed respiratory problems and died. Their deaths were attributed to adult respiratory distress syndrome, (ARDS). Investigations began immediately into what could have caused a dozen people, with no underlying problems, to keel over and die. The researchers found a previously unknown virus, Sin Nombre Virus (SNV) in the environment, and the twelve deceased were found to be carrying the virus. They found that Deer mice were vectors, carriers of this virus, further studies showed that all rodents can be carriers of SNV. Warm weather had allowed more than the usual amount of vegetation to grow, and the rodent population had exploded, New Mexico had experienced a 10 fold increase in rodents that year, by the start of 1994 there had been 55 cases resulting in 32 deaths. The term Hantavirus Pulmonary Syndrome (HPS) was used to describe the disease. Three more strains of the virus were subsequently discovered, New York 1 virus, Black Creek Canal virus and Bayou virus.

Hantavirus is a zoonotic disease, it crosses from animals to humans. It is carried by rodents but Deer mice seem to be infected to a higher degree than many other mice and rats. The rodents themselves are asymptomatic, they show no signs of disease and are not sickened by carrying the virus. Hantavirus is considered not to be spread by person to person contact, but studies of an outbreak in Argentina in 1996, indicated it is possible but the chances of it occurring are very,very slight.

The vast majority of people who contract Hantavirus do so in their own homes and gardens. The infection is caused by the victim inhaling particles of dried urine and faeces from infected animals. The clearing of nests, droppings and dead rodents is the usual cause of infection, the ingestion of contaminated food is the second most likely cause, and rodent bite, as it can be carried in the saliva of infected animals is third. The disturbance of infected nests, faeces etc aerosolizes the minute virus particles and as a result they are inhaled.

Symptoms will first appear 5-21 days after exposure. Fever, fatigue and muscle pain, particularly in the shoulders and thighs, followed by chills, nausea, diarrhoea and vomiting.

3-5 days after this the cardio-pulmonary phase begins. This is marked by shortness of breath as the lungs start to fill with fluid. If not treated at this point the disease will progress rapidly, usually within 24 hours the shortness of breath will turn into acute respiratory distress. Breathing will become increasingly difficult until it is impossible without ventilatory support. The heart rate will have dropped markedly and will continue to decrease in pace and force until the patient has negligible output and circulation ceases. This is a direct response to the lungs filling with fluid, the heart is reacting in the way it would with any other drowning.

Hantavirus is viral, antibiotics will not work, antiviral medication may be given iv but 50% of people die even with medical assistance that was sought early, the figure is much higher for those seeking late medical intervention. Speed is of the essence with Hantavirus, if you feel ill after cleaning out a shed, garage, holiday cabin, or the cupboard under the sink, and there was evidence of rodents...seek help immediately. Those who survive often have kidney problems and polyurea (excessive urination)

PREVENTION

First and foremost reduce contact with rodents, take all measures possible to keep them out of your home, tool shed garage, holiday home, bugout retreat, woodpile and anywhere else you frequent.

Keep rubbish bins well sealed and excess rubbish as far away from dwellings as is possible.

Keep low lying vegetation to a minimum in these areas to discourage nesting

Build yourself a hanta kit containing, goggles, HEPA mask,(high efficiency particulate air), thick rubber gloves, a second pair of gloves, latex or washing up type, rubber boots and disposable overalls with a hood, an old shirt and trousers that you can afford to lose and 2 plant sprays.

DO NOT sweep, shake rugs or vacuum in areas you suspect may have nests or droppings. Open all windows and doors and leave the place to air for at least an hour. Make up several buckets containing a minimum 10% bleach solution, don your protective gear before going anywhere near the area. fill a plant spray from one of the buckets and spray the area you are cleaning from the top down.

Remove items from the shelves and wipe with a bleach cloth, set each item aside as you go.

Use a towel or cloth wet with the bleach water and wipe the shelf down, making sure you wipe the edges as well as the flat surfaces. Rinse your cloth often in the bleach water.

When you get to the floor, use a shovel to remove nests, soil, paper etc, all of which should be soaked in bleach water. Put into two thick rubbish bags. When solid matter is removed, carefully wash or mop the floor, disposing of the mop head and cloths into the waste bag as you finish with them.

Wash your gloved hands in bleach water, wash you boots in bleached water and lightly spray your overalls with bleached water from the plant spray, empty any liquid left in the spray and put the plant spray in the rubbish bag. Still wearing the goggles, mask and gloves, remove your boots and set aside. Take off the overalls and put into the bag,wash your gloved hands again in bleached water.

Using a fresh cloth, wet it in bleached water, wring out and wipe the front of the goggles and the mask, do this twice, rinsing the cloth in between.

Rinse your gloved hands in bleached water, shake to remove excess and remove goggles, dropping them into the bleach water bucket.

Take a deep breath and hold it, remove your mask before releasing your breath. Dispose of the mask into the bag. Tie bag up immediately.

Remove the top layer of your clothes and put them into a plastic bag, hold you breath whilst taking anything over your head, tie the bag immediately.

Washed your gloved hands one last time but this time let the bleach solution go over the cuff of the gloves saturating the insides.

Take the unused plant spray, filled with bleached water and spray the outside of both plastic waste bags. Pull on a second pair of gloves, place both waste bags into a large thick plastic sack and tie up. Wash your gloved hands in the bleached water, removing the gloves whilst they are submerged.

Go inside and wash, bath or shower, paying particular attention to your hair.

The waste bag should be buried deeply, or burned when the contents have dried out.

It is far, far easier to be vigilant with pest control, but if for example, you are going to a cabin that has been unused for some time, or are cleaning out the furthest corners of the garage, you would be well advised not to cut corners if you find evidence of rodents.

If you are using a building that has not been used for a while even if it has no evidence of infestation or nests it would still be advisable to wipe all surfaces with bleached water before using them for food preparation.

Hantavirus is indescriminate, and in situations that would see a proliferation of the rodent population, for example a breakdown of services which allows rubbish to build up, Hantavirus Pulmonary Syndrome will likely become increasingly common.

Take care

Lizzie

Flesh eating bug...fourth case in Georgia

There have according to news reports been four cases of "the flesh eating bug" in Georgia over the last few weeks.

There are actually several bugs that can cause the condition necrotising fasciitis in humans, Areomonas hydrophila, Group A streptococcus and Zygomycetes. the result from all of these bacteria can be the deep seated infection, which often has to be cut away in order to remove it from the patients body

Necrotising fasciitis is also known as Fourniers gangrene or gas gangrene, due to the gas bubbles that form as tissue is destroyed. There are four district and recognised types of necrotising fasciitis;

Type 1 polymicrobial infection with aerobic and anaerobic bacteria in immunocompromised patients or those people with underlying chronic disease.

Type 2 Group A streptococcus, occurs in any age group in otherwise healthy people, can be accompanied by a staph infection.

Type 3 Gram-negative mono-microbial infection such as vibrio and aeromonas hydrophila, which often occurs after seawater contamination and sometimes after eating raw fish, and this hits patients with liver disease very badly. Marine infections are very, very virulent and can kill in 48 hours.

Type 4 fungal origin, infection with Zygomycetes following burns or traumatic wounds. This often progresses very rapidly and carries a high mortality rate.
These bacteria, once in the body get down into the facia, and move along it destroying tissue at an alarming rate. the condition is often mistaken for cellulitis, a far more localised and much less dangerous condition.

A good warning sign for NF is that the pain, tenderness and swelling are out of all proportion with the scrape, knock or cut that the patient has presented with. Systemic illness almost always accompanies NF and this is not the case with cellulitis, the condition it most closely mimics. The mottling and colour changes to the skin are less indicative in the early stages, as localised changes of that type are found in cellulitis, in which the spread of this discolouration is slow. With NF the mottling spreads very rapidly and is a clear sign that the infection is progressing.

If you suspect that you have this condition, or you suspect that someone you know has this condition go to the casualty department immediately. Time is very much of the essence with NF. It is a relatively rare disease but has a very high morbidity and mortality rate, treatment has to be started as near to the onset of symptoms as possible.

Wound debridement is used in conjunction with high dose antibiotics, and for those that survive it, the path to recovery is arduous and often filled with multiple surgeries to facilitate skin grafting and to close wounds. There is nothing that can be done to help those with NF if surgical expertise is not available.

for good quality information on all aspects of the disease check out www.nnff.org the National Necrotising Fasciitis Foundation.

Love and prayers go to Aimee Copeland, a student from Georgia who is currently battling this awful disease.

Take care

Lizzie

Differential diagnosis in a crisis

A couple of people have mentioned this over the last few days...you know who you are, can you pick something easier next time please?

Okay, a few definitions so we are all singing from the same song sheet.

Asymptomatic means you show no signs of illness.

Symptomatic means you show signs of illness, and you may or may not know the cause of it.

Definitive diagnosis means that you know the cause with certainty

Differential diagnosis means you have eliminated what it cannot be, and based on the information you see, hear, feel and smell, you draw conclusions as to the cause of the symptoms.

I often hear people say that in a dire emergency of an on-going nature, we will be blasted back to the stone age, and whilst it is undoubtably true that life would be very, very different, and would present us with major challenges, there is one very major difference between the stone age and the present....knowledge.

We have more more knowledge than we did then, we know how our body works, we know about hygiene and the roll it plays in good health, the list of what we know is almost endless. We know so much more now than at any other time time in our history, and it is this that will allow the human race, albeit much smaller in number, to continue on after any calamity that stops short of the complete destruction of the planet.

Differential diagnosis is still used today, it is based on the practitioners knowledge of basic medical problems, and the ability to interpret what that practitioner is told, or hears via auscultation, what they see, what they feel, heat, swelling etc and by what they smell. some bacteria has a distinct but sadly indescribable odour to it when it grows colonies in humans. In a situation where modern technology can no longer be used to give us a definitive diagnosis, differential diagnosis, will once again, as it was before the technology was available, become the only method of differentiating between given conditions and diseases.

Once again I stress that having a couple of good medical books around will be invaluable, a decent home medical book, written for lay people will give you a valuable reference of how to spot signs and symptoms, and treat illnesses, having the hard copy there, available for use, could be, and probably will be a real lifesaver in a crisis situation. Another good idea would be to have a field medicine manual around that can offer advice on field medicine, gunshot wounds and such like, again, a lifesaver, and another item it is far better to have and not need than to need and not have.

Right, moving on, a few examples of differential diagnosis. there are of course hundreds of them, and there is no chance of me listing them all here, one reason is time...we all have lives, and the second is I don't know them all, nobody does, so another reason to get some literature. the idea of this post is to give examples and a walkthrough of the process.

Giurza, a cyber friend on SHTFPlan, gave an example of toothache versus tooth infection so I shall start there. Toothache can be caused by many things, biting down hard and twanging the nerve, a chip, a loose filling etc. A tooth infection will cause a similar ache, but it will not subside, it will throb for an extended period. The owner of said tooth infection will notice an odd taste, often mildly metallic, and people close by may notice a faint smell that is not usually there. This is, in essence how differential diagnosis works, taking the same starting point and ruling out, or in, other ailments from the symptoms that are present.

Appendicitis versus general abdominal pain. Both will start with a dull ache in the midline. Most general non-sinister abdominal pain will be constant and will last a few hours, maybe a day, before subsiding. Appendicitis will start just the same way, it may come and go for a few hours, but will then migrate to the lower right side of the abdomen where it will become more severe and constant in nature. it will be accompanied by a fever and nausea/vomiting.

Daisy asked how to tell a bacterial from a viral infection, and the honest answer is with great difficulty.
VERY generally speaking, runny noses, watery eyes, DRY coughs, minor sore throats...as opposed to the feeling like you have swallowed a cactus sore throats...are viral, or allergic in nature. Coloured discharge from nose, coloured phlegm, slight 'off' odour and wet cough is usually bacterial.

whilst we are on this a note about MENINGITIS. This is a vile disease and can be caused by both a virus and a bacteria (as can pneumonia and diarrhoea) Meningitis is often confused with the onset of a heavy cold or flu in its early stages, but this disease can move very, very fast and is a killer. you NEED to look for the following signs that make it stand out as different to a cold/flu

Acute onset severe head ache that becomes chronic

Moving the head forward causes the patient to draw their knees upwards

Photosensitivity

Non-blanching rash..take a glass or jam jar and roll it over the rash, if it does not blanch it is a meningitis rash.

In babies and toddlers, excessive crying that is often high pitched, and very different from their usual cry.

Displeasure at being touched or handled.

Floppiness of limbs and body OR stiffening of limbs and body it can be either.



If you even suspect meningitis give high dose, as much as you can for the weight of the patient, broad spectrum antibiotics IMMEDIATELY. Meningitis often results in meningococcal septicaemia, this almost always results in limb amputations, failure to amputate leads to a rapid and agonising death. If you store antibiotics for no other reason let this be it, it is a dreadful disease and NOTHING except antibiotics has a hope in hell of stopping it. If you do not see the rash but the other signs are there, please, give the drugs, do not take the chance with this. Although it can affect adults, predominantly it is children and teenagers that appear susceptible, it is contagious and all those in close contact with the victim will need prophylactic antibiotics for five days.

As I said earlier, I could go on listing stuff for days on end, but nothing can replace having someone around with medical knowledge when you need it, second place goes to getting yourself onto a decent course that can give you some background knowledge of  emergency medicine, and third place is a well written book that allows you to cross reference and have the advice at your fingertips in the event that you need it.

I hope this was useful.

Take care

Lizzie

Gastrointestinal issues in a crisis...what will you do when the shit hits the pan?

On a regular day, in regular times, popping a couple of pills to sort out Dehli belly, Montezumas revenge or whatever else you want to call it, is second nature. A really bad stomach upset may see you consulting a doctor, and a really, really bad case, may lead you to the hospital.

What will you do if the doctors are no longer there? The hospitals are closed or full of the displaced and the diseased? You have no idea what bug you have, and you have no way to find out. I daresay you will pop another couple of pills and hope the problem goes away. Well it won't. Sorry, but your body does not work that way.

The oxygen free environment in your gut supports both good and bad bacteria, when the bad outnumber the good, you spend the day in the bathroom. When the good outnumber the bad, you don't, it really is that simple.

The good thing about taking anti-diarrhoeal drugs, is that they do exactly what it says on the box...they stop you going to the bathroom. The bad thing about anti-diarrhoeal drugs is that they do exactly what they say on the box...they stop you going to the bathroom. NO THAT LAST LINE IS NOT A MISTAKE. Having a drug that does what it is claimed to do, is generally a good thing, but, when that drug is sealing in the bacteria/virus that is making you ill, allowing it to remain in the environment that favours its multiplication, then it is not a good thing. In fact it is a bad thing, and doing it can lead to it becoming a very, very bad thing...like a fatally bad thing.

Vomiting and/or diarrhoea are your bodies defence mechanisms kicking in, you body is trying to rid itself of the bacteria/virus that is making it sick. Unless those toxins exit the body in a timely fashion you can become very ill very quickly. Allowing nature to take its course can also lead to problems, but thankfully these are problems that are relatively easy to solve. A person suffering from sickness and/or diarrhoea will very rapidly become dehydrated and weak. This can be combated by replacing the electrolytes, the salts and the sugars, and the fluids they are losing. These solutions can be purchased over the counter, in granule or powder form and are reconstituted with water. They store well if kept cool and dry, but as with most things they lose some efficiency over time.
If you do not have these to hand, half a teaspoon of salt and two teaspoons of sugar dissolved in hot water and left to cool will be a good way to start the re-hydration process. It will not stay in the system for long, like I said, nature has her way of ridding us of bugs, but some of it will have been absorbed. Repeat this at least every three hours to keep on top of the problem.

It is not only salt and sugars that are being lost, all other vitamins and minerals are diminishing as well. Crush a multivitamin and mineral tablet up, mix with the salt and sugars as before and administer every three hours.
In situations like this it is the dehydration that kills and rehydration is your number one priority.

If this condition persists for longer than 48 hours, and you have stored antibiotics, start giving them now, make sure the patient is not allergic to them, now is not the time to induce anaphylaxis, you should stop the rehydration therapy just for a couple of hours in the hope that the antibiotics will remaining the system long enough to start working.give them according to the recommendations on the container. If you have no antibiotics, or the person is allergic to them, continue as previously described with the rehydration therapy alone. Eventually, the bacteria will be flushed from the system and the symptoms will start to die down, either that or the antibiotics you have given will have started to work. There is no way of knowing which it is.

The patient may have lost a considerable amount of weight during the illness, and they may well feel weak for a considerable amount of time. Light foods should be offered at first, along with lots of liquids. Multivitamins with minerals will help replenish those that have been lost.

Now, back to the anti-diarrhoeal drugs. They have their uses, you have a bit of a upset stomach and you are going out...fine use them. You have had a little too much of something you know upsets your system....fine use them. They even come in handy for maintaining OPSEC, you need to maintain your position without interruption....they will stop you blowing your cover whilst you answer the call. They are fine for loose bowel moments, they are not fine for gastrointestinal illness, and if you think you don't know the difference, well, you would if you had suffered it, and you will if you suffer from it in the future.

Take care

Lizzie

Tylenol the reptile slayer-and other facts about Acetominophen

Sometimes, just sometimes, TV provides a fact you never knew. This happened to me last night. Acetominophen, paracetamol to those of you in the UK, kills snakes. Apparently it is being used in Guam to control the massive population of Brown Tree snakes. Lace a nice dead rodent with 80mg or more of the drug, and when the snake eats it, bye bye snake, this could be useful information in certain circumstances I think. Thank you Discovery channel.

For those of you who do not wish to kill things, including yourselves with this drug, read on.

Acetaminophen is the leading cause of acute(rapid onset) liver failure in both the US and the UK. It is extremely hepatotoxic, and can cause kidney and brain damage if overused.

Acetaminophen is a widely used over-the-counter drug that is often the first thing reached for when a cold or flu strikes, or minor to moderate aches and pains set in. It has a relatively quick onset of action, approximately 10-15 minutes, and it's effects last for between 1-4 hours depending on the severity of the pain or fever. It is commonly used to treat inflammatory conditions such as arthritis, but only works on the pain caused by the condition and does nothing to reduce the inflammation that causes the pain.

The standard recommended dose of Acetominophren is 1000mg(1g) in a single dose, and 4000mg (4g) over the course of 24 hours. Great care should be taken if using other preparations to make sure they do not contain Acetominophen as exceeding the dose can lead to liver and kidney issues and in some cases can be fatal.

Doctor Kenneth Simpson and his team of researchers at the University of Edinburgh, Scotland, looked at the medical records of 663 patients with acute (rapid onset) liver failure. Of these 161 had taken what is termed a "staggered" overdose. This is a non-deliberate overdose that has occurred by taking more than the recommended dose over a period of days, weeks and in some cases months. The timescale of this staggered overdose causing what is usually irreversible damage depends on the excess amount of the drug taken and the susceptibility of the patient to the drug.

The study found that staggered overdose patients, were more likely to develop kidney, liver and brain problems, in the long term, and to die as a result of complications, than people who took a one-off massive dose. professor Roger Knaggs of the Royal Pharmaceutical Society has backed these findings and has urged patients using paracetamol to re-visit their doctor if they find they need increasing amounts of the drug to deal with their condition.

The World Health Organisation, regards the drug as safe to give to children, but recommends that a child's temperature should be over 101.3*F (38.5*C) before starting to administer the drug.

Aminocetaphen is well tolerated by those with gastro-intestinal problems and is safe for use by asthmatics.

Winter is the prime-time for accidental overdose, people are taking over the counter remedies for colds and flu, and the aches and pains of arthritis are exacerbated by the cold and damp. Damage from staggered overdose is rarely found in time for effective treatment to be employed as blood toxicity tests will not show the massively elevated levels of the drug as it does with those who have taken a deliberate overdose.

Always read the labels of over-the-counter drugs, and if they contain Acetominophen note down how much and when you took it, just a little too much, a little to often, can cause problems for the rest of you life...if you live that is.

Finally, to end where we began, with non-human species, this drug is not suitable for cats...which it will kill very quickly in even minute doses, and dogs, who will in a short space of time, develop liver problems.

Thanks for taking the time to read this.

Take care

Lizzie

Why your water filtration system may be the death of you

There are many types of emergency that can befall us, personal, familial, local, national and global. This is why we prepare, this is why we have back ups, and back ups for those back ups. Have you ever looked closely, really closely at your kit, in particular at your water filtration system? Will it actually do what you think it will do? Do you know the size of the filter in your system? Have you read the list of nasties that it will filter out? See anything missing from the list?

Viruses

There are a great many viruses, and all of them will flourish if municipal water supplies fail. How fast they flourish depends on the weather, run off of untreated water into natural water courses, and how quickly humans soil the supply by indiscriminate disposal of animal and human waste.

West Nile virus, Coxsackie virus,hepatitis A, hepatitis E, adenovirus,reovirus, Calicivirus, poliomyelitis, and leptospirosis all have a size of 0.09-0.1 microns, this is smaller that the 0.2 micron pore size in the best of the best filters available today. All of these will increase if municipal water treatment is no longer available.

One of these, leptospirosis, is already in a great many fresh water supplies. Any situation that puts humans in contact with fresh water increases the risk of infection. It is endemic in tropical and sub-tropical regions, but not purely due to the climate. Many of these areas are in the developing world, and as such these areas have less treated water, less refuse collection services, and no pest control systems beyond those employed by individuals. This is exactly the situation we will find ourselves in if there is any event, natural or man made, that results in a long term breakdown of the power grid, which results in water treatment plants going offline. Those currently living an off grid lifestyle, or preparing to should some kind of collapse occur, should be aware of the dangers lurking in even the most pristine looking natural water supplies.

You may know leptospirosis as Weils disease, it's a zoonosis, that is it can cross the species barrier from animals to humans. The animals themselves are asymptomatic, they show no signs of illness or disease. Leptospirosis is spread by infected urine, and less commonly by other bodily fluids. The spiral shaped bacteria are safe when dry, but live for an extended length of time in damp and wet conditions. They can, if they have not been dry for too long, deactivate on contact with water. The prime sites for the bacteria to be found is in the water itself, alongside it on banks, under vegetation, mud, puddles and gardens where infected animals may have urinated.

A word about rodents, they are incontinent. If you have rats and mice, you have urine, it's that simple. Although rodents are the main vector for leptospirosis all animals can carry it, including domestic pets. It gets into the body via mucosal tissue, such as the eyes or mouth, via abrasions and rarely by ingesting infected meat, though cooking well usually avoids this.

Any Holmes the Olympic rower died of leptospirosis in October 2010, it is thought he contracted the disease whilst practicing on the river.

The World Health Orgaization monitors leptospirosis as it is a notifiable disease, most countries take part in the system, the USA does not. It removed leptospirosis from the list of notifiable diseases in late 1995 after being criticised, for failure to notify cases. It was questioned as to why a country as vast as the USA had such a low number of reported cases each year. The investigation concluded that the reporting system was flawed, and that based on land mass and fresh water volume the USA would have in the region of 10,000 cases per year. They were at the time, reporting between 58 and 70 cases per year. The report concluded that under reporting is less important than under diagnosing and that continued under diagnosis could have serious implications for the population.

Current statistics show leptospirosis is present in some 20% of the fresh water supplies on the planet. This figure will grow should water treatment, refuse removal and pest control mechanisms fail. Most of those 20% are found in countries that do not have these safeguards.

The answer then is obviously to avoid it, but sadly that is not possible. For example, the Hardjo version of the disease affects only cattle, but it is fatal to humans, it is currently kept out of the food chain by the destruction of animals found to be carrying it. Without veterinary care and excellent husbandry standards this will not be the case..

Many things increase you chance of catching leptospirosis, anything putting you into contact with fresh water, or wild animals increases your risk.

How to minimise your risk

* stout walking boots, long trousers and long sleeves should be worn where there is a danger of scratch injuries
* waterproof thick gloves should be worn when drawing water, be it from a well, stream or river
* eye and mouth protection, as well as long sleeves and waterproof gloves should be worn during ANY contact with wild animals, especially so when removing them from traps, skinning or butchering them
* thick plastic bags should be worn over foot ware when in areas contaminated by livestock waste
* areas where children play, and wild animals/rodents have access to, should be treated with chlorinated water prior to them playing there
* water destined for human consumption should be treated even if it has been filtered.
* domestic pets should not be allowed in food preparation areas
* food prep area should be wiped with a chlorinated cloth before use
* hands should be washed in chlorinated water before entering the home
* get in the habit of not touching your eyes and mouth with you hands when out and about

The signs and symptoms of leptospirosis are varied and many. Most people, 60-65% will have a flu like illness for a week, this will be accompanied by severe headaches and possibly an occasional nosebleed. 25-30% will have a severe flu like illness accompanied by severe incapacitating headaches and nosebleeds.they may well show unexplained bruising. Some in this group will go on to develop kidney and liver function issues at a later date. 2-5% will die, having gone into kidney failure. For these people the headaches do not subside, they have frequent profuse nosebleeds and unexplained bruising on a large scale. This is due to clotting mechanism malfunctions.

Antibiotics kill leptospirosis, the cyclines are best but these must not be stored as they become toxic  their expiration date. Penicillin was once the treatment of choice and works well. Chlorine also kills leptospirosis, as does boiling the water before ingestion.

I have gone into detail about leptospirosis because currently it is the one we all face everytime we come into contact with untreated fresh water. Of the others, some are killed by UV, some are not, some are killed by antibiotics, some are not, most are killed by chlorination, but some are not. 99.9% are killed by boiling. Employing two methods, such as filter then boil will exclude catching something from the water you drink.

So, filter or not, boiling your water before drinking is still advisable. It should also be noted that some bacteria are smaller than 0.2 microns and would therefore not be removed by filtering.

Water does not have to be boiled for an extended period, this wastes time, fuel, and water in the form of steam. Raising the water to a rolling boil for one minute is enough to kill any viruses and bacteria present.

Water filtration systems have their place, and are great items to have, filtering out the vast majority of organic and inorganic impurities, just be aware of the capabilities of the system you have.

Take care

Lizzie