Medical FAQ's Version 2.00
September 1997
Craig Ellis
(Copyright.(c) Craig Ellis 1997)
Part 2 .
The next two sections contain a significant amount of technical
information. It is intended as a very brief overview and introduction
of the subject area. I accept no responsibility for the accuracy or
otherwise of this material. The following are more specific
references for these topics :
Antibiotics
* Antibiotic Guide 1996. S. Lang. ADIS Press. 1995. ( Local NZ
book, most university hospitals produce similar)
* Handbook of Antibiotics, R.Reese. Little Brown and Co. 1993
Microbiology
* Microbiology : An introduction. G. Tortora. Benjamin&Cummings
1997 ISBN 0805385355
* Medical Microbiology and Immunology. Levinson. Lange 1996.
ISBN 0838562256
* Clinical microbiology made rediculously simple. Mark Gladwin.
Medmaster 1997. *** Excellent. My choice.***
Laboratory Medicine
No ideal book in this section, but these are a couple of
suggestions.
* Clinical Laboratory Medicine. K.McClatchey. Williams & Wilkins
1994. ISBN 0683052553
* Medical Laboratory Haematology. 2nd Ed. Butterworth.
7.0 . Medications
7.1 Storage and Rotation of Medications
Medications can be one of the more expensive items in your
storage inventory and there can be a reluctance to rotate them due to
this cost issue and also due to difficulties in obtaining new stock.
Unfortunately, drugs do have limited shelf life. It is a
requirement for medications sold in the US (and most other first world
countries) to display an expiration date. It is my experience that
these are usually very easy to follow, without the confusing codes
sometimes found on food products, e.g. -- Exp. 12/00=December 2000.
I cannot endorse using medications which have expired. But
having said that it is my understanding that the majority of
medications are safe for at least 12 months following their expiration
date. A colleague recently did some aid work in the Solomon islands
and a local pharmaceutical warehouse gave him a number of expired
drugs. They stated that the drugs were safe to use for at least
another 18 months. As with food the main problem with expired
medicines is not that they become dangerous, but that they lose
potency over time, and the manufacturer will no longer guarantee the
dose/response effects of the drug. The important exception to this
rule is the tetracycline group of antibiotics, which can become toxic
with time, there may be others that I am unaware of but it is very
difficult to obtain this information. Let the buyer beware, the expiry
dates ARE there for a reason.
In addition, I recommend that if you are acquiring medications on
a doctor's prescription that when you have the prescription filled you
explain the medications are for storage (you don't need to say exactly
what for), and request recently manufactured stock with distant
expiration dates.
The ideal storage conditions for most medications is in a cool,
dark, dry environment. These conditions will optimise the shelf life
of the drugs. A small number of drugs require refrigeration to avoid
loss of potency. These include insulin, ergometrine, oxytocin and
some muscle relaxants. Others such as Diazepam rapidly lose potency
if exposed to the light.
7.2 Antibiotics
7.2.1 Antibiotic Recommendations. In some cases access to
antibiotics may be very limited. The following is my preferred list
of antibiotics. If your limited in what you can get, I suggest you
purchase and expand in this order. All are good broad spectrum
antibiotics and have different strengths and weakness. I suggest you
purchase an antibiotic guide, most medical book shops have small
pocket guides for junior doctors detailing which drug to use for which
bug and outlining sensitivities.
1st A Broad spectrum Penicillin (e.g.-- Amoxycillin
+Clavulanic Acid)
2nd A Quinolone (e.g.-- Ciprofloxacin)
3rd A Cephalosporin (e.g.-- Cefaclor)
***** If allergic to Penicillin, I would advise A Quinolone as a
first choice with some Metronidazole as a anerobe back-up. Alternative
would be Erythromycin.
7.2.2 Antibiotic Summary
The Bugs:
-----------------
A basic understanding of how bugs (read bacteria) cause infections is
required to appropriately use antibiotics. I will not discuss viral
or other infective agents here. This is not the forum for a proper
discussion, so consider this a brief introduction. There are HUNDREDS
of bacteria, I will only discuss common disease causing ones in man.
Four Classes of Bacteria
- Gram positive ( + ve )
- Gram negative ( - ve )
- Anaerobes
- Others
Gram positive bacteria stain blue and gram negative bacteria stain
pink, when subjected to a gram staining test. It is related to the
presence or absence of a coating in the cell wall of the bacteria.
Anaerobic bacteria are ones which require no oxygen to grow. Bacteria
are also described by their shape (cocci = round, bacilli = oval) and
how they are grouped together (chains, clusters, pairs)
Gram Positive Bacteria ( Gram +ve)
- Staphylococcus: Commonest pathogen is S.. aureus. Gram + cocci in
clumps. Causes boils, abscesses, impetigo, wound infections, bone
infections, pneumonia (uncommonly), food poisoning and septicaemia.
Generally very sensitive to Flucloxacillin as first choice and
Augmentin and the Cephalosporins. A strain which is resistant to the
above, known as MRSA and is currently treated with vancomycin.
- Streptococcus: Gram + cocci in pairs or chains. Most are not
pathogenic in man, except Strep pneumoniae and the Strep pyogenes.
Strep pneumoniae causes pneumonia, ear infections, sinusitis,
meningitis, septic arthritis, and bone infections. Strep pyogenes
causes sore throats, impetigo, scarlet fever, cellulitis, septicaemia
and necrotising fascitis. Very sensitive to penicillins,
cephalosporins, and the quinolones.
Gram Negative Bacteria ( Gram -ve )
- Neisseria meningitidis: Gram -ve cocci iin pairs. Common cause of
bacterial meningitis, may also cause pneumonia and septicaemia. Can
be rapidly fatal. Sensitive to penicillins, cephalosporins,
quinolones, cotrimoxazole and tetracyclines.
- Neisseria gonorrhoeae: Gram -ve cocci inn pairs. Causes gonorrhoea.
Sensitive to high dose amoxycillin (single dose), Augmentin and also
cephalosporins and quinolones.
- Moxella catarrhalis: Gram -ve cocci in ppairs. Common cause of ear
and sinus infections, also chronic bronchitis exacerbations.
Sensitive to Augmentin, Cephalosporins, Quinolones and Cotrimoxazole
and tetracyclines.
- Haemophilus influenzea: Gram -ve cocco-baacilli. Can cause
meningitis (esp. in children under 5), epiglottitis, cellulitis and a
sub group cause chest infections. Sensitive as M.catarrhalis
- Escherichia coli: Gram -ve bacilli. Norrmally found in the bowel.
Causes Urinary infections, severe gastroenteritis, peritonitis (from
bowel injury), septicaemia. Drug of choice is a quinolone or
cephalosporin.
- Proteus sp.: Gram -ve bacilli. Lives inn the bowel. Causes UTI's,
peritonitis (from bowel injuries), wound infections. Drug of choice
is the quinolones.
Anaerobes
- Bacteroides sp. gram negitive bacilli. NNormal bowel flora.
Commonly causes infections following injury to the bowel or wound
contamination, causes abscess formation. Treated first choice with
metronidazole or second with chloramphenicol or Augmentin.
- Clostridium sp. Gram positive species.prooduce spores and toxins.
- C. perfringens/C.septicum - common cause of gangrene, treat
with penicillins or metronidazole
- C.tetani - tetanus ) damage is from toxins, not
- C. botulinum - botulism ) the bacteria themselves
- C. difficille - causes diarrhoea following antibiotics.
treat with metronidazole
Others:
- Chlamydia sp: Includes C.pneumonia, respponsible for a type of
atypical pneumonia and C.trachomatis, responsible for the sexually
transmitted disease chlamydia. It is best treated with Tetracyclines
or as second choice a macrolide.
- Mycoplasma pneumoniae: A cause of atypiccal pneumonia. Treated best
with a Macrolide, with a second chioce of a tetracycline.
The Drugs:
-------------------
Penicillins - These act by preventing replicating bacteria from
producing a cell wall. A number of bacteria produce a enzyme which
inactivates the penicillins ( B-lactamase).
A number of varieties:
*Benzyl Penicillin: Injectable preparation. Antibiotic of choice
against severe Strep pneumoniae and Neisseria sp infections such as
chest infections, meningitis and cellulitis.
*Phenoxymethylpenicillin (Penicillin V): Oral preparation of above.
Usually used only for the treatment of sore throats (strep throats),
in other infections largely replaced by amoxycillin which is better
absorbed.
*Flucloxacillin: Oral and IV drug of choice for Staph infection such
as cellulitis, boils and abscess and bone infections. Also usually
effective against Strep, but not first choice.
*Amoxycillin: (newer version of ampicillin): Oral and IV. Effective
against most gram positive and negitive bugs. Limited use secondary
to B-lactamase resistance in many bugs. This is overcome with the
addition of Clavulanic Acid ( eg Augmentin). Overcoming this
resistance, makes this combination my ideal survival antibiotic, with
good gram positive, negitive and anaerobic cover. This drug I feel is
the best "broad spectrum" antibiotic commonly available, other AB's
may be better for specific infections but this is the best all purpose
one.
Cephalosporins - Same method of action as penicillins. Developed in
three generations (now four, but not widely available). The third
generation e.g., Cefotaxime (Claforan, IV only) and Ceftriaxone
(Rocephin, IV only) have the most broad spectrum. They are effective
against most gram positives and negatives and some variable anaerobic
cover. The second generation e.g., Cefuroxime (Zinacef, oral and IV)
and Cefaclor (Ceclor, oral only) also have good general cover, but are
not as effective against some gram negitive bacilli. This loss of
gram negitive cover expands to most gram -ve cocci and bacilli in the
first generation cephalosporins e.g., Cephalexin (Keflex, oral only)
and Cephazolin (Kefzol, IV only). The third generation is ideal for
use in those with very severe generalised infection, meningitis or
intra-abdominal sepsis (e.g., penetrating abdo wound or appendicitis,
with metronidazole added in) and the second generation offer a good
broad spectrum antibiotic for general use in skin, wound, urinary and
chest infections.
Quinolones - Acts by inhibiting DNA replication in the nucleus of the
replicating bacteria. New generation of antibiotics. Most common is
Ciprofloxacin. Very broad spectrum cover, except anaerobes.
Excellent survival AB, but my second choice due to amoxycillin +
clavulanic acids better cover of anaerobes. Effective for most types
of infections except intra-abdominal sepsis and gangrene.
Macrolides - Acts by inhibiting protein synthesis in the replicating
bacteria. Includes Erythromycin and the newer Roxithromycin and
Clarithromycin. Often used in people with a penicillin allergy,
however it does have a reduced spectrum (esp. with Gram negatives),
but is an alternative to tetracycline in Chlamydia. First choice in
atypical pneumonias e.g., with Mycoplasma pneumonia.
Co-Trimoxazole - Acts by interfering with folate metabolism in the
replicating bacteria. Previously a very broad spectrum antibiotic,
now has a much more variable response rate due to resistance. Still
useful for urinary and, mild chest infections.
Metronidazole - Acts by directly damaging the structure of the DNA of
the bacteria/protozoa. Drug of choice for anaerobic infection.
Should be used with another broad spectrum AB in any one with possible
faecal contamination of a wound or intra-abdominal sepsis (such as
severe appendicitis). Also the drug of choice for parasitic
infections such as Giardia.
Others - There are many other antibiotics available. I have only
discussed the common ones above. For further information I refer you
to any Antibiotic guide, of which there are many.
NOTES
-----------
In pregnancy Penicillins and Cephalosporins are safe. Many others are
not (or only during certain parts of the pregnancy). You should
always check if any drug you are using is safe, before using in
pregnancy and breast feeding. The PDR will tell you. If you want a
specific reference try "Drugs in Pregnancy", Ed D.F Hawkins.
8.0 The Basic Laboratory
8.1 The basics of a diagnosis can generally be reached by a careful
history and physical examination. Modern medicine relies heavily on
laboratory investigations. In a survival situation these will not be
available. However there are some simple laboratory tests which can
be performed with very little equipment or chemicals. The problem is
that even basic tests require some equipment. Ranging from simple
test strips to a microscope and a few chemicals. Obviously what you
are preparing for will dictate what tests you may want to be able to
perform.
8.2 Urine Testing: Urine is easily tested with multi-function dip
stix. These can test for the presence of protein, glucose, ketones,
nitrates, red blood cells and white blood cells. The test strip is
dipped in a specimen of clean catch urine ( ie you start to pee in the
toliet, stop, then start again into the specimen container, stop, and
continue into the toliet) and panels containing the test reagents
change colour depending on the presence and concentrations of the
substance being tested for The colour changes are compared to a table
supplied with the strips. Can be used to diagnose urinary infections,
toxaemia in pregnancy, dehydration, diabetes (outside pregnancy) and
renal stones/colic.
The following is a quote on analysing urine from a book to be
published on the practice of medicine under relatively primitive
conditions.
********************************************************************************
>From . Roberts, S. D.; A Guide to the Practice of
Medicine Under Austere Conditions (Revised Ed.), 1997, to be
published.
Urinalysis
Of the various bodily fluids, urine is the most easily obtained. It is
possible to perform a number of tests on urine with little or no
equipment. Visual and olfactory examination of a urine sample
alone can provide considerable information. Urine which is pink, red,
or red-orange may contain blood, although it is important to remember
that these colors may also be seen in those who have eaten certain
foods, such as beets, blackberries, or rhubarb. Urine which is green
or blue-green, or which takes on these hues on standing, may indi-
cate diseases of the liver or gall bladder. Bright yellow or
yellow-orange urine is indicative of kidney dysfunction (if there is
no reason for the urine to be concentrated and if the color is
maintained for several days). Cloudy urine may result from abnor-
mally high levels of phosphates or carbonates in the urine, and may be
a precursor of kidney stones. Cloudy urine may also indicate the pres-
ence of an infection, particularly if the fresh urine has an odor of
ammonia or other disagreeable odor (note that urine will develop an
ammoniacal odor on standing).
It is possible to approximately localize an infection that is
producing cloudy urine by using the three glass test. This test
requires three clean containers (glasses), of which at least one (the
second used) will need a capacity of at least 500 ml. In this test,
the first 5 ml is voided into the first container, the second
container is used until the patient is almost done, and then the third
container is used to collect the last 5 ml. If the urine in the first
container is the most cloudy, with decreasing cloudiness in the
remaining containers, a urethral infection is the most likely cause.
If the urine in the first container is less cloudy than either of the
following two, a kidney, bladder, or prostate infection is indicated
as the cause, while, if the urine in the third container is
the cloudiest, the prostate is the likely site of the infection.
The odor of maple syrup associated with fresh urine is, of course, the
classic sign of maple syrup urine disease. The urine may also have
character istic odors which are associated with other genetic
disorders: the `mousy' odor associated with phenylketonuria, for
instance.The presence of glucose in urine has long been
recognized as an indication of diabetes, and its detection has been
assigned a high degree of importance by the general public. While its
presence was at one time detected by taste, a more aesthetically
acceptable method (which is also less likely to transmit infection) is
to heat the urine and observe the odor. If the scent of burning sugar
or caramel is detected, there is an excessive amount of sugar present.
Proteins, or carbonates and phosphates, in urine may be detected by
filling a test tube three-fourths full of urine and boiling the upper
portion. Any cloudiness produced by this may arise from either
the presence of carbonates and phosphates (which may be normal) or
from the presence of proteins. These two causes may be differentiated
by adding a small amount of acetic acid (3-5 drops of 10% acetic acid)
to the tube: if the cloudiness vanishes, carbonates and phosphates
were the cause; if the cloudiness persists (or becomes
apparent only after the acid is added), proteins are present.
The iodine ring test is a simple test which can detect the presence of
bile in the urine before color changes or jaundice make its' presence
obvious. In this test, the appearance of a green ring after layer-
ing a 10% alcoholic iodine solution over the urine in a test tube
indicates the presence of bile.
******************************************************************************
8.3 Blood Counts : There is no easy way to do blood counts without
some basic equipment. You require a microscope and a graded slide. A
graded slide is a microscope slide which has very small squares etched
onto its surface. Using a standardised technique a smear of blood is
placed on the slide. Now using the microscope the number of different
types of blood cells in a square on the slide is counted, this is then
repeated several times and then averaged. This technique will give
you:
- White Cell count
- White Cell differential
- Red Cell count
- Platelet count
8.4 Blood Grouping: The simplest thing to do is have your group or
expedition blood typed prior to your expedition or TEOTWAWKI. However
provided you have several basic chemicals a cross match is a simple
test. But due to its potential fatal complications if done
incorrectly I will not describe the procedure here. It is well
described in any basic laboratory medicine textbook. Also see
'Lucifer's Hammer" quote in section 12.0.
8.5 Pregnancy Tests: The ability to accurately diagnose pregnancy may
be important, both for psychological reasons and for the practical
reasons. Currently available pregnancy test kits test urine for the
presence of the hormone Human chorionic gonadothrophin (HCG). They
require only a small amount of urine, and are accurate from 10-14 days
from conception.
8.6 Blood Glucose test strips: Also known as BM stix, after a common
brand. This can be used to diagnose diabetes (in a survival
situation), both generally and during pregnancy, also it can detect
low or high blood sugars in other severe illnesses. A finger or toe
is pricked a a drop of capillary blood is collected onto a test strip.
It's allowed to sit for 30 seconds, then is wiped off, and a further
90 seconds, then the colour of the test strip is compared to a control
chart to give a blood glucose level.
8.7 Gram Staining: This is a technique for approximate identification
of bacteria in urine, pus, sputum, cerebral spinal fluid (csf) and
from bacterial cultures. Although not highly accurate in species
identification, combined with a knowledge of the clinical situation,
it enables a good guess to be made for the appropriate antibiotic. It
requires a microscope and also several chemical solutions. This is a
very standard microbiological procedure and can be learned very easily
at any entry level microbiology course.
The basic technique is: (1) the infected area or fluid is swabbed and
the swab smeared onto a slide and dried and fixed. (2)It is then
washed with crystal violet for 1 min, rinsed, washed grams iodine for
1 min, long rinse, washed safranin 30 seconds, washed again then
dried. It is then examined down the microscope. The bacteria will
stain certain colours and appear certain shapes depending on species,
this aids in identification as discussed already.
9.0 Simple Medical Tips
9.1 * Rectal Fluid Resuscitation
The standard technique of giving fluids to an unconscious, shocked or
dehydrated person is with intravenous fluids. However this may not be
possible in a survival situation. An alternative is to give fluids
rectally. This method will obviously not work if the cause of the
problem is severe diarrhoea. This is included for interest only and I
do not recommend this procedure :-)
The person is placed on their side, with the buttocks raised on two
pillows. A lubricated plastic tube with a blunt end (a large urinary
catheter or naso gastric tube is ideal) should be passed through the
anus into the rectum for about 9 inches. It should pass with minimal
pressure and should not be forced. The danger is perforating the
bowel.
The tube should be taped to the skin. A longer length of tubing and a
drip bag or funnel should be attached to the end and elevated. Then
200mls of fluid slowly dripped in over 15 to 20 minutes. The catheter
should then be clamped. This can be repeated every 4 hours with a
further 200mls. Upto 1000-1200mls/24hrs can be administered this way.
If 200mls is tolerated it can be worth increasing the volume slightly
or reducing the time to 3 1/2 or 3 hrs. If there is over flow the
volume should be reduced. A rectum full of faeces does not absorb
water very well, so the amounts may need to be reduced, but given more
frequently.
9.2 * Death
People are going to die, one way or another it will happen and
you need to be prepared for it.
9.2.1 Diagnosing Death:
No pulse.
No respirations.
No heart sounds.
No pupil response to light.
Hypothermia Note:
Precautions need to be taken where the person concerned has been in
the extreme cold, either the snow or very cold water. Severe
hypothermia causes a profound slowing in the bodies metabolism and as
a consequence can mimic death. Hence the saying " Your not dead, until
your warm and dead ".
One option is to aggressively resuscitate anyone found in the above
situations, although in my view this is likely to be an extremely
uphill battle in a survival situation, especially if they clinically
appear to be dead. The management of severe hypothermia is dealt with
in detail in most advanced first aid texts. But for interest the
basics are included below:
Extreme care needs to be taken in handling a very hypothermic
patient as they are predisposed to developing ventricular fibrillation
if roughly handled. But the goal is slow rewarming
- body heat
- warm room
- space blanket
- warm IV fluids *
- irrigation of stomach and bladder
with warm fluid *
- packing groin and axilla with hot
packs. *
* there is still some debate in the literature about the place
for these last 3 options.
9.2.2 Handling a dead person: The human body decomposes very quickly,
especially in hot weather. A decomposing body rapidly becomes a
health hazard. A dead person should be buried quickly, in a
reasonably deep grave to avoid predation by scavengers. Most
religions have short rites for the burying of the dead, but for
the non-religious a favorite poem may be appropriate.
9.2.3 Records: It is important to document the fact that someone has
died, but also the circumstances of the death, your guess as to a
cause of death and how the body was disposed of. This becomes
important for legal reasons should things return to normal or in the
case of an isolated expedition for the coroner on your return.
9.3 * Gastroenteritis and Dehydration. Gastroenteritis is still a
killer in the third world especially for young children (I include
typhoid, cholera, giardia, salmonella, "food poisoning" etc, under the
general heading gastroenteritis). The most important preventive
action you can take in preventing gastroenteritis is to wash your
hands following defecation. Also hands should be washed before
handling food, dealing with the sick or babies and infants. All
drinking water should be boiled unless you are sure of its purity.
Hand washing and clean water will prevent 99% of diarrhoeal disease.
This topic is very well covered in "Where there is no Doctor".
9.3.1 What kills is not having diarrhoea or vomiting, but dehydration.
Again this is not the forum for detailed medical treatments. But you
must understand how to recognise dehydration and know how to treat it.
The basis of any treatment is replacement of lost fluids and
electrolytes. This is a relatively simple matter if you have access
to IV fluids, but without you must rely on the patient drinking. It
is often difficult to get a patient to drink, especially when they
feel very unwell, but it must be emphasised to them that if they don't
drink they will die. The secret is small amounts of fluid,
frequently. If you try and force a large glass down, it will come
straight up right away. They must put in at least what they are
putting out, more in hot weather. There has been much debate over what
to offer to replace lost fluids and electrolytes. It must contain not
only water, but also Sodium (table salt), Potassium (light salt) and
also some form of sugar. The sugar is vital for absorption to take
place in the intestines, salts alone are poorly absorbed when the gut
lining is damaged as it often is in gastroenteritis. I refer you to
an excellent article in *Scientific American* May 1991 on oral
rehydration formulas (thanks to Logan VanLeigh for the reference).
9.3.2 Oral Rehydration Fluid: The following is an easy formulae for
making an oral rehydration fluid.
1/4 Tsp Salt (Sodium Chloride)
1/4 Tsp Lite Salt (Potassium Chloride)
1/4 Tsp Baking Soda
2 1/2 Tbsp Sugar
Combine ingredients and dissolve in 1000 mls (1 liter) of boiled
and cooled water.
9.4.0 Sterilisation:
I've tried to emphasise the importance of basic hygiene in any
survival situation. This is especially true when performing any
surgical procedure. From suturing a small cut or dressing a wound, to
dealing with a major injury or operation.
You should wash your hands for 2-3 minutes with soap or a
surgical scrub and then if available use a pair of sterile gloves.
The instruments you are working with should also have been sterilised.
There are several effective low tech ways to do this:
1) Soaking in Alcohol: Soak the instruments in Ethyl Alcohol. The
higher the concentration and the longer the soak the better.
Recommended that > 70% (ideal is >95%) solution for >12 hrs. This
time can be shortened to several hours by the addition of Formaldehyde
solution to the Alcohol.
2) Boiling in water: Boil in water for 30 minutes (at sea level).
Will cause rusting of anything which holds a edge such as scissors and
knives. De-ionised or soft water will reduce this problem.
3) Pressure cooking: The gold standard in a survival situation. This
is the basis for hospital autoclaves. Ideally the instruments must be
cooked for 30-40 minutes at temperatures >110 deg at 18-20 psi. Using
this method it is possible to sterilise instruments wrapped in cloth
or linen. This will mean they stay sterile following removal from the
pressure cooker and can be used at a later date. If packed allow
further 15-20 minutes drying time. The instruments need to be placed
on a rack in the pressure cooker, above the water in the bottom,
rather than in the water. The main problem is that home pressure
cookers and canners mostly they come in a range of 5, 10 and 15 lbs of
pressure which I understand equates to 220, 230 and 240 degrees
Fahrenheit at sea level pressure. There's no safe way to take them up
to 20 psi without the serious risk of blowing their pressure safety
valves. They generally come in two types, the dial gauge and the dead
weigh pressure gauge.The dial gauge can do odd pressure levels, but
really needs to be calibrated periodically with a year being the
suggested interval. This calibration is usually beyond what the
average homeowner can do, thus they are not well suited to
survivalist use. The dead weight gauge can only do what it is
manufactured for, 5, 10, 15 psi for most pressure canners and usually
only 10 or 15 psi for most pressure cookers. The best advise to those
using these devices is to use one set for 10 or 15 psi and lengthen
the "cooking time" by 15 minutes. There is no good information
available about improvising "autoclaving", so this information must be
used with caution. ( Thanks to Alan Hagan for help with this section )
10.0 Alternative Therapies.
10.1 Finally, I feel I should make a passing comment on alternative
therapies. I *EXCLUDE* herbal- and plant-based medicines from the
following comments, because obviously these medicines form the basis
of modern pharmacology and post-TEOTWAWKI will do so again. I stress
these are my opinions. If you find a particular alternative treatment
works, and wish to practice it and use it post-teotwawki then that's
fine. However I think it would be unsafe to ignore conventional
medicine. The alternative therapies are most commonly used and
successful with low grade chronic problems. I would suggest that what
will kill you and what you need to prepare for is not chronic lower
back pain or irritable bowel syndrome, but major trauma, or cholera,
or severe pneumonia and I don't think arnica or a good foot rub will
fix the problem. Things which are currently annoying or distressing
chronic problems may pale into insignificance alongside finding enough
to eat and drink and avoiding the baddies. (But who knows, under
survival stress it may make them worse :-))
10.2 Colloidal Silver should be specifically mentioned as it receives
a lot of questions on the news group. IMHO its merits have been
exaggerated in the extreme. There is no reputable scientific evidence
that it has any useful in-vivo (in the human body, rather than in a
lab) antibiotic or antibacterial effects. If its proponents can
supply recent case/controlled trials, published in a reputable
scientific or medical journal, I am prepared to revise my opinion and
include the results here. I just advise caution to those who plan to
rely on CS as their antibiotic in a survival situation.
11.0 Common Sense Medical Phrases
There are hundreds of little sayings within medicine about dozens of
topics. At first some of them sound extremely basic or stupid, but
the all have a basis in fact. Medicine is made up of common sense.
Here's a selection. I welcome additions.
* Knowledge is power.
* First do no harm.
* Masterful inactivity saves lives.
* The placebo effect has cured more people than any doctor.
* If it hurts rest it or immobilise it.
* Always wash your hands before touching a patient.
* Its better to boil all your water, than die of diarrhoea.
* Don't shit in the water you are going to drink (or let anyone else).
* A comfortable, warm bed fixes many problems, a good meal fixes many
more.
* Direct pressure stops bleeding.
* Pretend you know what you are doing and people will believe you do.
* Don't stitch a dirty wound.
* Clean boiled water is a great antiseptic (So is urine but we won't
start that one)
* If you've got a rash: If it's wet, dry it; if it's dry, wet it.
* 90% of problems get better by themselves.
12.0 Quotes and Final Comments
12.1 Quotes from "Lucifer's Hammer", Larry Niven and Jerry
Pournelle. Copyright Little Brown and Company (UK), 1995. pg 610-612
I've included these quotes because one accurately describe a primitive
medical technique, giving an example of how a life saving procedure
such as cross matching blood can be done under primitive conditions
and the second and third summarises several key realities of a long
term TEOTWAWKI situation. Obviously I do not recommend using this
procedure.
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When Maureen reached the hospital, Leonilla Malik took her and led
her firmly into a front room.
"I came to help," Maureen said. "But I wanted to talk to the
wounded. One of the Tallifsen Boys was in my group and he-".
"He's dead." Leonilla said. There was no emotion in her voice.
"I could use some help. Did you ever use a microscope?"
"Not since college biology class"
"You don't forget how" Leonilla said. "First I want a blood
sample. Please sit down here." She took a hypodermic needle from a
pressure cooker. "My autoclave" she said. "Not very pretty but it
works."
Maureen had wondered what had happened to the pressure cookers
from the ranch house. She winced as the needle went into her arm. It
was dull. Leonilla drew out the blood sample and carefully squirted
it into a test tube which had come from a child's chemistry set.
The tube went into a sock: a piece of parachute cord was
attached to the sock, and Leonilla used that to whirl the test tube
around and around her head. "Centrifuging" she said. "I show you how
to do this and then you can do some of the work. We need more help
here in the lab". She continued to swing the test tube.
"There", she said. "We have separated the cells from the
fluid. Now we draw off the fluid and wash the cells with saline." She
worked rapidly. "Here on the shelf we have cells and fluid from the
patients who need blood. I will test yours against theirs."
"Don't you want to know my blood type?", Maureen asked.
"Yes. In a moment. But I must make the tests anyway. I do not
know the patients blood types and I have no way to find out, and this
is more certain. It is merely very inconvenient."
The room had been an office. The walls had been painted not
long ago and were well scrubbed. The office table where Leonilla
worked was formica, and very clean. "Now", Leonilla said "I put
samples of your cells into a sample of the patient's serum, and the
patient's cells in yours, so, and we look in the microscope."
The microscope had also come from a child's collection.
Someone had burned the local high school before Hardy had thought to
send an expedition for its science equipment.
"This is very difficult to work with." Leonilla said. "But
it will work. You must be careful with the focus." She peered into
the microscope. "Ah, Rouleaux cells. You cannot be a donor for this
patient. Look so that you will know."
Maureen looked in the microscope. At first she saw nothing,
but she worked the focus, the feel of it coming back to her fingers.
..Leonilla was right, she thought. You don't really forget how. She
remembered that you weren't supposed to close close the other eye, but
she did anyway. When the instrument was properly focused she saw
blood cells. "You mean the little stacks like poker chips?", she
asked.
"Poker chips?"
"Like saucers-"
"Yes. Those are Rouleaux formations. They indicate clumping.
Now what is your blood type?"
"A" Maureen said.
"Good. I will mark that down. We must use these file cards one
for every person. I note on your card that your blood clumps that of
Jacob Vinge, and note the same on his card. Now we try yours with
others." She went through the same procedure again, and once more.
"Ah. You can be a donor for Bill Darden. I will note that on your
card and his."
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...................."We have no way to store whole blood, except as
now - in the donor".
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...................."No, we must learn to live without penicillin."
She grimaced. "Which means a simple cut untreated can be a death
sentence. People must be made to understand that. We cannot ignore
hygiene and first aid. Wash all cuts."
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12.2 For a fictional account I recommend James Wesley Rawles
"TEOTWAWKI". This contains accounts of survival medicine in practice
(in addition much other excellent material) with detailed descriptions
of several surgical procedures and childbirth in a post-collapse
society. Although there is some dramatisation to it I feel this
accurately reflects some of the medical situations which will need to
be faced.
12.3 These are some final thoughts about the medical situation post
a severe TEOTWAWKI. I've included this just to stimulate some
thoughts and discussions:
With no antibiotics there would be no treatment for bacterial
infections, pneumonia and a cut would kill again, contagious diseases
(including those sexually transmitted) would make a come back and high
mortality rates would be associated with any surgery. Poor hygiene
and disrupted water supplies would lead to an increase in diseases
such as typhoid and cholera. Without vaccines there would be a
progressive return in infectious diseases such as polio, tetanus,
whooping cough, diphtheria, mumps etc, especially among children.
People suffering from chronic illnesses such as asthma, diabetes or
epilepsy would be severely effected with many dying (especially
insulin dependent diabetics). There would be no anesthetic agents
resulting in a return to tortuous surgical procedures with the patient
awake or if they were lucky drunk or stoned. The same would apply to
painkillers, a broken leg would be agony and dying of cancer would be
distressing for the patient and their family. Without reliable oral
contraceptives or condoms the pregnancy rate would rise and with it
the maternal and neonatal death rates, woman would die during
pregnancy and delivery again and premature babies would die. Women
would still seek abortions and without proper instruments or
antibiotics, death from septic abortion would be common again. In the
absence of proper dental care teeth would rot and painful extractions
would have to be performed. What limited medical supplies were
available would have to be recycled, resulting in increases risks of
hepatitis and HIV infection.
***THE MOST IMPORTANT THING TO REMEMBER IS THAT GOOD HYGIENE CAN
PREVENT MANY PROBLEMS. WASH YOUR HANDS AND BOIL YOUR WATER!***
Any comments or suggestions welcomed. I plan to periodically update
this FAQ with any recurring questions from misc.survivalism and also
with any interesting things I come across.
Craig Ellis
loucr@globe.co.nz
All views in this FAQ reflect only my opinions and is not to be
considered in any way a professional opinion or advice.
(
geocities.com/mark_l_anderson)