Wednesday, 28 January 2015

09:24 – Barbara gets her staples out today, which should help a lot. She’s frustrated that she’s not recovering faster, even though according to her nurse and physical therapist she’s doing extremely well.

We’re re-watching Everwood, which features the adorable Emily VanCamp. As Barbara commented last night, she hasn’t changed much at all between age 15 in the first season of Everwood and age 27 now in Reven8e. She’s a young adult woman now, and she was a young adult woman then. If someone had told me she was 21 instead of 15 then, I’d have believed it. If someone told me she was 21 instead of 27 now, I’d believe it.

In one of the episodes we watched last night, the whole group ended up snowed in at a party. One of the characters came down with appendicitis and there was no way to get him to the hospital. There were three doctors present and a former Army nurse, so they had the skills they needed but not the equipment. Which got me to thinking of what I’d do in a similar situation. As it turns out, we’d be in pretty good shape, at least relative to most people. Other than whole blood, we’d have everything we needed or the means to make it, from povidone iodine to antibiotics to sterile scalpels and hemostats, masks, saline/D5W, and so on. I’d be very nervous about anesthesia, but I do have both chloroform and diethyl ether on hand, as well as the means to produce oxygen. Not to mention an earlier edition of the book Emergency War Surgery, which despite the title covers everything from doing appendectomies through C-sections.


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48 Responses to Wednesday, 28 January 2015

  1. OFD says:

    Most folks, including us here, would be outta luck. I can do basic first aid and CPR and that’s it, certainly not ‘war surgery.’ If things ever get that bad, peeps with EMT, paramedic and nursing backgrounds will be quite valuable to have around, let alone actual doctors. But good point; it would also be necessary to have the gear and dope available.

    Another day of sun and blue skies here, 10 degrees with a 5 below chill factuh. A bit more snow expected on Friday and warming up to high 20s and even 30!

    Mrs. OFD was scheduled to drive back from Concord, NH on Friday, directly to the airport here, and then fly to Mordor for a one-day mandatory meeting with the suits. She may not make it and would be quite happy not to.

  2. Robert Bruce Thompson says:

    The emphasis has changed in later editions of Emergency War Surgery. Older editions focused not just on what non-surgeon physicians needed to know to do surgery, but on nurses, veterinarians, dentists, and so on. Basically, the earlier editions were intended to help non-surgeons with nursing-level or above skills learn what they needed to do surgery in an emergency.

    In that situation today, I’d operate if no one better-qualified was available. I figure that a 99% chance of dying is better than a 100% chance. If a surgical nurse or vet were available, I’d assist if no one better qualified was available.

  3. OFD says:

    Agreed, just common sense and the odds.

    Many of us have noticed the difference with actual war-related injuries over the past half-century; guys coming back alive now would not have done so during the SEA capers. In fact guys coming back alive THEN would not have done so from Korea and the Good War. But the troops arriving here now ‘back in the World’ don’t come back in one piece; their better armor and more rapid evac from the battlefield still leaves them with missing limbs and the IED-related brain injuries.

    Speed is of the essence when treating major injuries and wounds, we know that much.

    And back in the day when I was on a rural small-town police department one of the guys blew off any advanced medical emergency training, saying all ya gotta do is stop the bleeding and call an ambulance.

  4. Robert Bruce Thompson says:

    Yep. I’d thought about doing a paramedic course, but that’s 2,000 hours that I really don’t have time for. I thought about doing now what I did almost 40 years ago by reading the texts for four full years of med school, but that wouldn’t work now. Back then, I could literally memorize texts on one reading. Nowadays, my memory is a very pale shadow of what it was then. It’s far more practical now for me just to make friends with doctors, nurses, vets, and so on. On my end, I need to figure out what I need to make them stuff they need. For example, sterile saline/D5W is trivially easy for me to make, but most doctors/nurses/vets would have no clue. It’s just something they pull off the supply shelves.

  5. Ray Thompson says:

    For example, sterile saline/D5W is trivially easy for me to make

    Is that anything like WD40? 🙂

  6. Robert Bruce Thompson says:

    Yep, exactly.

  7. OFD says:

    “It’s far more practical now for me just to make friends with doctors, nurses, vets, and so on…”

    How does this pan out if you’re still planning on moving to a safer locale? I dunno about you, but making friends with me takes some time. Especially if I do not ordinarily move about in their circles.

  8. JLP says:

    Try the Friendship Algorithm:

    http://i.imgur.com/pWnr8VC.png

  9. Robert Bruce Thompson says:

    Homeschooling is a big in. I don’t have time to teach high-school science courses, but I can help the local homeschool group or co-op plan and execute lab courses. I can also donate science kits and other gear as needed. That’s a good way to make friends quickly.

    It would probably surprise many who know me only on-line, but in person I’m actually pretty laid back and diplomatic. I can get along well with most people.

  10. jim` says:

    Hmm, I wonder if I could do an appendectomy. I know my anatomy and I’m really good with a sharp knife/scalpel. I know a couple different types of stitches, too. What I don’t have are retractors and needles and cat-gut or silk. BTW, I don’t know if it’s just me, but I hate those dissolvable stitches — they itch like crazy and my body tries to reject them.

    34.5 grams salt per 1 gallon distilled water makes 0.9% or Normal Saline. I mix it by the gallon to rinse my contacts. When I need it absolutely sterile I put it in a very clean, covered dish and pressure cook at 15 PSI for 15 minutes.

  11. Robert Bruce Thompson says:

    Yeah, it’s useful to know the formulations and have the materials on hand (including a pressure canner/cooker that can do 15 PSI) to make up D5W, D5NS, lactated Ringer’s, ORS, and so on.

  12. Robert Bruce Thompson says:

    Or, if you’re Ray, you can just substitute WD40 for any of those.

  13. Ray Thompson says:

    but I hate those dissolvable stitches

    Duct tape. That and WD40 and you can fix anything.

    Or, if you’re Ray, you can just substitute WD40 for any of those.

    I wonder if you have to sterilize it first?

  14. Robert Bruce Thompson says:

    I actually do have a roll of duct tape in my main medical kit. It’s surgical tape for Real Men.

  15. MrAtoz says:

    I actually do have a roll of duct tape in my main medical kit. It’s surgical tape for Real Men.

    It is also good for “waxing” your Mr. OFD Bigfoot hairy legs.

  16. Robert Bruce Thompson says:

    No, seriously I do have a roll in my main medical kit. It has many medical uses.

  17. rick says:

    Yep. I’d thought about doing a paramedic course, but that’s 2,000 hours that I really don’t have time for.

    An option is the Red Cross “Certified First Responder” class, which is about 50 hours. See http://en.wikipedia.org/wiki/Certified_first_responder

    I was certified a number of years ago. It requires annual re-certification, which I did not do, so I am not currently certified. I am considering doing it again. It’s not the same as EMT training, but it’s more comprehensive than standard first aid traning.

    Rick in Portland

  18. OFD says:

    Hmmm…new to me…they didn’t mention this at the one-day class I took in December…dunno even if it’s offered up here…

  19. Lynn McGuire says:

    I actually do have a roll of duct tape in my main medical kit. It’s surgical tape for Real Men.

    Or super glue.

  20. rick says:

    15 year old high school student “gets lucky”. Teacher charged with felony. http://www.oregonlive.com/clark-county/index.ssf/2015/01/stephanie_mccrea_vancouver_tea.html#incart_river

    Either that or a kid was really pissed at her and made it up.

    Political correctness gone wild. Whether they’ll admit or not, teenage boys are different from teenage girls.

    Rick in Portland who is the father of two boys (grown) and one 18-year-old girl.

  21. Lynn McGuire says:

    We just had a 62 year old guy convicted of sexual assault on a child for paying young ladies $300 to come to his house for sexual favors. They were mostly under the age of 17 except his “girl friend” who is 17? The judge is sending him to jail for six months and then probation for ten years.
    http://www.myfoxhouston.com/story/23911943/2013/11/07/62-year-old-man-money-mike-accused-of-paying-underaged-girls-is-out-of-jail
    http://www.chron.com/news/houston-texas/texas/article/Judge-sentences-Money-Mike-to-180-days-in-jail-6029952.php

    Now the girl’s parents are reputedly going to sue him for enticing their daughters to be prostitutes.

  22. OFD says:

    What a country!

    And cue up Miranda again, from “The Tempest,”

    “O brave new world…etc.”

    Hell, sing it!

    https://www.youtube.com/watch?v=R0xoMhCT-7A

  23. jim` says:

    Painter’s tape works as well…

    Sliced the flusk out of my hand and Doc in the Box wanted like 1300 for a couple stitches.

    Very clean laceration, so I told them to GTH and a friend and I did a modified butterfly. The butterfly was interesting and my own idea. Don’t think I’ve heard of it before.

    Anyway, gauze, bamboo skewers and painter’s tape took care of the rest.

    Nice thing is that the scar is so neat and tidy that stitches would look like shite compared to them.

    http://alwaysthecritic.com/images/painters_tape.jpg

  24. eristicist says:

    Eeesh, an emergency appendectomy doesn’t sound fun. I’d bet heavily against myself managing it.

    I wonder, theoretically, how plausible it’d be to do a non-invasive appendectomy with focused sound waves, like lithotripsy or HIFU tumour ablation.

  25. Lynn McGuire says:

    Hey jim`, you do know that images directory of yours is wide open?

    You can add an index.html file to it to close it.

  26. J Kamp says:

    @RBT

    Not sure if you know about the author James Wesley, Rawles so I thought I would pass this on. He is the author of the Patriot Novels about survival in the coming collapse. Each of the novels cover different regions of the world (US, Canada, Australia and the Phillipines). The author also has a web site SurvivalBlog.com.

    I’ve only read the novel Expatriates which covers Australia and the Phillipines. Not a bad read. Some religion but not too much. I thought you might be interested in the list of military manuals and medical books mentioned in chapter 10. I’ve listed some of them below. While checking out some of the manuals I came across the web site http://www.armymilitarymanuals.com/ which, if nothing else, could be used as a reference for other manuals that are available.

    Additionally, he has also written a book “Tools for Survival”. Subjects include food preservation, tools and firearms. He even writes about dry pack canning in #10 cans.

    Hope you find something of use in all this.

    Expatriates James Wesley, Rawles

    Chapter 10 DOWNLOADS

    Manuals:
    Survival and Evasion, FM 21-76-1
    USMC Survival Manual, MCRP 3-02F
    Camouflage, FM 5-20
    Camouflage of Vehicles, FM 5-20B
    Field Hygiene and Sanitation, FM 21-10
    Improvised Explosive Devices or lEDs.TM 31-210
    Infantry Rifle Platoon-Squad, FM 7-8
    Ranger Handbook, SH 21-76
    Survivability, FM 5-103
    NBC Protection, FM 3-4
    NBC Decontamination, FM 3-5
    Special Forces Unconventional Warfare, TC18-01
    M16 and M16A1 Rifles Operator’s Manual,TM 9-1005-249-10
    Sniper Training, FM 23-10 a
    USMC Sniping, MCWP 3-15.3
    Counter Guerilla Operations
    Jungle Operations
    Long Range Surveillance Unit Operations
    Military Mountaineering, FM 3-97.61
    Special Forces Use of Pack Animals, FM 3-05.213 (FM 31-27)
    Claymore Mine, FM 23-23
    Obstacles, Mines, Demolitions, FM 90-10
    Ordnance and Explosives Response
    Ranger Unit Operations, FM 7-85
    USMC Scouting and Patrolling, MCWP 3-11
    Military First Aid Manual, FM 4-25-11
    US Army Tactical Combat Casualty Care (TCCC) Correspondence Course
    NATO Emergency War Surgery
    Combat Lifesaver Home Study Course

    Medical:
    Where There Is No Doctor by David Werner
    Where There Is No Dentist by Murray Dickson
    Wilderness Medicine, 5th Edition, by Paul S. Auerbach
    2012 Nurse’s Drug Handbook
    Ditch Medicine: Advanced Field Procedures for Emergencies by Hugh Coffee
    Medicine for the Outdoors by Paul Auerbach
    The Merck Manual of Diagnosis and Therapy
    Primary Surgery: Volume 1: Non-Trauma by Maurice King
    Primary Surgery: Volume 2: Trauma by Maurice King
    The Sanford Guide to Antimicrobial Therapy 2012 Edited by David Gilbert
    Tactical Medicine Essentials by E. John Wipfler
    Wilderness Medicine, Beyond First Aid, 5th Edition by William W. Forgey
    Wilderness 911 by Eric Weiss’
    Wounds and Lacerations: Emergency Care and Closure by Alexander T. Trott, MD
    The Doom and Bloom Survival Medicine Handbook by Joe Alton, MD and Amy Alton

  27. Ray Thompson says:

    Sliced the flusk out of my hand and Doc in the Box wanted like 1300 for a couple stitches.

    In my younger days I was riding my Honda 50 back from a haying job about five miles up the road from where I lived. Coming around a curve and two cretins were racing each other and blocking my lane. I headed to the shoulder but unfortunately where I went an irrigation ditch came out from under the road and in I went. I had my extremely sharp pointed hay hooks with me and apparently one of the hooks sliced my chest diagonally for about 5 inches in the middle of my chest. Missed the major muscles for most part. But you could see the bone if you parted the cut.

    I struggled with much pain to get my motorcycle out of the ditch such effort consuming several minutes. The two cretins never stopped to help. A lot of blood everywhere. Once I got the machine started I drove with one hand and held my chest closed with the other hand. I was soaked in blood.

    When I got home I was so afraid I was going to get in severe trouble, have my machine confiscated and other nasty treatment (normal) by my aunt and uncle I decided to hide the damage. I cleaned myself up and destroyed my bloody clothes. I then used sports tape, a lot of it, to hold the wound closed. I also packed a lot of gauze under the tape to provide pressure. It was a very clean slice and there was no infection. Eventually it healed and today you can barely see the scar that was left. Probably healed as well as if I had had sutures. I suspect from the size of the wound there would have been 30 to 40 sutures.

    Yeh, I was stupid, but I survived.

  28. pcb_duffer says:

    [snip] I wonder, theoretically, how plausible it’d be to do a non-invasive appendectomy with focused sound waves, like lithotripsy or HIFU tumour ablation. [snip]

    I know that lithotripsy is used to break up kidney stones, but how well it would destroy the bacteria causing the infection in the appendix would be an interesting question. Then of course, could the body effectively rid itself of the destroyed bacteria, and presumably destroyed tissue of the appendix?

    As to the first question, I recall that both my parents used a machine to clean their dentures which used sound waves. It ought to be possible to culture some sacrificial bacteria, put the culture in a ziplock bag, and then into the denture cleaning machine. Zap them for say 20 minutes and then see how many of the little guys remain viable. Maybe an interesting experiment for some kid’s science fair project!

  29. OFD says:

    Jeezum, Mr. Ray, I dunno how in the hell you made it this far. Ditto myself, but my stories about near-death are mostly mil-spec- and cop-related.

    Oh wait—I fell through the ice at Walden Pond in Concord, MA when I was 14. I won’t forget that as long as I live, but I believe I’ve described it here before. You won’t see me out on the bay ice here fishing anytime soon.

  30. Ray Thompson says:

    Jeezum, Mr. Ray, I dunno how in the hell you made it this far.

    Yeh, it amazes me. Chest sliced open, finger nearly amputated while changing blades in a hay baler, run over by a fertilizer spreader, almost thrown off the front of a moving bulldozer, hung up on antlers hung on a barn with the antler in my armpit, multiple cuts of all varieties, fell 20 feet from the rafters of a barn onto a wood floor (some flex which minimized injury), kicked unconscious by animals more than once and some things I just don’t remember at this time. I have a lot of scars on my body. But I never broke any bones until I was in the USAF when I broke my back diving into shallow water.

  31. SteveF says:

    Eeesh, an emergency appendectomy doesn’t sound fun. I’d bet heavily against myself managing it.

    Hmmph. I’ve done open-heart surgery without any training. On myself! And I had to do it barefoot walking uphill in the snow! And I was grateful!

  32. Ray Thompson says:

    And I had to do it barefoot walking uphill in the snow!

    Wimp! It was probably during daylight hours.

  33. OFD says:

    He’s a wuss; a wittle birdie from the Capital Districk tol me he did it while listening to Barry Manilow on his iPod buds.

    “…I never broke any bones until I was in the USAF…”

    Yeah, I can attest that while the USAF comes across as the wimpy high-tech service and the zoomies get great chow and places to stay at, they can fuck you up just as bad as if you was in the Corps or the Seal boot camp.

  34. ech says:

    I checked with the wife (an anesthesiologist) and D5W isn’t used in surgery. Normal saline or Lactated Ringer’s is the standard. You don’t want to give much in the way of isotonic fluids to replace fluid loss. She also said the whole fluid management regime is under study right now and may change.

    I wonder, theoretically, how plausible it’d be to do a non-invasive appendectomy with focused sound waves, like lithotripsy or HIFU tumour ablation.

    Probably not a good idea. Half the idea in an appendectomy is to get out what caused the infection to start in the first place. The possibility of a rupture happening is a major concern.

    My dad had to do an emergency appendectomy in the Navy. He was a surgical assistant on the USNS Comfort in WWII. They were starting an emergency appendectomy when the surgeon went nuts and decided to open the patient with a bone saw. They subdued the surgeon, and since nobody else was available, my dad (then 18) did the surgery. He had two advantages: his dad was a GP and my dad wanted to go into medicine after college, so he had seen surgery; and my grandfather had studied under Charles McBurney – the pioneer of the appendectomy.

  35. Robert Bruce Thompson says:

    @J Kamp

    Thanks. I already have nearly all of those in print on my bookshelves, most from 35+ years ago.

  36. Robert Bruce Thompson says:

    I checked with the wife (an anesthesiologist) and D5W isn’t used in surgery. Normal saline or Lactated Ringer’s is the standard.

    Thanks. Yes, I understand what D5W/D5NS, physiological saline, and lactated Ringer’s are for, but I again I wouldn’t plan to do any medical stuff myself. I figure my job, should it come to that, would be to have the knowledge, skills, and materials to give the qualified medical folks what they needed. That’s why, for example, I know how to synthesize the purely synthetic antibiotics (sulfas, chloramphenical/thioamphenicol, etc.), as well as many other drugs.

    As I’ve said repeatedly, I don’t expect things to get as bad as OFD does. But he may be right, and if he is I intend to be prepared for the worst to the best of my ability. If things do get really bad, I expect that skilled medical personnel will be relative rare and in high demand. But wizards will be even rarer and in greater demand, so I’ve been training for 40+ years to be a wizard.

  37. OFD says:

    “…I don’t expect things to get as bad as OFD does.”

    I should probably stipulate for those yet unaware that my views stem from a very cynical, pessimistic and bitter outlook, and maybe a good chunk of what I say can be discounted thereby. Let’s hope so.

  38. Robert Bruce Thompson says:

    But you may be right. And, by a strange coincidence, my business inventory puts me in a much better position to be a wizard.

  39. jim` says:

    Lynn McGuire, yeah I know the directory is wide open. I only post pics infrequently and figure anyone with the know-how might have fun sniffing through the rest. One of those ROUNDTUIT projects.

  40. Lynn McGuire says:

    I should probably stipulate for those yet unaware that my views stem from a very cynical, pessimistic and bitter outlook, and maybe a good chunk of what I say can be discounted thereby. Let’s hope so.

    I hope and pray for Bob’s dystopia. We will build huge PRC’s for 50,000 people at a whack and convert the food stamp program into a daily nutritional yeast based product of 2,500 calories. To start, then later daily nutritional products will drop a few calories and move to a supplemental status. It will be rougher, way rougher, than it is now but at least we will have some sort of civilization. Grocery stores will have armed guards, trucks will travel in convoys, etc.

    OFD’s dystopia really, really, really sucks. I’ve read a lot of dystopian novels and they almost all start off with the non-preppers dying at 10% per month. At about three to six months in, about half of the population is dead. BTW, the preppers only die at 5% per month (statistically not much better). No grocery stores.

    BTW, I’m still looking for some idiot to loan me a billion dollars that I can pay back after the great mega-inflation of the USA dollar. It is easy to get a million dollar loan but those extra zeros loans are very hard to find.

  41. Robert Bruce Thompson says:

    The main reason I am more optimistic than OFD is, as I keep saying, that we have a metric boatload of competent people. Someone commented a week or so ago about the Dutch Survivor show and what the men did. As soon as they hit the ground, they started doing what needed to be done. It won’t be any different if things go to hell. The men will get things running again in surprisingly short order. The scientists and engineers will be important, yes, but so will those who are skilled in everything from plumbing to auto repair to maintaining power lines to … well, you get the idea. People who can do something don’t just stand around with their thumbs up their asses.

    And I don’t have a low opinion of women in a crunch, either. They will also do what needs to be done, and do it as competently as the men do.

  42. Ray Thompson says:

    People who can do something don’t just stand around with their thumbs up their asses.

    Well you have just excluded most of the people on welfare.

  43. MrAtoz says:

    Well you have just excluded most of the people on welfare.

    They’ll be the first to go during the Barackalypse.

    After these poor bastards of course.

    Bye, bye fatties!

  44. OFD says:

    Standard-ass routine nightly/daily DUI traffic stop up here in 2015 and back when OFD was imitating Buford Pusser in the late 70s and early 80s. This is the kind of shit you deal with every damn night on the streets, pretty much like that old Fox show, “Cops.”

    I noted at the time, though, that the show seemed to almost always be in tropical or semi-tropical areas of the U.S. We got the same crap during the warm months up here, and then a different angle on it when the cold weather kicks in good and hard, more domestics, extremely dangerous, and bar brawls. OFD’s advice: you see biker chicks brawling? Stay the fuck away, if possible, unless you have a machine gun and some grenades.

    But yeah, that arrestee person is typical of the vast hordes consigned to the potential mass dis-offs; he’ll last a few weeks, tops, and then be gone.

    Despite the plethora of dystopian novels, we really have no clue on how things might shake out here in the United States of Amnesia, but a look through the history books, particularly Europe between the first two world wars and post-Good War can illustrate key factors likely to be in play; urban slag heap wastelands, famine, disease, and crime run rampant.

    This is a huge country, the third most populous, and crammed with all kinds of weapons, gear and experienced peeps. Some of it depends largely on how long the regime can maintain control, and that’s a total crap shoot; they can keep control so long as the money holds out.

    Dr. Bob and Dr. Gary North don’t think it will get quite this bad and I surely hope and pray they’re right; they’ve been right about a LOT over the years.

  45. Lynn McGuire says:

    This is a huge country, the third most populous

    I did not realize that USA was the third most populous country until you mentioned it recently. I thought that we were number 7 or 8.
    http://en.wikipedia.org/wiki/List_of_countries_and_dependencies_by_population

    Obviously, China and India are vying for number one and hopefully we will not enter that race. Unlimited immigration with a population increase of 2% per year adds up after a while.

  46. OFD says:

    No chit, hombre. We busy on adding it up, looks like.

    We’re WAY behind Chiner and India, but way ahead of Indonesia.

    It’s a real eye-opener, with, IIRC, 40% living in coastal metropoles; we can write most of them off.

    Picture 80% mass die-off worldwide, leaving maybe 1.5 billion homo sapiens sapiens.

  47. Lynn McGuire says:

    It’s a real eye-opener, with, IIRC, 40% living in coastal metropoles; we can write most of them off.

    Are you including the Gulf Coast? And how about the Great Lakes coast?

  48. OFD says:

    IIRC, the last stats I saw were only for east and Left Coast, but really ought to include both the Great Lakes and Gulf coasts, thus adding Nawlinz, Tampa/St.Pete, Chicago, etc. And thus also making that percentage bigger, which sounds about right.

    What are our biggest “flyover country” cities? Dallas/Fort Worth, Denver, Phoenix, etc.? I’d write most of those inhabitants off, too.

    Bear in mind this is the “Jericho”/”Revolution” scenario, close to full-bore dystopia. We certainly hope it doesn’t ever get this bad.

    But it could. Read history; other vast and powerful empires went down the tubes; why not this one?

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