Monday Medical: Wound Care

So you've got a wound to deal with; yours, or someone else's.

In order:

Expose the wound(s). Find them all. ALL of them.

Get all the clothes, debris, dirt, blood, etc. out of and away from it.
If you have to cut or rip clothes, do it now, and do it fast.
Strip 'em and flip 'em is the rule to follow.

These all work for that:

If they aren't in life-threatening danger, and you're not a dick, you can cut along seams, and through laces preferentially. Laces can be replaced cheaper than boot leather, and cutting on/along seams lets them sew a garment back to being intact with a lot less trouble.
Which might be a consideration if clothes and sewing machines are hard to come by.
If they are or could potentially be bleeding out, BE A DICK.
Tell them I said it was okay. 

Leave impaled objects where they are.

If there are objects impaled further into the wound than you can see, leave them alone.
Why?

November 14, 1990

TUCSON(AP) — An 8-year-old boy was listed in critical condition today after surgeons unscrewed a steel rod that pierced his body when he fell from a roof.
"He probably just thinks this is kind of a slight inconvenience in his life," trauma surgeon Dr. Michael Esser said of Justin Stiner, who asked for some ice and wanted to play Nintendo on Tuesday after waking up from surgery.
The 4-foot-long, 1/2-inch-thick threaded bar used to reinforce concrete was literally unscrewed from the boy's neck and torso Monday in a 2 1/2-hour operation at University Medical Center. Eighteen inches of the rod had penetrated his body.
Esser said that the heart wounds should heal fully and that, although the boy's severed jugular vein was tied off, other veins can provide the needed circulation. The jugular vein carries blood back from the head to the heart.  

The 4-foot-10, 86-pound third-grader from Sierra Vista fell onto the rod while playing with friends on the roof of a house Monday morning. He was suspended two feet off the ground for about 20 minutes, alert the whole time, while paramedics cut the rod, which pierced him just below the breastbone.

Justin, who was taken the 80 miles from Sierra Vista to Tucson by helicopter, neither panicked nor screamed, and on arrival "wanted to know if I was going to remove it. He was very cooperative," Dr. Phillip Richemont said.
Richemont said surgeons were stunned to find that the rod had pierced the heart in two places and divided the jugular vein. "But yet it didn't bleed. It's amazing," Richemont said.
During the operation, the heart seemingly "contracted down between the threads," cutting off bleeding, Richemont said.

The rod was a piece of rebar that he fell onto from his garden shed roof; grandma used it as a stake to coil the garden hose around. After penetrating into and out of the right ventricle of his heart, the rod severed the external jugular (IIRC) and then pinned it against his right clavicle. If it had been moved at all, he would have died from either wound. The paramedics on scene hand-sawed it off , packed it, and transported him to the hospital with it in place. He's 38 years old now instead of dead in his grandma's garden because of that move.

The piece of whatever impaled into the globe of an injured eye may be the only thing keeping the aqueous humor inside the globe. If someone is blind, you won't fix that, but if they aren't, you might create the problem. Leave things alone you can't fix. Splint them so they don't move or cause additional problems.

Clean and disinfect the wound(s).

The solution to pollution is dilution.
Which is a med school canard that means "irrigate all wounds until they bleed saline solution".
Clean tap water is your second choice for superficial wounds.
And the only way to get something clean is to get something else dirty.
True with cars, houses, and patients.  Saline, gauze, rags, etc. will be consumed out of all proportion to the wound. Get over it, and get it done.

For deep wounds, a solution of half sterile saline, and half povidone iodine {Betadine™}solution (not Scrub, which is a stronger and harsher liquid form) gets squirted under plunger pressure from a syringe (5-20cc) into the wound. Splash shields and safety goggles are your friend here, unless you want a faceful of bloody (or something worse, think abdominal wounds) backsplatter.
One blast isn't nearly enough. Keep going, then irrigate with just saline, then repeat, then repeat, then repeat, until you're sure you've gotten everything foreign out.

You can also do this with superficial injuries.

For small stuff, like cuts and scrapes, Bactine[tm] has both BZK (benzylkonium chloride, a relatively harmless disinfectant) and a small amount of lidocaine (which numbs pain).
Use it.
Not isopropyl alcohol, which is flammable, and only for sterilizing instruments.
Not hydrogen peroxide, which is only for getting blood out of clothes, carpet, and fabrics, not cleansing wounds. (Like moving a body before the cops get there, and tidying up...)
Both of the latter also burn like hell in fresh wounds, because they're killing healthy vital tissue, and they don't work well. Using them anyways may get you socked by your patient.
Or their lawyer.
After Bactine, clean tap water, or water you've made sterile by boiling (and cooling, please) is okay.

Water from the ocean, lake, river, stream, pond, or from your or the patient's canteen that's been backwashed in, absolutely not.

We either use sterile solutions, or holy water on wounds.
Holy water? How do I make holy water?
You boil the Hell out of it.

Stop serious bleeding.

Direct pressure.

Direct pressure and elevation.
Tourniquet (TQ).
Pressure points.
In that order, unless you're under fire (in which case, you use the TQ now, get back in the fight, then go back and re-address things after the shooting stops.)

Nota bene: And for deep bleeding wounds, esp. of the torso, this is what that Combat Gauze was made for: as an internal instant scab over large bleeding wounds (assuming you're evacuating your patient to higher care, where someone can surgically repair what you're putting a temporary packing against, which will be removed at a Battalion Aid Station or equivalent, or else in an OR). If that higher level of care is not an option, because Zombpocalypse, Combat Gauze just means they'll die from infection in a couple of days, instead of massive hemorrhage now.
Your call in that case. Just remember, death is final, either way.

Apply Magic Spackle.

By which, I mean products purposely made to keep wounds clean. And help kill germs.
Neosporin (triple antibiotic).
Polysporin (double antibiotic).
Bacitracin (single antibiotic).
Burn gel (for burns, if you have that).

Most of what's in these (like 98% for the first three) is just sterile petroleum jelly, to hold the antibiotic components (the other 2% or so) in stasis where you want them, next to the open wound.

If it doesn't have FDA drug information on it, the answer is generally "No."
In some cases, "F**k NO!"

("But can't you put honey on cuts? I read this outdoors nature manual where Sumdood from the Discovery Channel wrote...")
Yes, honey can work. It also works to attract bees. Flies. Ants. Cockroaches. Etc. While providing a potential growth medium for new bacteria, and sticking them and anything else next to the wound. And getting bloody honey onto everyone and everything nearby.
Save your honey for hypoglycemia patients, or your buttered rolls, unless you have no other choices.

Save also your butter, Crisco, and any other concoction of cat piss, dog shit, and sourdough batter you got from your mom/granny/crazy aunt/some witch in the woods. Dumber than hell, and probably not a good idea, plus someone else will have to traumatize the patient later by scraping all that happy horseshit off again, somewhere down the medical pipeline. Neither patient nor practitioner will thank you for your misguided efforts at that point.

If the Zompocalypse has already occurred, you're on your own; use your best judgment. Starting with some judgment, sil vous plait.

And once a wound scabs over and seals in a few days, topical goo is pointless.

Dress the wound(s).

Sterile dressings, completely covering the injury.
Non-stick, if appropriate.
Absorbent and multi-layered, if appropriate.
Occlusive to air, if appropriate.
This is where your variety of bandaids, 2x2s, 3x3s, 4x4s, ABDs, and multi-trauma dressings will kick in.

Bandage the wound(s).

A dressing protects the wound; a bandage secures the dressing(s). Dressings therefore, must be sterile, because they're going on open wounds. Bandages only have to be clean.
Sterile is nice, but you can, for example, wash bandages that have gotten soiled, bloody, or dirty, and reapply them once they're dry.
Dressings get burned or red-bagged afterwards; they're single-use.
Plain gauze, Kerlix fluff, Kling/Coban/vet wrap, ACE wrap. Or even cut-up sheets in rolls.

Nota bene that old-school field dressings and new Israeli bandages in all flavors are both dressings and bandages. Less flexibility, but less bulk, and handier if you aren't the medic, nor carrying the well-stocked aid bag.

Secure the bandage(s).

Tape gauze so it doesn't unroll. Tape metal Ace bandage clips so they don't pop out (or get the cool ones with Velcro tips). Make things fit, and stay put, despite the patient walking, being carried, put on a helicopter, or just sitting out on a windy spot.

Wounds get dressed and bandaged before splints go on broken limbs.

Dressings get changed daily, and whenever soiled. Note that "soiled" means "funky from the outside dirt, water, and other contaminants". The stuff draining from the wound inside is why you change them daily anyways - unless we're talking dressings that are saturated suppurating puss buckets. In which case you have bigger problems than dressing changes.

There are a host of special application dressings and bandaging, many of which protect skin by not having you rip and replace adhesives daily. These can be learned from the appropriate chapter of a decent comprehensive textbook of nursing care, for instance this one ($25-80 on Amazon):

You can also download the 1957 Army Field Manual on Bandaging and Splinting for free, here.

Smartest would be to acquire both.

One way or another, you will see this material again.

Pull The Other One, It Has Bells On It

Sunday Music: You're No Good

The first single released off of her Heart Like A Wheel album rocketed Linda Ronstadt straight to No. 1, and made her an overnight sensation, after only 11 years in the music business. On the way up, her backing bands included 3/5ths of the Eagles, and by the end of her career, she had succeeded in nearly every genre there was to sing, from country, to country rock, to pure rock, to R and B, to soundtracks, to old favorites.

Like most entertainers, her politics were goofy and her personal life a disaster (largely due to being Jerry "Moonbeam" Brown's main squeeze during his first disastrous two terms running Califrutopia into the ground), but musically she was an arena-filling megastar, and one of the first women to ever pull it off as a headliner in rock and roll.

Palsy has stilled her singing voice forever, and at 74 she can barely croak out speeches, but the roster of hits she racked up over twenty solid years of greats will long outlive her own frailty.

Here's one more for the road, this one from Simple Dreams, and written by up-and-comer Warren Zevon:

Guest Post: Paine, Henry, Adams, Zevon

"THESE are the times that try men’s souls: The summer soldier and the sunshine patriot will, in this crisis, shrink from the service of his country; but he that stands it now, deserves the love and thanks of man and woman. Tyranny, like hell, is not easily conquered; yet we have this consolation with us, that the harder the conflict, the more glorious the triumph. What we obtain too cheap, we esteem too lightly: It is dearness only that gives every thing its value. Heaven knows how to set a proper price upon its goods; and it would be strange indeed, if so celestial an article as FREEDOM should not be highly rated."

"Shall we try argument? Sir, we have been trying that for the last ten years. Sir, we have done everything that could be done to avert the storm which is now coming on. We have petitioned; we have remonstrated; we have supplicated; we have prostrated ourselves before the thrones of Justice, and have implored its interposition to arrest the tyrannical hands of evil men.  Our petitions have been slighted; our remonstrance’s have produced additional violence and insult; our supplications have been disregarded; and we have been spurned, with contempt, from the foot of the throne! In vain, after these things, may we indulge the fond hope of peace and reconciliation? There is no longer any room for hope. 

If we wish to be free, we must fight! I repeat it, sir, we must fight! 

An appeal to arms and to the God of hosts is all that is left us! 

Is life so dear, or peace so sweet, as to be purchased at the price of chains and slavery? Forbid it, Almighty God! I know not what course others may take; but as for me, give me liberty or give me death!" 

"If you love wealth better than liberty, the tranquility of servitude better than the animating contest of freedom, go home from us in peace. We ask not your counsels or arms. Crouch down and lick the hands that feed you. May your chains set lightly upon you, and may posterity forget that you were our countrymen."

Uncle Joe Warned You

Fake News Goes For The Kill Shot

A careful perusal of the Constitution has revealed that the power to declare the victor in a presidential election has been relegated to anti-American news networks in exactly zero cases, going back to...oh, wait, 

...EVER.

Nice try, SeeBS, but no cigar.

While you're up, you can tell the rest of  the gang at ABCNNBCBS not to waste their time.

"Calling" a presidential election, where obvious fraud is apparent from satellites in space, when every state in contention is being referred to federal court, is reckless and irresponsible.

Which last two words, it should go without saying, have been the motto and corporate policy in all media nationwide since at least 2015.

You attention-whore Democratic shills, pining to be the story rather than merely telling the story, have all been fake news for decades, and you didn't graduate to "legitimate" today just because you cheered on rampant election stealing in broad daylight.

But by taking a partisan side non-stop for the last four years, at least, you're forever forfeited any claim to any shred of independent observer status, and now number among the ranks of the combatants - and we mean that in a Geneva Convention sort of way, lest you be in any doubt whatsoever - by your own choices, ratified over and over, time and time again, beyond number. There are iron-hard consequences to that. Some of them are rhetorical. Some of them, rest assured, will be corporeal. In a neck-rope-handy tree sort of way, and likely sooner than later. Mark my words.

Don't gasp, look shocked, nor clutch your pearls. You shilled and pimped for a banana republic here in the U.S. for a generation and more. Now you've almost got one within your grasp. Consult your colleagues in the same field working in actual ones, from Tijuana to Tierra del Fuego, and ask them about life expectancies in your career field under the sort of conditions you've cheerfully set in motion here. When you reap what you've sown, expect a full zero f##ks will be given by anyone else about what happens to you. No small number will think it too lenient, too little, and too late, if you only end up hanging, headless, from overpasses. Most of you will think it a mercy if it's only pliers and blowtorches, and getting medieval on your @$$#$. And with any luck, social media will record the video for posterity, so you can finally achieve the center stage you sought so hard, and for so long. And for bonus points, probably half of that will be dealt out by the communists you've empowered. Win-win, right?

So your total frothing complicity, and indeed active and full-throated abettance of, this monstrous grand theft is noted. The American people have a memory like an elephant. And a sense of justice and fair play about as subtle as a guillotine. You'd all best set your affairs in order. It's going to be a long, cold winter. And most of you won't live to see the sun come out again in your lifetime.

Besides, it isn't like your ilk have never done this sort of thing before, and bungled the call.

Vote Harder?

Let's see if Justice Alito's shot across the bow starts to stem the tide of fraud.

We hope it marks the penultimate signal that the Communist Party is over in this nation.

But if not, if rabid dogs cannot be reasoned with, we stand ready to vote harder next time.

We invite the Criminal Party to harvest all of those ballots they'd like.

I think due to the endless waiting for justice to roll down like waters, for decades, I've got a fever.

And the only cure is more cowbell.

Stevie Wonder Levels Of Election Fraud

"This business will get out of control, 

and we'll be lucky to live through it."

On current course and speed, if the courts don't get a handle on the rampant fuckery going on -- and right effing NOW! -- I figure we're on trajectory for weapons-free before year's end.

And there's always someone ready to jump even that conservative an estimate.

If sanity breaks out, and law and justice rule, well and good. But it's looking bad for that side just yet.

I don't see a Basket Of Deplorables just rolling over and watching impotently as a handful of states attempt to ham-fistedly swing an election fraudulently, dumping single-office ballots by the bushel into the counting hoppers, thinking the rest of the country swallows that mountain of bullshit in one gulp.

Not. F##king. Happening.

And if the media continues like they've done for 4 years, to play one side favorites, pretend everything is fine, and gaslighting corruption so obvious Stevie Wonder can see it ("Vote fraud. Whatever do you mean? I see no vote fraud here. If the people don't like sh*t sandwiches, let them eat cake."), they're going to be the first and easiest target in every market in the country. 

Followed, in short order, by anyone sticking up for them, or trying to tamp it down. 99-1 the military sits this out, and 80-20 most PDs do as well (less those that join the revolution outright), come the day.  I predict wisdespread Blue Flu if violence breaks out in cities like DC, Philly, Portland, et al.  The alternative is for 1% of the country (and most likely, far less) to hold up their hand to attempt to halt a speeding freight train. And even the police in Berzerkely know, you can't collect your pension if you're dead. That's always the problem with depending on mercenaries, and the only hold the Left has on most people in law enforcement is paychecks.

If the Antifatards come out of hiding, the violence prospects, and body count, goes up by orders of magnitude.

Biden and Harris will be lucky to see free sunshine this lifetime, and the only way they're getting sworn in, at this point, is in exile, from Venezuela.

A violent civil war to the death between competing ideologies in this country is the last thing I want:

but it's still  on the list!

The courts are down to about a New York Minute to return things to status quo ante, and prosecutors had better start rounding up election fraud conspirators in vanloads right quick.

Failing that, the soap box, ballot box, and jury box will have failed, and the Left coined the phrase, "By Any Means Necessary". So be it. Call that toss in the air, kids.

So if they intend to attempt to carry this farce through as if it isn't happening, I'm not going to sit here, watch the country thrown to the lions, and resolve merely to taste bad.

The Other Side, human frailty or not, is going to find out what blood tastes like in their own mouths, and we're going to see in living color what "enemies foreign and domestic" looks like when played out in 3D reality.

The made their grave when they resolved to steal an election, and a country, outright, in an election they knew they'd lose, narrowly (and did).

If they want forgiveness, that comes from God.
It may be time to start booking their travel plans for the meeting, and I for one will be more than happy to cancel as many tickets on that ride as humanly possible, as long as I have strength.

It's 11:58.

Here I stand. I can do no other.

Sauce For The Goose

The other side made "By Any Means Necessary" their mantra.

So turnabout is fair play.

Sow the wind, reap the whirlwind.

War to the knife, knife to the hilt.

Then gouge eyes, and bite ears.

Lemme Get This Straight, DNC...

While You Were Busy Ignoring Reality, The Consequences Called...

"You can ignore reality. You cannot ignore the consequences of ignoring reality." - Ayn Rand

Just a small update from the pandemic trenches:

1) Had two patients last week, both suspected for Kung Flu, who turned out to have it, absolutely.

First confirmed cases we've seen in over a month in the hospital that required hospitalization.

(And to be fair, only two patients out of several hundred, in a patient load best described as lighter-than-average.)

That coincides with the average lag between case spikes (about which IDGAF, generally), and hospitalization spikes. 

(Next come death spikes, like winter follows fall.)

2) But this was the significant takeaway.

One patient was confirmed to have been infected with it back last spring.

Double positive.

But minor symptoms, and never needed hospitalization. Like about 90+% of Kung Flu victims.

Then, once lockdowns largely ended in the U.S., he had a minor surgical procedure scheduled, which had been postponed earlier. 

So, COVID tests were done, and showed negative, two times, before being allowed to have the procedure. That was back around August.

So far, so good.

Now, three months later, in the ED last week, with sudden-onset shortness of breath, low oxygen saturation on room air, and a beautiful case of raging bilateral diffuse multi-focal pneumonia, and a positive rapid COVID-19 swab test.

In his 40s, and no co-morbidities.

Otherwise healthy.

Hospitalized.

Short answer:

You can get this again.

And again.

And again.

And subsequent infection is worse the second time.

You can kiss mythological "herd immunity" good bye when infection confers no immunity from subsequent infection waves.

Any Gilligans out there, keep preaching that "just the flu, bro" line of utter bullshit.

Lick handrails, and pee on electric fences, while you're at it.

{Hint: Don't screw around. Don't catch this. It isn't fake, and it isn't funny. Period. Full stop.}

3) Just to drive the point home, we also had a non-critical patient some weeks back, confirmed not to have it, who was hospitalized with another non-critical patient unsuspected and totally asymptomatic. Who, it turned out, was fully infectious with Kung Flu.

And gave it to patient #1.

Who subsequently declined, ending up sick enough in short order to be put in our ICU in critical condition.

But before COVID was diagnosed as the problem on that ICU visit, and the infected patient placed in respiratory isolation, they infected 10 ICU nurses, several of them seriously enough to be hospitalized.

The nurse with the worst case died of Kung Flu last week, after about a month's struggle.

Our ICU is currently (and perpetually) running at 1/2 capacity because of resultant staff shortages, and there's no one, anywhere, to bring in.

We've tried.

{This results in closing our ED regularly (to any incoming ambulances), forcing us to care for critical patients for days, rather than hours, and impacting medical care for the entire county, and by extension, a surrounding region encompassing 10% of the population of the entire U.S. of A. That's the razor-margin we work on even in good times. If things are fine for you in Mayberry or BFE, good for you. Your 0.001% success rate in an area with less than 0.1% infection is noted. You will, we hope, pardon us for a decided lack of interest in your infinitesimal success, against a virus you largely never encountered. Unlike, say, the 50 largest cities and suburban regions in the country suffering a far greater impact.}

No one wants to come play in COVID Land anymore, for any amount of money.

LIKE WE F##KING  TOLD  YOU WAS GOING TO HAPPEN, WAAAAY BACK IN MARCH.

I yell because I care.

4) BTW, our PPE is still cobbled-together horsesh*t, including souvenir-stand raincoats usually found at taco stands near tourist traps. Totally serious.

Remember than anytime you hear Fraudpeddler Fauci tell you "We can handle _______."

Like he said about Ebola in 2014.

People are going to fiddlefuck around on this, until they achieve the exact results predicted in worst-case scenarios, because the entire population is well-marbled with 80-IQ morons.

One Gilligan keeps seven castaways stranded forever, and one jackhole "just the flu, bro" asshole who takes zero precautions, because this is obviously an internet hoax, rather than some Frankenbug engineered virus, is going to be the actual super-spreader, eleven times out of ten.

For the oblivious @$$holes who will think this is pimping for another economy-killing shutdown, f##k off with that noise. It's probably a good argument for trimming activity back somewhat, only in the areas where this is raging, and by appropriate legislation, not imperial fiat.

But it's absolutely an exception-proof argument for you wearing a snot mask - not to protect you, but to protect everyone else from you - to curb the spread of the virus, and washing your g## d###ed hands, without exception, in 50 states and 7 territories, until this is either stamped out, or beaten by a Hail Mary vaccine. Wearing a sneeze mask is not communism, and washing your booger hookers is not Hitler, no matter about your pwecious feelz, Snowflake. Exactly like about 90% of you aren't doing, by observation, far outside of the local area.

And that's why you'll keep screwing yourselves, harder and faster, until even the dimmest bulbs amongst you figure that out.

Almost like Joseph Lister, Louis Pasteur, and Ignaz Semmelweiss all knew what they were talking about 150 years ago.

On those cheery notes, Have A Happy Day.

Sh'Yeah, As If...

h/t Phil

And magically, 8 hours after the polls were closed.

This is a straight-up coup attempt, and nothing short of putting the responsible mofos up against a wall and shooting them, or stringing them up in job lots, is going to suffice for a remedy.

Fast or slow, the solution is elegant, simple, and inescapable. 

A distant second would be Watergate-style show trials, in batches, and multi-decade prison terms.

Ankle-chained, at hard labor, or deposited in a hole in a modern-day Chateau D'If.

The alternative is boxcars unloading people at camps, and a Soviet/Chinese/Venezuelan purge and rapid decline.

Not A Warning Order; Just A Guesstimate

We will not be replaying the naked voter fraud of the 1960 federal election, under Marquess of Queensbury Rules, and stand by as good sports while an entire election is stolen in plain sight.

Fort Sumter v2.0, however, is very much in play.

Pray that the federal judiciary pulls its head out before they are overtaken by events.

At Last, Something To Celebrate!

Wishing And Hoping

Took all of 20 minutes' wait, after getting off work this A.M.

Straight ticket, most of whom have no chance, and my top vote won't matter in a state that's not going to be in play this side of fiscal apocalypse, the actual Black Death, or open season on Communists and no bag limit. (I yet live in hope.) Then voted down damned near every silly assed idea from city to state, all but one of which were expressly designed to expand the government deeper into my life, or get their hands deeper into my pockets, or both.

Was hoping to be off work tonight, but I got moved onto the shift, so if/when the silliness and The Purge is due to start, I'll be in Monkeyhouse Central.

I'm hoping it turns out to be like Y2K, but if the Yellowstone Caldera erupts, the dead rise from the grave and walk the earth, and aliens land on the White House lawn, I'm mentally prepared.

Plus, I'm bringing bags of caramel popcorn to work tonight to watch the show, so I've got that going for me.

And if I get to watch three nutwork (not a typo) news anchors, Bill Maher, Stephen Colbert, and Rachel Madcow all eat a 10-foot party sub sh*t sandwich, break down in tears, and wet themselves before 2AM, for the second time in less than 5 years, the stress leading up to this will all be worthwhile. Biden doesn't know who he is or where he is most days anyways; but seeing Nancy Alzheimers and the other assorted @$$clowns in Congress lose their collective sh*t, yet again, would be quite the early Christmas.

Think happy thoughts.

While you're stacking cases of beer and soda, and pretzel, chip, and popcorn bags like sandbags. 

And loading magazines.

Then we can go back to mostly ignoring the political $#!^show for another few years, as God and the Founding Fathers intended.

Here's a classic annoying earworm for you:

But be ready for

Monday Medical: Hypothermia

Never as funny IRL as this looks.

Hypothermia is technically anytime your body's core temperature is below 95° F.

Last week, Southern Califrutopia had its first "cool" day of the season. Cool is a relative term.

Hereabouts, it means shorts and a T-shirt aren't cutting it. We only visit snow in the mountains, we don't live in it, and our snow blower is called "the Sun". For some of you in other hardier places, our cool temp would be what you call "summer". YMMV. The greater lessons still apply.

Nonetheless, it wasn't that cold, even here. But my patient was over 60. Strike One. (Big risk factor. Older people, just like kids, don't cope well with thermoregulation, both having less muscle mass to generate heat, and a wonky temp control system. One because it's new, the other because it's worn out and old.)

And it was a perfect day for hypothermia. Low 50s. Overcast, hazy sunshine. Breezy, occasional drizzle. Strike Two.

Because on really cold-@$$ days, (and as I said, that is whatever it is to you, in your area) you bundle up. But 50s is just right for thinking, "Hey, it's just brisk, and I'll be working, not sitting, so I don't need to layer up."

My guy spent the day doing yard work. Six hours non-stop. In a sweatshirt.

Strike Three.

Kids, write this on your hand with a laundry pen: 

Cotton KILLS.

And I mean literally. It holds wet, and keeps it right next to the skin, on days when it's too cold to evaporate and dry off. Great in the desert in summer, but catastrophic for a wet day in fall or winter.

At 32° F., all that moisture next to your skin will freeze, wrapping you in a sheet of ice.

And. Then. You. Will. Die.

Deader-than-canned-tuna dead.

Frostbitten solid frozen toes and fingers and hands and feet and nose and ears dead. 

 Don't believe me. Wrap yourself in a bath sheet or beach towel, and soak it with cold water. Now go stand outside on a windy fall/winter day. 

(Please, come back in before you die, but after the point is driven well home.)

Silk, wool, and high-tech synthetics - like good old fleece - are all a hundred times better (or more) than a soaked cotton t-shirt and faux flannel shirt, plus soaking wet cotton jeans (that feel like frozen iron sheets), all made of 100% cotton.

No points for guessing of what 100% of my guy's sweatshirt was made.

Then, after he was worked out, sweaty, and already more chilled, he came in.

It felt hot inside (because he was part popsicled already). And because it was 20° warmer inside than out. But his internal thermostat was already out of whack. Strike Four.

So, in a genius move, he peeled off his sweatshirt (which had, indeed, become sweaty), and sat in front of a fan to cool off! Strike Five.

Which worked.

He rapidly cooled an already chilly body, after burning most of his calories, and was now sitting inside a cool room which took him to the near border of early hypothermia. Strike Six.

Oh, BTW, that 95° F. body core temp number?

Like scuba diving tables, that was determined by Uncle Sugar's best medical experts, based on the physiological responses of young, fit healthy studs in the Navy SEALs, Army Rangers, etc., with 5% body fat, and resting pulse rates in the 40s and 50s, not by testing the effects on out-of-shape 50+ sedentary adults. So for most people, you can throw that 95° number right out the window, unless you're in BUD/S now, waiting to start Hell Week.

This I where the family's common sense accidentally-on-purpose saved a life. Suddenly Paps was feeling weak, thinking fuzzy, not acting right, couldn't stand, and just didn't seem to be himself.

So they called 9-1-1. They knew something was wrong, just not what, exactly.

To arriving medics, given his age and chief complaints, he could have been a cardiac problem, like a heart attack, or a stroke. That's what they thought they had. Great guesses. But not really the problem.

When he got to me, he was shivering uncontrollably, on and off.

So badly that we couldn't get a temperature under the tongue.

Forehead and ear temps are really more like skin temps, not core temps, most of the time, and this was too big to risk on unreliable methods

Time for the tailpipe temperature: one red thermometer, inserted into the exit.

That's a core temp.

He had severe cardiac arrhythmia (really funky heartbeats), low blood pressure, lack of coordination, confusion, weakness, and moderate near-continuous shivering.

His magic number, on arrival at the E.D.: 96.5° F.

Technically, not the magic less-than-95°-F. number that equals hypothermia.

Reality: given his age, physical condition, and symptoms, he was already well into moderate hypothermia.

We put him in a Bair Hugger. It's like a giant hot blow dryer that attaches to a big air mattress quilt, on top of which you pile a layer or two of warm blankets. Think of it as human air fryer, and you're on the right track. After we peeled him out of everything wet , and left him with just a flimsy (but clean and dry) cotton hospital gown. Within two hours, we'd brought him up to more than 98° measured orally, because he was no longer shivering uncontrollably.

Weakness: gone.

Shivering: gone.

Cardiac arrhythmia: gone.

Confusion: gone.

Blood pressure: normal.

Problem solved.

Wherever you live, environmental concerns are a problem, and unless you're Down Under in Oz now, it's approaching winter, so cold is the default environment.

Zero degrees with a -40 wind chill is bad, but you can get into trouble being just a little wet, a little old, a little out of shape, and a little under-protected.

{BTW, other risk factors are diabetes, thyroid problems, alcohol consumption, other substance/drug use, some Rx medications, and severe trauma. Strike 7, 8, 9, 10, 11,12, if you're keeping score at home.} 

 

Hypothermia creeps up on people, and they don't notice.

Shivering is an early sign.

Later, you stop shivering, because the internal thermostat in your head is fried, and you're freezing.

You're confused, sounding slurred (as if you were drunk), you're tired, drowsy, can't remember things, and uncoordinated.

You think you're warm or hot, so you start taking warm clothes off.

Your pulse slows, you may pass out, and you feel very cold.

Think Mumbling, Fumbling, Bumbling, Stumbling, and Tumbling.

And if someone doesn't intervene, you'll die, feeling warm and fuzzy on the inside, and being a frozen meat popsicle in reality. Like Jack, in that pic up top.

The treatment is simple: REWARM, rapidly. Get them out of the weather, out of wet clothes, and warm them, inside and out. Hot food, hot drinks, and anything else that you can use, will keep from turning a mild problem (frequently mistaken for other things) into a life-threatening one.

Cody Lundin (the hippy dippy barefoot dude co-starring in Dual Survival all these years, entitled his first survival book 98.6 Degrees - The Art Of Keeping Your @$$ Alive. He's a subject matter expert; it really is that simple. And that hard.

Layer clothes.

 

Dress warm enough to stay warm and feel warm, but not enough to sweat.

COTTON KILLS. Ditch it. Silk, wool or high-speed synthetics are the way to go.

Wear a hat! 90% of body heat is lost through the skin, and most of that right out your bare head.

Conduction sucks. If you sit on the ground put something between you and cold ground, rocks, snow, etc. (Duh.)

Stay well-hydrated. With WATER, not booze. Caffeine is a diuretic (makes you pee) too, and will dehydrate you. Go for hot, sugary drinks. Without caffeine.

EAT, bubbe. Food makes calories, which you need to generate body heat and muscle movement. Young  healthy military troops in cold weather burn twice the calories you do sitting in a cubicle, and even at 5000/day, they - and you - will still lose weight over time working hard in the cold.

Hot food, high in carbs, protein, and even fat, is healthy in cold weather. Fat has twice the calories of carbs or protein, and you need fat to stay alive at cold temps. Butter, mayo, guac, nuts, nut butter, etc., are all your cold-weather friends.

Like batteries, the heart gets wonky when you're cold. It's fragile, and prone to weird rhythms. Which can turn into cardiac arrest. Handle cold people gently. If the pulse stops, CPR starts.

Warm the core first, then the limbs.

I you see something, do something. The longer you wait, the worse it gets, and the harder it is to fix.

Anything from to bodies in a sleeping bag to building a bonfire, to dunking them in a tub of really warm water or a jacuzzi, can work. Use what you've got, and right away.

Stay frosty, but don't freeze your @$$ off.

That concludes your hypothermia briefing. In six months or so, we'll talk about heat emergencies.

Sunday Music: New York State Of Mind

As promised in comments to last Sunday's piece. And not just any old version. Like last week, this one is Fan Participation, from a Q and A session at Vanderbilt U. in 2013.

Not a concert per se, but nonetheless, major props to musical legend Billy Joel for giving a newb a shot, and risking the faceplant that could have happened all too easily.

Calling Your Shot Over The Centerfield Bleachers Moment:

Billy Joel: "What key to you do it in?"

Michael Pollack: "What key do you want it in?"

In case that's not enough for today, here's another cut, a personal fave from the Turnstiles album which we selected last September, and one that could become altogether too close to reality in coming days.

Monday Medical: Tourniquets

Suggested by article comments at AP

The title is not a typo. Come Mondays, I'll start doing regular weekly medical posts. I'm jumping the gun with this one. Maybe you'll get two this week. After the recent Blogcation, I owe you some back content.

I hope you never need the info, but these are strange days.

tourniquet: a device for stopping the flow of blood through a vein or artery, typically by compressing a limb with a cord or tight bandage.

Note the keyword "limb". Neck tourniquets are saved for use on murderers, terrorists, traitors, serial rapists, child molesters, politicians, telemarketers, people who drive 40 in the left lane, and any other of the most egregious criminals in society.

Historically, tourniquets were considered the Dark Arts in medicine, esp. field medicine, because you were "sacrificing a limb to save a life".

That's how they used to be, mainly because they were done with actual cord, wire, leather straps, and narrow bandages. And thusly set up, sacrificing a limb is exactly what they do.

Do NOT do that.

A) Because you're a dumb@$$ if you do.

B) Because we have far better materials, and much more knowledge, training, and recent experience, plus hugely better examples to work with nowadays.

Peer-reviewed medical journal articles, and better equipment, have documented conclusively that tourniquets applied in battlefield situations have been left in place for up to six hours, with no neurological or functional deficits noted afterwards. Six hours from application to removal in surgery is one helluva window for first aiders. 

So how can you take advantage of it?

CAT

The original, and gold standard. For sale by North American Rescue for $30@.

You can put it on one-handed, crank the windlass until the bleeding stops, velcro it down, and drive on. One and done. You have four limbs; you would be well-advised to have four tourniquets handy, somewhere nearby. (Not all on your weapon, belt, etc., but one on the weapon, one on the belt, and two more nearby in a kit/pack/car would be a great way to go. When you need one, you'll need it right effing now, not in 10 or 45 minutes.)

How easy is it to use? 

One-handed, total time (with slow instructions), 00:01:15 to apply, from on to done.

You should carry extras.

I probably have a dozen or two of these, including a couple of orange ones I use just for training.

Why so many?

Power tools: in the shop FAK.

Vehicle kits, each, and extras.

Chain saw: on the chaps belt.

Shooting range cart: a mittful of 'em.

Big Boy Military Rules: your tourniquet is for you, your buddy's tourniquet(s) are for him.

He doesn't have any? How much do you love him?? Srsly. Explain the facts of life to him, and wise him up.

You only have one? How much do you love yourself??

These have been around for years. They're already up to generation 7, or more (I forget). Older ones still work. Why are they generally single-use? Blood contamination/decon. Critical life support gear. You already wrote the time applied on the used one. 

But after TSHTF, when re-supply is a critical problem, you may be less finicky about throwing them away after a single use vs. attempting to decon and re-use them.

***Important safety tip: Beware of Chinesium fake versions!***

They're out there, and in abundance, especially from the idiots at Amazon and affiliates. Buy yours from a reputable brick-and-mortar or online dealer. (Hint: "Reputable" does not mean "cheapest". That's a fool's economy.) I have a 5.11 store nearby, and NAR has a solid gold rep online. So do some others. But a Tupperware bin from Bubba's Qwality Medikal Emporium And Knives at the gun show is caveat emptor, unless you know Bubba personally, including his home address, and trust him with your life. YMMV.

And if you ever get stuck with one you can't get a refund for, smash it and burn it, just like you should for unfixably bad weapon magazines. Like fake $20 bills, don't palm off your bad counterfeit on some other unlucky schmuck. Take one for the team, and fold, spindle, and mutilate those POS fakes, with extreme prejudice.

If you find someone selling them, tell them.

If the seller doesn't offer a refund, or fold up their tent, out them ruthlessly and often until they do one or the other.

SOFT-TW

Same idea (not better per se, just different, IMHO) than the CAT, with an aluminum (versus hard nylon) windlass. And again, about $30 from Tac-Med.

Application? Pretty much the same.

Unlike the CAT, it comes pre-threaded. It's beefier. It has a belt-and-suspenders method to secure it. And comes in a couple more colors than the CAT.

It's also heavier, and tiny bit bulkier.

You pays your nickel, and you makes your choices. There's nothing wrong with either one, and I'd be fine using either one. I don't care which one you like better. It's a chocolate/vanilla question.

X8T

Stick it in and give it a spin. Click and crank.

Just another way to skin the cat. About $38 at Rescue Essentials.

Others

The SAM XT and the TMT are just newer knock-off CATs for all intents and purposes. And, probably, less corporate support or research, but that's just a guess. They should work as well as the genuine articles.

The RATS tourniquet gains you speed and ease of use, but loses any mechanical advantage of a windlass. It's also a lot narrower than I'd be comfortable using on someone.

There are also straps, like the Touniq-Kwik/TK4, and the SWAT-T. 

The TK4 is really just a strap that you shove something in and twist, which is a flashback to 1940.

The SWAT-T is really more like a phlebotomy tourniquet on steroids, allowing you to make a pressure dressing, but probably a lot less occlusion of bleeding possible than a CAT or SOF-T-TW, and if you try, you're warned not to pull it that hard by manufacturer materials and videos. But it could replace or supplement ACE wraps, etc., in a kit where space is at a premium.

Getting into the Stupid Zone, there's the SAM Junctional Tourniquet. It's a bona fide medical device, complete with BP cuff inflation bulb, and works for pelvic fractures and other hard-to-tourniquet spots like armpits. But that complexity makes it iffy in hard use, and more failure prone. Plus, with a price tag of $350-$400+, each, (yes, you read that right) it's geared towards hospitals, public agencies with deep pockets, and solo users with generally more money than brains.

There are probably eleventy others if you dig deep enough, which I won't. These are the best quality of what there is, and most of what's out there, until someone else builds a better mousetrap. IOW, unless you've markedly improved on anything listed, IDGAD. As it is, I wouldn't use some of the above, but the information is there for those who march to a different drummer (or have their choices dictated by fiat from on high).

All of the above have How-To videos available on YouTube, etc.

TL;DRs

1)Get tourniquetSSS. 

Plural. From many, to a metric fuckton, depending on what you do or think (or fear?) you'll be doing.

2) Train On/Learn How To Use Them.

On every type you have. Including one-handed, for self-rescue.

Not just watching the videos.

3) Practice with them.

Frequently. Get a dedicated trainer model, and practice hands on. Nothing less will suffice for mastery, especially bearing in mind that you or someone else will be screaming, in excruciating pain, and gushing blood when you're doing it. This is NOT something you want to re-familiarize yourself with OJT on the day, under those conditions. Learn now, succeed later.

With ALL of your tribe. Family. Co-workers. Team. Neighborhood security group. Hunting buddies. Circle of fellow BSers. Everyone who knows how to use one is one more person who could save lives if things get sporty. Teach people in non-tactical circumstances: power tools, chainsaws, auto accident response, CERT/earthquake/disaster preparedness. You don't have to approach everything like Paul Blart - Mall Cop, Tacticool Timmy, or Gunkid with his Tactical Wheelbarrow(tm). Exsanguination happens all kinds of times and places.

4) Stock them EVERYWHERE.

For all of the above reasons. In job lots.

Imagine you were a bystander at the Route 91 Harvest Music Festival. Or a cab driver nearby afterwards. Not just the staff at Sunrise Med Center ER. You don't have to be able to save everyone. But what if you could save one person? What if it was a family member, or friend? What if they could save you, the next time?

Get busy.

R.I.P. Sean Connery

Shaken. Not stirred.

In his sleep ("He was shaken, but he has not stirred." Yes, I went there.), aged 90 years, in the Bahamas. (Where else, for the once and forever James Bond?)

There's little to write about a legend with 50 years in movies that hasn't already been written.

But I think I feel a movie marathon coming on, and not a Bond flick in the lot:

Murder On The Orient Express

The Wind And The Lion

The Man Who Would Be King

A Bridge Too Far

The Great Train Robbery

Outland*

Highlander

The Name Of The Rose

The Untouchables

The Presidio

Indiana Jones And The Last Crusade

The Hunt For Red October

Rising Sun

The Rock

The League Of Extraordinary Gentlemen

All very good to great flicks, in no small part due to the star, and all done after he'd passed 40.

Long after he'd hung up the shoulder holster. So much for a "Bond" career curse.

We are poorer for his loss, but were blessed by his talent.

We shall not see his like for a long time.

*(Which elegantly solved the glaringly unforgivable deficiency in High Noon : the Hollyweird-stupid idea that in any Old Western town, the town would crawl off and hide from bad men. As John Wayne noted, "I don't get this picture." With any lesser screen legends than Gary Copper and Grace Kelly, it would have been a notorious mega-flop. Make it a company-town mining outpost in space, however, and it sells perfectly.)

Boo!

If that doesn't scare the crap out of you and give you nightmares, probably nothing will.

Happy Halloween.

You've Had 4 Years' Warning...

Peter has this one dead-on right.

No matter who wins Tuesday (if we even know that day) someone is probably going to be pissed.

Based on 2016 experiences, likely frothingly so.

The Lunatard Left has been hyperventilating, dry-running, rioting, even killing on a small scale, and working themselves into a suitable frenzy if they don't take down Orange Man this time either, and it's liable to make 2016 look like a church picnic in comparison.

And if they do manage to win, especially with voter fraud like 110% turnout in blue hives, it's going to be even worse.

Being prepared for either eventuality is not the same thing as running around with your hair on fire, and you should be ready to suck it up and hunker down, or take a little well-deserved vacay if you have the opportunity. And canned goods, whether from the supermarket, or in olive drab metal cans, aren't going to spoil this winter if you don't need them right away.

Resiliency means you don't care, because you've got cash reserves, meds, food, water, etc. stocked on hand, and are staying situationally aware of what's happening in the nearest 20 sq. miles around your home and workplace.

Then based on what happens - on a continuum from "nothing" to "mega-riots", you're good to go no matter what.

You've got all weekend; whip that plan into shape, and stay frosty.

And FFS, come Tuesday next, don't be the Reginald Denny/Gilligan who cruises into a riot, and then gets pulled out of the truck.

The only sure thing about this election is that no one is going to go along quietly with the outcome.

Epicaricacy

Get Off Of My Lawn

For Peter

Remus x Mattis x Dillon Aero Precision.

QED

Because those mobs aren't going to kill themselves.

Plan B (And C. And D. And E. &c.)

WRSA has a link to an American Partisan article by NC Scout, with a sobering thought:

"I’m sure you have thought about what happens when the hospital notifies the Anti-Terrorist Police about the GSW that just showed up at the ED entrance."

Firstly, NCScout's homemade blowout kit is solid stuff.

No quibbles.

As far as it goes.

But slapping on some QuickClot and an Israeli Battle dressing isn't the end of your GSW problems, should such befall you; it's only the beginning of them.

Ignoring the yuuuugely unopened can o' worms behind high-velocity penetrating trauma, and where bullets go, and what they do, and why the sea is boiling hot, and whether pigs have wings, we focus on a nominally so-called "uncomplicated" GSW.

I.e., the "flesh wound" of legend and lore.

IOW, even if no major bones, blood vessels, nerves, or other important bits and bobs are hit, a simple in-and-out, through-and-through projectile hole will still find eleventy ways to kill you deader than canned tuna, if all you've got in your magic bag is anticoagulant and a constrictive pressure dressing.

I've only been toiling in this particular vineyard for about a quarter century, so I may miss a thing or two, but let's take a slightly deeper peek at this from my side of the fence, so at least the brighter lights out there will have some wee appreciation for reality, and make a dent into knowing what they don't know.

Given: You have no major bleeding issues, and largely no problems with function, and you elect to skip the E.D. for reasons of your own. And you pounded in your hemostatic dressing, and wrapped it well with an IBD, ACE wrap, Coban, VetWrap, or strips of granny's torn-up knickers.

That's great.

For now.

What's next?

In no particular order:

1) When was your last tetanus (probably tDaP*) booster?

Why? Because you've got about a 72 hour window from puncture to an express ticket to the graveyard if you ain't got one of those. For cat bites and rusty nails, anything less than 10 years is probably ok. Bullet holes, 200 yards of donorcycle roadrash, or a shark or crocodile attack, and 5 years or less is much better. You probably got your first one between age 4 and 6. You got a booster between age 14 and 16. So if you're 26 or older, and don't know when your last booster was, you're already doing it wrong. They're cheap, easy, and can be had at drug store pharmacies and most any Urgent Care doc-in-the-box, for around $20-40, just for the asking. Make sure your tetanus booster status is up-to-date. Period. You WILL see this material again, IRL.

FTR, tetanus spores live on everything. Not just on rusty nails. Any hole in your people suit allows them to get from outside, in the air, to inside your meatsack, where they reproduce away from oxygen. And make a new home. That's not the problem. As a byproduct, they produce a toxin, which increases until it paralyzes all your muscles. S-L-O-W-L-Y.

And after about Day Three, the booster is too late to head the infection (and associated lethal paralysis) off at the pass. 

You. Will. Die.

Horribly.

For those of morbid curiosity, that would be with your body bent as all the muscles in your back contract, and draw you up like a bow, with only your heels and head touching the mattress, awake, unable to swallow, dying of thirst and starvation, fully conscious, until your diaphragm and rib cage muscles can no longer suck air, and you die staring at the wall behind your deathbed, in excruciating agony. Unless someone kindly holds a pillow over your mouth earlier until you stop breathing sooner, to cease your further descent through the levels of living hell before you embark upon the afterlife, or oblivion.

As iconic baseball manager Casey Stengel used to tell people, "You could look it up."

This description is from the era before there was a tetanus vaccine. About a century hence.

To the crybabies and pussies who whimper, bitch, and moan about a simple shot, I generally lay this out about this fast, and let them ponder

Tiny injection...horrible grisly death. Tiny injection...horrible grisly death.

Choose wisely.

But wait! There's more!

 2) What about what physicians referred to quaintly from 1500 A.D. until about 1930 as "mortification"?

IOW, you're going to get an infection.

Bullets aren't sterile.

Neither was your skin on the outside, before it became a new orifice.

Neither were the clothes you were wearing when a portion of them was injected into your body at upwards of 800fps, or worse.

QuickClot ain't fixing any of that. Every minute after the initial corporeal insult, a veritable Noah's Ark of bacteria are doing what they do: eating, dividing, and multiplying.

Inside of you.

They're going to make you the new lead solo in the Choir Invisible in about a week, left unchecked.

Septicemia, gangrene, and assorted related nasties will all have their way with you.

Unless you get some antibiotic prophylaxis. I.e. something to kill those cooties, and give your own immune system a leg up on winning that battle.

Currently, antibiotics in the cephalosporin family are the first-line choice for uncomplicated pentrating trauma.

A gram of Ancef given as a butt dart, followed by a week to 10 days of Keflex tablets will generally suffice. I leave it to the brighter and more motivated to research dosages and regimens from the standard medical trade references.

If you're not allergic to them.

If you have no contraindications for them.

If you have an IQ above that of plant life, and have researched what, how much, and how often to take them. And when not to. And what to watch for during and after. And when to know it ain't working.

If you can get your hands on them, both, and in sufficient quantity for a full course of treatment. Or the second- or third-line alternatives. (People who half-ass their antibiotic therapy, and quit early, aren't just quitters. They're generally referred to as morons with low gray matter titer, and future inhabitants of Boot Hill, in the trade. Don't be That Guy. For the younger set familiar with That 70s Show, the phrase you're thinking of is "Dumbass!").

Hint: There's a reason 18D school for SF medics is somewhere around 18 months long, and it's not for PT and obstacle courses. There's a lot of stuff to know, cold. Patients don't come with multiple choice bubbles tattooed on their chest.

Still not close to done, kids.

3) What about all that formerly viable flesh in the wound channel turned into non-viable chum?

It's maybe going to need removal, before it becomes food for #2, above.

Sooooooooo…..got local anesthesia handy?

How about general anesthesia; and someone to administer it, and monitor your vital signs until you wake up, and reverse any overdose, or 57 untoward effects, and the medicines to do all that?

Oh yeah, and someone to do the actual carving work while you're numbed up, or knocked out? (Look, Ronin was a great flick, as was John Wick: Parabellum, but absent a scriptwriter with a vivid imagination, and a paycheck like DeNiro or Keanu Reeves, you ain't gonna do the operation yourself, biting on a leather strap, and sewing yourself up afterwards while looking in a handy mirror.

Simply. Not. Happening.

So...d'ya know a good surgeon? Or even a bad one? Or a simple MD? A physician's assistant? A dentist? A vet? A former 18D with a sense of adventure? 

4) What about pain control, now, and later?

What, you actually thought this wasn't going to hurt like hell, or that you'd get by on a couple of motrin and maybe a slug of gin?

As if.

5)What about related problems? Side effects? Bad outcomes? Physical therapy? And tending to you, including changing dressings, wound care, and drug therapy, not to mention making sure you get rest, food, and drink, daily, including making sure everything works coming in and going out, and notices when it isn't, until you're completely back to normal, status quo ante? (Hint: In the trade, we refer to that last compendium as "nursing". I or any good nurse pulls six figures/yr for a reason, and it ain't for juggling bedpans, despite the lame attempts at wit by morons who don't know any better.)

Somewhere close to now, you should start to realize that while it's a good first step, merely slapping a battle dressing on a bullet hole isn't going to cut it, unless your clever plan is to simply die a week later, at home, sitting in a puddle of uncleaned feces and suppurating pus.

We repeat, NC Scout's list is a good beginning point. An IFAK and a hospital are both useful items, but they are hardly interchangeable.

Best do a long re-think for Spicy Times, and secondary and tertiary sorts of considerations.

As CA told you in the OP above,

"Plan accordingly."

Or else, keep your life insurance paid up.

I repeat:

You WILL see this material again IRL.

*(tDaP = Tetanus, diphtheria, and pertussis - AKA whooping cough. Because your childhood shots for those ran out of gas decades ago, and yet the ongoing influx of unvaxxed yard monkeys from all these Turd World countries like Shi*holia and Trashcanistan arrive here over the back fence instead of through the front gate - i.e. legally - and without benefit of things like a First World course of vaccinations against Life's Little Catastrophes. Like tetanus, diphtheria, and whooping cough. Not to mention plague, TB, Chagas Disease, and about 4M other exotic nasties formerly confined to...wait for it... Sh*tholia and Trashcanistan. QED. Now ask me again why your medical bill here is so much higher here than it is for folks in those tropical paradises.)

Two Is One, And One Is Dumb

Yeah, I know.

It's "Two Is One, And One Is None."

Meaning: Anything you have only one of becomes a single point of failure.

Because Murphy hates your guts.

My version, while pithier, is more accurate.

So you have two of many important things.

So...how well and how far have you thought that through?

Be honest.

Maybe (unlike moi) you live in Free America, and a CCW is easy to come by (or not required at all - yay, Constitutional Carry).

So - of course, duh! - you have a second G26, or thug-stabbing stiletto, or at least a second duct-taped roll of dimes, in case something happens to your primary one.

So you're good, right?

Natzsofast, Guido.

Look at EDC again.

What's your real everyday carry?

How about keys? A wallet?

You got a second one of those??

I'm not rich.

Nor a building maintenance supervisor.

But looking at my key ring:

Car remote fob.

Car key for other car. 

Front door key.

Back door key.

Office key.

Locker key.

Safe deposit box key.

Safe key.

Gun safe key.

Bike lock key.

Weapon carry box key.

Generic luggage key for briefcase and suitcase.

Mail drop door key.

PO box key.

Keyring light.

Stash capsule. (For spare $20, or your Rx pill(s), etc.).

Keyring pen knife.

I thought about it one day, and realized I had some spare keys.

But I didn't have a complete-in-every-detail duplicate-of-everything-on-the-ring EXTRA key ring.

Well, I do now.

And not in the house with the primary set, either.

Because that key ring would never fall out of your pocket while you were fishing. Fifteen miles offshore. At night.

(Like all your suddenly banned guns did, or will.)

Your cat will never bat them off the counter and behind the least accessible piece of furniture in your house.

Your dog will never bury them in the rose garden.

There will never be a hurricane, tornado, or 7 point earthquake where you left them on the top of the bedroom dresser, and in the morning, you couldn't find the dresser, or even the bedroom, anymore.

Let alone the darned keys.

Oh, HELL YES THEY WILL.

Ask me how I know.

I can check several of those boxes.

What about your wallet?

Forget the $10, $20, $50 if you lose it.

That's the smallest problem, every time, if it gets lost, stolen, mislaid, whatever.

But killing a day at the DMV for a new driver's license?

Kill me with a salad fork first, please.

A dull, rusty one.

It gets worse.

There's a professional license in there too.

And half a dozen gotta-have-em certifications.

My permission to buy-a-gun card. (Yes, really. It's Califrutopia.)

My CCW. (Because even though it's Califrutopia, I'm not stupid enough to live in a gun-free county.)

Both a yuuuge PITA to not have, or need to replace in haste.

Then 3 ATM/debit cards, two credit cards, 3 merchants' loyalty discount cards, and - oh, yeah - Uncle's Social Security card, without which I can't get hired 23 times a month on 22 different television or movie productions, because I have to fill out a new I-9 every time I pick up a one-day gig.

And a DoD expired ID.

And a medical insurance card.

And a dental plan card.

And even a passport substitute ID card.

And a shrunken version of an FFL.

All easily and quickly replaceable at 3AM on the Wednesday before the Thanksgiving 4-day holiday, 2500 miles from home, amiright?

And then we get into the other eleventy things in that wallet, even after the quarterly shredding of the no-longer-necessary-or-relevant detritus that accrues therein. 

Oh, and one of my favorite things:

In case you lose your wallet/cards, the toll-free numbers to report them are all printed on the cards.

Right on the back of the cards you lost.

Genius, right there, no?

Spot the Logic Fail in this plan

But you knew Kinko's/FedEx has color copiers, right?

And that your bank will issue you duplicate cards for free, just for asking?

So that if, say, your house burns down, you don't have to wait 72-168 hours to get a new ATM card, to buy a set of clothes, a tank of gas, replace a dropped transmission, and rent a comfy motel room for the night. Nor depend on the kindness of strangers to call you an Uber, so you're not stranded in BFEgypt on a Saturday, and your @$$hole bank shut off your credit, because even though you used your PIN-verified card to purchase a flight to BFEgypt, you didn't tell them you were going there, so they waited until you flew to BFEgypt to cut you off from all your wordly goods and chattels, but only mans the turn-it-back-on customer service phones M-F from 10-4, EST.

Ask me how I know this, too.

And see if you can guess why I have a spare wallet, down to the last detail, including a spare modicum of greenbacks, because 90% of the time, a color copy of your driver's license is good enough (for anyone but the White House gate guards, or Trooper Goober of the BFEgypt State Police when he's pulling you over for a good fleecing for the crime of driving while out of state), and most of the rest can at least be copied, so you have those toll-free 800/888 numbers handy to report loss before you've acquired a new bill for a shopping spree, courtesy of the guy who lifted your real wallet.

And that's just off the top of my head.

If you're going to be prepared, be prepared to deal with the simple stuff, before you worry about the Zompocalypse/black swan events. In the average person's non-Walter Mitty lifetime they're probably going to lose or mislay keys or wallet a lot more often than they're going to have to escape and evade zombie hordes and travel cross-country in a epic 3000 mile journey to a Bond villain lair.

My apologies if this is news to you.

So fix that, and see what else you can apply the wisdom of a belt and suspenders to in order to not be caught by life with your figurative pants around your ankles.

Sunday Music: Good Thing

I like some country (and now country/rock) music, but I'm not a Keith Urban fan, per se. (I'm not anti-Keith Urban either, just purely neutral.) And then somehow, this bit of serendipity showed up on a suggestion list.

After watching it, I'm a big Keith Urban fan. I never get tired of watching this moment, for the same reason some millions of us love watching the auditions on X-Factor or Whoever's Got Talent, when someone walks up on stage cold, and totally crushes a performance this way. It's Susan Boyle blowing the walls off a theater and exploding Simon Cowell's head; it's Marty McFly ripping out a better Johnny B. Goode than Chuck Berry. It's every former little leaguer dream-walking out of the seats, calling his shot, and parking a fastball over the center field bleachers. In Yankee Stadium. (And if you don't root for underdogs and amateurs who do that, I don't know you, and I don't want to.)

A sage once wrote that "luck" is what happens when preparedness meets opportunity.

In short, a guy is lucky who prepares for a million-to-one shot, and then out of nowhere, the opportunity to take it presents itself, and instead of making excuses for not being ready, they rise to the challenge of the moment.

This is exactly that moment for rookie of the minute Rob Joyce.

What were the chances?

Also, mad props to Urban for giving an unknown a shot, risking the guy getting on stage and sucking horrendously, but instead fortuitously picking the right guy at the right moment, and catching lightning in a bottle like this.

Ditto to Urban's bandmates, who rush back onstage, and back the guy up like a brother, because talent recognizes talent.

Enjoy the track, and the moment.

This is what life should be like as often as possible.

"Good Thing" indeed.

Yeeeeeeeeeeeehaw!

Finally got this pig back up on its skates.

The Super Deluxe Blogmaster is now running on Mr. Fusion, with a UHD display.

No more steam-powered drive with the add-on sepia-tone kinescope.

Those days are as dead as the old hard drive.

Including control of the formatting and paragraph breaks.

(And I'll go back and fix the previous entries. Especially for GVDL.)

Next step is getting my meme and pic library back up to spec.

(Update: score!)

And just in time for the fun a week from Tuesday, too.

Missed y'all. Hope you're well.

Here's Your Big Chance

Trump has Kung Flu. 

(Bummer for those of you who thought this was un-possible, but such is the price of delusion.) 

A) They rushed him to Walter Reed. Explain how this is exactly what they do every time the president catches "just the flu, bro." 

B) The Dumbocrats don't control the medical response, so feel free to explain how and why Trump is perpetuating this disease as a hoax, as if it is one. (When your head explodes trying to pull that off, feel free to get some toilet paper to wipe up all the sh*t it was full of.) 

C) He's doing well, and will in all likelihood (please, God) get over this with minimal impact. Like 97+% of those who caught it already have. Explain how they always do daily medical briefings coast-to-coast every time he catches a cold, gets a hangnail,or cuts himself shaving. 

Best wishes in those attempts, doomed to epic failure as they necessarily are. I'm sorry he got infected, despite some pretty stringent precautions. I'm glad he's doing well, and pray and trust that he will both recover completely, and kick the ever-loving sh*t out of the Hidin'/Kneepads (tm) ticket in upcoming debates, and the coming election. 

But neither sentiment does anything but confirm that this is really a thing, and it ain't "just the flu, bro", nor do anything but underline that you're far from done with it, even now. (Recall when we told you next Easter, minimum, while noting that anything better and sooner would bring nothing but shouts of ecstasy from this blog.) Then Google-search "European/Worldwide Second Wave", and get back to us. 

We have 200K fatalities (juiced or not, it's what we got to work with). WHO guesstimates - guesstimates, we emphasize - a worldwide penetration of this of no more than 10% of the population. (The @$$holes running NYFC and NYFS and running the city subways carefree 24/7/365 during the height of the outbreak there, and shoving infected patients into ill-prepared nursing homes were obvious over-achievers.) Do the math, and tell the class what a nationwide 100% penetration would tally to in the US, seeing as most states never got to even 5%, and then go back and look at our rosiest worst-case projections, if this had been met with zero response, from earlier in this year. 

Then, kindly STFU, as we already knew that answer before you did, and yet again, events have borne that out. 

To breezily quote no less an authority than President Jed Bartlett, "You were wrong. Just sit there and be wrong in your wrongness." 

Yet again, my epicaricacy knows no bounds.

I Toldja So, Pt. 2,487

Color me shocked: U. of Iowa re-opened, as did universities in many states, including in North and South Dakota. 

No points for guessing where the three highest per-capita Kung Flu infection rates in the U.S. are, as of right this minute. 

In Week One, U. of I. had a student body infection rate of 13+%. (That's worse than the documented infection rate for the entire state of CA after 9 months of this crap, FTR. FWIW, we're seeing a COVID case every 2 weeks or so, rather than 10-a-night, currently, here in my part of SoCal. L.A. is another story.) This week, Week Two, it's now north of 28% at U. of I. Well-played. I can hardly wait to see how long before they get to full goose bozo 100% infected. 

The really fun part is that somewhere around 50% will be totally asymptomatic. When those unharmed students start passing it on to their parents, professors, and ancillary staff, and so on, it won't be so bitchin' for the previous low infection rates in those three states. Or their hospitals. 

How fun is that? Flash back to food production earlier this year when national epicenters of beef, chicken, and pork production had sudden clusters of 10, 20, or 50 packing workers taken out with Kung Flu, and guess the price of bacon and chicken going forward a few weeks after that happens again. Remember: if you like your pandemic, you can keep your pandemic, and this is how you do that: trust the biggest jackasses to be responsible participants in society. In this case, that group being university students. And their moron administrators. Go, Team Gilligan! 

The only small silver lining in that clouded hurricane sky is the prospect that they might ass-idently wipe out an entire generation of aging hippie leftoid fruitcakes in academia, which will be an unexpected own-goal for the ChiComs who bungled containment, and the Leftards and NeverTrumpers cheering on the pandemic. If they can repeat the success from Iowa at places like Harvard, Berzerkely, et al, color me properly amused. 

But as expected, and right on track, the next COVID-wave spike now looks to be late September-October-ish, due to school re-openings from K-PhD. Followed by the inevitable one after that, likely from Thanksgiving to New Years', inclusive, secondary to large family holiday gatherings. Almost like Pasteur's Germ Theory and 150 years of epidemiology research was true or something. 

But for those not addicted to low double-digit IQs, and utilizing face masks, handwashing, 6' social distancing, and copious use of hand santizers, events tease the prospect of the smallest annual flu numbers in decades hereabouts. 

Whether society can survive the low-IQ pandemic, and the election held amidst it, is the open question of the year. So much for imaginary pandemics, and "It's Just The Flu, Bro." Hopeium is now trading in Zimbabwean Trillion-dollar treasury note ranges. 

Keep up the PT, and stocking your deep larders. 

You're only in the middle innings of this.