245 years of unbroken tradition, unhindered by progress.
Semper Fi, Devil Dogs.
Here's to 245 more.
Tuesday, November 10, 2020
Monday, November 9, 2020
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.
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.
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).
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.
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).
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).
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).
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):
Smartest would be to acquire both.
One way or another, you will see this material again.
Sunday, November 8, 2020
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."
Saturday, November 7, 2020
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.
Friday, November 6, 2020
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 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.
Thursday, November 5, 2020
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.
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
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| 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.
Wednesday, November 4, 2020
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.
Tuesday, November 3, 2020
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 @$$clowns in Congress lose their collective sh*t, yet again, would be quite the early Christmas.
Think happy thoughts.
While you're stacking cases of beer and soda, and pretzel, chip, and popcorn bags like sandbags.
And loading magazines.
Then we can go back to mostly ignoring the political $#!^show for another few years, as God and the Founding Fathers intended.
Here's a classic annoying earworm for you:
But be ready for
Monday, November 2, 2020
Monday Medical: Hypothermia
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| Never as funny IRL as this looks. |
Hypothermia is technically anytime your body's core temperature is below 95° F.
Last week, Southern Califrutopia had its first "cool" day of the season. Cool is a relative term.
Hereabouts, it means shorts and a T-shirt aren't cutting it. We only visit snow in the mountains, we don't live in it, and our snow blower is called "the Sun". For some of you in other hardier places, our cool temp would be what you call "summer". YMMV. The greater lessons still apply.
Nonetheless, it wasn't that cold, even here. But my patient was over 60. Strike One. (Big risk factor. Older people, just like kids, don't cope well with thermoregulation, both having less muscle mass to generate heat, and a wonky temp control system. One because it's new, the other because it's worn out and old.)
And it was a perfect day for hypothermia. Low 50s. Overcast, hazy sunshine. Breezy, occasional drizzle. Strike Two.
Because on really cold-@$$ 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, November 1, 2020
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.
Saturday, October 31, 2020
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.
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