A friend recently asked us to write about injuries that might be incurred in an earthquake scenario in the Pacific Northwest, so we decided to do a show on the various kinds of wounds you can expect in any major disaster, from a mudslide to a tornado to a major seismic event. Joe Alton MD recounts an incredible survival story of a woman who lived for a week at the bottom of a 200 foot cliff after running her car off it(!), and he and Amy Alton ARNP discuss everything from bleeding wounds, crush injuries, orthopedic damage, and much more, including basics on how to place a cast!
All this and much more in this episode of the Survival Medicine Hour with Dr. Bones and Nurse Amy!
Recently, I was asked by a friend to comment on medical issues related to Earthquakes. Seismic events are major concerns on the West coast of the United States, and the number of casualties could be significant, especially if access is lost to modern medical services in populated areas.
Even in normal times, there are many areas away from cities where the ambulance isn’t just around the corner. Take a cross-country road trip and you’ll realize that there’s a lot of territory where medical help may not be readily at hand.
The effects of an earthquake may be spread over a large area. The sheer number of casualties spread out over a seismic zone might overwhelm medical personnel. Those that report for duty, that is; some will understandably prioritize family over civic duty. Certainly, the distance of some rural areas from the nearest health facility makes it unlikely that help will soon arrive.
The types of wounds incurred in a major earthquake will include hemorrhages, sprains and fractures, burns, and crush injuries. We’ve talked about all the rest in past articles, so today, let’s concentrate on crush injuries.
Crush injuries are problematic when they happen and when they’re treated. Bleeding vessels may be disguised if the skin isn’t broken. They may present, instead, as severe bruising or an accumulation of blood in body tissues known as a “hematoma”. In the chest and abdomen, hemorrhage is hard to control with modern facilities. Depending on the location, direct pressure may cause bleeding to abate. But pressure at the suspected site would be more effective if there were a skin breach that allowed visualization of the wound and packing with dressings.
A complication of significant crush injuries is known as “compartment syndrome”. Groups of organs or limb muscles are supported in sections by tough connective tissue known as “fascia”. These form compartments. Ordinarily this provides strength, but in a crush injury, excessive pressure builds up due to volumes of free blood or the weight of the impacting body itself.
As a result, muscles may swell or blood may accumulate in one or more of these compartments. Because of the fascia, there is nowhere to go. The increased pressure prevents good circulation, leading to a lack of oxygen in the area. The end result is sometimes irreparable damage to nerves and other tissues. Paralysis, organ failure, or even death may ensue.
The first sign of compartment syndrome is, as you might imagine, severe pain. This is followed by “pins and needles” sensations. The limb becomes swollen and shiny, losing sensation and function the longer the weight is upon it.
If the injury is confined to a small area, say only a part of the foot, the effects are usually confined. When larger areas are involved, however, the situation becomes much more complex. The dilemma is that the victim is in danger while under the extreme pressure of the offending object itself, but also when the pressure is released.
severe crush injury
Releasing a person who has been under a crushing weight for a significant period of time is called “reperfusion syndrome”. Dying muscles and organs release toxins that can not only cause local effects like paralysis of the affected area or dysfunction of the particular organ, but also overwhelms the kidneys’ ability to eliminate those toxins, leading to renal failure. These toxins include potassium, which can be released in large quantities throughout the body when pressure from the crush injury is released, causing life-threatening irregular heart rhythms.
Remember the 5 P’s of compartment syndrome:
Pain and lots of it (at first)
Pale, ashen skin
Paresthesia – strange sensations like numbness, tingling, or pins and needles
Pulse (lack of it beyond the level of the injury or a rapid, irregular heartbeat)
Paralysis due to nerve damage
It’s a good idea to keep a crushed extremity below the level of the heart to aid blood flow. If the affected area has been under crushing pressure for a short period of time, say 10-15 minutes, try to lift the weight off them. Longer than that, let emergency medical personnel make the decision. They will often administer IV hydration, oxygen, and certain medications before removing the weight. Some recommend the placement of a tourniquet as well, to prevent toxins from flooding the rest of the body.
fasciotomy to release pressure
Once at the hospital, surgeons will often have to make an incision in the fascia to release the pressure in the compartment. It doesn’t get easier from here. Intensive care personnel will have to monitor the victim for kidney failure and a host of other issues.
Other that stabilization, there’s not much more you can do with a crush victim in an earthquake without modern medical and surgical care. Besides the crush itself, fractures, sprains, and internal bleeding combine to truly challenge the lone medic off the grid.
Joe Alton MD
Joe Alton MD
Fill those holes in your medical supplies with individual items or complete kits from Nurse Amy’s entire line at store.doomandbloom.net!
The human body is a marvel of biologic engineering. Its immune system usually kills bacteria and other harmful germs before they can multiply and cause symptoms. Our blood contains white cells, also known as “leukocytes” that attack bacteria. Even if we do experience symptoms, our bodies can usually cope and fight off the infection. It’s thought that this process of suffering an infection and its elimination by an immune response happens every day, usually without any obvious sign.
There are occasions, however, when the body’s defenses are overwhelmed. In these cases, help is needed, and it comes in the form of antibiotics. The word “antibiotics” is derived from the Greek “anti” (“against”) and “bios” (“life”). While this seems a strange foundation for a medicine that saves lives, the meaning is simply that the drug is “against” the life of the disease-causing organism.
Joe and Amy Alton discuss antibiotics from a historical standpoint, do you know which was the first to be placed on the market?
Also, Joe Alton MD finishes his discussion of bear encounters with advice on bear sprays and the difference between brown and black bear attack and defense strategies. Lastly, Amy Alton ARNP discusses how nutrition plays a role in keeping you healthy in good or bad times!
All this and more on the Survival Medicine Hour with the Altons!
In this video, Joe Alton MD discusses a short history of something that’s been on our planet for billions of years: microbes! Of course, most microbes are perfectly harmless, but some can kill you.
A few can cause worldwide pandemics, like Yersinia Pestis, the bacteria that caused the Black Plague. Yersinia lived on fleas that lived on rats that lived among humans, and still causes cases in various parts of the world (including a few in the U.S.).
In order to understand disease-causing germs (also called pathogens), it’s useful to know where they came from, how we humans came to realize they were there, and that they could cause disease. Dr. Alton talks about how we came to realize that we shared the planet with things we couldn’t even see.
To watch, click below:
A Brief History of Microbes and How We Discovered Them - YouTube
Wishing you the best of health in good times or bad,
Many consider a heat wave to be just a time to put an extra ice cube in the lemonade, but it’s a deadly natural disaster. More people die in heat waves in the U.S. than just about any recent weather event short of hurricane Katrina. Find out from Joe Alton MD about what causes and worsens a heat wave, and some advice from the Arizona state government (they should know about hot weather) to stay safe this summer.
Also, Those who are concerned about a disaster plunging us into an off-grid scenario, however, must realize that commercial drugs will probably no longer be manufactured, and existing supplies will run out very quickly. This fact alone leads to the conclusion that any medically prepared person should have knowledge about medicinal herbs and, hopefully, a working garden. Amy and Joe discuss the data behind the health benefits of Turmeric, a popular herb used in curries and other foods.
Bears are mammals of the family Ursidae, and I’ll bet you don’t know what their closest living relative is: It’s seals. What do you do if you’re come upon a bear in the woods or in your own backyard? In part 1 of this segment, Joe Alton MD gives some hint from the Park Service, plus some of his own comments.
Lastly, hope you had a safe 4th of July, but some people get injured every year by misusing fireworks. Here’s tips from the National Council of Fireworks Safety so that your next holiday will be a blast, and not the kind of blast that blows off your fingers!
All this and more in the latest episode of the Survival Medicine Hour!
Wishing you the best of health in good times or bad,
Joe and Amy Alton
Follow Joe Alton MD and Amy Alton ARNP, aka Dr. Bones and Nurse Amy, every week on their podcast and also at doomandbloom.net! Also check their twitter feed @preppershow, YouTube channel at DrBones NurseAmy, and Facebook page at Doom and Bloom(tm)!
And don’t forget to fill those holes in your medical storage with kits and individual items from Nurse Amy’s entire line at store.doomandbloom.net...
In part I of this series, I mentioned that headaches might be just an annoyance to some, but a dangerous sign of a serious medical issue to others. They can be caused simply by tension and stress, a case of the flu, or by something as life-threatening as a stroke.
Last time, we talked about tension headaches and other basics, but there are various different types of headaches. One that can really make you miserable is the “migraine”.
A migraine is a disorder that affects nearly 15% of the world’s population and is characterized by repetitive episodes of moderate to severe headaches. In general, it’s more common in women than men, starting as a teenager or young adult and reaching a peak in the late thirties or early forties.
The exact cause of migraines is a matter of some debate. They are thought by some to be related to spasms in the blood vessels. Others believe environmental factors are to blame, and still others consider it some misfiring of nerve cells. There may be some genetic aspect as well, as they seem to run in families.
There are four phases to a migraine, although not everyone experiences all of them:
1) The “prodrome”, which occurs hours or days before the headache
2) The “aura”, which immediately precedes the headache
3) The “pain phase” (the actual headache)
4) The “postdrome”, the effects experienced following the end of a migraine attack
Prodromal symptoms occur in the majority of migraine sufferers. They represent essentially a “premonition” that there’s a migraine in your future. Prodromes can start anywhere from two hours to two days before the actual headache and include all sorts of symptoms, including:
· Mood swings
· Stiff necks
· GI irregularity
· Increased sensitivity to noise or smells
· Food cravings
A prodrome may be followed by an “aura”. An aura is an unusual sensory effect that usually precedes a headache but is not uncommonly part of the headache itself. Symptoms can be strange visual phenomena (the most common), unusual sensations, and other irregularities. Many people experience their own set.
THE ACTUAL HEADACHE
The actual migraine headache (the “pain phase”) can last two to 72 hours and has certain signs and symptoms. They are usually:
• Throbbing in nature
• Nausea inducing, sometimes causing vomiting and other GI symptoms
• Pain-inducing when looking at light sources
• Causative of visual changes such as blurring, lights, and color phenomena
• Made worse by physical activity
There are, of course, variations to the above and different persons will experience different symptoms. For example, in a significant minority of cases, the pain is on both sides of the head or involves the neck. In others, dizziness and confusion are part of the symptom complex.
After the headache has subsided, a lot of people report soreness in the area and a foggy feeling similar to a hangover for a time, as well as weakness and other symptoms.
As you might expect, initial treatment for a mild migraine simply involves bedrest in a dark, quiet room and Ibuprofen (Advil) or acetaminophen (Tylenol). If that fails, consider a combination of acetaminophen, aspirin, and caffeine, each of which has known beneficial effects.
Some older medications like ergotamine, sometimes combined with caffeine (Cafergot) are still prescribed for migraines. Some come in nasal sprays. Some of these meds can cause spasms of the coronary arteries, so if you have a high risk of heart attack, they may not be for you.
Another family of drugs that work to relieve migraines are in the “triptan” family, the most popular being sumatriptan (Imitrex). These are effective against both pain and nausea in the majority of patients and are often given when simpler treatments fail. Taken in combination with Naproxen (Aleve), they are even stronger in their effectiveness.
Some medications are thought to have a preventive effect against migraines, including valproate, metoprolol, topiramate, and others.
In the next part of this series on headaches, we’ll talk about natural treatments for migraines and discuss sinus headaches as well.
It’s the 4th of July, and many proud Americans will be celebrating with fireworks. An unlucky (or careless?) few will wind up running afoul of their own pyrotechnics; just ask my old buddy “Three-Fingered Fred”. He’ll tell you.
Let’s face it, the safest way to enjoy fireworks is to be a spectator at your home town’s 4th of July event. Statistics show that from June 20th to July 20th of 2014, fireworks sent an average of 230 people to the hospital every day. 9 deaths were recorded, of which 2 were just innocent bystanders. Throughout 2014, there were more than 10,000 fireworks-associated injuries treated in U.S. emergency rooms.
Despite improvements in fireworks safety, injuries from accidents are rising. There were 349 injuries in Illinois alone in 2017, a 226% rise since 2008. None of these statistics take into account damage caused by pyrotechnics outside or in structures, totaling millions of dollars’ worth of damage.
Most (74%) fireworks-related injuries involve the fingers, hands, face (including the eyes), and head. Firecrackers were the most likely to be involved in mishaps. The majority of injuries were burns of varying degrees.
Many fireworks injuries (57%) are seen in children or teens, which should tell you that unsupervised use of fireworks by kids is a very bad idea. I remember one 4th of July on the beach watching fireworks when a bottle rocket lit by an 8 year-old wound up missing my head by just a few inches.
FIREWORKS SAFETY TIPS
If you must have fireworks for personal use, consider these safety tips, paraphrased from the website of the National Council for Fireworks Safety, peppered with some of my own advice:
Only buy legal fireworks for personal use. Avoid fireworks wrapped in brown paper; these are usually meant for professional displays and are dangerous to the novice. As the old saying goes, “when all else fails, read the instructions”.
Don’t be a mad bomber and make your own fireworks. Use the stuff made by the pros.
Never allow children to play with or ignite fireworks, even sparklers. Sparklers reach a temperature of up to 2000 degrees, as hot as a blow torch! A fireworks event should always be closely supervised by adults.
Adults: Have a designated “igniter” that holds off on the alcohol until after the fireworks.
Wear safety glasses
Never place your body directly over a firework when lighting it.
Never re-light or pick up fireworks that are “duds” or have not ignited fully.
Never point fireworks at another person (no Roman Candle duels!).
Always have a bucket of water or a garden hose nearby in case of fire or burns.
Don’t put fireworks in metal cans or glass jars as a “base”; if these containers explode, they will act like shrapnel!
Light fireworks one at a time.
Back off quickly after lighting a firework.
Douse spent fireworks with water.
Be aware of the laws in your town regarding fireworks, and obey them to the letter or risk a visit from your friendly neighborhood law enforcement officer. Many municipalities forbid the igniting of fireworks after 11 pm.
What about your pets? Curiosity killed the cat, and so can fireworks. Most cats and dogs probably won’t go anywhere near them, of course, but an investigatory sniff might get them into big trouble. They might be happier and safer inside the house.
If you or a member of your family is injured, it will probably be a burn injury. Call 911 or go directly to the emergency room after running cool water on the injury.
Following these safety tips will help keep your family safe and give you the best chance of a healthy 4th of July. Happy Independence Day!
It’s Independence Day in the U.S., and famous names like Thomas Jefferson and John Adams come to mind. It’s difficult to imagine that any of the 56 signers of the Declaration of Independence might not have been celebrated in their time. Influential and affluent, these men were so well thought of that they were given the power to declare freedom from the greatest empire of its time.
Don’t think for a second that these 56 men didn’t understand the risks involved of leaving the British fold. Hostile soldiers were occupying their towns, even their homes. The new country needed money and many of the signers loaned millions of dollars to the cause of freedom. Their personal wealth, their reputations, and their very lives were put on the line. They had committed high treason and they were in danger.
“We mutually pledge to each other our lives, our fortunes, and our sacred honor” is the last sentence Thomas Jefferson wrote in the Declaration. Sadly, for some of the signers, these were forfeited as a result of their brave act. 9 of them paid for their lives; almost 1 in 3 lost their fortunes and their homes. Yet none of the 56 ever recanted their decision to sign the Declaration or apologized for it, even under duress.
The Forgotten Founding Fathers
Here are the fates of some of the (mostly forgotten) Founding Fathers:
William Ellery, Rhode Island: A vocal opponent of slavery, his entire estate was burned to the ground.
William Floyd, New York: Escaping the British invasion of New York, they left behind their home and his entire income; it was burned to the ground. 7 years later, the family was destitute. Francis Lewis, New York: His home and estates on Long Island were destroyed by the British and he and his wife were captured. She died from complication related to their imprisonment. .
Lewis Morris, New York: Morris put his entire fortune at the service of the Continental Army. Loyalists confiscated his property and forced him into exile, not seeing his own family for many years.
Phillip Livingston, New York: One of the richest Americans in 1776, Livingston lost every penny he had as a result of signing the Declaration. His family was driven from their house by the British and his estate plundered. Livingston died penniless just two years later, while still serving in the Continental Congress.
John Hart, New Jersey: Hart’s wife was dying as he signed the Declaration. His efforts to reach her were thwarted by the British. His 13 children never saw their father again: they were all forced to flee for their lives as well. He died in 1779.
Richard Stockton, New Jersey: Judge Stockton was arrested by the British in 1776 and imprisoned in a military stockade. He was released, an invalid, 5 years later and died a pauper in Princeton.
John Witherspoon, New Jersey: He served as President of the College of New Jersey (better known today as Princeton University). The British responded to his signing the Declaration by burning the College library to the ground and pillaged the rest of the campus.
Robert Morris, Pennsylvania: Morris earned a fortune as a banker and commercial magnate – and gave it all away to finance the army/navy. The ships that brought provisions from Europe to the colonies were entirely paid for and provisioned by Morris. He also loaned an enormous sum to the Continental Congress when it was on the verge of bankruptcy in 1776. He never got his money back and died penniless in 1806.
John Morton, Pennsylvania: Despite living in a Loyalist-dominated part of the colony, and personally preferring reconciliation with Great Britain, Morton signed the Declaration. His neighbors turned on him and he never returned home. Just before his death in 1777, he submitted to Congress what became known as the “Articles of Confederation”.
Thomas Nelson, Virginia: As American guns shelled the British defenses, an anguished Nelson (now a General in the Continental Army) saw that they were sparing his house, which was General Cornwallis’ headquarters. As the story goes, Nelson personally turned a cannon towards his home and blew it up, to show that he was no less willing to sacrifice than his fellow Virginians. He loaned over $2 million to the Continental Congress, none of which was repaid, and died in poverty.
The entire South Carolina delegation: All four Palmetto State signatories paid dearly for joining the cause for Independence. Edward Rutledge, Arthur Middleton and Thomas Heyward, Jr. were all imprisoned by the British when Charleston was taken in 1780. They were beaten and humiliated in prison, then released to find their plantations had been burned and pillaged. They were more fortunate than co-signatory Thomas Lynch – he disappeared at sea while seeking medical help in the West Indies, together with his young wife, at some point in 1779.
Lyman Hall, Georgia: a physician, Dr. Hall helped to supply food and provisions for the Continental Army throughout the war. Despite living the furthest away from Philadelphia of all the signers, he returned to Georgia just once between 1775 and 1780 (when his friend and co-signer Button Gwinnett was killed in a duel). The British burned his property when they seized Savannah in 1780.
Francis Lewis, New York: His wife was captured by the British in 1776 and later died as a result of her captivity. Lewis himself lived out his years in relative poverty, having sacrificed his entire fortune to the cause.
Phillip Livingston, New York: He and his family fled their home to escape the British army and never returned.
George Clymer, Pennsylvania: His family fled to escape the British soldiers who ransacked their house.
Abraham Clark, New Jersey: Two of Clark’s sons were officers in the army. They were captured by the British and confined to the prison ship Jersey, where thousands of American captives died. One was held in solitary confinement and given no food. Reportedly, Clark still refused to change his position and support the crown when the British offered to spare his sons’ lives if he did so.
I would be remiss if I didn’t mention Dr. Joseph Warren (pictured above), one of the most important founding fathers in U.S. history. An early advocate of independence in Boston, Dr. Warren, a physician, would certainly have signed the Declaration of Independence except for one thing: he was killed by the British the year before when he commanded the colonial militia at the Battle of Bunker Hill. It was only the lack of ammunition that prevented Dr. Warren from taking his proper place with men like George Washington.
Dr. Warren and the above signers of the Declaration won’t be found on any coins and paper currency. Their faces won’t be on your stamps and it’s unlikely that there will be many colleges or parks named after them. Yet, they and many others freely risked all at a time when their country needed them most. The next time you are asked to risk something for your beliefs, think of the forgotten men and women who bravely assisted at a difficult birth: The birth of the United States.
Happy Independence Day!
Joe Alton, MD
Would you know what to do if the grid is down and someone is sick or injured? Get the plain English 700 page 3rd Edition of the Amazon Bestseller “The Survival Medicine Handbook and you’ll have a head start on staying healthy in hard times! It’s the essential guide for when medical help is not on the way.
Last week on the Survival Medicine Hour podcast, Joe Alton MD and Amy Alton ARNP talked about some basics on sprains, strains, and fractures, and this week they continue the subject, especially how to tell the difference between a sprain and a fracture, including something called the Ottawa Rules. The Ottawa Rules were meant to discourage unnecessary x-rays, but also have applications towards off-grid situations like survival scenarios.
Plus, Joe and Amy talk about headaches, sometimes an annoyance but sometimes a sign of a real medical issue and life-threatening event. Find out about the various types of headaches like migraines, sinus headaches, tension headaches, and more. Learn how to identify them, treatments both conventional and natural, and some medical illnesses of which headaches might be a sign.
All this and more in the latest episode of The Survival Medicine Hour with Joe and Amy Alton!
Medical issues that confront the medic on or off the grid can be obviously life-threatening, such as a heavily bleeding wound, or seemingly benign, such as a headache. A headache might not appear to be of much consequence, especially if you’re being chased by a grizzly bear; it can, however, be a sign of a imminent event, such as a stroke.
Headaches are one of the most common medical symptoms that you may face as a medic, but you might be surprised to know that brain matter itself doesn’t have any pain receptors. There are several structures around the brain that do, however, such as muscles, blood vessels, and sinuses. When stimulated, nerves associated with these structures can transmit pain signals to the brain, resulting in a headache.
Headaches are common components of flu syndromes and many other illnesses. There are almost more causes for headaches than you can reasonably write down. They include:
• Sinus or ear infections
• Sleep deprivation
• Teeth Grinding
• Hormonal changes
• Caffeine or alcohol excess and withdrawal
• Exposure to environmental toxins
· Adverse reactions to medicines
More serious concerns would include an imminent stroke, brain tumors, nervous system infections like meningitis, glaucoma, and much more.
Evaluating a headache involves determining what the symptoms are, the risk factors (e.g., high blood pressure), what makes it better or worse, and a physical exam. The part of an examination which evaluates the nervous system is called the “neurological exam”. Check reflexes, strength, sensation, movement, balance, coordination, vision, and hearing on both sides. It’s especially important to note any differences on one side versus the other.
This video is an excellent example of a short but comprehensive neurological exam:
How to do a 4-Minute Neurologic Exam | Merck Manual Professional Version - YouTube
TYPES OF HEADACHES
Once you have determined that the neurological exam is normal, you will have to determine what type of headache with which you’re dealing. The various types include:
• Tension headaches
• Migraine headaches
• Sinus headaches
• Headaches related to medical conditions
By far, the most frequently-seen type of headache is the tension headache. Although the cause has not been established definitively, it may be caused by spasms of the muscles of the neck and head, anxiety, abnormal posture, or any of a number of other issues. Stress appears to be the initiating factor in many cases.
Tension headache is usually seen bilaterally (on both sides) and/or the back of the head and neck. Sufferers report a dull ache and the sensation of a tight band of pressure around the forehead. Neck and shoulder muscles may also be involved.
Tension headaches may last a half hour or they can last a week. Treating a tension headache involves relaxation techniques and NSAIDs like ibuprofen (Advil). Some feel relief simply by taking acetaminophen (Tylenol). Excessive use of medications, however, may lead to “rebound” headaches, where the headache pain returns when off the drug.
A number of prescription medications like naproxen or even stronger drugs are also used in severe cases. If muscle spasm is suspected, prescription medications like cyclobenzaprine (Flexeril) may be of use. Relaxation techniques include massage, regular exercise, yoga, meditation, and deep breathing. Cold packs to the affected area may help.
Biofeedback training is another way to reduce stress that can cause a tension headache. This method uses devices that monitor heart rate, blood pressure, and muscle tension. It attempts to give you “feedback” to help control some of the factors that lead to headache. Counseling, also called cognitive therapy, may help by allowing you to voice your stress and find ways to deal with it.
Other alternative therapies may also play a part in dealing with tension headaches. Some attest to the effectiveness of acupuncture as a therapy. Other use herbal teas: Herbs that have sedative and antispasmodic properties may help relieve the pain of tension headaches. Consider teas made from Valerian, skullcap, lemon balm, or passion flower. Herbal muscle relaxants may also help: Rosemary, chamomile, and mint teas are popular options. For external use, some alternative healers recommend lavender or rosemary oil. Massage each temple with 1-2 drops as needed.
I’ll bet you have your own home remedy for tension headaches. If so, let me know what works for you.
In part two of this series, we’ll discuss migraines and other types of headaches, plus more natural remedies.