MEDICAL MONDAY - Treating Head Wounds & Concussions on The Survival Medicine Hour

World as we know it, World as we know it, World as we know it, And. Welcome to the Doom and Bloom Hour with medical preparedness experts, Doctor Bones and Nurse a Mey, your source for information on how to succeed if everything else fails. And now your hosts, Doctor Bones and Nurse a Mey. Phenomin the alternative the world as we know it. This is the Hour of Doom and Bloom. Ah, what was that all about? We didn't hear Nurse Amy's beautiful musical voice today out I'll tell you about that in just a second. Well, this is the Doom of Bloom Survival Medicine Hour with Doctor Bones in Nurse Amy minus Nurse Amy today a time of tranquility in a tumultuous world. I'm Joe Alton, MDI, the Disaster Doctor, also known as Doctor Bones. I'm a geezer on the go, a codure with a calling, a fossil with a fixation, and that's to keep you and your loved ones healthy in good times or bad. Now, my lovely wife is Nurse Amy. She's an advanced registered Nurse practitioner and certified Nurse midwife, and she is in the vast wasteland of unpreparedness known as Chicago, Illinois, visiting her eldest daughter for Mother's Day this weekend. She is the hostess with the mooses, make no mistakes, and she's so hot that Pato's refused to be photographed next to her. She is incredible. The only problem she's. Not here today, But rest assured that we are the watchers on the wall and we will watch it all for you to make sure that those bumps on the road to preparedness aren't the end of the road. I'm actually not alone on today's broadcast. Today. I have TD Bird, my African gray parrot, America's favorite loudmouth, in the room today, mostly because he only shuts up when he's in close. Proximity to me. He is amazing. Well, I'll tell you it's embarrassing when I tell people I have a talking parrot and he is a yacker, But they go and take a look at him in his caju. He doesn't say a darn thing. He's like mister ed. He only talks when he has something to say. But if I take those people and I take put him in another room with me and he can't see us, well, guess what. He starts yacking. So we're gonna have. A nice, hopefully quiet time, right bird, yep, and we'll see if we can get through today's show without my darling wife. I miss or. This is the first show out of probably about two and some shows that we've done in which we are actually not together. So this is a very rare thing, and I hope that you find it not too boring. It won't be boring, it'll be exciting. What are you talking about? Hey? Have you been injured in an accident with a salacious salamander? The Doom and Bloom attorney says, don't call me called doctor Bones, Nursey and listen to this. All information given and opinion's voice on Doctor Bones and Nurseamey's Doom and Bluem Hour are for entertainment purposes only, edutainment actually education and entertainment, and do not represent medical advice for anything other than post apocalyptic settings. No contract or provider patient relationship exists or is implied between the hosts and listeners. Doctor Bones and Nurse Amy strongly are their audience too, seek modern and standard medical care whenever and wherever it is available. Ah, but what if the uncertain future removes all that high technology. What if the rescue helicopter there is not on the horizon. Can you count yourself as one of the few that are medically self reliant or with a few supplies, a little time and effort. I'll bet you can. It's not impossible. Believe me, you can do it. This is something that I think that's very, very important. Now, remember if you have something in your cerebrum that you'd like to share with the class. I certainly hope you do. And there's lots of ways to reach us. You can contact us by email at Drbones Podcast at aol dot com, find us at Facebook at doom and bloom, or you can follow us on Twitter at Prepper Show. Don't forget our YouTube channel at Dr Bones Podcast, and remember our website at doomanbloom dot net. Gosh has now has about a five hundred and ten posts on medical preparedness, medicinal gardening, just about everything that you would. Need to succeed even if everything else fails. You can also check out our articles and leading magazines like Survival Forly, Backwoods Home Prepare Gosh a headd in links from hundreds of great preparedness websites throughout the Internet. Oh, I've got a question for you. Do you know how to deal with medical issues when help is not on the way? Ah to get a copy of our new book, the second Edition of the Survival Medicine Handbook. You'll get just what you need when you're the end of the line with regards to your family's health. You'll get about five hundred and fifty pages, I'd say, if I remember correctly, a useful how to information in plan old English that will help you deal with medical issues even if you the non medical professions are left as the highest medical asset left to your family in a disaster. Make sure to put old hoc your bones, that's me and the Lovely Nurse any in your survival library. But don't put td burden your survival library, because he'll chew up your books as happened before. I just want to say that our book is also available in kindle version on Amazon, or you can, of course get a personally signed copy by going to our website at doomanbloom dot net. Oh, by the way, if you bought your copy of the Survival Medicine Handbook from Amazon, even on the day it first came out, you qualify to get a kindle copy for only two ninety nine through its matchbook program. Check it out and over one hundred and five star reviews on the books print or kindle page at Amazon dot com. Hey, we want to say a great big hello to listeners from all the great networks that carry our shows, especially the Propper Broadcasting Network, the USA Emergency Broadcasting Network USAEBN, and a new network, Awake Radio that is now playing our shows even in the United Kingdom in the UK, so we are very glad to welcome you. If you're listening to this show for the first time, and I hope that you'll find it interesting and informative, make sure that you check out their lines of awesome shows soon. On these great networks, they have lots of great hosts send great information for you, and I want you to check them out when you get a chance. You can listen to our archive shows whenever it's convenient for you, just by clicking the podcast button on the toolbar at Doom and Bloom dot net. You know, we always start out by thanking everyone for your kind words and support for our mission, that is to put a medically self reliant person. On the moon. Nope, not on the moon, just seeing if you were listening. In every family and every mutual assistance group for times of trouble. We especially thank you for your warm reception of our second edition and for checking out our medical supplies at our store, at store thet Doom and bloom dot net. There's something there for every need and every budget, all sorts of medical supplies and medical kits. If you can put together the quality of kits that we produce on your own, I want you to do it. We publish the list of contents there, but otherwise get a kit put together by a real doctor and an advanced registered nurse practitioner. Lastly, of course, we want to mention a few special people. James Wesley Rawls, the well known popular survival blog founder, for calling us the real deal in survival medicine in his latest book Expatriates. Patrick Schreyer, a former Army recon who mentions our book as the medical resource to have in his latest book, The Simple Survival Smart Book. Our good friend and local prepper Charlie Hogwood, who mentions us in his book Mags The People part of Prepping, a book all about mutual assistance groups that also Jim Cobb of Survival Weekly his new book, Prepper's Long Term Survival, gives us a nice mention as well. Thanks to all of these great people for their kind. Words and support. I tell you we are truly blessed. Hey, are you in the Great States of Tennessee or Ohio and want to see the lovely nurse saving when she returns from the Windy City. Well you certainly. Can just by going to the Mountain Prepper Exponent Severeville, Tennessee on the weekend of May seventeenth, and on the weekend of May thirty first at the Prepared and Spared Off the Grid Expo in Dayton, Ohio. We'll give lectures, have hands on suture classes, and just have a grand old time. If you're in the area, and make sure you come see us. And if you want to sign up for a hands on class, just go to doom and bloom dot net and hit the classes button on the pretty blue toolbar on the main page. Hey, are you a loane prepper with a household full of people who couldn't find this stuff more boring? Well we might just have the answer for how to get your whole family interested in survival, We're pleased to announce our new board game, Doom and Bloom Survival. They say that you should have board games and other non electrical entertainment for off the grid situations. Now what's that. Isn't this show supposed to be about medical preparedness. Well maybe so, But if we can get the whole family involved in the survival mindset in a fun way, maybe we'll just increase your chances a little bit of succeeding when everything else fails. Our game has been up at kickstarter dot com. It's almost completely done. It'll be done probably by the time you hear this, but check it out. Just hit the word Doom at kickstarter. Dot com and you will find it. What is Kickstarter? By the way, Kickstarter is a funding platform, just so you know, for creative projects, everything from films, games, music, arts, stuff like that, design technology. As a matter of fact, three D Printers. There's one project there that's doing very well. I mean, it's full of ambitious and imaginative projects brought to life through the direct support of others, nice people like you, and for your support, patrons of a project get special rewards, and in our case, they range from a listing on our backers page on the game website, to special edition patches, special posters signed by our board game artists, t shirts, copies of the game from the first batch ever made, and even more, Remember that your pledge is not processed unless the project is indeed successful. So anyhow, so check out the game at www. Survivalboardgame dot com and get one of the first copies ever made of this board game specifically made for preppers by pledging your support. And by the way, just so you know, we'll just break even if we sell every game that we're contracting to manufacture. We are not in it to make a book. We're in it to get whole families involved in the survival mindset. In the news, a new study shows that suffering a concussion can be a different experience for everyone, and now new imaging research has revealed that the recovery process may actually be more difficult for one gender than the other. In a new study published in the journal called Radiology X Ray Specialties, researchers from the University of Pittsburgh have utilized scans on different concussion patients of each gender, and there are scams revealed that males tough, rugged males may actually take longer to overcome a concussion, also known as a traumatic brain injury or a mild traumatic brain injury TBI. Then females have similar injuries. So currently it is difficult to determine which patients will have a smoother recovery from concussions, and this study is hoping to be able to sort of figure that out. Approximately one point seven million Americans suffer a traumatic brain injury each year. Of these cases, seventy five to ninety percent are considered mild, according to the Brain Injury Association of America, such as a concussion. In order to determine the severity of these head injuries, physicians normally conduct things like AMRIS or CT scans of the head. But what if you don't have those resources at your disposal. Well, let's talk a little bit about this. People who have a concussion and are recovering will sometimes turn from a students to see students. They struggle to constant trait, they're unable to function, they lose efficiency, and clearly something's still wrong. And in the research done the scans performed by these people who use scientists from the University of Pittsburgh revealed that males seem to have much lower function in certain parts of the brain after a concussion compared to female counterparts, and these scores correlated with recovery times. An average female took twenty six days or so to recover from their concussion, while the average male patient took an average of sixty six almost sixty seven days to recover from THEIRS. Now, that is a big difference. The scientists said that their main goal wasn't to identify a difference in gender with regards to recovery, but actually it's to determine if there are potential benefits of using scans to better understand how an individual person recovers from a traumatic brain injury, and to have some kind of objective way of determining some kind of factor that tells you how they are doing, how they're recovering. Right now, physicians have to rely heavily on patients just reporting their symptoms, a measure that may be prone to bias among young athletes wanting to get back on the field. I can tell you that's true from personal experience. So let's talk a little bit about head injuries. Head injuries can be soft tissue injuries, either the brain, the scalp, or blood vessels, or it can be bony injuries, injury to the skull or the facial bones. Damage is usually caused by some kind of direct impacts, such as a laceration in the scalp or a fracture of the part of the skull that contains the brain also called the u cranium. An open head injury means that the skull has actually been penetrated of something very very bad, with possible exposure or brain tissue. If the skull isn't fractured, it's referred to as a closed injury. Damage can also be caused by the rebounds of the brain against the inside wall of the skull. Now, this can cause tearing of blood vessels in the brain, and that could actually result in the hemorrhage, which is very serious as well. There might be no obvious penetrating wound in this type of circumstance. The original trauma actually may have even occurred at an area other than the head. An example of this, for example, would be if you violently shook an infant. Basically you'll wind up causing these types of injuries, also known as a contra coup in injury in which the brain bounces around inside the cranium inside the skull. Now, anyone with a traumatic injury to the head must always be observed closely, as symptoms from bleeding and swelling may take time to develop. Now, the brain requires blood and oxygen to function normally. An injury which causes bleeding and swelling inside the skull will increase pressure inside the skull, and that's called the intracranial pressure. When the intracranial pressure is higher, how the heart to work harder to get blood and oxygen into the brain. What happens is if you break a blood vessel inside the brain, it causes an accumulation of blood a big clot called a hematoma, and that if that occurs within the brain tissue, it can cause damage to that tissue. This is a big issue now. Of course, without circulation, brain function ceases, and any pressure is high enough to actually cause a portion of the brain to actually press downward and push through the base of the skull where you do have an opening where your spinal cord goes. That's actually called a brain herniation. With how modern medical care, this is one of those things that's just going to cause your patient to die, so there's not too much you can do about that. It's strong. Intravenous steroids like manatole and other IV medicines have been used for that, but that's not going to be something you're going to be able to use in a survival setting. Now. Luckily, most head injuries result only in a laceration into the scalp or a swelling. At the sight of impact cuts on the scalp or the face, they'll tend to bleed, and they'll bleed a lot because there are a lot of small blood vessels that travel through this area. Now, this bleeding, although it's significant, doesn't have to necessarily tell you that internal damage has occurred. Most cases you can treat as any other cut. But there are a number of signs and symptoms I want you to look out for that might identify those patients that are more seriously affected, and they include loss of consciousness, convulsions, worsening, headache, nausea, and vomiting. Now, bruising around the eyes and ears especially or bleeding from the ears and nose, especially if the ears or nose or eyes and ears weren't actually directly hit, that is a significant sign to you. Now confusion, apathy, drowsiness, change in mental status. In other words, that's something that you'll see as well. When there's pressure on one one of the nerves that go to your eye, your pupil may dilate, and so you may see a person with this kind of injury and there we may have one pupil more dilated than the other. And so you can see that in people with a significant injury to the head. And of course if there's an indentation of the skull, there's obviously trauma that has occurred to the cranium. Now, a person with trauma to the head could be knocked unconscious for a period of time we were just talking about concussions, but they could remain completely alert, and so it's very variable. Now, if consciousness is not lost, the patient might just experience a headache or require a treatment for the superficial injuries. Some stitches or on the scalp staples are used often that wash the wound carefully beforehand. Please, Now, after a period of observation, a head injury without loss of consciousness is probably not going to be serious unless one of the other signs and symptoms I mentioned, or just a minute ago know exist now, loss of consciousness for a very brief time, let's say two minutes or so, that merits close observation for the next forty eight hours. If they actually lost conscience totally blacked out after an injury, now a head injury of this type, we call that a concussion of that mentioned. And when the patient awakens, though, you're almost always be very very foggy, and they may be unclear as to what happened, how the injury occurred, or even the events that occurred just beforehand. So this is something that is very commonly seen in people who have concussions. So it'd be important to make sure that your patient has retained normal motor function. In other words, make sure that they can move all of their extremities and with normal range and strength and equally on each side. So let's say tell them to grab two of your fingers in each hand and then try to pull that hand away. See if there's any difference in the strength from one hand. To the other. So that's and these kind of patients who have had these kinds of injuries, concussions, they are out for the next at least a day or so. You absolutely have to give them bed rests for the remainder of the day, and you have to closely watch them when they're asleep. It's probably a good idea to waken them every two or three hours. Make sure they're easily aroused and they haven't developed any danger signs that I mentioned previously. Now, in most cases, a concussion will cause no permanent damage unless there are multiple episodes of head trauma over time, as in the cases of boxers or other types of athletes that constantly get whacked in the head. Now, if the period of unconsciousness is over ten minutes in length, Remember I was talking about average period of unconsciousness and a concussion for about two minutes. If it's more than ten minutes in length, you have to suspect the possibility of significant injury. You check the vital signs, the pulse, respiration rate, blood pressure, keep monitoring them closely. The patient's head has to be immobilized because you know they could easily have gotten damaged to the neck and spine, So make sure you have a neck collar among your medical supplies in case the neck and spine are damaged. Verify the airways clear, of course, make sure that they're always they're breathing, and they're not actively bleeding. So these are some things that are important to do. Yeah, this person, I have to tell you, if they're really out for that length of time, this person's probably in a life threatening situation. They're probably going to have very few options if they don't regain consciousness relatively soon. Now, other signs of a significant injury to the head are the appearance of bruising behind the ears, around the eyes. We mentioned that very briefly. That is called the raccoon sign because they have a tendency look a little bit like a raccoon because they have that sort of a mask that occurs despite the impact not occurring necessarily in that area. This could easily be a sign of a fracture with internal bleeding eating from the ear itself or the nose without those areas having received direct trauma. That's another indication. Now, the fluid that comes out might not even be bloody, it could be clear, and that could actually represent, believe it or not, spinal fluid leakage. And that, my friends, is bad bad news. Let's see. Let's talk a little bit more about other injuries. And other injury is a stroke that can occur that can occur from trauma, or it can occur in people with excessive high blood pressure or people that are on even people that are on antiquagulants like aspirin, things like that. Now stroke is also known as a cerebrovascular accident or a CVA. It's basically damage to the brain caused by lack of blood supply, and that could have occurred due to a brain injury. It could be due to a clot, or it could be due to a hemorrhage or anything else that compromises the circulation in the area of the brain. Those cells are very sensitive, so whatever function are associated with the part of the brain affected will be probably lost or impaired, and so this could be an inability to speak, blindness sometimes one sided, the loss of comprehension, paralysis, weakness. When you get these symptoms, especially if they're on one side of the body or the face, this could easily be a stroke and you can always, well not always, but very often tell these people start off with a very severe headache, that is sudden headache. Now strokes may also occur due to other reasons. As I mentioned, high blood pressure is one significant one, and so make sure that your people have accumulated enough of a supply of their medication to last them for a while, at least to give society a chance to restabilize. So this is something that's very important and that they should be asking their doctors for an extra prescription or two. Although it's not difficult to diagnose a major stroke in an austere set, treatment is another issue. There are going to be few options that will exist to treat it. Of course, blood thinters might help a stroke caused by a clot, but they'll worsen a stroke caused by a hemorrhage. Due to let's say, being on antiquagulants like aspirin, it could be difficult to tell which is which without advanced testing, and this is the dilemma that we face in survival. Of course, you want to keep your patient on bed rest. They will oftentimes recover some function after a period of time, but if they do, most improvement occurs in the very first few days. Trauma in the head could have negligible consequences or could have life threatening consequences in some circumstances. It's true there may be little that you the medic can do in a long term survival situation. Now we're going to take a short break and we will be right back. You are listening to lonely old Doctor Bones without the beautiful Nurse Amy on the Survi Medicine Hour. Let the power of the sun charge all your devices. Visit sunjack dot com to see this amazing solar charger in action. It has enough power to recharge up to eight smartphones or two iPads and powers any USB powered devices with only five hours of sunlight. That's sunjack dot com. Perfect for camping, traveling, or even. A day at the beach. This beautiful, high quality design is engineered in the USA to provide wall outlet charging speeds with renewable green energy from the sun. Enter code GF six at checkout for a ten percent discount at sunjack dot com. Never run out of power again. We have excitement and welcome back. You are listening to the Doom and Bloom Survival Medicine Hour with Doctor Bones and TD Bird. No longer with Nurse Amy, at least for this week, the first week we have had. I've had to do a show alone, and I'll tell you I'm mister terribly but you will be back next week. Ladies, and gentlemen, So don't you worry. Now we were. Talking a little bit about stroke. You know that a daily dose of aspirin low dose aspirin has been shown to be effective in preventing a recurrence of a heart attack or stroke. The FDA, however, is now warning people who have not had a first heart attack or a stroke that taking an aspirin every day may not have a benefit. Oh my gosh, and how many people out there are on aspirins and may say, as a matter of fact that doing so may actually cause serious side effects. Now this is from Robert Temple, MD. He is a Deputy director for Clinical Science at the FDA, and so he put out a consumer update and said, since the nineteen nineties, clinical data has shown that in people oh burr, you almost said something there. Wow, I thought we were going to go the whole show without you making a noise. All right, Well, I help. Doctor Temple says that since the nineteen nineties, clinical data has shown that in people who have experienced a heart attack, stroke, or have had a history of the disease of the blood vessels in the heart, a daily low dose of aspirin, such as secondary prevention, can help prevent a reoccurrence a reoccurrence. Now, remember that the low dose aspirin is eighty milligrand or eighty one milligrams, and a regular strength aspirin tablet is three hundred and twenty fix. We're talking about low dose aspirin or of Saint Joseph's aspirin, that type of thing. However, following examination of scientific data from the from major studies that have been done over the last few years, the FDA has concluded that the data doesn't support the use of aspirin as a preventative by people who have not had a heart attack, stroke, or cardiovascular problems. In other words, for primary prevention. They apparently are very useful in people who have had these problems to prevent recurrence, but not as primary prevention. And as a matter of fact, and people who have not had a heart attack, they have not had a stroke, the benefit has not been established at all, and risks such as dangerous bleeding into the brain or the stomach are present. So he says that daily aspirin therapy should now only be used after you talk to your health provider and have weighed the benefits and risks. Now, also, if you are on the blood thinners such as warfarin, heperin, Gosha, a number of other ones per daxas zerelto eloquist, a lot of different medicines with generic names that are three times as long as their regular names as their brand names. These can be a big issue as well. Remember, aspirin works as an anti clouding mechanism, and if you take aspir with blood thinners, it increases the risk of bleeding, especially things like bleeding from ulcers or bleeding into your brain. These are major issues and some individuals therefore may not be the best candidates for aspirin therapy. For example, people who've had ulcers, So a person may have such low risk that aspirin may not be anything that they need. So if you've never had anybody in your family with a heart attack, you haven't had an heart attack, and you have lived a very very clean life, you probably don't need the aspirin at all, at least from a heart standpoint. There are some people that say that certain types of other medical problems may be improved by it. This is none of this is actually proven, and everything depends, of course, on other medicines you're taking. If you're taking medicines that are blood thinners. They also could be hard in the stomach that could increase the risk for stomach upset and in rare cases, bleeding. Aspirin, I have to say, is a great medicine. Everybody should have it in their supplies. But many times we assume that any medicine that's over the counter is completely safe just because you don't need a prescription. But it's important to check out either with your healthcare provider or do research on your own to make sure that the medication that you're taking is appropriate for you. Whether it's prescription or non prescription. There is a risk versus benefit ratio for all of these things. You have to decide what makes the most sense the clinical data. According to doctor Temple, the Deputy director of Clinical Research of the FDA, says that there's no benefit in people who have not had heart attacks or a stroke, but because of family history or at increase risk. The important thing to know is that if you're on asperin, you may no longer need to be on aspirin. Contact your medical provider now while modern medicine exists to find out if you are still a candidate for taking the medicine. That you were probably recommended to take a couple of years ago or last year. So this is something that's very very important. Also, find out what the correct dose of the aspirt is that you should be taking, if you should be taking it okay. On another subject, you know that scientists say they have succeeded in creating a new element. The element number is one hundred and seventeen. That amazes me because when I went to school, in high school or in college, there were exactly one hundred and three elements, and now there are one hundred and seventeen. This is the first time or maybe the second time that this particular element has been observed in a lab, and it will soon be officially recognized. Right now, there are one hundred and sixteen official elements. These are what are called super heavy elements, those that have more than one hundred I think one hundred and four protons in their nucleus. If you remember your basic science, uranium has a very high atomic number for anything found in nature. I think the highest for anything found in nature. That's ninety four. That means it contains ninety four protons and it's nucleus. But you know what they've been doing ever since they've had these labs that can sort of smash molecules together. Bird, I'm talking. Hey, I'm talking, bird, cut it out, all right. So what I was saying is to scientists now create the elements in a lab by smashing nuclei together with the hopes that they'll fuse and maybe remain stable. Now, the funny thing about a lot of these elements that have been formed is some of them are there for like a few seconds, maybe even less than a second, and they go away because they're so so unstable. Hey, hey, I'm talking. Still, scientists believe that one day that they're going to be able to find more stable elements that are are higher density than uranium, which is the one of the highest natural ones. Many of the The funny thing about many of these elements is that many of them only exist on paper now because the scientists observed them when they smashed two nuclei together in some kind of lab and they were so unstable. They lasted a second and then they went away. But they were a new element, and so they actually are named number one sixteen for example, on the periodic table is called Livermoriam was first detected in two thousand and it was named to honor the Lawrence Livermore National Laboratory in California. Bird, You're gonna make this very difficult, I see, because you decided to start yacking. But you know what, I'm going to muddle through, and we are almost done. I have got a. Couple more things, Bird, I hope that you will let me talk about before we go though. You know, years ago, we held the first SUTURE class for non medical people in the preparedness community at I think a Self Reliance Expo in Denver, and that was gosh several years ago, and our purpose in doing this was to provide education to non medical professionals that might be useful in a post apocalyptic setting. And we felt that teaching people medical skills may save some lives and long term survival scenarios, because, let's face it, people that we depend on to take care of us, I mean doctors and paramedics and nurses, they just may not be available or may not be able to reach us if a true disaster occurs to us. Any unnecessary death in times of trouble is one too many, and so I felt that it was important to learn new skills that would allow you to be able to function as a medical resource in times of trouble other when conventional medicine is not available. While these days there are a lot of people that put on these classes of all sorts of different stripes. Some of them are the er docs, some of them are paramedics, and they're all over the place nowadays. But the main goal is not simply to learn the mechanics of throwing us stitch, but to develop the judgment necessary to understand when a wound should be closed and more importantly, when it should be left open. This is something that is not necessarily taught of these classes. More they focus more on just the flick of the wrists to throw a stitch. I don't think that's enough. You've got to learn when to keep that wound open and what to do if you do keep that wound open. Now, when the medically responsible person evaluates a wound, you have to ask the following question, what are you trying to accomplish by stitching a wound closed? Well, I mean, goals of performing wound closure are pretty simple. You close wounds to repair the defect in the body's armor. The skin is your natural armor, and if there is a laceration. Then there's a defect in it, and you want to close it, eliminate that space that can lead to infection. We'll talk about that in a minute. You want to. Promote healing, and you want to provide a pleasing cosmetic effect, in though words, less scarring. Now it sounds like every woun should be. Closed, doesn't it. But it is much much more complicated than that. Closing a wound that should be left open can do a lot more harm than good and can possibly put your patient's life at risk. Now, take the case of a young woman injured in a zip line accident. She was taken to the local emergency room, where twenty two staples were needed to close a large laceration. Unfortunately, the wound had dangerous bacteria in it and causing a serious infection which spread throughout her body. She eventually required multiple amputations. This is a horrific, terrible, terrible thing that occurred. We learn from that poor girl an important lesson. This is a tragic case. That lesson is that the decision to close the wound is not automatic, but requires serious considerations. Now, the most important of these, whether you're dealing with a clean or a dirty wound. Most wounds you'll encounter in a wilderness or c lapse setting, they're going to be dirty, right, makes sense. If you try to close a dirty wound, you sequester bacteria and dirt in the body. Now, within a short period of time this wound becomes infected. It will look red, it will look swollen, it will be warm to the touch, it will be a mess. And of course, over time, if you actually close that, you've made perhaps your own personal abscess that you, yourself, are responsible for causing possible accumulate inside and of course can go into the blood stream. Now, when the infection spreads to the blood stream, you have caused a true life threatening situation. Leaving the wound open should have been done. In most cases. Leaving the wound open allows you to clean the inside frequently observe the healing process. It also allows inflammatory fluid to drain out of the body. Wounds that are left open healed by a process called granulation, that is from the inside out, and the scar isn't this pretty, I'll admit, but. It's the safest option in most cases. Now, other considerations when deciding whether or not to close the wound, or whether it's a simple laceration, neither a straight thin cut on the skin or whether it's an evulsion. An avulsion is a wound with areas of skin torn out, if hanging flaps, things like that. If the edges of the skin are so far apart they can't be stitched together without undue pressure. That wound should be left open. If the wound's been left open for more than six to eight hours, you should keep it open. To know why, it doesn't sound like you should, but you should because even the air around you has bacteria. An open wound will be colonized with this bacteria if it's left open for more than say, six hours or more. If you're certain the wound is clean, you should close it if it's long, deep, or gapes open loosely. Also, cuts over moving parts such as the knee joint will be more likely to require stitches. Remember you should close deep wounds in layers to prevent any unapproximateday space from occurring. Oh, there's that dead space? What is dead space? Dead spaces are pockets of bacteria laden air or inflammatory fluid in a closed wound, and these can lead to a major infection and then exception to this by the way, to is a puncture wound from an animal bite. These are deep wounds that should never be suited because they are loaded with germs, So that's very important to know. Now, if you're unsure whether something should be closed or not, you can choose to wait seventy two hours before closing a wound to make sure that no signs of infection developed. We refer to this as delayed closure. And some wounds can be partially closed, allowing let's say, a small open space to allow the draine of inflammatory fluids. There are drains, by the way that you can place into. That open part of the wound. These drains consist of thin lengths of either latex or night trial, which is better because some people are allergic to latex or even gauze. If you've place these in the wound, what they'll do is they'll wig out all this inflammatory fluid. Now, of course, this gets really messy, so you've got a place addressing over the exposed area while it's healing. Now, remember, if you have to close wound, use the absolutely least invasive method you possibly can. In other words, you should use not sutures, not staples, but maybe butterfly closures. If it will keep the wound together, it's certainly better than puncturing the skin again and again that like you would with sutures or staples. Also, using something that's adhesive, like tincture of benzuin to hold those tapes in place will allow them to stay in place for a longer period of time. Speaking of ahesas. Even super glue might be a better option in certain cases, and it's used routinely in undeveloped countries like Cuba with good effectiveness and appears to be perfectly safe unless you happen to be allergic to those kinds of glues. Those are called cyano relates. The other good reason to use the least invasive method is because if something really has happened that you are now the person that has to actually close a wound, then you know what, They're probably no longer producing sutures anymore. They're not manufacturing staples or staple guns, so therefore you should save those only for situations where you absolutely need them and use the lesser things. Even butterfly closure made with duct tape will be better because you will be able to conserve this precious material. So that's very, very important as a consideration. But anyhow, even though we were just talking about closing a wound, the safest method truly is to leave any questionable wound open. Using a sixty to one hundred cc irrigation syringe, you flush the area aggressively with the dilute solution of bettedine or sterilized saline. If you don't have any of those commercial steriol solutions, then certainly they'll run out soon enough. Body showed that clean drinking water can keep a wound from becoming infected in an austere environment, I would sterilize it by boiling it, but I would definitely consider that. What you would do is you would place a sterile moist dressing. When I say moist, i'm not talking about soaking, wet ring it out and just make it moist. You put that in the wound below the layer of the skin up up to the skin, and then you cover with a dry, steril gauze dressing, and you replace that dressing frequently, at least daily, more often if you can. Of course, if you're dealing with somebody with this type of problem, if you have antibiotics, this is a good time to use them. Make sure that you have accumulated lots and lots of antibotics. As you know, I am a proponent of using some of the antibotics that are used in aquarium stores and aviaries, and you could see lots of articles on that subject at Doom and Bloom dot. Now let's see, oh about hydrogen peroxide or undolute beldedine or alcohol using that as a cleaning agent. You know, you see people pouring whiskey into a wound. Well, if it's all you have, it's okay for the first cleaning before you place the dressing. But these substances tend to dry out newly forming cells and they could actually hinder healing. So stick with milder solutions or clean drinking water for long term wound care. Learning how to suture it's a useful skill. But knowing when to suture, now that's much more important. You know, we were talking a little bit about ulcers and the effect of aspirin on people with ulcers, how it might cause them to wind up having more bleeding, and so let's talk a little bit about ulcers. I think to close out the show, I have just a few minutes left. Ulcers, well, we're going to see a lot of chronic stress in any collapse scenario. And you know that manifests itself in emotional ways, of psychological ways, and physical ways. And one of the physical effects is increased stomach acid levels. Now, excessive acid can cause inflammation of the tube that goes from the throat to the stomach. We call this the esophagus or the stomach itself, or even the next part of the bowel, which is called the duodenum, which is part of the small intestine. Now, this irritated lining, because of the acid, it becomes weak, and what that does it forms in erosion. And this erosion is known as an ulcer. And so this causes bleeding and actually you could even proporate the entire thickness of the lining and be life threatening. The major symptom of a stomach ulcer is a burning or a gnawing discomfort in that area. We call that pan heartburn because it occurs usually in a left or mid up or abdomen and it travels up the breastbone. And this also has been called in before the actual lining gets eroded, can be called gastrosalthphageal reflux disease, or GERD GERD. Sometimes they'll be described as like hunger pangs or indigestion. Then the discomfort that goes along with this problem is really hard to ignore. It really affects work efficiency, so you really have to treat it to get. Your group members back to normal. And there are going to be a lot of people that have this. It's much more common now than it was in years past. There are many causes of pain in the chests and stomach areas. Of course, chest pain caused by heart disease is just one of the possibilities. But to make the diagnosis of ulcer or acid reflux disease gr D, the timing of the discomfort is very important. Also, an acid reflux discomfort occurs soon after eating, but it's sometimes seen let's say several hours up to several hours after a meal. Can be differentiated from other causes of chest pain. In another way, it gets better by taking antacids. So antacids are very very important for you to have in your medical storage for times of trouble. As you can imagine, taking an ant acid is not going to stop you from having a heart attack or from chest pain due to coronary artery. Disease. Now, many ulcers inflammation, interestingly enough, are caused by a bacteria called H. Pylori. That's the name of the bacteria, and it can be transmitted from person to person through contaminated. Treating water, so proper water filtration. And serilization will decrease the likelihood of this cause of ulcers. Antibiotics such as a moxicillometronitisol in combination are the most effective way to treat these types of ulcers. Unfortunately, you won't know if it's that type of ulcer if you don't have a laboratory available. Other causes, of course, include the use of ibuprofen or aspirin. It can be an irritant to the stomach and a lot of people the avoidance of the these drugs can prevent these ulcers and inflammatory pain. Smoking alcohol abuse are also known causes for this problem. Of course, it's hard to not give ibuprofen or aspirin to people if they have pain or I have joint issues, but these are some of the things you always have to weigh the risks and benefits of using any medicine. As one of the main issues and difficulties with being a survival meta. Your patients with this problem could benefit from avoiding certain foods. These would include things like oranges, other acidic fruit, fatty foods, coffee, certain teas, onions, peppermint, chocolate. All of these things can worsen gasc reflux or acid reflux. Eating smaller meals and avoiding acidic foods before bedtime that's a good strategy to prevent reflux as well. Obese people seem to suffer from this more than others. Weight loss so may be helpful actually as well as a treatment. Medications are commonly relieve acid reflux include calcium, magnesium, aluminium, and bismuth. Antacids, thumbs maylocks by lantipeptobysmal, as well as other medications such as xantac, tagamet, and prilosec. These medications are available in non prescription strength. They're easy to accumulate in quantity. Get them and get them in quantity. Home remedies abound for acid reflux. Organic apple cider vinegar mix one tablespoon in four ounces of water and drink before each meal. Owl vera juice mix one ounce and two ounces of water before a meal. These are things that might work. Baking soda one tablespoon and. A glass of water. Drink right away when you. Begin to feel the heart burn immediately. That is also a way that has been reported to help with this issue. And there's an amino acid that has an anti inflammatory effect that reduces acid reflux. It's called glutamine, and this is found naturally in eggs and milk, but you could also find it commercially as well. I'm sure it's important to remember to communicate with your patients. Many in the preparedness and homesteading community or rugged individualists, and they're not going to complain to the medic about heartburn something they think is very minor. But someone that's clearly in pain is losing efficiency, they should always be questioned about their symptoms. You know, if you see that someone's unable to function or notice that they're obviously uncomfortable, it could be something you just might be able to help them with. And isn't that your job? Absolutely it is. You know, this is all the time that we have today for the absence nurse Amy, who will be here next week, and for the present and occasionally Yaki TV Bird. This is doctor Joe Aalton, also known as doctor bones A disaster's doctor, asking you to tune in next week, and thanking you for listening in. We'll see you