(Continued from Part 2.)
STROKE, HEAT EXHAUSTION, HEAT STROKE, AND WOUNDS
Today’s presentation will cover protocols for the above topics. I hope that you have found Parts 1 and 2 interesting and helpful. Do you have at least one emergency medical notebook for quick, concise reference? If not, please consider starting one this week. There will be a few tips offered at the end of Part 4 to assist you with this project.
Remember that reliance on any information provided in this series is solely at your own risk. Always consult your own medical professional for advice and treatment. Do not, consider the following information as complete or as any attempt to advise, diagnose, treat, or manage anyone’s medical condition.
STROKE
A stroke occurs when blood flow to the brain decreases and cells die. What conditions predispose a person to suffering a stroke? Smoking, hypertension, diabetes, high cholesterol levels, obesity, and atrial fibrillation all increase the risk of having a stroke. What are some of the symptoms? Difficulty
moving or feeling on one side of the body, loss of part of one’s vision, dizziness, or problems speaking or understanding speech are all possible symptoms. If the problems last only two hours or less, it is called a TIA (transient ischemic attack). If it lasts longer, it is a stroke and damage may be permanent or even fatal. Call 911. Time is of the essence. The sooner treatment begins, the more likely the outcome will be a positive one. Do not hesitate to call for help. It takes only a few seconds to do a quick exam.
Does the person’s face droop on one side or is the smile lopsided? Is there weakness of the arms or hands? Ask the person to squeeze your hands. Hold out your hands with two fingers on each side for him to squeeze. Is the grip equally strong or is it weak on one side? Ask him to fold his arms like a chicken and raise his elbows to the level of his shoulders. Press down simultaneously on each elbow. Is one arm weaker than the other? Finally ask the person to repeat any sentence that you choose or to say “no ifs, ands, or buts.” Is his speech slurred or does he not understand you? If yes to any of the above, call 911 immediately. Remember the popular acronym “FAST” for face, arm, speech, time to call 911.
In dire circumstances where no professional medical care is available at all, we have prayer, bed rest, and perhaps daily aspirin for treatment. About 20% of strokes are hemorrhagic which may worsen if given aspirin. Take your chances as you think best. Optimize your health before the SHTF to improve your odds.
STROKE MEDICAL EMERGENCY SHEET
- FACE- IS THE FACE DROOPING ON ONE SIDE? IS THE SMILE LOPSIDED?
- ARM- ASK HIM TO SQUEEZE EACH OF YOUR HANDS (2 FINGERS) SIMULTANEOUSLY.
ASK HIM TO FOLD HIS ARMS LIKE A CHICKEN AND RAISE HIS ELBOWS SHOULDER HIGH.
PRESS DOWN ON EACH ELBOW SIMULTANEOUSLY.
IS THE STRENGTH EQUAL ON EACH SIDE OF HIS BODY?
- SPEECH- REPEAT ANY SENTENCE OR HAVE HIM REPEAT “NO IFS ANDS OR BUTS”.
IS HIS SPEECH SLURRED, OR DOES HE NOT UNDERSTAND YOU?
- IF YES TO ANY OF THE ABOVE, CALL 911.
HEAT EXHAUSTION AND HEAT STROKE
Heat sickness is more serious than many people realize. Last summer near us, a young strong healthy man worked a long hot afternoon in his workshop and died of heat stroke. It was a terrible shame. On the job one hot sunny day, my son was denied access to drinking water. He developed heat exhaustion by late afternoon and spent the evening on our living room floor lying next to the air conditioner with cool cloths on his head and a fan blowing on him. He was so nauseated he was unable to drink at first and suffered frequent leg cramps. It was a miserable evening for him, and he had to spend the next day off work to avoid overheating again.
If heat exhaustion is not promptly treated, it can progress to heat stroke with potentially deadly results. To help avoid heat exhaustion, allow yourself a week or two to gradually adapt to the higher temperature. Your body will adjust by increasing heart rate, oxygenation, and the ability to sweat. Drink a couple of glasses of water before beginning outdoor work and dress in cool, loose clothes with a broad rim hat. Drink more each hour. A person in heavy construction may require a quart or two per hour. Note that *ice cold* water can cause stomach cramps. Watch each other for signs of heat exhaustion and act quickly to help anyone getting into trouble. Signs of heat exhaustion are confusion, pale cool skin with goose bumps, and a weak pulse. Symptoms include nausea, vomiting, headache, dizziness, weakness, fainting, muscle cramps, and sudden marked increase in sweating.
Act immediately. Move him to the shade or the closest coolest site nearby. Remove excess clothing, apply cold water to head and body, and fan the patient. Apply cold packs to armpits and groin and encourage the drinking of cool water or rehydration drinks. Avoid caffeine or sugar laden beverages. Continue treatment until the symptoms have resolved. He must avoid heat exposure for the next 24 hours as his body will not be able to handle it safely. Even more serious is heat stroke. Signs and symptoms include the inability to sweat, red dry skin, disorientation or unconsciousness, and a temperature over 103F. Call 911 if any of these symptoms are present as the internal temperature is so high that the brain and internal organs are being damaged. While waiting for the ambulance to arrive, aggressively treat the patient to lower his body temperature as much as possible. Swift action is essential. Below is the appropriate sheet.
HEAT EXHAUSTION/HEAT STROKE MEDICAL EMERGENCY SHEET
- WATCH FOR HEADACHE, NAUSEA, VOMITING, DIZZINESS, WEAKNESS, FAINTING, CONFUSION,
MUSCLE CRAMPS, SUDDEN DRENCHING SWEAT, WEAK PULSE, OR PALE GOOSEBUMPY SKIN.
- MOVE HIM INTO SHADE OR THE COOLEST CLOSE LOCATION ASAP. FAN HIM.
- CALL 911 FOR ANY OF THE FOLLOWING SIGNS- TEMPERATURE OVER 103F, INABILITY TO SWEAT,
RED DRY SKIN, DISORIENTATION OR UNCONSCIOUSNESS, SEIZURES. TREAT THE PATIENT AS
BELOW UNTIL HELP ARRIVES. HIS BRAIN AND INTERNAL ORGANS ARE COOKING. WITHOUT
TREATMENT HE MAY DIE.
- STRIP OFF HIS EXTRA CLOTHING.
- APPLY COLD WATER, ESPECIALLY TO HIS HEAD. WRAP HIS BODY IN A SHEET SOAKED IN COLD WATER.
- FAN THE PATIENT.
- APPLY ICE PACKS TO THE ARM PITS AND GROIN.
- HAVE THE PATIENT SIP REHYDATION FLUID OR WATER. IF HE VOMITS, WAIT 10 MINUTES AND THEN HAVE HIM TRY SIPPING AGAIN. DO NOT GIVE CAFFEINE OR HIGH SUGAR DRINKS. LEG CRAMPS AND NAUSEA COMMONLY OCCUR.
- IF NO MEDICAL HELP IS AVAILABLE, AND IF HE IS UNCONSCIOUS, CONSIDER GIVING IV FLUIDS OR
COOL FLUIDS BY RECTUM (ENEMA).
- HE MUST AVOID HEAT FOR THE NEXT 24 HRS. HIS BODY IS TEMPORARILY UNABLE TO COOL ITSELF.
WOUNDS
We all experience them as a result of falls down stairs, yard chores, meal preparation activites, and even hobbies. Some of the scarier ones are stab wounds, gun shots, and chainsaw injuries. Due to the wide variety of manner, sites, and depths of these injuries, it is difficult to summarize succinctly. No brief sheet will cover even a tiny fraction of the knowledge of this topic, but it can be a starting point. The more serious the wound, the greater the need to seek advanced medical treatment from a professional. If an artery is cut, bright red blood will be vigorously spurting. Venous blood is darker and flows with less force.
Use direct pressure on the bleeding site in order to gain control. Press as hard as necessary In an effort to stop the spurting. Once a bandage, cloth, gauze is soaked, do not remove it. Another may be placed around or on the first one to absorb the blood. If bleeding is profuse, a bandage with a clotting agent such as celox may be utilized for compression. Some hunters carry along a tub of granulated sugar as an alternative. During compression, elevate the injured site above the level of the heart to decrease the pressure in the blood vessels. If a lung has been punctured, plastic wrap, a credit card, or other impermeable material can be used to cover the hole and stop the lung from collapsing further. An abdominal wound that traverses the body wall may have punctured or lacerated the bowel or other internal organ. This is quite serious.
If a limb has been amputated, the use of a tourniquet will be required. You-Tube has several helpful training videos to watch. In general, think two/too/two. Place the tourniquet approximately 2 inches above the site of injury, make it just tight enough to stop the bleeding but not too tight, and try to very slowly and cautiously release the constriction at 2 hours. For less serious injuries, check for damage to distal nerves (any numbness?), ligaments (Is movement normal?), or bones (fracture). Start antibiotics for the more serious injuries (open fracture, abdominal or chest wounds, gunshots etc).
In order to get a good look at a laceration site and assess the level of injury, briefly pump up a blood pressure cuff to cut off the blood flow. Use generous amounts of new soap and water to clean the area. Carefully remove all dirt, debris, and clots. Allot 2 oz of water per half inch of wound and flush out the foreign matter by using an 18g needle on a syringe. Use sterile tweezers for adherent debris if necessary. Also, consider irrigation with 2% betadine if the patient is at risk of tetanus and *not allergic* to iodine. If the wound is older than about 6 hours or at risk for tetanus, do not close it. Otherwise wounds may be closed with steristrips, medical staples, or sutures as needed. Cover the wound with antibiotic cream and a sterile dressing unless contraindicated. Treat the patient for shock, elevate the wound, consider what choice of pain medication, and reassure him or her. Here is a brief sheet.
WOUNDS MEDICAL EMERGENCY SHEET
- COMPRESSION- PUT DIRECT PRESSURE ON THE BLEEDING SITE TO GAIN CONTROL.
ELEVATE THE SITE ABOVE THE LEVEL OF THE HEART. CALL 911.
ADD EXTRA BANDAGE/GAUZE ONTOP IF SOAKS THRU. DO NOT REMOVE IT!!!
IF NEEDED, USE CELOX OR GRANULATED SUGAR.
IF WORSE, APPLY A TOURNIQUET- 2 INCHES ABOVE WOUND,
NOT TOO TIGHT (JUST ENOUGH TO STOP THE BLEED),
AT 2 HRS TRY TO SLOWLY DECREASE THE CONSTRICTION.
- CLEAN- USING LOTS OF WATER AND SOAP (PREFERABLY LIQUID RATHER THAN A USED BAR)
ALLOT 2 OUNCES (60CC) OF WATER PER HALF INCH OF LACERATION OR
2 CUPS PER HALF INCH IF AN OPEN FRACTURE.
USE AN 18G NEEDLE ON A SYRINGE FLUSH OUT ALL STUBBORN DIRT AND DEBRIS.
REMOVE ALL FOREIGN MATTER AND BLOOD CLOTS( ONCE NO LONGER BLEEDING).
USE STERILE TWEEZERS TO REMOVE ADHERENT FOREIGN MATTER IF NECESSARY.
- ASSESS FOR DAMAGE TO BLOOD VESSELS, NERVES, LIGAMENTS, AND BONE.
CAN USE A BLOOD PRESSURE CUFF TO DECREASE BLEEDING DURING ASSESSMENT OR CLOSURE.
- CLOSURE- DON’T CLOSE ANY WOUND OVER 6 HOURS OLD.
REMOVE ANY RAGGED EDGES. (ANESTHETIZE WITH ICE OR LIDOCAINE)
CLOSE WITH TAPE, STERISTRIPS, SUTURES, OR MEDICAL STAPLES.
- COVER AND ELEVATE- KEEP THE WOUND CLEAN.
ELEVATE TO THE LEVEL OF THE HEART TO DECREASE SWELLING AND PAIN.
ADMINISTER PAIN MEDS AS NEEDED.
TREAT FOR SHOCK (WARM, COVER, FLUIDS, ELEVATE LEGS, O2, REASSURE)
IV IF NEEDED OR 2 PINTS ORALLY PER HOUR. NO ORAL FLUIDS IF GI WOUND.
- OBSERVE- IF SITE BECOMES RED AND PUFFY OR SHOWS RED STREAKS, TREAT WITH ANTIBIOTICS.
TREAT GUNSHOT WOUNDS WITH ANTIBIOTICS.
- TETANUS- IF AT RISK FOR TETANUS, IRRIGATE THE WOUND WITH 2% BETADINE SOLUTION IF NOT
ALLERGIC TO IODINE. LEAVE THE WOUND OPEN. GET A TETANUS BOOSTER ASAP OR
TREAT WITH METRONIDAZOLE
- READ MORE INFO AS PATIENT RESTS.
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Tomorrow’s final installment will feature deep venous thrombosis, pulmonary embolism, choking, and nosebleeds plus a few suggestions on how to make an effective emergency notebook.