EMERGENCY MEDICINE QUESTIONS

[HLorfing]

hey guys this place is great and i am learning a lot reading through all the post. i would like to give back as much as i have received. so.... i have almost ten years of emergency medicine expirience with the Houston fire dept. and if there are any questions i can answer related to that would be happy to help.

[Matt In Oklahoma]

hey guys this place is great and i am learning a lot reading through all the post. i would like to give back as much as i have received. so.... i have almost ten years of emergency medicine expirience with the Houston fire dept. and if there are any questions i can answer related to that would be happy to help.

If I had to make a solution drip such as saline solution in a SHTF event whats the most field expendiant method and ingredients or is it easier to just buy the stuff and keep up with it? Also what vein to use if the arms are not usuable?

[arcangel911]

Matt- good question....

IV solution comes in several forms, but normal saline has most of the formulas on google.

Before I say which veins to use and or other forms of medication admin- what are you looking to do with the IV?

[Matt In Oklahoma]

Matt- good question....
IV solution comes in several forms, but normal saline has most of the formulas on google.
Before I say which veins to use and or other forms of medication admin- what are you looking to do with the IV?

I am just thinking bad situations such as the first summer when the majority of folks to include myself (I work in a climate controlled enviroment, am getting older, don't work as hard physically as I used to, etc etc) will get dehydrated while acclimating post SHTF. I am also thinking about illness, food poisoning, war wounds or even accidents after TEOTWAWKI. There have been many times in my life when the pressure was on, that dehydration or other fluid losses were solved by IV Hydration. The bags do not last long if I remember correctly only about 1yr and if they freeze they are no good, remember something about them getting crystalized and hurting the patient when administered, so PAW climate control may not be possible and this could be an issue. I have stuck a few veins with the green machine so it's not new to me but after seeing an upper body burn recently I was curious what one would do as in finding another vein. I don't know to much about leg vein stuff except femoral artery will bleed you out real quick even if it's real small and junkies use their feet and ankles veins to hide the marks. I'm not medical, just a knuckledragging guntoten monkey with high hopes so ya gotta keep it simple and use small words, K.

[arcangel911]

Drugies usually make the best "stickers". Also, don't over look them in a emergency. I have learned more from the homeless and drug users, than any drug school could ever teach me. Also they are incredibly adept at doing a IV on themselves or others. They also work well as GPS units if you can trade or barter knowledge or directions out of them.

If you need a vein or a way of rehydrating someone... truly, any vein you find can work; you could use a EJ (external jugular) in the neck area or you could use an IO (interosseous). If I can't get a person by try 2, or severally dehydrated, burned or obese patient or a small child/infant, I use the IO. Granted the video link below shows the main idea, the gun itself is expensive and each one of those needles is around 50-100 bucks. But I have also used the BIG gun, which works but let me tell you, if you have no experiance, I would go with the Easy IO gun.

http://www.youtube.com/watch?v=XVdK1g5Wh64

http://www.youtube.com/watch?v=3pZxOqfB3YA&feature=related

http://www.youtube.com/watch?v=wPW3z7M0kFk&feature=related

Another possible way, which I am told works well from the Army and Airforce that I deal with, is rectally. Here is some sites that may help you.

http://www.professionalsoldiers.com/forums/showthread.php?t=2067

http://www.eperc.mcw.edu/display/router.aspx?docid=72658&

*Personal note- I do not say any of the above links are the only solution to your problem, but I am saying that when SHTF, if you have the right training, these methods could be used. The more training you have, the better prepared you are.

[monkeybird]

FYI - careful with veins in the feet and lower legs. They are very prone to infection and even more prone to thrombus. If no arm veins are available - go with the jugular, next the femoral.

As far as mixing IV fluids is concerned, you must know the concentration of saline in the fluid. 0.9 Normal Saline is simply 9g/liter sodium chloride. My very first concern is accuracy, my second is bacteria. Why would you risk the death of the patient giving a fluid whose concentration you cannot be sure of and whose sterility is highly suspect.

Frankly, one must understand that I.V. fluids are DANGEROUS if improperly administered. Trying to mix you own is like trying to make your own gunpowder! STUPID. I'm sure everyone reading this understands that under no cir***stances can plain water be given IV. It will cause water intoxication and death.

Primum non nocere is a Latin phrase that means "First, do no harm". The Hippocratic Oath includes the promise "to abstain from doing harm". One must remember these phrases when providing medical assistance - ALWAYS.

[HLorfing]

If I had to make a solution drip such as saline solution in a SHTF event whats the most field expendiant method and ingredients or is it easier to just buy the stuff and keep up with it? Also what vein to use if the arms are not usuable?

If you wear contact lenses you probably know how exorbitant the various consumable supplies can be. You can make your own saline solution very cheaply because the main ingredients are just water and salt. Here's how to do it along with a couple of other tips on reducing costs: Buy some distilled (or de-ionised, or de-mineralised) water. You should be able to find it with the laundry supplies in your supermarket (it's used for steam irons), in a hardware store, or an auto store (for topping up car batteries). I suggest buying at least a litre or a quart, and preferably twice this much. It's cheap stuff: around 2-3 dollars for 2 litres (half-gallon) here in Australia.
The other supply you need is salt. In the absence of laboratory grade sodium chloride, I recommend cooking salt because table salt seems to have silica-type minerals added to make it free-flowing. Silica is exactly the sort of insoluble gritty stuff you don't want in your solution. The cooking salt should probably be plain rather than iodised (though I've used the latter myself), as I can't say what long-term effects, if any, the trace amounts of iodine might have.
If you can find a clean, sterile container that holds a litre or a quart, this will be handy too. You could use a well-cleaned plastic soft-drink bottle. Rinse it well with water that has been well boiled, then give it a small final rinse or two with some fresh distilled water. To really give your containers a thorough sterilisation, you could use a solution made with sterilising powder from home brew or winery supply shops. However, you'd have to use a fair bit of distilled water to rinse it out completely. Several small rinses are generally much more effective than one large rinse.
Now comes the only hard part: approximating the correct amount of salt. You are aiming for 8 grams per litre to make "normal saline" as it's called. If you have access to laboratory or jeweller's scales you'll be laughing. You can buy electronic jewellers scales fairly cheaply on eBay these days. Otherwise, use a teaspoon measure of the kind that is used for cooking. Make sure it's clean and sterile (boiling water is a good steriliser). A teaspoon holds about 5 mls, so allowing for the density of salt, I find that a very slightly heaped teaspoon is perfect for a litre of water. A quart is close enough to a litre that you don't have to worry if that's what you have - just make sure it's a very full quart.


Read more: http://wiki.answers.com/Q/How_do_you...#ixzz17WUt2BIE


IMHO...i think that it would be more easy to buy and store the equipment. but its always good to know more than one way to do something. also i would use this as a wound cleanse before i used it as a IV solution. BUT if the SHTF then you could use it as needed. if its your buddy thats hurt or family and no help is around.......then you do what has to be done. hope this helps

[Buktoof]

I have to agree with monkeybird on this one. If inaccurate on the amount of salt (hypertonic solution) that is used you can actually worsen the dehydration. The main problem I see with mixing your own IV fluids is the sterility. You are bypassing all the body's natural defenses and injecting bacteria directly into the blood stream if sterility is not maintained. You have a better chance survivng dehydration than a blood stream infection (as blood stream infections require IV antibiotics which most wont have access to). In shtf, IMHO, I would do either a rectal rehydration or drop a NGT (nasal gastric tube) to replace fluids. Only time I would chance mixing my own IV fluids would be due to bleeding out where the risks and benefits are more closely balanced.

As to vein choice, arms are prefered with the antecubital (easy to find where your elbow bends) being the easiest to hit from my experience followed by the external jugular. IMHO legs/feet are a better choice for rapid rehydration than IO because at about 5 years of age the bone marrow is replaced by less vascular marrow and it is a more difficult route for rapid volume replacement as compared to venous access.

[Fido]

I personally would not try to mix my own I.V. solutions. The risk of infection discussed here IMHO far outweighs the possible benfits.
That said, there are other serious considerations to be taken into account with I.V. rehydration.
First off, Why is the patient dehydrated? Is it an underlying metabolic condition such as Diabetic ketoacidosis (common in untreated diabetics), this will be a big problem post-SHTF. In this case you must be careful because if the patient is experiencing kidney failure, if you give too much fluid you could put the patient into congestive heart failure (CHF).
Second, what is the patient's past medical history. Again if the patient has a history of CHF thier system will be very sensitive to fluid level changes and it will be easy to overload them.
Third do you have a way to monitor blood pressure? How else will you know your teatment is working? Purchase a good stethoscope and BP cuff and learn how to use them. And don't take the lazy way and buy a machine! You will also need to be able to listen to lung sounds with the stethoscope to make sure you are not overloading the patient.

Taking these things into consideration, rehydrating a patient is more than just dumping fluid through an I.V. There is a certain technique.
On an adult patient fluids should be given in 200cc bolus' with vital sign checks after each bolus. You are looking for the patients pulse rate to drop and the blood pressure to improve. Once this has occured I would keep the I.V. at what is called a TKO or KVO rate which is about 1 drop of fluid every 5 seconds, and try to continue the rehydration through oral fluids with electrolytes if possible. Also I would not be comfortable Giving more than 2000 cc's of fluid at any one time without allowing the body to adjust.
On kids (<14 years old) your dosage is 20cc/kg up to 60cc/kg. Be careful with kids, not only do they get sick fast they heal fast too. So watch how much fluid you are giving and give them time to compensate.

These are just general guidelines. I STRONGLY suggest you continue your education if you plan to be your groups medic.
It would be easy to get into trouble and harm your patient if you try these techniques without some formal training.

[monkeybird]

I am going to RANT!

If someone mixes their own IV fluids, they are essentially committing murder. It's that simple. The accuracy of the osmolarity of the IV fluids is a SCIENCE. IV's were not given until after WWII. There was a reason for that. Attempts to administer fluids met with failure because the method and equipment needed for mixing and sterilizing the fluids was not yet available.

Septicemia is still a problem in hospitals. Look up the statistics for "bloodstream infections" due to nosocomial causes (namely IVs). This data is available from the CDC. So, if modern hospitals have a problem, what makes any of us think we can do better.

I have a master's degree in Nursing. I hold a certificate from the Certification Board of Infection Control and Epidemiology. To obtain this certification I studied for years and sat a national exam. I'm not just whistling dixie here. I do know of what I speak.

You can purchase IV fluids from numerous web sites. Do so now. However, realize that IV's are not a magic bullet that will save the day. They are an augment to other therapy. A large number of people, the chronically ill, the elderly, etc - will die, regardless of what you do. IV fluids should be rationed only to those who have a chance of living and are young enough to heal. Triage, while not pleasant, was designed for a reason. You EMTs and Parametics are very familiar with it. In the PAW it must be used by knowledgeable and ethical caregivers. Stock up on I.V. equipment and fluids as well as other equipment NOW.

After you've stocked up, get the books and materials which will guide you in administering the fluids. Each case is different. The type and amount of fluid is critical in some instances. Fido's next to last paragraph will not be remembered during a crisis. It must be learned. That is why, in hospitals IV fluids are ordered by a physician!

Please, please anyone reading this thread listen to me and drop ANY plan to make your own IV fluids in the PAW. I'm very worried about this issue. There will be enough death without the death caused by the healthcare provider.

[Klayton]

monkeybird, question for you, can you buy the needles too? I remember back in the 80s there was a huge block on selling needles to the public. And honestly I have not had the need since then to buy them, I always seemed to end up with "leftovers" after field medic training, hehe... But I drained my last IV bag -expired :( and have yet to replace it. I guess your post has reminded me this is something I need to better inventory. :)

[Fido]

Monkeybird VERY well said!!!!
My intentions were to give out the very basics to stimulate the thought processes of someone thinking about this.
I want people to know about the complexities of even a simple procedure.
Advanced medicine cannot be performed without training, period!

[Matt In Oklahoma]

Well Thanks Guys and Gals
Great answers and good info. Sometimes I know the answer or some of it anyway to what I'm asking. Relax Mommy Monkeybird I aint gonna mix nothing LOL. I was asking because I wanted to know wether I should just go get the stuff. As I've said I've stuck a few veins and I didn't kill anyone, even the blankty blank drunk privates I was keeping from court martial!
The needles, cathaders and tubes are easy enough from various sources. The proper solutions are a little harder and more expensive. If i was giving them care they would most likely already be dying and then it's Gods will as to wether anything I can do will help. This is no different than from them I have already saved, they were dead or dying and I gave it my all. So far I only lost one and had my arm in a cast and could not give proper CPR and had to direct my son with instructions while 75 or more zombies watched us struggle at the resteraunt, again Gods will but he can't be mad at me for trying. I saved several lives with things like CPR and Military First Aid etc but I know my limitations too. You all rock!

[bountyhunter69]

this is kinda along the same line so,monkeybird,im getting ready to go to south Texas for the winter (should have been gone already,6 inches of sno and single dig temps here) my ? is...i have heard that u can buy some antibiotics in Mexico without a perscption.. cheap too..i plan on going dn to Mexico since i will be within 6 miles of border..anyway..what kind of antibotics should i buy,doseage and ect any help from anyone appreciated

[Klayton]

bountyhunter69: yes you can buy any and all meds without a perscription in Mexico... BUT a word of warning, it is illegal to bring them back into the US... you know the deal, our oversized government knows whats best for you, and you should know that ;)