Medical scenario 1

[Lanky Yankee]

Ok this scenario is for non-medical people out there. I'm interested in seeing how someone would deal with a medical/trauma situation. Please try and think of this scenario as if you were in a post SHTF situation and you were only using the items and knowledge (books, training) you have already prepped. Also try not to read others posts before coming up with your answer.

A significant other has a cut to their forearm from chopping wood,glass breaking or mutant ninja baby attack etc. The cut is about 8cm long and goes down to the bone. There is no visible break to the bone but it has been bleeding for more than 10 min and a large pool of blood is next to them. They are conscious and in a lot of pain. They are applying pressure with a shirt that is soaked through.

Observations are:
A: clear airway
B: respiration of 24 per min
C: on radial pulse but carotid pulse is 124 per min
D: they are alert but looking a bit drowsy

Their affected arm is looking pale but there is no arterial bleeding present.

How are you going to treat it? You have all your preps to hand but time is a factor. Remember to think about the whole patient, not just the wound.

I will post my treatment plan on 14/4. If this one goes well I will try and add other scenarios. I figure this is a good way to let people get a little practice and give them a chance to actually think about these problems before they happen.

Also think about how your going to treat this long term (closing wounds, dealing with blood loss, possible infection )

[Yorkshire Andy]

Lay them down get their arm elevated leave the shirt on the wound for the moment but encourage them to keep pressure on the soaked dressing in place.. raise legs prop them up on something provide reassurance.......


From this point break open several large wound dressings and remove the shirt they have been using (its not staunched the bleeding in 10 mins so dont piss about trying to pile stuff on top of it...

See /feel for any broken glass if in pack round with dressings do not remove it

Pinch the wound closed apply large dressing applying lots of pressure and bind with dressing if its on the pad if not just be firm...

If this soaks through add another on too but keep the pressure up keep them down with legs and injured arm raised hopefully by then clotting will have started due to the pressure and decreased blood flow by the limb been raised

Try and keep them warm whilst your at it

[Lanky Yankee]

Time to give my answer to the scenario. Keeping in mind that I have a lot of medical experience and have a good bit of medical kit, I'm trying to look at this as a post SHTF situation and using things that most preppers would have. Hopefully this will get some of you thinking about new things to prep and at least give you an idea of possible situations you might see.

OK first off we have a patient who has a bad cut to their arm and is bleeding out. They are showing signs of shock, most likely due to hypovolemia (blood loss). In Andy's answer he was spot on with the initial treatment. Get the patient lying on the ground with legs elevated and also get the injured are raised. this will help raise their blood pressure a bit and also keep them safe if they decided to pass out on you. Andy mentioned leaving the shirt tied around their arm which is good and I'll talk more about controlling the bleeding in a minute. He also mentioned reassurance. I can’t emphasise this enough, talk to the patient and show them confidence. Even if you don’t believe in yourself and feel as if you don’t know what to do, take a breath and project confidence. Patients feed on the carer so if the carer is freaking out the patient is too. I see it with parents who call because of their children being sick/injured. I calm the parents first and the child will be calm. Sometime you may have to show tough love and tell them to f***ing calm down, but the shock of your words will get them to realise what they are doing .

Now back to the patient, they are showing signs of shock and we can tell this by them breathing fast, fast heart rate, and starting to feel drowsy. If we could do blood pressures we would find it low, but TBH most people won’t be doing this so look at the patient and treat what you see. Let’s start thinking now about what we need to do for this person.
1. Stop the bleeding
2. Pain relief
3. Clean the wound and treat it
4. Long term care

So let’s go systematically and see how we get on.

STOPPING THE BLEEDING: There are 4 primary ways to stop bleeding. Applying pressure, which the patient did by tying the shirt around the wound. We will add to that by putting on a large pressure dressing. I would remove the shirt and take a quick look to assess how long and deep the wound is. The few seconds of bleeding won’t mean much in the grand scheme of things and while you have a quick look, you can start to think about how to treat it. So now, we need to apply a large dressing. If you have cayenne pepper/black pepper you could put it in the wound prior to the dressing. In addition, if you have celox/ clotting dressings you could use it to good effect. I’m not a huge fan of the celox powder as it’s not easy to clean and could hamper recovery. The peppers work pretty well and have some antibacterial/antimicrobial properties. Once our large dressing is applied, you can put pressure on top of it to help stop bleeding.

Next, we can raise the arm to reduce blood flow to help stop active bleeding. If this doesn’t work with direct pressure then we can apply point pressure to the pulse point above the wound. If the cut is on the forearm then we need to apply pressure to the brachial artery on the inside of the elbow. Finally, if all else fails then apply a tourniquet. This is a very last ditch effort as you can only have them on for about 6 hrs before the patient will lose the limb and also you need a surgeon around to deal with the bleeding. For the scenario purposes, we used pepper and a large bandage and raise the arm for about 10 minutes to get the bleeding under control.

PAIN RELIEF: The patient will be in pain and when we start dealing with the wound, they will be in a lot more pain. The sooner you can get something into them the better. Most prepper's will have paracetamol/ibuprofen. Pick one and get it into them ASAP. Also, add 1 teaspoon of cayenne pepper to the water. This will again help with blood pressure and the clotting. If you have anything stronger like Codeine, Tramadol, Opiates go ahead and give them some. Start with lower doses and be mindful if it’s mixed with paracetamol/Ibuprofen. If you’re really prepared and have a local anaesthetic, you can get it ready for the cleaning.

CLEANING AND TREATING THE WOUND: Now the real fun is going to begin. Before we attempt to treat the wound, we will need to get supplies ready. You’re going to need loads of boiled water. I would make 2 litres of boiled water and separate it into 3 containers. Add a teaspoon of cayenne pepper to 2 of the containers and a couple drops of soap to the third container. We may need to cauterise (burn) any big bleeders, so having a knife on a flame or soldering iron (clean of course) available would be helpful.
When we first look at the wound use, some gauze soaked in the pepper water to look around the wound. We will be interested in any major foreign bodies, bone/tendon damage, major blood vessels damage. If the wound looks ok, we need to start irrigating it with the pepper water. Use a syringe to shoot water all around inside the wound. After we will use gauze and soapy water to clean inside and around the wound. Finally flush all the soapy water away with the last of the pepper water.
This wound needs to be closed up now. If you have the knowledge and ability/preps to do a couple internal sutures then go ahead, but for the majority it’s going to be about closing the wound on the surface. Steri-strips and glue work well. Put steri-strips every ½ cm to close it up then you can glue in between the strips to reinforce them. Some will also say use duct tape to close the wound. This will work well but I would make small strips and use them like steri-strips. I’ve seen skin staplers for sale at the prepper shop in Roxton. I would advise against this. Yes, they work well at keeping a wound closed, but how are you going to get the staples out? They don’t sell the removal tool and didn’t have a clue when I asked them about it. Also, they will hurt a lot, same as suturing unless you have a local anaesthetic.
Finally, after we clean and close the wound we need to immobilise it. The last thing we want to do is have all our hard work ruined because the patient started moving their arm. Put a small dressing to cover up the wound then put the patients arm in a neutral position so the bone is not trying to move under the wound. Once you find the position put a splint around the arm. You don’t need anything fancy for forearms, I regularly use magazines to splint forearms before taking someone to hospital. After its splinted then put it in a sling and keep them from moving it for at least a week.

LONG TERM CARE: Our patient has lost a lot of blood so we need to consider how to treat that. Not everyone will have the ability to start an IV infusion of fluids, but if you did then get some fluids started on them. Most people I would say get them into a comfortable position in bed and keep them there for a couple days until their colour starts to return. It might mean that you need to get a toilet/bucket next to the bed to keep them from moving too much. Also, get them to drink/eat a little bit but often, especially drinking water with some pepper over the next 48 hrs. Keep them dosed up on meds for the next several days. Continual doses of alternating paracetamol/ibuprofen every 3-4 hrs well help keep the pain down. If you start missing doses or only try and use it when the pain gets bad, then usually it takes more meds to get the pain under control and your fighting a losing battle.
Wound care is crucial, as antibiotics most likely won’t be available. Manuka honey is supposed to be a great way of helping wounds heal and keeping infection at bay. It also has a longer shelf life than any drug and can be stored in warmer environments.

Sorry for such a long post, but there is a lot of info in it. Hopefully it helps and you guys get something out of it. I really enjoy medicine and have been doing it for almost 20 years. I'm trying to adapt my knowledge and training to a more prepper/SHTF situation because when it goes down, we will be put back at least 100 years and have to find alternatives to what we normally do.

[preparedsurrey]

Whats your opinion on using super glue for wound closures, it's probably going romp be a lot easier to get hold of post SHTF than proper medical stuff? Also tea tree oil seems pretty useful and seems to have a long shelf life any does and don't s for using it?
With cauterisation do you just keep the heat on until the bleeding stops?

[Lanky Yankee]

Whats your opinion on using super glue for wound closures, it's probably going romp be a lot easier to get hold of post SHTF than proper medical stuff? Also tea tree oil seems pretty useful and seems to have a long shelf life any does and don't s for using it?
With cauterisation do you just keep the heat on until the bleeding stops?

Super glue can be used to good effect. It will cause some pain and isn't nontoxic, but to be fair it's safe enough and will work just as good as the medical glue.

I'm a big fan of tea tree oil as well as lavender. I know they work on superficial wounds but not sure about how they affect deep wounds. I've been looking at the uses for manuka honey as it can last indefinetly, but it's very expensive. A good site on it is
http://www.dermnetnz.org/treatments/honey.html. I'm sure other types of honey would work too, but havn't looked into it.

As far as cauterisation goes. If you can get the instument you're using red hot, then it's usually less than a second to fry the bleeding area. I've used butter knives placed on a hot stove burner to cauterise my dogs nails after cutting them too short. on a wound you would want something a bit smaller like the tip of a soldring iron or a long thin piece of metal that can touch a small part of the wound. In theaters their cauteriser tips are the size of a pen.

hope this helps. Some things I didn't touch on was about rehab and scarring, but my answer was getting a bit long and I was tired after a night shift.

[Malthouse]

Just a quick note - elevating legs in blood loss in out now (as of Spring 2015).

[Yorkshire Andy]

Just a quick note - elevating legs in blood loss in out now (as of Spring 2015).

What's the reasoning behind that? Keeping bp low and reducing blood loss? And better clotting?

[Lanky Yankee]

We had a bit of a discussion during our last training about raising the legs. As far as I know you don't raise the legs if they have a leg, spinal injury, or if it will cause them pain. Thinking about it I would throw pelvis injury in there as well.

Malthouse I'm interested where you got the info from because it hasn't filtered down to us yet. I would think it probably has something to do with internal injuries and bleeding out into the body, but not sure.

[Malthouse]

It was in the last first aid instructors update, there are a few big changes coming next year too.

Is essence, in first aid, we only raise legs now for a fiend, major bleed from the lower leg, or for a sprain/strain etc.

For shock we just lay them flat or in the recovery position.

[Yorkshire Andy]

Thanks malthouse

Only did my FA@W refresher in august last year