A week ago or so I recorded an episode of Radio Contra with the amazing NCScout of Brushbeater Training and consulting. He’s a very good friend of mine and an amazing instructor on a multitude of topics. I had the good fortune of teaching a TC3 class with him last year and hope to do several more in the future, we’re in the process of working out dates. He brought up having me on his amazing podcast Radio Contra and I happily accepted a chance to talk about anything medical. If you haven’t been listening to Radio Contra you need to start. There is a whole wealth of information shared there. In this episode I talked about battlefield medicine and what should be in an IFAK. I will be making a video about this to clear up some things and to be able to talk more in depth and include some different options for how to carry one. It was an amazing experience to be on his podcast and to talk about these things. And yes, I shamelessly plug myself and this site on the podcast. I’m a red blooded capitalist at heart. But enough chit chat. Go listen to the podcast and especially the episode I’m on. We talk about some good stuff. https://www.americanpartisan.org/2020/03/radio-contra-episode-16/
Another week, another Medical Monday post! This week we will be covering stab wounds. I will also include animal bites since the treatment and wound pattern is almost identical.
Stab wounds can be very frightening to think about. With the lack of imaging that a grid down situation causes you will be hard pressed to see what below the skin is actually damaged. The lucky thing is our body is very resilient. Organs have been noted to shift out of the way of a knife or other penetrating object. Most of that has to do with velocity.
If there is any major bleeding you are going to want to stop that first. If it requires a tourniquet use that, or if direct pressure works just use that. You might have to pack these wounds especially if they are in a junctional area. The junctional areas are where an extremity and the trunk meet. Armpits, groin, and neck. If the object that made the wound is still embedded then do not try to remove it. Just bandage around it enough to secure the object so it won’t move and cause further damage. These patients need to see a higher level of care.
If there is no major bleeding these wounds will need to heal on their own. Debridement should be performed using Dakin’s solution. Do not close these wounds up, do not suture these closed or try to use butterfly bandages. Use an antibiotic cream topically. Cover with gauze and check on them every few days to monitor for signs of infection. Clean the wound with Dakin’s solution every time you remove the gauze to examine it. Reapply the antibiotic cream and cover with a clean sterile dressing.
All the of the above applies for an animal bite, but you need to make sure you clean the wound extremely well. Use lots of Dakin’s solution and pay extra attention to these for signs of infection.
This was the last post that I already had the idea for. Now I will start posting polls on Unchained Preppers to get ideas. So if you want input for the next posts, join the forum and vote! Check out the rest of the forum as well, there is plenty of good information there on a multitude of subjects.
If you have any questions post them below in the comments section. Don’t forget to share these posts with anyone you think could benefit from the information, and subscribe to the blog as well. Don’t be left bleeding out like a stuck pig!
Another week and another month! I hope everyone had a great Thanksgiving and hopefully the holiday season is stress and injury free for everyone. This week we are going to be talking about blisters! Everyone has probably dealt with blisters in one way or another. Whether it be from burns due to cooking, or from hiking, blisters can be a miserable issue to deal with. If left untreated they can lead to infection which can be very dangerous even in a grid up situation.
Blister can be caused by many different things. Ranging from friction, heat, chemical reactions, and even allergies. The main ones we are going to look at today are ones caused my friction and those related to burns.
Friction blisters are some of the most common injuries seen in a military setting with light troops. Hiking long distance with heavy weight in any kind of climate can cause blisters, specially if someone doesn’t know how to properly care for their feet. Boots that are too tight can cause friction points on your foot, or boots that are too loose can allow your feet to slip around and cause massive blisters. Wet feet can be an issue all its own or can compound one of the previously mentioned causes. Make sure your boots are properly broken in before you step off to help prevent blisters from forming. Proper socks are also crucial. Most people, myself included, swear by wool socks. A big plus is to add very thin liner socks. An old grunt trick was to wear nylon or silk pantyhose or leggings underneath their issued socks. The liner sock will wick moisture away from your feet and to the wool sock. It will also let the friction be between the liner sock and the outer sock, instead of between your foot and the wool sock. Changing your socks after a long ruck is key to bringing your feet back down to a regular moisture level, more so if you had to cross any body of water. Dry feet do not blister hardly at all compared to wet feet, which is why the liner socks are so helpful. Sometimes crossing water is unavoidable and you won’t have the ability to change your socks at regular time intervals. Or you’ll have to chop more wood than you expected. You will end up with a blister. How to you take care of it? Well it all depends on when you catch it, and what it looks like when you do catch it.
Before the blister forms you will end up with a hot spot. A hot spot is just a reddened area of skin that will be tender to the touch and in an area where friction has been occurring. You will treat this with a donut of moleskin. Just cut a circle of moleskin about a 1/4th of an inch (6 mm for those of you still stuck on the metric system) bigger than the hot spot itself and then cut a hole inside the size of the edges of the hot spot. Slap on enough of these to prevent the hot spot from getting rubbed, and keep hiking.
If you don’t take care of a hotspot a blister will form. A blister is a pocket of fluid between the upper and lower layers of the skin. The fluid should be clear, if it is bloody that means that capillaries underneath the skin have been damaged. If it looks like puss then you have an infection and it’s not a new blister. Try to avoid draining these at all costs. If you have to drain a blister clean the skin and your hands with soap, disinfect a very sharp needle with alcohol (or use a very small hypodermic needle) and go in at the base of the blister with the needle level with the surrounding skin. Do not remove the skin covering the blister as it acts as a natural barrier to prevent infection. Once all of the fluid has been drained clean the area again and apply a topical antibiotic cream. Cover the blister with gauze and tape around the edges completely. A bandaid that mimics this would work depending on the size of the blister.
If the roof of the blister (the skin that covers the fluid) has been partially torn you will need to clean out the exposed area and make sure that no debris got stuck under the remaining skin. Try not to remove any of the remaining skin if you can. Dakin’s solution (talked about last week) would work well for the cleaning. Once it has been cleaned apply a non adherent dressing over the blister and tape it in place. Do not place tape directly over any blister as that will stick to the top layer of skin and rip it off when you go to change it. Use moleskin to protect the dressing and blister from further damage.
If the roof of the blister has completely been removed then clean all of the exposed skin with Dakin’s solution and apply a hydrocolloid dressing. A hydrocolloid dressing contains a gel forming material with gelatin that will absorb the fluids that will seep out of the now exposed skin. They are backed with a waterproof material that prevents that that fluid from evaporating. This keeps the moisture on the skin which encourages proper healing, decreases pain, and prevents any new tissue from being ripped off when you change the dressing. These are only for blisters where the entire roof has been removed. You would want to cover this as well with moleskin if you have to keep walking.
If the blister was caused by a burn you first want to treat the burn, reference https://stuckpigmedical.com/2019/11/20/medical-wednesday-20-nov-2019/ for burn treatment. Then treat the blisters. Leaving these blisters intact is more important because the surrounding skin is already prone to infection. Moleskin isn’t necessary on these blisters since they aren’t caused by friction. But situations are unique, so if it is needed then use it.
If you haven’t noticed by now, prevention is the best treatment for any injury, which is why I always talk about it on every post. Blisters are preventable, but not always. Pay attention to what your body is telling you, and make sure your footwear is broken in before you attempt to use them in a situation that matters. Get training! Don’t be left out in the woods bleeding like a stuck pig!
Another week, another medical monday post. This week we are going to cover cold weather injuries. Identification, treatment, and even prevention will all be covered. Once again, if you want an input into what will be discussed on medical monday, you must go join Unchained Preppers. I have topics for a few more weeks, but once I start getting very low I’ll start asking for ideas over there. So head over and make an account. I promise medical is not the only subject you’ll learn over there.
Cold weather injuries are some of the easiest to prevent and the hardest to come back from long term. Frostbite can lead to gangrene in the extremities if not dealt with quickly enough and hypothermia can cause death. But they are relatively easy to prevent.
Frost bite is generally defined as freezing of the skin and underlying tissues. Just like burns in comes in levels of severity. The first is Frost nip. Frost nip is generally mild, does not cause permanent damage and is easily treatable. You can identify by mild redness and a numb/tingling sensation in the affected area. Anything that is exposed to outside air can become affected but generally your appendages (hands, fingers, toes, and feet) and ears and nose are some of the first to be affected by frost bite at all. This is mostly due to the fact that the blood vessels in these are some of the first to shunt, or close off, during times of extreme cold. Simply rewarm the affected areas and be sure to keep them covered to prevent it from advancing any further.
Superficial frostbite is the next severity and is when the reddened skin starts to turn white or pale. After rewarming the skin may appear mottled (spotted or blotchy) and after 12-36 hours a fluid filled blister may appear. This type is frost bite reaches deeper into the skin and affects may be permanent. Prevention is the best medicine you can get for this.
Deep frostbite reaches all the way down to the underlying tissues beneath the skin and is the most serious. Skin will turn white or bluish gray and you will experience numbness. Loosing all sensation of heat, cold, touch, and even pain. Joints or muscles may no longer work. Large blisters will form 24-48 hours after rewarming. The skin will turn black and hard later, as the tissue dies. There is little to no treatment for this. You are treating the related issues, like gangrene.
With all kinds of frostbite, prevention going to be key. Keep exposed skin to a minimum in extreme cold. Wear clothing in layers that you can adjust to the temperature and your activity. You want to be able to remove layers to prevent from sweating if you are being extremely active, like chopping wood, or walking a perimeter patrol. Sweating can lead to hypothermia. Wear an outer layer that blocks the wind. Goretex is great for an outer layer. I won’t go into specifics because it really depends on your location, the specific climate, and what you are going to be doing. If it does occur gradually rewarm the affected areas. Do not stick them in hot water or extremely close to a fire. The loss of sensation will prevent them from noticing the tissue burning until you smell it, and at that point the damage is already done. Also do not rub or massage the affected areas because that can cause damage to the surrounding tissues.
Along the same vein as Frostbite is Chilblains. Chilblains is caused when it is cold but not freezing, and wet. The affected area will be red, inflamed, itchy, and blistered. Treatment is the same as frostbite. Remove the person from the weather, warm gradually, and keep dry. Prevent is pretty much the same. Keep warm and dry. Liner gloves play a big role here. Just like liner socks for hiking the idea is to wick away moisture and prevent skin to fabric friction.
Hypothermia is lowering of the core body temperature. It isn’t just relegated to cold climates either. Spending all day in the lake on a summer day can cause it. Normal body temperature is roughly 98.6 degrees F. Hypothermia is defined as anything less than 95 degrees F.
Shivering is the first symptom you will notice. Shivering is a natural response to lowering core temperature. This does not mean that they are into hypothermia so far that you need to worry about them, just that you should keep an eye on this person to make sure it doesn’t progress any further. Like how you sweat when it’s hot out. It is just your body trying to maintain normal the medical term for this is homeostasis.
You need to be concerned once the patient progresses further down the rabbit hole. Slurred speech or mumbling, slow and shallow breathing, weak pulse, clumsiness or lack of coordination, drowsiness or very low energy, confusion or memory loss, loss of consciousness, and in infants bright red, cold skin.
Most people with true hypothermia don’t know that they are experiencing it. The gradual onset is a big part. Another is the confusion and memory loss prevent self awareness. This is why it is important to stay in groups. Everyone can watch each other for these signs and symptoms.
Treatment is fairly simple. Remove the patient from the environment and slowly warm them. Remove all wet clothing and either leave them naked, or replace with dry clothing if you have it. This is why during cold weather field exercises people are told to keep at least one pair of dry clean socks in their bag, to wear at night. You do not want to dump them into a steaming hot bath or shower because it can cause the body to go into shock. If they are conscious have them ingest lukewarm fluids. Get them close to a heat source, but closely monitor them to make sure they don’t burn themselves. give them blankets or a sleeping bag to cover up with. Something we were taught when I was in scouting was “skin to skin wins”. Simply put, get down to your skivvies and get under a blanket with them. Let your body heat gradually warm them.
As with anything else in life, prevention is the best course of action. Layering is your friend. Stay away from cotton in the colder months. Especially if you leave near water (including the frozen kinds). Utilize natural and synthetic fibers to wick away moisture from your skin. I am a huge advocate of wool. Specifically Merino wool, but about any kind would do the job. Wool has amazing heat retention properties and when wet still maintains around 80% of it warming properties. Military surplus (especially foreign) is a great place to get ahold of wool clothing. I used to use a German military wool sweater, Czech military wool pants, a wool ski cap, poly-pro long john top and bottoms, and lined waterproof boots in Eastern Washington during the winter when my Scout Troop would go camping and it more than did the job even down to negative temperatures. Military Goretex jackets are great outer layers because they are waterproof and block the wind, but still allow moisture to exit. I am even more so a fan of wool now that I live in Eastern NC. If it came down to having to do patrols during the winter, that ability to stay warm while wet is invaluable. And remember, it’s not about being toasty and cozy, it’s about staying warm enough to not die. “Pack light, freeze at night” has been a part of the military vernacular far longer than goretex has been around. Find equipment that works for you in your environment. But part of that requires training. Get training.
Don’t be left out in the cold, bleeding like a stuck pig.
Made a video about some IFAKs I use and what I put in them. Hopefully this helps answer some common questions I get.
NC Scout and I were able to get dates figured out for this year.
More so than ever the need for quality training is becoming ever apparent. 25-26 September and 7-8 November are the dates we’ve got scheduled for this year. So go ahead and sign up now before spaces fill up! They should both be good classes and I’m excited to see both new and returning students.
Link to NCScouts training calendar https://brushbeater.wordpress.com/training-calendar/
I apologize for my absence over the past few weeks. Life has gotten a little hectic over here with training. I’ll get back to regular posting soon.
The internet here has not been cooperating at all the last few days so I am writing this on Monday. The extra post from last week is still coming. But enough excuses, on to the post.
This week we are going to talk about lacerations. Lacerations are tears in the skin, underlying tissues, muscles or organs caused by blunt force trauma. These are different from cuts or incisions.
Lacerations can vary in size and depth. You need to keep in mind basic anatomy as well, what underlying structures could have also been damaged? If it’s on their abdomen, are their intestines damaged? What about their kidneys, or their spleen? If it’s on their chest did they break some ribs, rupture their lungs? Depending on what is underneath, the damage can lead to much bigger issues than just an opening in their skin.
Our skin is our largest organ. It serves many purposes, one of those being our first line of defense against the environment. Once you break the skin it lets in all sorts of nasties that we wont to keep out. Infections are no joke either, before modern antibiotics and wound care techniques, it was the leading cause of death on the battlefield.
The first step after stopping any life-threatening bleeding is going to be cleaning the wound. Cleaning not only removes contaminants that can cause infection but it allows you to fully inspect the wound to check severity and size. Cleaning does not need to be performed with massive amounts of hydrogen peroxide or isopropyl alcohol. The military has found that the use of those and similar fluids have no noticeable effect on infection rates. At a minimum, you can get by with just potable water. The more fluid the better. Pressure higher than 15 psi not only damages tissue but it has little to no effect on decreasing infection rates. It simply pushes contaminants and bacteria deeper into the wound. One recommended way is to puncture a hole in a water bottle and use that in combination with mild scrubbing. The recommended solution is Dakin’s solution. Dakin’s solution is a cleaning fluid made of water, household bleach, and baking soda. It was first used in the First World War before the creation of modern antibiotics. The dilution recommended is known as a modified Dakins. Take 1 liter of potable water, add 5 ml of unscented household bleach, and 1/2 teaspoon of baking soda. Shake to mix it all up and it should keep for about a week in this form, but bleach and baking soda separately will keep for much longer. Then to use this for irrigation dilute that 1:10 with more potable water for irrigation. Use 1-3 L for small or clean lacerations, 4-8 L for intermediate or dirty wounds, and >9 L for large or very dirty wounds. Make sure you remove all sources of infection and any puss that is visible. Squeeze it to make sure you have all the puss and infection out. Topical creams like bacitracin or Neosporin work great for care after you have cleaned the wound. Just make sure to not put it inside of the wound.
After you’ve fully cleaned and inspected the wound you want to decide if you need to close it or not and how to dress it. This all depends on several factors. Location, size, and depth of wound all play a factor in whether or not to close it and how to dress it. You don’t want to close a wound when it is infected or is about to become infected. If you close an infected laceration it will form an abscess and may lead to an infection in the blood called sepsis, which untreated is deadly. Infected wounds will be red, the area may be hot, swollen, and it may be draining purulent discharge (fancy word for pus). Normal drainage will be light yellow or clear. If you start seeing large amounts of white puss you need to re-clean the wound and make sure you got all of the infection out. Also if the area you are at is normally dirty you want to leave the wound open as well. These types of wounds we want to heal through granulation, or from the inside out. You also don’t want to try to close a wound that is over a joint, the constant movement will just cause it to rip stitches out and the healing may prevent full range of motion further down the line.
Wounds you can close will be small, cleaner wounds, anything that isn’t over a joint, and wounds that don’t create pressure when you try to close it. Butterfly bandages work great if you don’t know how to suture. Superglue works great as well. Both have been used in third world countries for decades with lots of success. I even keep superglue in my larger aid bag and at home for situations just like this. If you do know how to suture you can do so here as well.
After you’ve made the decision to close or not close you are going to want to keep it covered to prevent infection. If it’s larger or more wide you will want to place a non-adherent pad down first to allow the healing process to be restarted every time you do a dressing change. You can always cut larger pads down to size to help make your supplies stretch. Medical tape will also be your friend here. There are a few things that I am brand particular on, and tape is one of them. I prefer 3M durapore medical tape in 1, 2, and 3-inch widths. I don’t like duct tape because if left on for too long it can cause tissue damage. Don’t overuse the tape, a little can go a long way. Always cover non-adherent pads with regular gauze.
Now on to dressing changes, they do not need to be performed daily. You can look at the wound daily, but you don’t need to change it daily. Current recommendations from the US Military’s CPG’s on prolonged field care are 2-5 days between dressing changes, depending on how the wound is healing. When you do the dressing change you are looking at the wound to see how it is healing and to check for signs of infection. Every wound doesn’t require antibiotics. It depends on the environment and the wound. This is where clinical judgment comes into play. This is also why it is really important to have a true medical provider in your group. Even just having a Physitians Assistant is your group is a HUGE advantage medically. They provide a much higher depth of knowledge than just a medic or a nurse can provide. Even if they aren’t directly where you are, having the ability to telemedicine with them can make a difference in the level of care that you can provide.
If you have any questions feel free to comment below and I will try to clarify the best I can. And remember, all the information in the world means nothing without quality training behind it. So go get training. NC Scout offers some great training, and I do teach medical classes (which I plan to start back up when I get back stateside). If you like what I am doing here share it with everyone you know! Don’t be left bleeding out like a stuck pig!
Once again I want to apologize for how late this post has been, I have been extremely busy the past week between classes with our new provider, different platoon tasks handed down, me getting sick, and other miscellaneous things have gotten in the way. On to the important stuff though, the post this week will be about burns. This will be a long, so buckle up, grab some coffee and settle in for a long ride.
Burns come in a few different forms. Determined either by the cause or the depth. You might be familiar with hearing them referred to as “degrees” as in first degree, second, etc. Medically they are referred to by how deep they go. Burns, simply put, are tissue damage caused by heat, the sun or other radiation, or chemical or electrical contact. Treat doesn’t vary much by cause, but it does key you into some other issues they may potentially have.
Superficial burns are the ones that almost everyone is familiar with. The most common form of a superficial burn is a sunburn. Superficial burns only reach the uppermost portion of this skin, known as the epidermis. They will be red and painful. Later on, you may see peeling depending on how bad it is. The same goes for blisters, although they are rare for this kind of burn. Treatment for these is relatively simple. Remove from the heat source and apply something to prevent further damage. Aloe Vera gell works very well for this. Sunscreen and full-length clothing is your best protection to prevent this. Wide-brimmed hats work exceptionally well for this task as well. The military still issues out the “boonie” cap to troops for this purpose.
Partial-thickness burns are the next severity of burns. These go partially into the next layer of the skin. There will be more blisters on these and the surrounding tissues may be superficially burnt depending on the cause of the burn. These are the most painful type of burns. Do not pop the blisters unless it impedes your ability to do basic tasks. Keep these dry and clean. STAY AWAY FROM BURN CREAMS. They never work and most of the time make the issue worse. Bacitracin is the only cream you want to put on these burns. Other than that just keep them dry and clean. Depending on how deep into the next layer of skin this burn goes it will scar. Prevention is extremely important here because treatment gets complicated depending on location and your ability to keep the area clean and dry. So no cooking bacon shirtless. Sorry. Keep your collars popped on those combat shirts under your kit and that tactical scarf makes sense now, it’ll keep hot brass from falling down your shirt and getting trapped under your shirt by your kit. Don’t go grabbing the lid for that dutch oven without a heavy-duty glove either.
Full-thickness is the next type of burn. These go beyond the layers of the skin and go into the underlying tissues. Muscle, tendons, ligaments, nerves, all have the chance to be damaged by this depth of burn. The nerve endings being damaged are why partial-thickness burns are more painful. Full-thickness will be surrounded by partial-thickness and then superficial burns. Especially when heat is the cause of the burn. These will have dead tissue with a dry, dark brown appearance. Removal of all dead tissue is a must, gangrene will start if the dead tissue is left on the wound. Skin grafts are normally used in hospitals for this, but I doubt ANYONE has that technology or the support structure to let that be viable. Compression therapy is also used to prevent scarring. For someone working within the idea that the grid and everything surrounding it will not be in full swing, manuka honey (or really any pure honey) has shown great promise and is even preached in the Military Clinical Practice Guidelines, or CPG’s, that govern how we handle medicine in austere environments with limited supplies. The honey works by first creating an airtight barrier that does not allow any bacteria to enter. Honey also only supports the growth of anaerobic bacteria, the kind that only grows in the absence of oxygen. Since the bacteria that can cause harm to us are aerobic or require oxygen to live, this makes honey an excellent choice for wound treatment, and not just for burns. The military has also found that daily dressing changes have little effect on the infection rate of wounds in an austere setting. Once again, prevention is the best course of action for this.
A huge consideration for burns is when the Total body surface area of the burn (partial and full-thickness only) is greater than 20%. At this point, you would have to start worrying about fluid resuscitation. Plasma from the surrounding tissue will leak into the burned tissue due to osmosis in an attempt to make up for the fluids lost. This will cause massive dehydration and a condition called hypovolemia, which is basically decreased blood volumes specifically of the plasma. This can cause a whole litany of complications leading to death. Also between the hypovolemia and the loss of skin hypothermia is also a massive concern. To determine the Total Body Surface Area or TBSA, you can memorize the percentages, or just use a handy reference chart. The DOD included it on the standard trauma documentation form so you wouldn’t have to remember it. It is called the Rule of Nines.
As you can see there are two different sets of percentages. One for infants, and one for adults. If you can’t decide what to use, just use the palmar method. It uses the PATIENTS hand to determine TBSA with the PATIENTS hand being equal to 1% of TBSA. If it is greater than 20% prepare to start pushing fluids. But you’ll need some more information. Like how much fluid to push, and how quickly. And do I have to be able to do an IV or are there other options for those of us not trained in that skill?!?! Well, I’m getting there.
Once you have the TBSA from the Rule of Nines, you’ll then use the Rule of Tens to determine how much fluid to give every hour for an adult who weighs no more than 80 KG (or 176 lbs) simply take the TBSA and multiply by 100. So if the TBSA is 25, your hourly fluid rate would be 250 mL’s an hour. And you want to use Lactated Ringers, not Normal Saline. For every 10 KG over 80 Kg, you will add an additional 100 mL per hour. So if you have a patient that weighs 120 Kg’s with a TBSA of 30 you would take 30 and multiply it by 100 to get 300 mL per hour. Then add 400mL per hour to get a total of 700 mL per hour. And this works for IV and rectal or oral fluids. If you are going to use rectal or oral fluids, take 1 L of water, and mix in 8 teaspoons of sugar, .5 teaspoon of salt, and .5 teaspoon of baking soda. The same rates apply. For children, you are going to use a different formula. 3 mL x TBSA x Bodyweight in Kgs. That will give you the total fluid to push over 24 hours. The first half gets pushed over 8 hours, the second half over the following 16 hours. Same fluid type as adults. This is why I keep enema bags in my kits. Super cheap and no need to store sterile fluids.
All of this information is a baseline to get you on the right track. If you do not have a medical provider in your group, you are seriously wrong. And no, I do not mean a medic or someone who is a nurse. They may have an amazing depth of knowledge, but there is a reason why PA’s and Doctors go to school for as long as they do. That level of knowledge can not be replaced.
The medical monday post for this week will be late. Between how busy our week was and the cold I came down with I didn’t have much time to put a post together. But as a consolation I will be posting another article this week to make up for it. Life happens.