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Online Discussion: Tracking new emerging diseases and the next pandemic.

DISASTER MEDICINE

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    Posted: February 04 2006 at 6:05am

During any Disaster, whether it is a pandemic, earthquake, hurricane, or even a terrorist attack, you may be faced with the need to provide emergency first aid to someone.  Taking a first-aid course, and getting a CPR certificate, are essential first steps to being prepared.  But there are more issues involved than you will learn in these venues. 

This is the first, of what I hope will be several, disaster medicine pearls.  Straight talk about the realities of handling medical emergencies. 

These are provided for educational purposes only, and represent the opinion of this lone, retired, paramedic. They are not, and should not be interpreted, as medical advice.

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The Realities of CPR.

A cardiac arrest, or `codeí, is the gravest emergency any responder will ever face. Yet, ironically, with proper training, a responder may save a victim with nothing more than his hands, mouth, and brain. Go figure.

To deal with a cardiac arrest you need to take CPR training. Please donít assume that, by watching ER, or viewing a website, that you know how to perform BLS (Basic Life Support). CPR requires specific motor skills that can only be adequately learned from practice. This pearl will not, therefore, attempt to teach CPR. You need to take a class for that. Instead, I will focus on what your CPR instructor may not tell you.

In CPR class you will learn how to assess a patient, clear an airway, how to position the head, how to monitor vital signs (pulse, respirations, pupils), and how to properly perform compressions and ventilation. You will learn the mechanical skills needed to provide BLS. If you havenít taken a class, do so immediately. If you havenít had a refresher course in a few years, take one.

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SAFETY: Electrocutions are a fairly common cause of cardiac arrest. As a BLS provider, ALWAYS inspect the scene before approaching an unconscious patient. Look for wires, water on the floor, or any other hazard that could endanger your life or safety. Donít endanger yourself while trying to save someone else.

Additionally, some people have been known to attempt suicide by ingesting caustic or poisonous chemicals. DO NOT DO MOUTH TO MOUTH in these cases. If you detect the strong odor of chemicals or pesticides on the patientís breath, and donít have an ambu-bag available, accept that the patient got his or her wish.

Please know that working a code is hard work. Two-person CPR is easier than one person CPR, but it too can be strenuous. Add to this the adrenalin and stress of dealing with the situation, and a rescuer with a heart condition may be risking THEIR LIFE doing CPR. Sadly, Iíve seen this happen. An ambulance `attendantí (pre-paramedic days) in his 60ís died in St. Pete doing CPR. Ambulance pulls up to the ER, the driver gets out, opens the back doors, and has a double code on his hands. In that case, neither the patient nor the rescuer survived.

A reasonably healthy person should, however, be able to perform CPR for 20 to 40 minutes without problems. But if you begin to experience chest pains, or difficulty breathing, IT IS TIME TO STOP. Let someone else take over, or call it a day. Don't add to the body count.

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EMOTIONS: During a medical crisis, some people panic and flounder about, while otherís rise to the occasion. Everyone reacts differently. Parents are notoriously bad about dealing with an injured or sick child. Their inclination is to hold or cradle a child instead of rendering substantive aid. You have to learn to detach yourself, at least for the duration of the emergency, in order to be effective. Even when dealing with your own children.

You must put aside your emotions, take a deep breath, and deal with the problem at hand. Otherwise, you are simply part of the problem, not the solution. If you can't handle it, get out of the way and let someone else do it.

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STARTING CPR: The first consideration for a BLS responder is whether it is appropriate to administer CPR. Here we get into an ethical question, and if any doctors are reading this and have some additional input, I would welcome that. All I can do is offer my opinion.

Generally speaking, unless the patient has been obviously `deadí for more than 20 minutes, or you know the patient is in the last stage of a terminal illness, or the patient has sustained obviously mortal injuries, CPR should be started immediately.

Sounds simple, but it isnít. What constitutes a `mortal injuryí? How can you tell if someone has been `deadí for more than 20 minutes? How can you know the patientís medical history and/or wishes?

First, if anyone is around who knows the patient (relative, friend), ASK!. They can often tell you if Old Max is in the final stage of liver cancer or not. But understand, you canít know what you canít know. Better to err on the side of caution and administer CPR than to withhold it from a potentially viable patient.

Mortal injuries generally involve the head. If the head is some distance from the body, you can forget about CPR. If large amounts of gray matter (brains) are beyond the confines of the skull, cover the victim up and move on. But please know that many other, terrible looking injuries, are survivable. If transportation to a trauma center is possible within the first hour, even devastating injuries can sometimes be salvaged.

When faced with a non-breathing, pulseless patient who has been `downí for an unknown length of time, there are a few clues that can tell you if the patient is viable. No, there is no surefire way to determine if the patient has been in arrest for 15 minutes or 30. But beyond 30 minutes, changes do occur in the body, which are fairly easy to see.

Skin color and temperature are big indicators. Deep cyanosis (blue coloration) and cold skin are an indication prolonged cardiac arrest or death. If the body is beginning to stiffen, then rigor mortis has set in, and the patient is long gone. And dark pooling of blood at the lowest point of the body (livor mortis) usually does not occur until several hours after death. But in my experience, the eyes are the best short-term indicator. The pupils will cloud over, dry out, and become lackluster beginning about 20 minutes after death. They will be dilated and non reactive to light. That, when combined with other signs, can give you a clue.

If the victimís skin is cooling, deep cyanosis is present, and the eyes are dilated, fixed, and clouding over, then you are probably too late to the party. But unless you are absolutely certain it is too late, initiating CPR is still appropriate. The `codeí can be stopped by the ALS team when they arrive or by the doctor in the Emergency Room.

---------------------------

How long should I do CPR?

Under normal (non-disaster) conditions, help can nearly always be summoned (first step: CALL 911) and should arrive within 20 minutes. During a hurricane, or other disaster, help may be hours away. This will make a difference, on a practical level, for what you can reasonably do. The standard recommendation is that once CPR is begun, it be continued until ALS trained rescuers can arrive. If you are isolated, cut off, and no help can be reasonably expected within an hour, you will have some very hard decisions to make.

CPR alone will rarely re-start a heart. Yes, Iíve seen it happen, particularly with a witnessed arrest, but it is an uncommon occurrence. And if itís going to happen, it will generally happen in the first few minutes of resuscitation. If no help is forthcoming, and the patient has not responded after 30 or 40 minutes, itís time to think about calling off the code. Cases involving hypothermia, including drowning, have a better chance of survival than other cardiac arrests, even after a significant amount of `down timeí. And the younger the patient, the more likely you are to have a good outcome. But even in those cases, if more than an hour has gone by, itís time to accept the finality of the situation.

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Expectations: Even with ALS equipped and trained personnel on hand, the best we seem to be able to do is a 50% survival rate. In many areas of our country, where response times are long, less than 10% survivability seems to be about average. If ALS is more than an hour away, well . . . letís just say miracles sometimes do happen.

-------------------------

Liability: We live in a litigious society, and many people fear that learning CPR will somehow embroil them in legal liability issues. The lay public has no `duty to act', meaning that no one can legally force you to use your CPR training, nor can you be held liable for not using it. The Good Samaritan laws in nearly every state protect you if you decide to render assistance, as long as you do so in good faith, without intent to cause harm. Even if you do something wrong, if your intent was to help, you are not liable.

-------------------------

Dealing with Death: This is something that is rarely covered during CPR class. And in my humble opinion, ought to be.

The odds are, if you are called upon to do CPR, you are probably fighting a losing battle. If ALS help arrives within the first 20 minutes, and you have done timely and effective CPR, a good success rate would be perhaps a 30%. Thatís a best-case scenario. Reality is probably less than 20%. A spontaneous re-start of the heart, without the aid of ALS, will happen perhaps 5% of the time. Still, thatís better than zero.

Patients in cardiac arrest, despite the best efforts of their rescuers, often die. You need to be prepared for that.

Know that, by learning CPR, and using it, you gave your patient a chance. A chance they wouldnít have had if you hadnít taken the time and the trouble to learn this procedure. If the patient dies, you did not fail. You did all that you could do. You tried. No one could ask for more.

When the loss involves a friend or a loved one, it is 1000 times more difficult to deal with. There are no words I can give that will mitigate this loss. I wish there were.

All I can tell you is that this is the single best reason to learn CPR. Knowing you did everything possible is the only salve that may someday help heal that wound. Donít put it off. There are some things in life you will never forgive yourself for.

Donít let this be one of them.


Final Note: If you are at a public place, a hurricane shelter, for example, and a cardiac arrest occurs, check to see if an automatic defibrillator is available. They are often mounted on the walls of auditoriums and other venues. These are truly lifesaving devices, and are very easy to use. Just follow the illustrated instructions on the cover.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote fritz Quote  Post ReplyReply Direct Link To This Post Posted: February 21 2006 at 6:26pm

Hi F-M, I was thinking about ordering a portable defibrilator. They are pretty expensive though. It's a great thing to have around if you need one, that's for sure.  :>}

thanks for all the great info.

"I am only one; but still I am one, I cannot do everything, but still I can do something. I will not refuse to do the something I can do." -- Hellen Keller
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: February 21 2006 at 6:41pm
The vew defibrilators are very good. They have an electronic voice to give instructions and it will not 'fire' if the pads are on wrong or if the patient is not in fibrilation.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: February 21 2006 at 6:52pm
The auto defibrillators are pretty much foolproof.  Costs are now about $1200-$1600.  About half of what they were a year ago.  Wish I had one in my kit.




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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: June 08 2006 at 1:31pm

Hi,

Not to rain on your parade, but the defib has the potential to restart the heart, however without meds to sustain it you're back where you started.
Before spending the bucks, invest in a good emergency medical textbook like Tinnel's and also purchase a medical dictionary (since a lot fo the words won't make sense to you.)  You probably also want to get the American Heart Association book on ACLS (Advanced Cardiac Life Support.) and READ THEM!

If someone in the house is at serious risk for sudden death syndrome You would be better off by trying to get them in the best possible shape (stop smoking, do exercise etc.) now - before it hits.

If you feel the defib is important, than read up on how the code goes down.  Decide how to handle the drug issues.  Is someone in the house at least a CNA who knows how to inject the meds?

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Post Options Post Options   Thanks (0) Thanks(0)   Quote sardog01 Quote  Post ReplyReply Direct Link To This Post Posted: July 18 2006 at 7:20pm
Ok, I guess I gotta rain on everyones parade. I have been a CERT instructor for eight years and a disaster responder for over twenty years.
CPR is a maintenance procedure. You may spend an hour beating on a dead man while a person ten feet away bleeds to death because you didn't take thirty seconds to tie on a bandage. CPR takes you out of the resource pool that helps viable victims. CPR has little or no place in a disaster situation. Too tough a call for the rookie.
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If I have a heart attack where my heart stops during a flu pandemic without any medical help available, I hope they let me die. I think it would be harder to come back and live with the idea that my heart could stop at any time since there would be no medical intervention to stop that, then to just die outright. I think in all things, people have to ascess the situation before they use extrodinary measures to save someone. My sister in laws, mother had severe lung disease and a weakened heart, she told her dad, if you ever find mom laying on the floor unconcious walk slowly over to the neighbors house and call the hospital. He found her just like that, he did what his daughter said, and his wife and her mother went on to a place where it was no longer hard to breathe, rather then to come back to slowly suffocate to death. I hope that all lay people take that into account. It is especially more important during a pandemic. Where no medical ability to aleviate pain and anxiety in the dying process may even be available.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jazzy Quote  Post ReplyReply Direct Link To This Post Posted: November 01 2006 at 8:16pm
when i think of 'disaster medicine' i think of how to handle an emergency on my own.  i have no real training.  but i have made a point to read as much as possible, gather medical books and items i think i might need.

the truth is, i dont know what i can do, but the more i educate myself, the better off we will be.

i also made a point to research anitbiotics to have on hand.  i knew what each member of my family has been perscribed for specific treaments--i and i went to vet sites and bought the 'fish' antibiotics.

i asked a friend who is a pharmacist and she told me they are the exact same medicine used for people.  just watch the mg dose.  if you buy a bottle that is 250mg and the correct does is 500mg, adjust it.

it is incredibly cheaper too.

it doesnt hurt to stash away in your fridge some 'fish' anitbiotics.  do the research, find out for yoursel.f.  do a search on each and print out what it is used for and the dose.

cipro is going for about $150 a bottle, but you can get it for 100 tablets $24.99.

after talking to my friend, i am convinced it is worth doing.


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Mississipp Mama Quote  Post ReplyReply Direct Link To This Post Posted: November 02 2006 at 3:24pm
  Hi Jazzy, is there any vet site that you like more than the others.  I just might get some of these meds as a last resort.  Thanks a lot.
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Originally posted by Mississipp Mama Mississipp Mama wrote:

  Hi Jazzy, is there any vet site that you like more than the others.  I just might get some of these meds as a last resor
t.  Thanks a lot.
hi msmama, there is a place here in jackson that sell vet meds. not sure what kind but it's just a few blocks from my house. i'll get the name and number in the morning, if ya want it
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jazzy Quote  Post ReplyReply Direct Link To This Post Posted: November 03 2006 at 1:11pm
Hi ya'll.  www.vetameric.co  and www.calvet.com are the 2 places i go to, very prompt, excellant prices.  remember it is the 'fish' antibiotics only--not any others.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Mississipp Mama Quote  Post ReplyReply Direct Link To This Post Posted: November 03 2006 at 8:25pm
  Hi Maysday and Jazzy, thanks a lot for the websites.  Will you guys give me a general idea of what you ordered.  Thanks
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jazzy Quote  Post ReplyReply Direct Link To This Post Posted: November 05 2006 at 7:02pm
hi MM,

i ordered cipro from vetamerica.com and i ordered amoxicillan, ampicillan, keflex and doxycycline from calvetsupply.com.  these are medicines my family has used before for different reasons with no problems (we've never used cipro before tho).  i bought a few books to read up on them and checked doses for adults (all the kids have grown up now) and ordered what i thought would take care of us in an emergency situation. 

but just having some antibiotics for when TSHTF--things we have used and are accustomed to---makes me feel alot better.  i keep them in the bottom drawer of my fridge.  i had told my pharmacist what i had in mind (they know me there) and one thought i was a ninny and one thought i was being prudent.

i also did research on anthrax exposure & pneumonia--a secondary infection with flu and thats what made me decide to get the cipro.  i honestly believe that our time of being able to get these things is coming to a close fast.  especially the cipro---just today i read a DHS article that was in a question and answer form about anthrax exposure to the general population.  what struck me is that the question was  "should i ask my doctor for a perscription to have just in case".  the answer was a resounding NO,  NO, NO.  the government will rush in to the area with cipro if there is proof of an attack.......

that did not make me feel warm and fuzzy at all.
i believe foremost in herbal remedies and use those primarily, with some homeopathics.  we rarely take a pill for anything, but i am glad i decided to get some antibiotics 'just in case'.

go to those sites , just compare prices and dosage in bottle--i prefer pills over capsules--but thats just me.  both of them have some sort of sale on a few things right now.  just compare prices.

also--im putting in a plug for oregano oil---that stuff has NEVER failed me for fighting an infection, toothache, bronchitis.....and i saw that puritanspride.com ishaving a sale  buy 2 get 4 more free.--no fooling.
i will never be without it, so i am stocking up big time.  im only saying what i am doing, i have no expertise.

i hope this was a help to you, MM
from one southern gal to another (i was raised in memphis and still have family there)

take care

jazzy

ps
get your stuff now
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Mississipp Mama Quote  Post ReplyReply Direct Link To This Post Posted: November 05 2006 at 8:49pm
  Hi Jazzy, this has helped me a lot.  I already have oregano oil, I might order some more since puritanpride has a sale.  I will order cipro and other meds tomorrow.  I' getting tired now.  I was raised in Greenville Ms. Thank you for taking the time to give me so much information.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Mississipp Mama Quote  Post ReplyReply Direct Link To This Post Posted: November 06 2006 at 3:28pm
  Hi Sherrie some how I missed your post.  Yes I would like for you to get the number and name of the vet in Jackson.  If they have what I am looking for I might drive to Jackson.  Please read the Hattiesburg and Ms. city forum I posted a message for you.  Thank you Sherrie
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Mississipp Mama Quote  Post ReplyReply Direct Link To This Post Posted: November 06 2006 at 4:39pm
  Hi Jazzy I just visited the Vetamerica site.  Their prices are good.  I would like to get an idea of how much you are odering.  I see you can get few tablets of each or 100.  Are you ordering the large ammounts of each meds  Are you orderring 250mg. or 500mg.  Next to the medicine it states something like for fish tank use, is this what I'm suppose to me ordering?  Sorry for so many questions but I want to be sure that I'm getting the right stuff.  Thanks so much Jazzy. 
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hi  MM,

i decided to order one bottle of 100 of each item i was interested in for each member of my family.  amoxicillan, cipro, doxycycline.  different things for different potential problems.  i am thinking long term and emergency here.

i did a search on each item, what it was used for and what dosage it required and printed it out to have on hand.  i just gave it my best guess as to how much to get---who can know what we may face down the road.  i can plan for facing pneumonia, upper respitory infections, , ear, nose, throat infections.....the hardest was considering anthrax exposure ..that requires 60 days of treatment.  and how would i know we were exposed or not?  i dont want to go into a panic mode and  take something we dont need.  nor do i want us to be in the position to need something and not have it or have to go register somewhere to be able to get it, you know?

i have 2 friends who are doctors, if there ever was an emergency situation beyond the simple things i can recogize, & if it was at all possible, id ask them, tell them what i had on hand and ask for their directions.  i have no training and little knowledge, but im thinking, what might we have to face-worst case scenario.

but in a true emergency, everythings gone to hell situation--id much rather have a bottle of each to have on hand.

the cipro is 250mg, the amoxicillan i got 500mg and the doxycycline 100mg., thats just what i did.  im sure there are much more educated people than i how can tell you more.  if you have a good relations with your doctor or pharmacist you might ask them what they suggest you stock for an emergency situation----i got mixed reviews from mine, was given an off-the-cuff suggestion of what to look for from one and went from there.  i just strongly suggest you find and print out each antibiotic that tells what they are used for , what not to take when using it, dose and possible reactions. its very easy to find on the net.  then get a big binder notebook and keep all info in that for future use, i dont ever plan to rely on my memory especially in an emergency situation.

yes, the fish or fish tank use is what you want---those are the same antibiotics used for humans as i was told.  i was told only the fish antibiotics.  again, i only bought those things my family had already used for certian conditions and worked for them, except for the cipro, we have never used that, but i bought it because it is a newer antibiotic and supposedly harder to get.

well, i dont mean to sound weird or paranoid, and i guess i come off like that, but i am convinced 100% that we will be facing some very, very hard times and i want to make sure i can help my family and friends (including a doctor and a pharmacist i am close to) the best i can.  they seem to understand my desire to prepare and the wisdom in it, but they dont do it for themselves. 

hey, i just love that oregano oil---have used it for years and never had anything that it didnt work forand will be stocking up on it.  and im an elderberry tincture freak too...great stuff to keep on hand and sooo easy to make.

all the best,


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Please check all your preps. 
 
 

Contamination Causes Massive Pain-Reliever Recall

Millions Of Bottles Of Acetaminophen Recalled

POSTED: 9:20 am EST November 9, 2006
UPDATED: 12:48 pm EST November 9, 2006

WASHINGTON -- A major manufacturer of store-brand acetaminophen recalled 11 million bottles of the pain-relieving pills Thursday after discovering some were contaminated with metal fragments.

There were no immediate reports of injuries or illness.

Perrigo Co. said it discovered the metal bits during quality-control checks. The company passed 70 million pills through a metal detector and discovered the metal in about 200 caplets, according to the Food and Drug Administration. The fragments ranged in size from "microdots" to portions of wire one-third of an inch long
The recall affects bottles containing various amounts of 500-milligram caplets. Consumers can determine if they are in possession of a recalled product by locating the batch number printed on the container label. The full list of batches is on the FDA's Web site.
 
 
 
IMPORTANT PHONE NUMBERS
  • Perrigo's Consumer Affairs Department: 877-546-0454
  • FDA's MedWatch Program: 800-FDA-1088
  • FDA's MedWatch Fax: 800-FDA-0178
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dlugose Quote  Post ReplyReply Direct Link To This Post Posted: November 09 2006 at 4:31pm
Originally posted by jazzy jazzy wrote:


i ordered cipro from vetamerica.com and i ordered amoxicillan, ampicillan, keflex and doxycycline from calvetsupply.com.  cipro. 
 
It is illegal to order veterinary meds for human use.  People sometimes get busted.  See for example,
Besides, fish antibiotics might make you sick to the gills... Smile
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