The Survival Doctor

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Part 2 in my modern wound care series. See part 1, on the latest advice for cleaning a wound, here.

by James Hubbard, MD, MPH

How many cuts and scrapes have you gotten in your life? Probably quite a few. Yet, to this day, do you know whether it’s better to keep a wound covered or let it air out?

Simple wound-care questions like that have left even doctors debating the answers. So earlier this year, an article in American Family Physician, the journal of the American Academy of Family Physicians, offered some answers. For the article, three researchers from Thomas Jefferson University looked at a number of studies on wound care and formulated guidelines based on the findings. Here are some highlights.

1. Can I get my stitches wet?

It turns out getting your stitches wet is not as big a deal as we once thought. In one study cited in the article, people who got their sutured wounds wet within 12 hours had no more infections than people who kept their wounds dry for 48 hours. In another study, washing a wound within 24 hours [... continue reading]

Author: LAwordsmith
Posted: April 20, 2015, 10:00 am

by James Hubbard, MD, MPH

If you want to expand your survival-medicine knowledge beyond first aid but don’t know where to start, wound treatment is a great choice. Whether it’s during a disaster or just in your everyday life, you’ll eventually face a wound of some sort.

You can learn a lot of advanced but easy-to-follow treatment details from my two affordable, interactive e-books, The Survival Doctor’s Guide to Wounds and The Survival Doctor’s Guide to Burns. They cover gashes, bites, burns and more. I’ve also come across an excellent review regarding certain aspects of wound care: the Wilderness Medical Society Practice Guidelines for Basic Wound Management in the Austere Environment, published last summer.

To create the recommendations in this report, researchers reviewed available studies for objective evidence of what works and what doesn’t. In this post I’ll go into some of their conclusions about cleaning a wound. Some of the findings may surprise you.

Plain Water Is Usually Best

In my books and posts on wounds, I suggest that drinkable water is one of the best options for cleaning a wound. The review goes a little [... continue reading]

Author: LAwordsmith
Posted: April 13, 2015, 10:00 am

This is the Combat Application Tourniquet (C-A-T) by North American Rescue ($28.99*). Note the stick you can use to wind the tourniquet tighter.

by James Hubbard, MD, MPH

A tourniquet seems so simple. At its most basic, it’s just a strip of strong material.

Its use seems simple too. You tighten it until the bleeding stops. Voilà. Life saved.

But thanks to studies conducted over the last several years, the guidelines on tourniquets have become more sophisticated, causing emergency professionals to change how they use these lifesaving devices.

Here’s the latest thinking, according to the research I’ve been reading. I’m eager to also hear from you if you’ve used a tourniquet in the field. What have you found works or doesn’t?

How Quickly to Use a Tourniquet

In the vast majority of injuries, applying direct pressure to stop the bleeding is the way to go. But in cases where this doesn’t work, experts are increasingly advising that tourniquets should be used more often and applied quicker than they have been. Studies done during the last several wars have shown that tourniquets are more unlikely than previously thought to cause serious arm or [... continue reading]

Author: LAwordsmith
Posted: April 6, 2015, 10:00 am

The X-ray owner, Tim Snell, says this injury didn’t hurt as much as you’d think. “I can’t claim that the process of ‘popping it back in’ didn’t hurt though,” he wrote on Flickr, where he shared the X-ray. “What i thought would be a 5 second ‘click’ ended up taking 3 professionals over 10 minutes of tugging, twisting and pulling to get the little bugger back in place. it’s a good job i was pumped full of laughing gas.” (“Snap My Fingers,” shared via CC BY-ND 2.0.)

by James Hubbard, MD, MPH

Broken bones and dislocated joints are pretty common injuries, and I have several posts on how to treat them in an emergency. But many people have asked specifically how to “set” a bone, meaning, I presume, how to straighten a broken arm, leg, finger, or toe if it is crooked.

The answer is most of the time, you should do nothing for a crooked bone or displaced joint other than splint it as-is until you can get to a doctor. Trying to move it around is likely to cause more damage.

But there are some injuries when, indeed, you may want [... continue reading]

Author: LAwordsmith
Posted: March 30, 2015, 10:00 am

by James Hubbard, MD, MPH

A couple of weeks ago I wrote about deciding what to do if you have chest pain far away from expert help. As usual my readers contributed some thought provoking comments. Two suggestions in particular inspired me to write additional posts. Last week I discussed so-called cough CPR. This week, it’s cayenne pepper.

The claim that cayenne pepper can stop a heart attack in its tracks is found far and wide on the Internet. So I decided to check out, as best I could, whether there’s any truth behind the headlines.

In fact, capsaicin, which is the chemical that makes peppers hot, does have some medical uses, which I’ve written about previously. It can relieve some types of pain and may fight certain cancers. It’s sold over-the-counter in a diluted nasal spray (for runny noses and headaches) and cream (for nerve pain). But whether it helps with a heart attack is more questionable.

Often, when the subject of cayenne and heart attacks comes up on the Net, a 2009 study is cited in which heart attacks [... continue reading]

Author: LAwordsmith
Posted: March 23, 2015, 10:00 am

by James Hubbard, MD, MPH

Last week I wrote about deciding what to do if you have chest pain far away from expert help. Several comments on that post and on Facebook suggested vigorous and repetitive coughing could be tried. Since that suggestion is found far and wide on the Internet, I decided to check out, as best I could, whether there was any truth behind it.

The Premise

As far as I can tell, the thinking behind so-called cough CPR is that taking a deep breath, then a deep cough can raise your blood pressure for a second or two, thus delivering more blood to the brain. Also, the claims go, if your heart is in an abnormal rhythm, a deep cough might revert it back to normal by doing the same thing as a Valsalva maneuver (a technique that changes the pressure in your chest to make your body think your heart should slow down).

The Problems With the Premise

1. There’s a better way to raise a lower blood pressure.

Why Does Low Blood Pressure Matter?

A heart attack can cause very low blood pressure. When that happens, your body has [... continue reading]

Author: James Hubbard, M.D., M.P.H.
Posted: March 16, 2015, 10:54 am

by James Hubbard, MD, MPH

If you have a heart attack in the wilderness, it’s judgment-call time. In my last post, I talked about the fact that you’ll have to weigh walking for help with waiting for help that you don’t even know is coming. Walking could damage your heart further. Waiting could postpone care too long.

In this post, we’ll go into the details of how I’d make the decision. Of course, this is by no means individual advice, nor is it meant to cover every scenario. It’s just meant to give you an idea of some things to think about.

First: Are You Really Having a Heart Attack?

The first thing you might wonder is whether you’re actually having a heart attack rather than muscle pain, indigestion, tightness in the chest from wheezing, or another problem that can cause chest pain. The unfortunate answer is you cannot know. This is one of the most important things to remember. Without tests, even doctors can’t make a definite diagnosis.

You also can’t tell just from symptoms how severe a heart attack is. If you’re not having major pain, you could still be having a major attack. In [... continue reading]

Author: LAwordsmith
Posted: March 9, 2015, 10:00 am

by James Hubbard, MD, MPH

Many years ago, my wife and I were in Arizona to attend a conference. We had several hours to kill until the first meeting that night, so I decided we’d make a quick trip to the Grand Canyon. Then, I calculated we had three hours to kill before we had to leave and decided we should hike the trail down the Canyon, at least for a bit.

Well, I miscalculated the extra time and effort it would take to walk back up, so the hike became a speed walk. With about a mile to go, I heard my wife from behind me yell, “I think I’m having a heart attack.”

I replied, “You can’t be.”

“Why not?”

“No one can get to you. We’re on the edge of one of the steepest canyons in the world. And we’re behind schedule. You can’t have a heart attack until we get back to the top.”

Well, that wasn’t my finest moment as a doctor (or husband), and I reaped the consequences of my words for quite a while, but seriously, what if you find yourself on a hike, far from help, and begin to [... continue reading]

Author: James Hubbard, M.D., M.P.H.
Posted: March 2, 2015, 1:19 pm

by James Hubbard, MD, MPH

In 2002, a couple of years after he won the Olympic gold medal in wrestling, Rulon Gardner went snowmobiling in Wyoming. “I told myself it would be a short trip,” he told the Associated Press. “We were going to go out about three hours and get home for dinner.”

But he got lost and ended up stranded for 17 hours. The temperature reached as low as 25 below zero, according to the AP.

By the time Gardner was found and flown to a hospital, he had extreme hypothermia and severely frostbitten feet. But he ended up losing only one toe.

What Most People Don’t Learn About Cold-Weather Survival

As I explained in this post, one reason Gardner’s frostbite didn’t have a worse outcome is once his feet got frozen, they stayed that way. He didn’t warm them, only to have them freeze again.

That’s a tip most people don’t know. He may not have either; he just said he had to choose between keeping his hands or his feet warm. Gardner’s father said his son’s “knowledge of the cold” helped pull him through. But even in wilderness-survival [... continue reading]

Author: LAwordsmith
Posted: February 23, 2015, 11:00 am

by James Hubbard, MD, MPH

A reader emailed to remind me there’s been a spate of carbon monoxide poisonings and several carbon monoxide deaths to go along with the cold weather in the Northeast United States. To me, that sort of news is always so troubling because even though carbon monoxide is a stealthy killer, the deaths are so preventable. All you need is a working carbon monoxide monitor. (Working is key, so test it occasionally to make sure the audible alarm is good to go. Also ensure the battery is alive and well and you have a few extra batteries just in case.)

No matter how safe your home may seem you need this monitor. Any furnace may malfunction; any vent to the outside may get blocked. All you need is exposure to the fumes of something burning to potentially be in trouble. Whether they’re from automobile exhaust, a generator, or a heater, if you breathe in these odorless fumes, you’re at risk for carbon monoxide poisoning. The only heat that I know of that doesn’t contain carbon monoxide as a byproduct is electric.

For more information about carbon monoxide poisoning from heat sources, check out continue reading]

Author: James Hubbard, M.D., M.P.H.
Posted: February 17, 2015, 10:30 am

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