Episode 135 S4-11
Post Collapse Abdominal Injuries
Battle for the South Ch 11
Dr. Joe Alton a.k.a. Dr. Bones
Abdominal injuries are on of the most complex issues in a post collapse situation. There are many organs that can be affected by this type of injury. The most important thing to know is how the injury was sustained.
Currently about 75% of abdominal injuries are blunt trauma that occur from car crashes. Many penetration injuries also occur from knives and bullets. There are both soft and solid organs that can sustain damage. The solid organs like the kidney, liver and spleen are more likely to bleed if injured. The hollow or soft organs like the intestines and stomach will spill their contents into the abdomen if ruptured.
If you sustain an abdominal injury is is a long, painful way to die. If you are bleeding you will die faster and this may be for the better. If something ruptures a doctor needs to go into the abdomen and close up the organ. If not you will swell up like a balloon and suffer a horrific fate. These days our technology allows us to conquer many abdominal problems but in a post collapse society this may not be possible. Abdominal injuries must be constantly watched. They usually don't show up right away. Once they progress the abdomen will become bloated and rigid.
A good way to tell if there is blunt force trauma to the abdomen following an injury like a car crash is to check if there are visible marks on the abdomen. If there are it is likely that some blunt trauma has occurred. This is even more true with children. They have not developed the abdominal muscle structure that adults have. Also if a child has blunt force trauma and has not been in a car wreck or bicycle accident, suspect that abuse may be occurring. Many abusers target the abdomen because it is harder to see damage there.
In a post collapse society we can expect the same survival rates for abdominal injuries that they had in Civil War times. Back then there was a 60-70% chance that you would die due to an abdominal injury. Even if you enter the abdomen to fix the problem you may cause more because of the lack of a sterile environment. There will probably be digestive byproducts floating around inside there that can cause additional infection. However if the patient is bleeding out internally, you have to intervene or they will most likely die.
One way to identify internal bleeding is called peritoneal aspiration or lavage. During this process, you will need a IV catheter, tubing, and a syringe. You puncture the abdomen with the needle and suck out the fluid. If it is bright red you have an active internal bleed. The abdominal lining or paritaneum contains lots of blood and bleeds a lot when it is ruptured. The blood pooling inside the abdomen will put pressure on the other organs and you will go into shock.
All women should be given a pregnancy test first if she has abdominal pain.
If someone has an abdominal injury in a post collapse situation, do a full exam first. Perform and inspection. Expose the patient from the nipples to the pelvis and look at the belly. Does it have discoloration? Is it distended? Then perform an auscultation. Listen with the stethoscope to the patient's belly. Can you hear noise? You should. If you don't the bowel has stopped movement and that is not good. Next perform a percussion exam. Put one hand gently on the patient's belly and tap on your knuckle with your other hand. Did it cause pain? If it did, that is not good. Finally palpate the belly. Put your hands on their belly and feel around in all four quadrants of the abdomen.
In the upper right hand quadrant of the abdomen you will find the gall bladder and liver. In the upper left is the spleen. The appendix is in the lower right and pain in the lower left could be caused by an ovarian cyst or the large intestine.
Perform an initial exam and record your findings. Keep checking back on the patient. Only 65% of the time are abdominal issues identified on the first exam. If blood is accumulating the issue will become more noticeable over time. Ask about their medical history and recent accidents.
Do these inspections over an extended time period and take notes of your findings. Typically only 65% of abdominal issues are identified on a first visit. If blood is accumulating it will be more noticeable over time, along with most other problems.
To identify appendicitis, pain usually starts at the belly button. Then it moves down to the right upper quadrant. Finally it reaches what is called McBerney's Point. This is exactly 1/3 of the way from the pubic bone to the belly button. There will be "rebound tenderness." When you press on the belly the pain is worse when you release.
If there is ballistic trauma to the abdomen, check all around the body for additional wounds. The bullet can bounce around and come out in unexpected places. The shock wave from the bullet is another concern. It can cause bleeding from organs even if they weren't actually impacted directly by the bullet. Additionally, bullet expansion and fragments can cause problems. If bone was contacted, these shards can travel through the abdomen piercing organs as they travel.
There are four regions of the belly. The part below the rib-cage and lower ribs contains the diaphragm, most of the liver, stomach and spleen. The pelvic abdomen contains the female organs, small intestines, rectum, and bladder. If there is bleeding during urination the bladder may have been impacted. If the bladder was pierced, urine may get into the abdomen. There is a chance that you can survive this injury. Sometimes the gut will put pressure on the wound and scarring will form on the bladder. The body will form a walled off area that contains the offensive material. The true abdomen is the parts that float freely in the peritoneum (stomach and intestines). The area behind the peritoneum and the ribs contains the aorta, vena cava, and kidneys. If you are going to be the medic you have to learn your anatomy!
There are many issues that modern medicine can take care of that doctors will not be able to do anything about in a post collapse situation. There are going to be discomforts that people will have to learn to live with. There are some hard realities when it comes to survival that will absolutely break doctors' hearts because with the proper tools they could have fixed them.
Even if there is a chance to go into the abdomen and properly handle the problem the risk of infection is going to be huge. Think about stocking fish antibiotics and lots and lots of medical supplies. The most survivable abdominal injury may be something out of Hollywood. If you get a puncture wound to your "love handle" area, that does not impact the abdominal lining or organs you will be okay. Otherwise it is very hard to escape life threatening injuries when it comes to an abdominal injury.
If there is blunt trauma to the abdomen look for "Cullen's Sign" or bruising around the belly button. Also look for "Grey Turner's Sign" or bruising in the flank. If you see these things there are some major issues going on inside the patient's body. There is not much you can do besides observe the patient. You can try to apply pressure but it usually doesn't help much. You can intervene surgically if you are willing to take the risk. Make the decision using the peritoneal aspiration test. You could use suction to remove blood but there will be a lot. If you have power, you can use a suction machine. If the blood is bright red, there is an active bleed. Blackish red blood means the bleeding has stopped and you are removing old blood. In a best cast scenario you would only see clear fluid. This would indicate no bleeding has occurred.
If someone has appendicitis you have to make the decision to remove the organ or not. Catching it early is your best bet. Unless the abdomen is very rigid you can try treating it with antibiotics: doxycycline, metronidazole, Fish Zole, or bird biotic. The appendix may cool on its own. If the appendix has ruptured, they might survive but you need to learn to do an appendectomy.
With all injuries, don't wait until things get really bad! The early you catch things the better. Be on the lookout for people having pain and follow up with them.
There are some things you can stock to prepare for your group's medical needs. If you can get IV fluids you should. Ringers lactate is what you want. However, usually you can only get it with a prescription, it is heave to carry, you need to stock a ton of it. They are usually available by the liter and one liter is not going to even going to begin to help someone who is in full blown hemorrhagic shock. If you have someone who is hit in a major artery they only have three to five minutes until they die. That's just reality.
You should have a surgeon's kit as well as an isolation room to deal with infectious disease. You need a lot of medical supplies and you need a ton of medical supplies if you are going to be caring for a community. You should have supplies on hand for orthopedic issues. There should also be a designated procedure area with an instrument tray that is only used for medical utensils. You want the area to be clean. Sterile is best but the reality is that is not going to happen. Do your best to decrease the bacteria in the area. For your medical tools, you can sanitize them in a pressure cooker. Wrap them in newspaper and put them in the pressure cooker with 250 psi for 30 minutes. Use bleach for cleaning. One part bleach to nine parts water. Make sure there are only hard surfaces not covered with any type of fabric. Liquid bleach will last a year to eighteen months in storage so it is not the best choice to stock. Get pool shock or calcium hypochlorite. They will sterilize water and make bleach. What ever product you decide to buy the percentage of hypochlorite should be more than 65%.
Medics are going to face hard situations. Things that seem simple now are going to be very difficult to handle.
Want to learn from Dr. Bones and Nurse Amy? They may be coming to a town near you. Check out their schedule of available classes at: www.doomandbloom.net/medical-classes/
Cullins Sign and Grey Turner's Sign
Featured Quote From Today's Chapter:
"In the middle of the crowd but completely alone."
Featured Survival Product:
50 Person Multiperson Trauma Medical Unit
Multiperson Trauma Medical Units for; Fifty (50) Includes: 6- Instant Ice Pack 6 x 9 Bag, 1- Cervical Collar, 1- Splint Kit (1-18 &24 + Gauze & Pins), 10- Multi Trauma Dressing 12 x 30, 5- Triangle Bandage 38 x 52, 15- Bloodstopper, 1- Eye Wash (4 ounces), 1- Packed in a Duffel Bag (Trauma Medical Unit), 1- Burn Care Kit (15 Pieces), 1- Penlight, 2- Bandage Shears, 100- 1 x 3 Plastic Bandages, 5- Adhesive Tape 1 x 10 yards, 10- Solar Blanket 6' x 4', 2- Paramedic Blanket 54 x 80, 4- Ace Bandages 3 x 5 yards, 100- 1/4" x 3 Plastic, Bandages, 1- 2 x 2 Sterile Gauze Pads (100 Count), 1- 2" Non-Sterile Kling Gauze Rolls (12Pack), 1- Hydrogen Peroxide (4 ounces), 1- Nitrile Gloves-Medium (100 Count)