Thursday, September 10, 2009
Pain Relief and the Prepper Medic, Part 1
Providing relief for moderate to severe pain post-disaster can be a problem for the prepper group. Same for providing basic, light anesthesia for minor procedures such as wound debridement, wound closure, and bone setting.
Biting a stick or having the patient swig some whiskey may make for good cinema but it makes for bad medicine. The anesthetic dose of alcohol is near the fatal dose. The severe pain and stress associated with doing surgical procedures without pain relief or anesthesia can seriously compromise the patient's recovery.
This is the first installment of a two part article on very very basic “survival anesthesiology”. I'll cover some basic terminology and standard rules as well as the use of two herbs for pain relief. Part two will cover some good pain relievers that are not on the DEA's scheduled list, so easier to obtain legally. Part two will also cover local and regional anesthesia and list some useful references for learning more about this vital part of survivalist medicine.
I am writing from my experience as a former EMT, dental surgical assistant; my brief, additional anesthesia training; my experiences as a chronic pain patient for 16 years; and my research into anesthesia for austere environments. This does not constitute medical advice. These two articles are for informational purposes only. Discuss these subjects with your personal physician and get his or her advice in this area. I write this only to help the prepper to learn more about this important aspect of SHTF medical care.
The aim is not to enable the prepper to ape the highly trained anesthesiologists who are experienced physicians,with extensive post-graduate work. That could never happen without intensive, extensive study, a great deal of practice, coupled with an incredible amount of good luck. The end result of such madness would likely be a dead patient. But by using the information in these articles, coupled with some hard study and practice, the layman prepper medic could safely manage control of an injured person's pain and anxiety.
The focus here is on enabling the intelligent prepper to provide their wounded companion with some modern pain relief in an austere situation. Providing good pain relief to an injured companion helps with their recovery, through reducing the severe stress pain places on the body, and and enables the prepared, trained, practitioner to care for the patient's injuries in a systematic and thorough manner without having to additionally deal with a patients cries and throes of agony.
Always remember, whenever you anesthetize someone, there is always the risk of serious complications or death. It is a fine line between rendering a patient insensible to the procedure and killing them. Study hard, be alert, use common sense. And most of all, only use these techniques and materials when a real professional is not available within the needed time frame.
The aim here is to point you toward some useful choices for relieving pain in hurt companions and facilitating relatively “comfortable” minor surgery in an austere or post-Obammacare environment. This first article will deal with two useful herbs for your prepper medical kit that could serve you well in lieu of morphine or ketamine: morning glory and salvia.
Note that the first one is illegal to use for non-gardening purposes in the USA, so only use this one under true emergency conditions. The second herb is illegal in several jurisdictions in the USA as well as several countries. Research your local laws before stocking this herb in your medical kit. And most of all, use these for legitimate medical purposes, not for “kicks”. Because if you use these herbs irresponsibly,then you risk the One World Government, or other modern demon, banning access to these useful herbs for all of us.
Definitions and Principles
For our purposes, anesthesia is defined as a state in which the patient is unconscious of their surroundings and of sensations , has amnesia for the operation, muscles are relaxed, and the body's visceral reactions to the operation (e.g. increased pulse rate) is blunted.
There are three types of anesthesia: general, where the patient is completely insensible and every term of definition is present. The patient's airway, circulation, and general well being are completely in the hands of the anesthetist. Regional anesthesia involves the injection of local anesthetics around a nerve such that an entire region of the body is anesthetized. Examples are wrist blocks to allow repair of a mangled hand. And finally, local anesthesia where local anesthetics are infiltrated into the soft tissues around the area that needs operation. An example is anesthetizing a tooth so it can be filled.
In a survival situation, local anesthesia and where needed, regional anesthesia are the preferred techniques for the prepper. There are risks of possible infection, allergies, and serious cardiovascular effects if too much agent is injected or injected into a blood vessel. But, with study and some practice, a reasonably intelligent, deft prepper could safely do the job. The patient is still fully conscious so airway problems will be nearly non existent.
General anesthesia is to be avoided for the non-physician because of the risk of complications up to and including death. General anesthesia means the patient is no longer conscious. At the depth of anesthesia required to do involved surgery, the patient has no gag reflex and if you are not careful, no breathing reflex! As we all know, the patient can "vomit" while going under or during the operation resulting in the risk of getting vomitus into the lungs--a serious complication. For general anesthesia, the prepper medic must be able to secure the patient's airway and be able to recognize a developing crisis and respond effectively to it. A very tall order for the layperson!
As prepper medics, we will only be doing minor surgical procedures so general anesthesia is not going to be needed.
The best, safest, choice for the lay person is local anesthesia and where needed, regional anesthesia if the prepper medic has received thorough instruction and practice in the procedures.
It is important to remember that local anesthetic agents relieve pain first, then at higher dosages' the other sensations (temperature, pressure, proprioception, etc.) are temporarily shut off. But these higher doses tend to be very near the toxic threshold for the agent, so just use local anesthetics to eliminate the pain of the procedure. In practice, this means that when you use a local anesthetic, expect your fully conscious patient to still report feeling “pinching”, stretching, and any temperature differences.
This is where distraction, use of sedation or "disassociative agents" is useful. The two herbs described below provide relative analgesia and some amnesia for minor procedures, with the caveats listed for the herb.
For our purposes analgesia is defined as the state of being pain free while still being conscious. Analgesia is familiar, with a little common sense, analgesia can be achieved safely for your patient.
The standard of care for anesthesia calls for monitoring of the patient's body state during the procedure. For our purposes, you need to monitor their pulse, blood pressure, breathing [depth and rate], and where needed, the amount of oxygen their blood is carrying at a point in time.
The instruments needed are simple: a blood pressure cuff, your two eyes and one hand (to check pulse), and for oxygenation, a pulse oximeter. There are several combo devices on the market that can monitor blood pressure and pulse simultaneously and pulse oximeters monitor both the pulse and the oxygen saturation (of the arterial blood). Pulse oximeters can cost under $200 or as much as $800+ for very advanced models.
For all survival medical procedures, keep good records. For the “survival anesthesia worker” , you must note carefully how the patient's physical and mental condition fluctuated over the course of the procedure as well as what effects the agents administered had on said conditions over time. By keeping good records you also tend to be more focused
We've flotsam been, and the jetsam In highness being,
gonna get some On the water walking,
it's easy to be Centralised we to infinity
Dying Seas, Hawkwind
The two herbs described below are widely available in most jurisdictions and can be used for pain relief and the induction of light anesthesia in survival situations. Both provide a useful alternative to stocking morphine or ketamine, both DEA scheduled drugs, for relief of moderately severe pain and for [very] light anesthesia.
However, the DEA and NWO types want to ban people from using these herbs whose roots surely must be in Hell itself. Part of the reason is irresponsible [ab]users of this class of herbs, part is in getting political mileage out of sheer demagoguery. Neither herb, with the exceptions noted below, will harm the prepper who uses them for the stated purpose of pain control or light anesthesia. In many cultures around the world this class of herb is used frequently for various folk medicine purposes as well as use as sacraments. Common sense says that usage of these herbs does not mix with driving, handling guns or the like.
Long and the short: be responsible, don't encourage the DEA or manipulative politicians in curtailing access to this useful class of herbs for all of us. The effects from these two herbs can be very powerful; note the cautions given below, use them only for necessary medicinal or spiritual purposes, and take responsibility for using them—no blaming their being available for any stupid act you do which results in harm to another!
These herbs are psychedelics, some call them hallucinogens or even entheogens. They provide pain relief and [very] light anesthesia by two mechanisms: making all sensory input “equal” so that pain becomes no more important than the fact that the Earth orbits the sun, and these agents facilitate a disassociative state in which the patient's interpretation of pain or pressure signals can be radically altered by simple measures such as playing music, reading of Bible verses or the like.
Extensive research in the 1950s and 1960s, and today, on LSD; for example, found that the drug provided better pain relief than morphine or demerol, with few, if any, side effects. The few formal studies done on salvia, the second agent below, have found that it also offered strong, short-acting pain relief, tends to calm the patient to a degree where continuing pain perception and anxiety are reduced for a relatively long period, and has the potential to be used as a general anesthetic.
In using these herbs, one must pay special attention to two vital factors; set and setting. Set refers to the state and focus of the patient's mind; a relaxed patient who is focused on positive thoughts will be unlikely to experience an anxiety attack whether given one of these herbs, ketamine, or morphine. Setting refers to how pleasant, or at least non-chaotic the treatment or convalescence area is. Operating in a quiet, clean room will help allay patient anxiety and thus reduce the need for additional meds during the procedure. If available, readings from religious texts or use of music will help control your patient's anxiety and pain levels.
Good setting, coupled with a show of calm competence from you, should help ensure a good psychological outcome for your patient. When using either of these two herbs, good set and setting are vital because of the mechanism of action of their active agents; as psychedelics. When using either of these agents, you need to assign one person to do nothing but serve as a "companion" for the patient, providing distraction as needed, monitoring their psychological condition, and serving as a "reality anchor" (point of stability for the patient's altered perceptions). If possible, this person should not be the same person who is assigned to monitoring the patient's vital signs.
This means that if you do not maintain a good environment and support calmness and positive introspection in your patient the dreaded "bad trip" (marked increase in anxiety, coupled with a shift of perceptions toward the horrific and negative)can occur. If this does occur, you must capture the patient's attention through mirroring calmness and serenity for them, keeping them from physical harm, redirecting them gently with music/religious text/beautiful objects (e.g. flowers, actual or in pictures). And most importantly, reminding the patient that they have taken a medication which has altered their perceptions and that the effects will pass as the drug effects pass. In extreme cases, confer with a psychological professional as soon as you can while keeping the patient physically and emotionally safe.
The first herb might be as available as your garden; morning glories, preferably Heavenly Blue or Flying Saucers. Yes, these are the real names. But the truth is that the active agent in the seeds, lysergic acid amide, is a strong analgesic that can provide six or more hours of pain relief with a single dose of roughly 200+ seeds that are chewed thoroughly and swallowed. Pain relief is less than that which can be achieved with LSD but is still an effective, strong analgesic.
Effects begin in about 1 hour after ingestion. Pain relief is variable, but generally this herb can relieve pain of level 6,or higher with larger doses, out of 10.The active agent, LSA, also has potential for use for cluster headaches.
The downside is that tolerance, of about three days duration, develops quickly. So that a second dose given for pain control 10 hours after the initial dose must be roughly twice as large and so on. The total effects last for upwards of 12 hours.
The seeds must not be treated or must be washed free of the arsenical which is commonly used on the seeds to prevent psychonauts or survivalists from utilizing them for non-gardening purposes.
The taste is vile and tends to induce moderate nausea and vomiting, treatable with mild anti emetics such as Benadryl, so the patient will probably never want to repeat the psychedelic trip. So be aware of the patient's state at all times; protect that airway if vomiting occurs. Satan is unlikely to make a new convert of the patient who is given these seeds to facilitate a wound repair.
Cautions. The seeds contain several ergot alkaloids and the active agent, LSA, causes uterine contractions so this agent is contraindicated in the pregnant patient! Do not use if the patient is taking MAO inhibitors such as Nardil or Parnate as dangerous cardiovascular effects can occur.
Use in patients who are in significant psychological distress or in patients with a family or personal history of schizophrenia is unwise as LSA or salvinorin-A (described below) can exacerbate psychological difficulties or activate latent schizophrenia. Or, with expert use, say by a psychologist, these agents may help the wounded person's psychological state.
This agent will permit wound debridement or closure as long as the patient's attention is captured by music, art, or a deep discussion about whatever interests them at that millisecond. It would provide good relief of pain for bone setting but careful monitoring of the patient's blood pressure and heart rate would be required because this agent is a poor anesthetic and provides no amelioration of the patient's body's response to the surgery. Used in conjunction with one of the strong pain killers described in part 2 of this article, such as tramadol, this herb could be used for minor surgical procedures.
Salvia divinorum, a member of the sage family,is an herb which provides good pain relief and can significantly ease the pain and discomfort associated with minor surgical procedures. It provides profound pain relief for about 5-10 minutes, then good pain relief for about 1.5-2 hours more. Salvia frequently produces a calmness and “afterglow” for up to a few days post-usage that will help greatly in reducing post-op pain and anxiety. No study to date has shown any direct harmful physical side effects from usage of this herb or its active agent. But be aware that this agent has only been seriously studied since the 1990s so it is to be considered “experimental”.
It also produces a slowed reaction time and coordination side effects so the patient should not operate the retreat's truck for several hours after salvia dosage. Since it acts on the kappa-opioid receptor in the brain, rather than the mu-receptor affected by morphine and the like, salvinorin A is highly unlikely to turn the patient into a raving, addicted, member of the Army of Darkness. Euphoria is very uncommon with salvia use, indeed people do not tend to ever take it for “kicks”. It also has potential for treatment of addiction as the kappa-opiod receptor is key in addictive behavior.
Overdose will not kill , but it will result in a dangerous agitation of the patient though of short, under 30 minutes, duration. With higher doses, salvinorin A induces a dramatic urge to get up and move that could easily result in your patient sustaining secondary injuries as well as knocking you flat as a cartoon character. Salvia is usable for our purposes only if the operator pays very close attention to dosage, using only enough to enable the surgical procedure, but not so much that the operation suddenly becomes catch-the-delirious-staggering-patient!
My personal experience with salvia has been with use for relief of chronic and acute pain. It has reliably relieved pain of level 7 (roughly the pain from a leg being shattered in a bike wreck) completely for 1.5 hours, and kept said pain at endurable levels for three hours or more from a single salvia dose. Tolerance does not develop so analgesic doses of salvia can be given consecutively.
A salvia researcher, Daniel Siebert, has published a guide to salvia which includes his model of “planes of the salvia experience”. As “survivalist anesthesiologists”, we will be getting our patients to Siebert's “plane” 4 (vivid visionary state-with eyes closed, outside world is “gone”) to 6 (amnesiac state, also high movement potential!).
Salvia can be purchased as a live plant which grows very well in the Northwest USA as an indoor plant. It can be grown elsewhere if due care is taken to protect from frost and to provide enough humidity, etc.
It is also available as dried leaves. Dried leaves are only marginally usable for our purposes though. It is also available as a crude 5x or 10x concentrate, or as a standardized extract. The standardized form is obviously the best choice for our purposes.
It can be administered by mouth, by chewing 15-20 fresh leaves and holding the chewed leaves in the cheek for 15 minutes. The effects then last about 45 minutes. Ingesting the leaves or concentrate is useless as the agent is inactivated by stomach acid. Obviously, using the agent by mouth increases the risk of nausea/vomiting so be aware and monitor the patient's airway carefully.
Or it can be smoked, vaporized actually. Effects occur in under 30 seconds. Vaporization allows the best titration to effect. It also is associated with a high “failure rate” as it is very technique sensitive. When vaporizing salvia concentrate, it is vital that the concentrate be heated as much as possible (with direct flame), the smoke drawn deeply into the lungs, and held there as long as possible. Throat and lung irritation can happen when using the vaporization method . I have asthma; salvia vapor does not induce bronchospasm for me, but “your mileage may vary”.
The active agent, salvinorin A is extremely potent, being effective at 200-500mcg for an inhaled/vaporized dose. Its effects begin in under 30 seconds which makes titrating an analgesic dose fairly easy. It provides good analgesia, being about as potent as morphine, though it only provides, at best, two hours of strong pain relief. After inhalation, drug effects begin to fade within 3-5 minutes of dosing.
At higher doses of 500-1,000mcg, it provides relative disassociative anesthesia for about 5 to 7 minutes. However, at these doses the drug causes severe “motor hyperactivity”. Think a PCP zombie who also drank three double espressos! Heed the cautions that Siebert gives at the previous link Titrating the dose to true disassociative effect ,Siebert's “plane” 6, without the patient lashing about and injuring herself can be tricky.
If used for just relieving the pain of simple wound debridement, having the patient “smoke” small amounts of concentrate until they report no sensation when the intact skin is pricked with a sterile needle . If possible, capture the patient's attention while the wound is cared for. Patient will probably still be somewhat aware of pressure and stretch sensation, thus the need to capture their attention elsewhere.Then, work quickly and efficiently. If patient begins to feel pain, use more salvia.
If a bone must be set or extensive wound debridement is required, then a higher dose of salvia must be used, preferably along with a “conventional pain med” and maybe (with all due precautions and pre-research) an inhaled agent such as trilene (warning: can be toxic to liver in prolonged use) or methoxyflurane (warning: can cause kidney damage). This will mean a brief excursion back to pre-19th Century surgical practice; the use of sturdy assistants to hold the patient in place. The purpose here is to keep the patient from moving about and injuring themselves or facilitating a horrible surgical disaster.
As you can see from the number of links in this article and from the detailed knowledge needed to safely use these agents, careful study is necessary before the balloon goes up so that you can make a positive difference with your wounded companion or family member. Basic anesthesia care can be provided by the well informed, meticulous prepper medic when the nearest physician or anesthesiologist is under 50 tons of rubble. Just act only within the scope of your knowledge and only in case of true need.
Please consider the subject of pain control in a austere environment in your medical prepping plan. Read about the two herbs discussed here, consider stocking them in lieu of or as supplements to prescription pain killers. In Part 2, I will cover some useful analgesics that should be relatively easy to obtain from your doctor, the [very] basics involved with local anesthesia.