Wednesday, September 16, 2009

Pain Relief and the Prepper Medic, Part 2

Control of pain post-disaster can be problematic. Getting your personal physician to write you the prescriptions for effective pain meds can also be problematic. Many of the “good” painkillers are on the DEA schedules, so you and your physician can easily become targets of a DEA no-knock raid. Better to avoid the potential problem in the first place by stocking only non-scheduled drugs.

Non-drug pain management is best for our purposes. Consider learning hypnosis for pain control. I had good results using hypnosis as an EMT, etc. In any event, account for pain management in your medical kit and plan. Read the link below from the University of Basel re: pain management. Then integrate pain management into your prepper medical plan.

There are some useful prescription pain killers that are not on DEA lists and should be fairly easy to obtain. All have the potential for significant side effects so thorough study is required before using these drugs.

Toradol (ketorolac) is the strongest drug in the NSAID class and is available in pill,eye drops,and injectable forms. As eye drops, it can be used for a [very] few days for relief of pain from a corneal abrasion. It provides excellent relief of post-operative pain. It is also an anti coagulant so any bleeding must be under good control before giving Toradol. It can cause serious liver or kidney problems in relatively rare cases. Because of these “side properties”, Toradol cannot be used for more than 2 days of continuous dosing for injection or 5 days of oral dosing.

Tramadol is a pain killer which works well for moderate to moderately severe pain. Or in laypersons terms, it will do for pain relief for most of the common injuries the survivalist might deal with . It is available as both a pill and in an injectable form. It does not elicit as much nausea as other opiods such as morphine and unlike morphine, will not completely shut down the breathing reflex at high doses.

Another bright spot is that tramadol is rarely associated with addiction as it relieves pain without euphoria. But addiction can occur sometimes. If needed, it can also be used for your dogs or cats. On the downside, it does lower the seizure threshold so it is a poor choice if the patient has a history of seizures or is taking other drugs which lower the seizure threshold.

Nubain® (nalbuphine) is a very strong pain reliever that is only available in an injectable form. It is incompatible with ketorolac and is an “opiod effect reverser”. This means that giving Nubain to someone who is addicted to opiods will result in withdrawal symptoms. I was told by an Army medic, who had completed the US Army Field Anesthesia course, that Nubain is ineffective for bad war wounds.

There are a few prescription “para anesthesia” drugs which should be stocked. For reversal of overdoses of opiods, stock Narcan (naloxone). It has significant side effects, be aware, be proactive. Benadryl (diphenhydramine) is a useful antiemetic, antihistamine, and mild sedative. Prilosec or the like would be useful for victims of significant injury to help prevent stress ulcers.

Murphy's Law says that the group member who requires emergency surgical care will have a full stomach, risking aspiration of vomitus, a serious complication. Reglan (metoclopramide) is an anti nausea/vomiting drug and it accelerates stomach emptying. But do not rely solely on Reglan in the patient who ate or drank within a few hours pre-surgical- need.

Phenergan (promethazine) is a venerable anti emetic and sedative that also helps dry up secretions. It is available in both pill and injectable forms. If injecting it, dilute and give slowly and carefully as it can cause tissue damage and does cause pain on injection. When injecting phenergan, correct technique is critical as the drug can damage tissue if not injected properly.


Again, local anesthesia is the safest for the prepper medic. Here are some good online resources for learning more about local and regional anesthesia. As always, study hard, practice, talk these issues over with your personal physician or nurse practitioner.


http://www.anesthesia.wisc.edu/med3/localanes/localhandout.html
(from University of Wisconsin Dept. Of Anesthesiology. Quick overview of how local anesthetics work, basic technique and spinal blocks—do not attempt these)

http://www.nda.ox.ac.uk/wfsa/ (an international online journal of anesthesiology; a few articles on local anesthesia, many articles on the fundamentals of anesthesia for practitioners in developing countries. Good site for preppers)

http://www.palmer.net.au/talks/regional_anaesthesia_blocks/default.htm (Very good slides on various regional blocks. Site is for Internet Explorer only)

http://www.bordeninstitute.army.mil/published_volumes/anesthesia/anesthesia.html
(Anesthesia volume of the US Textbook of Military Medicine. Very good reference on anesthesia. Good chapter on local/regional anesthesia)

http://www.medana.unibas.ch/eng/internt/AC_PAIN.htm
(from University of Basel, Switzerland. This link is to a page re: pain management. There are many more useful pages here: http://www.medana.unibas.ch/eng/amnesix1/amnesix.htm)

http://www.operationalmedicine.org/Powerpoint/Lectures/Local-Regional_Anesthesia.htm (Excellent PowerPoint-based course on local anesthesia. Many more courses in operational medicine available from this site)

http://www.nysora.com/peripheral_nerve_blocks/index.1.html
(New York School of Regional Anesthesia. How to do regional blocks if you have local anesthetic agents in your kit. Thorough, with very good illustrations).

Anesthesia and pain control must be factored into planning a survival medical kit. I hope this article has helped point you in a useful direction. With the items described in this article, you can provide better, more comfortable medical care to your group members in a crisis environment. In a 96 hour crisis, you will have the ability to perform exigent minor surgery. In a TEOTWAWKI scenario, you will have a solid base for providing [very] basic anesthesia care to your group members.

Bibliography:

Introduction to Anesthesia; 9th Edition; Longnecker, edited by: David E. and Murphy, Frank L.; Saunders; 1997. Good coverage of the theory and practice of anesthesia from the ground up.

Special Forces Medical Handbook; Citadel Press; 1982. ISBN: 0806510455 A very good general reference. Good, simple chapter on anesthesia using ether as an inhaled agent, local /regional anesthesia and excellent charts showing signs of anesthesia depth).

3 comments:

Kymber said...

wow! what an informative post! thank you so much for sharing!

MT_serval said...

Thanks Kymber. Our group has been discussing this issue over the last few months as we see a need to prep beyond just Check/Call/Care.

I am glad you found the post helpful. Hope the Big One never hits in Canada.

matthiasj said...

Great post MT. Pain management would be very important during a disaster. Being extremely careful not to injury yourself would be top priority. Although if a injury happened, knowing how to treat and deal with it would then become top priority.

matthiasj
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