Medical Week: My philosophy on preparedness, and an MD perspective on wound closures

When I reflect on what drives me to prep, I realize that this motivation was born long before I actually started prepping. In fact, it was something that was forged through my life experiences beginning as early as childhood. My parents divorced when I was young, and with that I spent the good portion of my life experiencing what it is like to be financially limited. Although difficult, I never felt like my situation was hopeless or that I was powerless to change my surroundings. This was in part due to my mother acting as an example of strength and determination that kept hope and optimism alive. It was not just her encouragement but also her sacrifices to do things like send me to private school even though we were living six people in a two bedroom apartment in the ghetto of Los Angeles.  Now, as a young resident family medicine physician with a wife and three very young sons, this motivation to prepare for the worst is even stronger. The burden of caring for my family is something that I carry with me every day; and the knowledge that when things go bad, I will need to protect and care for them, drives me to learn more about preparedness and defense every single day. This is the preface for my current outlook on life, and what I would like to share with you.

 

The most important lesson that I have ever learned is that whatever your goal is, there is always a way, but that way may be of great resistance, and the resistance is simply your own subjective perception of inconvenience. Granted, there are very concrete obstacles to any goal in life, but those obstacles can still be surmounted with determination – essentially the basic mechanism through which we accomplish all things in life.

 

Unfortunately, our society has become sorely deficient in the core values that distinguish us as Americans. The political machine that is our government has, over time, fashioned a dependent populous that has become so dysfunctional and de-conditioned that we now have an entitlement pandemic with no cure in sight. The democratic system was designed to be a fair and balanced way to elect public servants. Presently, that system has been maligned by politicians seeking power which can only be granted by the masses, so social infrastructure has been put in place to divide the American people into those who have, and those who have-not. This addresses the key component to why I worry about our future as a functional society if we were to ever have a lapse in rule-of-law.

 

I’m no Nostrodamus, but as I see what is going on currently in our world, the most likely “doomsday” scenario plays out something like this: Since oil is the Achilles heel of our economy, when – not if, we become engaged in another major Middle East conflict (most likely with Iran), we will be wishing for $5.00 per gallon gas prices. Subsequently, a shockwave of inflation will affect every single person in America. When this happens, those without financial reserve will become even more strained. Unknown is whether this is a relatively slow or abrupt event. When we cross that threshold into societal breakdown, the current way of life we now enjoy will be gone. No more push button world that we currently enjoy, and the only person you can rely on is yourself, and the only certainties are those preps that we have done, despite mocking or questioning from people around us. It will be a time when you now have to worry about keeping yourself safe from those who will want to take advantage of a scenario like this.

 

Now insert a spouse and kids into this picture. It is not something we want to imagine having our family exposed to, but is essentially the main motivation for why I prep. Single, I’d still prep, but my family gives me even greater passion, and even more than that, responsibility,  to prep, and to broaden my mindset to prep in anticipation of helping others with the skill sets that I have been blessed with having and learning.  Some would ask, in a survival scenario, why utilize your preps or aid those who have failed to prepare? Well, the short answer is that as preppers we need to be the beacons of recovery. I know I would not want to be perpetually stuck in a state of survival and high stress existence, and restoration of order can only be achieved as a community. Therefore, to aid others is to thyself, and it is an investment in the future if our world were to change for the worse. Saving myself and my family isn’t enough; I have a commitment as both a human and a doctor to heal and help. Preparedness is essential to being ready to fulfill that commitment when things go bad. Preparedness isn’t a hobby for me. It isn’t a sport. It’s a necessary piece of life; something that is as essential for the future as breathing. Because my family won’t be breathing long if I’m not prepared to care for them in every possible way. I work in my career field learning to be a better doctor and helping care for people. I work to earn the money to care for my children in the Today, but I also work on the means of preparing to care for my children in the Tomorrow that I fear is coming. If I am coming into the “game” – so to speak – a bit late, I am coming into it with passion, determination, and the will to succeed. Every day, I work on learning, collecting, securing the tools and information I will need for the future, whether it’s a spare suture kit, antibiotics, UHTP milk for the kids, baby wipes, or wilderness medicine techniques. Every day, I am bettering myself as a productive human, and I am preparing to care for my family and my community in every way that I can. So, why do I prep? I prep because it’s my duty to my family, to my community, and to my country. It’s our job and prerogative to care for ourselves. After all – no one – cares more about the survival of ourselves and our families than we do. Preparedness can only help, not hurt, so there’s no reason not to and every reason why I should.  I’m glad to be a part of the prepper community knowing there are others out there with the same mentality and mindset. Although my experience is limited, I do have some information to share with the community that I hope is helpful in regards to simple wound closure since in a SHTF scenario, injuries will become more frequent due to the increased demand on ourselves for physical labor, maintenance, and altercations we may be involved in. The following is intended to give you a brief summary of the approach I take when considering wound closure in the emergency department or clinic, and also to stimulate your own learning on how to improve your own techniques and skills to have during a SHTF scenario. Any comments or suggestions for improvement are always welcome.

 

SIMPLE WOUND CLOSURE 101:

 

***DISCLAIMER: Whenever you require medical attention, unless you are a trained medical professional, I would seek out medical help. This information is intended for application during a less ideal situation where medical attention may not be readily available and you need to treat yourself or your loved ones in an emergency.

There are essentially two ways to heal a wound:

1)      Primary intent: bringing the wound edges together via bandage, suture, or glue.

2)      Secondary intent: allowing the wound to heal “as is” when primary intent is not indicated (such as a very contaminated, dirty wound with multiple deep entry points).

It’s important to close a wound by primary intent for several reasons:

1)      Hemostasis (stopping bleeding): because if you lacerated a vessel with your injury, you will need to ligate it somehow. Granted, if you lacerate a major artery, you will just need to apply pressure because ligating it may compromise blood flow to whatever body area it feeds.

2)      Infection prevention: since our skin provides a barrier to bacteria, this is pretty obvious why closing a wound is important to restoring that barrier. There are, however, exceptions to this rule when the wound is fairly contaminated, and by closing the wound you may actually trap bacteria under the skin and cause a deeper infection. I will explain how to minimize this chance.

3)      Cosmesis:  if you have a deep laceration in an area where “looking good” or “not looking like Frankenstein” is important, then repair is indicated.

REPAIR MATERIALS: *Any suture kit will include a needle driver, forceps, and scissors.

1)      Tape / Bandage closure: butterfly and steri-strips are excellent ways to close a wound for the simple reason that they require no anesthetic to employ. Their downfall is that they cannot always establish good hemostasis with deeper wounds.

2)      Dermabond: a synthetic bio-glue that differs from krazy glue in that it won’t cause tissue damage on contact. Also an excellent choice since it can be used without anesthetics, and can close deeper wounds than bandages alone since you can place it inside the crevices of wounds to get a deeper closure. Again, like bandages, you cannot guarantee hemostasis with this method. Never put a bandage over it, and be careful around the eyes since you can glue an eye shut. This material will dissolve within about 48-72h depending on moisture exposure.

3)      Staples: great for quick closure of the skin. Not for use in deeper layers since you never want to have any non-absorbable materials permanently under the skin when you do a wound closure.

4)      Sutures: there are different types depending on 2 major parameters:

1. Type: Non-absorbable vs. absorbable – important because surface skin closures for skin repair will be non-absorbable and hence will need to eventually be removed. Absorbable sutures are used for deeper layer closures if you require closure of a deeper layer (if you have a deep wound, you always want to try and repair each layer that was injured such as muscle, fascia, subcutaneous fat, and then skin).
2. Thickness: 0-7.0, 0 being the thickest, 7.0 being very fine (for vascular repairs). Depending on the area of the body you are repairing, you will use different thicknesses like thicker to provide mechanical support over a high stress area like a joint or thinner to reduce scar formation and get finer approximation of the skin edges. For example, on the face you would use a fine thickness like 5.0 or 6.0.

REPAIR TYPE AND LOCATION:

SCALP: Staples or 3.0 non-absorbable suture

FACE: 5.0 (or 6.0 for children’s faces or eyelid), LIP/MOUTH/TONGUE: 4.0 absorbable suture

BODY: 4.0 for most areas

OVER JOINTS (KNEE/ELBOW): 3.0

HANDS: 4.0 – *Make sure in any type of hand laceration repair you stay very SUPERFICIAL to avoid tendon/nerve/vessel damage since there is not much subcutaneous tissue to protect those underlying structures.

REPAIR TECHNIQUE: Simple interrupted suturing technique will never fail you for any skin closure, and is the easiest/most reliable to learn. When I started learning I learned on hot dogs, chicken breasts, any type of meat really. There are lots of You-tube videos out there describing this technique as well as how to tie the knots with instruments.

Since a lot of people will be storing antibiotics as a component of their medical supply kit, it’s important to remember that unless you develop a skin infection (cellulitis – which is red, tender, warm skin after a skin wound), you do not need to routinely give antibiotics after a wound since copious irrigation with simple tap water is sufficient to ensure clean healing. We routinely put bacitracin over the wound once we close it, and that is OK because it is something that can easily be obtained unlike antibiotics. Neosporin is something more common but contains neomycin (antifungal), which some people can get allergic reactions to which is why we use bacitracin in the emergency department and clinic.

I will work on an antibiotic usage guide and my recommendations for the top antibiotics I would store up for an impending collapse of society in order to be prepared to treat simple bacterial infections that, in a SHTF scenario, would be life threatening untreated – stay tuned!

-Doc Morgan

 

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