Fires & blackouts

Fires & blackouts

October 3: Thursday

Fires are cropping up all throughout California. On top of that, the power companies are having scheduled blackouts throughout California this week, thanks to the Santa Ana winds and associated fire risks. Fortunately none of them are supposed to affect my neighborhood.

Power outages are the most common disaster in America. Aside from the obvious annoyance of not being able to see well, losing electricity could result in dangerous or even life-threatening situations. Issues during power outages include: not being able to cook food, heat exposure, cold exposure, lack of water pressure (= no running water in your home), loss of medications that need to be kept cool, and lack of communication (once the cell phones and laptops lose their charge).

A few days after we moved to San Diego, we had a several-hour power outage. We used one of lighters to light the gas stove, heated up water to make camping food for dinner, and then played dominoes by the bright light of our LED lanterns. During that time, we never opened the fridge or freezer, to help them retain their chill as long as possible. As far as power outages go, it was uneventful and barely disturbed our regular nightly routine. And that’s the goal: to make a commonplace disaster no more than a mild disturbance in your life.

We keep a blackout box in the house, filled with flashlights and other useful items. The list is in the “Blackout box” recipe below.

October 6: Sunday

A patient accidentally cut themselves so they came to the ED for stitches because the bleeding wouldn’t stop. At first glance, this was a common complaint and everyday injury that I see in the ED. I’ve put in thousands of sutures over the past 10 years. However, for some reason, when the patient couldn’t get the bleeding to stop, they stuck their injured extremity into coffee grinds. Yes, coffee grinds: the wet dredges of tiny little particles that stick to everything and make a mess. While yes, I have heard of people using coffee grinds to stop bleeding, this is a TERRIBLE idea! DON’T DO THIS!! We need to put a stop to this behavior RIGHT NOW. While I can’t argue against the fact that the caffeine likely did cause some vasoconstriction that aided with bleeding cessation, now I’ve got a grossly contaminated wound to deal with. The bleeding would have stopped anyway. Poor patient. The wound could have been cleaned and closed easy enough, but instead, I had to dig out the miniscule particles, power-wash the wound clean, and give the patient antibiotics to help prevent infection. I used plenty of numbing medication and carefully removed every last grain of coffee, but it took much longer than a typical wound cleansing and closure due to the contamination.

If you’re bleeding, just hold pressure. Better yet, take a Stop the Bleed course! Learning proper wound care is a great skill to have, for the safety of you and your family.

While we’re at it, if you or a loved one gets seriously burned (like a blistering fire/hot surface/hot liquid/scald/electrical/gas/etc. burn), just rinse with cool water and come to the ED. We’ll take care of the rest. DO NOT put any of the following on the burn (I’ve seen all these): butter, aloe, moisturizing lotion, cream, honey*, ice, tea, iced tea, iodine, bacitracin, alcohol, or any other cream, gel, or food substance. It will hurt, and odds are it won’t help. Don’t pop the blisters, either. If you’d like, apply a cool, clean compress and take some pain medication. Nothing else. Again, taking a first aid course would be greatly beneficial.

*Honey is a wonder food with incredible medicinal properties and associated health and wellness benefits, and we’ll talk more about it in the future.

October 9: Wednesday

I’m at an undisclosed location, at one of the many disaster committee meetings I attend. The meeting space is the location that would be used in the event of a real disaster in San Diego. Everything you’d want for a disaster command center is here: a large open space filled with various tables and computers everywhere, large TVs, a giant white board, smaller cubicles and side meeting rooms off to the sides and back, a megaphone, a coffee maker, hand sanitizer, markers, large maps of the local and surrounding areas, a speaker podium, a fridge, microwave, a stash of bottled water, and, of course, the requisite American flag and California state flag,. And that’s just what I can see. There’s even a red phone in the corner, with a direct line of communication to who knows where. Truly a preppers dream command center.

***

The fires are worsening and there are now evacuations taking place throughout California. I’m lucky that my house isn’t included, but my husband and I reviewed our 72-hour bags and our evacuation plan, just in case. One area that is within the mandatory evacuation zone is my aunt and cousin’s former home in LA. It’s a beautiful brick home in the San Fernando Valley, where I spent every summer of my life swimming and hanging out, instead of going to summer camp like most children in Long Island. Although San Diego is (so far) fairing well, it’s disturbing to see one of my childhood homes under evacuation due to an encroaching fire. 


Recipe: Blackout box

A few of my many, many flashlights, lanterns, and headlamps

  • Flashlights

  • LED lanterns

  • Headlamp

  • Batteries

  • Candles

  • Matches/lighter to light the stove

  • BBQ with gas

  • Fans

  • Blanket

Additional items:

  • Food

  • Water

  • Medication

  • Generator

  • Security

Flashlights, LED lanterns, and headlamps help with the most obvious issue of limited sight in the dark. Older individuals are at greater risks for falls when in the dark, so having strong lighting may prevent traumatic injuries. Many of our lights are solar-powered so that we don’t have to worry about batteries running out, though we have a pretty large stash of batteries as well.

I’ve got two large, clumsy dogs. They’re great as watch dogs, but the idea of having candles and open flames all around the house during a power outage seems dangerous idea to me. Instead, we use the lighting mentioned above, and save the candles for romantic dinners. We do, however, keep matches and lighters. We have a gas stove so even if the power is out, we can still use the stovetop. If you don’t have a gas stove, you can cook on your BBQ outside, a camping stove (we’ve got a Jetboil and BioLite), or backyard fire pit. Make sure to have a gas on hand for your grills.

Our blackout box is stored in our linen closet, where we also happen to keep extra blankets. Extra cold and hypothermia is definitely a risk, especially if you live a cold climate. On the flip side, we have battery-powered fans to help combat the heat in case the air conditioning goes out. Heat and cold exposure each have their own risks and warning signs, and in extreme situations, they can be deadly. During the massive heat wave in Europe in 2003, approximately 35,000 people died from heat exposure and heat-related illnesses!

Additional items:

Food & water: We keep our water and camping food with our camping gear, near our 72-hour bags, so the food and water is not actually in the blackout box.

We also have a 100-gallon water storage tank that fits into our bathtub. In the event of a long-term blackout, water pumps may eventually fail. If you suspect that the power may be out for a prolonged period of time, consider filling your pots and pans (or your 100-gallon waterBOB) with fresh water. Keep in mind, each person and pet will need about a gallon of fresh water per day for drinking, washing, and cooking.

Generator: while we don’t have one, we’d love to get one someday. Having a generator would be a luxury if the power went down. We wouldn’t have to prevent spoilage of the foods in the fridge and freezer, and the air conditioner and heater would keep running. Warning: a generator would also potentially attract unwanted visitors.

The other reason to consider a generator is if you take medication that needs to be stored in a fridge. There are certain life-saving medications that must remain refrigerated, such as insulin for diabetic patients. We are fortunate in that our lives do not currently rely on any medications but if you have a medication that must be refrigerated, I’d strongly recommend investing in a generator. It could save you life.

Security. People feel strongly about protecting their homes and their stuff. For us, we’ve got a pair of sweet and loving Rottweilers that look and sound menacing and vicious. They run on kibbles, water, and belly rubs, and are constantly on alert.


Hiking in Palo Duro Canyon State Park, Texas

Recipe: First Aid for heat-related illnesses

Some areas in the US are undergoing a heat wave, like us, while other areas of the country are already feeling the sting of winter. Here’s some info on heat-related illnesses.

As always, the information is for general information and education only, and is not medical advice. Please call your doctor or an ambulance if you have medical questions, concerns, or any emergent condition.

Heat illness is the most frequent cause of environmentally related death in the USA in the past 10 years.  The hottest day on record took place in Death Valley, CA, on July 10, 1913, where the temperature reached a scorching 134.1 F.

The most important factor in heat illness is prevention.

  • Drink a lot of water and stay hydrated

  • Wear a wide brimmed hat

  • Avoiding working or being outside at the hottest times of the day

  • Wear light, loose clothing

  • Apply and re-apply sunscreen > 30 spf

  • Have a handheld or electric fan

  • Spray bottle

What happens when we get hot? We sweat, to increase our evaporative cooling. Our blood vessels dilate, causing flushing, to increase blood flow to our skin and increase the amount of heat our body radiates. Our heart rate and cardiac output will increase.

Risk factors for heat illness:

  • Heat wave, high ambient temperature

  • High humidity

  • Lack of air movement

  • Lack of shady rees and shrubbery

  • Lack of shelter or air conditioning

  • Age: small children and older adults

  • Obesity

  • Poor physical fitness level

  • Lack of acclimatization

  • Dehydration

  • Medications/drugs: diuretics (water pills), beta blockers, antihistamines, amphetamines, antidepressants, alcohol

  • Poor health: current infections, heart disease, diabetes, skin disorders

Heat illness exists on a spectrum, ranging from heat cramps to heat stroke.

Heat Cramps

Symptoms: brief, painful involuntary muscle spasms following exercise in heat (usually an hour or so later), typically in the thighs, calves, and shoulders

Core body temp is normal.

Treatment: Rest and passive stretching of the muscle and supplemented by fluids and salt (gatorade, powerade, pickle juice) will rapidly relieve symptoms

 

Heat Rash, aka prickly heat, lichen tropicus, miliaria rubra

Symptoms: Small, red, raised, itchy lesions on the skin caused by inflammation and obstruction of the sweat ducts

Prevention: wearing light, loose clothing and avoiding heavy, continuous sweating

Treatment: The rash will resolve once the patient cools off! Get out of the sun, and use fans, ice packs, hydration, and other cooling methods.

 

Heat Edema

Symptoms: mild swelling of the hands and feet, more frequent in women, during the first few days of heat exposure

Treatment: resolves spontaneously. You can try using compression stockings and elevating your legs. Do not use diuretics, as this could worsen the symptoms and lead to other heat-related illnesses.

 

Heat Exhaustion

Due to salt and water depletion

Body temp: ranges from normal up to 104 F (40 C)

Symptoms: profuse sweating, general weakness, fatigue, headache, dizziness, lightheadedness, nausea, vomiting. The patient may be pale, with cold clammy skin.

Vitals: Weak, rapid pulse, tachypnea, hypotension

Treatment: stop exercising/physical exertion, move to a cool and ventilated area. Lay down and elevate feet 12-18 inches, give fluids, and monitor the temp

 

Heat Stroke

This is MEDICAL EMERGENCY. There is high mortality if rapid cooling measures are not employed.

Body temp: >105 F (40.5 C)

Symptoms: hot and DRY skin (typically NO sweating), rapid and shallow breathing, rapid heartbeat, unusually high or low blood pressure, lack of sweating, mental confusion and disorientation, unconsciousness, physical collapse/syncope.

There are two types of heat strokes: classic heat stroke, and exertional heat stroke. Classic heatstroke will typically affect older patients, while exertional heat stroke affects younger people that have been working out in the sun.

Treatment: initiate rapid cooling! Remove heavy, dark, or constrictive clothes. Place the patient flat on a cool surface in the shade. Fan the patient aggressively and spray cool water on them. Place ice packs on the patients, and give them cool water to drink. If it is safe to do so, you could even place their lower body in a body of water such as a stream or lake*.

Caution: people that are altered due to heat stroke may be aggressive or combative so be careful! 

*Ice packs and water immersion were initially thought to cause peripheral vasoconstriction and activate shivering, thus increasing body temperature and was discouraged. BUT, in heat stroke patients, the activation threshold for shivering is greatly increased, so the current teaching is to just cool as fast as possible by any means!

Should you give a patient who is overheating secondary to an environmental exposure tylenol? No! In heat stroke, the elevated body temp is due to a failure of normal cooling mechanisms, not due to infection. Giving tylenol in the midst of a heat-stroke could contribute to liver damage.

Stay cool!






Do you even yoga, bro?

Do you even yoga, bro?

A doctor and a patient walk into a bar...

A doctor and a patient walk into a bar...