attn: RESQDOC (or whoever - mixed topics)

[tangent]

Was going to send this as a e-mail, but I think it's of general interest, so will post instead.

Hi Keith,

I just read your post on ORT at TF - very interesting. I presume hypodermoclysis refers to the s.q. administration of field expedient (or not) saline solutions, with rotated administration sites, due to tissue saturation - yes? Do you know the medical term for rectal fluid replacement?

On the topic of ORT, look into coconut water. the following biblo focuses on it's IV use (I'm working on a paper summarizing it's use for this), and there are probably 3 papers for every one I have listed here on medline that address it's use as a ORT solution. (only one is negative). I've also seen refs to alternatives for ORT solutions recently, in case the ingredients of choice were not available - thinking docs in the WHO DB, medline abstracts or when I was digging for docs at the med school library, recently. Don't know if I could dig up that ref easily. Keep in mind that medline missed about 20% of relative articles. Chasing refs in looked up articles is *VERY* worthwhile!

Are you familiar w/ the research on using cadaver blood as a transfusion source (blood bank). Rather interesting the stages blood goes through, post-mortem, no anti-coagulant needed. Good for 6-8 hrs after death. Another paper I'm working on...

It sounds like you have written some interesting things!, could you send me a biblio or at least tell me your last name so I could do a medline search?

btw: I am putting together a CD for RR and a couple other people of medical relief org manuals including 2 of the lab manuals (Maurice King's book and a old copy of the WHO lab manual included). I also have a 1960 era civil defense med lab booklet in hardcopy. If you would like copies of these, send me a snail mail address.

current contents (of the CD) include:
A Barefoot Doctors Manual
Health Care In China
Health Record Systems
Manual of Basic Techniques for a Health Lab - WHO, 1980 (2nd? ed)
med care in dev. countries (incl lab section) - M. King
Med Lab for Dev Countries - M. King
Philippine Medicinal Plants in Common Use
Simple Dental Care for Rural Hospitals
The Tooth Trip (counterculture book)
Where There is No Doctor
How to look after a refrig (kerosene)
Where there is no dentist
Anesthesia in the District Hosp
General Surgery In the Dist Hosp

that's just under 380 MB so far, and I have a bunch of other docs I want to add, but they are rather labor intensive to include, as I have to cut and paste every illustration. CD will hold 650 MB, might end up w/ 2 CD's - we'll see. Probably throw on some docs on fabricating lab equip from scratch too...

If you know of other resources for good austere med books/papers I'd be very interested! Been meaning to contact SOMA as I suspect their proceedings, newsletter, journal, publications (whatever they put out) would be very interesting... know anything about this? Some of the obscure relief organizations have interesting documents that I stumble across from time to time. Definitely gray literature/white papers, etc. Hard to locate and obtain, but very worth the effort!

I was very glad to see in your medlab post that I was at least asking some of the right questions ;-)

On a very "off topic" question - been looking for (and probably going to botch the spelling of) a oto-/opthalma- /laranga- (for ET tube insertion) scope heads that will fit on a mag-lite and use that for a light source. It seems like such a critter should exist - know of a source? Also, the microscope you mentioned. I presume this is the one that comes in the portable medical lab (the expensive one, not the one I mentioned). Is this the same as the military uses? Rather expensive!, but very nice! As I mentioned at the beginning of the medlab thread, older AO ones w/ 100x oil immers. lenses can be had for $180-$250, though I would hate to pack one into a remote area. On the scope you mention - who makes it?, who sells it? BTW: Edmund Scientific sells very compact battery chargers (on the expensive side) that are little bigger than the batteries they charge - solar. I've seen schematics for same on the web - much cheaper!

I'm currently working on a term paper for a class at the university on the use of expired medications and use of drugs for their side effects. Do you have any experience in this area? Do you know of any references that are good on the topic? (your post on expedient analgesics was *VERY* interesting!)

Did come across a company in England (non-profit, and picky about who they sell to) that carries interesting items. Reusable ET tubes (rubber), portable, multi-fuel autoclaves, hand powered centrifuges, plastic, autoclavable, lure lock syringes, etc. Know of other sources for things like this that aren't so picky?

Are you familiar w/ the TI graphing calculators and the CBL (Calculator Based Lab)? They have numerous probes (some rather expensive, but it's possible to fabricate sensors). One in particular is an EKG - low cost (~$250 - for everything), low mass, not rated for medical use, due to liability. Also does temperature - one of the 3 included w/ the CBL by default. They also have probes for different ions (useful for medlab work - but some of the more expensive of the sensors), a radiation detector, a velocity probe (hmmm - a pair of these might make a decent sniper locator system, given the correct software....) endless possibilities!!!!!

thanks,

Nathan
(tangent)
nfe2@home.com

biblio on coconut water as an IV solution (DRAFT):

Acharya VN, Gupta KC, Golwala AF, Store SD, Sheth UK., Comparative study of intravenous use of natural coconut water, synthetic coconut water and glucose saline in acute gastro-enteritis, Indian J Med Res 1965 Nov;53(11):1069-73

Campbell-Falck D, Thomas T, Falck TM, Tutuo N, Clem K., The intravenous use of coconut water, Am J Emerg Med 2000 Jan;18(1):108-11

Cooper ES., Coconut water, Lancet 1986 Aug 2;2(8501):281

Dagli AJ., Green coconut water, J Assoc Physicians India 1997 Nov;45(11):904

Eiseman B., Intravenous Infusion of Coconut Water, A.M.A. Archives of Surgery, 1954 68:167-178

Goldsmith, H.S., Coconut water for intravenous therapy, Brit. J. Surg., 1962 49:421-422

Iqbal QM., Direct infusion of coconut water, Med J Malaysia 1976 Mar;30(3):221-3

Karalus J., Coconut water and rehydration, N Z Med J 1980 Jul 23;92(664):67

Kuberski T, Roberts A, Linehan B, Bryden RN, Teburae M., Coconut water as a rehydration fluid, N Z Med J 1979 Aug 8;90(641):98-100

Msengi AE, Mbise RL, Msuya PM, Do Amsi DM., The biochemistry of water from unripe coconuts obtained from two localities in Tanzania, East Afr Med J 1985 Oct;62(10):725-9

Olurin EO, Durowoju JE., Intravenous coconut water therapy in surgical practice, West Afr Med J Niger Med Dent Pract 1972 Oct;21(5):124-31

Pummer S, Heil P, Maleck W, Petroianu G., Influence of coconut water on hemostasis, Am J Emerg Med 2001 Jul;19(4):287-9

Pradera E.S., Fernandez E., Calderin O., Coconut Water; A Clinical and Experimental Study, Am. J. Dis. Child 1942 64:977-995

Ranti IS, Kwee TIEN BOH, Thio IN LIANG, Tan ENG HOEY., Coconut water for intravenous fluid therapy, Paediatr Indones 1965 Jul-Dec;5(3):Suppl:782-92.

Tan ML., Philippine Medicinal Plants in Common Use: Their Phytochemistry & Pharmacology, 1980, Alay Kapwa Kilusang Pangkalusugan (AKAP), 66 J.P. Rizal, Project 4, Quezon City, Philippines. Also in A.T. Sourcebook Library.

Rao PS, Rao SR, Kumar SV, Murthy KJ, Dussey P., Intravenous administration of coconut water, J Assoc Physicians India 1972 Mar;20(3):235-9

Suresh TP, Sharma KN., Electrolyte changes in plasma and urine during tender coconut water infusion in dogs, Indian J Physiol Pharmacol 1979 Jan-Mar;23(1):44-8

Suresh TP, Hedge VR, Setty SV, Rangachar TR., Fluid therapy by tendar cocoanut water in veterinary practice, Indian Vet J 1968 Oct;45(10):829-37

Satpathy R, Nanda NC., Green coconut water, J Assoc Physicians India 1998 Aug;46(8):748

[RESQDOC]

Hi Nathan,

Wow, that’s a lot of stuff. Here is a partial answer, I’ll get to the rest tomorrow. BTW, what is your background, if you don’t mind sharing? You are looking into some interesting, esoteric topics. E-mail me off line if you prefer.

Cadaver blood transfusions has been looked at several times over the years, as I recall. Always too many degradation products and problems with rapid harvest. Probably solvable, but effort continues on blood substitutes so I doubt that this will be addressed.

The CD sounds like a great resource, you have some good books listed. “Where there is no…” series including ‘…Vet; A Book For Midwives’; District Hospital series; Oxford Handbook series; King’s books all good. Would suggest Primary Anesthesia, Primary Surgery I & II, Care & Safe Use of Hospital Equipment, books on sanitation & water supplies.

Regarding your laryngoscope question, there is nothing that adapts to a Mag-Light, but there is one that uses a similar system based on a Pelican Light. This is a review I wrote on TF of the L-scope and ENT set:

‘Hands down, the best bit of kit was my ENT set http://www.galls.com/shop/viewProductDetail.jsp?item=DD996
This thing got the workout from hell, still going strong on the first set of batteries. Plenty of room in the kit for extra stuff, I added 18 & 25 Ga. needles for FB removal, tons of Flouro strips, tubes of sterile water like are used in nebulizers, Tetracaine, Tobradex Optic, Gent Optic, Cipro Otic, still room left. $80 from Galls, free if you are in Uncle Sugar’s supply chain. Flashlight part was very bright, attachments all worked well. Seems a bit flimsy on first pass, but it stood up well with zero problems. Don’t leave home without it. Seriously, this should be in every TEMS & tactical medics bag. You can cobble together a kit, but this has all the goodies and attachments, all of which are useful. Ultralight, compact. Thumbs up. They also have an advanced kit with an ophthalmoscope, which you do NOT need, unless you know what to do with it (lets me out).

Same company makes an ultralight laryngoscope set, http://www.galls.com/shop/viewProductDetail.jsp?item=AM825
No one has been gracious enough to die around me lately, so have only used this in training, but seems to work well enough. Again, seems a bit flimsy, but have not been able to break it, and that says a lot. For something that is carried a lot but used little, this is perfect.

Both are made by CFM Technologies at http://www.cfmtechnologies.com although their website is not yet up.’

I’m happy with both. You have training in intubation? Difficult to learn out of a book.

The field microscope is the Swift FM-31, through any Swift dealer. Never found one used, or I’d have it. The size/weight though is really not an issue – if you are humping gear there are a heck of a lot more important things than a microscope & portable lab. Portability is relative.

Regarding expired meds, the answer is “it depends.” All modern drugs made in the U.S. for human use have been formulated so that they do not degrade into toxic metabolites. The classic case was Tetracycline, which in older forms could become toxic with age. Now, drugs may lose potency, but are not supposed to be harmful. This assumes proper storage conditions, avoiding damp & heat, etc. Note that this does not necessarily apply to veterinary medicines, or medicines made overseas. References? This is what I a have been told by pharmaceutical company chemists, off the record. Nobody will put much down on paper fearing lawsuits. The party line is “don’t use if out of date or improperly stored”. Use your own judgement.

What company in England has the stuff like the hand-powered centrifuge? Let me check, I can probably order anything anyone wants if needed.

No experience with the TI CBL system, sorry. I understand that the EKG was abandoned for the 2nd generation system, do you know if this is true?

I have an answer on the ‘coconut milk for IV solution’ stuff on my office computer, I’ll paste it in tomorrow.

Hope this helps,

Keith

Yes, hypodermoclysis is the administration of fluids under the skin. Proctoclysis is the
term for rectal fluid administration. Both are quite effective when done properly. I am
about 70% done with a textbook on fluid resuscitation in wilderness and remote
situations, which I hope to have done & published this spring.

I am aware of the work done using coconut milk as an IV solution, and discuss this a bit in the book. I am not in favor of this at this time unless no other fluid is available, for several reasons. The electrolyte content is typically too high (potassium, calcium, magnesium, chloride) or too low (sodium), the lipid content is too high, it is too acid, and no one has looked at the microbiology to my satisfaction. In particular coconuts are known to harbor a variety of fungi, some of which are quite toxic if spread through the blood (although
destroyed in the digestive tract). As an oral solution, I consider both the sugar and lipid content too high and more likely to promote diarrhea due to the impaired ability of the intestinal mucous to manage these substances during acute gastroenteritis episodes.

That being said, coconut fluid could be used as an IV solution, if nothing else was
available, especially if diluted with water, with the addition of sodium salt, and if boiled and given under as sterile conditions as possible. Case reports and Jackie Chan movies aside, I do not think plugging the IV drip set straight into the coconut and hanging it up would be my choice. Besides which, the inline filter found on standard drip sets in America clogs rapidly with coconut particles - I know, I tried this last year, just to see if it works. But if you are going to all this trouble (adding salt, boiling, etc.), why not just make sterile IV solutions to begin with & avoid the potential complications? I would not use it for hypodermoclysis. Administration by either nasogastric tube or proctoclysis however would certainly be a possibility, especially if diluted & boiled first. Because of the very high salt content I would not use it in renal failure, burns, or soft tissue trauma - and that is another point, this is not appropriate as a volume expander in trauma patients