On Equiping a Med Lab

[tangent]

For lab work, you really need a microscope, and you should be looking for an older one w/ an oil immersion lens - (that's 100x), general lens combinations include 20x, 40x, 60x and 100x. you want one w/ a mirror, so you're not dependent on electricity or batteries and it should preferably be of a common make and manufacturer so repair services and spare parts are available. Try for one made between 1920 and 1960. Binocular lenses are nice, but not required. A mechanical stage should be high on your list of desirable features - this is a rack and pinion type thing that moves the slide by very slight increments on 2 axis. Do NOT assume that you can retrofit one, esp if you end up w/ a odd make of microscope. It's possible, but a gamble. You can generally find good ones on e-bay for between $180 and $240. Be patient, and watch for a while - learn to recognize brands, features, etc. A poorly described, but pictured one, w/ maybe just a model number given is your best bet for getting a deal. That's where being able to recognize what it has from a pic comes in. Be willing to pay extra for packing, or have them take it to a pack and ship place and pay for the packing - they are fragile. The exception being that some come w/ cases that the base screws into, and gives it numerous points of support.

you will need a few biological chemicals, for grams stain, blood typing, etc - it depends on what you want to do, also a special slide for cell counts. The microscope is the expensive item. The other major items of equipment you will want are a centrifuge, and hand crank units are available, but hard to find. Believe I have an article on making one somewhere, from a hand drill. Lucifer’s Hammer talks about using a sock on a string for this (NOT the method of choice!, but it works in a pinch...), and I believe that part is copied in Craigs medical FAQ, that's online here, somewhere. You will also want an "autoclave", though in our case, that means a pressure cooker. A triple beam balance is the last major piece of equipment - pressure cooker: ~$50, triple beam: ~120-150, centrifuge: ~$80-150, or make one. Everything else should be pretty minor. A class in microbiology will teach you a lot of the basic skills needed while classes in medical technology are probably a waste of time - you'd learn about a lot of high-tech methods that simply are not practical in the field. Alternately, you can use the relief org manuals, and there are several. Some are online, as noted below, that deal with specialized aspects. There are 3 main ones, however:

A medical Laboratory for Developing Countries, by Maurice King, Oxford U Press, This one is probably my favorite. from the intro: "Laboratories have to be numerous and cheap...The methods therefore have been chosen to be the greatest diagnostic value for the limited funds available; the total cost of the equipment in the basic list given here is about $500, including the microscope" (note, that's 1973 prices, but if you shop well, you could probably still pull it together for about that). This book is available on CD (or fiche) in the Appropriate Technology Sourcebook Library.

The WHO manual: Manual of techniques for a Health Laboratory. This one is also quite good, it's been undergoing revisions for quite a while now, but a new edition is expected soon. An older edition is also available in the Appropriate Technology Sourcebook Library (CD or fiche).

Medical Laboratory Manual for Tropical Countries, vol 1 and vol 2 (old title) or District Laboratory Practice in Tropical Countries vol 1 and vol 2 (new title), by Monica Cheesbrough. This one contains a wealth of information and fine grain detail that is very interesting. The new version, unfortunately, has gone the way of high tech, w/ portable digital instruments and professional lab equipment - equipping a lab as she details would be incredibly expensive and impractical on a small, distributed scale. This also creates repair problems, as if things break you will need a digital electronics lab and good stockpile of spare parts to fix it. Still, the book has worthwhile information. Try to find an old edition, if possible. The new book seems more oriented to doing more extensive tests than a field laboratory would do. Things that might be sent out to it if it was beyond the smaller labs capabilities. This is closer to methods you might learn for working in a med lab in the USA. Neither the old edition or the new one are available as part of the AT Sourcebook Library. Cambridge U press, btw.

please note my post on motherload of med manuals online - there are 2 WHO lab manuals, one on bacteriology (what kind of critter is this so I can figure out what kind of antibiotic it will respond to) and the other on malaria microscopy.

Also note that RR does stock centrifuges and microscopes from time to time, but none of the hand crank units of the former, so far. Write to inquire.

[tangent]

this thread really took off at AW - go see:
http://assaultweb.net/ubb/Forum32/HTML/000193.html

CORRECTION!: this thread was archived, so I'm going to pull it over here.

[deerwchr]

In reference to tangent's post:
Med Tech classes do not teach only high tech methods. Like lerning Algebra and Trig you have to start with multiplication, lab techniques start with basic analysis methods. You have to learn about the old to understand the new. The last I heard, pretty much only techs that held licenses and/registrations could jump into classes for med techs anyway. It's usually need to obtain CEU's for re-licensure. The high automation used now can be learned by anyone. It's easy to teach people how set a tube in a carousel and push a button. It takes learning the old stuff to understand the why's and wherefor's.

How about some ISBN numbers for those books. It can help make them much easier to locate.

_________________

[tangent]

deerwchr wrote:
I'm open to questions as well. I was Lab Tech before the army during the army and after the army. I've been with a CSH, a general hosp. and several different types of hospitals civilian.
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"The U.S. isn't running out of targets, Afganhastan is running out of targets!" D. Rumsfeld

[tangent]

RR wrote:
deerwchr, you have no idea what you just said. :smile:
How about the basics for determining blood type and Rh factors? Low tech of course. And what the about reasonable shelf lives on the needed reagents?

RR

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“I am not going to fire a $2 million missile at a $10 empty tent and hit a camel in the
butt.” George Bush 9/16/01

[tangent]

Deerwchr wrote:
Shelf life on the reagents is dependant on manufacturer and storage conditions.
Basic Type/rH determination is simple:
Reagents needed:
A Antigen (yellow)
B Antigen (blue)
Rh protein Antigen (clear)
Albumin Protein (translucent)

Specimine type:
Any blood that has been collected in an anticoagulant ie: Heparin, EDTA, etc.

Equipment needed:

Cuvettes or test tubes or microscope slides
Droppers

Add 3 drops of A Antigen to a clean piece of above equipment and do the same for the B Antigen. Both can be placed side by side on a slide or each in its own tube or cuvette.
Add 1 drop whole blood to each Antigen. mix the blood thoroughly in each. If the blood clumps it is considered positive. If not it is considered negative.


If A is clumped it is A
If B is clumped it is B
If A and B are clumped it is AB
If neither clumps it is O
This determines the rH

Add 3 drops Rh Antigen to slide or tube and one drop of blood. Mix. If it clumps it is positive. If not it is negative. To verify a positve Rh, add a drop of Albumin protein and warm mixture to 98f. If the clump breaks up the Rh is actually negative.
If you are unable to heat the sample and an infusion is needed, give negative blood.

O neg is the universal donor blood.

The reagents needed if I remember correctly, must remain refrigerated and thus are not suitable for the field. If blood typing is unavailable and blood is needed, again, give O neg. Plasma can be given any type to any type. Packed red blood cells and whole blood must be as stated before. If type specific is available, negative can be given if positive is not available. ie: A+ patient A negative donor = good transfusion.

In order of rareness:
O+
O-
A+
A- <6%
B+
B-
AB+
AB- <1%

negatives are always rarer than the positives. AB's are mostly found in Blacks and Mulatto's.
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"The U.S. isn't running out of targets, Afganhastan is running out of targets!" D. Rumsfeld


[This message has been edited by deerwchr (edited 16 November 2001).]

[tangent]

Lee7.62 wrote:
As I sit in the blood bank at work on 3-11 (yawnnnnn) doing a crossmatch on a guy with a 4.5/15 crit I recall reading in Lucifer's Hammer about a procedure that the female russian astronaut used for blood typing. She gathered up folks who absolutely knew their blood types and recorded them. Then she got a string, test tube and drew blood on the person in question and mixed it with plasma of someone she knew. After spinning it around her head (for lack of a centrifuge) for a while she noted if the blood clumped in the plasma or remained free. Rather a hit or miss procedure. Doesn't tell types but only compatible or incompatible. But deerwchr is correct in what is needed. I have managed to put together a small portable lab (missing a microscope- they ain't cheap) but could do basic blood typing, urinalysis, hemetology, and some basic parasit. Great kit to take on medical missions.

[tangent]

Deerwchr wrote:
quote:
--------------------------------------------------------------------------------
Originally posted by LEE7.62:
I have managed to put together a small portable lab (missing a microscope- they ain't cheap) but could do basic blood typing, urinalysis, hemetology, and some basic parasit. Great kit to take on medical missions.
--------------------------------------------------------------------------------

Nice to encounter a fellow Med Tech on here. Keep in touch. I've been outof it for almost 10 years but still retained a lot of knowledge. I specialized in Hematology, Bloodbanking and Special Chemistry. I've worked in a Geriatric Med/Surg hospital, an open heart hospital, and TMC's, Generals, Fields and CSH's. I miss it sometimes but not often. I remember many nights spent trading lab medicine lessons to Dr's for E.R. lessons because it was quiet. But many nights I spent doing emergency type/cross th entire shift for an aneurysim or accident.
I saw fairly low end binoc scopes for sale on E-Bay not a month ago. They were going for under $200. Not the quality of an AO or a Ziess but functional. Monocs from Army surplus are available. Ithink there is one or two on there now.


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"The U.S. isn't running out of targets, Afganhastan is running out of targets!" D. Rumsfeld

[tangent]

Lee7.62 wrote:
thanks for the heads-up. I might have to start cruisin' E-Bay for the scopes. I've searched for the milspec ones. I'd give my Corgi's naughty bits to find the ones we had in our clearing company- OD, folding, worked off 12V system, 110, candle/flashlight, or D-battery and would fit in a shoe box.
Will try to keep in touch. There's a lot of good material and info/advice on this forum. Good folks!

[tangent]

tangent wrote:
Nice replies guys!
on shelf life of reagents, med lab for dev countries says: most of the chems in the main list will keep god for ever. But Anti-A serum and Anti-B serum (and albumen) are not like this and need to be refrigerated. Freeze them if you won't use them for a while.

Are anti-coagulants really necesary if you do the work right away?

Lee - on your portable med lab, what's in it and what will it allow you to do - specifically? (contents -> test mapping)

just peeked over at e-bay - they have several AO's up w/ current bids between $150 and $250, those actions are ending between 12 and 36 hours from now. I got a AO-Spencer, monoc and am very happy with it.

on cross matching, the manual gives a albumen method and a saline method, so could do w/out the albumen in a pinch. Thinking how they did it in Lucifers Hammer.

also mentions that if the pt has been given dextran, this will cause the cells to rouleaux and thus give a false possitive match.

One lab in a suitcase is interesting: http://www.gospelcom.net/ia/programs/frames/frlis.htm

Diagnostic capabilities are microscopy, hematocrit, WBC, CBC differential, ESR, chemistry profile and urinalysis. The user may opt for fluorescent, AFB or Gram stains plus immunology testing, inclusive of Hepatitis B, pregnancy, malaria, syphilis, tuberculosis or HIV panels.

The Lab-in-a-Suitcase includes:

Field colorimeter
Stainless steel solar panel
Binocular microscope
NiMH (nickel metal hydride) battery
Urine centrifuge
Hematocrit centrifuge
ESR
Hemocytometer
5-amp adapter
Manual and appropriate reference books
Molded polyethylene suitcase
Also available are the following supply kits of disposable items:

Microscopy kit
Hematocrit kit
Hematology kit
Colorimeter kit
Urine kit
Blood collection kit

The Clinigal Guidlines book (see med books online post) had this to say about a portable labs capabilities and function:

Role of the laboratory

A basic medical laboratory of the type described by WHO can play an important role. Nevertheless, there are special constraints upon the operation of a laboratory, which should not be underestimated. There are staff constraints (necessity of trained and competent technicians), logistic constraints (supply of reagents and other equipment), time constraints (a minimum of time is necessary for each examination) and quality constraints. If attention is not paid to the above considerations, the laboratory will loose its accuracy and therefore its useful purpose.

Two levels of examination should be considered:

BASIC EXAMINATION

- Stool exams direct and stained with Lugol's iodine solution, for parasites (ova, cysts, protozoa...).

- Blood slides: thick and thin smears (for malaria, trypanosomiasis, filiariasis, relapsing fever, screening for leucocytes): GIEMSA stain.

- Hemoglobin (Lovibond method).

- Urine exam:
· urine analysis: dipsticks for glucose and proteins.

- Sputum exam: Ziehl - Nielsen stain.

- Urethral and vaginal swabs: slides for gonococcus and trichomonas.

- CSF exam

COMPLEX EXAMINATIONS

Certain more complex examinations may be provided according to the specific program.

A laboratory can be used in two complementary ways:

- Clinically: examinations can be requested for individual patients according to the clinical picture. The aim will be to assist the practitioner in:
· diagnosis orientation (e.g. leucocytosis in blood count);
· etiological diagnosis (e.g. stool exam for parasites, malaria smear...).

- Epidemiologically: the aim will be to construct or to validate clinical and therapeutic protocols. One can investigate a sample of patients presenting with a particular clinical picture (symptoms and syndromes) specify the etiology of that clinical picture and thus arrive at an appropriate standardized therapeutic management protocol.
For example:
· Fever and chills: are they due to malaria ? Rather than being obliged to perform blood slides on every febrile patient, choose at random 100 patients presenting with these symptoms and investigate them. If a significant proportion of the blood slides are positive, such cases can henceforth be presumed to be malaria and treated according to an appropriate protocol.
· Bloody or mucusy diarrhea with no fever: the same approach can be used to determine if this clinical presentation is synonymous with amoebiasis and/or another intestinal parasite.
· This epidemiological method of using a laboratory is especially appropriate in responding to priority needs. It can be used in emergency or "normal" conditions. Bibliographical references n° 2 and 19 give two examples for malaria, one in a refugee camp, another one in Malawi.


so, what do you think are the most important capabilities for a portable lab to have and what should be in one in order to do these. In what order of priority?

As to MILSPEC equipment - anyone know what they use for a field ballance? - triple beems and backpacks don't get along too well... :smile:

[tangent]

Deerwchr wrote:
quote:
--------------------------------------------------------------------------------
Originally posted by tangent:

Diagnostic capabilities are microscopy, hematocrit, WBC, CBC differential, ESR, chemistry profile and urinalysis. The user may opt for fluorescent, AFB or Gram stains plus immunology testing, inclusive of Hepatitis B, pregnancy, malaria, syphilis, tuberculosis or HIV panels.
Depending what most folks here at AW want to do for SHTF/Survival Flouroscopy, AFB, Syphilis would be far from needed.


BASIC EXAMINATION

- Stool exams direct and stained with Lugol's iodine solution, for parasites (ova, cysts, protozoa...).
********************************************
Do they include formalin for floatation. How about needed supplies to concentrate the specimine to reduce the likelyhood of false negatives when searching for Ovum and Cysts?
********************************************
- Epidemiologically: the aim will be to construct or to validate clinical and therapeutic protocols. One can investigate a sample of patients presenting with a particular clinical picture (symptoms and syndromes) specify the etiology of that clinical picture and thus arrive at an appropriate standardized therapeutic management protocol.
For example:
· Fever and chills: are they due to malaria ? Rather than being obliged to perform blood slides on every febrile patient, choose at random 100 patients presenting with these symptoms and investigate them. If a significant proportion of the blood slides are positive, such cases can henceforth be presumed to be malaria and treated according to an appropriate protocol.
· Bloody or mucusy diarrhea with no fever: the same approach can be used to determine if this clinical presentation is synonymous with amoebiasis and/or another intestinal parasite.
· This epidemiological method of using a laboratory is especially appropriate in responding to priority needs. It can be used in emergency or "normal" conditions. Bibliographical references n° 2 and 19 give two examples for malaria, one in a refugee camp, another one in Malawi.


so, what do you think are the most important capabilities for a portable lab to have and what should be in one in order to do these. In what order of priority?
********************************************
1.General hemetological disorders including volume loss, WBC and Diff
2.Ability to perform Grahm Staining
3.UA screening
4.Glucose monitoring
5.O & P screening
********************************************
As to MILSPEC equipment - anyone know what they use for a field ballance? - triple beems and backpacks don't get along too well...
********************************************
I can't see where a scale would be needed at all. You would not be making up any stock reagents from raw chemicals. Most of your portable/stable reagents would be of the reconstituted variety, needing only to ad DI H2O to ready for use.

Centrifuges that are hand cranked are available for sale. They aren't fast enough to do crits or separate protiens in serum but they'll do in a pinch.

I erased it above but Sed Rates (ESR) are about worthless and were pretty much removed from use 15 years ago. They are too dependant on proper conditions to be accurate and require a large sample as opposed to most hematologicals that can be performed on a finger stick or pediatric sample.

Glass graduate slides for CSF, RBC, WBC, etc are good to have for doing fast counts if the reagent bottles for proper dilution are available.
And yes, anicoagulants are necessary for most analysis. Try doing a cell count or morphology when your sample is full of clots, agglutination, strings, etc. Heparin is the most universal of the Anticoagulants and can be obtained in vial form and added by syringe.

There is more to add and I'll do so at a later time.


:smile:


--------------------------------------------------------------------------------

------------------
"The U.S. isn't running out of targets, Afganhastan is running out of targets!" D. Rumsfeld

[This message has been edited by deerwchr (edited 17 November 2001).]

[tangent]

tangent wrote:
http://whqlibdoc.who.int/emro/-1993/LAB_243-E_L.pdf
p13-23 talks about local production of blood typing reagents

[tangent]

deerwchr wrote:
OK folks, here comes part 2:
One of the problems with an individual setting up a field type lab for quick WTF's is the storage and availability of reagents and stains. First off, reagents are going to be extemely difficult to obtain for a few reasons:
1: Most reagent suppliers won't deal with a non lab director or hospital supply officer/representative for sales.
2:Reagents, whether fresh, frozen, freeze dried or a combination come in bulk only.
To give an example: Anti & Anti B for the blood typing question as far as I know come in packs of 6 or 12 of each flavor. It's outrageously expensive and would expire well before you could utilize it.
3.Many of the early type of chemistries that require you to make up your own stock solutions, stains, suspensions, etc. are no longer available for sale. Enzymatic testing overtook colorimetrics 20 years ago and the reagent reps/companies don't carry what they don't sell. I watched analytical methodologys change many, many times when I was teching and am fortunate to say I was there when chemistry was chemistry and not just add a drop and swish for 30 seconds.

On a final note and I stress this most emphatically:

LAB ANALYSIS IS DEADLY BUSINESS. YOU CAN'T LEARN MORPHOLOGY AND METHODOLOGY FROM A BOOK. PERIOD! ACCURACY IN IDENTIFICATION OF HEMETOLOGICAL ENTITIES, PARASITIC IDENTIFICATION & BLOOD CHEMISTRY REQUIRES EXPERIENCE THAT YOU CAN ONLY GET FROM BEING IN A SETTING WHERE YOU SEE THESE NORMAL AND ABNORMAL ITEMS REPEATEDLY. MED TECHS CAN BE THE CAUSE OF DEATH FOR A PATIENT VERY QUICKLY AND INNOCENTLY IF THEY ARE IGNORANT OR INEXPERIENCED IN THE DEPARTMENT THAT THEY ARE WORKING IN.
If you want an idea how stressful lab work is I'll tell you:
In a study done about 15 years ago or so they listed the burnout rate for medical employees. Lab techs were number 2 on the list with an average career span of 5 years. This is second only to Critical Care ACLS Nurses.

I don't mean to yell but I don't feel that anyone but a veteran Lab Tech attempt to do anything related to this field. A simple error in a blood typing can cause an irresversible autohemolytic reaction in a patient and once started, cannot be stopped.

Flame away if you want but I've seen these things happen and often at that. If you want horror stories, email me privately and I'll be more than happy to make you ill at ease for your next hospital visit.

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"The U.S. isn't running out of targets, Afganhastan is running out of targets!" D. Rumsfeld

[tangent]

tangent wrote:
Deerwchr,
I have to agree with you on at least one point, but disagree with you on most others.

The one I agree with you on is blood typing - if you mess up, it's very easy to kill someone! At the same time, blood transfusions are a method of absolute last resort! They are best avoided, if there is ANY possible alternative - even for doctors. There may be others that can get you in trouble, and it would be usefull to know which, but I'm not awair of any.

anti-A and Anti-B, etc. can be obtained in small quantities and it can be gotten lycotomized(sp? - sure I misspelled that) from places that sell teaching supplies, so as to get a long term storrage capacity. MOST CHEMICALS / REAGENTS LAST FOREVER! - quick expiration is not an argument for giving up. Information on making your reagents from scratch - the old chemical way, is well documented in the relief org lab manuals, and they also hold your hand and were written to be be self teaching manuals, in simple language for locals that have not had alot of education and with lots of plates (pictures) for identification.

There are also places that sell chemicals, especially analytic, and reagent types in small quantities to individuals. This is something that can be done.

I think most people here are looking for a basic setup that will help get them out of trouble, give them an idea what's wrong with them and for example, decide what the best antibiotic to use would be, rather than trying to guess blindly or try one after the other and see what it responded to.

If I'm trying to get somewhere, I'd rather use a map than the sun and stars, and some basic lab tests are a map...

Baseline is a handfull of simple tests, that can be done with simple equipment, basic reagents, and minimal training or learned through self training. This can be done, and is done daily in remote labs all over the world. Take a look at a med lab for developing countries or the WHO manual, there are a couple of others, there's also a book on making reagents from scratch, though the books mentioned generally have a formulary, focus on basic, more easily obtainable, and less toxic chemicals. The manual I'm looking at now lists 46 basic chemicals in it's main list, most are common and they list what each is used for, if you can get by without it, alternatives (tests and chemicals), and in a few cases where it's relative, shelf life as well as how to make all the reagents and appropriate quantities to have. They use the old ways, that are still efective, and present alternative tests, whenever possible, in case you don't have a reagent or the chemicls to make a reagent - a not uncommon situation.

[tangent]

tangent wrote:
for sources of chemicals - listing of supliers starts about 1/2 way down. Have to search for the sources of the biologicals - syrums, etc. - that's not in this doc.
http://pub16.ezboard.com/flibertyquestandfreedomboardfrm5.showMessage?topic ID=456.topic


post refered to was pulled over here, under sources for chems/home chem lab in this forum

[tangent]

tangent wrote:
Deerwchr,
your first post in this thread was great!, the second was interesting. the third, (part one) was usefull, the 4th (part 2), was not usefull, that with the exception of point 3, that was interesting! We have lay readers here, and this has gone way over the heads of all but a handfull of medics, most of those, like me, only understod a portion of what you said. I'm guilty here too, as I posted that blurb about the suitcase med lab that was full of jargon, and used at least one word that would be geek to anyone not in the know. It seems time for a vocabulary lesson - what do you say? Lets put this into english for everyone...

hematocrit - hemo, hema, heme is a latin prefix for bleeding or blood - beyond that have no idea.
WBC - White Blood Cell - these are the cells in your blood responsible for attacking invading organisms. They also form clots (scabs) and act as a sealing/healing mechanism for your body.
CBC differential - C? - ukn, BC = Blood Cell or Blood Count
ESR - no idea
chem profile - are you talking blood gasses? - no idea
urinalysis - looking at glucose (diabeties) and bacterial infections.
florescence - no idea
AFB - no idea
gram stains - these find what kind (family) of bacteria is attacking your body so you can determine what kind of antibiotic would be best suited to counter attack with.
immunology - has to do w/ your immune system, WBC's, HIV (AIDS), etc.
hematological - vol loss (lab test???)
WBC - above
dif - ???
UA = urinalysis - above
glucose - diabeties - above
O&P - no idea (reminds me of D&C though... don't explain that one - there are christians on this board, ya know!...;-)
DI H2O - distilled water
sed rates (ESR) - no idea
CSF - Cerebral Spinal Fluid, collecting CSF is VERY dangerous and VERY painfull! not recomended for non-professionals, as w/ blood transfusions!
RBC - Red Blood Cell - these are the cells in your blood that carry oxygen from your lungs to the cells in your body and return CO2 to the lungs as a waste product.
morphology - no idea
aggulations - no idea
WTF's - What The F*CK's ???
rouleaux - stack of RBC's, like a stack of coins - (the root meaning of the word) durring crossmatching, meaning that blood is compatable for a transfusion. If it clots, that's WBC's attacking the introduced blood meaning you have a problem and if you tried it your veins and arteries would look like rush hour traffic with constent multi-car pileups...

any other words that anyone else didn't understand?


[This message has been edited by tangent (edited 18 November 2001).]

[tangent]

TheWar Hound wrote:
m mostly a nuts & bolts kinda field medic, but I do know the meanings of some of the above:
CBC = Complete Blood Count, contains the Hemoglobin & Hematocrit, and the WBC;

ESR = Sed Rate, helpful in determining if the patient had gout;

dif - Differential, which breaks down all the different types of white blood cells;

chem profile, usually a chem-7, which is the basic serum eletrolytes, such as sodium, potassium, CO2, chloride, BUN, creatinine, and glucose. The other most common chem profile is a chem-24, which includes the above with a calcium level, and various liver enzymes levels.

Steve

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"Make your enemies by choice . . . not by accident" - Alfred Bester

[tangent]

tangent wrote:
deerwtcr,
please explain: "needed supplies to concentrate the specimine..."

"hand crank centrafuges are available" - WHERE!???? Also, please explain the speed differences and what speed is needed for what and why. (I guess the old test tube in a sock isn't going to cut it.... ;-)

thanks,

tangent

[tangent]

Deerwchr wrote:
OK Tangent, I'll supply the answers you couldn't.
As for speaking in techese, sorry, it's a habit of years and repetition.
Hematocrit is the measurment of cell volume used for the determination of redcell loss.

WBC is White Blood Cell and not only are the tool for fighting infection but are only a PART of the clotting factor.

CBC / Diff Complete Blood Count and cellular Differential. This provides the White cell count, red cell count, various red cell characteristics and the types of white cells present.

ESR is an Erythomite Sedimentation Rate and is an older style test used mostly (as well as I remember) for imflammation study.

Chem Profile is a battery of tests chemically performed to give a basic overlook of bodily functions. Usually sreening kidney, liver, pancreatic, enzymatic functions.

Urinalysis is not only for determining glucose spillage and infections. It is a primary source for determination of other organ and system failures.

Flouresence / AFB are staining procedures for micro-organisms that allow thier identification.

Hemetological covers those things pertaining to the blood volume and blood cels themselves.

O & P is Ovum and Parasites testing performed mostly on fecal samples in the search for mature parasites, pieces of parasites, eggs of parasites and the cysts of parasites.

SEd Rate is shor for Erythrocite Sedimentation Rate

Morphology is the characteristics of a blood cell.

Agglutination is the clumping of blood cells to a reagent or an antigen like substance.

Sorry you didn't like the majority of my prior post Tangent but the lack of your ability to define some of the terminology (the words) and inaccurate definitions on others tells me that you have no or little experience in the field of Laboratory Medicine.

As to teh ANti A/B serums: The word you are looking for is Lypholized and if you can find small quantities for teaching purposes then by all means go for it.

Specimine concentration is used, for example, in O & P hunts. You use formalin to concentrate and float the O & P's to the surface to make a concentration that allows you to more redilly find that one parasite of the few ovums or OOcysts that are present.

Hand crank centrifuges are/were available. Try Edmund Scientific for starters.

Test tubes in socks aren't going to cut at all. Different centrifugal speeds are needed to separate red blood cells from the white and the plasma. Higher speeds are needed for hematocrits (around 8000 rpm I believe it was) and yet higher speeds are needed to separate interfering protiens in serum (12-14000 rpm) because using sulfosalacylic acid to precipitae the protien is not always advisable or practical.


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"The U.S. isn't running out of targets, Afganhastan is running out of targets!" D. Rumsfeld

[This message has been edited by deerwchr at the request of RR(edited 18 November 2001).]

[This message has been edited by deerwchr (edited 18 November 2001).]

[tangent]

tangent wrote:
Deerwchr,
thanks for that reply! It should have been very obvious from my first or second post on this thread that my experience in lab medicine is quite limited, I'm a learner here too!, as is everyones that doesn't do it for a living or has never had to do it in the field.

What I was taking exception to is your defeatest comments, that in effect would result in a lot of people not even trying to develope some skill and knowledge in this area. Lets look at facts: some lab tests are VERY simple. patients and nurses aids do things like monitor glucose levels, there are test kits for various things sold OTC in drug stores, home pregnancy kits and so on. The color, ph and odor of urine is a useful diagnostic indicator. These are CLEARLY in reach of someone trying to increase their medical knowledge and add to their diagnostic toolkit. Taking it a step further, anyone that has had microbiology, or depending on your teacher, HS biology was taught how to do a gram stain. A lot of people have various kinds of antibiotics storred away and being able to tell which ones are likely to be effective is valuable - VERY valuable! (ie: don't take an antibio that's effective for gram neg bacteria if you know it's gram pos...). I also agree that there are areas that will get you into trouble - transfusions can kill people. trying to collect CSF is likely to cause meningitus if the pt doesn't allready have it, or can potentually paralyse someone. those procedured are dangerous. And it's a process of learning to determine which are dangerous or can have bad results and what's within reach that we're talking about here. There is a lot of middle ground between those two exteems! If we were talking about neuro or abdominal surgery, I would accept your "it's ALL over your head, so don't even try any of it" attitude without question. But we're not, and it's obvious that any diagnostic indicators that can rule out a cause of disease, while maybe not telling you exactly what is the cause but narrowing it down, is of value. Finding that middle ground and determining what is within reach and worth learning about, prepairing for, is of value - emence value! By a similar token, if TSHTF having the forsite and knowing enough to have put away information, equipment and supplies is of emence value if you can later hook up w/ a MT, MD, RN, teacher or scientist who has training and experience using these things. You have to know a little in order to know what to stock, however.

Something else that needs to be addressed is the obvious bias that came from working in the medical field in this country. Some of these unspoken assumptions and values are that you have to be right the first time, have to know with absolute certainty what's wrong w/ a patient. That's the reason doctors in this country order barrages of medical tests and one of the reasons medical care is so expensive. It has everything to do with malpractice insurance and the fear of getting sued and very little to do with helping the patient, to the best of your abilities and at minimal cost. In most cases, it's NOT a life and death situation if an antibio doesn't work or another med doesn't work, you can try something else. Granted, sometimes it is, but that's the exception, not the rule. This adjustment in attitude and only ordering one lab test if it's really needed, and knowing when it's needed is something the manuals and training cources for nurses and doctors going overseas talk about alot. If TSHTF, and that's the whole spirit of this thread, we will not be following the same rules or values and people are going to have to do as much as they can with what they've got. Saying ALL lab tech is over your head is like telling people here that ALL medicine, beyond basic first aid, is above their head unless you've been to nursing or medical school. I couldn't disagree more! - cources are good, but people can and do manage to learn on their own and should be encouraged to learn as much as possible. To say these specific procedures are dangerous and shouldn't be attempted and here's why, is one thing. A *VERY* helpfull, nay, INVALUABLE thing!

You keep talking about dire consequences - aside from transfusions and CSF, what did you have in mind and how are these dire TO THE PATIENT or the LABTECH? specific examples and explanations would be very usefull. What's the worst that's going to happen to the patient if you get it wrong? and lets try to be realistic to a SHTF situation - nobody here is going to have a bag full of cardiac drugs and if they do, they should have the knowledge of what else could be going on. antibio's, anti-parasidic, herbal remedies, changes in diet, OTC meds, antifungurals - treatment options are going to be pretty limited... if it's a tape worm we're probably talking starving the patient and putting a bowl of warm milk in front of their mouth - the old tx, or eating a cigarette to stun them long enough to pass. But being able to tell if you have worms or whatever is valuable vs looking at a different cause and possibly a different treatment.

as to chem, I've had both HS and college engineering level chem.

as to the kits going overseas, yes, a nurse that's had a crash cource goes with them to train a local in their use and sometimes helps run the lab for a while. The lab is left and nurse returns to the states, leaving the trainee to train others locally. That's why the manuals are written in easy english or spanish, or whatever language is appropriate, and hold your hand alot. In many countries, the "doctor" has the level of training equivelant to a paramedic in the USA and medical aids are lucky if they have a third to 5th grade education - these are the nurses, lab techs, etc and often do the primary care, diagnostics, prescribing, etc, refering to the "doctor" only if it's above their training and level of knowledge. We're lucky in this country to have so many highly trained people, but very unlucky because access to medicines are so tightly controled and medical peoples training is hard to adapt, in many situations, to austerity, what with disposable everything and high tech tests, equipment, etc. But I'm preaching and will get off my soap box - sorry about that, I rant sometimes...

on the hand crank centrafuges - edmund sold it's surplus biz to another company and what's available has really gone downhill. I do have a couple of plastic hand crank units that came out of kids chem sets, but consider them too flimsy to rely on and they are slow, REALLY slow. know of other sources?

Most of your posts on this topic have been very informative and helpfull, THANK YOU! Looking forward to seeing more.


[This message has been edited by tangent (edited 18 November 2001).]

[tangent]

RR wrote:
Gentlemen, let's dispense with the insults here. Nothing is accomplished by same and it only detracts from the objective at hand, which is to *learn* for possible (IMO likely) future scenarios. Don't make me go Motley and start using the delete button.
In fact, it'd be appreciated if the posts would be edited to delete such references and stick to the info itself. I'm not asking everyone to embrace and sing Kumbaya, just be tolerant of opinion as it relates to the subject at hand.

RR - sometimes I have to be a moderator

[tangent]

RR wrote:
Now that that has been taken care of:
I'm one of those looking for ideas on how to perform what lab tests are reasonable and practical. I've had HS chemistry and biology and LPN school. They don't teach much in the way of labs in Paramedic school, or at least did not back in the dark ages.

Offhand I would suggest the tests I am asked about/interested in particular in myself consist of:

- Blood typing. Crossmatch would be great, but as pointed out it is likely beyond the ken of most of us. I'll settle for a minimum of 85% certainty. We are talking post-SHTF here.

- Urinalysis. Especially when it relates to diabetics. Chemstrips do have a shelf life and they are expensive to stock up on. How well will a specific gravity test work for a diabetic, a la the "old" methods? I actually had to do those in nursing training.

- Cell counts, especially WBC's to ascertain infection.

- Hemoglobin levels

- Hematocrits

- Chem 7 (sodium, potassium, chloride et al?)

For my own stocks I do have a couple old hemoglobinometers (colorimeters) a haemocytometer - the graphed slide for doing cell counts manually - plenty of glass dropper bottles, blood collection tubes and accessories, a couple of monocular 'scopes, - though I'm not sure if they have enough magnfication - some reagents (have to dig them out to list them), alcohol lamp, glass syringes measured in 1/100th ml, a urinomter for specific gravity and a few other things that escape me right now. Oh yes, a used lab centrifuge, and tubes, though I'm not sure if it's a variable speed or not.

I also have a few lab references, mostly relating to hematology and transfusion. Older books that work with 40's/50's/60's technology.

I've started adding Chem 9 strips. What else do I need to accomplish my ideal goals here? Besides a tapeworm tongs...

RR

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Got band-aids? http://medtech.syrene.net/

[tangent]

Deerwchr wrote:
Tangent: Valid points made. Thank you.
RR: Moderator's wishes understood.
CLASS BEGINS:

Home type nearly goof proof testing.

Glucose levels: There are many types of small home analyzers for blood glucose levels costing from 10.00 - 100.00 dollars. Test strips are what become expensive. These do quantitative testing, that is, they give you a number as a value that falls within a normal range for glucose. A pinprick of blood is about all that is needed. The test strips generally come with a calibration stip to calibrate the machine so that you know your results are accurate. There may be test sticks that may do this as well where you place the blood on the strip and it give a result without using a machine. Urine glucose sticks are best for measuring the presence of ketones. A by-product of acidosis that is created by abnormal sugar levels and can indicate impending or occurring respiratory problems. A foul odor of the breath can tell you this as well. Urine stick glucoses are qualitative, that is, they tell you only that it is present in varying degrees. Glucose in the urine is indicative of high blood sugar levels and that the patient has reached the renal threashold for retaining sugars and is now ridding the body of what it can't handle.
Presence of glucose on a urine stick should be verified with a blood glucose level. A patient with high sugars can display a variety of symptoms such as:

Respiratory problems
Restlessness and loss of appetite
nausea and vomiting
lethargy
coma
death

Low sugars can display the symptoms of:
Lack of energy
lethargy
thirst
increased appetite
dry mouth
visual problems

When the sugar is low dextrose and glucose are given to increase the level rapidly. Substitutes are fuit juice with table sugar added, chocolates, and other high sugar items.

When high, insulin is required to bring it down.

Monitoring blood sugar levels is highly recommended when trying to correct glucose troubles.

Normal values for blood sugar varies by the region that you live in. Average values are about 65 - 130 mg/dl. A high sugar in the 300 -400 range is better than a sugar that is 25.
Don't panic unless the blood sugar levels start reaching 600+ .

Questions?

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"The U.S. isn't running out of targets, Afganhastan is running out of targets!" D. Rumsfeld

[tangent]

Tangent wrote:
prev msgs edited per RR's request.
Deerwchr,
my apologies for being abit too confrontational. I'm glad we could find some middle ground. Still not sure where you are drawing the line of where that middle ground is - you seem to be addressing the bottom level of testing.

On the issue at hand, glucose/ketone testing. I see you are going the OTC/high tech route. In general, I see severe disadvantages to this line of reasoning, but also advantages. In many ways, the issue is mute, as the lowest common denominator is the weak link in the chain, where it all falls apart. In this case, the weak link is insulin. It's shelf life can best be described as less than stellar... Now if someone can figure out how to MAKE insulin, or alternate treatment stratagies that don't involve it, that's another story all together. The other side of the coin is glucose (or fructose, or sucrose), and that can be produced (honey, maple sap, sugar beets, sugar cane, etc) and stores very well. This topic is probably best left to it's own thread, however...

Lets look at the two sides of the testing situation with an eye to austerity in mind. Specifically, no chance to obtain additional spare parts, all repair work done in house, energy and supplies must be stockpiled or produced and this also brings up the issue of shelf life of supplies and energy sources for those items that cannot be locally produced.

high tech/OTC - ie: electronic gizmo's. These have the following advantage:
o readily obtainable
o easy to use
o quick in operation
o low to moderate in cost

They have the following disadvantages:
o easy to break
o must be calibrated
o rely on batteries or other power source
o rely on (expensive) test strips that have a limited shelf life, and are easily destroyed

Possible work arrounds:
o stocking extra units for hot swap or repair by canablism
o obtaining schmatics and spare parts
o having someone "in house" that knows electronics and has a parts inventory and test equipment to fix items.
o being able to splice in alternative energy supplies that can be locally generated.
o having the "old methods" as a backup

Additional notes on electronics: cracked circuit boards can sometimes be repaired w/ liquid solder, or a replacement fabricated from scratch. If the circuit board is multi-layer, your out of luck. Amaizing things can be done with a fork, a bic lighter, some solder from a tin can, some sap as flux and a pile of dead electronic appliences - if you have someone w/ some knowledge and inguinuity, but don't count on this as a repair strategy. Commercial electronics are going more and more to surface mount technology, this makes repairs MUCH harder! In the next few years we will be seeing FPGA (Field Programmible Gate Array) based devices entering the market, these re-route the wireing between logic elements so you can configure a device to be a cell phone one minute, a pager the next, a radio receiver the next and a PDA (or glucose test machine) the next. These will actually make field repairs easier, because if you can program them you can test for bad pathways/logic elements and route arround them to reconfigure something that will work.

"old ways" - advantages:
o less subject to failure (breaking)
o reliable (results)
o can fabricate most equipment needed in a pinch
o chemicals generally do not have the same shelf life problems
o alternate methods to obtain the same results are generaly available

disadvantages:
o relies on chemicals that may be difficult or expensive to obtain in reasoable quantities (1 lb - $10, 50 lb - $50)...
o assumes some skill, equipment (can be made) and knowledge in chemistry to make reagents
o generally more time consuming and harder than modern methods to perform tests
o when you are out of the reagents or materials to make reagents, you are out of business. (unless you can make the chemicals)
o some things can not be made (Lovibond disks, Neubauer counting chambers, etc)

I will write something on the older methods for glucose/ketone testing later, for comparison, have to get back to homework now.


[This message has been edited by tangent (edited 19 November 2001).]

[tangent]

deerwchr wrote:
I am starting with the most easily obtained testing apparatus that require the least amount of skill to operate in order to obtain results that will be reasonably accurate. Most, if not all of the OTC types have been clinically tested and developed and are acceptable. They are stout, well made items that will carry into the field in a pack with little or no fear of breakage. They can be set up and utilized within seconds and will cover a multitude of test with very little space being taken up.
As for insulin production. There are compound phamacists that can make up insulins. We have one near us that makes PZI type for us at a reasonable cost on demand. If they can do it then there might be the means of doing it yourself given the directions and availability of components.
If you wish to expound on the more difficult techniques and proceedures, by all means do so. I will not unless there is no other alternative testing methods ie. Blood Cell Counts.
------------------
"The U.S. isn't running out of targets, Afganhastan is running out of targets!" D. Rumsfeld

[tangent]

RR wrote:
Gentlemen, these are instructive!
I think we can all agree (I hope?) on one issue, and that is unless Bill Gates or Nelson B. Rockefeller are of the mindset we won't be seeing Gemini et al lab units in anyone's stores.

Glucometers - wonderful devices. Have used them for years. The best IMO are the plug in the stick, drop blood on the end, and forget till it rings you types. How long can we expect the required batteries and strips to last in storage?

Hemoglobinometers - field trialed one by Hemo-stat (I think). Handy, basically a portable reflectometer-based unit, about 1.5 lbs. Same issue.

Since the cost on any of these is 500 or less - much in the case of the glucometers, how practical are they for us?

Please keep this going. It's invaluable material.

RR


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Got band-aids? http://medtech.syrene.net/

[tangent]

Deerwchr wrote:
quote:
--------------------------------------------------------------------------------
Originally posted by Reasonable Rascal:
Gentlemen, these are instructive!
I think we can all agree (I hope?) on one issue, and that is unless Bill Gates or Nelson B. Rockefeller are of the mindset we won't be seeing Gemini et al lab units in anyone's stores.

Glucometers - wonderful devices. Have used them for years. The best IMO are the plug in the stick, drop blood on the end, and forget till it rings you types. How long can we expect the required batteries and strips to last in storage?

Since the cost on any of these is 500 or less - much in the case of the glucometers, how practical are they for us?

Please keep this going. It's invaluable material.

RR





--------------------------------------------------------------------------------

Ok, let's go with Glucometers for the moment. I use one here at home that I bought at WalMart for less than $10.00 and 50 test strips for $29.00 (the machine comes with 25 strips I believe it was). I've been using it for a year now for my diabetic cat and still have a year left on the expiration of the strips. The batteries are the original ones that came with it. The machine is the size of a credit card and the whole case with lancets, test strips and tester is no bigger than your checkbook. I've tested it with glucose controls (samples with known values) that I got the vet to lend me when I got this thing and it's dead on the money. It goes by the name of Reli(on . It comes with clear concise instructions for its use and troubleshooting.


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"The U.S. isn't running out of targets, Afganhastan is running out of targets!" D. Rumsfeld

[tangent]

Lee7.62 wrote:
I'll have to do a check on the contents of my lab kit. Basically I can do a hemacytometer cell count, spin a crit, calculate the RBC indices, give a WBC and differential for the CBC. Gram stain for bacteria. I remember enough micro to ident. most of the common pathogens but Lord help me if I had to go back and set up differential media. Mainly it would be used for gram pos, neg, intracellular or not, encapsulated, etc, etc. STool exam for OCP. Would have to get the stains together for doing AFB. In an extended period of breakdown of hygiene, healthcare we're use to TB would become more prevelent. It's already been on the rise and it's more resistant to treatment. Doing a UA would be difficult if you didn't have a supply of the strips we have become so accustom to. Remember, old doctors use to either taste urine for sugar or leave some spilled on the counter to see if ants came to it. (hence the terms pissant and sugar ants.) Not a good idea in the wonderful world of Hepatitis and HIV we have today. Eventually, we'd be breaking open the 40s,50 era textbooks and the old military lab manuals that give recipes for oldies such as Gower's solution, methylene blue, iodine, etc and making our own. To heck with QC!!!!!
I managed to bring home a bunch of old manuals from the service when I left. Being training officer helps to build the library. Throwing away oldies but goodies managed to build my library. Managed to find an old autoclave in a yard sale. Looks like a pressure cooker. Those will work, too. Sister who's a doctor gave me a small 37degree incubator. I'd love to find plans to turn a 10 speed bike gearing system and wheel into a centrifuge. Hmmmmmmmmm.
And I will be on the lookout for a decent scope. Sis being a doc, brotherinlaw being a dentist, wife having had some nursing, and me being a medtech, medic, and MSC officer seems to have the start of a medical aid station. The joke was appendectomy for a milk cow, teeth pulled for laying hens and gas always welcome before Y2K.

[tangent]

RR wrote:
Quality Control (QC) is going to be relative post-SHTF. Not by choice mind you but borne of necessity. Like I say we may have to settle for 85% + as opposed to 99.9999% positive. No 3-decimal-place values.
If I have to I can read a screen-fade ECG signal, have done that in the beginning. I'd prefer a non-fade 6 sec screen, but less vs. nothing? Far better I have that than rely on by guess and by golly.

Since a cardiac enzyme count will be out of the question I'll have to rely on signs and symptoms and watching for elevated T-waves.

So far it sounds like use what technology we can, i.e. glucometers, and rig others and do without the multi-function analyzers?

RR

------------------
Got band-aids? http://medtech.syrene.net/

[tangent]

Lee7.62 wrote:
yep, unless you're lucky enough to have laid in a bunch of reagent strips for a clinitek, a couple cubes of Isoton for the cell counter (although you could probably make a saline soln and filter it enough to work, or raid some hospital lab supply closet (hehehe) after the lights go out we'll be back to what was refered to in the service as Mickey Mouse lab work. Just mind your technique, read the procedures, turn out good work. I had a bumper sticker from school that read "WITHOUT MED TECHS DOCTORS
JUST GUESS". Until a doctor ripped it off my bumper.

[tangent]

RESQDOC wrote:
Respectfully, I would have to disagree with Deerwchr about this comment:
“Don't panic unless the blood sugar levels start reaching 600+”

Blood sugars in the 300-400 range, when seen in the face of diabetic ketoacidosis, non-ketotic hyperosmolar coma, and some other rare problems are quite enough to lead to death, as we see from time to time despite the most aggressive treatments. Thus do not be given a false sense of safety by a blood sugar that is “only” 400. Panic, of course, is never indicated, LOL.

Remember - treat the patient, not the lab test, number, EKG, etc.

Interesting thread on low tech lab. Having done low tech lab with nothing in the middle of nowhere, I appreciate your interest. I’ll try and dig out some info for you this weekend if I have time.

Later,
Keith

[tangent]

Deerwchr wrote:
LEE and RR: Thanks for the additional input. Different view points and ideas help immensly. QC will most definitely be gone but some sort is needed to ensure (on occasion) that your machine, reagents, test strips etc are functioning correctly. This could be done easily enough by sampling say 10 people that are healthy and averaging the results. If they read way low or way high you can assume that there may be a problem. Also, corrolation of the results on a patient and his/her symptoms will also act as a good indicator that things are functioning properly.
Resqdoc:
Thanks for your reply as well. I have not finished out on glucoses yet and have not covered everything at this time. As far as "not panicking" it is true that panic is never truly warranted but the Values I indicated are mearly as an idea of where the most critical points are in an elevated glucose. I know that there are cases where things do occur at lower ranges (400) but are more the exception than the rule IMHO. I, as well, do not want anyone to attain a false sense of security with any elevated value but want folks to understand that most severe reactions will happen at the higher ranges and require immediate attention.
Treat the patient and not the test is an accurate statement as wel and I concur with you on that point but also maintain that there are indeed times when those lab values are most needed to ensure that what you are diagnosing is correct and that treatment is effective.
If you have low tech info and some of the older manuals, by all means, please input. I don't know it all and a lot I have to pull from memory. I no longer have my texts and references with me so cannot resort to them. Many of the old manual procedures I have forgotten over the years and many of them were replaced by newer methods in my first years of entering the field. I have gone weak in areas that I did not work in much so thusly have forgotten much simply from the lack of performing the tests.

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"The U.S. isn't running out of targets, Afganhastan is running out of targets!" D. Rumsfeld

[tangent]

Bugs and Gas wrote:
Wow first time I ever noticed the other MT/MLT's out here. I here you all on the olde days of being a real Chemistry tech. Who here remembers flame photromitry (sp)or clening a thrombin clot out of a SMA 7 machine!!! Field Lab work is not to bad. I keep a very small lab. Mostly Urine Stix 9 a One touch Gram, Geisma and Lugols on hand a old Hemocytometer and a box of slides and plastic tubes. Plus a frozen stash of A, B Rh and Albumin. I try to rotate my stocks from the main lab at work. I keep a card on each of the team members after I make them go donate a pint. This way I get ABO Rh and Antibodys on each member. Could make my life much easier
Bugs and Gas

[tangent]

Deerwchr wrote:
Bugs and Gas:
Welcome to the board and the thread. I remember Flame Photometry all to clearly. Also doing Fe/TIBC in glass cuvettes with a spectrophotometer. Gawd what a hassel! The first lab I worked in we had an old Hycel Super 17 for chemistry and that dog was always down.
Input from another oldster in this thrad is appreciated. Jump right in.
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"The U.S. isn't running out of targets, Afganhastan is running out of targets!" D. Rumsfeld

[tangent]

TheWarHound wrote:
I think medicine will suck in a post-SHTF scemerio, without electricity & biomed to calibrate and check CQ of machines: soon, it will be a precordiol thump and check a pulse, thump & check a pulse, until rigor mortis sets in . . .
Steve

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"Make your enemies by choice . . . not by accident" - Alfred Bester

[tangent]

Tangent wrote:
Detection and estimation of glucose in urine
Principle
Glucose (sugar found in the urine of diabetics) is a reducing substance: it reduces the blue copper sulfate of Benedics solution to red copper oxide, which is insoluble.

BENEDICT METHOD:

1) Pipette 5ml of Benedict solution into a test tube
2) Add 8 drops of urine and mix well
3) Boil over a bunsen burner or spirit lamp for 2 minutes (other book says at least 5 min) or stand in boiling water for 5 min.
4) Leave the mixture to cool to room temp
5) Examine the mixture for any color change and for precipitate

Color result (glucose present) aprox concentration (mmol/liter)
Blue negative 0
Green a trace 14
Green w/ yellow precip + 28
Yellow to dark green ++ 56
Brown +++ 83
Orange to brick red ++++ 111 or more


Benedict Qualitative Solution:
Copper Sulfate (CuSO4*5H2O)……………………17.3g
Trisodium citrate (Na3C6H5O7*2H2O)…………..173.0g
Sodium Carbonate (Na3C6H5O7*2H2O)………….100.0g
Distilled water………………………………….…1000ml

Dissolve the copper sulfate crystals by heat in 100ml distilled water.
Dissolve the trisodium citrate and the sodium carbonate in about 800ml
Water. Add the copper sulfate solution slowly to the sodium carbonate/
Trisodium citrate solution, stiring constantly. Make up the mixture to
1000ml with distilled water.

[tangent]

Tangent wrote:
Testing urine for acetone
A) w/ ‘acetest’ tablets

1) put an acitest tablet on a piece of plain white paper
2) put one drop of of urine on the tablet
3) wait 30 seconds and look at the colour. If there is no acetone in the urine, the tablet will stay white or be colored yellow from the urine. If there is acetone in the urine, the tablet will will change color. If there is only a little acetone (+) it will go pale purple, if there is much acetone (++++) the tablet will quickly go to a deep purple.

B) Modified Rothera method

1) the modified rothera’s reagent used here is a mixture of ammonium sulphate, sodium carbonate and sodium nitroprusside.
2) Using a spatula, put a small quantity of powder in a test tube, enough to cover the round bottom of the tube.
3) with a pasteur pipette of urine, just moisten the powder at the bottom of the tube. 3-4 drops of urine is probably enough
4) wait one minute, hold against a white sheet of paper and note any color change.
5) If there is no acetone in the urine, there will be no color change
6) If there is much acetone a deep purple color will form rapidly
7) The folowing way of reporting can be used for this and the next method:

No color change -
Very slight purple color +-
Definite purple colour +
Slow forming med purple ++
Slow forming deep purple +++
Rapid forming deep purple ++++

C) standard Rothera Method

1) the standard Rothera’s mixture contains sodium nitroprusside and ammonium sulphate
2) use a spoon or spatula to fill the bottom half inch of a test tube with Rothera’s mixture
3) just cover the layer of powder with urine
4) shake gently – most of the powder will dissolve in the the urinewhich will become saturated with ammonium sulphate.
5) Add strong ammonia. This must be 22% or 25% ammonia w/ a specific gravity of 0.92 or 0.88. the exact ammount of ammonia to add is not important, but only to add about a third as much ammonia as urine.
6) Mix and report the color change exactly as in method B) above.

Making Rothera’s reagent

A) Standard Rothera’s reagent

Put a few crystals of sodium nitroprusside on a sheet of clean newspaper and crush then to a fine powder by rolling them with a clean dry glass bottle. Weigh out about half a gram (0.5g) of the fine powder and mix it well with about 100g of ammonium sulphate. Store the pale pink powder you get in a screw caped jar. The powder goes dark blue after a few weeks and may not work so well, so don’t make up too much of the reagent at one time.

B) Modified Rothera’s reagent

Weigh 3g of sodium nitroprusside into a plastic cup. Grind it into a fine powder w/ the bottom of a test tube. Add 100g of ammonium sulphate and 50g of anhydrous sodium carbonate. Mix well and keep the mixture in a whide mouth screw cap jar.

(Note that the modified reagent/method has better shelf life and avoids using concentrated ammonia)

[tangent]

Deerwchr wrote:
Tangent: Thanks for the methodologies for Urinary glucose and acetone. Would you also please post the signicance for each for those that do not know. :smile:
------------------
"The U.S. isn't running out of targets, Afganhastan is running out of targets!" D. Rumsfeld

[tangent]

Tangent wrote:
if much glucose (sugar) is found in a patients urine it indicates that they are a diabetic. if acetone is found in a diabetics urine, it means they will probably go into a diabetic coma shortly. The results are usefull to tell how much insulin to give the pt.
w/ benedicts method:
blue - too little sugar, at risk of hypoglycaemic coma - needs sugar.
green - levels are about right
yellow or red - sugar levels are too high, needs insulin
the urine should be collected and tested before meals, after meals the % of sugar in the urine spikes temporairly (would be yellow or red) and this is OK, but the pre-meal color should be green. If the urine is yellow or red (before meals) you should test for acetone, if you find acetone, the pt needs treatment (w/ insulin) quickly. If the pt is allready receiving insulin, but still has acetone in their urine, the dose of insulin needs to be increased.

hope I got that right...

acetone is sometimes found in urine without sugar if a pt has been vomiting, (especially in children), has been without food for some time, or in women who are very tired after a long labor (giving birth). There is seldom much acetone in the urine in these cases, and it has nothing to do w/ diabeties.

[outreachmedic]

You might check out a place called "International aid" in spring lake michigan. They have whats called a "lab in a suitcase" It can run most of your basic lab work. The microscope comes with a guarantee. All the centrafuges run off a battery that can be recharged with a vehicle or with a solar panel which is included.

We ar going to use it in our remote clinics in Ghana West Africa.

[Reasonable Rascal]

This would be worth looking in to. Hmmm, I think I know some folks who practice in pretty remote areas in Central America. ;-)

RR

[AGreyMan]

Hi Folks:

I saw the links for Reasonable Rascal's site many times on Frugal Squirrels and other boards, but thought it was only a commercial site. I did not know about this forum. I think it is great!

This topic is fantastic. I have come to the point in my emergency preparations where considering the addition of some equipment to perform basic lab tests is realistic. Although I have medical experience, it has almost always been on the treating end, not the diagnostic portion. I will be checking out some of the manuals suggested on this thread.

I wish that there was a more visual way to learn from some of you folks who have this stuff nailed down!

Anyway, thanks for sharing your knowlege.

Stay Safe,
AGreyMan

P.S.: Anybody know what one of those "Lab-in-a-suitcase" things cost?

[tangent]

> Anybody know what one of those "Lab-in-a-suitcase" things cost?

usually 2-4K... the most expensive item is usually the field microscope. If you don't need to be portable (will never carry it in a backpack) you can save a lot here by buying an older, used microscope on e-bay. other big ticket items are centrafuges, lovibond, etc. If you really shopped arround you could put together a lab for a lot less. ( < 1K ) If you want something you can put in a backpack - it will be expensive.

-t

glad you like the board.

welcome!

[AGreyMan]

Tangent:

Thanks for the welcome!

If you have a few moments, please clue me in as to the differences between a transportable microscope and a non-transportable one? Beefier, I would imagine, but any actual design differences?

Also, if you have time, what brands and models of "regular" microscope is suitable for use in a TEOTWAWKI lab? I am thinking specifically of manual CBCs, and the saline portion of the type-and-cross.

Also, any recommendations for a centerfuge?

Thanks in advance!

Stay Safe,
AGreyMan

[tangent]

yeah - field microscopes are a bit different...

http://www.microscopy-uk.org.uk/mag/libindex2.html#microscopes


-t

if it takes - rename the file from .zip to .pdf

[tangent]

for microscopes - Spencer/AO is pretty good. They are older, heavy and well made. Fairly common - can be had on e-bay for $150-200. get one w/ a mechanical stage and 100x oil immersion lens.

no real recomendation on centrifuges. the link to the 3 books on building science equip has plans for one that will do 300-500 RPM. In the chem book. this place has some battery powered and portable ones:

http://www.gordon-keeble.co.uk/dht.htm

-t

[AGreyMan]

Tangent:

Thanks for the info. The "Field Microscopes" certainly are different.

I'll haunt e-bay and see if I can find a decent, relatively inexpensive microscope.
Or maybe I can pull the fire alarm at work and swipe one from the lab! (Just kidding, of course.)

As to centrifuges, I am a (very!) amateur machinist, so maybe I can make something that will work.

Seems as though this site is kinda quiet.

Stay Safe,
AGreyMan

Edited to add: I looked at the downloaded file: Good stuff! Thanks! I noticed that there are a bunch of books on CD for sale on third world/disaster medicine and lab stuff over at the VillageEarth.org site. Anybody have these? Are they worth the money?

[Andrew Dennison]

I am new to the forum and still trying to figure this out, but here goes.

I am an Older retired MLT who hasnt worked at it since 1974, but I have volunteered with projects in developing countries. I bought a rather nice all metal cast hand centrifuge with 4 heads for under $60 from

http://www.basicsciencesupplies.com

use their search and type in centrifuge. Mine has NO plastic parts except the handle on the crank arm.

In my work I have found diagnostic tests fall into 3 catagories of necessity.

1. The patient seems to have some kind of bacterial/virus infection

2. Parasites

3. Injuries and burns

Generally I have only needed to do basic blood tests to determine blood counts, hematocrit which could show hemmoraging and micro work to identify paresites like malaria. Most of our medical aid was treatment of injuries, cuts and burns and abcesses. cleaning, suturing and providing worm medicines for the locals.

A great book is "Where There is No Doctor" by www.hesperian.org and is published in many languages on village health.

I have done type and crossmatch with only an ABO-Rh kit. you will get the type right, but no way to explore all the antibody studies a modern hospital would do. But the patient would most likely survive the donation, however might be really sick from it. In those cases I tried to type with a close reletive and we never had a serious complication. Knock on wood.

I am enjoying all the great info on this forum so far!

[FlightERDoc]

Great reference!

Is that 'fuge good enough for real use?

How about spinning 'crits?

Any other suggestions for a portable, austere lab?

Thanks again

[DrBaboon]

That does look like a nice/useful centrifuge.

http://www.basicsciencesupplies.com/Merchant2/merchant.mv?Screen=PROD&Product_Code=320353&Category_Code=labsup&Product_Count=11

That should go straight to the particular product.

The shape of the test tube holders make it look as if it's most easily used to pellet urine sediment, by placing urine tubes into the holders.

Urine sediment tubes should be re-useable after cleaning.

You could probably also separate clot from serum or cells from plasma on a blood sample with that centrifuge - the forces needed are comparable to what's used to pellet urine sediment.

Somehow or another, you'd also probably need to switch to (after buying or making) test tube holders that have the right shape to accomodate a blood tube. The more aggressive taper of the test tube holders it comes with will probably keep the round bottom blood tubes from seating all the way down and leave them sticking up.

To me, the obvious solution would be buy/make 2 test tube holders for regular blood tube, and swap them with 2 of the original test tube holders. I'd leave 2 original test tube holders for urine sediment tubes. Both types of test tube holders arranged opposite it's own type. That way you could centrifuge a blood sample or a urine sample without further changes in configuration.

Obviously, the specimen tube always need to be balanced with a tube filled to the same degree on the opposite test tube holder.

I keep blood tubes filled with water for that purpose, in case I only have one blood tube to centrifuge. You can always centrifuge 2 samples opposite each other, if the tubes are the same type and are filled to the same level. I usually simply fill a 2nd urine sediment tube with water to the same level as the urine sample in my 1st urine sediment tube each time.

I do not believe this type of centrifuge will generate sufficient forces for a spun hematocrit, nor is the capillary tube supported sufficiently in this type of set up. That's not to knock this centrifuge - a basic electric test tube centrifuge meant to separate serum in an office lab is not suited to spun hematocrits with glass capillaries, either.

[tangent]

I bought a rather nice all metal cast hand centrifuge with 4 heads for under $60 from

http://www.basicsciencesupplies.com

use their search and type in centrifuge. Mine has NO plastic parts except the handle on the crank arm.

In my work I have found diagnostic tests fall into 3 catagories of necessity.

1. The patient seems to have some kind of bacterial/virus infection

2. Parasites

3. Injuries and burns

Generally I have only needed to do basic blood tests to determine blood counts, hematocrit which could show hemmoraging and micro work to identify paresites like malaria. Most of our medical aid was treatment of injuries, cuts and burns and abcesses. cleaning, suturing and providing worm medicines for the locals.



re: centrafuge: ENVY! - mine cost arround $80-90, but it has a metal handle...

I love your practical breakdown of what/when - but want more detail - PLEASE!????

thanks,

-t

[JNT]

Just exploring options and came across these two products. Does anyone have any experience/input on them?

http://cgi.ebay.com/ws/eBayISAPI.dll?ViewItem&item=400022759772&ssPageName=MERC_VI_RSCC_Pr8_PcY_BIN_Stores_IT&refitem=390022398998&itemcount=8&refwidgetloc=active_view_item&usedrule1=StoreCatToStoreCat&refwidgettype=cross_promot_widget&_trksid=p284.m184&_trkparms=algo%3DDR%26its%3DS%252BI%252BSS%26itu%3 DISS%252BUCI%252BSI%26otn%3D8

http://www.proscientific.com/hand_centrifuge.shtml