RESQDOC
02-21-02, 14:46
Several comments here on the “Buck Rogers” threads, all lumped together ‘cause I’m lazy.
1. One of the primary purposes of this entire site is to develop new and lower cost, lower tech solutions to the problem of giving medical care. So I think that brainstorming, asking “what if” and thinking out loud about solutions is fantastic, and tangent is again to be congratulated for throwing out some questions for us to chew on – Thanks T.! Not every question may have an answer, yet, not every question may lead to somewhere, we may not all agree on the solutions proposed – but that’s OK, we are here to share, brainstorm, and learn from each other.
2. The Vagus nerve proper does not extend below the level of the transverse section of the large intestine. If you are going to stimulate that you are going to have to stick your thumb awfully far up…but wait, there’s more. There is a branch nerve, the Inferior Hypogastric plexus does extend from the sacral area and join with the pelvic plexus at the level of the ureters, this goes on to join the distal Vagus nerve. It is possible that stimulation far up inside the sacral curve at the level of S2-3-4 could stimulate this Hypogastric plexus and trigger a parasympathetic (= slow down signal) signal through to the Vagus nerve and slow a ventricular fibrillation, however the chance of this happening is unlikely, more likely to deteriorate to asystole than convert to sinus rhythm and would require stimulation up in the area of the descending colon – this is the source of the rare bradycardia seen during colonoscopies. The area between the scrotum/vagina and rectum is called the perineal raphe’ and is innervated by the perineal and pudental nerves with some involvement of the rectal nerves if you get far enough south. These connect into the spinal cord system at the sacral level and do not involve the Vagus nerve per se. There is much of value in the G-Jo system but I am going to have to disagree on this point. Stick with a precordial thump and leave the perineal raphe’ technique for more recreational endeavors.
3. Ultrasound. The portable unit in question is quite spiffy, but limited in that it does not have the ability to print out or transfer images, but I do like it. One study used this to screen for hemo/pneumothorax in the chest on the ski slopes, with mixed results and questionable utility given the expense. There are other almost as small U/S units that use 110 power starting at $3000 or so that work quite well if a portable power source was included. U/S has great utility in diagnosing many trauma and medical conditions – if you know how to read it. This takes both teaching and practice, it’s not easy. For those interested two CD-ROM’s are available that are excellent introductions, Obstetric Ultrasound Principles & Techniques and General Abdominal Ultrasound Principles & Techniques from Silver Platter Education Inc & the AMA (try the online AMA catalog) steep - $175 each as I recall. A nice capability if you can afford and use it. The concept of a home brew U/S unit is quite intriguing, I would think that the power and display modules would be quite straightforward. The transducer might be the tough part, commercial units start at about $500 and go up from there, perhaps there is some off the shelf industrial unit that could be adapted. Calling all electronic types!
4. X-Ray. Another nice modality if you can afford it. Handheld x-ray units are available that are used by podiatrists, dentists, and vets have been studied and produce some very reasonable quality films in under 30 pound units. Examples of these include adaptation of a dental unit to form a 15.5-pound unit by the Army as the HDX/medical unit and the MinXRay Company in Illinois that makes various units. There are others. Processing the film is a separate problem. I believe that the Polaroid Company was experimenting with a newer type of film and portable processor in the 20-pound range. As I recall it produced a “positive” image rather than the tradition film, i.e. the bones showed black, air white rather than the other way around. What became of this I don’t know. I believe that the medical support unit for a Special Forces deployment to south america several years ago tried a portable system with good results and published an article in Military Medicine, somebody do a search for it. Also Javahed might have some input. There were complete plans for a homebrew x-ray machine in the Scientific American “Amateur Scientist” column I believe in the early 60’s. They reported excellent results with it. 10 bonus points to anyone who can ID this quote “Why worry, each of us is wearing an unlicensed nuclear accelerator on our backs.”
5. Of course, using a video camera and light is just a form of transillumination, why not simply transilluminate? The problem is that it takes quite a bright light to accomplish much, which generally means heat as well, unless using an expensive cold light. Then there is attenuation as the light passes through the tissues, to the point that you can’t see anything at all. Still, it can be helpful for fingers, sinuses, and the like.
6. How about other means of diagnosing, fractures for example. Perhaps Javahed would be kind enough to share with us the SF take on the use of tuning forks, the two-coin test, and other similar tricks of the trade.
7. Field suction sucks, or more to the point, often doesn’t suck. In small kits I use a large syringe, 60 cc, and a small catheter and larger bit of tubing. Toomy irrigation syringes and basting bulbs are OK too. There are at least three hand-held suction units on the market that use one form or another of a squeeze handle to generate suction and dump junk into containment bottles, the Ambu Rescue Pump, Res-Q-Vac, and Laerdal V-Vac. All are OK and start around $50.00. Or you can go down to the auto parts store and get a handheld vacuum pump used to pull air out of lines for $29 and stick a tube on it. This incidentally is the EXACT same pump we use as a vacuum extraction aid for delivering babies, except that the hospital pays $250 for it, go figure…I’ll have to get the brand name when I am in the hospital tomorrow – the problem with this is that if you use it directly it tends to clog up, so you need to cobble some kind of bottle as the intermediate suction chamber. I have been meaning to do this, somebody give it a shot. A Nalgene type screw top bottle would be perfect. Look at the Res-Q-Vac or Pump and you will see immediately what I mean.
8. Regarding using a purifier to generate “usable” if not perfect solutions, I think this would be an excellent method for generating fluid for PROCTOCLYSIS but I would prefer other means for intravenous or hypodermoclysis. For those of you unfamiliar with the concepts of osmolarility, tonicity, RBC crenation and herniation, look them up. For those of you who understand these already, the problem is of course obvious. I believe that sterile water is acceptable for the rectal route, although a roughly isotonic solution would be better. The risk here of course is that you would screw up and generate an excessively hypertonic solution and worsen the dehydration rather than correct it. We often use solutions of variable tonicity for intravenous infusion, within limits, such as ¼ and ½ normal saline, D5W, etc. so a little variability is acceptable but being grossly off is not. And of course there is the entirely different problem of infection control. I think that distillation is the better course for intravenous fluid generation. Remember one of my favorite sayings, “Necessity is a mother.”
9. The EKG. The TI calculator seems an inexpensive solution certainly worth considering. There is now a package available for Palm Pilot like devices, there are several for laptops, and there is a unit available from Germany that is the size of a Palm Pilot but is a stand alone EKG with three contacts on the back – you just hold it on the chest, instant three lead! You can hook addition wires to it to get more leads, 12 I think, it has a big memory, ability to uplink to a laptop or telemetry or even a printer. I have used this, it has several years of progressive modification, works great. Price? Don’t ask.
Well I’m going outside to play with my new puppy now.
Keith
Five more bonus points if you can ID the title...
1. One of the primary purposes of this entire site is to develop new and lower cost, lower tech solutions to the problem of giving medical care. So I think that brainstorming, asking “what if” and thinking out loud about solutions is fantastic, and tangent is again to be congratulated for throwing out some questions for us to chew on – Thanks T.! Not every question may have an answer, yet, not every question may lead to somewhere, we may not all agree on the solutions proposed – but that’s OK, we are here to share, brainstorm, and learn from each other.
2. The Vagus nerve proper does not extend below the level of the transverse section of the large intestine. If you are going to stimulate that you are going to have to stick your thumb awfully far up…but wait, there’s more. There is a branch nerve, the Inferior Hypogastric plexus does extend from the sacral area and join with the pelvic plexus at the level of the ureters, this goes on to join the distal Vagus nerve. It is possible that stimulation far up inside the sacral curve at the level of S2-3-4 could stimulate this Hypogastric plexus and trigger a parasympathetic (= slow down signal) signal through to the Vagus nerve and slow a ventricular fibrillation, however the chance of this happening is unlikely, more likely to deteriorate to asystole than convert to sinus rhythm and would require stimulation up in the area of the descending colon – this is the source of the rare bradycardia seen during colonoscopies. The area between the scrotum/vagina and rectum is called the perineal raphe’ and is innervated by the perineal and pudental nerves with some involvement of the rectal nerves if you get far enough south. These connect into the spinal cord system at the sacral level and do not involve the Vagus nerve per se. There is much of value in the G-Jo system but I am going to have to disagree on this point. Stick with a precordial thump and leave the perineal raphe’ technique for more recreational endeavors.
3. Ultrasound. The portable unit in question is quite spiffy, but limited in that it does not have the ability to print out or transfer images, but I do like it. One study used this to screen for hemo/pneumothorax in the chest on the ski slopes, with mixed results and questionable utility given the expense. There are other almost as small U/S units that use 110 power starting at $3000 or so that work quite well if a portable power source was included. U/S has great utility in diagnosing many trauma and medical conditions – if you know how to read it. This takes both teaching and practice, it’s not easy. For those interested two CD-ROM’s are available that are excellent introductions, Obstetric Ultrasound Principles & Techniques and General Abdominal Ultrasound Principles & Techniques from Silver Platter Education Inc & the AMA (try the online AMA catalog) steep - $175 each as I recall. A nice capability if you can afford and use it. The concept of a home brew U/S unit is quite intriguing, I would think that the power and display modules would be quite straightforward. The transducer might be the tough part, commercial units start at about $500 and go up from there, perhaps there is some off the shelf industrial unit that could be adapted. Calling all electronic types!
4. X-Ray. Another nice modality if you can afford it. Handheld x-ray units are available that are used by podiatrists, dentists, and vets have been studied and produce some very reasonable quality films in under 30 pound units. Examples of these include adaptation of a dental unit to form a 15.5-pound unit by the Army as the HDX/medical unit and the MinXRay Company in Illinois that makes various units. There are others. Processing the film is a separate problem. I believe that the Polaroid Company was experimenting with a newer type of film and portable processor in the 20-pound range. As I recall it produced a “positive” image rather than the tradition film, i.e. the bones showed black, air white rather than the other way around. What became of this I don’t know. I believe that the medical support unit for a Special Forces deployment to south america several years ago tried a portable system with good results and published an article in Military Medicine, somebody do a search for it. Also Javahed might have some input. There were complete plans for a homebrew x-ray machine in the Scientific American “Amateur Scientist” column I believe in the early 60’s. They reported excellent results with it. 10 bonus points to anyone who can ID this quote “Why worry, each of us is wearing an unlicensed nuclear accelerator on our backs.”
5. Of course, using a video camera and light is just a form of transillumination, why not simply transilluminate? The problem is that it takes quite a bright light to accomplish much, which generally means heat as well, unless using an expensive cold light. Then there is attenuation as the light passes through the tissues, to the point that you can’t see anything at all. Still, it can be helpful for fingers, sinuses, and the like.
6. How about other means of diagnosing, fractures for example. Perhaps Javahed would be kind enough to share with us the SF take on the use of tuning forks, the two-coin test, and other similar tricks of the trade.
7. Field suction sucks, or more to the point, often doesn’t suck. In small kits I use a large syringe, 60 cc, and a small catheter and larger bit of tubing. Toomy irrigation syringes and basting bulbs are OK too. There are at least three hand-held suction units on the market that use one form or another of a squeeze handle to generate suction and dump junk into containment bottles, the Ambu Rescue Pump, Res-Q-Vac, and Laerdal V-Vac. All are OK and start around $50.00. Or you can go down to the auto parts store and get a handheld vacuum pump used to pull air out of lines for $29 and stick a tube on it. This incidentally is the EXACT same pump we use as a vacuum extraction aid for delivering babies, except that the hospital pays $250 for it, go figure…I’ll have to get the brand name when I am in the hospital tomorrow – the problem with this is that if you use it directly it tends to clog up, so you need to cobble some kind of bottle as the intermediate suction chamber. I have been meaning to do this, somebody give it a shot. A Nalgene type screw top bottle would be perfect. Look at the Res-Q-Vac or Pump and you will see immediately what I mean.
8. Regarding using a purifier to generate “usable” if not perfect solutions, I think this would be an excellent method for generating fluid for PROCTOCLYSIS but I would prefer other means for intravenous or hypodermoclysis. For those of you unfamiliar with the concepts of osmolarility, tonicity, RBC crenation and herniation, look them up. For those of you who understand these already, the problem is of course obvious. I believe that sterile water is acceptable for the rectal route, although a roughly isotonic solution would be better. The risk here of course is that you would screw up and generate an excessively hypertonic solution and worsen the dehydration rather than correct it. We often use solutions of variable tonicity for intravenous infusion, within limits, such as ¼ and ½ normal saline, D5W, etc. so a little variability is acceptable but being grossly off is not. And of course there is the entirely different problem of infection control. I think that distillation is the better course for intravenous fluid generation. Remember one of my favorite sayings, “Necessity is a mother.”
9. The EKG. The TI calculator seems an inexpensive solution certainly worth considering. There is now a package available for Palm Pilot like devices, there are several for laptops, and there is a unit available from Germany that is the size of a Palm Pilot but is a stand alone EKG with three contacts on the back – you just hold it on the chest, instant three lead! You can hook addition wires to it to get more leads, 12 I think, it has a big memory, ability to uplink to a laptop or telemetry or even a printer. I have used this, it has several years of progressive modification, works great. Price? Don’t ask.
Well I’m going outside to play with my new puppy now.
Keith
Five more bonus points if you can ID the title...