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Old 03-11-2019, 07:12 PM
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Default Book Review: Survival and Austere Medicine, 3rd ed.



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This free to download book is a joint effort of about a dozen semi-anonymous medical professionals. Despite the fact that it's self-published and written by amateur writers, itís the best book Iíve seen dealing with medical care in a SHTF situation. Unlike some of the wilderness medicine books that assume help is a helicopter ride away, Survival and Austere Medicine assumes thereís no help coming and tailors its advice to situations where self-care is the only option.

Pros:
1) Useful for both laymen and medical professionals and it usually points out that a procedure is too advanced for someone without formal medical training to perform.
2) The book covers many of the conditions and diseases likely to be encountered in a SHTF situation
3) Detailed assessment and examination instructions
4) A detailed list of recommended medical supplies is given
5) Debunks a few prepper myths such as maggot therapy which results in a 75% mortality rate unless the maggots are sterile

Cons:
1) It wouldnít hurt to have more detail on the symptoms of diseases. Iíve found this to be an issue with other prepper medical books. Web MD and the Mayo Clinic website do a better job of describing symptoms
2) Book could have used better editing
3) Chapter on veterinary medicine appears out of place

Just Strange
1) The authors seem to be infatuated with rectal rehydration which is discussed in several sections

This is definitely a book worth downloading, and, if you are prepping for a grid down situation, printing out, although the 600+ pages will probably cost you $50 or more to print at a print shop.

Hereís the download address:
https://docs.wixstatic.com/ugd/3b311...a4d441b662.pdf
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Old 03-11-2019, 07:39 PM
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Disclaimer: I have no professional affiliation with the authors.

From a clinical perspective this is IMO an excellent book on the topic.

No offense intended, but if looking for a more definitive treatise on symptoms, and how to deal with them in austere times - also get a 50s or early 60s copy of the Encyclopedia Britannica, a 70s edition of the Merck Manual, and the latest iterations of the Merck Manual & Where There Is No Doctor / Dentist - 'horses for courses'.

Rectal rehydration may sound weird but the science is fundamentally (sorry :-) ) correct. For those of us used to getting cannulas in, in the field, in the very ill, maybe less need; but for those not so trained and / or without cannulas, it's a workable solution (no pun intended this time) especially in children. And much easier to learn than the interosseous approach.

A useful review of the technique applied-in-the-field:
https://ndnr.com/gastrointestinal/en...f-uncertainty/
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Old 03-11-2019, 10:57 PM
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I know one of the co-authors. This newest edition is one of the best prepper medical books around. Useful for doctors and nurses that may not, propbably will not, have their normal selection of tools of the trade and treatments with them or available at all, as well as providing useful information for those with at least some moderate training, and some things even a layman can follow.

Just my opinion.
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Old 03-12-2019, 12:20 PM
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(takes a bow) On behalf of the author team we thank you.

Regarding the listed Cons:

1.) I agree on the detail aspect but we are already at 600+ pages and pricing ourselves out of reach for print costs for the color edition. To offer more detail for the disease symptoms would have added another 100 pages. Not everyone can follow the logic path and arrive at an educated conclusion as to what a malady is. That is why the References chapter, to point the reader to those books that expand upon the knowledge base. Not everyone needs to extra info, hence the referrals for those that do or have the interest in learning more.

2.) Editing: willing to listen. We did what we could with the time and resources available. Personally I would have liked an Index and a Glossary as well.

3.) Veterinary practice has a definite place in the prepper medicine world. Animals are key to long-term survival, and there is very little offered from a prepper standpoint. There is Where There Is No Veterinarian but good luck trying to find a copy. The vet who wrote that chapter is also trying to learn people medicine as well, the better to address matters in their immediate area. In a grid-down world you might be lucky to find a dentist as the highest-qualified medical professional. Hope and pray that they are of a preparedness mindset and put away reference materials and related supplies accordingly. Myself I would rather have a competent vet with some surgical skills practice that extends beyond the oral cavity.

Just Strange:

We're very anal. That's why we wrote the book.

Actually Madoc hit the nail on the head. Proctoclysis is a valid technique of long-standing that most laypeople can learn and use effectively. There are limitations, of course, but absent an IO drill or related, or the ability to perform a venous cut-down it is your only other choice aside from hypodermoclysis (which still requires sterile needles, tubings, etc, unlike procto).

BTW, the book is available in printed form, saving your printer and pocket a work-out for the B/W versions at least. Mind you there are no royalties involved in the book; the cost is for the printer only. The cost difference between the B/W and color version was eye-opening though, for me anyhow.

https://www.lulu.com/shop/search.ep?...utorId=1550817

RR
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Old 03-12-2019, 07:00 PM
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Quote:
Originally Posted by Reasonable Rascal View Post
(takes a bow) On behalf of the author team we thank you.

Regarding the listed Cons:

2.) Editing: willing to listen. We did what we could with the time and resources available. Personally I would have liked an Index and a Glossary as well.

3.) Veterinary practice has a definite place in the prepper medicine world. Animals are key to long-term survival, and there is very little offered from a prepper standpoint. There is Where There Is No Veterinarian but good luck trying to find a copy. The vet who wrote that chapter is also trying to learn people medicine as well, the better to address matters in their immediate area. In a grid-down world you might be lucky to find a dentist as the highest-qualified medical professional. Hope and pray that they are of a preparedness mindset and put away reference materials and related supplies accordingly. Myself I would rather have a competent vet with some surgical skills practice that extends beyond the oral cavity.

RR
Thanks for writing this book. With regards to editing, I wasn't trying to be overly critical. Since this is a free book no one really has any right to complain. I simply meant to point out to others that they shouldn't expect an extremely polished book. But I prefer your book to the Survival Medicine Handbook which appears to be professionally edited but is weak in some areas even though it's a decent prepper medical book

While I agree that veterinary medicine is very important to well prepared preppers, I merely meant that it seems strange to have a solitary chapter on vet med in a human medicine book.

With regards to rectal rehydration: I was aware of the theory before I read your book. I was just surprised it was mentioned three or four times. Bear Grylis (in)famously demonstrated the technique on his show and there was a survival show where the participants suffered this treatment.

Anyway, you wrote a great book and I've read it and incorporated much of the material into notes I keep on medical preps.
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Old 03-12-2019, 10:48 PM
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No offense taken, sir. Was just wondering. We came a long ways from the 2nd edition (210 pages) and that a far cry from the original FAQ's published back in "98 to Usenet.

No one has done vet medicine before, so we thought we'd keep the lead. You may have noticed the vet also wrote the women's medicine chapter as well. At least one of the authors (non-vet that is) keeps animals as part of their preps so there was interest amidst the group to begin with.

We have been kicking around the idea of a Vol II, because the printing cost of the existing book is already high, and were we to add another 200+ pages to that even the B/W versions would be getting prohibitive. A 2nd volume would offer options; add blocks as affordable, or just the one that interests you the most.

Some of the potential added areas would include basic surgery and respiratory chapters. Doubtful it would happen yet this year, but hope springs eternal.

RR
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Old 03-16-2019, 10:46 PM
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Very well written book for those who have little to no training in medicine. I think/hope this book would stimulate a person with interest here to peruse further education.

I would suggest anyone who wants to use a book like this for TEOTWAWKI days, they read the book now. Today is the day to learn and understand the concepts and verify safety and validity of the book you may one day call your bible. No book is perfect, and without formal training, you are resting your life on the heels of a "use at your own risk" disclaimer. And, it's there for a reason.

For example, on page 53,

In an austere situation, I would at all costs avoid any vicryl or other multifilament suture. If one is making the commitment to purchase to have on hand, Nylon (ensure monofilament type it does come braided too) for "simple" closures will work just fine. If you want absorbable suture, go with monocryl/byosin. Monofilament sutures have a lower rate of infection, and we are discussing suboptimal situations and possibly without antibiotic options. One can always close the skin tight with running mattress monocryl and still finish with simple interrupted nylon for strength.

Missing in this section is a skin stapler. This is probably the best tool for the untrained in an emergency setting attempting to close skin AND the trained in a large wound where there is a benefit for a fast closure.

3-0 or 4-0 is best for hands because you likely get it on a PS2 needle making smaller skin holes, is easier to manipulate for someone who may have never sutured before. Also when purchasing for skin closure, one needs to ensure they are buying a "cutting" needle. Taper points should be reserved for deeper tissues as they will be more difficult to pass through the subcuticular and risk skin tears as one needs to apply more force at the insertion points and forceps holding points.

Scissors should be ones with a point on the end to allow for removal of the suture on a later date. Forceps should have "teeth" as this will allow manipulating the skin much easier and reduce sheer/tearing.

small clips is ambiguous here - Surgical hemaclips? To permanently "tamponade" a bleeding artery?

Also, I would not recommend someone to insert an NG tube to control nasal bleeding - ever. This is more likely to make it worse, not better... I think perhaps the author of that section is thinking of a "foley catheter"? I would hope this section be removed/revised to protect the readers.
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Old 03-20-2019, 03:24 PM
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Quote:
Originally Posted by Im RIght View Post
Very well written book for those who have little to no training in medicine. I think/hope this book would stimulate a person with interest here to peruse further education.

I would suggest anyone who wants to use a book like this for TEOTWAWKI days, they read the book now. Today is the day to learn and understand the concepts and verify safety and validity of the book you may one day call your bible.
Couldn't agree more, don't trust, verify everything. Overall this book gets 4 of 5 stars IMO. Already mentioned a few macrolide antibiotic inconsistencies in other threads, won't rehash those here but some others the authors might want to look into more closely for the next edition:

Cephalexin is a "Second generation cephalosporin antibiotic". pg 546
Clindamycin "Is a stand-alone class antibiotic". pg 548
Doxycycline indicated for "c diff" infections. pg 548
Bactrim has "very little effect against gram positive infections (streptococcal infections are an exception)". pg 550

There's others, but are what I'd call omissions rather than inaccuracies, so maybe not worth mentioning.

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Originally Posted by Im RIght View Post
small clips is ambiguous here - Surgical hemaclips? To permanently "tamponade" a bleeding artery?
Question on the hemoclips, they make ones to permanently tamponade/ligate an artery? As in leave it attached and close the wound? Are they better than using suture material?
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Old 03-23-2019, 11:48 AM
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Originally Posted by Borskill View Post
Couldn't agree more, don't trust, verify everything. Overall this book gets 4 of 5 stars IMO. Already mentioned a few macrolide antibiotic inconsistencies in other threads, won't rehash those here but some others the authors might want to look into more closely for the next edition:

Cephalexin is a "Second generation cephalosporin antibiotic". pg 546
Clindamycin "Is a stand-alone class antibiotic". pg 548
Doxycycline indicated for "c diff" infections. pg 548
Bactrim has "very little effect against gram positive infections (streptococcal infections are an exception)". pg 550

There's others, but are what I'd call omissions rather than inaccuracies, so maybe not worth mentioning.



Question on the hemoclips, they make ones to permanently tamponade/ligate an artery? As in leave it attached and close the wound? Are they better than using suture material?
To answer your question, not assuming the author's intent in the verbiage...

Autosuture makes a small, medium, and large preloaded multi fire hemoclip applier which is what I assume this author might have been writing about and what you seem to be asking about. example here: https://www.ethicon.com/na/products/...e-clip-applier

The surgical hemoclips are sized from maybe a 2 mm opening to extra large that will clamp down on up to a 10 mm section. Bleeding control is important, but most can be controlled with direct pressure and will stop once the tissue is sewn back together.

The concern I have is the untrained person may attempt to clamp off a small bleeder, but also clamp off the large vessel supplying the blood to the bleeder and the rest of the limb. Or maybe without the benefit of suction, they just push down to grab the tissue, but also grab a nerve... Bleeding stops all would seem good. Visualization is not optimal in a trauma under the best conditions and training with OR equipment...

I can see a lot of things going wrong attempting to stop bleeding with permanent deep clips in the hands of the untrained/inexperienced.

Almost all bleeding can be controlled with tissue closure and pressure dressings. And, I think someone untrained, in the SHTF environment attempting to do more than what they KNOW how to do... the risks outweigh the benefits.
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Old 03-23-2019, 03:20 PM
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Thanks Borskill, as I’ve said before we absolutely welcome corrections and I have been collecting them for an update. We welcome ommisons as well - cannot fix them if we don’t get any feedback on them - when you read something dozens of times it all blurs. Points are noted re abs - I know Clindamycin is a lincomysin - the comment was in reference to the fact I understood Clindamycin was the only one on the market and Lincomycin A was gone.

I’m Right - the disclaimer at the beginning of the books says exactly that and ends with “Trust but verify. "Доверяй, но проверяй" Russian folk proverb”
Also I think staplers are in there - maybe not in huge detail, but certainly covered - in the wound section.

We genuinely want feedback - PM and I will give you my email.

Thanks.
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Old 04-21-2019, 09:33 AM
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Ketamine section (pg 566)

Quote:
Pain relief in an adult: 20-50 mg IV every 3-5 minutes.
Is that right? Seems a bit high, unless the patient is an elephant.
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Old 04-22-2019, 05:37 PM
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Morphine section (page 565)
Quote:
IV for analgesia: 1-5 mg every 3-5 minutes for an adult.
Like Ketamine that's not right either, I think what the authors meant to say was direct IV injection of morphine (and Ketamine) is done slowly, as in injected over 3-5 minutes, not every 3-5 minutes. -1 star for dangerous dosage/administration directions, 3 of 5.
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Old 04-22-2019, 07:20 PM
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I reiterate the invitation to get in touch with your feedback and to help edit it. Medical editing is a challenge as when you read something 20 times it all blurs.

I agree accuracy is important for safety. But disagree with with your safety comment - the dosing and time frames are not unsafe - but could be better worded with max doses and who to use the lower end of the spectrum in - the point of giving a range is that different people need different doses. Our ems dose for both ketamine and morphine reads exactly as written here and we are not drowning in narced and dissociated patients.

Specifically with the ketamine an infusion titrated to effect is probably the optimal approach to pain rather than bolus dosing, with bolus dosing we have had a lot of problems with side-effects / lack of efficacy at the lower doses - the 5-20mg range so we have increased it and are happy with the change. Certainly we haven't seen any serious ADRs.

Your welcome to snipe here if you want but we also welcome your direct input - like i have said before, we want to produce a useful book for the wider prepper community and the feedback in important.
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Old 04-23-2019, 07:23 AM
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Quote:
Originally Posted by bce1 View Post
I reiterate the invitation to get in touch with your feedback and to help edit it. Medical editing is a challenge as when you read something 20 times it all blurs.
This is a book review thread, I'm not interested in a new hobby. Maybe someone will take you up on your offer if you post it in the "looking for - want to buy" section.

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Originally Posted by bce1 View Post
I agree accuracy is important for safety. But disagree with with your safety comment - the dosing and time frames are not unsafe - but could be better worded with max doses and who to use the lower end of the spectrum in - the point of giving a range is that different people need different doses. Our ems dose for both ketamine and morphine reads exactly as written here and we are not drowning in narced and dissociated patients.
According to the PDR (on morphine), "Initially, 2 to 10 mg/70 kg IV, IM, or subcutaneously every 3 to 4 hours as needed, titrated to pain relief." and "Peak analgesia is obtained within 20 minutes after IV injection". Following only the instructions on page 565 of your book you'd have up to 30mg onboard in 18 minutes, possibly 2 minutes before the analgesic effect from the first dose even peaked. Since I was incorrect in my assumption that you meant injecting it "over" 3-5 minutes, then you've made no mention of the slow infusion requirement ("over 4-5 minutes" as recommended in the PDR), and by failing to mention it are ignoring the warnings that, "Rapid IV injection of morphine may result in an increased frequency of adverse effects. For example, the maximum CNS effects occur 30 minutes after administration. Rapid intravenous administration could result in an overdose.". That an individual may be alone and self-administering this according to your dosing instructions, or lack thereof, makes it even more dangerous. I'll stand by my earlier comment that the instructions as worded are dangerous.


Quote:
Originally Posted by bce1 View Post
Specifically with the ketamine an infusion titrated to effect is probably the optimal approach to pain rather than bolus dosing, with bolus dosing we have had a lot of problems with side-effects / lack of efficacy at the lower doses - the 5-20mg range so we have increased it and are happy with the change. Certainly we haven't seen any serious ADRs.
You're the doctor, my point is that there's an assumption on the part of the reader that the dosage recommended is both safe and likely to achieve the desired effect when given as directed over some reasonable amount of time. If you state 50mg every 8 hours, as in the case of Tramadol a few pages earlier, then shouldn't we expect that amount at that frequency is generally safe? What then about "Pain relief in an adult: 20-50 mg IV every 3-5 minutes." for Ketamine, is that dose at that frequency generally safe and effective? And again, since I was mistaken that you were referring to a slow IV push, then the book makes no mention of the requirement that, "Ketamine must be administered slowly over at least 60 seconds; more rapid intravenous administration can result in respiratory depression, apnea, and enhanced pressor response."

Quote:
Originally Posted by bce1 View Post
Your welcome to snipe here if you want but we also welcome your direct input - like i have said before, we want to produce a useful book for the wider prepper community and the feedback in important.
This is my direct input about the book, sounds like public praise for the book is welcomed but you'd prefer any inadequacies to be discussed with the authors privately?
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Old 04-23-2019, 07:18 PM
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Thanks Borskill,

Not sure I have welcomed or sort out praise anywhere to be fair. Ultimately you can post comments where you like. We have had several other health professionals engage with us around language and clarity and corrections (because we absolutely know it has more hiding in there) and its a more useful way IMO. We want to improve the quality and will take notice of your comments regardless - I was just hoping you might engage directly - but if you don't want to that is ok.

You right about the wording - I thought I acknowledged that - my comments were more the dosing is correct - just the caveats - that are required, are absent or not clear.

BCE
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