# Politics and News > SOCIETY & humanities >  "What if..." Injury thread

## Gemini

We have a few people on here with some medical savvy.  @Trinnity, @Perianne, @TheTemporaryBG, myself, and possibly others that may be lurking about.

Hypothetical injury and situation-

Grid down scenario, power will be out for 2 weeks, potentially longer due to civil unrest.

You have a gun shot (shotgun, buck shot) wound to the leg, patella destroyed, tibial plateau is basically shattered, distal segment of femur in similar condition - BUT you have a pulse in the foot.  There is arterial bleeding, entry wound on medial side of knee, exit wound is spectacular on the lateral side.  Subject is 42 year old white male, diabetic but not insulin dependent, with high blood pressure.  

Emergency services not available, what can you do, if anything, to save the life and the limb from infection/amputation?  

You start out in a walmart parking lot with what you habitually carry, and what you have in your car, transit home is going to be safe for hypothetical purposes as in your home.  Commercial stores are shut and shop keepers are busy arming themselves refusing to let customers in - resupply or going to get supplies in not any option.

How do you care for this victim?  What supplies would you use?  What things can be improvised to care for this individual until order is restored and he can get into a hospital to get his knee sort of fixed?

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## St James

If you do not have a surgeon on hand, it is assuredly fatal. tourniquet will stop most of the bleeding and pressure directly on the wound, but serious injuries like this often require intense treatment, especially when diabetes is concerned. If the bone is that badly damaged, it should probably be removed. But again, it requires immediate attention.........if it happens. The biggest concern for diabetics is infection which turns to gangrene exceptionally quick.

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## Calypso Jones

Is someone going to post a solution.    What did our forefathers do in these situations?  Was it automatic death or did they do, do it yourself surgery?    Patella destroyed?  does that mean loss of function of that leg?

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## Gemini

> Is someone going to post a solution.    What did our forefathers do in these situations?  Was it automatic death or did they do, do it yourself surgery?


In many cases, yes, and yes.  Doctors weren't the end all be all authority on medicine - mothers were.  But in those days infections were the bulk of the army's problem.




> Patella destroyed?  does that mean loss of function of that leg?


Patella = kneecap.  For the most part it destroys the function of knee extension.  Without it, there is precious little keeping the joint together from anterior dislocation.

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## Perianne

Stop bleeding if possible by applying pressure.  Apply ace bandage or similar as a pressure bandage.  The knee is not salvageable.  The collateral ligaments in the knee are gone.  The patella is gone.

I tend to have a lot of faith in the body's ability to heal wounds when there is adequate blood flow (as is indicated).  Even if patient is diabetic, if pulses are palpable in extremities, then  significant blood flow is present as slight blood flow is not  palpable. The popliteal artery in the knee is quite large.  If pulses are palpable in the foot, this suggests that the arterial bleeding in the knee is one of the minor arteries and can hopefully be stopped by pressure. 

Also, avoid nsaids as they tend to prevent proper clotting.

Without knowing more, this is the best I can do.

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## Gemini

> Stop bleeding if possible by applying pressure.  Apply ace bandage or similar as a pressure bandage.  The knee is not salvageable.  The collateral ligaments in the knee are gone.  The patella is gone.
> 
> I tend to have a lot of faith in the body's ability to heal wounds when there is adequate blood flow (as is indicated).  Even if patient is diabetic, if pulses are palpable in extremities, then  significant blood flow is present as slight blood flow is not  palpable. The popliteal artery in the knee is quite large.  If pulses are palpable in the foot, this suggests that the arterial bleeding in the knee is one of the minor arteries and can hopefully be stopped by pressure. 
> 
> Also, avoid nsaids as they tend to prevent proper clotting.


What are nsaids?  And what is the mechanism that prevents proper clotting?




> Without knowing more, this is the best I can do.


Okay.  Assuming you can get the bleeding to stop and clot properly, and that the patient is is now conscious and able to speak, you learn that he has not other health problems.

What could be done to help his future recovery during the next two weeks of grid down time?  And to have a shred of incentive to inspire you to help - his is your uncle for scenario's sake.

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## Gemini

Warning: Graphic material below.
 @Perianne @Trinnity @roadmaster




Cue to 14:13.

If you have to amputate, is leaving the wound open like they suggest still wise medical practice?

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## Perianne

> What are nsaids?  And what is the mechanism that prevents proper clotting?


NSAIDS are non-steroidal anti-inflammatory drugs.  They inhibit the chemical mechanism of platelets sticking together to form clotting.  Common nsaids are ibuprofen, naproxen, aspirin.  Aspirin is one of the first drugs given during a possible heart attack, or myocardial infarction (MI).  MIs are caused by lack of blood flow to the heart muscles, usually caused by plaque.  Blood platelets can accumulate around plaque and cause complete blockages.  Thus, aspirin will help to prevent this accumulation of platelets.  If you think you are having a heart attack, take one 325 mg aspirin and call 911.




> Okay.  Assuming you can get the bleeding to stop and clot properly, and  that the patient is is now conscious and able to speak, you learn that  he has not other health problems.
> 
> What could be done to help his future recovery during the next two weeks  of grid down time?  And to have a shred of incentive to inspire you to  help - his is your uncle for scenario's sake.


Without access to facilities and medications such as antibiotics, even the experienced medical professional can do little to aid the patient.  Keep clean bandages on the wound.  If normal saline and sterile bandages are available, wet-to-dry dressings might help to remove dead tissue and help healing, though there is considerable debate about that.  I am in the camp that wet-to-dry bandages do significant harm, but others disagree.  The main concern is bacterial contamination.  Keep the wound covered with sterile bandages and hope that the body can heal itself, as is its nature.

I have treated many terrible, unbelievable wounds in my career.  I used to work on a unit where that was the main focus.  I have seen shotgun wounds, with horrific, gaping areas of the body, survive and leave our unit.  The main thing is regular, clean dressing changes and relying on the healing power of the body... which is indeed significant.  A person with an under-perfoming immune system has a poor prognosis.

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## Calypso Jones

> Patella = kneecap. For the most part it destroys the function of knee extension. Without it, there is precious little keeping the joint together from anterior dislocation.


then without the knee cap/patella can that person walk.  Or would a brace suffice?

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## Perianne

> Warning: 
> If you have to amputate, is leaving the wound open like they suggest still wise medical practice?


While I have never worked in surgery, I have seen many patients after amputation.  From what I have seen, the amputation site is closed with only a small opening for drainage of fluids.

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## Calypso Jones

I understand it is not necessary to get the bullet out if you can control the bleeding and infection.  Is this correct.

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## Perianne

> then without the knee cap/patella can that person walk.  Or would a brace suffice?


Since in the scenario the tibia and femur (lower and upper bones of the leg) are destroyed, the person would not be able to walk at all.

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## Calypso Jones

> Since in the scenario the tibia and femur (lower and upper bones of the leg) are destroyed, the person would not be able to walk at all.


well forgot that part in the initial post.   but Peri, can a person walk with 
femur and tibia intact and a missing patella?

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## Perianne

> I understand it is not necessary to get the bullet out if you can control the bleeding and infection.  Is this correct.


In this case, the wound is by shotgun.  There would probably be several pellets in the knee.  To remove them outside of surgery would probably cause more damage and introduction of bacteria in the wound.  Only a surgeon/vascular surgeon would determine if the bullets or pellets should be removed.  Outside of a sterile environment, avoid all possibility of introducing bacteria into the wound.  Cover it and let the body heal it.  In this scenario, the major impediment to survival is bacterial contamination.  That is always the danger with wounds.

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## Calypso Jones

> While I have never worked in surgery, I have seen many patients after amputation. From what I have seen, the amputation site is closed with only a small opening for drainage of fluids.


is that opening permanent or just for the healing process?

my grandfather lost a thumb working in the N&W shops.  It was closed.  But that was a thumb.  Large limbs?   closed eventually?

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## Calypso Jones

> In this case, the wound is by shotgun. There would probably be several pellets in the knee. To remove them outside of surgery would probably cause more damage and introduction of bacteria in the wound. Only a surgeon/vascular surgeon would determine if the bullets or pellets should be removed. Outside of a sterile environment, avoid all possibility of introducing bacteria into the wound. Cover it and let the body heal it. In this scenario, the major impediment to survival is bacterial contamination. That is always the danger with wounds.


would you wash that wound initially and then maybe use alcohol/peroxide/anti-biotic OTC med.

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## Perianne

> well forgot that part in the initial post.   but Peri, can a person walk with 
> femur and tibia intact and a missing patella?


My understanding is that the patella (kneecap) is protection for the anterior (front)  knee.  I don't think I have ever run across anyone without a patella, but I don't know why they couldn't walk.  The stability of the knee would be seriously limited though.  My knowledge of the knee is not great, lol.

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## Perianne

> is that opening permanent or just for the healing process?
> 
> my grandfather lost a thumb working in the N&W shops.  It was closed.  But that was a thumb.  Large limbs?   closed eventually?


It is just for the healing.  A lot - A LOT - of fluid is generated during the amputation/healing process.  They have found it is better to drain the fluid.  When the amputation heals, the opening should close itself since there is nothing to keep it open.

I hope ya'll understand that I am a nurse and am drawing only on my knowledge, which is considerably less than that which a physician has.

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## Calypso Jones

> It is just for the healing. A lot - A LOT - of fluid is generated during the amputation/healing process. They have found it is better to drain the fluid. When the amputation heals, the opening should close itself since there is nothing to keep it open.
> 
> I hope ya'll understand that I am a nurse and am drawing only on my knowledge, which is considerably less than that which a physician has.


we understand you feel compelled to say that, but Peri, if things get bad, more than likely we're not going to have a doctor.   We'll be doing it ourselves and any advice would mean the difference between life and death.    Thanks for sharing.

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## Perianne

> would you wash that wound initially and then maybe use alcohol/peroxide/anti-biotic OTC med.


If the wound was dirty you would wash with something called normal saline, which is 0.9% salt.  I suppose tap water would be better than nothing if the wound was filthy.  The danger there would be washing away any clots that had formed.  I, personally, would cover the wound and let nature take over.  I would not put alcohol in the wound.  And NEVER put peroxide in wounds.  Peroxide is bad for wounds... very bad, unless diluted.  We rarely, if ever, use hydrogen peroxide.  Antibiotic ointments are okay for small wounds, or for wounds that have been sutured, but only for a couple of days.  Afterwards, use vaseline if an ointment is needed to prevent dressing from sticking.

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## Gemini

> It is just for the healing.  A lot - A LOT - of fluid is generated during the amputation/healing process.  They have found it is better to drain the fluid.  When the amputation heals, the opening should close itself since there is nothing to keep it open.
> 
> I hope ya'll understand that I am a nurse and am drawing only on my knowledge, which is considerably less than that which a physician has.


Not to worry.  Knowledge is good.  I figure you wouldn't tell us falsehoods and you'd limit the scope to that which you feel knowledgeable on.

I bring up injuries like this because I figure something like this could easily happen in the near future with civil unrest.

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## Gemini

> In this case, the wound is by shotgun.  There would probably be several pellets in the knee.  To remove them outside of surgery would probably cause more damage and introduction of bacteria in the wound.  Only a surgeon/vascular surgeon would determine if the bullets or pellets should be removed.  Outside of a sterile environment, avoid all possibility of introducing bacteria into the wound.  Cover it and let the body heal it.  In this scenario, the major impediment to survival is bacterial contamination.  That is always the danger with wounds.


Obviously it is wise to get the fragments out, but my concern is that if some pellets are left in, the patient is doomed because of lead poisoning.  And long bones like the femur and tibia are where the blood is created.

If lead pellets were  still stuck in there, would an amputation be necessary to save the patient's life?

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## Perianne

> we understand you feel compelled to say that, but Peri, if things get bad, more than likely we're not going to have a doctor.   We'll be doing it ourselves and any advice would mean the difference between life and death.    Thanks for sharing.





> Not to worry.  Knowledge is good.  I figure you wouldn't tell us falsehoods and you'd limit the scope to that which you feel knowledgeable on.
> 
> I bring up injuries like this because I figure something like this could easily happen in the near future with civil unrest.


Well, thanks.  I am glad to help.  

Remember, stop significant bleeding first and do it as cleanly as possible, using sterile bandages.  Second - and this is the thing that can be eventually fatal - do your best to prevent bacterial contamination.  It is bacteria that killed those guys in the Civil War, not necessarily the amputations.  When they were shot "in the gut", which was considered a kill, it is because of the release of bacteria from the bowel that resulted in sepsis and then death.

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## Perianne

> Obviously it is wise to get the fragments out, but my concern is that if some pellets are left in, the patient is doomed because of lead poisoning.  And long bones like the femur and tibia are where the blood is created.
> 
> If lead pellets were  still stuck in there, would an amputation be necessary to save the patient's life?



The body will encapsulate the foreign bodies, or pellets, and render them harmless.  The ability of the body to survive is incredible.

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## Gemini

> The body will encapsulate the foreign bodies, or pellets, and render them harmless.  The ability of the body to survive is incredible.


So it will likely create a cyst then which could then be removed at a later date?  I know that soft tissues will do that marvelously, but bone does everything slower doesn't it?

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## Perianne

> So it will likely create a cyst then which could then be removed at a later date?  I know that soft tissues will do that marvelously, but bone does everything slower doesn't it?


In all likelihood, the "cysts" would not even need to be removed.  Since it is in a joint, then maybe so.  Probably, in the long run, the tibia/knee/femur injury would require total knee replacement.  The bones would not heal themselves to make the knee functional.  And neither would the ligaments.  I cannot envision any outcome other than total knee replacement to have a functional leg.

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## Gemini

> In all likelihood, the "cysts" would not even need to be removed.  Since it is in a joint, then maybe so.  Probably, in the long run, the tibia/knee/femur injury would require total knee replacement.  The bones would not heal themselves to make the knee functional.  And neither would the ligaments.  I cannot envision any outcome other than total knee replacement to have a functional leg.


I kinda figure that without a knee replacement this imaginary victim will simply hobble about for the rest of his days assuming he lives.

What about cloth that tears and is left in the wound cavity?  Is the body pretty good about breaking that down or does that need to come out ASAP?

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## Perianne

> I kinda figure that without a knee replacement this imaginary victim will simply hobble about for the rest of his days assuming he lives.
> 
> What about cloth that tears and is left in the wound cavity?  Is the body pretty good about breaking that down or does that need to come out ASAP?


It would need to come out ASAP, as would any other such material.  I happen to know about bullet fragments/shotgun pellets being left in the body because of my experience in the medical field.  They often are left in for life.

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## Gemini

> It would need to come out ASAP, as would any other such material.  I happen to know about bullet fragments/shotgun pellets being left in the body because of my experience in the medical field.  They often are left in for life.


Why are they left in when they could be removed during the initial treatment?  That makes no sense to me.  You'd think leaving them in would cause for a lasting recurring pain in the area.

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## Perianne

> Why are they left in when they could be removed during the initial treatment?  That makes no sense to me.  You'd think leaving them in would cause for a lasting recurring pain in the area.


They _are_ removed when practical.  But in this case, the biggest dangers are (1) bleeding (2) bacteria.  So leave them in to avoid a worse outcome than would be if they were left in.  

In surgery, after a gunshot wound, they are removed IF removing the fragments would not cause additional damage.  As per your service in the military, you know that a bullet commonly will break apart.  If a fragment goes into an area where it is doing no harm by being there, and removing it would cause significant additional tissue damage, then it is better to leave it alone and let the body encapsulate it.  If the fragment causes pain later, it can then be removed.  In my experience, the encapsulated foreign body causes no pain.  The encapsulation is as smooth as a pearl and the surrounding tissue is not affected by it being there.

That is the way I understand it.

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## Gemini

> They _are_ removed when practical.  But in this case, the biggest dangers are (1) bleeding (2) bacteria.  So leave them in to avoid a worse outcome than would be if they were left in.  
> 
> In surgery, after a gunshot wound, they are removed IF removing the fragments would not cause additional damage.  As per your service in the military, you know that a bullet commonly will break apart.  If a fragment goes into an area where it is doing no harm by being there, and removing it would cause significant additional tissue damage, then it is better to leave it alone and let the body encapsulate it.  If the fragment causes pain later, it can then be removed.  In my experience, the encapsulated foreign body causes no pain.  *The encapsulation is as smooth as a pearl and the surrounding tissue is not affected by it being there*.
> 
> That is the way I understand it.


I see the merit of that now.  No sense in dragging something sharp across tissues when you could wait a big and drag something smooth.  Especially when it is near stuff like nerves and thin fascia of certain muscles.

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## Roadmaster

> The main thing is regular, clean dressing changes and relying on the healing power of the body... which is indeed significant.  A person with an under-perfoming immune system has a poor prognosis


 Yes that and if you are out without a Dr. you may have to cauterize the wound to keep from bleeding to death. She pretty much answered all the questions. There have been cases where it's best to leave the bullet in. And yes some opening to allow fluids to drain.

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## Trinnity

> If you have to amputate, is leaving the wound open like they suggest still wise medical practice?


I don't know, but in a survival situation I would think stopping the bleeding is job 1. Then keeping it cleaned and covered is the best course.




> then without the knee cap/patella can that person walk.  Or would a brace suffice?


The patella's purpose is to protect the joint. A person could still walk, I think. It might be that the leg would be less stable.





> So it will likely create a cyst then which could then be removed at a later date?


About cysts...they may be good-to-go and be left alone, but it depends on if they grow much and where they are. For example, if a cyst (say from glass that got in there from an accident of  some king) was on the anterior surface of the thumb at the joint , it would prevent you from bending the thumb if it grew past a point. Then it would need to be removed.

 @periann, feel free to correct me on anything I might write that's not entirely correct. You "outrank" me in some areas since I'm an xray tech.

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## Roadmaster

> Yes that and if you are out without a Dr. you may have to cauterize the wound to keep from bleeding to death. She pretty much answered all the questions. There have been cases where it's best to leave the bullet in. And yes some opening to allow fluids to drain.


Oh yea we have lasers now all types of new stuff. It's actually amazing to watch some of these specially Dr.s work.

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## Perianne

> @periann, feel free to correct me on anything I might write that's not entirely correct. You "outrank" me in some areas since I'm an xray tech.


 @Trinnity We are all part of the same team.  We in ER could not make it without you guys.

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## Perianne

> It's actually amazing to watch some of these specially Dr.s work.


Yes it is.  Sometimes they make me go "wow!".

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## Perianne

> About cysts...they may be good-to-go and be left alone, but it depends on if they grow much and where they are. For example, if a cyst (say from glass that got in there from an accident of  some king) was on the anterior surface of the thumb at the joint , it would prevent you from bending the thumb if it grew past a point. Then it would need to be removed.


 @Trinnity

I know you see lots of things.  But doesn't it amaze you the injuries from which people can recover?

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## Trinnity

> @Trinnity We are all part of the same team.  We in ER could not make it without you guys.


Thanks, hon. Yes, without xray, mortality rates would skyrocket and suffering would too. It's a miracle of technology. But, lol, there are parts of the body I know little about because I don't xray them. Spleen? A reservoir of emergency blood. That's all I know. See?


Yeah, we da team. The docs would be totally effed w/o us.

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## Trinnity

> @Trinnity
> 
> I know you see lots of things.  But doesn't it amaze you the injuries from which people can recover?


I don't see much recovery - not like you do. I see more of the urgent and the chronic.

But it's amazing and says so much about the will to live. The one thing that worries is the time window in a crisis. You know what I mean.

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## Perianne

> Thanks, hon. Yes, without xray, mortality rates would skyrocket and suffering would too. It's a miracle of technology.


I know!  How many patients have been x-ray'd and found to have pneumonia?  Sometimes we don't EVEN expect that until the chest x-ray.

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## Calypso Jones

Except when it is used to pad the bank accounts of founding physicians.   In our local hospital, before you could go into the hospital, you were required to have a chest xray.   EVEN if you were pregnant.    How many children have been irradiated for no good reason at all. As well as their mothers.   NOT to mention the thousands of patients forced to go thru that.

I'm not saying that xrays aren't beneficial. But physicians and hospitals tend to abuse technology.

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## Trinnity

> I know!  How many patients have been x-ray'd and found to have pneumonia?  Sometimes we don't EVEN expect that until the chest x-ray.


Pneumothorax anyone???

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## Trinnity

> Except when it is used to pad the bank accounts of founding physicians.   In our local hospital, before you could go into the hospital, you were required to have a chest xray.   EVEN if you were pregnant.    How many children have been irradiated for no good reason at all. As well as their mothers.   NOT to mention the thousands of patients forced to go thru that.
> 
> I'm not saying that xrays aren't beneficial. But physicians and hospitals tend to abuse technology.


The more pressing concern is for kids having head CTs at the drop of a hat. Not a good idea. 

Pregnant women and children can and should be shielded. And the scatter from xray is not really a concern. Trust me on this. People are scared of what they don't understand.

As for the entry CXR, you may have a valid concern there. I don't know...the chest is a big deal and can often pick up silent problems.  Maybe most hospitals include that in standing orders; I don't know. In areas of the country where there are a lot of migrant workers or illegal aliens from Mexico, I'd recommend it for sure. WHY? 

*Tuberculosis*.

 @Perianne, what do you know about the inclusion of CXRs in standing admission orders? Is that routine?

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## Perianne

> Except when it is used to pad the bank accounts of founding physicians.   In our local hospital, before you could go into the hospital, you were required to have a chest xray.   EVEN if you were pregnant.    How many children have been irradiated for no good reason at all. As well as their mothers.   NOT to mention the thousands of patients forced to go thru that.
> 
> I'm not saying that xrays aren't beneficial. But physicians and hospitals tend to abuse technology.


Yes, that would annoy me.  And it is wrong.  Should be illegal.

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## Perianne

> The more pressing concern is for kids having head CTs at the drop of a hat. Not a good idea.


Waaaaaayyy too much of that.  Sometimes parents demand it.  Most of our physicians say "no".

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## Perianne

> @Perianne, what do you know about the inclusions of CXRs in standing admission orders? Is that routine?


No.  Only for certain things, which as you know, is understandable.

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Trinnity (07-09-2013)

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## Trinnity

Note to @Perianne, see edit in my last post.

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## Perianne

> Note to @Perianne, see edit in my last post.


 @Trinnity
I saw your edit.  Thinking about it again, no, it is not a standing order.  But most patients get a chest x-ray and for good reason.  Like you said, lots of hidden things can be revealed with a simple chest x-ray.  It is a tiny amount of radiation that can have big payoffs.

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## garyo

Getting back to topic, I would just shoot him, I don't have time to screw with him.

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## Perianne

> Getting back to topic, I would just shoot him, I don't have time to screw with him.


What if it was a goat?

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## Trinnity

> @Trinnity
> I saw your edit.  Thinking about it again, no, it is not a standing order.  But most patients get a chest x-ray and for good reason.  Like you said, lots of hidden things can be revealed with a simple chest x-ray.  It is a tiny amount of radiation that can have big payoffs.


In fact, it's no more radiation than you would get sitting on the beach for about 10 minutes.

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## Trinnity

> What if it was a goat?


Fresh meat and jerky.

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## Calypso Jones

> In fact, it's no more radiation than you would get sitting on the beach for about 10 minutes.



with each kid, not to mention, xrays at the dentist, the foot doctor, orthodontist, etc?   So this radiation does not remain in the body and increases with each xray?

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## Trinnity

> So this radiation does not remain in the body and increases with each xray?


 no


I could explain radiation half-life to you, but I'll spare you the boredom

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## Perianne

> with each kid, not to mention, xrays at the dentist, the foot doctor, orthodontist, etc?   So this radiation does not remain in the body and increases with each xray?


 @Trinnity this is for you.

Edit:  Never mind.  You beat me to it.

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Trinnity (07-09-2013)

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## Perianne

> I could explain radiation half-life to you, but I'll spare you the boredom


I don't think @Calypso is a nerd.

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## Gemini

> no
> 
> 
> I could explain radiation half-life to you, but I'll spare you the boredom


Radiant material won't remain - you're absolutely right.  But I think what @Calypso Jones is alluding to is the imperfections in cellular regeneration due to minute damage to existing DNA strands, thus leading to damaged data for protein RNA transcription - which leads to imperfect cellular regeneration.  Every now and then a big enough mistake happens and we get things like cysts and tumors that are filled with really weird stuff like teeth, hair, bone fragments...

Radiation will take its toll if not taken seriously.  But the average amount that the X-ray machines are spitting out is laughable at best.

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## Calypso Jones

well THAT is a relief!!

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## TheTemporaryBG

@Gemini 

What I would have on me now or what if I was preparing for this?  Right now I'd have to use a belt as a tourniquet, though I might have on a reserve weekend my gear with me in the car.  Salt water, hydrogen peroxide if you have it, I guess I need more info.  As you know we had that quick clot stuff on us.

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## Gemini

> @Gemini 
> 
> What I would have on me now or what if I was preparing for this?  Right now I'd have to use a belt as a tourniquet, though I might have on a reserve weekend my gear with me in the car.  Salt water, hydrogen peroxide if you have it, I guess I need more info.  As you know we had that quick clot stuff on us.


I have since decided that quick clot is the devil.  I am in favor of styptics vs. incendiaries.  Less trauma and danger to both the patient and the applicator.  No need to worry which way the wind is blowing.

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