Completed Preventing Ashes to Ashes & Dust To Dust

Mere & Trevor sit in on a class with Nya at the Panacea.

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Syka is a new settlement of primarily humans on the east coast of Falyndar opposite of Riverfall on The Suvan Sea. [Syka Codex]

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Preventing Ashes to Ashes & Dust To Dust

Postby Nya Winters on July 17th, 2017, 2:49 am

Timestamp: 10th of Summer, 517 AV


The Kelvic shifted restlessly. She was settled on cushions inside the loosely termed healing clinic of Syka. Just a simple structure, one that could not be called a building by any means in another city, the open-aired rancho was covered in a palm frond roof and only had glistening mosquito netting that wad currently drawn up against pillars inactive. It was a very exposed place, though Nya still felt safe in Syka. She just wasn't used to not having walls. She liked the fact a great deal, but it still felt strange not to be penned in.

A breeze blew up her hair and whispered in her ear that others were coming. Nya noted them when they padded up the wooden steps and joined her on the cushions making up the main floor of the Panacea.

Jansen and Kalum Alavarth were still working in what appeared to be some sort of lab next to the open aired pavilion, knowing it wasn't quite time yet to start the class on medicine. Nya had brought a blank book and pen with ink so she could take advantage of notes if she needed them. The kelvic was having her doubts about picking up some basic medicine and jungle healing.

Nya knew she needed to learn something about medicine, and taking a class from the Akalak with his twin souls seemed the best way to do so. She just hoped she knew a few people in the class. Syka was small, but there were newcomers every day.

When Merevaika arrived, Nya smiled and nodded a greeting. The second man she did not know, so all she did is offer him a smile and say simply... "Hello. I'm Nya. Are you both here for Jansen's class? Basic Medicine in the Jungle?" The Kelvic asked, tossing her her brindled hair which had already started to creep loose from its long braid. Nya was dressed in a simple pair of cotton shorts and a thin tank top. Her feet were bare as she'd kicked her sandals over to the side. Her blank journal lay open on her lap and her pen and ink were handy in case Jansen started.

Nya kept one eye on the newcomers and one eye on her would-be instructor. She decided he was definitely getting ready to approach and start things going.

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Last edited by Nya Winters on August 14th, 2017, 3:41 am, edited 2 times in total.
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Preventing Ashes to Ashes & Dust To Dust

Postby Trevor Hightly on July 17th, 2017, 4:19 am

Timestamp: 10th of Summer, 517 AV


The boards of the Alavarth twins' clinic creaked a bit as Trevor's brown boots sat down gently onto them, carrying the man unobtrusively over to where the other students sat. The young man noted the faces of the two women that entered the Panacea before he had.

Trevor's blue eyes did not stare rudely at either woman as he approached them; although, the young man's curiosity couldn't help but be a little caught on the deep green and brown colors of Nya's hair--it was as if the woman's locks were the color of the forest only darker and more sinister, almost covertly masquerading as brown, something that Trevor found a bit odd but nonetheless not worthy of more than a passing and lighthearted curiosity and amusement.

Merevaika also caught Trevor's gaze momentarily on the short walk over to the two. The girl was wild-looking, but also distinctly foreign in her appearance; Trevor had spent his life around Akalaks--giant, blue and red, muscled towers of strength--but, nonetheless, Merevaika was still different from what Trevor was used to seeing--she was more human than an Akalak for sure, but also had an air of hailing from a culture that was different than what he had been exposed to.

As he often did, Trevor found himself wondering where the two unique looking individuals might come from and what their stories might be.

Trevor came up to the two woman and lowered himself softly down onto one of the pillows near the two, doing his best to make as little a ruckus as possible as he situated himself.

"Hello. I'm Nya. Are you both here for Jansen's class? Basic Medicine in the Jungle?" Nya said, as she also tossed her hair.

Trevor smiled a bit of a reserved, but also genuinely and subtly friendly smile towards the two women.

"Hey there, Nya," Trevor said in a calmy warm and shy voice. "I'm Trevor. It's good to meet you."

"And you too," Trevor told Merevaika in the same tone.

Trevor opened the blank journal that he had carried into the Panacea with him.

"I guess we're all here for the same thing, then? I bought this journal to take notes on anything I might want to get down for the posterity," Trevor laughed a small bit before continuing, as if he had found something funny with his own sentence, "and, well, so I don't forget anything--that might not be a good thing when you're learning a set of steps to save someone's life, eh?"

"Ha, sorry for the bit of off the cuff humor," Trevor added, before drawing his calm rant to an end.

"I just noticed that I wasn't the only one who had the idea," the man said and held up his journal in a gesture that indicated the 'idea' he was speaking of was of taking notes during the class.

Trevor smiled a polite smirk for a moment, signaling to the two women nonverbally that he didn't expect a response if one didn't come naturally to either of them and indicating that he had just wanted to break the ice a little bit and that he was trying to be a generally friendly, but not too obnoxious, fellow.

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Preventing Ashes to Ashes & Dust To Dust

Postby Nya Winters on July 21st, 2017, 2:28 am



OOC: I'm just going to keep this rolling. Mere can join us as she has time.

Nya smiled at the newcommer and nodded. "Hello Trevor. It's good to meet you as well." She felt stupid saying that. But the Kelvic honestly didn't know how else to respond. Something had happened to her in Ravok, something that had stifled her ability to make normal conversation without stumbling and staggering over the worlds. Before she'd been happy, naive, unbroken. But now, something ... no everything had changed.

"I remember things well. But I'm taking notes for someone else, in case they want to see what we learn here. This is important but not everyone could come. I suspect Jansen will be a good teacher and I want to be able to help if something is wrong and he is not around."
She added, awkwardly, though she tossed her head and thus her hair to cover her nervousness.

It was then a breeze teased her hair and caused it to toss again, almost on its own. Nya smiled then, seemed to relax, and took her eyes from Trevor and seemed to track something else invisible in the wind. She seemed to nod to whatever she was watching, then shifted her eyes to where she'd last seen Jansen and Kalum Alavarth.

He was indeed moving that way. Nya stiffened. It was an automatic reaction because the male was big, powerful, and she was not used to Akalaks.

She switched her gaze back at Trevor and nodded. "It was a good idea, no need to apologize." She said, responding to his word and offering him a hesitant smile, her eyes darting back to Jansen's approach. The cat was definitely restless within her, almost nervous. Nya grew absolutely still as Jansen approached the trio and greeted them.

"I'm glad you folks took me up on my offer of classes. The more people we have here that know a bit about medicine the better we are since actual doctors are few and far between in Syka. I'm Jansen, and will you three please introduce yourself and tell us a bit why you are here?" The big Akalak said, taking a seat across from the three, really painting a picture that the class would be causal, almost informal.

Nya waited for the other two to take their turns before she took hers.

"I'm Nya Winters. I'm here because I want to be useful to the settlement in more than one way. I've been seriously hurt before and I know how important someone with a good working knowledge of medicine can be. So I'd like this to be one of many lessons in this area I will be learning." She said, her words soft, her voice a rich alto. Then she glanced at the other two and wondered if she'd said too much.

The truth was Nya was still on the run. Wanted in Ravok, she had to be careful what she said to whom because anyone could be marked by Rhysol. Anyone could be ridden by him. Abashai was proof of that.

Jansen nodded. "Thank you all."

He then gathered his thoughts and decided to give the group a good idea of what they could expect in the coming days. "This first meeting we are going to learn about vitals, bleeding and how to stop it, and the types of wounds. We'll move on to assessing a situation or the wounds in this case and basic wound care. We'll discuss shock and how to counter it. Then moving back into wounds, we'll talk about sutures and I'll give you suture kits which you will have to purchase and I'll teach you how to use them, whats in them, and how to suture up wounds. Then we'll go into tourniquet's. Depending on how much time all that takes, we can move forward and talk about broken and dislocated bones and how to realign and reset them." He said, running down a mental checklist.

Nya was frantically writing, taking notes, and in essence creating a syllabus as Jansen wrote. Her handwriting was small, neat, and effectual. She understood most of what Jansen said because she'd experienced what he'd said, at one time or another. Prison in Ravok was like that... and worse.

The Kelvic shifted uncomfortably as the instructor got done with his course outline and switched gears to focus on what he wanted to talk about then and there. Vitals.

"Okay, first and foremost everyone has a set healthy function to their bodies. We call these normal functions vitals. And when we check your vitals we call it checking vital signs. Vital signs are measurements of the body's most basic functions. The three we can measure are temperature, pulse rate, and respiration rate. Mage Crafters and fancy clinics have things called thermometers that can give an accurate reading of temperature. Humans and demi humans mostly measure around 96 degrees. Akalaks run 98. Some of the smaller races like Konti run even cooler. Since we are in the jungle and have no way to accurately measure temperature, we have to go by feel. Check your patient's forehead. Do they feel hot? Are they cold and clammy? The normal body temperature of an individual can vary depending on gender, or even food and fluid consumption. Any recent activity, time of day, the weather, even the climate, and, in women, the stage of the menstrual cycle can also cause fluctuations. Too hot and the temperature may indicate fever. Too cold and the person might have hypothermia. Fever by definition is an inflation of the body core temperature. Hypothermia is similar in that it simply means a drop in the body's core temperature." Jansen said, pausing then to give those taking notes a chance to catch up.

Nya was grateful for his pause. It gave her a chance to catch up her notes. When they appeared caught up, Jansen continued.

"Next lets talk about pulse or more accurately pulse rates. The pulse rate is a measurement of the number of times the heart beats per minute. As the heart beats, it pushes blood through your body in tiny tubes called arteries. The arteries expand and contract depending on the flow of the blood in them. So in order to check one's pulse, we need to know the baselines." He went on, taking a breath before continuing.

"The normal pulse rate in adult humans ranges from 60 to 100 beats per chime. Like temperature, a whole host of things may cause a pulse rate to fluctuate. Some of those could be injury, illness, extreme emotions and even exercise. Akalaks beat slower, creatures like Konti beat faster. " Jansen explained, moving on to give the students a whole list of baselines.

He then quietly read off a list of races and gave them the baseline plus rates of an average individual of that race. The list was lengthy and caused Nya to groan as her hand cramped a bit.

"Now, lets talk about how to check one's pulse. Then I'm going to have you practice on each other...." He started out by holding up his hand, indicating the first and second fingertips on his right hand. "Using these fingertips, press firmly but gently on the the underside of your wrist (or someone else's) until you feel their heartbeat. Its easiest if you have two people helping. Have the victim count to 15. While they do that, count the pulses you feel, the heartbeats, until they tell you they've reached 15. Then multiply that count you have by 4. That will give you the pulse." He repeated his instructions again... carefully, then asked the students to check each other's pulses.

Nya checked Mere's then turned to see if she could check Trevor's. If someone wanted to check hers, she'd let them, counting to fifteen for them.

"Finally we need to talk about respiration rate. The respiration rate is just the rate of breathing. This is simply the number of breaths a person takes per chime at rest. Like the other vitals, any number of things can change the respiration rate. The rate is usually measured by simply counting the number of breaths for one chime by counting how many times the chest rises. If they are having trouble breathing, sometimes the medical condition can be something as simple as a blocked airway. We'll talk about how to unblock airways really fast too... though I hadn't intended to include it in this class." He said, chuckling and nodding as seemed to realize he was going to get lengthy when he promised himself he wouldn't.

"Alright... dislodging food from airways really fast...." Jansen switched gears and started to explain.

00C: Feel free to write about the instructor teaching us this in your next post unless you aren't comfortable then I'll include it in my next post.

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Preventing Ashes to Ashes & Dust To Dust

Postby Trevor Hightly on July 21st, 2017, 2:04 pm

"Hello Trevor. It's good to meet you as well," Nya said.

Trevor listened to Nya's response to his greeting. Despite the girl's apprehension, Trevor didn't look too deeply into her words or actions; he took them for what they were, a happy greeting--albeit a shy one.

"I remember things well. But I'm taking notes for someone else, in case they want to see what we learn here. This is important but not everyone could come. I suspect Jansen will be a good teacher and I want to be able to help if something is wrong and he is not around," Nya went on to explain her reasoning behind bringing her notebook.

Trevor was favorable to her words--the woman wasn't wrong; in a small settlement like Syka, who knew what could happen and when anyone might need medical help, even if only first aid. The young man did detect a bit of nervousness in Nya's voice, however, but only took it in a lighthearted way--he attributed the woman's apprehension to his being a new acquaintance; in his mind, it was perfectly normal for her to have a bit of the social jitters.

He was going to say something else, or his mind was at least calmly going over what Nya had said and thinking about how he might reply, when the girl's attention turned away from him--it was a natural movement, one that fit into the conversation well enough and one that prompted Trevor to follow Nya's gaze to where Jansen and Kalum were entering; respectfully, Trevor calmed himself, relaxed into the cushion that he sat upon, and waited for the doctor to speak.

The Akalak healer cut a powerful figure, as all Akalaks did--which was something that didn't bother Trevor. If anything, having been whelped in Riverfall, it would be being around humans and other beings that were shorter or equal to him in height constantly that felt a bit odd. His natural stature aside, though, there was a certain air of scholarly authority that clung, layered atop of, and mixed with the physical intensity of the big, blue physician that made him seem respectable, approachable, and wise.

"I'm glad you folks took me up on my offer of classes. The more people we have here that know a bit about medicine the better we are since actual doctors are few and far between in Syka. I'm Jansen, and will you three please introduce yourself and tell us a bit why you are here?" the big Akalak said, taking a seat across from the three.

Trevor looked around, waiting for a second or two to pass before speaking; he was in no rush to be the first or the last to introduce himself--he liked to talk, but he didn't mind allowing others to have their say if it would brighten their mood, or allow them to feel more into the lesson.

"Well, I already introduced myself to Nya and Merevaika, but," Trevor chuckled very slightly so that it didn't disrupt the flow of his words, but rather was laced into them and their meaning, "my name's Trevor."

"I'm here to learn, to grow. Life is fragile and sometimes it just slips away--I think sometimes it can be almost too easy for it to--but it's also something that matters. I don't know if we should let it if someone has more to do, or to say, or to see," Trevor explained calmly. "I'm here for that, I guess, and those people."

Trevor waited a bit and then Nya spoke up.

Trevor smiled softly at Nya when she glanced at him after speaking her introduction; not with a smile that held her gaze, but with one that was meant to calm it before she looked away. The man couldn't help but wonder just who had hurt the woman in the past as she had mentioned; it was none of his business, but he wondered nonetheless.

When Nya's attentions diverted from his own, Trevor's eyes naturally found their way back to Jansen; Trevor had missed the man's nod but had turned his head in time to hear the doctor thank his class for their introductions and to go on to explain the lesson plan.

As soon as Trevor realized that Jansen's outline was going to be lengthy, he opened up his journal and began to scribble a brief introduction to the day's notes within it, essentially penning a bullet point list of the topics that Jansen was announcing that they'd cover today. The young man couldn't help but think that it was a lot to go over; informal class or not, he suspected that he'd be writing a lot down if the topics of the lesson were as extensively explained as the lessons' verbal introduction was.

And sure enough, Jansen went on to explain all about vitals, and heart rates, and body temperatures, all in detail--his point about mage-crafted thermometers especially interested Trevor's curious mind; the man briefly wondered just what else the world of magic might have to offer the discipline of healing.

Now, let's talk about how to check one's pulse. Then I'm going to have you practice on each other...." Jansen explained on how one was to check a pulse; as he spoke he held up his hand, indicating the first and second fingertips on said appendage. "Using these fingertips, press firmly but gently on the the underside of your wrist (or someone else's) until you feel their heartbeat. It's easiest if you have two people helping. Have the victim count to 15. While they do that, count the pulses you feel, the heartbeats, until they tell you they've reached 15. Then multiply that count you have by 4. That will give you the pulse."

Trevor waited patiently for Nya and Merevaika to practice amongst themselves; the man was politely receptive when the former of the two inquired to see if she could check his pulse and was grateful when she allowed him to check her's in turn. Trevor's hand was reserved and polite in its touch, with the man thinking mostly on just the beating within Nya's veins. The kelvic's heart pounded slower than he would have expected considering her earlier show of shyness--he wondered if perhaps the woman had settled in and become more comfortable with the class, but then again Jansen had said that exercise could lower one's pulse and Nya seemed to be relatively healthy.

As Jansen moved on to lecture about airways, so too did Trevor politely thank Nya for her help and likewise allow the lesson to move along.

"Now, there's a couple of ways to handle someone not being able to breathe. Sometimes you're not going to be able to use one method or another and sometimes you'll have to try them all," Jansen explained.

"You also really don't want to use some of the techniques on certain people," Jansen explained.

"For babies and pregnant women, especially, you can't always do what you might do to an adult man who was choking, for a perfect example," the Akalak clarified.

"But no matter who they are, the signs of choking are almost always the same; gray or blue skin, anxiety, or just a whole lot of coughing... and of course they could be unconscious," Jansen went on. "Sometimes it's just best to ask someone if they can breathe; a lot of the times they'll definitely be willing to gesture in the affirmative if they are."

"So, if they are choking, you should start by telling them you're there to help and by doing your best to calm them--they won't use up their air so badly if they're not panicking about and they'll also likely be more inclined to be cooperative with your aid," Jansen said. "Often, the body can take care of choking itself if you let it, though; that means that the first thing that you're going to do, if a patient is conscious enough, is to simply tell them to cough hard and often--they'll probably end up spitting out whatever's hurting them most of the time."

"But, if you can't get them to cough anything up, then you need to take action. Tell them that you're going to help them, talk them through what you're doing as you go and bend them forward, put one hand on their chest, and then use the other to strike between their shoulder blades with your palm--don't hurt them, but use a bit of force," Jansen spoke and demonstrated the motion of hitting that he was speaking of and what part of the hand to use.

"You can deliver back blows to anyone--babies, women, men, it doesn't really matter. Of course, don't be too rough with pregnant women or infants," Jansen said.

"For a baby, you can also take your two fingers--your index, and middle--and push against their chest if the back blows don't work," Jansen said. "Also don't be afraid to reach into their mouths to clear out any blockages that you might see--babies are fragile and they need their air," Jansen commented while holding up the two fingers that he'd mentioned.

Jansen shifted on his cushion and allowed his hands to fall back into his lap.

"Now there's one more thing that you can do to grown men, young adults, and anyone who's not with child," Jansen continued. "All you do is stand behind the choking person, place one hand below their chest bone and between their ribs and your other hand over that hand. Then you pull up from behind. If nothing else works, then that should."

Jansen smiled and slowed his speaking to a casual and sympathetic pace.

"Now I know that was a lot. So, before I move on I'd like all of you to just demonstrate the back blows and the chest compressions with your hands in the air; it'll look silly, but it'll let me know that I explained everything well enough that you understand," Jansen said.

Trevor waited for the others to follow Jansen's request and then did as the Akalak requested.

Jansen, for his part, critiqued the students where he could.

"And if anyone has any questions before I move on, you can definitely ask them," the blue doctor offered his class.

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Last edited by Trevor Hightly on July 23rd, 2017, 6:13 pm, edited 4 times in total.
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Preventing Ashes to Ashes & Dust To Dust

Postby Nya Winters on July 23rd, 2017, 4:26 pm



Nya smiled, noting Trevor’s name before she continued her attention at Jansen. He moved fast, talked fast, and she took notes furiously.

She paid attention when Trevor introduced himself, listening to what he had to say about why he was there. So he wanted to grow? Nya could understand that. The fragility of life was something she understood all too well. The man, Trevor, seemed to revere life. That was unique, especially in human males whom Nya had learned tended towards violence. Most she’d known were quick to hurt, to kill even, to get what they wanted.

The Kelvic caught Trevor’s quick gaze and that strange calming smile. Nya thought she saw a glimpse of curiosity in his gaze but the man thankfully said nothing. She wanted no questions. Syka was a new place for her, a new beginning, and one that had slowly allowed her to heal. There were still fresh wounds on her soul, but the bleeding… no hemorrhaging… had stopped. Ravok and its prison and its slavery were far away from here. Here there was always a breeze to talk to, always lots of room to run, and that made her happy… that and the male’s calming smile.

She returned that smile with a slight up curve of her lips before she glanced down at her notes, breaking eye contact purposely. The Talderian Forest Cat didn’t want a glimpse of his soul. She didn’t want his questions. She wasn’t even sure she could make him a friend. All those things seemed so distant and so untouchable. The Kelvics’ hands trembled as she clearly outlined in her notes what Jansen said… forming the Syllabus. It was a lot to cover and she hoped she was smart enough as a Kelvic to understand it.

Vitals were interesting. Nya understood what Jansen spoke of and took clear notes. She hadn’t liked touching the other woman. Nor had she liked touching the man. But looking back after her firm grip constrained his wrist briefly, it was nothing painful or taxing. It was just the shadows in her mind that made the touch hard. Her grip on his wrist was strong, steady, though she held her breath as she counted. Long brindled hair fell forward, loose from its restraining band, and concealed his wrist as she counted. Normal. Normal like hers. Normal. It was almost a chant in her mind. She released his wrist, met his eyes, and nodded.

While he was near she inhaled deeply, committing his scent to memory.

A line she hadn’t know existed with her had been crossed and she survived it. Touching others. Being touched. Both her companions had moved slowly and that had helped. Nya ran her tongue over her teeth and almost willed her cat form into being. She didn’t like the feel of her tongue sliding across her clean blunt white teeth. There should be sharp fangs even canines. They defended far better. Humans were so weak and their teeth reflected that. So too was the human form, lacking grace and strength and the prerequisite claws. Nya calmed further and relaxed deeper. They were all weak in the forms they were in currently. They were here to learn healing, not torture. Glancing at the Healer she dismissed him as a threat. She knew Rak’keli forbad him from harming and forced him to heal. Mere was another story, but one she’d met before. She was capable of many things. Trevor was an unknown, and male. She would watch him closely.

Choking was another interesting thing. She listened to the lesson carefully and took notes furiously. Her handwriting was neat from her years in the tower under her mother’s teachings. Nya had never been denied an education. And for a Kelvic, she considered herself smart. But medicine was a whole new pathway.

Nya noted that the medicine used on choking people varied from type to type and age to age as she wrote down the signs of choking.

Signs of Choking
  • Grey or blue skin
  • Anxiety
  • Coughing
  • Loss of consciousness
s



There was a list of quick steps to take when someone choked. A lot of verbal communication was required. Nya understood that, but it seemed silly to her because someone choking couldn’t talk back could they? She didn’t think so. The Talderian Forest cat wouldn’t wait to ask questions if someone was choking, she’d thump them on the back and then use the technique Jansen had taught them for grown men, young adults and anyone not pregnant. It was a sort of make a fist with your arms around them and squeeze pulling back and up as you did so. She thought she could do it.

And when she was required, she demonstrated them in the air, as if she had someone choking in front of her. She was relieved beyond measure that Jansen hadn’t asked them to demonstrate on each other. Nya knew she wouldn’t have tolerated either the woman or the man’s hands around her middle constraining her. She broke out in a cold sweat just thinking about it before the big Akalak had asked them to demonstrate with her hands in the air.

The kelvic concentrated on breathing, finished her section of notes, and started a fresh page when Jansen started a fresh lecture.

Jansen then gave them a small five chime break to stretch, move around, get water, or relieve any bladders that might need tending too. Nya jumped up and jogged down to the water quickly and back up, getting the stiffness out of her limbs. When she returned, Jansen was ready to lecture more.

“Now, I’m going to talk about the types of wounds and move into how to stop bleeding. I’ll include bloody noses into the bleeding issues, so before any of you can ask about it that particular medical situation is on the list to be covered.” Their instructor said, moving among them.

“There are four types of wounds. The first type is a laceration. That’s basically any sort of cut or torn tissue. To treat it, first and foremost you need to clean the wound of any blood clots or dirt, debris, or foreign material, then debribe and irrigate it. To debribe something is to remove dead, contaminated, or dead or ruined tissue and foreign material. To debride a wound is to remove all materials that may promote infection and impede healing. It’s all part of the cleaning process. If you don’t get it cleaned, then you don’t heal well. Irrigating a wound means to flush it with clean water, preferably only water you’ve boiled. If you flush it with fresh water you might be introducing more things to the wound that can get directly into the body. Remember, wounds are breaks in the protective layer of our body that covers us and keeps us safe. Once a laceration is completely cleaned, debribed, and irrigated, then you should realign any misaligned tissue and dress it. A laceration can be a cut, a puncture, or even say the claw swipe of an animal that opens you up. Consider anything that made a laceration such as a knife, claw, or even a puncture by a shark bite to be dirty. Clean clean clean.” Jansen added, pausing for questions if there were any.

Then he moved on. “The second type of wound is an abrasion. This is an injury where a superficial layer of tissue is removed or damaged. This is scratches, being rubbed raw, or even burns. We’ll cover burns later in class. Many times abrasions have fine particles in them like sand or gravel. They need to be scrubbed clean before they are allowed to heal so that all the debris doesn’t heal into the wound and create roughness, or marking not unlike tattooing. You can apply local anesthetic to numb the pain, but treatment is usually a moist dressing and a healing cream. I’ll teach you about dressings and healing creams later in the class as well.” He added, then looked thoughtful.

“The next type of wound is a contusion. This is just a fancy name for a bruise. They usually result from a forceful blow to the skin and soft tissue, but they don’t break the outer layer of tissue and your skin is attached. They can be found in conjunction to abrasions. These injuries don’t require extensive care. You can however get blood pooling under the skin that becomes painful. These are called hematomas. And an expanding hematoma can damage the skin and should be punctured with something like a thin knife that’s been dipped in boiling water to be allowed to drain. I have a cream I can show you how to make to help contusions heal. That will be in the second more advanced part of our healing course.”
He added, chuckling.

“Incidentally if you stumble upon the site of a kill where something has been taken down and partially eaten and then left for later, skin it sometime. When big predators like cats or wolves take down prey, they form huge contusions under the skin. Disease, injury that’s festered and left an animal open for predation often allows smaller animals to make the kills. So if you come upon a relatively fresh kill in the jungle and are hungry, skin it. If it has large contusions still visible under the skin its more than likely safe to eat from as well. If it has none, steer very clear of the meat because there might be disease or infection that can harm you as well.” Jansen advised, giving them a slight glimpse into his way of thinking and a hint at wilderness survival.

Nya looked thoughtful. She never had wondered if her bites caused huge bruising. She’d have to look sometime when she took down her next kill.


“This final type of wound is the worst. It’s called an Avulsion. This is where a section of tissue is torn off, either partially or in total. There are subtypes in Avulsions. A partial avulsion is where the tissue is elevated but is still connected to the body. A total Avulsion is where the tissue is completely torn from the body with no point of attachment. Think shark bites here where huge masses of tissue (or small masses) are missing. To treat these partial avulsions, you need to decide if the torn tissue has blood flow to it. If it doesn’t, cut it off and create a total avulsion. If it does, then gently clean the wound and tissue, irrigate it, and reattach the tissue into its correct or as correct as you can get it position using sutures. I’ll teach suturing a little later in the class. And like I said, if the tissue isn’t going to be connected well to the body with noted blood supplies – veins and arteries heading in and out of it – then you need to cut it off. This is called excising it. You might have to shave the tissue down by debulking it or defattening it before laying it back in place. Amputation of extremities, such as fingers, ears, nose, scalp and are probably beyond your capabilities without a doctor with years of experience or at least two marks of Rak’keli. If you are in a situation where an arm is lost… tourniquets which I will teach later… are invaluable. But you might have to cauterize the wound to stop the bleeding. IF someone bleeds too much and loses a lot of blood, they will die. So the only way to stop that quickly is to heat something in a fire until its red hot – say a knife or sword – and press the blade to the open tissue where the amputation was, and burn the tissue. It is the least pleasant thing a healer might have to do, but it’s something that can often save a life.”
Jansen finished, looking thoughtful.

“Are there any questions? IF there aren’t, I’m moving on to the ways to stop bleeding.
” Their instructor said, letting them take a few chimes to finish up their notes and ask questions if they had any.

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Preventing Ashes to Ashes & Dust To Dust

Postby Trevor Hightly on July 23rd, 2017, 7:33 pm

Trevor was glad when Nya returned his smile--the gesture didn't seem too formal or drawn only out of politeness, making Trevor think that the girl might be warming to him at least a bit. When Nya looked away, the young man was perfectly and patiently fine with the woman breaking eye contact, as he had come to the conclusion that she was shy--perhaps by nature or perhaps, based on what she had said earlier about her past, based upon experiences. In any case, Trevor found quieter individuals to be generally kind and more intellectual than others, and such was a disposition that he didn't mind being around, so Nya was not someone that he'd go out of his way to avoid or not to talk to--there were very few people he'd outright ignore in the first place.

The lesson went on and Trevor didn't even notice when Nya scented him, he had no reason to--there was no way he could have possibly guessed her true nature.

When Jansen gave his students a break, Trevor simply stretched, asked his teacher a number of small questions, made small talk with the man very briefly, and then waited as everyone returned and the healer moved into talking on all the many varieties of wounds.

Trevor was careful to note everything that was said in detail; wound types sounded to him like something that was foundational and that most other more advanced knowledge of healing would be likely to be based upon. He found lacerations and avulsions to be particularly interesting; the fact that even large chunks of flesh could reattach themselves to the body was truly amazing to the young man and he wondered how far this could be taken in a patient, additionally the bit on keeping utensils that were to be used for healing sterile stuck in his mind as something that should never be forgotten.

When the Akalak male moved on to speak on the hunting habits of larger predators in his analogy about bruising, Nya might have been surprised about how close her and Trevor's mental response to the doctor's words had been. Trevor had yet to master his late wife's last gift to him and to achieve a full-body morphing transformation. However, the man's curious mind yearned for the chance to see life through the eyes of beings that were born drastically different than himself, through the eyes of creatures like the predators that Jansen had spoken of, and the more Trevor willed his djed to hold shapes other than his own the less his body and mind seemed to recall what he was supposed to be; as of the current date, his mind and body still remained somewhat inflexible, but that was something that was changing in Trevor with every use of his magics. While neither of them were aware of it, as a morpher and ever-curious soul, Trevor was perhaps more poised to understand Nya's unique sense of split-identity caused by being a kelvic better than most.

"Now bleeding, almost nothing will kill a person faster unless such a thing had already caused a near-instant death. Even a lack of air can be a slower killer than a loss of blood," Jansen explained, as he went on.

"That said, if someone is bleeding seriously and there are multiple casualties, you're almost always going to want to take care of that person first," Jansen offered his advice. "You must always assess a situation where there are more than one injured persons carefully, but never more so than if someone is losing blood."

"Additionally, if a patient is bleeding, then there's a definite chance that they're going to either be panicking or be in a state of shock, so they very likely won't be able to tell you the extent of their injuries themselves," Jansen stated. "Shock can be caused by a lot of things including fear and traumatic events, but severe bleeding will definitely do it to a person. They'll likely be dazed and unresponsive if they're in shock; you still need to help them, but they'll probably have trouble helping themselves--if you think someone might be in shock, you can check to see if they're clammy, if their eyes are unresponsive, or if they can reliably talk to you. Panicking can also lead to shock and it can cause an injured person to bleed a lot quicker, so you definitely need to calm someone if they're truly experiencing panic--the best way to do this is to stop their bleeding and to show them that things are going to be okay. Most people, though, if they're hurt bad enough to be in risk of bleeding out will definitely panic, so expect it."

"As for bleeding itself and how to treat it, you first need to know that there are different types of bleeding because there are different types of blood vessels in the body," Jansen said. "You have small vessels, those are usually what get cut open to bleed with scraps and other small injuries--injuries of these will generally scab themselves up rather quickly and will be fine as long as you clean and bandage them, they're your everyday wounds. However, you also have veins which are found a bit deeper in a person's body; these can heal on their own too when cleaned and bandaged, but if enough of these are damaged then you might have to go beyond just a bandage, although generally applying pressure and cleaning any wounds with punctured veins is enough."

Jansen paused for a moment to allow his students to catch up on their notes, he was well aware that he was now moving into the more technical portion of the lesson from a beginner's standpoint; although, for the skilled healer, what he was teaching was the equivalent of basic math to a mathematician--incredibly important in its own right, but something learned long ago. Still, the long-lived akalak didn't seem to project an air of superiority, but one of calm.

Trevor was listening closely as Jansen spoke on the anatomy of blood vessels. The man wondered just how much of what the akalak was teaching could relate to other creatures besides the more sentient and sapient races.

"And then there's the worst possible type of bleeding. The largest veins in our bodies are called arteries, most of these connect almost directly to your heart and they carry large amounts of blood all throughout our systems," Jansen continued. "Arteries are oftentimes only going to be punctured by horrific accidents such as terrible falls, or by malicious attacks."

"Every other blood vessel in your body is connected to an artery and every organ in your body relies on them working correctly to function. You can, and will, die in minutes if one of your major arteries is punctured and allowed to bleed," Jansen said. "There is no time to waste when treating an arterial bleed. Which brings me to telling you how to know when you're facing such a case."

"Firstly, arteries carry a lot of blood and they do it fast; that's the reason you're so likely to die from one being cut or otherwise opened. Because of this, arteries don't just ooze and drip blood like veins and smaller blood vessels, they spurt. If a wound is shooting out blood violently, or to any extent where the blood is being thrown away from or onto the skin, and not just sliding over its surface, then you're facing an arterial bleed," Jansen instructed.

"Secondly, your arteries run from your heart to your major organs. You have them in your neck, your arms, and your legs. The most likely arteries to be injured are in the wrist, on the inside of your thigh, and on your neck. If these areas are bleeding terribly then, again, you likely have an arterial bleed," Jansen stated.

"While arterial bleeds may sound especially vicious, and they are, they can be treated in much the same way as any other bleed," Jansen encouraged. "You should always put immediate pressure on a spurting wound, always, to prevent possibly irreparable blood loss. As long as their body isn't losing blood, which the pressure should prevent, then your patient is likely going to be fine--as long as they haven't lost too much blood already," Jansen stated. "After applying pressure, you may have to do so for up to fifteen minutes just to let the bleeding stop; if you don't know what to do after this, and you're able to, it's best to use these fifteen minutes to get the patient to better qualified help if you can do so while also keeping pressure on their wound. If you can control blood loss with pressure, then it's best for you to pack a wound with clean cloth and to bandage it up tight enough to keep the same amount of pressure on it, so you can then get help."

"There might be a case where pressure simply isn't stopping an arterial bleed, if that happens then you can combat this by applying pressure to the wound and to the unwounded flesh above the wound on whatever side of the body is closest to the heart. This works because it further holds up the blood flow to the wound. If this work-around works, then you can bandage the wound and then also wrap the second area that you applied pressure to up tightly for a time," Jansen explained.

"I'll let you get your notes in," Jansen stated. "That's a lot of information, but I still need to cover a little bit more on bleeding."

Trevor scribbled his notes carefully, but as quickly as he could while also being thorough, neat, and organized. He knew that he'd never be able to decipher his notes if he left them disorganized and untidy.

"The last thing that I'll say about bleeding--for now, until I teach you suturing and how to apply a tourniquet--is that if there is a weapon or object lodged in someone's body, and you're not currently capable, or do not possess the skill, to operate on them, then do not remove said weapon or object," Jansen warned. "If you remove a weapon, you're seriously risking making any damage worse. It's best to apply pressure where you can and to immobilize the weapon with cloth and bandages. And remember, if a weapon is lodged into someone's body and they're not bleeding externally it either means that their blood is leaking inside them, in which case they'll still almost definitely need immediate help from a surgeon, or that the weapon is preventing them from bleeding. In either case, again, if you're not skilled enough, never remove the weapon--you'd be almost certainly killing the casualty or making everything much worse."

Trevor was truly humbled by the amount of confidence that it seemed to him like it would take to treat someone who was injured severely. A doctor held life in his hands, perhaps even more so than a soldier or a warrior; a doctor dealt with death and pain almost every day that they worked, whereas a warrior only did so in the worst of battles and even then they did not have to risk killing someone that they wanted so badly to save.

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Preventing Ashes to Ashes & Dust To Dust

Postby Nya Winters on July 24th, 2017, 1:56 am



Nya was enjoying the class. It had been a long time since she’d sat down to learn from another person for the sake of learning new things. She’d had lessons with one of the Founders in the jungle on wilderness survival, but this was different. The atmosphere was relaxed. They had time to take notes, and while the subject was life and death, there was an ease at which they spoke on it.

The company wasn’t half bad either. Neither student felt threatening to Nya. She relaxed completely around them, so much so she was soon stretched out on her stomach and writing furiously to keep up with Jansen’s words. By the time the wound types were taught, she had expansive notes and her fingers were stained with ink. There was even a smudge on her cheek where she’d dipped then splattered her face lightly when the quill had hit the ink jar awkwardly and she’d rubbed at a splatter by twisting her head to her shoulder and dragging her cheek along it.

But her book was full of surprisingly neat handwriting with notes and small sketches where they were necessary. She also had a penchant for linking things together with little arrows as if she were diagraming her writing as she went along. In fact, the Kelvic found the work to be satisfying. The learning appealed to her on levels and scratched itches she hadn’t known existed.

As she laid there listening, the sun sprinkling her back through the palm fronds shading The Panacea Clinic, she lightly purred.

There were so many new terms. Jansen was a good teacher, painting a picture of the blood flow through the body and naming the pathways they took. Arteries? Blood flow… it was more than she’d known before. She’d never given much thought to her human form or its anatomy. In this lesson it was all she could think of. Nya wrote and wrote, taking notes on the type of bleeding and how to treat it. What type of vein or artery got cut depended on how it was treated. Small vessels could heal themselves and weren’t dangerous as long as they were cleaned and bandaged. The same was true with veins, she learned. But arteries were a whole different story.

Nya was glad Jansen paused, let her catch up, and even took a few questions.

One thing she did learn – the big take home message – was not to get her major arteries punctured. It was almost a guaranteed death. Other cuts, bleeds as Jansen called them, could be dealt with. She made notes and notes on how, thinking deeply and committing the knowledge to memory.

She also learned, and noted, that sometimes things lodged in the body caused problems and to not take them out unless it was completely necessary. It was perfectly fine to deliver a patient with a weapon lodged in their body to a healer.

Nya also discretely watched Trevor. He seemed … somehow to be looking at Jansen like he was some kind of … person to be respected. Was he impressed with Jansen’s medical knowledge? What was he thinking? The man had a closed expression but every once in a while a fleeting emotion would cross his face that Nya could almost smell on him. Admiration… was it admiration for Jansen or for the skill they were learning? Nya wasn’t certain.

Then, after another short break, Jansen started in on another aspect that was important in regards to healing. He talked about patient assessment. “When one is faced with a wound in someone and forced to act as a healer, there are steps you should take in treating a patient. Its all situational, of course, but here’s a general outline in what you should be doing when you will be faced with this situation. Remember, it’s not a matter of if… it’s a matter of when. You can even ‘self assess’ as needed and follow these steps if you are acting as your own healer.” The Akalak said, pausing a moment to gather his thoughts before he launched into his explanation.

“First, ask yourself ‘Who is the Patient?” Is this an adult verses a child? Children need calming and pain treatment often before adults – especially adult males. Remember, do the bare minimum. If they can tolerate the wound, treat it without pain medication. If they are calm, treat them first and skip trying to calm them.” He said, moving on to the next step.

“Step two… pain assessment and treatment. Is the patient in pain and can they not tolerate it? Take care of the pain situation if you can before you begin working on the wound because your actions might bring about additional pain. Sometimes this is simply giving them something to bite on. Other times it might mean dosing them with a numbing tincture. Often all you can do is make them feel not alone and tell them to hold on. That can go a long way to soothe someone. If you have access to pain blockers use them in all occasions except the eye. Sometimes treating eye wounds for pain can lead to brain interference and can shut down body functions. You should always, if possible, carry pain blockers in a medical kit in your survival bags. Anyone who’s been here any length of time has been lectured on survival kits or bags.” He added before again moving on to the next step.

Nya took more notes, listening carefully. Indeed she had a survival kit and had been taught to make one by one of the Founders. Randal had trained her in Wilderness Survival and that was one of his first lessons. She didn’t have a pain blocker in it. She wondered if she could buy one from Jansen and asked him. He nodded the affirmative. She also found it was interesting that humans needed soothing and that sometimes pain assessment and treatment was simply a soothing word.

“The third step is a tourniquet. A tourniquet is a belt, bandanna, or even a piece of ripped fabric that’s tied around a limb or extremity tight enough to cut off the blood flow. I will teach you tourniquets in a few chimes, but for now just understand that if a wound is bleeding to the point of being life threatening, especially on a limb or extremity, then you apply a tourniquet. You need to stop the flow of blood and that’s the best way on a limb. But remember, you need to be properly trained on their use before utilizing them. So pay attention.”
He said, pausing to let them once more catch up on their note taking.

“The next step is wound preparation. You need to cleanse the surrounding skin with alcohol or boiled water to prevent future tissue damage. Then, you need to explore the wound and stabilize it. You simply check the wound for any foreign bodies and determine the extent of the injury by assessing the tissue injury, amount of tissue lost, and the absolutely relation of the injury in terms of damage in regards to deeper structures. What I mean is… a chest puncture.. did it also puncture a lung? Sometimes you can’t tell. Use your best judgement.” He said, gesturing at his chest as if someone had stabbed him.

“Moving on, it’s time for debridement of the wound. Assess the viability of the wound margins, remove all the ruined tissue that is not attached, excise the ragged edges into smooth ones by cutting them off clean, and then move on to the next step. That step is wound closure. IF it needs sutures, stitch it. If it does not, leave it open. “
He added, giving her perhaps more information than she needed.

Nya wrote on, her hand cramping slightly as she tried to keep up with the information given. IT was a lot to take in but she could definitely tell she was learning.

“The last two things are dressing and herbalism usage. Does the wound need dressed? Do so now. If you can use herbs to prevent infection both before and after the wound is closed, do so! Infection comes quickly here in the jungle, so err on the side of caution and use what herbs you can. You also can get infected from animal bites. It’s almost a certainty. So proceed with caution. I can teach you both an herbalism class later on that lists herbs to use for what, but we don’t have time in this basic course to cover those facets. It’s definitely knowledge I’ll share though.”
Jansen explained, gesturing to a stack of bandages he’d dragged out when they’d taken their last break.

At that point, Jansen led them through a step by step process of cleaning and dressing wounds. The students spent the rest of the bell learning how to dress different parts of the body and trying on bandages on both themselves and each other. It was altogether a weird feeling, having someone wrap your temple with gauze gently or having to wrap a stranger’s not-broken arm. Nya was more at ease now and wondered what was next? He’d promised tourniquet use and a bell lecturing on shock, but she wasn’t sure where the instructor was going next. There were also sutures. Would they learn those too?

Nya was eager to keep going. She only went and got water when Jansen gave them a break this time.a

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Preventing Ashes to Ashes & Dust To Dust

Postby Trevor Hightly on July 24th, 2017, 7:07 pm

It was true that Trevor's face was generally peaceful and more prone to expressing emotions that were softer and more subtle than some others when he was relatively calm and at rest; the expression that Nya had seen crossing across the young man's face was indeed somewhat rooted in respect, but it was not an admiration that was solely directed at or for Jansen, but for the weight of what the man was teaching as well.

Trevor had drawn much the same conclusion as his fellow student had when she'd mentally noted the fatal danger of some wounds, but his thoughts also went on with a bit of a diversion from Nya's own; although Trevor was indeed also careful to make sure that he grasped the fragility of his body and the dangers of certain types of injuries, what he mostly heard from Jansen's words was not only that any severe injury could kill a person but that a person could be saved from almost any such damage as well.

As he took his carefully penned notes, the young man's mind worked and turned in a relaxed but fruitful state, opening itself more and more up to a certain conclusion that it seemed that all of his life experiences had slowly been working to reveal to him: that perhaps nothing was truly beyond the reach of anyone--whether they were mortal, god, or beast--if they simply knew what was necessary to accomplish a goal. This was not a life breaking and spontaneous epiphany on Trevor's part, but more a gentle, natural evolution of his thinking that Jansen's teaching was further nurturing.

Once, when he was a child, an infant Trevor had thought his parents' home was the entirety of the known universe, only to find out otherwise when he had grown bold enough to walk on his own two feet and out into the nearby world; and once he had also thought himself bound to his human form, but that too had been proven a logical fallacy thanks to his discovery that one's own djed was less than a concrete and unchangeable thing... and once his wife had been his entire world, but she too had faded into the past. And now, Jansen had revealed that even death itself could be combated and staved off... perhaps even prevented entirely with the right medicine or techniques, although this was not something that the akalak had hinted at directly, more a random musing of Trevor's mind.

Trevor did not go through all of these thoughts individually or even consciously, nor did he relive his memories. Rather, the cumulation of all of his past experiences allowed him to receive Jansen's teachings in a way that caused the knowledge that the akalak healer was passing on to support the mindset that Trevor was more and more slipping into as the days of his life went by--one of freedom, of limitless possibilities, and of there being a choice in all things. In truth, as of late, the young man was beginning to wonder if one's own beliefs about what was and what wasn't were'nt mere self-imposed limitations and that if a faith in what might be possible was a more freeing and favorable foundation for one's personal belief system and morality.

But, again, Trevor was still absorbed into the lesson and with his surroundings; for the most part, he was entirely present in the moment and merely found Jansen's words informative and interesting. His attentions were mostly concentrated on his notes in truth, but he did notice the absolute comfort which Nya had seemed to develop with her surroundings and couldn't help but muffle a chuckle in his throat upon his noticing how a fairly well-sized glob of ink had found its way onto her cheek; Trevor approved of the almost night and day change in the woman and her own light mood helped to further uplift his own cheery disposition. The girl's purr did raise his eyebrow, however--not in a hostile or violent way, but in a whimsical and curious manner.

Jansen's lecturing on wound cleaning and his demonstration on the proper method of doing so moved a bit slower than the rest of the lesson had. On one hand, Trevor was happy to learn the practical skills and to go through the motions of learning to bandage all the many parts of the body with the other students, but on another hand, he was also somewhat eager to go back to the more fast-paced lecturing of Jansen--as the akalak's informative words quenched his desire for knowledge and occupied his interested mind. Nonetheless, Trevor was not too bothered by the bell that was dedicated to practicing what the class had been taught, perhaps he just slightly wished it would pass more quickly.

During the next break, Trevor deigned to stretch instead of simply sitting and to fetch a bit of water for himself and looked forward to what might come next.

"So, we've covered bandaging and blood loss, checking a pulse, and choking," Jansen reviewed, as the break he'd given everyone came to a close. "We might have time for bone-setting and we might not. That said, what we still really need to cover is shock treatment and then suturing. There's nothing more common than cuts and almost nothing worse than shock."

"Still, we've already covered bleeding and I remembering warning you all that someone with an arterial bleed was likely also to slip into shock," Jansen reminded himself. "We can start there."

"What you really need to know is that medical shock isn't just being upset or stunned, it's something that happens when your body is shutting down or just can't get enough blood to every part of you," Jansen stated. "Everyone dies of shock in a way, no matter the wound or illness, because it's simply your body failing in the simplest sense. Your body needs blood to operate, that's why bleeding causes shock; damage to the spine can cause shock; infections can cause shock; and heart damage can cause shock."

"When someone begins to slip into shock, they're going to get cold and they're going to become disoriented," Jansen explained. "That said, there's a chance that they won't lose consciousness right away--and if you can stop them from doing so, this might be your best chance to save them before their life is truly in very real danger."

"Firstly, to tell if someone is in shock, as I said when I talked about bleeding, you can check their responsiveness and their temperature. The best way to check if someone is going into shock, however, is to simply pinch their fingertip. It should only take a moment or two for a pinched fingernail to go from purple and back to its normal color; if it takes longer, then it's a good indicator that the person is in shock or is going into shock. This happens because blood flow is slowed or even almost stopped when a patient is in shock; their body is failing," Jansen stated. "If you let this go on for too long, then it's almost a definite that your patient will die."

"The good news is that you can prevent most shock from escalating to an extreme case, unless the patient's injury is truly severe," Jansen said. "Most importantly, if you can identify the cause for someone's shock, then you almost always need to treat that before doing anything else; if someone is bleeding, you stop the bleeding, if they're choking then you stop the choking. Sadly, if someone is going into shock because of an infection then there is usually very little you can do; if you can't treat an infection with herbs, cleaning, or upkeep care, then sometimes it's best to completely remove the infected area well before it can compromise the entire body--I'm speaking of amputation, which should always be a last resort, but it is a last resort that should be done the moment that it is needed, nonetheless. Amputation is something that should only really be done by someone who is experienced, however. Honestly, in the case of septic shock, its causes should have been treated long before they became anywhere near fatal--which is why we do everything we can to avoid infections, even in the most minor of wounds, and why we should viciously combat any infections that do arise before they worsen or even spread to other parts of a victim's body."

"Moving on, once you treat any obvious cause of shock, then if your patient is awake, then you can do a few things to give their body the chance to regulate itself," Jansen stated. "First, you can raise their legs above their head--this will help with their blood flow; just remember never to lift any injured or broken limbs. After that, you can keep them warm with a blanket or thick piece of clothing; as I said, shock hinders blood flow and can cause chills and a drop of body temperature--the body needs to be warm and if you can keep it at a decent temperature, even despite the onset of shock, then you give it a better chance of bouncing back before things worsen."

"If you've treated the symptoms of their injury and put your patient in a position to recover, then you can either wait to see if their body begins to move away from going into shock, or you can get help," Jansen stated. "It's generally never a good idea to leave a patient who is in shock or who has recently been in shock alone, however, so if you have the skills to treat said person yourself or someone else can fetch someone who does, then those options are always best."

"If your treatments are successful, then generally your patient's blood flow will be restored and they will slowly warm back up with time," Jansen stated. "If someone has lost a lot of blood, though, then this may take longer and they will likely be fragile and weak for a time. Once the threat of shock has subsided, it's generally alright for a patient to sleep. However, you should keep a close watch on them for quite some time."

Trevor turned yet another page in his journal; the formerly blank book was quickly beginning to resemble the beginnings of a basic textbook on medicine.

"If a patient falls asleep while being in shock, though, you're going to need to watch them very closely," Jansen stated. "If at any point they stop breathing, or if their pulse fades, then you're going to have to move into giving them emergency treatment--the same goes for patients that you previously thought were okay."

"If someone isn't breathing and they have no pulse, then their body has either stopped or almost stopped fighting," Jansen warned. "If you want someone in this state to live, then you're going to have to do their body's job for them."

"In order to pump someone's heart for them, you're going to want to take the palm of your hand and place it over a patient's chest. To find the right place to do this, you can touch their sternum with two fingers and then place your other hand's palm above that. Once your palm is on their chest, lock the fingers of that palm's hand with your free hand's. Then you're going to push deeply into their chest; most people don't push hard enough when they do this, but if you don't then you might very well fail in keeping someone's heart pumping."

"We call what I just described chest compressions," Jansen stated. "You not only have to do them hard but also fast as well--at least two a second are needed. You'll get tired, and if someone else is around then it's best to alternate who is working on the patient if you can. No matter who is giving the compression, though, after you deliver thirty in a row then you should immediately move into giving your patient air."

"If someone is truly not breathing, then you'll have to open their airway manually. To do that you simply tilt their chin into the air and hold it there. Then you blow a breath into their mouth while holding their nose sealed. If you feel that person inhale, then you know that what you've been doing has worked and their body has re-started, but if they don't feel them inhale then you need to tilt their head back into a resting position, and then tilt their chin back up all over again and attempt to give them another breath. If you still fail to get them breathing even after this, then you want to put their chin and head back down and repeat everything--including the chest compressions," Jansen stated. "You can keep doing this until there's just no way that you can go on, but there is a chance that there might come a point when the patient is obviously just not going to come around."

Jansen paused to let the gravity of what he said drift and fade a bit.

"If a person does accept your breath or takes one of their own at any time, then you can continue to treat their wounds or to monitor the patient; there's a chance, and sometimes a good one, that they may slip back into shock and that you may have to repeat everything once more to save their life," Jansen explained. "A truly critical patient may very well need around-the-clock monitoring to ensure that they don't fade away."

"As a side note, if it's a truly young or fragile child that isn't breathing then you'll need to use only two or three fingers to give them chest compressions," Jansen added. "It's also probably good to note that chest compressions and giving someone breath also works extremely well to dislodge an obstruction from a person who has fallen unconscious from choking. You can give such a person the same thirty compressions as you give a shock victim, and then you can enter their mouth with your index finger from an angle to attempt to clear any obstructions or blockages, and then you can give them a breath; if you know someone has choked but can't see a blockage, then just repeat the compressions and breaths until you can see what's choking them and then remove it, or until the blockage is removed by your breaths and the patient begins breathing on their own."

"On the subject of breathing, if someone appears to be taking very weak breaths that sound very strained, it's usually best to count that as the same as them not breathing--the body will often times fight on and continue to try to breathe even when no air is coming into it, and that's still a case where a patient needs your help," Jansen stated.

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Trevor Hightly
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Preventing Ashes to Ashes & Dust To Dust

Postby Nya Winters on July 29th, 2017, 3:07 pm



The Kelvic took a break to shake her hand. Writing wasn’t something she was used to and she needed to uncramp the muscles of her fingers before she continued. She tilted her head, listening, even as she did so, and resumed her note taking as soon as her hand felt like it could bear the brunt of the burden. There was so much information here. Nya wondered if she could ever absorb it. The obvious fact perhaps later than sooner was that she’d have to study her notes, place them so firmly in her mind that they’d help later maybe even automatically because her body knew what to do even as her mind was still processing. Medicine wasn’t an easy topic. Lives were at stake. Maybe even her own life and its continuation would be determined on how much of this material she learned. Nya wondered if Trevor felt the same way, if that’s why he had that distant burdened but encouraged look on his face.

Shock.

It wasn’t a cut and dried topic and she did stop the instructor before he could get too far. When he said if they could identify the cause for someone’s shock, then it was easier to save them. Nya wanted to know all the causes of shock… though she imagined there were many… and stuck her hand in the air until Jansen called on her and she asked her question. “Can you tell us all the things that might cause shock?” The kelvic asked. Jansen nodded, looked thoughtful, then started to list them. Nya took careful notes.


CAUSES OF SHOCK

• Severe infections
• Severe burns
• Severe trauma
• Blood loss
• Dehydration
• Severe allergic reaction - this may be due to medicinal herbs, foods, insect stings or snakebites.
• Heart failure
• Severe head injury, traumatic brain injury


Nya liked neat lists. She needed them in her life. And she purred as she made this one.

Finally, one last clarification question was asked on her part. Jansen made sense when he said STOP THE CAUSE. She put that in her notes more than once, underlining the words. She didn’t like the idea of amputation, but if it saved a life she could see its necessity. And she didn’t understand what septic shock meant. She thought it had something to do with blood infections because Jansen had hinted at it, but she wasn’t quite certain. “Jansen, can you tell us what all the symptoms of shock are so we can easily recognize it?” Nya asked, again, when there was a break in the converstation and it seemed a good time to ask a question.

Jansen smiled indulgently and then rattled off a list that caused Nya to almost miss half of it when she was writing. The healer knew his stuff. He enjoyed his job, and she wondered if anyone ever cut into his brain if pages would fly from it, fluttering loose on the wind, like some great book housed behind his eyes.

She had another list for her book. This one even bigger.

SIGNS OF SHOCK

• Pale, cold, clammy or cool to the touch, and sweaty skin
• Rapid pulse
• Sweating
• Nervousness, agitation
• Disorientation/confusion, giddiness
• Thirst
• Bleeding/blood loss
• Rapid breathing, gasping for air
• Blue-tinged skin, lips, or fingernails
• Nausea or vomiting
• Weakened pulse
• Dizziness / fainting
• Unconsciousness (possible eventually).



But they were moving on, and even as Nya glanced at her fellow student and noticed he’d seemingly lost himself momentarily in thought. Then she studied Jansen and wrote furiously about chest compression and breathing for a person. Nya wasn’t sure she could do it, but she trusted the instructor that it would work to save a life. The chest compression and breathing section got pages of its own where Nya indicated where to press, how many times, and then when to breathe. She also noted the fragility of some bodies – like babies – and how to work around the trouble there. The Kelvic gritted her teeth, shook out her hand again, and wondered how the healer had stuffed so much information into his head for about the tenth time.

Her eyes turned to Trevor and she watched his calm interest. Was he understanding all of it confidently? Was this class turning him into a healer? Nya wasn’t so sure of things. The Kelvic knew she wasn’t a natural born healer. The best she could do is gain some skills to assist others in the settlement… and in many ways assist herself because any moment of any day Jansen could be lost to them. The world was rough, it hurt you many many ways, and then it stole your life. Death was inevitable. This class was about prolonging the inevitable.

Nya refocused as Jansen took a breath then gave them a five chime break. Nya jumped up, nodded to her fellow student, then darted down the steps to the beach and ran out to the water for a few chimes before she came back and then drank deeply of her waterskin.

Jansen had returned by then and had three little leather bags. He left one where he’d been habitually standing and then handed out the other two giving one to Nya and one to Trevor. “It’s time we talked about suturing. You can’t properly suture without proper suture tools. Suturing is just a fancy term for sewing. Now, these are just a loan today because the tools in them are expensive. I do sell them though, and make virtually no profit on it. They cost thirty gold, so if you’d like to keep them you need to pay for them. And the bags are big enough that you can flesh them out with a few more items and have a decent medical kit. What these contain is everything you need to have to do decent sutures. The tools are good quality and won’t rust in the weather here if you keep them well oiled. There is a small vial of oil to do so within each kit. “ Then, slowly, he began to unfasten the kit and take all the tools out of it. As he did so, he explained what each item was.

Nya took careful notes.
  • Scissors
    • Suture Scissors – medium sharp-blunt scissors for general cutting and to trim off excess suture material after placing a suture and tying the knot.
    • Suture Removal Scissors - Small versions of Sharp-sharp scissors are used to cut sutures in order to remove them.
    • Dissection Scissors – Designed to cut tissue towards a certain direction where a scalpel is impractical to cut through certain tissue.
  • Probes
    • Both sharp and straight, as well as one that is blunt and slightly curved.
  • Misc Items
    • Skin Hook – used to lift a section of skin to facilitate the placement of sutures while minimizing the amount of injury to the tissue.
    • Scalpel – a surgical knife with a fixed or removable blade for cutting tissue.
    • Forcepts – In essence, giant tweezers – used to grab or hold something.
    • Needle Holder – a special type of forcepts that are designed to security hold the surgical suture needle when placing sutures.
    • Sutures – Silk thread used as the material to bind wounds together.
    • Thread – A Spool of Suture Thread
    • Vial of Oil – Used to keep the tools from rusting. There is a small rag tucked around the vial.
    • Needles – semi-circlular piece of thin rounded metal with a sharpened cutting edge on either the outer or inner curve and an eye on the non-sharpened end in which to fit suture through.


As Jansen explained each item, Nya carefully took it from the kit and looked over each item. They had unusual shapes which she sketched in her notebook next to the item name so she wouldn’t forget what was used for what. The scalpel was super sharp and she ended up nicking herself with it which caused her to hiss and stick the wounded finger into her mouth. She growled and noted that the scalpel was super sharp in her own notes.

When Jansen was done, Randal showed up almost as if he timed it hauling a package wrapped in burlap. He set it down with a thunk and unwrapped it. Big pieces of what looked like pork with the skin still attached lay wiggling in the center of the burlap. There was one each for Nya and Trevor and one for Jansen as well. The slabs were about two foot by two foot and several inches deep. Nya poked at the one that got deposited in front of her and wrinkled her nose. She was hungry. Nya was always hungry, but these slabs didn’t look appealing.

“I’ll use them for bait after you’re done with them.”
Randal said, nodding to Jansen and then the two students in turn. “Nya, don’t eat them. They are going bad. It wasn’t from something we killed, but from a carcass that washed up on the beach this morning.” With that piece of advice, Randal nodded and headed off. Nya nodded her understanding and poked at the slab again.

It wiggled. Gross. Her hunger dissolved into an instant appetite loss as she wrinkled her nose at the smell.

“Relax. We are just going to use them to practice our sutures. This is an important part of stopping blood loss and saving lives, so listen up. I need to teach you knots, stitches, and technique. Then we’ll practice on the pork slabs.”
Jansen said as Randal departed leaving the class alone with itself once more.

Jansen then asked them to watch closely. He took about twelve inches of suture off the roll of suture and removed one needle from the kit. He fit it into the needle holder and clamped the needle roughly in the middle of its body. He then folded the last inch and a half of suture double and passed it through the eye of the needle. Then he opened up the double thread to slightly form a loop and passed the needle through the loop. He pulled the short ends loose ends of the double thread away from the needle and tightened it into a simple knot. That firmly attached the thread to the needle and made it ready to use.

Nya groaned, and slowly began to copy Jansen’s actions. It was slow awkward work, but both students eventually had threaded needles. When that happened, Jansen had them set those needles aside and handed them out string.

“I need to teach you a square knot verses a granny knot. We’ll use the string to distinguish the difference." He carefully demonstrated then left them to their knot practice. They learned the differences between a Granny Knot and a Square Knot. Square Knots held while granny knots gave. The difference between the two knots were almost indistinguishable save for one loop over another a different way. Nya practiced it carefully over and over until she was sure she would always be tying a square knot rather than a granny knot.

Then Jansen went around and cut various ‘wounds’ in the meat in front of them. He demonstrated on his own slab how to safely and securely suture up the wounds, tying the stitching off with a square knot when they were done. Then he turned them loose on their own meat to sew up the cuts he’d made. Once they’d had some practice, he outlined when and where to sew up, when not too, and when to sew mostly up but also leaving a way for infection to drain out.

Nya’s head was spinning and she wasn’t sure she was going to remember ANY of the lesson by the time her slab of meat and skin was filled with neat little stitches.

“So one final thing. You can’t suture a wound properly unless the blood flow to that area is cut off if possible. So now we will learn something about tourniquets and why they are important. Keep suturing as I talk if you aren’t finished, and feel free to make more cuts in your slabs and sew them up if you want more practice. But listen carefully, because the next bit is important too." He said, looking as if he'd be glad when the class was over for the day as well.

Nya thought everything Jansen was teaching was important, but she held her tongue in responding.

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Nya Winters
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Preventing Ashes to Ashes & Dust To Dust

Postby Trevor Hightly on July 31st, 2017, 3:27 pm

Jansen went on with his teaching and Nya asked her questions.

Trevor was a bit impressed with the woman's inquisitions. The young man went on to make sure that he amended his notes to reflect what Jansen said in response to Nya's inquiries.

As his hand held on to the waxy shaft of his quill and moved its scratchy and sharp tip across the paper of his journal, Trevor's mind pondered his fellow student. Nya's questions had flagged the man's curiosity -- out of all the traits that men and others possessed, intelligence and a quick wit were among the qualities that Trevor found most pleasant to experience in another's personality.

Trevor continued to write, for the most part grasping what he was putting down on paper and resolving to study later that which he wished to better carve into his memory. When Jansen gave the group a break, Trevor stepped outside, stretching his legs before class resumed.

When the students' akalak teacher continued his class, distributing a collection of tools and explaining their intended purpose, it didn't take much encouragement for Trevor to return into the Panacea.

Trevor's was engrossed in Jansen's explanation, being somewhat interested in learning the names and uses of all the tools in the suturing kit, until he saw and heard Randal's approach into the clinic. The wildsman carried with him a rugged looking bag full of what appeared to be pork upon its opening.

The pig's flesh did not smell all that fresh, however -- rather it reeked of salt, fish, coral, and deterioration -- and it did not take long for the decomposing husks' scent to reach Trevor's unsuspecting nose.

Trevor cleared his throat, trying to be polite, but also trying to dislodge the pork's unpleasant smell from his displeased nasal cavities and throat. The man did his best to ignore the smell and to focus on those around him.

Jansen demonstrated the use of the suturing kit and Nya worked to follow the man's lead. Trevor did the same, but could not help but notice the visible discomfort with which his fellow student did as she was told -- the woman's earlier ease appeared to now be laced with frustration and disgust.

Trevor felt a bit sorry for Nya, but nonetheless still did his best to pay attention to Jansen.

"Tourniquets -- if I'm simple about their explanation, then they're just a tool to stop blood flow," Jansen explained. "In reality, there are quite a few dos, don'ts, and warnings associated with their use."

"Firstly, never use a rope or any type of string to tie a tourniquet -- you'll risk doing damage to your victim's flesh and blood vessels with chord like that. Rather, use a shirt sleeve or a pants leg, or just a set of bandages to tie one," Jansen warned. "Secondly, I should tell you that a tourniquet should not be kept on for too long. Ideally, you will only keep it on a wound long enough to stop the bleeding of a wound by either suturing it, cauterizing it, or amputating a limb in the most extreme cases. If you do keep a tourniquet on for more than a couple of hours, then you risk your patient losing the use of whatever limb you're using the tourniquet to cut their blood off from."

Jansen dug into his pocket and removed a long, but thin cloth bandage.

"That said, a tourniquet can save your or someone else's life quite easily. There is almost no better tool to stop bleeding in a simpler manner. It's never a bad idea to have the supplies to make one on you," Jansen advised. "There is more than one way to make a tourniquet and most of these ways involve using a stick or lever of some sort to apply pressure -- but I'll show you how to create a tourniquet using only cloth, it's simpler and easier really overall."

Jansen folded the bandage that he'd withdrawn from his pocket over itself so that both its ends touched each other.

"First you want to make a loop with the bandage," Jansen said. "I'll just show you how to tie one on the pig's leg -- it's already there."

Jansen took the folded clothe and laid it over the leg of the decomposing pig.

"Now, you want to put your tourniquet above the wound and on an artery to stop blood flow," the man explained. "Then, take the folded ends of your cloth and run them through the loop that folding the cloth makes at the middle of the bandage."

Jansen ran the unconnected ends of the bandage under its connected end.

"Then you want to pull the sides of the ends of your bandage away from each other tight -- this will probably end up hurting whoever you're applying it to, but that's normal -- you need to put a lot of pressure on arteries to stop them from pumping any blood," Jansen said and demonstrated what he was speaking about.

"Once you have the ends pulled tight away from each other, then you're going to want to keep pulling them and turn them ninety degrees like a lever -- this is why you don't need to use a stick, the folded cloth essentially becomes your lever if you're smart about how you're tying," Jansen explained.

"From there, simply wrap the ends of the cloth around the arm and tie a square knot with the ends to secure the cloth on the arm or leg," Jansen said. "Just remember the dangers of using a tourniquet, but also know that it has its advantages too. It can help immensely when treating a damaged limb."

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