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swatsurgeon 06-09-2008 18:07

personal medical kit contents
 
What would you consider the essentials to have in your personal carry kit? Size is typical leg bag/molle pouch. What are the contents and be specific. I reserve the right to critique and be critical. Realestate and weight as well as utility are all major factors.
This can be a wish list by the way..
If you want a tourniquet you have to specify which one (and why), etc for all equipment. My goal is to find a standardized list that civilians or military "should" carry. Most civilians carry stuff that serves little or no purpose...but it looks cool and chicks dig it.

Ss

FMF DOC 06-09-2008 18:28

If I'm the Doc I need to know number of personnel on mission, length of mission, ect ect..... But lots of pressure bandages, got to control the bleeding. As far as a tournaquet why have one in med kit when you use your wounded belt.

The Reaper 06-09-2008 18:44

Quote:

Originally Posted by FMF DOC (Post 212471)
As far as a tournaquet why have one in med kit when you use your wounded belt.

Because you may need more than one, you may only have one hand to place it, or you may want something more effective than a belt to save your buddy.

TR

desertmedic 06-09-2008 18:47

In a drop leg rig for the care under fire phase:

1. Tourniquets, CAT (3-4) (Easy access to this type)
2. Surgical cric kits (2) ("home made" and sealed with ET tube, shortened scalpel, "hook" to stabilize trach, alcohol preps, and tube tamer)
3. 12ga decompression needles (4-6 needles) with one way valves
4. A couple Israeli dressings
5. Petroleum gauze/tegaderms
6. Trauma shears
7. Pen light
8. Non-latex gloves

The rest of the bag is stuffed with a few cravats, roller gauze, alcohol preps, etc. Most equipment choices are based on what I can get through the current supply chain. NARP used to make a cric kit like the one described above, but I don't think it is availabe in the compact packaging anymore. Keep a lot more stuff in the aid bag to use when things calm down a bit. Stay safe and standing by for critique/advice,

Desertmedic

swatsurgeon 06-09-2008 19:17

Let me clarify, this is not the medics kit, this is a kit that is on everyone...you get wounded and you either use the contents on youself or the medic uses it on you, saving his own equipment for others or when your pouch contents are inadequate to care for you.

Ss

MtnGoat 06-09-2008 19:25

Quote:

Originally Posted by swatsurgeon (Post 212468)
What would you consider the essentials to have in your personal carry kit? Most civilians carry stuff that serves little or no purpose...but it looks cool and chicks dig it.

Ss

I just go down to my Local WALMART.. would that work SS? :p

MtnGoat 06-09-2008 19:53

OKAY on the real side now...

First off in all side pockets (arms & Legs pockets) 1ea CAT or SOFT Tourniquets; 5 total with one in Chest area. If I'm driving the lead V... I have 1 to 2 ea on my legs (Thighs) if needed, road IED threat. GMVs, M1114s get smokey FAST.

I go for something on side of my kit, waist level. What my Tm Medic hands out. Something along these lines.

2ea "Isreali" Fld Dressings
2ea kerlix gauze
2ea Chest Dressing
2ea Non-latex gloves
1ea Pill Pack
1ea 3" roll coban gauze
1ea 4" Elastic (ACE) Bandage
1ea Medical Shears (not in IFAK, I carry it center of chest area)
1ea Pk Petroleum gauze
1ea one 28fr nasopharyngeal airway with lubricant packet
1ea hemostatic gauze Pk

VXMerlinXV 06-09-2008 21:19

6” self adhering ACE
3” self adhering ACE
Asherman Chest Seal
Xeroform dressing
2 ABD pads
5 pack of sterile 4X4 gauze
6” Kerlex
14 ga. Angiocath 2.5” length
100 ml Saline eyewash
2 pr. Large gloves
2” roll Durapore
10 blade scalpel
32 fr NPA
Packet surgilube (taped to npa)
In a perfect world a Benchmade Rescue 5, but a pair of trauma shears will do
Hemostat
2 safety pins
All of this fits in a large ziplock, which will fit in a BDU pants pocket.
The kit can be chopped down to fit in a 1 qt canteen pouch, which would contain the 6” ACE, the Kerlex, the ACS, one ABD pad, The 14 ga. IV cath, the eyewash bottle, the gloves, tape, and the NPA with lube.

Razor 06-09-2008 21:43

I'm assuming we're talking GSW/Blast trauma kit, and not something I'd take with me on a backpacking trip, right?

Razor,
Correct, not for backpacking

Surgicalcric 06-09-2008 22:01

1. Gloves (PPE)
2. Nasal Airway 7.0 (secure Airway)
3. (2) large safety pins (secure bandage, sling, or to secure airway in a pinch)
4. 14 ga or larger 3” catheter (needle drill)
5. Cinch Tight “H” bandage (large bandage)
6. (2) Cinch Tight priMed gauze roll (smaller vaccum sealed Kerlix)
7. Duct tape (no kit is complete without it)
8. Quick Clot, HemCon, or TraumaDex as you prefer (duh)
9. Tourniquet SOFT-T(there should also be a minimum of 1 more on the soldiers centerline which he can get to with either hand (2 is 1; 1 is none)
10. Pill Pack (Mobic 15mg, Acetaminophen 1000mg, and Gatafloxacin 400mg)
11. Chest seals (Package from item 5 & 6 can be used for occlusive dressings along with duct tape thus saving weight and space)

I think that about covers it.

I am rethinking what I am having my guys carry. There may be changes to this list as I test out a few newer bandages...

Crip

nmap 06-09-2008 22:16

Quote:

Originally Posted by swatsurgeon (Post 212468)
My goal is to find a standardized list that civilians or military "should" carry. Most civilians carry stuff that serves little or no purpose...but it looks cool and chicks dig it.

Ss

Sir, thank you very much for creating this thread.

I wonder what level of training the civilian is expected to have. I would not know how to use a tourniquet, much less a catheter.

krod 06-10-2008 07:42

this is what we got on our shoulder:

14g catheter
vacuum sealed kerlex
NPA
HEMCON or quikclot
Asherman or Opsite for chest wounds
Israeli bandage

and a CAT on the front of our kit.

This is vacuum sealed and in our shoulder pocket.

swatsurgeon 06-10-2008 13:41

Gentlemen,
I will not have computer access again until thursday so I will begin my comments then. Please continue to post what you think is the personal kit contents of choice.
Thanks
ss

Kyobanim 06-10-2008 14:05

Crip,

Duct tape? I can imagine a use but I'd like to hear it from you. What do you use it for?

Surgicalcric 06-10-2008 14:13

Kyo:

I use it because it will stick to anything. Though I must admit, sometimes it sticks too well.

Crip

The Reaper 06-10-2008 14:15

Quote:

Originally Posted by Surgicalcric (Post 212567)
Because it will stick to anything.

Crip


Except WD-40.:D

TR

Surgicalcric 06-10-2008 14:16

Quote:

Originally Posted by The Reaper (Post 212568)
Except WD-40.:D

TR

Nothing sticks to WD-40 Sir...

Crip

rab97 06-10-2008 14:57

Don't forget PO Antibiotics and pain meds for the conscious patients. We put those in our guys kits as well in addition to the trauma goodies.

mdb23 06-10-2008 14:58

Quick question.... I am seeing people list non latex gloves as part of their PPE, is that due to possible allergic reaction to the latex ones, or is there another reason as well?

Thanks.

swatsurgeon 06-11-2008 17:35

Quote:

Originally Posted by MtnGoat (Post 212484)
OKAY on the real side now...

First off in all side pockets (arms & Legs pockets) 1ea CAT or SOFT Tourniquets; 5 total with one in Chest area. If I'm driving the lead V... I have 1 to 2 ea on my legs (Thighs) if needed, road IED threat. GMVs, M1114s get smokey FAST.

I go for something on side of my kit, waist level. What my Tm Medic hands out. Something along these lines.

2ea "Isreali" Fld Dressings
2ea kerlix gauze
2ea Chest Dressing
2ea Non-latex gloves
1ea Pill Pack
1ea 3" roll coban gauze
1ea 4" Elastic (ACE) Bandage
1ea Medical Shears (not in IFAK, I carry it center of chest area)
1ea Pk Petroleum gauze
1ea one 28fr nasopharyngeal airway with lubricant packet
1ea hemostatic gauze Pk

MtnGoat,
What is a 'chest dressing' and for what purpose? Not meaning to be a wise ass....just trying to understand the 'what' and 'why'. Most people ask for equipment that they have little understanding of it appropriate use and more importantly, it's limitations. What kind of hemostatic gauze? What do you need the kerlex for, or koban, petroleum gauze??


ss

swatsurgeon 06-11-2008 17:39

Quote:

Originally Posted by VXMerlinXV (Post 212501)
6” self adhering ACE
3” self adhering ACE
Asherman Chest Seal
Xeroform dressing
2 ABD pads
5 pack of sterile 4X4 gauze
6” Kerlex
14 ga. Angiocath 2.5” length
100 ml Saline eyewash
2 pr. Large gloves
2” roll Durapore
10 blade scalpel
32 fr NPA
Packet surgilube (taped to npa)
In a perfect world a Benchmade Rescue 5, but a pair of trauma shears will do
Hemostat
2 safety pins
All of this fits in a large ziplock, which will fit in a BDU pants pocket.
The kit can be chopped down to fit in a 1 qt canteen pouch, which would contain the 6” ACE, the Kerlex, the ACS, one ABD pad, The 14 ga. IV cath, the eyewash bottle, the gloves, tape, and the NPA with lube.


okay, so what is the utility of the self adhering ace (and in 2 sizes), the xeroform is used for what, 14G 2.5 inch caths for what? (they wouldn't make it into the Reapers chest...no offense TR, just the truth.

ss

swatsurgeon 06-11-2008 17:41

Quote:

Originally Posted by Surgicalcric (Post 212504)
1. Gloves (PPE)
2. Nasal Airway 7.0 (secure Airway)
3. (2) large safety pins (secure bandage, sling, or to secure airway in a pinch)
4. 14 ga or larger 3” catheter (needle drill)
5. Cinch Tight “H” bandage (large bandage)
6. (2) Cinch Tight priMed gauze roll (smaller vaccum sealed Kerlix)
7. Duct tape (no kit is complete without it)
8. Quick Clot, HemCon, or TraumaDex as you prefer (duh)
9. Tourniquet SOFT-T(there should also be a minimum of 1 more on the soldiers centerline which he can get to with either hand (2 is 1; 1 is none)
10. Pill Pack (Mobic 15mg, Acetaminophen 1000mg, and Gatafloxacin 400mg)
11. Chest seals (Package from item 5 & 6 can be used for occlusive dressings along with duct tape thus saving weight and space)

I think that about covers it.

I am rethinking what I am having my guys carry. There may be changes to this list as I test out a few newer bandages...

Crip

Surgcric,
what do you do with the chest seal ...and what is it's intended use....and why use it? What is the reason you would want to apply one?
ss

swatsurgeon 06-11-2008 17:45

Gentlemen,
No one has listed the science/theory behind each component they want to carry.....we need to put real medical theory/facts into play here. Everything you want to carry takes up space and is weight on your person. Everything should have a "real" purpose, not a perceived purpose.
I could carry saran wrap and duct tape and nothing else from what I am reading in these posts......
Your life could and will depend on what you choose to carry. Let's make it the absolute right equipment..for the right reasons and the right uses.
Next.....

ss

I will begin to argue your choices with facts that you may/may not have thought about or heard before, from a trauma surgeons point of view. As an example, 2 significant studies demonstrated that a 3 inch chest decompression needle will make it into the majority of male chests and over a 4 inch could cause serious injury to either lung or heart if placed incorrectly. Less than 3 inches has a 35-40% miss rate into the thoracic cavity.

Surgicalcric 06-11-2008 20:07

Quote:

Originally Posted by swatsurgeon (Post 212722)
Surgcric,
what do you do with the chest seal ...and what is it's intended use....and why use it? What is the reason you would want to apply one?
ss

I use the outer packaging from the "H" bandages (Israelis) for occlusive dressings (with the duct tape.) Chest seals (improvised, BCS, ACS, defib pads, etc) are applied to penetrating trauma between the umbilicus and chin.

As for the remainder:

1. Gloves (PPE)
2. Nasal Airway 28fr (used as a NPA or can be used for a cric in a pinch)
3. (2) large safety pins (secure bandage, sling, or to secure airway (pin thru tongue then cheek))
4. 14 ga or larger 3” catheter (needle drill)
5. Cinch Tight “H” bandage (pressure dressing, large)
6. (2) Cinch Tight priMed gauze roll (packing wound tracks)
7. Duct tape (no kit is complete without it)
8. Quick Clot, HemCon, or TraumaDex (this depends more on what is available at the time of order than what I want)
9. Tourniquet SOFT-T(there should also be a minimum of 1 more on the soldiers centerline which he can get to with either hand (2 is 1; 1 is none)
10. Pill Pack (Mobic 15mg, Acetaminophen 1000mg, and Gatafloxacin 400mg; for battle wounds where the soldier is conscious, in pain and the medic isnt there, SR, Recon, etc...)

Again, I have been rethinking the kit my guys carry and this is also METT-TC dependent, meaning the kit changes depending on whether we will be fighting in an urban environment (short patrols with medevac/casevac assets close) vs the jungles of South America or the mountains of A-stan (they carry much more stuff (personal sick-call meds, Antimicrobials, IV kits, etc) in the jungle and would on extended patrols in the mountains of A-stan, etc...)

There really isnt a one size fits all solution to this, atleast for the SOF soldiers. We can narrow it down to a bare essentials list for most everything but the truth is the kit will vary greatly depending on the where and for how long factors. The civilian side (LEO) should be much easier to cover though...

Crip

MtnGoat 06-11-2008 20:31

Quote:

Originally Posted by MtnGoat (Post 212484)
OKAY on the real side now...

First off in all side pockets (arms & Legs pockets) 1ea CAT or SOFT Tourniquets; 5 total with one in Chest area. If I'm driving the lead V... I have 1 to 2 ea on my legs (Thighs) if needed, road IED threat. GMVs, M1114s get smokey FAST.

I go for something on side of my kit, waist level. What my Tm Medic hands out. Something along these lines.

2ea "Isreali" Fld Dressings
2ea kerlix gauze
2ea Chest Dressing
2ea Non-latex gloves
1ea Pill Pack
1ea 3" roll coban gauze
1ea 4" Elastic (ACE) Bandage
1ea Medical Shears (not in IFAK, I carry it center of chest area)
1ea Pk Petroleum gauze
1ea one 28fr nasopharyngeal airway with lubricant packet
1ea hemostatic gauze Pk


SS

No problem on the why, what and hows..

2ea "Isreali" Fld Dressings ( better & easyer than the standard Mil Field Dressing. Has everything rolled up into one)
2ea kerlix gauze (Pack those GSW.. Takes at least 3 rolls IMHO-E)
2ea Chest Dressing (Asherman Chest Seal is the one issues.. Which SUCK IMHO.. When Rick sold his Company the new "Owners" changed the Dressing Adhesive so now they suck)
2ea Non-latex gloves
1ea Pill Pack [(Mobic 15mg, Acetaminophen 1000mg, and Gatafloxacin 400mg) is the standard issued "drugs" help for that first med "Boost" for the PATs body]
1ea 3" roll coban gauze (Helps make stuff (Dressings) stick when needed)
1ea 4" Elastic (ACE) Bandage [Hold back those Field Pressure dressing and all that Kerlix for thos enasty GSW]
1ea Medical Shears (not in IFAK, I carry it center of chest area) [Cut all he clothes that are around those open wounds, Shapnel and GSWs]
1ea Pk Petroleum gauze (Aids in Chest wound GSW or Shapnel holes-sealing them)
1ea one 28fr nasopharyngeal airway with lubricant packet (Air way through your Nose) [Body needs air and water to OP(live)]
1ea hemostatic gauze Pk [(Quick Clot, HemCon, or TraumaDex) Helps to stop all that red liquid running out of those openings in your body] I know DOCs Surgeons don't like what is can or does to tissue. But....


I would like to add.. Military wise. It helps to have a IFAK, Med Bag, Blow out bag that can be PULLED off the persons BA. It speeds up the Medical Process. That guys BA will be taken off and thrown to the side and now you have to go looking for his IFAK-BOB.

PROs and CONs to both. Just my .02

Peregrino 06-11-2008 20:40

Keep going guys - we're all learning here. This is a timely discussion from my perspective because I have a couple empty IFAK pouches I need to set up. You're already influencing some of my initial choices. To backstop SS - lets get some "rationales" for the whats & whys. Us "knuckledraggers" need that if we're going to be convinced to carry anything more than the most obvious minimums. I always went with whatever the team medic handed me without a lot of questions. Now it's time to (I have to) do a little more thinking on my own.

VXMerlinXV 06-12-2008 08:19

Quote:

Originally Posted by swatsurgeon (Post 212721)
okay, so what is the utility of the self adhering ace (and in 2 sizes), the xeroform is used for what, 14G 2.5 inch caths for what? (they wouldn't make it into the Reapers chest...no offense TR, just the truth.

ss

The ace is used in combination with the ABD, gauze, or kerlex to create a pressure dressing. I like the 6” for arm and leg coverage, but I prefer the 3” for heads, hands, and feet. I also like the Ace for the splinting of ankles, used in conjunction with either a SAM or a stick, it covers the R and C in RICE therapy (Rest, Ice, Compression, Elevation). I prefer the self adhering model so I am not relying on little metal clips or tape.
The xeroform is used with the ACS. For multiple penetrating injury to one side of the chest the ACS can be used to occlude the wound allowing the most air passage, and the xeroform can be used to seal the other holes. While I know that history shows us the wrapper or plastic wrap can be used as an occlusive, I think the semi-adherent nature of the xeroform makes it more suited for this purpose.
I like the shorter IV caths because they can also be used for peripheral IV access, and I feel the 3” models give a lot of resistance when you try to advance the catheter when used for this purpose. The deciding factor would be if a 2.5” angiocath could reliably decompress a chest when inserted into the 5th or 6th intercostal space on the midaxilary line, where you would encounter less mass.

x SF med 06-12-2008 09:06

Hint for the duct tape that Crip carries - a small dab of petrolatum keeps it from sticking to bandages, and other areas where the adhesive might remove derma or cause issues...:rolleyes:

crash 06-12-2008 20:08

my kit
 
2x CAT tourniquets (amputations)
1x M2 ratchet style tourniquet ( easier to apply, tougher than cat; prob replace cats with 2 more of these, or the sof-t)
2x H&H compressed gauze (wound packing/dressing)
1x civilian compression bandage similar to Israeli (pressure dressing)
1x Israeli bandage (pressure dressing/improvised tq)
2x opa's (keep patent airway / bite block; 2 in case u loose one)
2x npa's (keep patent airway / can be used for cric)
2x 14ga needles (chest decompression / also can be scalpel for cric)
3x asherman chest seals (sucking chest wound)
4x petroleum gauze (sucking chest/exit wound , shrapnel to the thorax)
1x quick clot powder (better to have and not need than need and not have)
1x quick clot sponge "
1x celox "
1x IV starter kit 18ga, alcohol prep, op-site, 10cc flush
1x roll tape
1x scissors
1x pen light
1x sharpie

then of course still have my med pouched and aid bag ect, but I figure if i need any more than that I'm f'd.. advise, recommendations, critics welcome.

krod 06-13-2008 00:39

Im not a medic... never seen the 14g used for a scalpel. How does it work?

Surgicalcric 06-13-2008 04:27

Quote:

Originally Posted by krod (Post 212917)
...never seen the 14g used for a scalpel. How does it work?

Remove the catheter from the needle, turn needle 90 degrees so the bevel is now facing left or right as opposed to upward and use on a 10-20 degree angle just as you would a scalpel. It takes a lil practice and isnt as fast as using a scalpel but it will work in a pinch.

Crip

swatsurgeon 06-13-2008 06:15

Gentlemen,
I would like to focus briefly on the equipment used for an open (sucking) chest wound. Multipart answer here:
1)Has anyone dealt with a true open chest wound where there was free movement of air both in and out of the pleural space, and 2) used a 3 sided dressing or asherman type device. What was the result? Did the dressing or device prevent the need to provide positive pressure ventilation (BVM or ETT intubation, etc) and most importantly, was it a true open chest wound?
Ss

shadowflyer 06-13-2008 06:29

First on scene to a 32 y/o Female with multiple stab wounds to chest and back. PT is combative and bleeding profusely. Once we got PT into back of truck we exposed her and found a wound to left upper chest and neck just above sternal notch, with free air moving in and out of chest wound. PT complaining of having a hard time breathing. 3 side occlusive dressing placed. 2 large bore IV's placed. Fluid challenge with .9 NS started as she had no radials at the time. PT did say it was easier to breathe once we got dressing on. PT was maintaining her own airway at time. By the time we made it out of the apartment complex PT arrested. ACLS protocols followed on rest of way to trauma center. PT pronounced DOA at ER. Autopsy noted aorta and lung laceration. PT bled out before we could get her to OR.


Hope this helps.

JJ

D9 (RIP) 06-13-2008 09:16

2 torniquets (1 SOF, 1 CAT) carried on person and accessible

2 pr Nitrile Gloves
4 Alcohol swabs
4 Betadyne swabs
2 14 ga Catheters
4 Chest seals, self-adhesive
1 6" self-adhering ACE
1 4" self-adhering ACE
2 Z-Pak Gauze dressings
1 HemCon
1 Quiklot
1 Laminated 9-line card
1 Alcohol pen
1 Marker
Trauma shears (not to be used for hooch construction)

Surgicalcric 06-13-2008 12:04

Quote:

Originally Posted by swatsurgeon (Post 212935)
...1)Has anyone dealt with a true open chest wound where there was free movement of air both in and out of the pleural space...and used a 3 sided dressing or asherman type device.

Yes. Too many infact, both in the ER and at EMS.


Quote:

2) What was the result? Did the dressing or device prevent the need to provide positive pressure ventilation (BVM or ETT intubation, etc) and most importantly, was it a true open chest wound?
I have used ACS, defib pads, large tegaderms, and seran wrap.

Of the patients who were conscious, and maintaining their own airways, all claimed relief of the SOB, until pressure built up from the 4-sided dressings requiring a needle-drill.

Of the ones who were ETT'd, O2 sats was higher until pressure increased, resulting in venting becoming more difficult, indicating the need for a needle-drill.

Hope that answered your questions...

Crip

swatsurgeon 06-13-2008 14:28

Surgcric,
You answered it perfectly.....IF and when a patient becomes symptomatic (non-intubated pt.), time for a 3 sided dressing/ACS, etc. All patients with positive pressure being applied via ETT or BVM, don't need one. A dressing somewhat reduces the future contamination (above and beyond what has already occured). The fact is that you have to watch these people like a hawk....if the open end is not letting go of the air, they get a tension PTX. I haven't found a reliable tape or adhesive that sticks well to the body when it is dirty, slimy from sweat, etc. I haven't tried duct tape but I will now to see if it holds.

Back to the original issue: what method works most reliably for these wounds?
So far multiple people have used different methods to seal the chest. Can we safely say there is no one standard? Any product that can form a barrier to the inflow of air and yet release it when necessary would seem to work......
$15 for an ACS, <$1 for saran wrap and duct tape and everything in between.

Needle decompression for tension PTX: need a needle that is 3-3.5 inches long, longer and placed in the incorrect place, you harpoon the heart or lung potentially. How many to carry on your self??? I say 5. They bend too easily and repeat decompressions are >60-70% likely. Little weight and little size, so more is better. My record was 7 in one side....he lived to the hospital.

Prep pads: alcohol and betadine....why both? Needed at all? Do they sterilize the skin or just act as a method to wipe away some of the grime?

more to follow.

ss

Surgicalcric 06-13-2008 16:11

Well lets see if I can convey my thought this afternoon while medicated...
 
Quote:

Originally Posted by swatsurgeon (Post 213021)
Surgcric,
You answered it perfectly.....IF and when a patient becomes symptomatic (non-intubated pt.), time for a 3 sided dressing/ACS, etc. All patients with positive pressure being applied via ETT or BVM, don't need one. A dressing somewhat reduces the future contamination (above and beyond what has already occured). The fact is that you have to watch these people like a hawk....if the open end is not letting go of the air, they get a tension PTX. I haven't found a reliable tape or adhesive that sticks well to the body when it is dirty, slimy from sweat, etc. I haven't tried duct tape but I will now to see if it holds.

I really have used everything from the ACS to moleskin to saran wrap. Also to be honest I was never impressed with the one way valves (as they seemed to fail once blood worked its way into the flutter valve) or with the function of the 3-sided occlusive dressing for the same reason. I cant begin to tell you the number of studies I have read which argue back and forth on whether the 3 sided or 4 sided occlusive dressing is the Gold Standard" for the initial treatment of penetrating trauma to the thorax. Quite frankly I don't really see what the fuss is all about. I understand the theory behind the 3-sided/valved dressings but again have never seen them work very well, OMMV. With either, close attention needs to be paid to the patients respiratory status, for changes signaling a tension PTX, as you mentioned above.

Quote:

What method works most reliably for these wounds? So far multiple people have used different methods to seal the chest. Can we safely say there is no one standard? Any product that can form a barrier to the inflow of air and yet release it when necessary would seem to work...... $15 for an ACS, <$1 for saran wrap and duct tape and everything in between...
As for adhesive, I have never been that impressed with COTS solutions with the exception of the Hyfin Chest seal (which has an adhesive akin to that on the old ekg pads or moleskin which will take skin and all when removed) however I havent used one on a real patient yet and have only tested the adhesive on a water soaked patient. (More to follow on this as I get back to my civilian job.) The ACS sucks; the BCS seems better but not a 100% solution; saran and duct tape work damn near 100% of the time but causes some obvious skin irritation due to the strength of the adhesive; Defib pads work but who carries them in the field; and large tegaderms / opsites work great due to the material being very flexible. No scientific data to support any of that though, just trial and error.

Quote:

Needle decompression for tension PTX: need a needle that is 3-3.5 inches long, longer and placed in the incorrect place, you harpoon the heart or lung potentially. How many to carry on your self??? I say 5. They bend too easily and repeat decompressions are >60-70% likely. Little weight and little size, so more is better. My record was 7 in one side....he lived to the hospital.
I agree about the caths, however the caveat being, shorter (2-2.5") will work if you move your site from 2nd ICS MCL to 5th ICS MAL. The bending is spot on with my experiences as well SS and as such one needs to prepare for that. I think my record was 5... I dont know about carrying that many in a BOK, but am not opposed to the idea but would like more discussion on it before I would try to convince my guys to carry more than 2 ea. Hopefully by ythe time someone has drilled someone twice there would be someone else around (the 18D or if working without a medic someone else) with a aidbag or CLS type bag which is over stocked with extra's of the commonly used items...

Quote:

Prep pads: alcohol and betadine....why both? Needed at all? Do they sterilize the skin or just act as a method to wipe away some of the grime?
I generally just use alcohol to wipe the site clean moreso than trying to sterilize the site itself... I think most providers (emt's, nurses, MD's) do it because they were taught it was the right thing to do and it becomes muscle memory with everything else (iv sticks, injections, etc...) I dont see why we worry about it in a combat setting or the ER for that matter. If the patient has an open chest wound anything foreign micro that can get in got in through the larger hole the foreign object made on its path into the thoracic cavity. The patient will be receiving the antimicrobial of choice once at "bright lights and cold steel" anyways. Not attempting to promote bad medicine or that teaching to cleanse the site is wrong but in the scheme of things its not an issue... If that makes sense...

Enough of me babbling...

Crip

swatsurgeon 06-14-2008 05:26

Crip,
The issue with decompressing in a lower spce is that with your "muscle memory" if you use or are handed a longer catheter, the risk of a cardiac puncture in the 4th, 5th, 6th interspace increases significantly. I have operated one 2 patients with this issue in the recent past. One had a tamponade and one had an arterial line...thankfully the medic realized it and capped it rather than pulling it out. Hit the left ventricle with a 5 or 7 inch angiocath (hence harpoon). Cook catheter co. Makes a 3.5 inch wire wrapped cath that can't bend or kink in 12 gauge. They double as a needle cric but I use them for the chest. Here is a multipurpose item, which is where I'm trying to go with all kit items.
As far as the skin prep, we remove all field placed lines within 24 hrs anyway, no sterility in the field.
ss

Surgicalcric 06-14-2008 09:05

SS:

Thanks for the reminder of the hazards associated wtih decompressions in the MAL with longer caths. While on that subject, have you noticed any such inadvertent punctures using shorter caths or is it all based on the longer versions? Just curious.

As for multiple purpose items I am all for it. I am a firm believer in the more educated we are the less we need to carry.

Keep the ideas coming.

Crip

swatsurgeon 06-14-2008 09:20

I have only seen one cardiac injury with a 2.5 inch needle placed parasternally, 7th space and got the heart.


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