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Old 01-31-2012, 14:38   #91
Cake_14N
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simple civillian kit.

I am just a simple civilian so my kit is very simple. I used to be an EMT-I in New Mexico, so in a life or death situation I could start an IV, but without ready access to the supplies (need a prescription to get them here in NM) I left IV off my list.

I need to be able to maintain an airway and stop major bleeding until better equipped help arrives to take over.

To do this I need the following:
Gloves. I use the nitrile gloves you buy in the cleaning section of WalMart. I get 10 pairs in a package for a couple of bucks.
3 piece NPA kit ( sm, med, lg) plus a packet of KY jelly. This lets me at least make an attempt to correctly size the airway for the patient.
6 4x4 gauze pads. Used as a quick dressing for small stuff.
2 x Field dressings. I get them at the local surplus store and check them over to make sure package is intact.
2 x triangular bandages. Multi uses here. Can be folded into a 1.5 to 2 inch wide band and made into a TQ in a pinch. Also used to hold dressings in place.
1 roll med tape, cloth preferred.
6 inch long piece of aluminum dowel. Used to tighten the TQ made from the triangular bandage. It is lightweight and works.
My cell phone to call for better equipped help.

All this ( except the cell phone, its in my pocket) fits inside an old Nalgene water bottle wrapped with about 25 feet of duct tape and fits inside the cup carrier of my car.
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Old 02-10-2012, 17:12   #92
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26 y\ o male pt with gsw to L. side upper chest wall from a 7.62 round ( casing found by atlanta pd). Entrance in front, exit wound in back. Pt. vitals: respirations 14. shallow, BP 92/68, P 126 / weak, o2 sat 96 %, warm and sweaty. Pt found lying supine on ground. Found wounds, cleaned blood and lung matter so that we could use sterile 4x4s and packaging from a abdominal dressing to seal off gsw. 3 sided occlusive anterior, 4 sided posterior. 14 g Iv in left arm, 16 g iv right arm, 0.9 % NS hung. Pt went unconsious and was intubated using 8.0 ett. Had to bolus to keep pt bp above 90 systolic. Pt made it to Grady ER where he was evaluated by staff and sent directly to OR. Called ER staff approx 2 hr later to find pt made it into surgery where he died due to blood loss from a slight aortic tear. Dressings did their job, however I had to use several strips of tape to secure them to the skin.


Quote:
Originally Posted by swatsurgeon View Post
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?
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Old 02-10-2012, 20:38   #93
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2<<SNIP>>>
Bama23:

This isnt the intro thread. Your first post should have been there, make your next one so.

Attention to detail, attention to detail...
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Old 02-16-2012, 22:34   #94
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Blow Out and OUCH pack

On my Body armor I carried a pull away molle pocket for TCCC/Self aid buddy care type issues that was packed with
2x CAT on the Out side
9 line card and PT tx cards in a small zipper
2x S fold Kerlix
1x ACE
2x 14G NARP Cath
2x NPA
1x Cric Kit with 6.5 Shelly
1x HALO dressing (Chest Seals the best ones i have ever seen 2 come per pack and they are the size of Defib pads very nice)
2x Hemcon Injectors
1x Quick Clot
5x Large Safety Pins (to many uses to mention)
1x Trauma Sheers


Something else I got in the practice of keeping with me is what I refer to as an "OUCH POUCH" that keeps the little thats that we as medics all so often don't have. Its stocked with
5-10x Band-aids
5x Blister Guard band-aids
1x Sheet Mole Skin
1x Super Glue
5x OpSites great to cover small cuts that have been sealed with Super glue
6x Benyadryl 25 mg
16x 200mg Motrin (Mobic when available)
1x tube Oral Glucose (if available, when not I put 2or 3 Dum Dum Pops in)

This little kit has come in handy more times then I can count so that I don't have to break into my main to treat a small cut or blisters. Just think how often you are asked for a bandaid and don't have one. Just something to think about.
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Old 08-28-2012, 22:47   #95
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Quote:
Originally Posted by Odin21 View Post
I am a National Guard medic with one tour and I know that I have a lot to learn still. Why do you carry 8 betadyne swabs in addition to 8 alcohol pads? I have heard of using alcohol pads to help clean the site before a NCD and I understand that you could do the same thing with betadyne. However, it looks like you only carry 2 14 ga needles for NCDs- do you swab the site multiple times? I was told in 68W school to try to use alcohol before sticking, but that it was not as important as them breathing- "That is what we have ABX later for." Is there another use for betadyne that I am missing? Is sterile technique that important that I need to carry more alcohol pads and betadyne swabs in my vest kit? Thank you so much for your time and guidance.
Hey Odin,

I'm pretty sure the 8 betadyne and alcohol swabs had more to do with space than it did with anything else. A large 14GA cath for a decomp is an awkward piece of kit to jam into a little pouch. Sometimes, a medic can find him/herself in the position of getting as many of those into the pouch as possible and still finding a little space to cram in a few odds and ends - hence the extra swabs.

Unfortunately, sometimes the pouch dictates what extra few items can be squeezed in.

Personally, if my patient load is such that I've decompressed two chests and there are still more tension pneumos awaiting relief, then I'm probably in my second line equipment and telling my 18E to get our MASCAL protocol rocking - just me.

Remember, your second line is still there.

Additionally, a good medic is treating guys with tension pneumos out of their own kit, not out of his own. Yours are for emergencies (read: kit failures), or for you.

Thanks for the PM. Sorry for the late response. Take care.

D9
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Old 07-22-2013, 09:11   #96
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My current bug-out/get-home bag's FAK list. Suggestions and advice welcome.

Trauma Kit:
EMT Shears
3.5” Hemostat
Tweezers
Nitrile Gloves
Gorilla Duct Tape
Alcohol Wipes
Ace Bandage
Cravat
Combat Gauze
Quickclot 2x2 (Thanks again. )

6" Israeli Battle Dressing- Plan to change to Tac Med Solutions' 4" Olaes Bandage
SOF-T Tourniquet
HALO Chest Seal

Snivel Kit:
Ibuprofen
Benadryl
Imodium
SAM Splint
Neosporin
Moleskin
Gauze
Small bottle of Betadine
Povoiodine Swabs
3-0 Nylon Sutures
Butterfly Sutures
Cyanoacrylate
Med Tape
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Last edited by Barbarian; 08-02-2013 at 08:50. Reason: Temp. SA failure.
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Old 08-22-2013, 02:35   #97
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Here's my personal (me & family) medical kit, which I take on any outdoor trip, ride, walk, hike etc. I divided it to two pouches, which are very easy to attach to any of my backpacks via MOLLE attachments. In the pics below attached to me smallest backpack, MR Spartan. Of course if the backpack is bigger than it's even easier to attach. And (of course) all of my backpacks have MOLLE panels. The pouches are long version of Trauma Pouch from ITS Tactical.

Pouch #1 -> Trauma Kit (marked with medical cross and red tab for easy recognition)
- Olaes Modular Bandage
- CELOX
- gloves, trauma shears
- chemical light stick (white) so that I'm never without emergency light
- bandaids, antibacteria swabs, small burns gel
- small antiallergy steroids for kids (just in case)

Pouch #2 -> Adrenaline Kit (black ITS logo pouch)
- EpiPen autoinjector for severe or life-threatening allergy reactions (after multiple bee bites in vital areas like neck etc.). I travel with small kids, who have never been bitten by a bee, so it's "just in case" device.
- I keep it in foam padded Peli case to protect against elements and overheating.

So that's it. My medical kit to deal with bleedings & allergy shocks. From small cust to life-threatening accidents on the trial. If I miss anything important - please, let me know.
Attached Images
File Type: jpg its_medic_1.jpg (316.6 KB, 48 views)
File Type: jpg its_medic_2.jpg (255.8 KB, 49 views)
File Type: jpg its_medic_3.jpg (301.2 KB, 49 views)
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Old 08-23-2013, 07:03   #98
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Quote:
Originally Posted by PiterM View Post
Here's my personal (me & family) medical kit, which I take on any outdoor trip, ride, walk, hike etc. I divided it to two pouches, which are very easy to attach to any of my backpacks via MOLLE attachments. In the pics below attached to me smallest backpack, MR Spartan. Of course if the backpack is bigger than it's even easier to attach. And (of course) all of my backpacks have MOLLE panels. The pouches are long version of Trauma Pouch from ITS Tactical.

Pouch #1 -> Trauma Kit (marked with medical cross and red tab for easy recognition)
- Olaes Modular Bandage
- CELOX
- gloves, trauma shears
- chemical light stick (white) so that I'm never without emergency light
- bandaids, antibacteria swabs, small burns gel
- small antiallergy steroids for kids (just in case)

Pouch #2 -> Adrenaline Kit (black ITS logo pouch)
- EpiPen autoinjector for severe or life-threatening allergy reactions (after multiple bee bites in vital areas like neck etc.). I travel with small kids, who have never been bitten by a bee, so it's "just in case" device.
- I keep it in foam padded Peli case to protect against elements and overheating.

So that's it. My medical kit to deal with bleedings & allergy shocks. From small cust to life-threatening accidents on the trial. If I miss anything important - please, let me know.
Where's the tourniquet???
Celox?? How about combat gauze as a better choice (personal experience)
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Old 08-23-2013, 07:46   #99
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Quote:
Originally Posted by swatsurgeon View Post
Where's the tourniquet???
Celox?? How about combat gauze as a better choice (personal experience)
I am not sure how familiar you are with all the variants but that would likely depend upon which Celox.

UK, Germany and Spain are using Celox that tested highest at the ONR (over CG). The Celox variant that was sold in the US earlier by Sam Medical under-performedv against CG. Both were tested in the ONR study. I don't think the EU ever had much of it. It was intended more for burns.

I will see if I can get a PDF of the ONR study and post it. In the meantime, here is a briefing from MHSRS (the conference formerly known at ATACCC) that summarizes the findings from this and other studies.

I hope this helps explain PiterM's choice. Also of note, I think you will find most SOF units carry ChitoGauze or Celox in their kits. Each did their own testing to confirm their selection.
Attached Files
File Type: pdf Bennett_3rd Gen Hemostatic_14 Aug.pdf (2.46 MB, 6 views)
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Old 08-23-2013, 08:47   #100
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I was very fortunate to be an 18D when all of these bandages were coming into the inventory. Being in SF we got first dibs on this stuff as it came available. I actually had to look up a bunch of the brand names to see what each one was as there was no brand name for the chitosan bandages when we first got them.

We preferred the chitosan over the quick clot (and its variants) because of the exothermic properties of the quick clot and the HemCons were just not that much more effective at 5 times the cost. The problem with the chitosan at that time (2003+) was that it came in a large 4x4 dressing that was very stiff and very hard to get because the factory was being built. At first we would try stuffing the whole thing in the wound but quickly adapted and started cutting off small pieces and putting that right on the bleeder. As you can see the problems on the battlefield trying to cut a small piece of chitosan. The quick clot was a powder that you just poured into the wound but most people under stress would hardly get enough to the source of the bleed and it was ineffective.

That said seeing that they heard our recommendations for a gauze that could be pushed into the wound these products sound like they will be VERY effective in the future. As of my retirement in 2008 our primary go to for a bleeder was still a TQ and regular rolled gauze and we had a few chitosan bandages each for severe emergency bleeds.

Good to see these products fulfilling their potential!
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Old 08-23-2013, 13:09   #101
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Originally Posted by swatsurgeon View Post
Where's the tourniquet???
Celox?? How about combat gauze as a better choice (personal experience)
Have to agree with Miclo18d on this one too. The kaolin based combat gauze works by presumably increasing absorption of water. That is why gauze has hemostatic properties. Kaolin just improves that supposedly. I saw a comparison between combat gauze (kaolin hemostatic) versus regular gauze in a controlled hospital setting. No statistical difference in the mean clotting time. I'll try to find that study and post it. As a side note, this is why native Americans used a poultus of clay on wounds (kaolin is a component of clay). That probably is the source of "rub some dirt in it" as 98G was nearly admonished.

Kaolin's water adsorption is exothermic and that gives me concern as well. As noted by miclo18d. Also, kaolin is a microparticulate mineral that is not dissolved and provides an excellent surface for biofilm formation and bacterial growth.

On the other hand, chitosan is a pharmaceutical grade natural product derived from the exoskeleton of arthropods. In fact it is the chitosan that provides the agglutination of insect and shell fish heamolymph and protection after their exoskeleton has been breached. Same basic principle in human clotting. Chitosan interacts directly with the platelets to induce clotting factor release. Sound biochemistry and cellular biology IMO. You also don't have those pesky problems of exothermia and surfaces for biofilm formation. JMO
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Old 08-23-2013, 14:39   #102
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Found It

Here's that study I mentioned.
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Old 08-23-2013, 16:36   #103
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Quote:
Originally Posted by swatsurgeon View Post
Where's the tourniquet???
Celox?? How about combat gauze as a better choice (personal experience)
As I said I'm not in a combat situation. tourniquet is probably the last device I'd ever need. And just in case I have always with me a good piece of paracord, which would work great as a tourniquet (combined with a piece of stick or folding knife to apply good torque).

Celox... easy to find here, and seems to be a good general solution for severe cuts. I'm not afraid of bullet wound. I'm afraid that I can cut myself BADLY with one of my knives when working with them in the wild. For knife cuts and stabs Celox™ Granules seems to be quite OK. Especially combined with OLAES Modular bandaid.

What I really consider (additionally) is Celox Applicator for deep stabs...
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Old 08-23-2013, 17:29   #104
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Originally Posted by PiterM View Post
As I said I'm not in a combat situation. tourniquet is probably the last device I'd ever need. And just in case I have always with me a good piece of paracord, which would work great as a tourniquet (combined with a piece of stick or folding knife to apply good torque).

Celox... easy to find here, and seems to be a good general solution for severe cuts. I'm not afraid of bullet wound. I'm afraid that I can cut myself BADLY with one of my knives when working with them in the wild. For knife cuts and stabs Celox™ Granules seems to be quite OK. Especially combined with OLAES Modular bandaid.

What I really consider (additionally) is Celox Applicator for deep stabs...
Piter, there are a lot of unanticipated situations where the tourniquet can save lives.

I would encourage you to get a good one (or two) and learn how and when to use it.

You really do not want to use paracord unless there is nothing else.

TR
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Old 08-23-2013, 17:37   #105
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Originally Posted by PiterM View Post
As I said I'm not in a combat situation. tourniquet is probably the last device I'd ever need. And just in case I have always with me a good piece of paracord, which would work great as a tourniquet (combined with a piece of stick or folding knife to apply good torque).

Celox... easy to find here, and seems to be a good general solution for severe cuts. I'm not afraid of bullet wound. I'm afraid that I can cut myself BADLY with one of my knives when working with them in the wild. For knife cuts and stabs Celox™ Granules seems to be quite OK. Especially combined with OLAES Modular bandaid.

What I really consider (additionally) is Celox Applicator for deep stabs...
As a 91B4S at one time and a physician I would say that paracord makes a lousy tourniquet . It is narrow. The wider the better when it comes to a tourniquet. Even with a stick is is hard to get sufficient pressure to stop arterial flow on a limb. Probably would work on a finger.
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