Originally Posted by Brush Okie (Post 558251)

Will do, it was higher medical authority that told me that. I sent a PM for clarification so as not to come off as an ass again.

Originally Posted by Brush Okie (Post 558233)

I apologize I read you wrong. I have seen 1/2 trained volunteer firefighters almost kill people because they did not know what they were doing. While well meaning the patient is still dead.

Originally Posted by Surgicalcric (Post 558250)

I don't. Most of my stuff comes from online companies. Have you tried the intraweb for what you need? And what do you mean "military friendly," discounts?

Originally Posted by Surgicalcric (Post 558236)

Your question is one of triage at the root of it and so the decision on who and how many gets treated for "X" injuries occurs long before the first rotor or tire rolls out of the gate. As harsh as it sounds we can't carry everything for everyone so we carry supplies based on injuries expected over the largest demographic of patients. Triage truly should begin with patient demographic analysis (US, coalition, civilian - adult vs pediatric, enemy personnel) of the AO or target area. I am not talking about pulling up complex consensus reports but looking at places of worship or schools in or around the target area(s) and population density. If I am concerned about a high possibility of taking pediatric casualties I will toss a pediatric specific pouch in my extended care/evac bag but I don't usually carry any pediatric stuff in my assault bag. Pediatric specific supplies in my bag include airways: NPA & cuffed ETT for crics, IV cannulas and a buretrol, and a dosing chart tethered to the pouch.

As for CLS trained personnel and pediatric patients, MOO based on previous interaction with some is if there are casualties a CLS guys time would be much better spent working on the patient populace in which they trained instead of "winging it". I don't agree with the axiom that peds are little adults and get treated accordingly.

Hope that addresses your question.

Crip

Originally Posted by Defend (Post 558209)

Only other question is can anybody recommend a military friendly medical supply shop to do business with in the Hampton Roads area?

Originally Posted by Defend (Post 558209)

Only other question is can anybody recommend a military friendly medical supply shop to do business with in the Hampton Roads area?

Originally Posted by Surgicalcric (Post 558237)

Speaking of half trained...that is incorrect.

The Facial Nerve (CN V) mediates the corneal (eyelash) reflex and the gag reflex is mediated by the Glossopharyngeal and Vagus (CNs IX and X) nerves. These nerves do not share any common pathways and the presence of one does not imply anything about the other. Anesthesiologists often times will utilize the method you outlined to gauge alteration in gross sensory function from a known baseline. There is a correlation (although not perfect) between unconsciousness and loss of gag, so there is some value in the lash test for that but using it in the field while suggestive, isn't the same.

The history of the lash test is that in the OR after administration of an induction agent, the anesthesiologist would lightly brush the eyelashes to check for a blink. The reasoning behind this practice is not so much to check for a gag (going to make that go AWAY!) but to check for unconsciousness prior to the administration of a neuromuscular blocking agent. If no blink is present, the anesthesiologist could be reasonably certain they were not paralyzing a patient who is "awake".

Originally Posted by Stephens (Post 567864)

IMO, Some Excellent info from SurgicalCric. Also, I feel Okie is correct in advising caution to anyone using an NPA---especially in the field where things are much less controlled than in the OR.

This is true. We induce and then brush eyelash for reflex, then tape eye shut.
It's to answer the question "is this guy asleep?" Tape eyes. Muscle relaxant.

And yes, a NPA in a pt who is not deep enough can provoke brutal
Vomiting
Laryngospasm
Bleeding

Ask me how I know. :( Years ago, I had one huge guy I put a NPA in immediately valsalva and shoot a huge stream of green battery acid out of the NPA. He did fine but he could have aspirated and died.

I put an NPA in a lady in the OR once and she immediately started gushing blood. Turns out she had a history of terrible nose bleeds. I didn't ask her about that pre-op and frankly never expected to need an NPA for her--but I stupidly pulled the trigger and paid the price. She did fine with afrin and elevating her head but it slowed the case down.

Learn from my mistakes.
Take home;
They work great but I hesitate to pull the trigger on one unless I have to.
I've been in anesthesia (nurse) 10 years and an NPA will scare me.
I have low threshold for aborting insertion attempt if it isn't smooth as butter.

Originally Posted by NurseTim (Post 567963)

Would retreating with neosynphrine (spelling?) have prevented this? The bold portion I mean.

Originally Posted by Brush Okie (Post 567964)

Sounds like you learned the same way I did.