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Old 06-10-2008, 14:15   #16
The Reaper
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Originally Posted by Surgicalcric View Post
Because it will stick to anything.

Crip

Except WD-40.

TR
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Old 06-10-2008, 14:16   #17
Surgicalcric
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Originally Posted by The Reaper View Post
Except WD-40.

TR
Nothing sticks to WD-40 Sir...

Crip
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Old 06-10-2008, 14:57   #18
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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.
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Old 06-10-2008, 14:58   #19
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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.
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Old 06-11-2008, 17:35   #20
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Originally Posted by MtnGoat View Post
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
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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Old 06-11-2008, 17:39   #21
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Originally Posted by VXMerlinXV View Post
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
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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Old 06-11-2008, 17:41   #22
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Originally Posted by Surgicalcric View Post
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
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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Old 06-11-2008, 17:45   #23
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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.
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)

Last edited by swatsurgeon; 06-11-2008 at 17:49.
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Old 06-11-2008, 20:07   #24
Surgicalcric
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Quote:
Originally Posted by swatsurgeon View Post
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
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Last edited by Surgicalcric; 06-11-2008 at 20:38.
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Old 06-11-2008, 20:31   #25
MtnGoat
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Originally Posted by MtnGoat View Post
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
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Old 06-11-2008, 20:40   #26
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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.
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Old 06-12-2008, 08:19   #27
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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.
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Old 06-12-2008, 09:06   #28
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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...
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Old 06-12-2008, 20:08   #29
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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.
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Old 06-13-2008, 00:39   #30
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Im not a medic... never seen the 14g used for a scalpel. How does it work?
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