Sandbox Med Thread

[Sneaky SF Dude]

Lessons Learned - credit ozzy from LF.Com
-CHEST TUBES SAVE LIVES!!!
-Pack light (i know you want to be ready for everything but you cant)
-chitosan bandages seem to be working pretty good.
-BEWARE the one handed tourniquet
-IV fluids are over rated(except in the most extreme cases)
-Hespan good for packing light or the new hextend(this stuff has promise)
-For cas. still in the fight gitafloxacin(not sure about the spelling)for war wound therapy q24 w/ vioxx and tylenol make a good combo
-for cas not in fight IV morph. w/ cefotetan Q12
-TOURNIQUETS in combat cas care saves lives quick
-You cant beat 3in ace and kerlex
-sublimaz lollipops are worth their weight in gold (tell em to suck on it till it doesnt hurt...that sounded pretty bad oops)
-leg bags are great(i can work my first 2 pt from mine)
-Have lights lots of them 2,3,4 even
-TSSI M-4 bags are great(not an add)
-If your in a truck bring the world you dont have to carry it(I have pelican case for meds and a paramedic internal frame ruck i use. the guys wont mind the extra space)
-Foam hand sanitizer is a must have for everyone
-GET A VACCUM SEALER AND SEAL EVERYTHING(trauma packs, ET tubes etc)
-OTTER med boxes work really well for protecting narcs
-Small tackle boxes(the clear ones)work for other meds
-Make kits i.e. chest tube, cut down, cric. IV
-Quickclot works but you have to be very careful

[Sneaky SF Dude]

Lessons Learned Mog
- Curlex, curlex, curlex, ya can't have enough.
- Little (field type) dressings suck.
- Everyone needs to carry IVs, ace wraps and curlex.
- Strong pointing save lives, get off the streets, that's where you get hit.
- Transport is treatment.
- If higher's plan does not support medical aspects, don't argue, just show how those planning holes will cause failure when casualties occur.
- Exsanguination and airway problems will kill most people. The basics save lives much more than the advanced treatments.
- You can do a bunch with just a tourniquet and an airway adjunct.
- In combat/firefights there is a very low occurrence of c-spine injuries, but always consider MOI.

Operational considerations for 18Ds

The basics save lives! ABCs and common sense really work and will keep casualties alive. Train everyone in those simple tasks.

The "Golden Hour" is essential in special operations casualty care. Medical intervention on the battlefield will have its greatest impact on survivable injuries if the patient is treated within the 1st hour.

Train realistically, include rehearsals and plan for worst-case scenarios. Whenever possible, include casualty play in training. Make the scenarios as realistic as possible and perform every task as stated in your plan.

Always have contingency upon contingency plans. Try to keep them as simple as possible so they will be easy to remember. They probably will never be used exactly as planned, but thinking about different situations and possibilities during training will enable you to make decisions faster and smarter during the mission.

Make sure everyone on the team can perform a primary and secondary survey and keep them proficient in self and buddy aid. It may be you they are working on someday.

Always keep bandage material, an airway, a flashlight and bandage scissors readily accessible on your body; somewhere you can get to quickly. If you can maintain an airway and plug a hole quickly, you have bought time until you can move to a protected area and render definitive care.

Find an aid bag that is comfortable and practical for you according to the mission. Set it up efficiently and be able to work out of it blindly.

Always think about improvisation of everything you may need. You cannot carry enough supplies (i.e. bandages and splints) with you if there are many casualties. Pack multi purpose items.

Move the casualty to some kind of protection before working on him. He probably fell near where he was shot. Do not get tunnel vision on treating him where he was just exposed to the shooter.

Keep in shape! Know your weapons and shoot them well! Do not forget your basic skills as a soldier. You are another gun in the fight until someone gets hurt - then you are a gun and a medic. You may very well find yourself alone with casualties because your team is focused on moving ahead, so do not forget your own security.

Cross load medical gear and supplies on everyone.

Remember to treat the "whole” patient, not necessarily the “obvious” wound. Assess the whole casualty and all wounds while thinking of any possible anatomy that may be involved by primary and secondary missiles. Do not assume bullets take a straight path from entrance to exit wounds.

Use different classes of pain meds effectively to keep as many people in the fight as possible. Remember the effects that narcs will have on casualties.

Consider early anti-biotic use.

Consider using saline locks to gain early IV access.

[Risk]

Great post SSFD. Can't find this info anywhere. Invaluable.

Thanks.

Risk

[Sneaky SF Dude]

Health Information for Travelers to the Middle East



--------------------------------------------------------------------------------
Bahrain, Cyprus, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Turkey, United Arab Emirates, Yemen

Note: Check the Outbreaks section for other important updates on this region.


--------------------------------------------------------------------------------


To find out about current U.S. Department of State travel warnings and public announcements, see http://travel.state.gov

The preventive measures you need to take while traveling in the Middle East depend on the areas you visit and the length of time you stay. You should observe the precautions listed in this document in most areas of this region. However, in highly developed areas of Israel, you should observe health precautions similar to those that would apply while traveling in the United States.

Travelers’ diarrhea, the number one illness in travelers, can be caused by viruses, bacteria, or parasites, which can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis). Make sure your food and drinking water are safe. (See below.)

Malaria is a serious, but preventable infection that can be fatal. Your risk of malaria may be high in these countries, including some cities. Prevent this deadly disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites (see below).

Travelers to malaria-risk areas, including infants, children, and former residents of the Middle East, should take an antimalarial drug. Travelers to some areas of Iran, Iraq, Oman, Saudi Arabia, the Syrian Arab Republic, Turkey, and Yemen may be at risk for malaria. There is no risk of malaria in Bahrain, Cyprus, Israel, Jordan, Kuwait, Lebanon, Qatar, and the United Arab Emirates. For additional information on malaria risk and prevention, see Malaria Information for Travelers to the Middle East. See also Preventing Malaria in the Pregnant Woman (Information for the Public) and Preventing Malaria in Infants and Children (Information for the Public).

Chloroquine is the recommended antimalarial drug for Iraq, Syria, and Turkey.



Travelers to Iran, Saudi Arabia, and Yemen should take one of the following antimalarial drugs: (listed alphabetically): atovaquone/proguanil, doxycycline, mefloquine, or primaquine (in special circumstances).



In Oman, the risk of malaria is in the Musandam Province only; because the risk is very limited, no antimalarial drug is needed in this area.



Dengue, filariasis, leishmaniasis, onchocerciasis, and plague are diseases carried by insects that also occur in this region. Protecting yourself against insect bites (see below) will help to prevent these diseases.

There is no risk for yellow fever in the Middle East. A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements.

CDC recommends the following vaccines (as appropriate for age):

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

Hepatitis A or immune globulin (IG).
Hepatitis B, if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment.
Meningococcal vaccine is required for pilgrims to Mecca for the annual Hajj. However, CDC currently recommends the vaccine for all travelers to Mecca, including those traveling for the Umra. (For more information, please see Meningococcal Disease Among Travelers to Saudi Arabia.)
Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
Typhoid, particularly if you are visiting developing countries in this region.
As needed, booster doses for tetanus-diphtheria and measles, and a one-time dose of polio for adults. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who have not completed the series.
All travelers should take the following precautions, no matter the destination:

Wash hands often with soap and water.
Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid travel at night if possible and always use seat belts.
Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.
Don’t eat or drink dairy products unless you know they have been pasteurized.
Don’t share needles with anyone.
Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
Never eat undercooked ground beef and poultry, raw eggs, and unpasteurized dairy products. Raw shellfish is particularly dangerous to persons who have liver disease or compromised immune systems.
Travelers visiting undeveloped areas should take the following precautions:

To stay healthy, do...

Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, make water safer by BOTH filtering through an “absolute 1-micron or less” filter AND adding iodine tablets to the filtered water. “Absolute 1-micron filters” are found in camping/outdoor supply stores.
If you visit an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)
Protect yourself from mosquito bites:
Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
Wear long-sleeved shirts, long pants, and hats.
Use insect repellents that contain DEET (diethylmethyltoluamide).
Read and follow the directions and precautions on the product label.
Apply insect repellent to exposed skin.
Do not put repellent on wounds or broken skin.
Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
Children under 10 years old should not apply insect repellent themselves. Do not apply to young children’s hands or around eyes and mouth.
For details on how to protect yourself from insects and how to use repellents, see Protection against Mosquitoes and Other Arthropods.
To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
To avoid getting sick...

Don’t eat food purchased from street vendors.
Don’t drink beverages with ice.
Don’t handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague). (For more information, please see Animal-Associated Hazards.)
Don’t swim in fresh water. Salt water is usually safer. (For more information, please see Swimming and Recreational Water Precautions.)
What you need to bring with you:

Long-sleeved shirt, long pants, and a hat to wear while outside whenever possible, to prevent illnesses carried by insects (e.g., malaria, dengue, filariasis, leishmaniasis, and onchocerciasis).
Insect repellent containing DEET.
Bed nets impregnated with permethrin. (Can be purchased in camping or military supply stores. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.)
Flying-insect spray or mosquito coils to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
Over-the-counter antidiarrheal medicine to take if you have diarrhea.
Iodine tablets and water filters to purify water if bottled water is not available. See Do’s above for more details about water filters.
Sunblock, sunglasses, hat.
Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).
After you return home:

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (chloroquine, doxycycline, or mefloquine) or seven days (atovaquone/proguanil) after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.


For more information:

Ask your doctor or check the CDC web sites for more information about protecting yourself against diseases that occur in the Middle East, including the following:

Diseases carried by insects

Dengue
Malaria
- General information
- Prescription drugs
Plague
Diseases carried in food or water

Cholera
Escherichia coli diarrhea
Hepatitis A
Schistosomiasis
Typhoid fever
Diseases from person-to-person contact

Hepatitis B
HIV/AIDS
- Prevention
- HIV-infected travelers


For more information about these and other diseases, please check the Diseases page and CDC Health Topics A–Z.



--------------------------------------------------------------------------------

This document is not a complete medical guide for travelers to this region. Consult with your doctor for specific information related to your needs and your medical history; recommendations may differ for pregnant women, young children, and persons who have chronic medical conditions. In addition, you may also check the following CDC sites:

Malaria: General Information
Preventing Malaria in the Pregnant Woman (Information for the Public)
Preventing Malaria in the Pregnant Woman (Information for Health Care Providers)
Preventing Malaria in Infants and Children (Information for the Public)
Preventing Malaria in Infants and Children (Information for Health Care Providers)
Prescription Drugs for Preventing Malaria (Information for the Public)
Prescription Drugs for Preventing Malaria (Information for Health Care Providers)
Vaccine Recommendations for Infants and Children
Food and Water Precautions and Travelers' Diarrhea Prevention
Be sure to read the information about all the regions you are planning to visit.

[Sneaky SF Dude]

http://www.phrusa.org/research/health_effects/humiraqkurd.html

[Sneaky SF Dude]

http://www.odci.gov/cia/publications/factbook/geos/iz.html

[PSYWAR 1-0]

subscribing

[okami1]

Excellent, excellent thread. Reading and learning...

[Sneaky SF Dude]

I'm not doing it all.

[Bandaid]

Originally posted by Sneaky SF Dude
I'm not doing it all.
Sir Sneaky-
Really, I am not so sure. LOL
Now you know what I feel like in my effort .....

[ECHO6GOLF]

Good Gouge...Thanks gents.

[Sneaky SF Dude]

E6G,
Get some of your Corpsmen to give us some stuff. Jeez, you'd think the Marines are working with no med support at all.

[GRENDEL]

Damn good stuff. We have the world fact book sit eposted in our shop...always a good read. Although alot of you guys may have this, I'll post it for the masses. Robert Lee Pelton's The worlds most dangerous places...this book has great medical info for all the happy places on the planet, as well as first hand area intel.

And just for fun check the Moulage area of Trauma.org, good stuff.

[ECHO6GOLF]

Originally posted by Sneaky SF Dude
E6G,
Get some of your Corpsmen to give us some stuff. Jeez, you'd think the Marines are working with no med support at all.

I will talk to them after the leave period and see if they can add any more info. Im just trying to learn everything and anything I can.....
6G

[DY]

Sneaky--chitosan bandages seem to be working pretty good. What are these?
-You cant beat 3in ace and kerlex All my battle packs have these instead of battle dressings. An old 18D taught me that years ago but I've only seen it coming around recently.
-Make kits i.e. chest tube, cut down, cric. IV 7.0, 8.0 ET tubes for makeshift chest tubes. Shorter, but better than nothing, especially for pneumo and can carry several.

[Doc T]

Originally posted by DY

7.0, 8.0 ET tubes for makeshift chest tubes. Shorter, but better than nothing, especially for pneumo and can carry several.

do you cut extra holes in the tube if you are using it for this purpose?

[Bandaid]

Originally posted by DY
chitosan badages..........Sneaky- What are these?


DY-
info you requested.

Chitosan Bandage Will Save Lives in Battle

News and Media - Mercury - May 2003 Mercury
by Karen Fleming-Michael
Fort Detrick Standard

Shrimp shells, of all things, may contain the military's solution to the problem of hemorrhage on the battlefield. More specifically, the shell's chitin, after it's transformed into a specific form of chitosan, forms a seal that can stop uncontrolled bleeding.

"There are lots of dressings that can stop small oozing or capillary bleeding, but that's not good enough because that's not what kills soldiers on the battlefield," said Dr. Anthony Pusateri, who's managed the Hemostasis Research Program since 1999 at the Institute of Surgical Research, Brooke Army Medical Center, Fort Sam Houston, Texas.

On modern battlefields, more than nine of 10 combat deaths occur before evacuation, and a little more than half of those are caused by uncontrolled hemorrhage, said Pusateri, a physiologist who's worked in hemorrhage control for nearly eight years.

"We need to keep casualties alive longer so we have more time to evacuate them for surgical treatment. When we can get them to surgeons, they almost always survive," he said.

In studies performed at ISR in 2002, the chitosan dressing effectively stanched a wound that in the first 30 seconds put out more than 300 milliliters of blood.

Created by researchers at the Oregon Medical Laser Center using a research grant from Medical Research and Materiel Command, the 4-inch by 4-inch chitosan dressing is well suited for the battlefield and better than gauze and pressure bandages currently used to stop extreme bleeding, said Col. Bob Vandre, director of Combat Casualty Care research for at MRMC.

The dressing's durability and flexibility make it "soldier proof," he said. The dressing can withstand blunt force as well as inclement weather, temperature and rugged terrain.

"We haven't actually run over it with a humvee, but it does stay together well, and that's an important factor because we need soldiers to be able to carry it in their packs and run around with it, fall down on it (without damaging it), et cetera," Pusateri said.

Further, chitosan is also antimicrobial, so it kills germs as a "nice freebie" for soldiers injured on dirty battlefields, Vandre said.

The bandage poses no threat to people who are allergic to shrimp, he added.

"It turns out that though many people are allergic to shrimp, they're not allergic to the chitin," he said.

Who will receive the bandage is an issue that's currently being discussed at the Army Medical Department Center and School. The current issue plan gives two bandages to the combat lifesaver and 10 to the medic, though Col. John Holcomb, commander of ISR, thinks someday every soldier may carry one.

Because the dressing uses chitin, a natural polymer found in shrimp shells, as well as lobsters, crabs, insects, worms, fungus and mushrooms, Vandre said he hopes the bandage will be fairly inexpensive.

"If the company that's producing the bandage can find a good source of chitin, the price could drop," he added.

The Food and Drug Administration has approved the chitosan dressing for external use and the Army will use it on arm and leg, or extremity, wounds, which account for 10 percent of battlefield deaths.

Recalling the scene in the movie "Black Hawk Down" where a soldier dies from a leg wound, Vandre said, "Although we don't know it for a fact, it appears this bandage can stop that kind of bleeding. The people who do pathology say they believe it can stop that kind of bleeding."

In fact, a hemostatic dressing like the chitosan dressing could have saved lives during Operation Enduring Freedom, according to Chris Kelly, public affairs officer at the Armed Forces Institute of Pathology, which performed autopsies on the first 30 service members who died in Afghanistan.

"We found that with early, adequate treatment, hemostasis can reduce mortality," he said. "By looking at our autopsy findings, at least three cases could have been saved had we had a hemostatic dressing."

Researchers also believe hemostatic dressings can save limbs as well as lives because they limit the amount of time a tourniquet is needed.

"You can't leave a tourniquet on for more than a few hours, or the loss of circulation in that limb will cause it to need to be amputated," Vandre said. "The thought with this dressing is that you can put on a tourniquet, stick the dressing on, stop the bleeding, then take the tourniquet off and keep circulation to the limb [so amputation isn't necessary]."

Researchers will take the dressing to the next level—internal use—this spring to see if the body can absorb the bandage.

"You go for external first because it's easiest to get through the FDA, and on the battlefield external is what medics do," Vandre said. "But on the battlefield and in emergency surgery, the first thing you try to do is stop bleeding. If you have a bandage you can put over a large bleeding area and stop bleeding, it would be nice to be able to leave it there ... and have the body resorb the bandage over time."

The Army's other hemostatic dressing, a fibrin bandage, is not out of the picture, although the chitosan dressing is more durable and cheaper.

"For internal use, it's not as clear which product will be the winner," he said. "We're not clear if it [the chitosan dressing] will resorb, and we're pretty sure the fibrin bandage will."

Tests at ISR will help answer that question by summer, Holcomb said.

Vandre said the bandages will be invaluable on future battlefields.

"If there's a way to stop the bleeding faster, it will save lives," he said.

From the May 2003 Mercury, an Army Medical Department publication.http://www.armymedicine.army.mil/news/mercury/03-05/chitosan.htm

[DY]

Doc T. Is that a suggestion? I can't see how that would hurt so long as you intend to use the tubes for said purpose.

Bandaid, Thanks. Currently reading...

[DY]

Who will receive the bandage is an issue that's currently being discussed at the Army Medical Department Center and School. The current issue plan gives two bandages to the combat lifesaver and 10 to the medic, though Col. John Holcomb, commander of ISR, thinks someday every soldier may carry one. This article is from May. Are they in wide distro for the Army now? Do you have SN?

[okami1]

Originally posted by Bandaid


Recalling the scene in the movie "Black Hawk Down" where a soldier dies from a leg wound, Vandre said, "Although we don't know it for a fact, it appears this bandage can stop that kind of bleeding. The people who do pathology say they believe it can stop that kind of bleeding."

Given the fact that this wound involved a retracted femoral artery, how would these bandages address that situation? Would the fibrin bandage be a better choice to staunch the internal bleeding in this instance?

[Bandaid]

Originally posted by DY
Doc T. Is that a suggestion? I can't see how that would hurt so long as you intend to use the tubes for said purpose.
Yes, I think it was a - "if you aren't already doing it, then think about it".
I don't pretend to have Doc T's expertise, but I think she is referring to the fact that an ET tube has an end opening vs. a normal catheter for a chest tube that has an end opening and one or two side openings to allow for increased drainage.

Therefore, she was suggesting that to be more effective, you could modify the standard ET by cutting a 2 small openings 1 cm apart from the end opening.

I only answer because sometimes Doc T is away from SOCNET for a while due to her busy professional schedule. I am sure she will confirm her thoughts when she gets time. Hope that helps explain it though.

[DY]

Yup. There is already one small hole about 1/4 inch from the tip, but I will consider cutting additional, esp if Doc T comes back and says the holes are vital. In fact, my best guess is they are there primarily to circumvent clotting.
Bandaid or anyone else, got a stock number for the chitosan bandages? PM if deemed appropriate...

[Sneaky SF Dude]

I think cutting extra holes is a good idea.

[Doc T]

its too easy for lung or blood to block off the two openings found in an ETT.

anyway, we modify tubes all the time in the OR to make them do what we want so would suggest adding a few more holes to the ETT being used as a chest tube to increase the chance that they will actually function as you'd like. Just be careful not to place the holes too distally and wind up with an airleak from one of your holes...ETTs aren't very long when you compare them to the average CT.

doc t.

[Sneaky SF Dude]

Yeah, what she said. LOL

Merry Christmas ma'am.

[Doc T]

Originally posted by Sneaky SF Dude
Yeah, what she said. LOL

Merry Christmas ma'am.

I get to work on Christmas as the only jewish one among my partners... the girls are enjoying hannukah as the gifts just seem to keep on coming....

A merry Christmas to you... and your family.

doc t.

[Sneaky SF Dude]

Well, Happy Hannukah then.

[Doc T]

Originally posted by Sneaky SF Dude
Well, Happy Hannukah then.

when the girls are old enough to understand we will probably wind up doing both as Teutates isn't jewish...

best of all worlds i guess....

thanx.

doc t.

[Sneaky SF Dude]

Teutates probably wants them to celebrate the festival of Mars.:D

[RIT_MEDIC]

Originally posted by Doc T
when the girls are old enough to understand we will probably wind up doing both as Teutates isn't jewish...

best of all worlds i guess....

thanx.

doc t.

Damn dont that bring back memories from my childhood.

Father was Jewish...mother was Roman Catholic...little James was confused, very confused. Still is BTW. lol

Happy Chanuka Doc T.

BTW...Where has the Team Sarn't been hiding lately.

James D

[Doc T]

Originally posted by RIT_MEDIC


BTW...Where has the Team Sarn't been hiding lately.

James D

didn't realize he was in hiding...probably just too busy putting together kitchens and little supermarket shops and strollers and .....

[Guy]

Excellent thread! As I slowly unwind, I'll add what I can from my trip.

I spent more time treating illnesses than injuries, mostly upper respiratory infections and the shits.:cool:

Take care.

[Sneaky SF Dude]

Excellent Guy! Just the man we were looking for.

[Sneaky SF Dude]

Hey!

[Xdeth]

Traumadex, cheap and highly recomended clotting agent. The chitosan, fibrin, and other high speed bandages are pretty cost prohibitive unless your working for uncle sam or only need a few blowout kits.

If chest tubes save lives then all medics and corpsman need the training not just 18D's. Is there a way to learn this for field expedient purposes? If so where? The typical answer is "you need too much training, licensing etc.." That aint cutting it, surely there is a foreign medical college we can send guys to for a week or two.

A nice primer on antibiotics would be helpful, doxycycline and cipro are being used all over the place these days for all kinds of reasons.

Being lazy I haven't looked to see if there was a thread discussing fluid push, saline, ringers, hespan. Rate of flow, order, and responding to patients status.

I know some of the answers to these but I want to see the best gouge get posted, thanks folks!!

-C (Not a medic, doc, corpsman or any of those cool guys)

[javahedz]

I think a good idea might be to get everyone trained up in needle decompressions - hook a 30cc syringe up to a 10g cath in someone's chest and you can do a lot in the way of helping a lung to reinflate. I've seen too many 1st year residents butcher PTs while doing chest tubes - I don't wan't my boys giving me an extra gaping chest wound when a needle thoracentesis would be just fine for a couple of hours as a stopgap treatment.

But that's just me ;)

Dan

[Doc T]

I have a couple of thoughts on this...

1. needle decompressions can be just as dangerous as chesttubes if done with poor technique. I have seen patients with "decompressions" of the heart, subclavian artery and lung...rather than just the pleural space.

2. A chest tube is a simple technique to learn...... if first year residents where you are are having difficulties then you should look to the more senior people to see how they are being taught.

doc t.

[javahedz]

Sigh.......

Where I am is on an ODA. I see the bad techniques in military and non military hospitals when I do my ER rotations. Worst chest tube I saw was in Harborview medical center in Seattle (The #1 trauma center in the Pacific NW)

Chest tubes in the ER are great. Chest tubes w/o a pleura-vac in the jungle with a 6 hour wait for the evac bird are a different story.

I adjust my medicine to the area I'm working in ;)

Just my two cents :D

Dan

[Doc T]

Originally posted by javahedz
Sigh.......

Where I am is on an ODA. I see the bad techniques in military and non military hospitals when I do my ER rotations. Worst chest tube I saw was in Harborview medical center in Seattle (The #1 trauma center in the Pacific NW)

Chest tubes in the ER are great. Chest tubes w/o a pleura-vac in the jungle with a 6 hour wait for the evac bird are a different story.

I adjust my medicine to the area I'm working in ;)

Just my two cents :D

Dan

my comments were not directed at placing CTs in the field... my comments were directed at the fact that your post seems to indicate that chest tubes are fraught with danger while needle decompression is a benign procedure...

[Sneaky SF Dude]

Sigh...

Is pleura-vac suction?

I think both of them are relatively easy to do.

[Doctor_Doom]

Pleura-Vac is the one-way water valve with fluid collector, it's the plastic container that can be attached to suction.

With proper teaching the trocar placement of chest tubes can be pretty simple. I was pretty comfortable with both trocar and regular techniques in trauma settings in the ER.

Without a Pleura-vac, one can use a condom with the end cut off and petroleum jelly to make a field-expedient one-way valve, but that's just what the textbooks say.

[Sneaky SF Dude]

Sigh...

Oh, you mean the flutter valve from the finger of a surgical glove. Got it.

[Doctor_Doom]

Oh yeah, the glove-finger works too... don't know why we were always told to use a condom.

[DY]

How about using a urine collection bag?

[Doc T]

Originally posted by Sneaky SF Dude
Sigh...

Is pleura-vac suction?

I think both of them are relatively easy to do.

why all the sighing??

anyway... the pleurovac system is just a ready-made system of collecting chamber, waterseal chamber and suction if desired...
I copied this from a search on the internet and edited it a bit... hope it helps explain it.

The first chamber (White on a Pleurovac) is a simple trap to catch any fluids drained from the chest tube.

The second chamber (Pink on a Pleurovac) is the underwater seal or water seal chamber. This chamber exists to provide the one-way valve that will allow air to exit the chest but not to enter it. Note that the tube from the drainage chamber is immersed under water about 2 cm deep. Any pressure in the pleural space greater than 2 cm H2O will result in bubbles forming in this chamber. If you see bubbles in this chamber then there is air coming from the chest tube or connecting tubing.

The third chamber (Blue on a Pleurovac) is the suction control chamber. The level of negative pressure applied to the pleural space is equal to the depth that the vent tube is placed under water. 20 cm H2O would be a typical level of suction. Some chest drainage systems substitute a needle valve suction regulator for the suction control chamber. To measure the pleural pressure, one can pinch off the suction tubing "S" and read the water level in the underwater seal chamber (second chamber).

[Sneaky SF Dude]

I can't find the picture, but we used to be taught how to make them out of milk bottles.

i'm sighing making fun of Java.

[RIT_MEDIC]

Originally posted by Sneaky SF Dude
I can't find the picture, but we used to be taught how to make them out of milk bottles...

Sneaky:

It is in ST 31-91B pg 1-17.

Yes Sarn't, I have been working on my night time reading.

James D

[Sneaky SF Dude]

I know that, I can't find it on the internet to post it. Damn!

[Doc T]

Originally posted by Sneaky SF Dude
I know that, I can't find it on the internet to post it. Damn!

it won't let me post it but here is a site that has it on page 14 and 16....

http://www.tycohealth-ece.com/files/d0000/ty_flwr6y.pdf

[Sneaky SF Dude]

That's it.

[javahedz]

Trying to remember - couple Heimlich Valves and some tubing, and a big assed syringe hooked up (in a specific way of course - a Y coming off the syringe branching into each valve) to the end of a chest tube make for nice field suction. You keep pumping in and out on the syringe - air comes out the 1st one way valve when you draw the plunger back and is expelled out the 2nd one way valve when you depress the plunger. You do this until light resistance is felt - then you clamp the chest tube - pull the suction contraption off and put a regular heimlich valve back on - don't forget to remove the clamp on your chest tube.

Sneaky - fuck off about the sighs ya bastid :D - I'm just tired of being grouped in either the hospital crowd or the 91b type crowd - it gets old (and I had been up for 48 straight so I was a bit cranky ;) )

BTW - I don't consider a chest tube to be fraught with danger if I do it, I do see it as a very scary procedure if my weapons guy is doing one on me at 0200 in the dark after a big firefight (also an event fraught with danger) or even in the teamroom for that matter :)

and yes - I do consider a needle decompression a relativly safe procedure - even for a zoned out, knuckle dragging, sleep deprived weapons guy ;) I'll say this - if my boys have a hard time needling my chest - think of the damage they could do trying to tube me :eek:

Dan

[Sneaky SF Dude]

That sounds like it ought to work.

Everybody still loves you, 1st Group puke. :D

Get some rest and quit going to town. LOL

[javahedz]

Bah - what kind of a care provider would I be if I wan't a prick all the time :D

Hugs & kisses

Dan

[mac3982]

a enpty 2l bottle of pop works fine but i don't recommend it.. we got a device called a casp tube in our ER it works well for simple neumos... one of our staff came up with it and got it brought on line for use...

[ECHO6GOLF]

Originally posted by Sneaky SF Dude
E6G,
Get some of your Corpsmen to give us some stuff. Jeez, you'd think the Marines are working with no med support at all.

I spoke to one of my docs and showed him all the things that were posted.
He swore by curlex, big time!!!!!!!
AS far as quickclot, he said that he would prefer to never use it. He said that it could cause more harm than good.
It would be redundant if I wrote down everything he said, becaue you guys have covered it all. A good thing is that most Marines will carry these new and improved Med Kits that will hopefully save lives. (our old ones were worthless). The new ones will contain a shitload more (including quickclot) I just hope we all get some training to go with the new bags.
I know this wasnt much to add, but this thread pretty much covered everything.

Semper Fi
6G

[Gryfen-FL]

I've seen a lot of references to quickclot....

From what I've read so far; there seems to be quite a bit of diference between quickclot and traumadex.

Is the military only using quickclot, or is that term used to describe the traumadex powder as well?

[DocHabu]

Just found out I'm leaving in a couple of weeks, so I'll bump this back to the top for anyone else who's looking.

[desertdoc]

the problem with quick clot seems to be one of training. When I first saw it, QC was touted as the be all and end all of bleeding control. Shit dont work without the pressure to slow the flow and allow it to work.
Sneaky, my covers off to you for throwing that stuff out to the masses. I first saw the 18D lessons learned from a guy in the pipeline when they were in the NYC rotation. Great stuff and now Im here again and was using those pearls as hip pocket training for a new guy.
My addition to the thread will be that most(not all) of what I have seen here has been community based viral syndromes. Similar to prison, homeless shelters etc. Mostly symptom based treatments
Loperamide/cipro, Promethazine, and fluids. Progressive sinusitis/URI decongestents/trimox , some stuff from left field and the occasional indirect fire stuff. Most of what I try to pass on to guys is that knowing symptoms and the why snot is running down
the throat as opposed to being shot monkeys and pill pushers makes for a better doc

[DY]

My addition to the thread will be that most(not all) of what I have seen here has been community based viral syndromes. Similar to prison, homeless shelters etc. Mostly symptom based treatments Thats a hell of an idea for medical rotations.

[Doc P]

Originally posted by Sneaky SF Dude
Curlex, curlex, curlex, ya can't have enough.


Hell yes. It's like the duct tape of medicine.

Great post.

[desertdoc]

When I worked 911 in NYC, the amount of time I spent in those places, Rikers, Wards Isle etc, it was one endless rotation.