Combat lifesavers and medical experts needed!

[Guest HillyKarma]

I bought a trauma kit and in it there was a 10 gauge chest decompression needle with a catheter. 

What exactly would this be used for, and how would I go about using it?

[pitt2magic]

If you haven't had direct training with it, do everyone a favor and don't use it at all.  It is used to reinflate a collapsed lung but if you don't know what you are doing you can easily hit an artery.

Edited February 2, 2014 by pitt2magic

[TMF]

I wouldn't use that for its intended purpose unless you get some formal training. A bit more complicated than running an IV. Well, not exactly more complicated, but a lot more you can do wrong. The bright side is that, unless you're on the battlefields of Afghanistan, the knowledge of how to treat a tension pneumothorax with a needle decompression is pretty pointless. You'll never be that far from care to require it. Sent from my iPad using Tapatalk

[Guest HillyKarma]

If you haven't had direct training with it, do everyone a favor and don't use it at all.  It is used to reinflate a collapsed lung but if you don't know what you are doing you can easily hit an artery.

I'm planning on getting training, of course, I just happened to have the funds to go ahead and buy the kit so I could have it, and this came with it, though it wasn't listed.

Thanks for your help.

 

I wouldn't use that for its intended purpose unless you get some formal training. A bit more complicated than running an IV. Well, not exactly more complicated, but a lot more you can do wrong. The bright side is that, unless you're on the battlefields of Afghanistan, the knowledge of how to treat a tension pneumothorax with a needle decompression is pretty pointless. You'll never be that far from care to require it. Sent from my iPad using Tapatalk

Thanks for the help!

[TMF]

I think a lot of these kits marketed nowadays are designed by former action people or wannabe types who get wrapped up in the idea of 'combat loadout' and put a lot of things in there that sound cool, but aren't intended for use in an environment where there is immediate care. Guaranteed, if there is a shooting there will be lights and sirens coming towards you. In combat you might be hours, even days from receiving care. That's when doing some of these field expedient procedures makes sense, since the worst that could happen is the patient dies, gets infection or has a permanent medical condition related to field treatment by a knuckle dragging trigger puller. Not too many cons there if the likelihood of death without field expedient treatment is likely, due to proximity to care. But in our setting, in the US, the chances of 1) being wounded in such a manner or treating someone wounded in such a manner is incredibly slim (unless it is part of your job such as police, fire, EMT, postal worker, stripper...) and 2) the chances of being in such a situation and being hours or days away from care is practically nil. I have a trauma kit in the truck to deal with the big ones, such as airway and bleeding, like j tubes, nasal trumpets, tourniquets, curlex, ace wrap.. . Those will kill you quick. I also have things like chest seals and quick clot, but not so much because I have intention of using them, but I just don't have anywhere else to put them. The last thing I would do would be to introduce some of the crap I have into a patient if I know an EMT is gonna be there short order and the work I did is only gonna complicate things for the doc when he gets to the hospital. So take some of the stuff in that kit with a grain of salt. All the wizz bang stuff is good to have in a SHTF environment, but for the stuff you would encounter and how you would treat it should be the simple stuff; bandages and airway. Heck, even for SHTF it won't do you much good, since if you're treating many of the ailments that cool stuff is designed for the patient is gonna die anyway. On another note, of the EMTs out there, have any of you actually treated or are aware of a colleague treating a sucking chest wound with needle decompression? I'm just a knuckle dragger, but I figured that'd be something that could wait until the doc stuck a hose in the patient. Sent from my iPad using Tapatalk

[pitt2magic]

" On another note, of the EMTs out there, have any of you actually treated or are aware of a colleague treating a sucking chest wound with needle decompression? I'm just a knuckle dragger, but I figured that'd be something that could wait until the doc stuck a hose in the patient. "

 

 

 

 

 

I am an ER Nurse/SWAT Medic and I agree with everything you said above.  If one of my guys got stabbed or shot in the chest and I suspected a pneumo, unless I knew that transport was unavailable (which I can't ever see being the case) there is no way I would ever use this thing.  Slap a chest seal on it and let the ER doctor insert a chest tube.

Edited February 2, 2014 by pitt2magic

[Guest HillyKarma]

I think a lot of these kits marketed nowadays are designed by former action people or wannabe types who get wrapped up in the idea of 'combat loadout' and put a lot of things in there that sound cool, but aren't intended for use in an environment where there is immediate care. Guaranteed, if there is a shooting there will be lights and sirens coming towards you. In combat you might be hours, even days from receiving care. That's when doing some of these field expedient procedures makes sense, since the worst that could happen is the patient dies, gets infection or has a permanent medical condition related to field treatment by a knuckle dragging trigger puller. Not too many cons there if the likelihood of death without field expedient treatment is likely, due to proximity to care. But in our setting, in the US, the chances of 1) being wounded in such a manner or treating someone wounded in such a manner is incredibly slim (unless it is part of your job such as police, fire, EMT, postal worker, stripper...) and 2) the chances of being in such a situation and being hours or days away from care is practically nil. I have a trauma kit in the truck to deal with the big ones, such as airway and bleeding, like j tubes, nasal trumpets, tourniquets, curlex, ace wrap.. . Those will kill you quick. I also have things like chest seals and quick clot, but not so much because I have intention of using them, but I just don't have anywhere else to put them. The last thing I would do would be to introduce some of the crap I have into a patient if I know an EMT is gonna be there short order and the work I did is only gonna complicate things for the doc when he gets to the hospital. So take some of the stuff in that kit with a grain of salt. All the wizz bang stuff is good to have in a SHTF environment, but for the stuff you would encounter and how you would treat it should be the simple stuff; bandages and airway. Heck, even for SHTF it won't do you much good, since if you're treating many of the ailments that cool stuff is designed for the patient is gonna die anyway. On another note, of the EMTs out there, have any of you actually treated or are aware of a colleague treating a sucking chest wound with needle decompression? I'm just a knuckle dragger, but I figured that'd be something that could wait until the doc stuck a hose in the patient. Sent from my iPad using Tapatalk

I understand. I got it, and some things were included that weren't listed in the kit online, including oral airways (but strangely, no shears, go figure) and this was one that I just couldn't figure out.

I've recently started going camping and hiking a lot more, and have had to deal with large gashes, breaks, and sprains. The only medical training I have is a basic course on simple injuries. I really appreciate the insight though, guys.

[TMF]

Go figure, no shears. That's one of them items I couldn't be without in my medkit. Get you a good solid set that won't bind from extreme grip pressure when cutting something rigid. Sent from my iPad using Tapatalk

[Guest Lowbuster]

Go figure, no shears. That's one of them items I couldn't be without in my medkit. Get you a good solid set that won't bind from extreme grip pressure when cutting something rigid. Sent from my iPad using Tapatalk

What brands do you consider solid?

[npgunner]

[quote name="TMF" post="1105036" timestamp="1391318885"]On another note, of the EMTs out there, have any of you actually treated or are aware of a colleague treating a sucking chest wound with needle decompression? I'm just a knuckle dragger, but I figured that'd be something that could wait until the doc stuck a hose in the patient.Sent from my iPad using Tapatalk[/quote] I'm not an EMT, rather an ICU NP, but have performed needle decompression a time or too in the ICU for pneumothorax (obviously not traumatic in nature ...). Chest tubes were soon to follow, but sometimes you just can't wait till the tube goes in to fix it. Poking through and getting that whoosh of air is such a satisfactory feeling ... especially when the patient tells you he can breath again!

[pitt2magic]

What brands do you consider solid?

 

Having tried many different shears over the years, both cheap and expensive these are the ones I use now.  I think every medical guy on the team has gone to these.  The coating on them keeps stuff like tape adhesive from sticking to them and gumming them up.  They are also cheap enough that you can grab a few sets.

 

http://smile.amazon.com/Prestige-Medical-Fluoride-Scissor-Black/dp/B002WJHE7E/ref=sr_1_cc_1?s=aps&ie=UTF8&qid=1391353131&sr=1-1-catcorr&keywords=trauma+shears

[TMF]

[quote name="Lowbuster" post="1105062" timestamp="1391342477"]What brands do you consider solid?[/quote] I've never bought any before, just been issued a few different kinds. The ones that were army issue were solid. A year or so before I got out I was issued a med kit which was a non-standard unit purchase and the shears that came in it were garbage. I couldn't believe that they were included in there or expected to be used for anything. I don't think they'd cut through a belt. Sent from my iPad using Tapatalk

[Guest theconstitutionrocks]

I did 21 years as a medic...the last ohhh I dunno 7 or so sucked because I was in the "more administration than care" rank window. That said I believe in the KISS principle. In reality you have three basic categories of casualties:

1. Those who are going to die no matter what you do

2. Those who are going to live, no matter what you do (assuming you don't do something stupid and kill them)

3. Those who are going to die but will survive with the right intervention. It is this category that you can make a difference.

 

Based on experience the big 4 are still applicable...

1. Get or maintain a patent airway

2. Get breathing restored

3, Get bleeding stopped (and at the same time if applicable, get circulation restored).

4. Deal with something else the body is doing chemically (or has had done chemically) that is going to effect on of the above. (ie:anaphylaxsis, neurogenic, metabolic shock)

 

I can't count how many times that I have seen a gung ho wanna be caregiver (in an emergent situation) want to shove an IV into somebody without addressing one of the above. Couple of points...if red fluid is running out of the person and you are pumping in crystalloids (all this does is replace volume, it doesn't provide any of the plasma, red blood cells, or platelets necessary to replace blood loss) and you don't get the bleeding stopped, the person is going to die unless transport and definitive care is close. STOP THE BLEEDING. Now, in primitive settings, far from care, when you are talking about having to replace fluid volume and evacuation isn't available, well...there is a way to treat that...here we go. It's called proctolysis. Basically it consists (in it's simplest form) of connecting a tube to a fluid supply and shoving it up the patient's ass. By using controlled flow delivery and something to plug the rectum (usually the balloon on a foley catheter) the fluid is introduced into the rectum and absorbed through the wall of the large intestine. While not as effective as IV's it does have distinct advantages...the solution doesn't have to be absolutely sterile, you don't have to worry about screwing up the intravascular acid/base balance, you don't have to lug heavy bags of fluid subject to freezing or worry about warming them up prior to infusion. The disadvantages include perforation of the rectal wall, introduction of a parasite (inadequately prepared/filtered solution), and enema action (flow too fast or not effectively sealed)

       Otherwise, it's hemostatic agents (quick clot/celox) pressure, and/or tourniquets. If it's massive internal bleeding and evac is not immediately available...break out the bible and holy water...your patient is going to die.

 

With regard to needle decompression, this is to reduce a tension pnemuothorax, it is not to treat a sucking chest wound. In all actuality needle decompression IS a sucking chest wound unless you put a flutter or one way valve on the needle hub. The patient has two lungs. If one collapses but tension doesn't build up, the other can continue to operate which then reverts to...BLEEDING and AIRWAY.

 

Needle or surgical cricothyroidotomy (a "trach"...which is an incorrect term for this procedure) is applicable in a VERY limited number of cases..(mechanical airway obstruction unable to be manually cleared, significant facial trauma, cervical spine injury with airway compromise, anaphylaxsis not responding to initial drug therapy with airway compromise).  If you aren't damned careful you could cause major additional injury trying to do this.

 

Circulation-CPR is better than nothing but unless there is spontaneous revival the chances of the person surviving are slim. It has been proven over and over again that early defribrillation (where warranted) is the best/primary tool to address cardiac arrest (typically ventricular fibrillation (VF) or pulseless ventricular tachycardia). Contrary to a lot of myths out there defribrillation does NOT "jump start" the heart. In VF you have a whole bunch of individual cells trying to do their own thing (kinda sounds like politicains right?). As such there is no coordinated muscular activity and the heart is quivering rather than pumping. Defibrillation basically comes in and slaps all those cells into a standstill hoping that the right cells (pacemaker) will kick back in and start functioning. Defibrillation will generally NOT work on "flatline" (although it is tried as options run out). In that case you work on the problem (blood loss, metabolic imbalance, cardiac tampnade, etc). Soooo...if you are concerned about having to deal with cardiac arrest at some point, stocking drugs and IVs for that is pretty much pointless unless you have a fully capable defibrillator with an oscilliscope and can read/diagnose what you are looking at and know precisely what you are doing. A good AED for our purposes here is probably the best "bang for your buck" in this case.

 

Lastly ARE the drugs. They DO have their place at certain times. I firmly believe that 1:1000 epinephrine and 50 mg injectable Benadryl should be part of a kit carried by someone who knows what they are doing. If you have a case of anaphylaxsis you HAVE to have epi (and the means to deliver it)...it is (to my knowledge) the only drug that will address swelling of the airway and cause vasoconstriction to maintain blood pressure. Albuterol in an inhaler can help but there is no way I would soley rely on it. Benadryl is necessary because, as an anti-histamine, it blocks the histamine release of the allergen and thereby stops the body's reaction to it. While you could administer it orally (or another antihistamine for that matter) I personally prefer the injectable route for rapidity of onset. I have personally treated people with anaphylasis and severe asthma and I can tell you, the life saving properties of epi are impressive (guy has gone from flat on his back, unable to move air, gasping, to talking to me in a matter of a minute or so. That was some SCARY S***.

       The issue about local anesthetics is up to the individual. A lot of people have this fantasy about sewing up a laceration without anesthetic...THAT HURTS! in addition, depending on the wound, sewing it up may trap/introduce bacteria leading to infection (which then causes the whole antibiotic debate that I'm not going to go into). I have lidocaine 1%. I COULD, if necessary close a wound, but I wouldn't do it unless I had no other choice. There are other application such as anesthesizing an area prior to draining an abcess, or dealing with dental issues abcess, extractions...thanks go out to the snake eaters and dentists I worked with), but again, these are grid down OMG, TEOTWAWKI, situations where there is NO ONE ELSE to turn to.

 

So, in closing, the right answer in my opinion is...leave it to the people who do this for a living. Only act when it is necessary to keep the person alive or prevent further injury until help arrives, and for pete's sake...stay within your capabilities. 

[Guest theconstitutionrocks]

" On another note, of the EMTs out there, have any of you actually treated or are aware of a colleague treating a sucking chest wound with needle decompression? I'm just a knuckle dragger, but I figured that'd be something that could wait until the doc stuck a hose in the patient. "

 

 

 

 

 

I am an ER Nurse/SWAT Medic and I agree with everything you said above.  If one of my guys got stabbed or shot in the chest and I suspected a pneumo, unless I knew that transport was unavailable (which I can't ever see being the case) there is no way I would ever use this thing.  Slap a chest seal on it and let the ER doctor insert a chest tube.

Absolutely agree...do the basics to keep them alive until they get to definitive care.

[Guest Lowbuster]

Having tried many different shears over the years, both cheap and expensive these are the ones I use now. I think every medical guy on the team has gone to these. The coating on them keeps stuff like tape adhesive from sticking to them and gumming them up. They are also cheap enough that you can grab a few sets.

http://smile.amazon.com/Prestige-Medical-Fluoride-Scissor-Black/dp/B002WJHE7E/ref=sr_1_cc_1?s=aps&ie=UTF8&qid=1391353131&sr=1-1-catcorr&keywords=trauma+shears

Thanks I will order some.

[kevhunt80]

Speaking of the KISS method.  In simpler terms.  Stop the bleeding, maintain their airway.  But like everyone here has mentioned.  Get some training.  It's just like shooting.  All the cools gear and guns does not make a great shooter.  Shooting makes a great shooter.  Now for a shameless plug: I teach for an amazing company called Wilderness Medical Associates.  We teach everything from first aid up through advanced life support , but we teach you how to deal with these issues when 911 is not an option.  This is a great approach to medicine because it causes you to think outside the box. We are no the only company that teaches this stuff, but we are one of the best (biased opinion)  I would be happy to tell you more about it.  Just hit me up

[DMark]

...if red fluid is running out of the person and you are pumping in crystalloids (all this does is replace volume, it doesn't provide any of the plasma, red blood cells, or platelets necessary to replace blood loss) and you don't get the bleeding stopped, the person is going to die unless transport and definitive care is close. STOP THE BLEEDING.

 

Some of the best and most important "Good Army Training" that I ever got was the Combat Lifesaver stuff.

 

Its the only Good Army Training that I wish I could get a re-fresher on now that I'm retired...., because I know a lot of hard lessons have been learned.

 

As an example, sticking an IV in somebody was a big-time-do-it-now-do-it-quick-everytime sort of deal when I did my first CFS course. 

 

Reckon we were worried about Dehydration.  :shrug:  

 

Its clear that what theconstitutionrocks has pointed is one of those great "duh" deals.    

[cj0e]

I understand. I got it, and some things were included that weren't listed in the kit online, including oral airways (but strangely, no shears, go figure) and this was one that I just couldn't figure out.

I've recently started going camping and hiking a lot more, and have had to deal with large gashes, breaks, and sprains. The only medical training I have is a basic course on simple injuries. I really appreciate the insight though, guys.

 

Find and take a Wilderness First Aid course. They're not cheap, but they are a good resource if you're going to make decisions about/provide care in the outdoors.

 

Here's the reference used in the class (WARNING-GIANT PDF).

 

And the pocket reference (STILL A PDF)

 

Finally, if you're going to provide any manner of care, learn to take SOAP notes.

 

I use this pattern, printed on write in the rain paper. I keep a few folded and tucked in my first aid kit.