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Thread: First Aid Kit for the layman

  1. #11
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    Quote Originally Posted by gunnerbob View Post
    To piggy back off of Chen, as far as the tourniquet goes... we have always been taught that this is the last measure used to stop bleeding. As you know, use direct pressure on the wound, if it's an extremity raise it above the heart and if this doesn't slow the bleeding you would then move to place pressure on the pressure points (Google where they're located). We are taught to think that if we apply our own or have a tourniquet applied to us, that because of the time required to be taken to a hospital, this would likely mean losing the limb. This, however, is combat trauma treatment and hospitals are usually much further away but, I believe the line of thinking to remain true... a tourniquet is the last option. If you're conscious, and there are bystanders, you can direct them to apply the pressure for you being as that you may very well go into shock soon and may lose the ability to self-treat. Do your best to explain what needs to be done to them and if you can... tell them how to treat for shock as quickly as you can... because you are about to be in it.
    EMS got rid of pressure points and elevation about 5 years ago due to new information coming out of the military.

    The procedure for uncontrolled bleeding is direct pressure with gauze, if bleeding doesn't stop apply another gauze (keep the original gauze in place, pulling it off risks pulling any clotting that has occurred) and apply more pressure, if bleeding doesn't stop apply a tourniquet and write on the tourniquet the time it was put on. A tourniquet is recommended to be a minimum of 2" wide, placed 2" above the wound if possible, and can be on for 6 hours before any risk to the limb distal to the tourniquet.

    Pressures points are a good thing to know, but we no longer delay a tourniquet for pressure points or elevation. The least amount of blood lost the better...so even if help is 6+ hours away, it's better to lose the limb then the life.

    Good post though Bob, the more tools in the tool box the better.

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  3. #12
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    Quote Originally Posted by Firefighterchen View Post
    EMS got rid of pressure points and elevation about 5 years ago due to new information coming out of the military.

    The procedure for uncontrolled bleeding is direct pressure with gauze, if bleeding doesn't stop apply another gauze (keep the original gauze in place, pulling it off risks pulling any clotting that has occurred) and apply more pressure, if bleeding doesn't stop apply a tourniquet and write on the tourniquet the time it was put on. A tourniquet is recommended to be a minimum of 2" wide, placed 2" above the wound if possible, and can be on for 6 hours before any risk to the limb distal to the tourniquet.

    Pressures points are a good thing to know, but we no longer delay a tourniquet for pressure points or elevation. The least amount of blood lost the better...so even if help is 6+ hours away, it's better to lose the limb then the life.

    Good post though Bob, the more tools in the tool box the better.

    Sent from my HTCONE using USA Carry mobile app
    Ah, there ya go... Chen, you'll have the best and most recent information.

    I'll back what Chen has said about NOT removing the original gauze, KEEP the original on the wound to assist in clotting. As far as the tourniquet goes, we use the "CAT" or Combat Application Tourniquet... they're pretty great! You can pick them up here: http://www.amazon.com/C-A-T-Combat-A.../dp/B003IPZRYI.

    Now, who wants to get into the subject of the "sucking chest wound"?
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  4. #13
    gunnerbob, I addressed sucking chest wound in my post with the comment about adding a disposable poncho. They're small, cheap and plastic. Good insurance for about a dollar.

  5. #14
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    Quote Originally Posted by Chrisdrummer View Post
    gunnerbob, I addressed sucking chest wound in my post with the comment about adding a disposable poncho. They're small, cheap and plastic. Good insurance for about a dollar.
    Oh... well, then.
    Quote Originally Posted by Deanimator View Post
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  6. Mappow

    Anything is better than nothing in an urban setting where EMS is a quick 911 call away. Uncontrolled bleeding is the most important problem you should face. Anything that can be used to control bleeding is a must.

    As a First Aid trainer, Community First Aid classes are very inexpensive and will prepare you better than just buying a new kit.

  7. #16
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    Thumbs up I Thought This Was Pretty Cool:

    Quote Originally Posted by Deanimator View Post
    [*]Don't be afraid to use sarcasm, mockery and humiliation. They don't respect you. There's no need to pretend you respect them.
    Operation Veterans Relief: http://www.opvr.org/home.html

  8. #17
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    Go with your ABCs, which is what's told to all first responders. A-irway, B-reathing, and C-irculation. Bleeding may be the most common threat to life with a gunshot wound, but you have no way of knowing what emergency situation life is going to throw at you. Get trained in CPR. It's changed some, so if you haven't had it recently, it might be a good idea to get the training again. In many cases you encounter, simply changing the position of the victim can open a blocked airway. Keep in mind that you aren't trying to be a medical worker. Your task will simply be to preserve life until you can pass the patient off to a higher level of care. That helps keep you focused on the things that matter most, and helps prevent you from being tied down with issues that aren't life threatening, or are of a lower priority than others. If you're going to carry tourniquets, know how to use them. Let me clarify that. If you're going to carry tourniquets, KNOW HOW TO USE THEM. Tourniquet technology has improved dramatically over the past few decades, but it's all a complete waste if you don't know how to use them properly. Worship at the altar of YouTube. Since many of the best tourniquets come in sealed packages that shouldn't be opened until use, YouTube becomes an invaluable training resource on how to use them. If you're serious about them, I very highly recommend the Combat Application Tourniquet (C-A-T) made by Composite Resources. Since there has been an issue with people making cheap knockoffs and counterfeit C-A-Ts, I suggest buying them directly from North American Rescue, which is one of the five authorized distributors.
    .
    As Chen stated, I don't suggest using artificial clotting agents unless you're at the point where other methods of bleeding control are nonviable. However, the use of clotting agents isn't a black and white issue at all. For instance the resistance to Quik Clot among Chrisdrummer's EMT/ER friends probably stems from before Quik Clot switched to using kaolin as the active ingredient. Prior to that, some patients would have allergic reactions to chitosan, the prior ingredient made from shellfish, and there was also a significant amount of heat generated, even to the point of causing burns at times. The latest formulation generates a small amount of heat, but not enough to cause any burns. The other aggravation ER personnel had with clotting agents was in attempting to clean them out of a wound. They solidify pretty good. But that objection was based on people using it when it wasn't needed, such as a guy who sealed up a cut on his hand so he could keep fishing for a few more hours instead of going in and getting stitches like he should have. ER personnel won't complain if it's used in a true life or death situation. Additionally, it comes in bandage form now, so many of these people who used to pour it into non-life threatening cuts probably won't be doing that as often. That'll make ERs happy. However, the really big, life-threatening bleeds may necessitate the use of the granulated versions that you can pour into a wound. By the way, you may also see it as CELOX, ChitoFlex, HemCon or other such names. Anyway, points to ponder.
    .
    Essentially, get CPR training and have a kit that addresses basic first aid needs, but that also gives you the ability to control traumatic bleeding, and that should cover the bases that have been discussed here. You probably don't want to do what I did. I have three full trauma bags. But that's because I'm an EMR and I support large events that are held way out in the boonies. Or at least I did before I broke my back anyway. The downside to that is those bags are expensive, and much of the stuff in them expires and has to be replaced at regular intervals. That's something you should also keep in mind for your personal first aid kits. Some of the contents do expire, and that's part of the reason why you may not see items in some kits that you feel should be in there. Nobody who sells those kits wants to be blamed if something goes wrong in an emergency, and someone thinks it's because something in that kit expired eight years ago.
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  9. #18
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    Quote Originally Posted by Rhino View Post
    Go with your ABCs, which is what's told to all first responders. A-irway, B-reathing, and C-irculation. Bleeding may be the most common threat to life with a gunshot wound, but you have no way of knowing what emergency situation life is going to throw at you. Get trained in CPR. It's changed some, so if you haven't had it recently, it might be a good idea to get the training again.
    Just want to add, the newest changes make it C-A-B, focusing on good quality compressions. Don't delay compressions for breathing or airway. This is for unresponsive patients though.

    For gun shot wounds, if they haven't deteriorated to needing cpr, you will most likely need to know how to stop uncontrolled bleeding, tension pneumothorax, and airway problems.

    But again...none of that should delay compressions if the patient is unresponsive. Check for a pulse, if bad pulse then start compressions.

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  10. #19
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    That's right chen, of course. My wife recently (2015) went through a CPR refresher course and A-B-Cs has been replaced with C-A-Bs. The new course puts a lot of emphasis on doing compressions for unresponsive patients above nearly everything else. The logic, as far as I understand it, is that there will still likely be usable oxygen inside the blood stream even if the patient isn't breathing on their own... for hopefully long enough for EMTs to arrive to put them on O2. So, compressions should/may be good enough for the trained bystander to perform in order to keep the patient from suffering brain damage, organ failure, etc.

    Also, there's the fear of contracting diseases associated with mouth-to-mouth that should be avoided when possible. We have CPR masks with our vehicle first-aid kits but, I suspect we're the exception.

    P.S. Good post, Rhino.
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  11. #20
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    Quote Originally Posted by gunnerbob View Post
    That's right chen, of course. My wife recently (2015) went through a CPR refresher course and A-B-Cs has been replaced with C-A-Bs. The new course puts a lot of emphasis on doing compressions for unresponsive patients above nearly everything else. The logic, as far as I understand it, is that there will still likely be usable oxygen inside the blood stream even if the patient isn't breathing on their own... for hopefully long enough for EMTs to arrive to put them on O2. So, compressions should/may be good enough for the trained bystander to perform in order to keep the patient from suffering brain damage, organ failure, etc.

    Also, there's the fear of contracting diseases associated with mouth-to-mouth that should be avoided when possible. We have CPR masks with our vehicle first-aid kits but, I suspect we're the exception.

    P.S. Good post, Rhino.
    If you progress to the point of learning intubation, you will see what they mean by blood oxygen saturation (SpO2).

    The air we breathe is only 21% oxygen. The amount of oxygen we exhale is 14-16%, so we only use 5-7% of the air we breathe. That's why rescue breathing works.

    The more obese and or out of shape someone is will cause available oxygen in the blood to decrease faster. In the OR I was able to see a very fit person last a very long time while intubating, SpO2 didn't drop past 95%. I saw a very obese person drop to 93% in a matter of seconds, that's with preoxygenation too.

    So...compressions are the most important because there is available oxygen in the blood, as well as the pressure in the chest during compressions will exchange some oxygen. Breathing and airway are still very important and should be started immediately when safe to do so (just like you said).

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