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Jsorr
5
Nov 6, 2016
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A good first aid kit for the field should contain an inexpensive blood pressure cuff and stethoscope. Very handy for helping diagnose shock early which cannot be reversed once it reaches a certain point. It's a killer. The other use for the cuff is as a very good tourniquet. Tighten it only enough to cause the pulse below the injury to disappear. Using a tourniquet is tricky and dangerous. Learn how and when to use one properly. I was a medic for 30 years. I do not recommend store bought tourniquets. Too narrow - they damage tissue.
Nov 6, 2016
outofmemory
176
Nov 8, 2016
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Will a blood pressure cuff fit around someone's neck? (yes, that's a joke) - In all seriousness, will a BPC fit around a fat and/or muscular thigh? And much thanks about the tourniquet width tip. While I do 'have one' it is my utmost desire to never have to use it. Clearly knowledge is superior to the resources available...but having good resources helps too!
Nov 8, 2016
Jsorr
5
Nov 8, 2016
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Blood Pressure cuffs are available in many sizes from new born infant up to sizes that will wrap around a large thigh. I'm sure it's possible to find a limb that's too big for a cuff. In that case, go to plan "B", a wide belt.
Nov 8, 2016
outofmemory
176
Nov 8, 2016
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I appreciate the reply. I may look into adding one to my range kit...maybe a standard and a large. In any event...without I'd go for tissue damage over bleeding out, of course! :) Thanks for the information bud.
Nov 8, 2016
Jsorr
5
Nov 8, 2016
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Welcome!
Nov 8, 2016
warriorscot
317
Feb 2, 2017
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Your average trained first aider will have far more success diagnosing the symptoms of shock directly or treating for potential shock regardless than using a stethoscope or blood pressure cuff. Also a CAT is now the most commonly available tourniquet and they aren't narrow enough to cause damage unless applied incorrectly too close to a wound and unlike a blood pressure cuff are easier to put on and remove in the field.
Frankly from my own experience as an expedition first aider and range medic if you aren't an MD or qualified in advanced life support you don't have any business carrying a stethoscope or blood pressure cuff as any treatment options in where those diagnostic tools are useful require an MD or trained paramedic to apply. Carrying a tool beyond your skill level just encourages bad practice.
Feb 2, 2017
Jsorr
5
Feb 2, 2017
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While I agree with you in principle, these comments are for folks that are far off the grid and experiencing unexpected critical, immediately life threatening situations. It would be great to have one person on the team as a trained medic or ACLS/ATLS certified but, that's not happening. In lieu of that, if a person is dying and you're too far from trained help, you have to do it yourself. Learn as much as you can during the times you aren't boon docking so that you become more and more skilled over time. Eventually you will be able to use that BP cuff and stethoscope for more than a good tourniquet.
Feb 2, 2017
outofmemory
176
Feb 7, 2017
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yeah...that kind of defines me...I have 'the stuff' in the hopes that someone around me knows better how to use them...my goal is to prevent further damage/injury/harm and transport as safely as possible to trained medical individuals. 'far off the grid' applies more knowledge wise than actual physical location! :) So I'm all for better methods for us untrained folks! I'd rather carry a steth and cuff and have someone say 'Thank god you have these' than for me to 'think I know what I'm doing' (I'm smart enough to know I don't but damned if I'm not going to try if I have no other options). The only reason I ever 'got into' medical supplies is because I went to a gun club and asked them where their first aid kit was, and they brought out a plastic box with 10 year old band aids...that never sat well with me.
Feb 7, 2017
Jsorr
5
Feb 8, 2017
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Ask your doctor to show you how to suture or look it up online. You should be able to get your doctor to assist you with obtaining a suture kit. The farther you are from help, the more your ability to suture a large laceration comes into play. Don't pour hydrogen peroxide into a large gash. Use it for minor lacerations and abrasions. Large and smaller lacerations should be irrigated thoroughly with water clean enough to drink.
Feb 8, 2017
outofmemory
176
Feb 8, 2017
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I bring about a gallon of saline...not sterile but super clean...and I have heard hydrogen peroxide kills cells, thus copious irrigation/cleaning with saline. I do have suture kits...and wouldn't hesitate to use if I ever got into that bad of a situation. From my reading most harsh chemicals are bad for open wounds...although if it were seemingly dirty I wouldn't hesitate to use some tincture of iodine...especially if I felt closing it up was warranted (ala I didn't have time available for transport). For the record I am rarely too far from my vehicle...and usually not more than a few hours out...though my situations vary...we 4x4, climb rocks, hunt and shoot guns...all activities with high likelihood of mechanical and piercing injury. So keep the tips coming! More often than not I'm just 'the guy that brought aspirin/acetaminophen', but I'm okay with that too! I'm also not the wait and see...he'll be fine...type of guy...I'm more the 'get to the choppa' type...ala I'll abort a mission at the first sign of need to do so!
Feb 8, 2017
outofmemory
176
Feb 8, 2017
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To be honest...my biggest worries are sucking chest wound and heart attack (some I travel with aren't in good physical condition...it's an older 4x4 group). I have cursory understanding of both, but it's more the 'would I recognize it' when it happens...pretty easy to see a major laceration and figure out what's going on (here, take these diarrhea pills and you'll be fine)...or a broken bone. I feel fairly confident that I could support someone with something obviously traumatic...it's the internal stuff that worries me most (stroke, heart attack, diabetic attack, allergic reaction, etc.) - sadly the presumption is: The guy with the kit is also the most knowledgeable...which I know I'm not. Trying to get there though.
Feb 8, 2017
Jsorr
5
Feb 8, 2017
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No body uses iodine anymore. Saline, in addition to drinking water gets to be pretty heavy. 86 the saline unless you really don't mind carrying it. If you're within 24 hours of trained help, don't put anything on a wound. Irrigation and clean or, preferably sterile, bandage and dressing is good. You're going to be put on antibiotics when you get help. In addition, make sure you keep your tetanus current.
Feb 8, 2017
outofmemory
176
Feb 8, 2017
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I did know that (iodine)! Admittedly I haven't torn down my kit and removed it...I'll probably replace it with a chunk of ivory bar soap. I do appreciate all these tips and tricks...and normally I'm no more than an hour out from trained help. Thank you for the knowledge dumps.
Feb 8, 2017
Jsorr
5
Feb 9, 2017
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You're welcome.
Feb 9, 2017
warriorscot
317
Feb 9, 2017
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While to a certain degree it's true, I always educate myself to a higher standard than needed, BUT it's worth keeping in mind carrying equipment you aren't qualified to use can get you in trouble, both from using it incorrectly and legally as in many parts of the world if you treat beyond what you are qualified to do you are in violation of your liability cover.
Honestly though I can't think of any in the field treatment options that would actually require a BP cuff and stethoscope. The skill to hear heart defects is something only for professionals that do it regularly(and honestly you can't treat that at all) and so continuous pulse monitoring is far more reliably done with an app on your phone with it's camera. And knowing BP can be valuable info in a trauma when you get to a proper treatment facility, but it's not going to actually give you any information to treat with anything a civilian can carry. Plus if you are so far out response time means you are out of the golden hour I would say extra CATs, quickclot and other general items for dealing with major trauma are better worth your weight. Anything else is just flash and potential distraction as you aren't qualified or even legal to carry treatment options for things like heart attack and stroke unless you are qualified to prescribe(and so wouldn't be buying this) so additional diagnostics beyond hands and eyes mean little. Things like BP cuffs and Stethoscopes don't go in first aid bags, they go in trauma kits and remote conditions medical kits, and the smallest I've ever packed that kind of kits was about 20L and around 4Kgs.
Good first response is very much a KISS effort, even with qualified EMTs that I've seen make mistakes it almost always simple things they get wrong because they are distracted.
Feb 9, 2017
warriorscot
317
Feb 9, 2017
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If you want a good read I would recommend the Sea Captains Medical Guide, it's probably the best book you can get on providing first and short term medical care for all sorts of trauma and common ailments. Best of all it's totally free, it's all very general, but it includes a lot of the old fashioned techniques for making do without all the gadgets you have available 10 minutes from an ambulance so it's good for expedition first aiders. But as a general rule of thumb anything that can't be fixed with a bandaid and a couple of painkillers generally you should at least phone for medical advice if not an ambulance/search and rescue(it is after all their job).
I wouldn't close wounds i.e. suture unless you know what you are doing as your friends won't thank you for the scars. Generally steristrips will close 90% of lacerations you would get with suturing, especially if you aren't a regular at it, plus you can't carry locals so it will hurt. If it's really deep and it's an emergency I would go for glue rather than amateur suturing, but only if after quickclot and packing the wound doesn't reduce bloodloss. iodine is a little old fashioned but it doesn't do you any harm unlike peroxide. For cleaning out wounds the best thing are those little disposable containers of saline you get for washing out eyes(20 or 40ml with twist off caps usually in a strip of 4 or 5 you tear off) they are great and since they are designed to irrigate you need less of them than just a bottle of saline(which if it isn't sterile is useless, you can add a bit of iodine to it which should keep it sterile).
Feb 9, 2017
Jsorr
5
Feb 9, 2017
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If you are referring to the Good Samaritan Act, it will protect from liability those who attempt to intervene into a situation with the intent, in good faith, to help the person or persons in distress. If you are qualified and don't intervene, you can be found liable. If you are qualified and botch the attempt resulting in injury or death, you can be found at fault. If you are not qualified but you attempt to assist, you're supposed to be protected. There are small nuances in addition to be aware of. If you are not qualified and decide to use equipment you're not trained on and this results in injury or death, yes, you could be found liable for those injuries and/or death. BUT, I can't picture a situation in which a blood pressure cuff and/or a stethoscope could be tools used to cause injury or death. You're much less likely to cause injury using a BP cuff as a tourniquet than if you used a piece of rope. I like BP cuffs as tourniquets. And it just so happens, the BP cuff and stethoscope have other uses, should you wish to utilize these additional uses. It doesn't take 4 years of med school to learn how to take a blood pressure. Monitoring a blood pressure on a victim, miles away from help with the knowledge that you are many hours or even days away from help, can help you determine if the victim is beginning to show signs of shock. You can, contrary to your statement above, treat for shock (a killer!) in the field. Elevate the feet, keep the victim warm, if they're able to take liquids you should be sure to keep them hydrated. These are all things you can find online and are non-invasive, are simple to do and can save a life, won't get you into legal trouble and, if you choose to not do these things, you or your mate could die. Better to have the tools and not need them. The same thing goes for suturing. It's not going to make the victim's situation worse, so why not do it? These are not things you would do if you are close to help, only if it's otherwise.
And a book I would recommend is the EMT manual. You can pick it up at your local junior college or technical school's book store. (for outofmemory)
What kind of a scar do you think your friend would end up with if your 3 or 4 days from help and don't suture it up? In either case the docs can re-open and re-suture when you get back, in most cases. But suturing helps keep out debris, control bleeding and in many cases ease pain. Suturing is not rocket science. I do agree with you that glue and steri strips are useful tools. But for life threatening soft tissue injuries steri strips are useless. You could combine suturing and glue in some cases. But getting glue into a deep gash rather that just gluing the surface together can cause tissue necrosis (death). I also agree with your comments on the newer clotting agents out there now. The problem with them is that they are expensive compared to other techniques, they have an expiration date after which they may lose their ability. But, I would definitely have some in my kit if I was going out into the boonies.
Irrigation of wounds with water or saline that isn't sterile is not useless. As I stated before, it's acceptable if it's good enough that you'd drink it. Of course sterile is preferred. But it's expensive and has an expiration date. You're going to be put onto a massive course of antibiotics regardless of which you use. I had never thought of adding a few drops of iodine to the water. Sounds like that would be a good idea. Water purification pills and/or boiling is an option if you have the time.
Lets not forget the original reason for this discussion. No help available for a significant length of time and a victim with life threatening injuries.
Feb 9, 2017
outofmemory
176
Feb 9, 2017
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Y'all can argue all the ins and outs all you want...in my 27 years as an engineer, I've learned there are a thousand ways to skin a cat. And no 'new fangled' tool is going to supplement knowledge.
So yeah...I'm a guy that 'goes out there' and plans ahead, to the best of my ability. I'm usually not that 'far out' but you never know when a 60 minute drive might turn into a 3 day walk.
So if I have to go to jail or get sued because I try and keep someone alive...that's the way it's gotta be...I'm not going to replace my compassion with fearful logic. Simplest fact is: If I do nothing, surely more harm will come. Because I AM NOT GOING TO TRY something unless the situation is dire. Obviously if I have a phone I'm going to hand it to someone and instruct them to call 911, Fire Department, Highway patrol...whatever. I'm not going to randomly try stuff either...Simple ABC wins out...usually.
For the record, I do have the 50ml saline packs...and these big bottles...that I got when in the hospital...and there's really no such thing as 'sterile'...just varying levels of fewer/more contaminants. When 'out there' there's no such thing as clean...you do the best you can with what you've got at the moment. If someone is bleeding out and you just jumped off a cliff wearing board shorts...guess what...the board shorts become 'what you have got'. And if I have to dangle in the wind to save a life I'll not be ashamed of Mr. Squiggly Wiggly dangling about.
I do thank you both for your reading suggestions...I will pick up both books and continue to increase my knowledge...all the while hoping I never have to use it.
Also, saline doesn't 'expire' it just gets a little less clean...and I suspect a sealed bottle that was previously sterile likely never expires (at least to the degree of cleanliness 'out there')- and same with medications...this presumption of expiration is foolish. So 325 mg of ibu is only as effective as 295 after 5 years...just because it's not as effective doesn't mean it's expired. I know as a 'trained medical professional' you have further legal risks that don't apply to me. Get everyone home alive and healthy is step 1...that notwithstanding in the best condition I can!
Feb 9, 2017
outofmemory
176
Feb 9, 2017
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Also...I do carry multiple levels of 'kit'...up to and including that 20L stocked kit (accident scene mitigation). Always on me is a trauma kit (the little mini AdvMed one, with a couple of additions)...since I live in a 'carry' state, GSW is high and likely. In my Jeep (always) is the next higher level. Thrown in the back when I think situation might warrant is the 20L fully stocked (note I work from home, so no longer commute, it used to always remain in the car).
But lets face it...most traumatic issues are easy to deal with. It's the others that you mentioned HA, Stroke, anaphylactic shock, diabetic issues (I do stock glycerine, candy and sugar) or others that I'm not anywhere close to understanding or even recognizing. God willing chewing some aspirin will deal with the HA...stroke I have no clue as to 'what to do' (outside the obvious get someone who knows involved)...the others...hopefully I'd use what information I have available...once I had an engineer start going woogidy and someone said he's diabetic...one candy later and getting him seated was enough until the para's arrived.
So if I am 'in town' it's someone else's problem...I'll jump on a bleeder for direct pressure if I have to...or whatever else seems obvious and pertinent...but I'm not going to start suturing wounds just because I bought a suture kit. But if I AM 'out there'...running out of supplies and resources...I just might have to. But if I have transport abilities THAT's what's going to happen until I get cell service or to a response location.
Feb 9, 2017
warriorscot
317
Feb 9, 2017
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GSA is pretty specific to the USA, most of the places where you might be without help for days are outside the continental US which has pretty good search and rescue cover, not as good as Europe, but pretty good. A lot of countries don't even have an equivalent of the GSA, you are mostly left to rely on your liability cover, I get mines via St Johns because I trained to their system which covers me for most of the world through reciprocal agreements, when I travel I always check that A. I'm covered and B. what local laws are as you can get yourself in trouble as things like rules on CPR in some countries are VERY strict.
It can be useful to diagnose shock, but there are a lot of indicators for shock and almost no contraindications for treating shock. In fact when I teach first aid(I've trained about 60 people in the last year or so outside refreshers) I teach the same thing I was taught myself and learned from my own experience, "if in doubt treat for shock". My point wasn't that you couldn't treat for shock in the field, my point was that you should almost always treat for it ANYWAY so diagnosing it via BP(which would only be for those ones that sneak up on you anyway which does happen) isn't as useful as just treating anyway. In fact showing off my British heritage my field pack always has a burner, mess tin and ample supply of tea and honey which are the best ways to A. stave off shock in the ambulatory and B. keep people busy that aren't needed. Plus honey is the actually the best thing to carry for hypoglycemia I've found, it's a fraction of the price of the over the counter glucogels and functionally the same so a good two for one stone item to carry and of course unlimited shelf life.
As to tourniqets, as I said a CAT is now a cheap and ubiqoutous piece of equipment, very easy to carry, it's one of the things I moved from my range bag to my civvy one, and they are actually better than most BP cuffs for the job as a small BP cuff won't work as a tourniquet on say a 2m man mountain like myself, but an XL BP cuff need to take my BP won't take the BP off say a petite women, but a CAT will get around not only any size arm, but also right up to someones thighs even if they are huge, which is where other than a brachial injury you are most likely to need to apply a tourniquet. Plus it's getting increasingly hard to get old fashioned BP cuffs anyway, now that hospitals and emergency services have finally migrated in many places to more modern digital cuffs getting hold of reliable manual BP cuffs is actually not easy(at least where I am living now). It's weirdly a pro and con off Iraq and Afghan that trauma care has so much changed, things like CATS are a massive improvement on tourniquets, but the old fashioned gear that's good for some people just isn't compatible with the golden hour methodology emergency services in much of the world now use.
As to the saline, I think that came across wrong, my point was if you aren't carrying sterile saline you are better not bother carrying saline i.e. just carry water as for most irrigation it's kind of surplus using saline(unless you are irrigating say a sinus cavity really salines only used for irrigation because it's sterile not because it's saline. If I need to irrigate a wound on an expedition usually what I do is simply drop some extra steritabs into my geigerrig and use alcohol to clean the tube and fittings before irrigating.
As to your point in suturing, a University friend who happened to be a trauma surgeon taught me that you are in fact better not suturing unless A. the bleeding can't be stopped with temproray fixtures (steristrips/glue) or B. you are more than a week away from medical attention or can't maintain conditions for maintaining the dressing. It's in fact much harder to reopen and resuture than it sounds and many doctors won't do that at all if it's started healing unless there will be detriment to function. On the converse keeping the wound open and treated appropriately for an open wound in many ways is actually superior and often how they would treat it in hospital as not all deep wounds SHOULD be immediately closed and it's something that is a lot harder to judge after the fact. Generally if you are at the point where you would consider it something has gone very wrong as generally by that stage you should have medical advice from a doctor over comms(another vital part of my kit).
In my professional life I'm actually an engineer myself, ironically it's the part time military and expedition stuff that leads me to maintaining medical skills. But personally I always prefer having better skills than is need on the job site or in the lab, some training standards are pretty shoddy out there, I remember having a burns incident in the lab once(still not entirely sure how they managed it in an engineering lab)g and having near fisticuffs with a rather out of date lab supervisor who wanted to mess around AFTER I had already appropriately treated the casualty and was set to get her off down to the nearest minor injuries unit. And because when I am in the field(being a rare bird of geotech and marine) I'm in high risk environments it's always a good idea to be more skilled than less, especially since as the engineer you are often the "senior" person on site and even when you aren't the designated medic the buck still often lands with you.
One thing I would caution against, as I have been cautioned myself, cautioned others and have seen the aftermath of is just what @outofmemory says " If I do nothing, surely more harm will come " in good first aid sometimes doing nothing is the best thing to do and it's important to understand when and where that is. I've seen professional full time EMTs fall into this trap(the most recent case being moving a casualty with suspected spinal injury without first doing a full survey). It's actually one of the main arguments as to why you shouldn't carry equipment you can't use the treatment options that derive from it that may be dangerous. And you learn what treatment carries no or little dangers at all i.e. doesn't matter if you mistakenly do it anyway like treating for shock or immobilising for C-spine injuries. It has sadly happened before and will likely happen again that people have in all good faith made efforts to help people that actually made people worse than just following the basics and not going beyond them.
I always like a good discussion on first aiding and response, it's good to share knowledge and experience. I changed a lot of my methodologies after I worked more with Army first aiders/medics as they incorporated a lot of newer techniques that haven't filtered down even to civilian paramedics(although you won't catch me trying to do an IV into a bone anytime soon). But a lot of stuff like when and where to suture was pretty interesting and something I followed up on with doctors advice.
p.s. on clotting stuff and expiry, it's worth looking at various types of clotting agents if you are buying, some of them fall into the "don't actually go out of date category" as they don't use a drug the inherent clotting power is actually a byproduct of the material itself that doesn't actually degrade, in fact some of the products the shelf life is from the material the clotting agent is applied to i.e. the sponges and gauze. The older Sulfa style powder packets if you look some only have the standard NATO required manufacturing date because in theory they shouldn't expire at all. Half of my kit was purloined out of Army stores because it was officially expired, but not so expired that it was signed off for disposable as so far even the newer clotting infused israelis so far are still good several years after "expiry". It's not the case for everything, but it's worth keeping an eye out for the good stuff, expiry dates are the biggest pain there is for a first aider most of the time as they are the biggest cost for maintaining your kit.
Feb 9, 2017
Jsorr
5
Feb 10, 2017
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Good stuff. We've gotten a bit off the subject. But it's been fun and informative. I'm going to look into the CAT as I'm not familiar with it. And as far as my BP cuff, I'm locking it up in my safe deposit box as it sounds like it's becoming a rare and valuable instrument.
Now, go build you a good first aid kit! :)
Feb 10, 2017
outofmemory
176
Feb 10, 2017
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All good stuff! I actually read the Captain's Medical and the Guide to EMT in the time it took me to read that post! :P I'm kidding of course!
Thank you for all your knowledge and insight from both you and Jsorr! You guys rock!
Good luck across the pond! Cheers.
Feb 10, 2017
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