/ What's in your first aid kit?

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maisie - on 19 Jan 2014
Following on from the excellent winter emergency kit thread, I just had a quick look at my first aid kit. I do carry some fancy bits and bobs - as a vet with SAR experience - but this was basically mine:

Fancy stuff - stethoscope, ET tube (for the unending number of tracheostomies one tends to do on a Saturday afternoon at Bosi), adrenaline, local anaesthetic, iv lines, syringes and needles, suture material and small surgical kit, aerohaler chamber, lacrimal cannula, intrasite gel and antibiotics.

Common sense stuff - aspirin, two crepe bandages and some old plasters; a couple of safety pins, some antiseptic wipes and a tube of savlon.

Stuff in the second list probably gets used 99 times out of a hundred. What do sensible people put in their kits, and what gets used most? Which fancy bit of kit has NEVER come out of its wrapper?

Martin
Ben Sharp - on 19 Jan 2014
In reply to maisie:

I'm no medic but this is ukc so I'd better bite/give my two penneth worth..

I'd leave the sutures and anti-biotics and swap them for writing materials for details and grid references and a plastic survival bag. I think I'd get by without anti-biotics till we get to A&E and I'd be inclined to refuse someone offering to suture me up in an unsterile winter bog, especially if they said they needed their medical kit 99 times out of 100! ;-)
ow arm - on 19 Jan 2014


duct tape
maisie - on 19 Jan 2014
In reply to Ben Sharp:

Agree with you pretty much in entirety - in my case, my head is so far up my own @rse as a result of all that training that half my kit probably wouldn't get used in a lifetime (to be fair, though, the antibs, suture kit and local etc are more for use on multi-day excursions).

I haven't had to use the adrenaline, but a friend has - and almost certainly saved a life.

I think my point would be that most things in a first aid kit are substitutible for other stuff - material, tape etc - and I'm interested in what stuff other people carry (and in particular, stuff which has never seen the light of day).

I do also carry a light, 4-foot thermarest and a foil bag, but was thinking more about a self-contained kit.
sparra - on 19 Jan 2014
In reply to maisie:

I did an outdoor first aid course at pyb, and their suggestion was cling film and duct tape.
BikeClimbWalk - on 19 Jan 2014
In reply to maisie:

Main kit...

Gloves
Face shield
Waterproof paper + pencil
2x wound dressing
2x triangular bandage
Plasters
Sterile water pods
Asprin
Sheers
Vet wrap
Duck tape
Bothy bag



Small kit (mostly for running)

Gloves
Face shield
2x Wound dressing
Plasters
Asprin
Paper + pencil


lost1977 - on 19 Jan 2014
In reply to ow arm:
> duct tape

same here and not even a full roll just a few wraps around a water bottle
Post edited at 22:04
SAF - on 19 Jan 2014
In reply to maisie:

2Xtriangular bandages
Emergency blanket
loo roll
Whistle
Tampon
Medical gloves
2x14 gauge cannulas (needle decompression of chest)
Small bag jelly babies (used to have glucose gel until it exploded coating my kit in sugar) & flapjack for hypo's
Compeed
Guedel Airway
2Xwound dressings
1crepe bandage
Drugs - Paracetamol, Diclofenac, ibrufen, Aspirin 300mg, Loperimide, Fluid replacement sachet, piriton
My own personal/medical/emegency contact details
All wrapped up with a SAM splint that doubles up to protect kit.
Mr Trebus - on 19 Jan 2014
In reply to maisie:

-small roll of gaffer tape with gloves and plasters stuffed into the middle.
-triangular bandage, bandage
-couple sanitary pads
-Couple tabs Aspirin / ibuprofen / Imodium (from a previous bad experience!) / antihistamines / energy gels
-Small tube superglue
-compeed
-pencil and paper
-couple of big plastic sandwich bags ( I find more useful than clingfilm)
-a small pair of shears.

All stored in a wee Alpkit dry-bag. All in it weighs a a few hundred grams and good for general hill dings.
tom_in_edinburgh - on 19 Jan 2014
In reply to maisie:
Often used:

Nurofen, Immodium, antihistamine, Dextrose tabs, savlon wipes, savlon, band aids, blister plasters, finger tape, swiss army knife.

Almost never needed:
steristrips, gauze pads, cable ties, duct tape, spare laces, water purification tablets, spare compass, spare small headtorch, fire starter.

Kept in a dry bag with first aid markings.

One person carries the first aid kit the other person carries a bothy bag.
Post edited at 22:38
Alan Breck on 19 Jan 2014
In reply to maisie: Fancy stuff - stethoscope, ET tube (for the unending number of tracheostomies one tends to do on a Saturday afternoon at Bosi), adrenaline, local anaesthetic, iv lines, syringes and needles, suture material and small surgical kit, aerohaler chamber, lacrimal cannula, intrasite gel and antibiotics....None of that lot!

How about.....Steri-Strip, Dermabond Pen, Tipset sachets, Glucogel & on a personal note a laminated card from: http://www.medids.com/free-id.php#.UtxVTKNFA5s
maisie - on 19 Jan 2014
In reply to Alan Breck:

Now be honest, Alan - you did say you were carrying celox, which even I wouldn't bother with ;-)
Alan Breck on 19 Jan 2014
In reply to maisie:

> Now be honest, Alan - you did say you were carrying celox, which even I wouldn't bother with ;-)

I just like carrying a load of rubbish that I'll, hopefully, never use!
alex_arthur - on 19 Jan 2014
In reply to maisie:

No offence...but please don't try to intubate me under ANY circumstances. I'll also wait till a+e for any IV lines, sutures and especially any probing with a lacrimal cannula thanks.

I haven't heard of any medical-legal issues in this country regarding "good samaritan acts" but your post leaves me concerned this may well change.
captain paranoia - on 19 Jan 2014
In reply to maisie:

Depends on what you're doing, where, and for how long, i.e. how far from 'civilisation'; if you're in a SAR team, you've been called out because someone is injured. If you're out there as a 'punter', how likely are you to encounter a significant casualty?

A widely discussed topic as found by a search on UKC, but I confess that my thoughts chimed with those of vark on this thread:

http://www.ukclimbing.com/forums/t.php?t=502873

Yes, you can drag along a whole bunch of obscure 'what if' stuff, but, realistically, what is the probability you'll have to use it, and then, what is the probability it will be life-changing if you get to use it? Given the population density, it might be argued that you 'ought' to carry a comprehensive medical emergency kit walking around the shops: do you...?
csw on 19 Jan 2014
In reply to maisie:
This is mine:

pair of non-latex gloves
2x4" melolin squares
2x medum size adhesive melolin strips
Bag of pills - 5 aspirin 18 paracetamol and shitloads of codeine
4" wide cutdown roll of clingfilm
2m duct tape
2xHigh absorbency sanitary towels
tube of hypostop gel
2x3" bandages
6"crepe bandage
Tick tweezers
2x condoms

In addition I have my SAM splint wrapped round my goggles, and I carry an 18" square of karrimat as a sit mat, or an emergency splint.
Post edited at 00:01
maisie - on 20 Jan 2014
In reply to captain paranoia:

Yeah, this is the point I'm trying to make - I think it's fairly clear that I'm not making a case for this kind of set-up. Knowledge is the most critical tool in any situation, and there are very few physical injuries where equipment can't be improvised, up to and including splinting.

Some immediately life threatening conditions can be countered with slightly more involved gear - cannulae, adrenaline, even a correctly placed scalpel. But you need to be very sure about what you're doing.

But I'd warrant that most of the stuff people carry wouldn't make the difference between living and dying - or even between having a sh*tty day and a slightly more sh*tty day. The suggestions about clingfilm are interesting, though.

My question was really about what people do carry, but this being UKC, I should have known the brickbats would be flying before long.....
maisie - on 20 Jan 2014
In reply to alex_arthur:

> No offence...but please don't try to intubate me under ANY circumstances.

You know it's going to happen, don't you?

We had a paramedic on the team (I don't do SAR any more, btw), and on two occasions I saw him attempt to get a tube into a (obviously deceased) patient without success. There is almost literally no situation out on a hill where intubation would make a difference - even if I had access to a bag and oxygen. Survival would be almost impossible from the time it was necessary.

But one day I'll probably repair my thermarest with it, so I'll leave it in there for now ;-)
alex_arthur - on 20 Jan 2014
In reply to maisie:
Fair enough, completely agree with your post above that knowledge and basic interventions are the best tools. Intubation rarely makes a difference for in-hopsital cardiac arrest.

Learning how to support an airway however could definitely save a life and is relevant to the hazards involved with climbing.

To answer your question I don't carry anything other than tape for the occasional flapper!

I used to carry a basic first aid kit in my car but stopped as the same principles apply. Anything more involved than basic life support principles is ultimately futile unless your prepared to carry a full first responder kit including 02 and keep it in date and maintained. The ambulance service in this country is probably one of the best in the world and is usually not too far away. If it is then that's a risk an individual takes.
Post edited at 00:56
James Jackson on 20 Jan 2014
In reply to maisie:

> Knowledge is the most critical tool in any situation, and there are very few physical injuries where equipment can't be improvised, up to and including splinting.

Indeed. This is why I carry a few generic bandages, some absorbant dressing, and a tourniquet. Stopping catastrophic bleeding being the first priority, followed by clear airways and circulation.
In reply to maisie:
Out of interest, what is the legal basis of carrying prescription drugs outside a clinical environment? Where do you correctly get them from? Nick (doc)
Post edited at 08:34
maisie - on 20 Jan 2014
In reply to nickinscottishmountains:

> Out of interest, what is the legal basis of carrying prescription drugs outside a clinical environment? Where do you correctly get them from? Nick (doc)

In the UK, I have no need to carry them; but they'd by law have to come on prescription from a doctor and I have absolutely no rights to prescribe to other people, including my own family. Abroad, it depends on the country: France and Spain come under the same EU rules, but seem much more relaxed about the whole thing. Just been in Morocco, where I carried everything - and I think this is borne out by the recent tragedy involving a British schoolkid (but then, that's moving from first aid to requiring more autonomous field life support - something which wasn't really touched on here).

Last year, I went out to Nepal with a gigantic bag of drugs, all veterinary but mostly prescription-only. I was worried about export, import and possession pretty much all the way through the process, so I contacted my regulatory body, who said that provided I could account for their use and destination, they had no issues. I contacted the Nepalese embassy, who sent a very polite but slightly amused email back, wondering why I'd even bothered to contact them, and I went through Nepalese customs with printouts of the relevant local legislation and a number of self-penned letters on their ultimate destination.

Nobody gave two hoots.

After being in SAR, I'm convinced that the most useful, non-substitutible, piece of physical kit you can carry is an insulation layer for the casualty to lie on - pretty much everything else that a well-informed layman would be carrying would be either improvisable or else not that necessary (e.g., off the shelf NSAIDs - nice to think about, but not exactly life saving).

Not an argument not to carry a first aid kit at all - but it's interesting to see what's being carried and why. Sanitary towels and clingfilm seem most popular, which tells you everything you need to know about UKCers ;-)

Martin

alex_arthur - on 20 Jan 2014
In reply to James Jackson:

Can't imagine any situation I would apply a tourniquet as part of first aid to a climber...unless they were unfortunate enough to stand on a landmine. Direct pressure will stop almost all non blast related bleeding. Tourniquets are not without their own problems.
maisie - on 20 Jan 2014
In reply to alex_arthur:

> Can't imagine any situation I would apply a tourniquet as part of first aid to a climber...Tourniquets are not without their own problems.

Broadly agree - a tourniquet is a life-saving but limb-sacrificing procedure in most cases. If you do want to carry one, though, look at CAT tourniquets - usually available for about twenty quid and one of the few bits of kit where substitutes are likely to do even more damage. Doubt you'd use it in thus country, though, unless you got in with the loony branch of the bushcrafters
captain paranoia - on 20 Jan 2014
In reply to maisie:

> this being UKC, I should have known the brickbats would be flying before long.

No brickbats from me; I'm just suggesting what I think is a pragmatic, risk/probabilistic approach to what to carry.

As for the variation in people's FAK contents, there's some discussion of a survey in this article:

http://www.ukhillwalking.com/articles/page.php?id=3593

It also discusses the activity specific variation. The suggested kit seems a little OTT, but only moderately so; saline, for instance, where your water bottle would do just as well.
The Lemming - on 20 Jan 2014
In reply to maisie:

If you are a professional working outdoors then your employer or personal Risk Assessment thingie will dictate your First Aid kit. However if you are a punter like myself, and out with mates, I'd suggest a personal First Aid kit to suit your needs and ailments.

I have stuff to:

Stop me feeling sick
Stop diarrhoea
Toilet roll
Stop mild pain such as head aches or sore knees
Purify drinking water
Reduce insect bites
Some tape for all sorts of stuff
Triangle bandage
Couple of plasters
Obligatory Swiss knife with cork-screw bottle opener
Mars Bar
Whistle for crying like a baby when the Sh1t hits the fan

There's other small stuff but it all fits within an A5 waterproof bag and weighs practically nothing. And if it can't fit in this small bag then, it ain't any use to me.

Personally I'd rather carry the weight more water and a spare fleece than have an all singing/all dancing First Aid kit that I know I will never use in a month of Sundays.
The Lemming - on 20 Jan 2014
In reply to maisie:

> Now be honest, Alan - you did say you were carrying celox, which even I wouldn't bother with ;-)

Hands up all those people that have used celox in anger?
Don't forget to say when, where and why.

I got the stuff at work towards the end of last year and as yet I have not heard of a single instance of Celox being used on the road.
planetmarshall on 20 Jan 2014
In reply to maisie:

Once had a discussion with a medical advisor to the BMC, Dr David Hillebrandt ( who has a UKC profile but don't know if he's often on the forums ), who suggested that virtually everything in a shop bought first aid kit could be improvised, and the most vital piece of kit was a waterproof notebook and pen to take down notes from the emergency services. Hence that's what I take, and nothing else.

Andrew.
woollardjt - on 20 Jan 2014
In reply to maisie:

Well working for the ambulance service we carry major haemorrhage kits but still yet to use them personally, a crewmate has had to use a tourniquet before though.

Winter climbing due to all the sharp toys I carry celox,olaes pressure bandage, tourniquet and Russell chest seal. I hope to never have to use any of it in the mountains but it's there just in case.

There is a good vid of downhill mtber Cedric Garcia online when he came off his bike and ended up with a femoral bleed
Ben Sharp - on 20 Jan 2014
In reply to planetmarshall:

It is true and quite a lot of climbers seem to play the "I can improvise" card, getting by with a roll of finger tape and a head full of knowledge.

Personally if a piece of falling ice cuts my eye open I'll be glad to have heaved a 20 gramme ambulance dressing up the hill instead of having to rely on my partner improvising a bandage out of a sweaty buff and a piece of duct tape. Although I guess it makes a less cool story of how Ray Mears you are, each to their own!
Dave B on 20 Jan 2014
In reply to maisie:
I have about 4 or five different 1st aid kits.

The most commonly carried one is just gloves and a face shield. I have these most places I go.

The next one is the go out with the kids one, which has alcohol free wipers, plasters, small dressing, tweezers, tick twister, and a triangular bandage in it and two saline eye wash pods. This is just to make them comfy on the day if they fall over.

I have one packed for the requirements for MMs too.

Then there is the bigger one that goes on longer trips with more dressings, tape, and more triangular bandages and shears in it On top.

Then there is the biggie, which has O2 kit, a defib, trauma dressings, glasses, high vis vest, clinical waste bags, etc. and a mini sharps bin (in case we find sharps on the sand), cling film for burns, Saline spray can for wound wash or eye cleaning.

Then there is the one that is for non critical care which is essentially a BS first aid kit for people who can walk to it that has clear up materials as well. This can be taken to scene after the responder bag if needs be.


The one I have for work has glucogel, aspirin, gtn spray in it, bvms, guidals, tourniquet, frac straps and a spine board. I think this year it's going to have salbutamol in it too. There was talk of epipens, but I think that's is still going to be we can assist to take, but will not carry it.
Post edited at 13:07
maisie - on 20 Jan 2014
In reply to Dave B:

See, now you're just showing off ;-)

Interesting that salbutamol is being phased in; certainly, it's use is becoming more widespread. As an asthmatic, I always carry one (but usually don't need it), but both my non-asthmatic kids have been prescribed them as adjuncts for mild, self-limiting respiratory complaints.

A doctor mate, when a house officer or some such, had cause to use some adrenaline on an anaphylaxis case on the hill (this is a good few years ago now). I've always carried a couple of vials as a result, but every couple of years replace them, unused.

I've sutures myself, and colleagues, on a number of occasions. But generally because nobody has wanted to spend four hours in A&E, undergoing inflammatory cascade, so that a 12 year old can practice on us. I've used my FAK suture material more often to sew buttons back on. Artery forceps are great for fishing elastic cord back out of trousers and tent poles.
In reply to maisie:

> nobody has wanted to spend four hours in A&E, undergoing inflammatory cascade, so that a 12 year old can practice on us.

Tell me you are less condescending to your animal patients??
maisie - on 20 Jan 2014
In reply to nickinscottishmountains:

Ha ha, sorry - that was a deliberate fishing expedition. I have nothing but praise for our local docs, from the GP to the soft tissue surgeon who saved my son's life. But stitch ups do tend to get done in-house, for the simple reasons that they can be done immediately (no local, little pain) and we're not tying up emergency personnel.
climbwhenready - on 20 Jan 2014
In reply to maisie:

So I'm just a bit curious, so I hope you don't mind me being nosy - in what context have you done SAR, and what training/qualifications do you have?
maisie - on 20 Jan 2014
In reply to climbwhenready:

Coastguard CRT. Apart from fairly generic first aid qualifications and some esoteric stuff (some random yachting association's Survival at Sea for example), all competencies are assessed and ticked off in-house. It's an interesting mix, and you do get to do some fun stuff, like mud rescue training (running round an estuary on top of soft mud, wearing expanding shoes). What I liked about it was the mix of skills, which I'd think was common to most teams - we had medics, paramedics, dentist, logistics bods etc. It meant that we could do a lot of peer training and pick up practical stuff from people who did these things for a living.

Hope that answers your question

Martin
king_of_gibraltar - on 20 Jan 2014
In reply to maisie:

MOD FFD, Kidnapping tape and zinc oxide tape.

That's enough for me to deal with most situations keeping in mind that most things you carry already can be used for first aid and casevac situations.

In an expedition where it could take a long time to get a casualty to hospital I like to have kit such as what the OP mentioned.
Pete Cook - on 20 Jan 2014
maisie - on 20 Jan 2014
In reply to Pete Cook:


In fairness to the many considered posts on the thread, they've already covered most of the article's content.

It's gratifying to see the kind of common sense that's evident here - it seems that most of us would be in safe hands with UKCers.
Dr.S at work - on 20 Jan 2014
In reply to nickinscottishmountains:

> Tell me you are less condescending to your animal patients??

We can be as condescending as we want Nick, they rarely complain;-)

I used to carry a bigger kit with suture equipment, scalpel blades etc - but never quite got as far as an ET tube!

Now just have a selection of expensive plasters, finger tape, hand cleaning stuff, knife, duck tape.

JayPee630 - on 20 Jan 2014
In reply to Dr.S at work:
Medical stuff really does seem to bring out the slightly odd ex-squaddies, Walter Mittys, and some quite strange people carrying stuff more suited to a battlefield or a A&E doctor or paramedic. Decompressing chests, ET tubes and cannulae?!
Post edited at 18:58
Dr.S at work - on 20 Jan 2014
In reply to nickinscottishmountains:

> Out of interest, what is the legal basis of carrying prescription drugs outside a clinical environment? Where do you correctly get them from? Nick (doc)

Well, for non-controlled drugs, and, once controlled drugs have been dispensed to a patient, there are very few if any rules that I can see.

I once had a slightly mental colleague who prescribed a canine patient a vial of morphine, to be administered by the owner, if the dog broke its leg. ( dog had osteosarcoma so fairly likely to fracture). As far as I can establish that was totally legal.

Getting them correctly - just have to be prescribed, or if you are a potential prescriber then you can cart them around in your car.....
Dr.S at work - on 20 Jan 2014
In reply to JayPee630:

> Medical stuff really does seem to bring out the slightly odd ex-squaddies, Walter Mittys, and some quite strange people carrying stuff more suited to a battlefield or a A&E doctor or paramedic. Decompressing chests, ET tubes and cannulae?!

Vets generally are quite strange.

I think the problem at times is that you might know how to do something, and then worry that you might need to do so, but not have the kit. So you carry it, and never use it whilst looking a bit of a tool.

Suture kit great for repairs though.
maisie - on 20 Jan 2014
In reply to JayPee630:

> Medical stuff really does seem to bring out the slightly odd ex-squaddies, Walter Mittys, and some quite strange people

No, that's just the UKC demographic. From there on, the threads are quite predictable ;-)

The thing is, there's a division between the survivalist, who do carry some high-falutin' gear for the same reason as they spend four hundred quid on a bush knife, and the highly trained individuals / health professionals who can use all of this gear, know that the chance of using it is vanishingly small, but can't quite take the risk of being caught unprepared (whether they look a tool, I'd have to defer to my esteemed colleague Dr S).

Looking through my own kit, it strikes me that all the gear that could be seen as OTT (cannulae - you might be less disparaging if you suffered a pneumothorax from falling off a path) is the stuff that's non-substitutible; the sparseness of the rest of the kit reflects that almost all of it could be improvised quite easily.

Obviously, none of us want to be at the mercy of an enthusiastic weirdo, but a highly qualified professional with a small needle might just save your life one day ;-)

Martin
ow arm - on 20 Jan 2014
In reply to maisie:

nobody carrying a negative pressure ventillator anymore then?
you know, just in case like......
maisie - on 20 Jan 2014
In reply to ow arm:

> nobody carrying a negative pressure ventillator anymore then?

> you know, just in case like......

I had an iron lung once, but it won't fit in the Alpine Attack. I might fit some skis on it, though......
Alan Breck on 20 Jan 2014
In reply to maisie:

Obviously, none of us want to be at the mercy of an enthusiastic weirdo, but a highly qualified professional with a small needle might just save your life one day ;-)

Myself & hopefully a couple of others on here excepted BUT how do you tell the difference?
JayPee630 - on 20 Jan 2014
In reply to maisie:
Just out of interest are you qualified or/and experienced and clinically trained to recognise a tension pneumothorax and then decompress a chest?
Post edited at 19:40
Dr.S at work - on 20 Jan 2014
In reply to maisie:

What was that about fishing?
Dr.S at work - on 20 Jan 2014
In reply to ow arm:

Positive pressure vents are much more compact - I always have a pair with me.
maisie - on 20 Jan 2014
In reply to JayPee630:

> Just out of interest are you qualified or/and experienced and clinically trained to recognise a tension pneumothorax and then decompress a chest?

Yes. On all three counts. Do I have a burning desire to be in a situation where I needed to do it on a human? No, the thought fills me with horror.

There may be a misunderstanding here that I'm trying to promote myself as some kind of superhuman, omnicompetent mix of first responder and ICU specialist. My wife finds this hilarious - she has a hard enough time believing I'm a real vet, despite the old ladies in Tesco telling her what a nice 'young' man I am. It strikes me there's actually a great wealth of talent and expertise in this area, lurking in the background on UKC - and I'm neither. My first post was a kind of self-deprecating pop at those of 'us' who stagger round under the weight of every conceivable bit of kit, oblivious to the fact that most of it is pointless.

Martin
maisie - on 20 Jan 2014
In reply to Alan Breck:

> Obviously, none of us want to be at the mercy of an enthusiastic weirdo, but a highly qualified professional with a small needle might just save your life one day ;-)

> Myself & hopefully a couple of others on here excepted BUT how do you tell the difference?

The weirdos are veterinary surgeons, apparently....

I think it's fairly simple to spot the people who know what they're doing.
maisie - on 20 Jan 2014
In reply to Dr.S at work:
> Positive pressure vents are much more compact - I always have a pair with me.

I had one of those in the loft, but took it out and plastered over the hole. Bugger.
Post edited at 20:26
Dave B on 20 Jan 2014
In reply to maisie:


Thankfully most of the big stuff either lives in the beach lockup in summer, or in my home in winter. Being transported if we need it elsewhere. In case people were wondering this is for surf lifesavingtraining and sport.. I certainly wouldn't carry it on the hills...

The work stuff is for lifeguarding.

At my main job, I'm not even allowed a plaster, but someone who has done a 4 hour course can.

One thing I'm suprised at is the use of I gels in the advanced club training as that's pretty invasive. We don't use them. I forgot we also have cold packs at the club, bit not at work. Always useful for sports idiots like myself.


We also don't have entinox at work as we are too closer to a hospital...


maisie - on 20 Jan 2014
In reply to Dave B:

> One thing I'm suprised at is the use of I gels in the advanced club training as that's pretty invasive. We don't use them

They're the supraglottic thingies, yes? I must confess, the principle of these has always confused me. We have a broadly similar device for small furries - which I've never used, but a mate has promised to show me - as they're complete b*st*rds to intubate (for most of us), but the pharyngeal anatomy is prone to collapse under anaesthesia, causing airway occlusion. Is this such a problem in people? Recent resusc guidelines have been moving progressively away from any kind of positive ventilation via the airways, so I'm kind of lost as to the usefulness of these devices in people. Certainly, I can't see a benefit where airways are blocked BELOW the larynx, and above that you're going to be maintaining airway through chest compression.

Nick, what are your thoughts on these?
Dr.S at work - on 20 Jan 2014
In reply to maisie:

> The weirdos are veterinary surgeons,

I do think it would be quite entertaining to see how good vets are in some medical scenarios, and vice versa - my wife (a proper vet) and I were pleased to find out our obstetrician had his first experience of his trade calving a cow!

It's a shame vet courses do not have a significant first aid component - it's not that uncommon to be in a situation where the skill set vets poses could be usefully applied, if they had the formal training to give them the confidence to act.

ow arm - on 20 Jan 2014
In reply to maisie:

duct tape, 70cc of something 40%, an inflatable nurse, 10mg midazolam

also works incase of boredom
Hannes on 20 Jan 2014
In reply to maisie:

> They're the supraglottic thingies, yes? I must confess, the principle of these has always confused me. We have a broadly similar device for small furries - which I've never used, but a mate has promised to show me - as they're complete b*st*rds to intubate (for most of us), but the pharyngeal anatomy is prone to collapse under anaesthesia, causing airway occlusion. Is this such a problem in people? Recent resusc guidelines have been moving progressively away from any kind of positive ventilation via the airways, so I'm kind of lost as to the usefulness of these devices in people. Certainly, I can't see a benefit where airways are blocked BELOW the larynx, and above that you're going to be maintaining airway through chest compression.

igels are great inventions. They will keep a clear airway, you can put a nasogastric tube down them and any idiot can put one in. It basically goes - lube if you have it, otherwise some other fluid will work, press down throat until it goes no further. In fact they are so good if they were invented before the ET tube I'm fairly certain the amount of endotracheal intubations would be very close to zero.

As for CPR good quality chest compression come before ventilation but as soon as possible you need a good airway device to keep the airway open and ventilating. The amount of air exchange you get with chest compressions is inadequate for any length of time longer than it takes to get an ambulance in a major city, let alone on a hill. The other advantage is that you can stick an igel in without disturbing the c-spine and you won't need fingers of steel to keep the jaw thrust for the whole time. Besides, if you have airway obstruction below the larynx nothing short of a good surgeon will help you.

Mine consists of some antiseptic wipes, a few small plasters, some fabric tape, an army field dressing, a pack of matches (does no one else have this in their med kit?), a couple of safety pins, a pair of sturdy scissors, cling film, duct tape, super glue and some pain killers (paracetamol and tramadol) and a single suture.

If it was a bigger trip I'd add a minor operation kit (a pair of forceps, straight and curved scissors, scalpel, needle holder in a sterile pack), a couple of sutures, local anaesthetic, local with adrenaline, a couple of syringes and needles, an orange cannula or two, a couple of dressings in addition to more drugs like antibiotics and other pain killers.
maisie - on 20 Jan 2014
In reply to Hannes:

So I'm assuming that you're a medic.

I can see the benefit of establishing an airway without potentially exacerbating a C-spine injury, although there seems to be some to-ing and fro-ing on cardiac output and tissue oxygenation with chest compressions. But I guess the question is, do you consider that survival would be increased in situations where medical assistance is an hour away? I think one of the strands to this discussion is about what makes a difference, and is useful to the layman.

In other words, leaving aside frequency of use, would carrying an I-gel be of any practical use in remote first aid scenarios?
Withnail - on 20 Jan 2014
In reply to maisie:



> There is almost literally no situation out on a hill where intubation would make a difference - even if I had access to a bag and oxygen. Survival would be almost impossible from the time it was necessary.

Totally agree. If they've lost gag reflex ie due to a head injury out on the hill things are likely only headed one way.... I carry a nasopharyngeal airway though, less likely to vomit than with an opa so probably a bit easier to manage a compromised airway on my own...not so great with base of skull# though! Probably jaw thrust/ in line postural drainage in that case as best I could.

For me, I think it's worth carrying a couple of large gauge cannulas aswell. Very light and useful for tension pneumothorax decompression. Might just make a difference.

Beyond that a few painkillers, light bandage, sweets and the king of bodging anything some gaffer tape:). Cable ties for bodging crampons and a phone.

Jon

ads.ukclimbing.com
marsbar - on 20 Jan 2014
In reply to maisie:

I need to check mine, my first aid renewal is in a couple of weeks.

Stuff I have used most is tape and melolin dressing for cuts grazes and blisters, (I am allergic to plasters) then triangular bandage for hand wrist or arm injuries. Glucose tablets for a diabetic I knew were used a lot at one point. I have saline pods for wound or eye irrigation, but haven't really needed them. I have crepe bandages, but haven't used them except as a knee support, not really in a first aid situation. Other than that, strong scissors, pins, foil blanket. Not always carried but sometimes useful are instant heat packs, more a making things nicer thing than essential. Instant cool packs are also useful in certain circumstances.
Withnail - on 20 Jan 2014
In reply to maisie:

....that's for a day out kind of thing. Had a great trip to Alaska this year and we had a lot more bits and bobs:)
neuromancer - on 20 Jan 2014
In reply to maisie:
I keep in a kit in the car;

Ibuprofen / Naproxen, Codeine, Tramadol, Paracetamol, Loperamide, Dipenhydramine, Caffeine, Amoxycillin, Cetrizine, Sudocrem, Vaseline, Wound Wash Spray, A tube of runny honey

SAM Splint
CAT Torniquet
Israeli Trauma Bandages
Hemcon/Celox bandage
Non-adherent dressings
Plasters
Zinc Oxide Tape (Leukotap P)
Small roll Cling Film
Vetrap Bandage
Suture strips
Alcohol/cleaning wipes
Safety Pins
Triangular bandages

Scalpel + blades
EMT Shears
Nitrile Gloves

And on me when I go climbing in a little drybag (size of half a small chalk bag?) which usually contains (just for me):

Tramadol, Ibuprofen, loperamide, Zinc Oxide Tape, Scalpel Blade, A few non adherent dressings/Gauze, Alcohol pads, Rehydration Sachets, small tub vaseline, small tub sudocrem.

Those above that said they're taking celox - surely you don't mean in granule form? Have you ever had the joy of using that in the wind? And re:airway opening, isnt the advantage of nasal ones that the person doesn't panic and start gagging if roused / conscious? Finally, from what I've been told by the medics I've worked with, taking a suture kit is a reasonably moronic thing to do.
Post edited at 22:10
marsbar - on 20 Jan 2014
In reply to Dr.S at work:


> It's a shame vet courses do not have a significant first aid component - it's not that uncommon to be in a situation where the skill set vets poses could be usefully applied, if they had the formal training to give them the confidence to act.

The reverse can apply too, my dog got a glancing blow from a car at low speed, (he was fine) it did frighten me, but my (human) first aid training kicked in and kept me calm, I found that I was at the side of the road doing a head to toe/paw check before I knew what I was doing.
maisie - on 20 Jan 2014
In reply to Withnail:

> Totally agree. If they've lost gag reflex ie due to a head injury out on the hill things are likely only headed one way.... I carry a nasopharyngeal airway though, less likely to vomit than with an opa

My take on these, though, is that they're contraindicated with head injuries, so not useful for a high proportion of likely scenarios. Again, though, I get the feeling that you're competent at placement and already know this....

> For me, I think it's worth carrying a couple of large gauge cannulas aswell. Very light and useful for tension pneumothorax decompression. Might just make a difference.

> Beyond that a few painkillers, light bandage, sweets and the king of bodging anything some gaffer tape:). Cable ties for bodging crampons and a phone.

Which is, I think, in line with a lot of contributors: carry a few pieces of specialised, non-substitutible, bits of kit, and then a fairly small range of the other stuff.

Withnail - on 20 Jan 2014
In reply to neuromancer:

If they're conscious they probably don't need an airway adjunct of any kind.Nasal airways are also handy when people have locked jaw type situations ie seizures. Often People try to pull out and gag on both npa's and opa's if they become rousable in which case best just to pop it out. I'm not sure if that's answered your question or whether I've completely misunderstood what you meant there...apologies if so!

Jon
maisie - on 20 Jan 2014
In reply to neuromancer:

> Finally, from what I've been told by the medics I've worked with, taking a suture kit is a reasonably moronic thing to do.

Clearly, neither you nor they have ever popped a trouser button at altitude.

You've obviously had a fair bit of experience. What did you need to use the celox granules on?

Martin
Dave B on 20 Jan 2014
In reply to Withnail:

Forgot. We also have handheld suction in the big bags. Again not something I'd take to the hills.


Withnail - on 20 Jan 2014
In reply to maisie:

Yes and no: contraindicated with suspected base of skull # and facial #s. No specific contraindication with other types of head injury. The concern, as you point out , being misplacement. However, they are useful for pts with trismus ie seizures and those with low gcs but intact gag reflex. In other words less likely to make patients vomit, but it can still happen!

I think though these things (and first aid kits) are all personal to people's own training, skill levels and what suits the individual. There is no right or wrong: I think that's maybe what your post is getting at?

For me, if I fall off a winter climb and get really fubard I'd much rather someone put me on my side with some care for cspine, wrapped me up as best they could and phoned for help with the correct grid reference quickly than farted about with airway adjuncts they'd never used before.

I think most folk are pretty sensible that way though
splat2million on 21 Jan 2014
In reply to maisie:

> In other words, leaving aside frequency of use, would carrying an I-gel be of any practical use in remote first aid scenarios?

I-gels are really good in the correct hands because they make ventilation less labour intensive. I.e. one person can perform CPR. With a bag valve mask one person technique is really difficult to maintain for long, I've managed 90 minutes once but my hand was in agony and I was really struggling towards the end and I'd have killed for an I-gel.

Prolonged resuscitation in remote places can be successful, particularly in hypothermia - see http://www.youtube.com/watch?v=jLr15BBBtrc although of course this is an unusual case.

I only carry any sort of clever trauma stuff if I'm cragging somewhere popular where i dont care about the walk in. if I'm out somewhere remoteI have a couple of simple dressings, triangular bandages, tape and some pain killers because I don't want to carry a big kit I don't need. I'm not an ice climber (yet) though. I'd probably carry more if I was more than 1 day from a hospital though but this is rarely the case for me.
neuromancer - on 21 Jan 2014
In reply to Withnail:

No, no that's Ok. I was imagining things like anaphylactic shock, airway burns e.t.c, but you are right I suppose.

In reply to Maisie:

Less experience than my kit might suggest. It's mostly buckshee stuff team medics have given me or I've acquired - I've used celox bandage for a wound before (when the israeli bandages would probably have been fine), but the granules were phased out before I got to the game because they used to blind people around the casualty (when they react with the moisture in the eyes).
maisie - on 21 Jan 2014
In reply to splat2million:

Well, I've certainly learnt a couple of things on this thread, and as a result of some reading around. I Gels are something of which I've been aware for a while, mainly through the veterinary world, but not something I've used personally (mainly because I do very little rabbit anaesthesia, but also because on our side of the fence, they cost 120 a pop). I'm never comfortable with gaps in my skill base, so I'll be doing a bit of work on this one.

But I think the question's still valid - amongst the largish number of emergency medics that have posted, how many feel that an I Gel would make a significant difference to survival, and for how long?

Thank you for the responses. What started out as a fairly casual thread demonstrated quite a large base of skill and experience on the site (so much for the dadsnet jibe). It's also evident that the people who know how to do this stuff are less likely to belittle everybody else, and are aware that whilst incidents requiring these levels of equipment are extremely rare, it's better to be a bit over-equipped than to live with missing the opportunity to save a life. There was the customary b*llsh*tt*r, but I think we all saw through him straight away.
maisie - on 21 Jan 2014
In reply to neuromancer:
I think given some of your comments, it's entirely evident that you're carrying kit that's not entirely commensurate with your skills base. The suggestion that a medic would term carrying sutures as moronic was a dead giveaway, I'm afraid, and does you no credit. Trying to disparage others about use of celox powder, implying in the process that you have experience of problems with its use was another - this thread was supposed to be supportive and educational, not for trolling or self-aggrandizement. What exactly is the point of trying to inflate your capabilities on here? Do it on the hill, and you could find yourself catapulted into a position of responsibility for which you're not adequately trained.

Me, I was always happy to defer to the human medics when dealing with serious casualties - despite having done, say, far more tracheostomies on my animal patients (the level of responsibility involved in dealing with critical human casualties is far in excess of my daily duties), but when we did animal rescues, I was team leader because that's what I do for a living. Having read about the problems of celox powder doesn't give you any authority to preach to others.
Post edited at 11:59
mh554 on 21 Jan 2014
In reply to maisie:

I carry a basic first aid kit with bandages, blister repair, paracetemol, space blanket, bothy bag. But I also carry a face shield and post op bandage (for sucking chest wounds).

It may seem excessive but I figured if someone falls and there are ice axe picks flying about, its not beyond the realms of possibility...
lardbrain - on 21 Jan 2014
In reply to Dr.S at work:

> Vets generally are quite strange.

That's just you, Paul ;-)

SAF - on 21 Jan 2014
In reply to JayPee630:

> Medical stuff really does seem to bring out the slightly odd ex-squaddies, Walter Mittys, and some quite strange people carrying stuff more suited to a battlefield or a A&E doctor or paramedic. Decompressing chests, ET tubes and cannulae?!

I carry a couple of cannulae for chest decompressions, I'm trained to use them, and have recognised a few (but yet to be the person to stabbed the needle in). I carry the same first aid kit for all outdoor activities, including mountainbiking, which carries a greater risk of someone injurying themselves in such a way as to have a tension pneumothorax.

As for iGels, I've used on once outside hospitals, and LMAs in theathres whilst training. iGel worked really well in a cardiac arrest situation, went in easy and did it's job. In resus after the job was chatting to two of the consultant (one who advises mountain rescue locally) about there use, and they are considering them for MR.
Postives - easy to use, quicker to use, little if no delay in Chest compressions whilst inserting it as you would get if intubating.
Negatives - bulky piece of equipment if you carry it in the 4 or 5 sizes that you might need. Without anaesthetics drugs, they probably aren't going to go into anyone with any gag reflex remaining or stay in if they regain consiousness at all, so only really any use in cardiac arrests which in the mountains is a pretty pointless excercise anyway.

So not really sure how they have come up being discussed in a mountain first aid kit thread.
neuromancer - on 21 Jan 2014
In reply to maisie:
You seem to have a deep fried potato planted somewhere upon your scapula about all of this; I'm not quite sure why, but you needn't seem so angry and you could probably do yourself more credit to not be quite so acetic.

I don't know quite what it means to be carrying kit commensurate with ones skills base. My skills are primarily dealing with military trauma and injury. I was taught by someone who personally was temporarily blinded in the middle of a fire-fight by celox granules, and nearly lost a patient because of it. I have also poured them onto wet skin and enjoyed the reaction as evidence. I was also taught never to semi-permanently close wounds in unsterile environments. But I'm sure it all behaves differently on 'the hill'.

I would appreciate if you pointed out where I had trolled or self-aggrandised, but please do it in private message so as not to shit this thread up anymore, thanks.
Post edited at 15:38
johncb - on 21 Jan 2014
In reply to maisie:
It's not what's in it so much as if it's in date.

I recently went to use my kit and some items had dried up.
OK, shame on me, but it's a lesson learned.
ow arm - on 21 Jan 2014
In reply to maisie:

chill out! carry stuff you think is necessary and that you have sufficient training to support its use, and that you are capable and competent to use, bearing in mind that if you injure or kill somebody by using a particular item then you would be liable and possibly commit manslaughter.

This thread si getting out of hand!

What each person carries in their first aid kit depends on what they are doing and there are no right and wrongs, just underprepared or overkill.
The Lemming - on 21 Jan 2014
In reply to ow arm:

> This thread si getting out of hand!

Sadly rather than being helpful and constructive about First Aid kits, this subject matter quickly turns into a Willie Waving competition about who has the biggest and baddest kit.

Its a shame really as a First Aid kit should really do what it says on the tin, as in to provide First Aid.

Most of us don't actively go looking for blood and gore while out on the hill, so why bring the kitchen sink in the hope of finding something gruesome with which to treat?

If you are a professional with paying clients then you are obliged to carry something that will satisfy the H&S part of the job. However if you are a punter, and I am most definitely in the punter camp, then you just need the basics.

May I suggest that a basic First Aid course is also worth its weight in gold and more practical that an all-singing-all-dancing First Aid kit box?
Hannes on 21 Jan 2014
In reply to maisie:
> But I think the question's still valid - amongst the largish number of emergency medics that have posted, how many feel that an I Gel would make a significant difference to survival, and for how long?

I would say in the right circumstance I believe it could help, but those cases will be fairly few. The only situations where I can imagine it to be of that much use would be coming upon a cardiac arrest from for example a heart attack or a head injury putting the person into a state where they are not protecting their airway. In both cases it would make less difference if you were with a friend there. I could consider carrying one on an expedition to a remote place but I wouldn't for anything else simply because of the small chance of it being used. Good thing is that they are pretty cheap though, you can get them off the internet for 8. I can see the point of having one in the car though. However, before doing a bit of googling I believed they were far more expensive than they are. Here's a quick video how to use one http://www.youtube.com/watch?v=ao-Sb_OulE8
Post edited at 16:21
vark - on 21 Jan 2014
In reply to Hannes:

Sticking an I-gel in someone with a head injury bad enough to mean they cannot protect their airway, without the use of drugs, will put up their intracranial pressure and worsen their brain injury.

Feel free to use them in a cardiac arrest but consider how long you may have to sustain CPR in a pre-hospital environment, especially in the expedition setting you mention.

Much of this kit is not designed to be used in isolation. It forms part of a much bigger set of kit needed to have a significant impact on the patients outcome.

For all those claiming to carry cannulae to decompress tension pneumothoraces I wouldn't bother. There is evidence that in a proportion of patients they are not long enough to reach the pleural cavity. Secondly, in a trauma setting, they are likely obstruct pretty quickly due to blood etc. It is better to make a small lateral thoracostomy using a knife. This is not without its problems in a spontaneously breathing patient and other kit/skills will be required.

As has already been said, first aid should be just that. Move beyond this and you will need a large amount of kit, lots of extra training and access to rapid evacuation.
marsbar - on 21 Jan 2014
In reply to mh554:

I seem to remember that we were told that gaffa tape and a credit card was the way forward for sucking chest wounds.
Dave B on 21 Jan 2014
In reply to vark:

any issues for their use on drowning victims you would consider. Let's assume no spinal injury for now?

It is something that might done in to club kit in the future though.

As I said before, they're not part of std kit at my club as we don't have the training and we need to consider what things we have that need additional training over the standard qualification.
vark - on 21 Jan 2014
In reply to Dave B:

No major problem with drowning that I can think of but you will need a range of sizes and training to use them. You will also need a self inflating bag to ventilate with.

Probably best to stick to bag and mask or mouth to mouth if you are not regularly using the kit as it is possible to cause a long delay without oxygenation playing around with kit you are not familiar with
maisie - on 21 Jan 2014
In reply to neuromancer:

> You seem to have a deep fried potato planted somewhere upon your scapula about all of this; I'm not quite sure why, but you needn't seem so angry and you could probably do yourself more credit to not be quite so acetic.

No. Pretty much in the entirety of your post. You had at least two pops at other people and implied in the process that you had more experience than you actually have. This is a decent definition of self-aggrandisement. The comments you make do give your position away, I'm afraid: it's like listening to someone speaking English as a second language, and not particularly well.

And it's my thread, I can do what I like with it ;-)
maisie - on 21 Jan 2014
In reply to SAF:


> As for iGels..... not really sure how they have come up being discussed in a mountain first aid kit thread.

No, me neither - but I find it really interesting, as it's clearly something outside of my own experience. Your comments on them are really useful, so thanks for that.

Martin
maisie - on 21 Jan 2014
In reply to vark:



> For all those claiming to carry cannulae to decompress tension pneumothoraces I wouldn't bother. There is evidence that in a proportion of patients they are not long enough to reach the pleural cavity.

Hmmm. I'd take issue with that, as it seems a bit bald. Couple of points - a proportion is by no means all, and it really depends on the size of your cannula (fnaarr) - some of the veterinary ones go up to about 6", so most fat b*st*rds would be OK. But most importantly, leaving aside issues of misplaced cannulae, if the pleural cavity isn't penetrated, then at least you're no worse off than you were - so no significant harm done, with the small risk of having done something useful.

The real risk is in misdiagnosis, which is what keeps both human and veterinary medics awake at night....

maisie - on 21 Jan 2014
In reply to The Lemming:

> Sadly rather than being helpful and constructive about First Aid kits, this subject matter quickly turns into a Willie Waving competition about who has the biggest and baddest kit.

I see the point you're making, but I think that's overstating it: what's mostly displayed here is a tacit acknowledgement by a number of people who know their stuff, that much of this kind of kit is of little practical use in isolated, unsupported environments. Carrying it is, for me, a mix of insecurity and fear of failure when it all goes tits up - but that's just me, and not a reflection on anybody else ;-)

FWIW, clingfilm and duct tape seem to be the most useful bits of first aid kit. I find that strangely uplifting.

There's probably a bloody good article in thus from one of the human medics. Any volunteers?

Martin
Firestarter on 21 Jan 2014
In reply to maisie:

Anything to cure a hangover
Dave B on 21 Jan 2014
In reply to vark:

Thanks. Yes, I think the overhead of equipment would be a major issue. As we train each week, and basic life support is regularly trained, I'm more worried about the bag of stuff than training. Mind you I'm not sure ourbasic resus Annies will take them either. So that would be a consideration for fund raising.

Other clubs have vehicles to move the equipment on the beach. We have shanks pony.
And some of our ponies are quite small. The work bag is really big and heavy for more than a short sprint unless you're big and strong and cv fit.
maisie - on 21 Jan 2014
In reply to Firestarter:

> Anything to cure a hangover

Completely disagree: surely it's more important to carry stuff which will cause a hangover?
Dr.S at work - on 21 Jan 2014
In reply to lardbrain:

Just me? How could you forget the rest of team anaesthesia so soon?!


> That's just you, Paul ;-)

maisie - on 21 Jan 2014
In reply to Dr.S at work:

Are you Dr Strangeglove?
Dr.S at work - on 21 Jan 2014
In reply to maisie:

> Hmmm. I'd take issue with that, as it seems a bit bald. Couple of points - a proportion is by no means all, and it really depends on the size of your cannula (fnaarr) - some of the veterinary ones go up to about 6", so most fat b*st*rds would be OK.

Maybe a 'red devil' is the way forward;-)

http://www.kruuse.com/en/ecom/Hest_produktionsdyr/Sonder_pump_trokarer/Trokarer_skeder/prod_190430.a...

Probably good for an ice anchor as well.......
Dr.S at work - on 21 Jan 2014
In reply to maisie:

> Are you Dr Strangeglove?

Guilty as charged
maisie - on 21 Jan 2014
In reply to Dr.S at work:

> Maybe a 'red devil' is the way forward;-)

See, now that's funny!

I was going to go down that road, but how the hell do you adequately describe one? (And that goes where now? Seriously, you screw THAT into a body cavity?)

I haven't put one in for years, but seem to have a steady trickle of repair cases after other people have....
neuromancer - on 21 Jan 2014
In reply to maisie:
Question marks generally suggest questions not statements. Stop implying things just to be rude. Something something speaking English.

Could you help me out then and let me know why:

Carrying celox granules on a wet and windy mountain to treat catastrophic bleeds is a good idea when trauma bandages and impregnated gauze exist?

Fully suturing wounds in an incredibly unsterile and infection-laden environment is advisable practice over packing and bandaging and waiting for expert help?

Thanks vet.
Post edited at 22:33
maisie - on 21 Jan 2014
In reply to neuromancer:

Yeah, that didn't help you at all. The first line of your post makes no sense: stop, think about what you want to say, and have another crack at it. I'll be patient for you.

Your argument about celox granules is embarrassing post-rationalisation: the actual issue is that you constructed a slur on other people to make yourself look more knowledgeable and experienced than you are; you actually had to retract on this point later. I'd say that it pains me to point this out to you, but I'd be a hypocrite.

Nobody sutures wounds on a day out on the hill. Did you think that was being suggested? Bless you.

Can I direct you to the Dunning-Kruger principle? It's calling to you.

Thanks ex-squaddie
lardbrain - on 21 Jan 2014
In reply to Dr.S at work:

No, i'm Spartacus.
neuromancer - on 22 Jan 2014
In reply to maisie:

It is evidently clear why you are a vet.
vark - on 22 Jan 2014
In reply to maisie:

I guess most people will be carrying normal Iv cannulae. They are nowhere near 6 inches long.
It would be possible to damage the internal mammary artery and cause significant bleeding into the chest if the procedure if performed incorrectly.
The other harm that may well result is hypothermia from exposing the patient unnecessarily. This has a big impact on outcomes from trauma.
vark - on 22 Jan 2014
In reply to Dave B:

By practice I mean placing iGels regularly in patients not BLS practice on dummies
Dave B on 22 Jan 2014
In reply to vark:

Understood. Helpful info.

mh554 on 22 Jan 2014
In reply to marsbar:

It would work in theory to create a 3-sided seal. But the credit card, IMO, wouldnt be flexible enough to create the seal on the inhale...
dunno and dont especially want to find out :-)
mh554 on 22 Jan 2014
In reply to marsbar:

Thinking about it, you would be better off chopping up you waterproof sack liner and doing a three-sided seal...
mh554 on 22 Jan 2014
In reply to neuromancer:

> Carrying celox granules on a wet and windy mountain to treat catastrophic bleeds is a good idea when trauma bandages and impregnated gauze exist?

> Fully suturing wounds in an incredibly unsterile and infection-laden environment is advisable practice over packing and bandaging and waiting for expert help?


I dont know the answer to that. In the Met we have a version of Isreali bandages. Put one on, then a second... if its still bleeding its arterial so then go to tornique (forgive spelling). And working in South London I had a steady stream of willing customers with various gunshot and knife wounds to practice on. I patched up a lad with 7 once, 2 were sucking chest wounds. He lived.... just.
But we may not carry celox because we are always within a reasonable time from 'proper' medical attention.
Who knows??

maisie - on 22 Jan 2014
In reply to vark:

> I guess most people will be carrying normal Iv cannulae. They are nowhere near 6 inches long.

> It would be possible to damage the internal mammary artery and cause significant bleeding into the chest if the procedure if performed incorrectly.

> The other harm that may well result is hypothermia from exposing the patient unnecessarily. This has a big impact on outcomes from trauma.

No, granted. It wasn't a serious suggestion that people carry 15cm iv cannulae (!) And whilst I agree with you re complications of insertion, I'd also alluded to that. But in a situation where this procedure were truly necessary, one would hope that there was some degree of expertise - I think if anyone's suggesting that everybody should carry a couple of cannulae, just in case, then we're all largely doomed.

My point was really in response to the contention that because some people are too fat for a cannula to penetrate the pleural cavity, it's not worth bothering. Assuming a competence with insertion, I don't agree with that premise. This isn't exactly an elective procedure - and not all pneumothorax cases are equal, so I'm not suggesting whipping out the needles at the first sign of dyspnoea - and the likely success of a procedure obviously has to weighed against the likely outcome of non-intervention. But if non-intervention means death before the chopper arrives, then pretty much everything is on the table, isn't it?

Out of interest, say somebody went right through the internal mammary artery, what are the likely outcomes of this? Is it a bit of a sh*gger, but ultimately fixable, or is it likely to be a terminal event within, say, an hour?
Dr.S at work - on 22 Jan 2014
In reply to lardbrain:

> No, i'm Spartacus.

I've seen you in the showers Lardy, you don't much look like the guy on TV.
maisie - on 22 Jan 2014
In reply to vark:

Sorry, couple more questions.

You're clearly a medic (or else some kind of savant with too much internet time), and you're clearly the bloke (?) who everybody would want to be around if they decided to self-thoracotamise with ice axes.

It's evident that a lot of people carry redundant and/or optimistic first aid kit (I still haven't jettisoned that ET tube yet). So, first question: what do YOU carry?

Second question - I'm certain there's space here for a common sense article. Not particularly for training purposes, but more to illustrate why some bits of kit are pointless and/or downright dangerous, which bits of kit are non-substitutible - and so essential - and which bits aren't. Would you be interested in writing one?
JayPee630 - on 22 Jan 2014
In reply to maisie:
I carry a very small waterproof red roll top bag with a Petzl e-lite, whistle, some painkillers, a few plasters, duct tape, pair of nitrile gloves, bits of waterproof paper and pen, and a few other small bits I've forgotten.

Level of my training is UK paramedic, and I'm a bit disturbed by people that carry ET tubes, Celox, cannulaes, iGel airways etc. unless they're a nurse, paramedic, doctor, or MR team.
Post edited at 10:27
mh554 on 22 Jan 2014
In reply to JayPee630:


> I'm a bit disturbed by people that carry ET tubes, Celox, cannulaes, iGel airways etc. unless they're a nurse, paramedic, doctor, or MR team.

Indeed, seems like a one way ticket manslaughter charge and getting sued

The Lemming - on 22 Jan 2014
In reply to maisie:

> Sorry, couple more questions.

> You're clearly a medic (or else some kind of savant with too much internet time),

Vark is a tad more qualifed than a medic, and I agree with him, we only need the most basic of First Aid kits when out and about with friends.

Work is work, and that requires all manner of stuff to meet H&S obligations. At work I have all the toys you mention but when I'm out playing, as a punter, I take just enough to treat minor ailments.
vark - on 22 Jan 2014
In reply to maisie:

> No, granted. It wasn't a serious suggestion that people carry 15cm iv cannulae (!) And whilst I agree with you re complications of insertion, I'd also alluded to that. But in a situation where this procedure were truly necessary, one would hope that there was some degree of expertise - I think if anyone's suggesting that everybody should carry a couple of cannulae, just in case, then we're all largely doomed.

The paper showing the problem can be found here:
http://www.ncbi.nlm.nih.gov/pubmed/19145519

Admittedly the population was american but it still suggests some likely difficulty in a UK population.

There is also a study showing incorrect selection of position even in those trained to do needle thoracostomy although I can't recall the citation.

> Out of interest, say somebody went right through the internal mammary artery, what are the likely outcomes of this? Is it a bit of a sh*gger, but ultimately fixable, or is it likely to be a terminal event within, say, an hour?

The last stabbing death I saw bleed out from a laceration to the IMA. They had delay in presentation of around one hour but even a resuscitative thoracotomy within minutes of arrival did not help.
vark - on 22 Jan 2014
In reply to maisie:

> It's evident that a lot of people carry redundant and/or optimistic first aid kit (I still haven't jettisoned that ET tube yet). So, first question: what do YOU carry?

Climbing in the Peak: roll of finger tape.
Further afield: finger tape, duct tape, compeed, 1 large dressing, analgesia, antihistamine, salbutamol inhaler, leatherman.
I may have a blizzard bag/bothy bag in addition to the above depending on the circumstances.

> Second question - I'm certain there's space here for a common sense article. Not particularly for training purposes, but more to illustrate why some bits of kit are pointless and/or downright dangerous, which bits of kit are non-substitutible - and so essential - and which bits aren't. Would you be interested in writing one?

Possibly although I don't do any pre-hospital care so there will be better qualified people than me to write such an article
JayPee630 - on 22 Jan 2014
In reply to maisie:

IMO if people need to read an article on UKC about what bits of kit are useful or not then they have no business carrying more than plasters and duct tape and a few painkillers.
The Lemming - on 22 Jan 2014
In reply to JayPee630:

I carry a Swiss Army Knife with a cork screw opener and thing for removing stones from horses hooves. Is that OK.

:-)
JayPee630 - on 22 Jan 2014
In reply to The Lemming:

I'm always most impressed by people that carry a hipflask TBH, but a SAK is up there as well.
SAF - on 22 Jan 2014
In reply to vark:

> I guess most people will be carrying normal Iv cannulae. They are nowhere near 6 inches long.

> It would be possible to damage the internal mammary artery and cause significant bleeding into the chest if the procedure if performed incorrectly.

> The other harm that may well result is hypothermia from exposing the patient unnecessarily. This has a big impact on outcomes from trauma.

You seem to be implying that people including myself who have mentioned carrying this equipment, are untrained, incompetent or both...
I am trained and competent, I have based my decision to carry all the kit I carry on evidence and experience. JRCALC, who i would suggest are slightly more of an authority on these things than you still recommend the use of needle thoracentesis in there 2013 guidelines, they obviously don't have such as issue with it as you and Neuromancer.

SAF - on 22 Jan 2014
In reply to vark:



> There is also a study showing incorrect selection of position even in those trained to do needle thoracostomy although I can't recall the citation.

I've seen a doctor misplace a chest drain in a trauma patient, maybe we should just ban all health professional from carry out any procedure involving a anything sharp and pointing, in case they get it wrong on that occasion!!!
ads.ukclimbing.com
JayPee630 - on 22 Jan 2014
In reply to SAF:

But there's a difference between someone that's trained and experienced in a procedure, and someone that is neither trained nor experienced who then attempts same procedure.

Both can make mistakes, but one is much more likely to than the other! And one has back-up legally and morally, and one doesn't!

Dave B on 22 Jan 2014
In reply to splat2million:


> Prolonged resuscitation in remote places can be successful, particularly in hypothermia - see http://www.youtube.com/watch?v=jLr15BBBtrc although of course this is an unusual case.

Our Protocol is that we don't try to resus anyone who' been under water for more than 90 minutes, but recover body and then it is warmed in hospital.
SAF - on 22 Jan 2014
In reply to JayPee630:

But you and several others on here have made assumptions that myself and others who carry specific pieces of kit are not qualified, trained or experience. You are not the only Paramedic who uses this forum. The original post asked what was in other peoples first aid kit... In response I got my kit out, which I had been meaning to do for a while and went through it (finding all the out-of-date meds in there along the way) and simply list what I have in my kit. You made an assumption that I am not entitled to have that kit in there.
JayPee630 - on 22 Jan 2014
In reply to SAF:
No, I didn't make assumptions, apologies if it seemed that way, I just asked. Don't be so touchy, obviously the concern is directed to people that are neither trained nor experienced, if people are then that's fine of course!
Post edited at 12:08
SAF - on 22 Jan 2014
In reply to JayPee630:

That's fine. Apology accepted

I do have to question whether anyone considering carrying iGels, had ever actually seen the size of one in all it's packaging (let alone a set), let alone has any experience using one.
JayPee630 - on 22 Jan 2014
In reply to SAF:
Thanks.

They are huge in their packs. I carry them for work, but wouldn't consider it in the hills. Don't even carry an OPA/NPA in the hills, although I can see the argument for doing so.
Post edited at 12:18
Dave B on 22 Jan 2014
In reply to vark:

I made a mistake earlier - practice BLS should have been practice ILS - which seems to include supraglottal airways according to the resus council. I'm still happier about having a Guidal ariway in the work pack than I would be about having a iGel in the club

E.g. http://www.remotemedic.org.uk/immediate-life-support.php (not that we use this provider, we have our own provider).

There does seem to be a tension between some people who say, 'they are really easy to use and they're pretty useful, worth having' and those who say that its not really something to consider unless you are using them for real a lot... and this is pretty interesting to someone like me who gets given a protocol to use and follows it. Or more generally, 3 different protocols - One for my qualification, one for my work and one for my main work. Thank goodness I just get told what to do and have the kit to do what I am trained to do rather than having to decide on the protocol itself.

maisie - on 22 Jan 2014
In reply to JayPee630:

> IMO if people need to read an article on UKC about what bits of kit are useful or not then they have no business carrying more than plasters and duct tape and a few painkillers.

No argument

Sorry, wrote the world's most reasoned reply to this, and then the computer crashed and it disappeared. But my point shares ground with yours - and my idea is for a kind of debunking essay on what is / isn't achievable, which bits of kit are redundant, perhaps a dissection of stuff like celox and CATs and problems with their use (they seem, having looked at various web stores, to be sold as panaceas for everything above a paper cut) and some useful info on what can be made use of from the contents of the average rucksack. With huge signposts and reminders, obviously, towards first aid training.

You're a paramedic; any interest in producing something like that?

I think some of the distrust on here is down to the anonymity of posters. I now know that vark, Nick and the Lemming are docs, yourself and SAF are paramedics, and Dr S and lardbrain are highly qualified veterinary experts in emergency medicine (at which level, there's a lot of crossover into human fields in terms of expertise and knowledge). Me, I'm just a lowly grunt - mixed practice MRCVS - but I'm good at it and I've been doing it a long time. I know some stuff and am quite good at sticking sharp things into bodies. But I'm always learning, just like on here, even if what I'm learning is that I need a foot up my arse.

Martin
JayPee630 - on 22 Jan 2014
In reply to Dave B:

I don't think, I just follow protocols too! ;-) I think 'easy' is not as simple as it sounds as the insertion might be easy (if you have practised it, even just on a manakin) but the understanding of when to use it or not, and then the knowledge of how to use a BVM correctly when airway is inserted, etc etc. is much more complicated.

As for carrying them, you also need a fair few other bits and pieces to make them worthwhile, and sooner or later you find yourself with a huge bag of gear that you never really use and goes out of date ever few years.
JayPee630 - on 22 Jan 2014
In reply to maisie:
It would be an interesting article/book for sure but would require a huge amount of work, so I'm not going to do it!

My take on it is unless you're a HCP do a mountain first aid course with one of the many excellent providers and renew it when it expires, carry a small FA kit with a few bits and pieces in and leave the airways/CELOX/CATs/etc at home and just be sensible!
Post edited at 12:25
maisie - on 22 Jan 2014
In reply to vark:

> The paper showing the problem can be found here:


Perfect. Thanks a lot for that one - and if you do find the paper on incorrect placement, I'd be most interested (mainly just for comparison with our situation - I certainly think that thoracocentesis and tracheostomy in our patients is a hell of a lot less complicated - although, obviously, not without their complications).

They did stop short, though, of suggesting that it's a pointless pre-hospital exercise; more that it did attract a predicted failure rate of up to 50% That also was taken off imaging of uncompressed tissue and made no allowance for measures that could be taken to reduce tissue depth. What worries me most about it, though, was the implication that paramedics who'd placed cannulae might not be able to tell whether they were working or not.

Equally, this is in a setting where the hospital is a fast ambulance ride away and supportive measures could bridge the gap. With an hour or so till rescue, I think the balance might shift somewhat.

Great info, thank you.

Martin
Dr.S at work - on 22 Jan 2014
In reply to maisie:

> I think some of the distrust on here is down to the anonymity of posters. I now know that vark, Nick and the Lemming are docs, yourself and SAF are paramedics, and Dr S and lardbrain are highly qualified veterinary experts in emergency medicine (at which level, there's a lot of crossover into human fields in terms of expertise and knowledge).
> Martin

I must demur, I'm a lowly anaesthetist, lardbrain is the ECC bod.
maisie - on 22 Jan 2014
In reply to JayPee630:

> It would be an interesting article/book for sure but would require a huge amount of work, so I'm not going to do it!

> My take on it is unless you're a HCP do a mountain first aid course with one of the many excellent providers and renew it when it expires, carry a small FA kit with a few bits and pieces in and leave the airways/CELOX/CATs/etc at home and just be sensible!

A couple of photos, and you're already pretty much there!
vark - on 22 Jan 2014
In reply to SAF:
I have no idea about you background or training and do not believe I have made any comment/implication about it.
Part of being trained in a procedure is being aware of the limitations and adverse consequences. I was merely pointing these out to those who may think a needle thoracostomy is without risk and likely to be of benefit.

Guidelines such as JRCALC and ATLS lag behind current best practice because of the time taken by the committee's of such groups to review the evidence.

Misplacement/harm due to chest drains in trauma and non-trauma is well recognised which is why in many organisations the group of people allowed to insert them is very limited. This is often supplemented with ultrasound guidance.

Diagnosis of tension pneumothorax is not necessarily straightforward. The last time I saw anyone suggest a needle thoracostomy it was a consultant anaesthetist. Fortunately the the ultrasound I was doing at the time demonstrated a massive haemothorax not a tension pneumothroax. This was in hospital in a (relatively) controlled environment compared to the bottom of a crag somewhere.

All UKC first aid kit discussions seem to follow the same path as this one, with increasingly complex procedures being mentioned. Feel free to carry whatever you fancy, but whatever procurers you carry kit to undertake the key question you should ask yourself is "and then what?". Pre-hospital time in the Peak is fairly long, even with a good mobile signal and good weather.
Post edited at 12:34
Dr.S at work - on 22 Jan 2014
In reply to maisie:

> Perfect. Thanks a lot for that one - and if you do find the paper on incorrect placement, I'd be most interested (mainly just for comparison with our situation - I certainly think that thoracocentesis and tracheostomy in our patients is a hell of a lot less complicated - although, obviously, not without their complications).

> Martin

Broader topic, but I think we have a dearth of good data on the rate of complications of most interventions in veterinary medicine, which might colour our approach compared to that of the medics.



maisie - on 22 Jan 2014
In reply to Dr.S at work:

> I must demur, I'm a lowly anaesthetist, lardbrain is the ECC bod.

Anaesthesia is witchcraft - thank God the nurses do it. I've seen the stuff you anaesthetists talk about, and I don't understand any of it.
Dave B on 22 Jan 2014
In reply to JayPee630:

Huge bag of gear... check! the work one is so big that its a big of manual handling issue for a lot of the smaller lifeguards. WE can be called out with that as an 'community responder' by the Ambulance service, so it can be a good haul with it by the time you get to the incident. Good job we have to be fit to keep the job (we are tested every month).

The club one I went for one that is a LOT smaller so even our 16 year old diminutives can carry it, or even run with it. We're lucky in that its been a BIG award from a local organisation to get the first aid kit for patrolling beaches/having at club training. The committee all said we'd feel pretty foolish if having got as many members as possible to surf lifeguard status we didn't have the kit to match the training we had. Especially if something went down in front of us and all we could russle up was a plaster and some duct tape. I guess in about 3 years time we'll have to do another fund raiser to replace all the out of date stuff - like AED pads and bandages.

In the mean time I'm trying to get a big grant for more training equipment...
maisie - on 22 Jan 2014
In reply to vark:

> Diagnosis of tension pneumothorax is not necessarily straightforward. The last time I saw anyone suggest a needle thoracostomy it was a consultant anaesthetist. Fortunately the the ultrasound I was doing at the time demonstrated a massive haemothorax not a tension pneumothroax. This was in hospital in a (relatively) controlled environment compared to the bottom of a crag somewhere.

I know it's wrong, but imagine the look on his face when negative pressure was applied!

> All UKC first aid kit discussions seem to follow the same path as this one, with increasingly complex procedures being mentioned. Feel free to carry whatever you fancy, but whatever procurers you carry kit to undertake the key question you should ask yourself is "and then what?". Pre-hospital time in the Peak is fairly long, even with a good mobile signal and good weather.

Which is the point - these procedures are being discussed by a bunch of anonymous people who, it appears, are medical professionals. Small wonder that most laypeople disappeared a while back. A good, solid description of the limitations of first aid - and hence the degree of usefulness of some FAKs - might be worthwhile.
vark - on 22 Jan 2014
In reply to Dave B:

Whatever kit you choose they key is to pick a size and use it rapidly and then be able to rapidly assess if it is working or not.
The problem is harm due to failure to ventilate promptly rather than directly from the device itself.
vark - on 22 Jan 2014
In reply to maisie:

There is a good page here summarising the problem.

http://emcrit.org/podcasts/needle-finger-thoracostomy/
Withnail - on 22 Jan 2014
In reply to vark:

I have to agree with some of the other posters re: needle decompression. I understand what your saying about joint colleges guidelines being less current but they are the current pre-hospital guidelines. Are there any concrete plans to remove needle thoracosentesis from the prehospital care setting?

Annecdotally, I have performed only 2 needle decompressions in 8 years working in pre hospital care. One of which was with a male RTA casualty id estimate around 115kg in weight. Reached the pleural cavity without difficulty. Another decompression was required shortly before arrival at hospital due to clogging, as you mention.


I agree, The definitive diagnosis between haemathorax and tension pneumothorax is difficult in the prehospital setting. Needle decompression really is an extreme measure in the prehospital field but then in this environment there is no trauma series of X-rays, resus team etc. difficult decisions are often based on limited information and support within the limits of your training and experience. I'm sure you understand this as you clearly have a much higher level of training to myself.

My thought process is: Cairngorms a mate falls off, develops a tension, helicopter flight time is probably around 20 to 30mins from lossiemouth, maybe bringing 2 cannulaes (even if one clogs up after 20minutes) might make a difference....

I agree with the rest of your post. First aid in General is just that, simple, quick, get help etc

Cheers

Jon
Andy DB - on 22 Jan 2014
In reply to maisie:
Firstly I should probably say I am a not particularly qualified mountain rescue volunteer.

I always find these discussions interesting as there seems to be a split between plaster and duck tape to the contents of an ambulance.

I just thought I would share with you the most profound bit of first aid advice I was every given (by someone very qualified to give it) "All you have to do is stop them dying before you can hand them on to someone more qualified! and if you can make them comfortable and slightly better in the process then that's even better"
I think this is a good sentiment in that what ultimately saves people who are seriously injured is taking them to hospital. Therefore the only thing that should delay taking them to a hospital is something that will meant they won't make it to hospital.

As for the talk of fancy things in personal first aid kits personally I don't see the point of airways etc. My thinking goes along the lines what would I do if I needed an airway but didn't have one? Use a manual method and so for the very limited case of coming across someone in the hills that doesn't have an airway I will just accept that I would have to use a manual method. The same argument can be made for most chest seals etc etc.

My personal first aid kit for me serves two purposes. Allows me to treat minor accidents / ailments for me or the group I'm with and do a few initial life saving things at an accident which I accept I will need help dealing with. On this basis to deal with the first situation I have a few plaster, tape etc to deal with minor bumps and scrapes. Some pain killers and antihistamines for head aches allergies. Some vet rap to support a twiste ankle etc. Trianglar bandage to sling a busted arm. To deal with an accident I have casualty card and gloves as an aid to my primary survay. A big trauma dressing to stop bleeding. Anything else I need would be improvised or brought in by a rescue team.

Just my 2ps worth
vark - on 22 Jan 2014
In reply to Withnail:

> My thought process is: Cairngorms a mate falls off, develops a tension, helicopter flight time is probably around 20 to 30mins from lossiemouth, maybe bringing 2 cannulaes (even if one clogs up after 20minutes) might make a difference....


In theory I would agree with you if the diagnosis is indeed a tension.

My thought process is:
Tension pneumothorax causing haemodynamic instability is unlikely in a non-ventilated patient.
It is much more like that other pathology is causing respiratory distress.
Accessing the chest in the cairngorms is likely to result in a very cold patient.
The balance is therefore against needle thoracocentesis until the diagnosis is more certain (clinically).


SAF - on 22 Jan 2014
In reply to vark:

My thought process is:
If a friend or even myself (getting someone else to do the decompression) had suffered a climbing or mountainbiking injury (more likely, collarbone/ 1st/2nd rib fracture = high risk of underlying lung injury), and help was a long way off, for the sake of carrying a few grams of kit, and the possibility of some complications, and the person was in respiratory distress with evidence of a tension pneumothorax, I'd like to have the option available to me.
maisie - on 22 Jan 2014
In reply to vark:

> There is a good page here summarising the problem.


At first glance, that looks like a cracking resource for pragmatic approach to the downsides and difficulties - I'll have a good look later (for information purposes only, I must stress)

Martin
maisie - on 22 Jan 2014
In reply to Withnail:

Good post, thanks a lot
Withnail - on 22 Jan 2014
In reply to vark:

> In theory I would agree with you if the diagnosis is indeed a tension.

> My thought process is:

> Tension pneumothorax causing haemodynamic instability is unlikely in a non-ventilated patient.

> It is much more like that other pathology is causing respiratory distress.

> Accessing the chest in the cairngorms is likely to result in a very cold patient.

> The balance is therefore against needle thoracocentesis until the diagnosis is more certain (clinically).


Fair points and these type of patients are likely multi system trauma patients which complicates the issue further. I think id probably agree to disagree but will have a look at the article you've linked to when I've finished. Looks interesting.

For now, my 3 month old baby has mashed my brain into a sleep deprived mess. My spelling is getting worse with each post! Off for a catnap:)

Jon
maisie - on 22 Jan 2014
In reply to Andy DB:

"All you have to do is stop them dying

That's often the hard part....

A solid post, though - completely honest and pragmatic.

vark - on 22 Jan 2014
In reply to maisie:

The other key phrase is " don't just do something, stand there"

There is often a tendency for people to, quite reasonably, feel the need to be doing something when presented with an ill or injured patient. Sometimes the right thing to do is nothing, and wait for assistance.
Not doing something is often much more difficult than doing lots of interventions.
The Lemming - on 22 Jan 2014
In reply to vark:

> Not doing something is often much more difficult than doing lots of interventions.

I was taught a valuable lesson by a senior work colleague. Once you've done something, you can't undo it.

A calm level head on a pair of shoulders is the most important thing, especially when others are flapping and demanding things to be done.

maisie - on 22 Jan 2014
In reply to vark:

> The other key phrase is " don't just do something, stand there"

AKA, the art of masterly inactivity, something which is actively selected against in fee-paying environments. Clients somehow feel less well disposed to getting only advice and a smaller bill, than to getting 'treatment' on top for an otherwise self-limiting condition. But that's a whole other thread.

Essentially, this is my point: if the patient has an ow-ee or a boo-boo, by all means dig out the plasters and paracetamol. A bandage will look cool in the pub. If they need proper attention but they're likely to survive till help arrives, keep them warm and safe and leave them the hell alone. For everything after that, it's a personal choice.

It might be best if we all go out with a treatment preference plan: 'If I suffer an irreversible laryngeal occlusion, on no account let my mate get his knife out, because he's a f*ckw*t who works in B&Q and besides, I'd rather die than risk losing my beautiful singing voice'. Or something.

Martin
Andy DB - on 22 Jan 2014
In reply to vark:

I see this "wanting to do something" a lot in in the mountain rescue firstaid (cascare) exam / pre exam practice. A classic scenario presented in the exam is someone having a stroke. Most candidates diagnose a suspected stroke in 30s but then fail to verbalise the fact that there is no intervention that they can do for the patient and they want an urgent evacuation. Que a tw*t of an examiner asking them what they are doing for the patient and they panic and start to suggesting all sorts of things that won't help and my hinder.

Moral of the story there are times when the best you can do is monitor and evacuate.

I think there is a perpetual problem with more training comes a greater level of kit that can be used but all the kit is of no use if it's so dam heavy it gets left in the boot of the car.
maisie - on 23 Jan 2014
In reply to vark:

> There is a good page here summarising the problem.


Just got round to watching the longer presentation on the podcast. Holy Cr*p. I must admit, for the first 90 seconds, I thought it might be a wind-up - the guy seems to be high on life, to put it charitably. The casualness with which he wishes to 'touch lung' puts the fear of God into me. Certainly effective, although his throwaway remarks about how if the presumptive diagnosis is wrong, you can just move on to the next differential put the dead back in deadpan.

I was interested in the link to Michelle Lin's site, where she compared 5th ICS needle placement against 2nd - although I seem to remember it was on Canadian patients, who may be slightly less tubby.

Extremely unlikely (as in, lottery win unlikely) in my lifetime to have to do a needle thoracocentesis in a human; chances of doing a finger thoracostomy are exactly zero.

Great link, thanks very much. Just out of academic interest, which site do you prefer for needle placement? And do you push many fingers through the pleural space as a diagnostic procedure?(!)
vark - on 23 Jan 2014
In reply to maisie:

In a trauma setting it is relatively easy in hospital as we will (almost) always have advanced warning of the patients arrival and likely areas of injury. There should also be a decent sized team so many things can happen simultaneously. If the patient is in significant respiratory distress then the steps would probably be as follows:
Immediate intubation
Rapid chest ultrasound to confirm pneumothorax simultaneous with the above
Lateral thoracostomy and either immediate insertion of drain or delayed drain after CT depending on the situation.

In the setting of traumatic cardiac arrest bilateral thoracostomies would be performed immediately in conjunction with airway/ventilation management. Care may then include rapid echo and possibly resuscitative thoracotomy.

I might resort to a needle if a blade was not immediately to hand e.g. in CT but would always proceed to thoracostomy if there was not immediate relief of signs of tension. With regard to site it would depend on the size of the patient and what access I had to the chest. I don't think it matters so long as you are in a safe area and aware the procedure may be ineffective.


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