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Discussion in 'Vintage Topic Archive (Sept - 2009)' started by warwemust, Feb 5, 2008.
Post your practice drills for dealing with a gunshot wound. List the supplies you would use.
gun shot or any other wound/injury
The best way to remember is ABCD
Airway-If they don't have any clear airway then you wake up dead very quickly.
Breathing-If the airway is open, and they ain't breathing, well then they wake up dead too.
Circulation-After you have established that they can breathe on their own, or with your help, then stop the bleeding, spurting=artery, most dangerous, just leaking, not as dangerous, generally, but still needs to be stopped, or, well they wake up dead.
Definitive care, pretty up the bleeding parts, splint any fractures, I believe the current thought is to splint the way they are, but I have been out of the field a while, immobilize head/neck, etc, this is least likely point for them to wake up dead, but can happen too.
The most important equipment to bring is a calm head, if that is not present then a full fledged MASH right on site would be useless.
I keep a good first aid kit in my vehicle, but in a crunch situation, use what you can find after the aid bag is used up. It is easier to take an antibiotic for an infection from a less than sterile bandage, than it is to WAKE UP DEAD!!!
KWICK-CLOT That stuff is bad arse.
Not sure if that is the proper spelling but the stuff works great. Other than that a aussie bandage works great to. If all else fails I have to go for the old school field bandage.
As far as cleaning. I will go see the medics lol.
QuikClot = Great stuff. Supposed to be able to stop the bleeding from a severed femoral artery (though I think I'll personally pass on trying that for now).
One of those quick clot types is supposed to cause burns though...
I thought I was the only one who used the expression "wake up dead". Anyways, ABC is always the rule of thumb, but longer term you have to worry about infection (antibiotics), bone and tissue damage (splint, surgery), and if you live past all that, rehab for the atrophied tissue. That should about cover it
P.S. I would not like to find out how well quick clot works on a femoral artery either, and the poor b****** who does has my sympathy.
BEFORE YOU EVEN SHOW UP: MAKE SURE THE SCENE IS SECURE.
Nothing like showing up to treat a gunshot victim, and having the guy who shot him aim a pistol at you and say "I shot him cause I want him dead. GTF out of here". Unless you can determine beyond a reasonable doubt it was an accident, wait for the police to arrive before treating (or, if in a combat zone, at least drag the guy behind some cover and have a buddy standing overwatch... in this case, saving the life is more important than worrying about protecting the C-Spine). AFTER ALL THAT:
First: Secure the airway (even if they're breathing, put in an airway adjunct)
Second: Ensure circulation (pulse)
Third: Locate and access all entry/exit points. There may be more of one than the other. Stop the bleeding and treat the wounds in order of severity.
Fourth: Treat all other wounds in order of severity.
Let me tell you this, gun shot wounds are usually "wierd" in some way or another, and are always different. You can have a bullet do a through-and-through, or you can have a pinpoint entry wound and a huge gaping exit wound. You can have 2 entry wounds and 5 exit wounds, or the reverse. I've seen a bullet go in a man's arm and an exit wound in his leg (apparently it bounced off quite a few bones). Buddy of mine had an exit wound and no entry wound (lets just say there was a pre-existing entry point, and it wasn't a place we normally do a detailed check).
In a pocket you can't see are gloves, quic-clot, some other stuff... most important stuff in there are the OP/NP airways, trauma dressings, triangulars, epi-pen, etc. Don't carry an intubation kit, or an IV set, as they take up too much room, but if space isn't an issue and you have the training definitely get one. Even a combi-tube would be helpful. Don't have that either because even if not for size, I have no room for a bag valve mask.
The original QuikClot could cause burning, however it'd be preferable to bleeding to death. The new QuikClot does not have the burning problem.
Before we got any type of quick clot we had used tampons.
Only problem with Tampons is two things:
1) In general, it's not a good idea to stick ANYTHING inside an open wound.
2) Ask a female about toxic shock syndrome. Not as common anymore, but still possible... especially if you put one in, transfer care to another provider, they forget/don't know about the tampon inside, and sepsis sets in.
Toxic shock syndrome most often occurs in menstruating women using highly absorbent tampons. Left in place longer than other types, these tampons provide the breeding ground for Staphylococcus bacteria, which may then enter the bloodstream through small tears in the vaginal lining.
An open wound would be the equivalent of one huge tear, thus guaranteeing rapid spread through the body should the bacteria develop. Not knocking it, but thats why tampon like devices have never been advocated as a method of blood control, and why they never will be. Same reason you wrap a wound, and not stick a bandage inside of it.
huh, Wel it doesnt stop the fact that they were used and saved a few lives.
Everything you said is true.
But they were used. Also I would rather have a tampon stuck in there then bleed out. They were only used as a first response until the medic or medivac arrived. Most often the tampon was inserted by the injured person themself.
During battle if you go down Help may be yourself for a few minute or more.
Self preservation and all.
The medic for the was handing them out.
If I am correct toxic shock would take much longer than a few minutes heaven forbid you had to endure a few hours.
Again COMBAT is not the ideal world and alternate methods must be utalized.
That little bandage they issue really isnt good for much more than cut.
And the quickclot brands have been a godsend to the forces.
Trust me you get hit a tampon becomes a real good idea in face of the bandage or bleed out.
Idealy you would not be hit or if hit, hit in the arm Real life doesnt always work out ideally.
References Sorry SEEN it
Like I said, I wasn't knocking it, but just wanted to throw the warning out there. I've seen all kinds of things left in open wounds (and forgotten about), including surgical instruments, sponges, etc. I've also seen people die from them. If a doctor can forget a sponge inside a sterile controlled enviorment like an ER, it can easily be forgotten in the field. I'd take a tampon over nothing, but I'm just putting out the warning to do your best to make sure someone knows about it if possible.
On subject, a great way to deal with those bullet holes is to make a butterfly valve /3 sided cover over the wound.I've treated everything from 1" holes to sucking chest wounds with a plastic wrapper from a combine dressing. Take the clear plastic wrapper from a combine dressing or a gauze roll (or anything else that comes wrapped in that... even an IV drip set wrapper will work). You're not sticking anything inside, you can see the wound, and it gets the job done. If getting a pneumothorax isn't an issue, you can complete occlude it with a 4-way.
Sounds as if you were giving a class on this you are dead on, with the field expiediant procedure for the sucking chest wound.
The tampon method was created for the quick, litteraly seconds vs a few minutes.
Now that quickclot is an issue item becoming more popular the tampon method will soon be a thing of the past.
The wife is in iraq and just had a quick Yahoo messenger chat, They stil carry some tampons as not every joe yet gets issued the quickclot, this is a medic item.
Side note, waiting for the wife to get back to chat. LOL
If you want, I can do my best to try and get you information on suppliers for some good quic-clot. The military's been taking most of the supply making it hard to get on the civilian market (our firehouse still doesn't have any), but I can check around. Best wishes to your wife, may she return home safe.
These are two of many places to purchase.
I was taught NEVER put anything in an open wound just cover and apply pressure. I don't feel right sticking something in. that's just me
Can you recommend a commercial trama kit like the one in your photo? I have a couple hundered saved for a new firearm but am thinking about getting a trama kit instead. I know I could probably make one cheaper by buying all the pieces but I'm sure I'll never take the time to do it. Easier to spend a few extra bucks and get a kit. These guys seem to have some decent ones http://www.practicaltrauma.com/range.shtml and may fit the bill after adding a couple packs of QuikClot.
Yeah as far as the tampons I dont remember that one in the CLS class. But I have heard a few medics say that they work. I sure havent heard about any unit being deployed with them. But hey what ever stop the bleeding.
The quick tourniquet that is used is also a great way to stop bleeding to limbs. (Some people need them for head wounds).
As far as Pneumothorax (Sucking chest wound) I would not recomend puting anything in it.... First things first get the sucking to stop! (If you are not still under fire). The Army is now using a flutter valve that is very nice. Takes all of the taping 3 sides, waiting for the person to inhale, leave the lower side open, etc.... just apply over the wound and let it do the work. I know the Army is using needle decompression as well. Not sure what the other forces are using but I know the Air Force trained by the Army get it.
Bottom line is if you can't stop the bleeding you will die or the casulity you are helping will die. I know a Dr. that said if we can stop the bleeding on the battle field and get them to the CASH with a heart beat that they (his CASH) had a 92% save rate!! That is pretty damn amazing.... Bleeding out is the biggest killer to our Troops.
Thayltd21: Tell your Mrs. to keep her head down and I am sure I am not the only one that keeps her and all of the Service members in our thoughts! Stay safe Mrs. Thayltd21 and godspeed!
thayldt21....we will keep your wife....and all our boys and girls over there in our prayers and thoughts.
The USAF won't let us use Quick Clot unless a Tourniquet doesn't work. Swear to God. The thing about that stuff is that it chemically causes 3rd degree burns to the entire surrounding area, and it reacts to moisture. So, if you go to apply it, DON'T OPEN THE PACKET WITH YOUR TEETH!!!! Also, if your hands are wet, you're screwed. What has happened in the past is that people have used it on upper and lower extremeties to stop severe bleeding and the chemical burn was so bad that the individuals ended up losing their limbs anyway. The stuff was designed to enable Combat Life Savers a way to stop severe bleeding without doing permanent damage to the injured party. In practical use, this turned out not to be the case. Personal opinion, if a Tourniquet won't work, you're history anyway, so that means the USAF won't be using alot of Quick Clot in the future.