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Thread: AAR: Condition Red 1 Day Medical - Human Cadaver Lab (4/30/21) *GRAPHIC CONTENT*

  1. #11
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    Lunch

    We wrapped up bleeding control around noonish and took an hour break for lunch.

    So why am I talking about lunch in this review?

    Turns out, I was pretty hungry. Which surprised me.

    It's just that I wasn't exactly hankering for a slab of bloody well-marbled flesh even if cooked well done.

    Nope, this was lunch for me around the corner in Boston Chinatown.

    Last edited by 30 cal slut; 06-01-21 at 12:28.
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  2. #12
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    Airway: Non-Surgical

    When the oxygen supply is interrupted, you lose consciousness within 15 seconds and the brain cells start to die after 4-5 minutes.

    Non-surgical interventions to help keep the airway open include the nasopharyngeal airway (NPA) and the oropharyngeal airway (OPA).

    To mechanically ventilate a casualty, the King Airway can be inserted.

    We ran into a small problem working the King Airway.

    Rigor mortis in the jaw (which starts to occur 20 minutes after death) made it difficult to open the mouth.

    Chris couldn't get the jaws apart without getting super medieval.



    So...that was a perfect segue into...
    Last edited by 30 cal slut; 06-01-21 at 12:39.
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  3. #13
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    ...Surgical Airway - Cricothyrotomy

    A cricothyrotomy is an incision made through the skin and cricothyroid membrane to establish an airway blocked by a foreign object, swelling, or facial trauma.

    This was one of the procedures I wanted to get more comfortable with and it turns out it's actually pretty easy once you do a few reps.

    Step 1: Locate the cricothyroid membrane



    Step 2: Make the first incision through the skin



    Step 3: Cut through the cricothyroid membrane



    Step 4: Without losing your place, insert the cric tube, inflate balloon and attach bag. Provide one bag squeeze every five seconds.



    While not necessary, the use of a flexible wire called a bougie can be very helpful in guiding the cric tube into incision made in the trachea.



    It's only possible for one incision to be made in the cricothyroid membrane. However, each student could rep the initial incision on a patch of skin cut from the donor's abdomen.
    Last edited by 30 cal slut; 06-01-21 at 12:30.
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  4. #14
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    Anatomical Detour

    To show us the airway anatomy (as distinct from the esophagus), our lab tech Mike retrieved a head (from another donor) that was cut down the middle.

    Naturally, the conversation wandered a bit from life-saving to life-taking, with my friend Kenny remarking how small a target the the medulla oblongata is.

    Me: “Yeah, that's a precision pistol shot for sure.”

    Also me (quietly): “Is that a cafeteria tray?

    Last edited by 30 cal slut; 06-01-21 at 12:30.
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  5. #15
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    Tension Pneumothorax

    Tension pneumothorax is a life-threatening condition that can start as soon as 10 minutes folllowing penetration of the chest wall (example: gunshot wound). Air from the outside gets trapped and starts compressing the lungs, major blood vessels, and eventually the heart.

    To a certain extent, tension pneumothorax can be delayed by using chest seals (although I'm told the thinking on this might be subject to change based on new data).

    Once underway, tension pneumothorax can be relieved by thoracostomy.

    That can be accomplished with needle decompression, a finger through the chest wall, or with a chest tube.

    Most of us are familiar with the concept of needle decompression. There are two places on each side of the chest you can safely do this with a needle, taking care not to puncture the heart if you are decompressing the patient's left side. The hardest part is finding the correct intercostal spaces and the correct lines.

    The finger thoracostomy was … interesting. Best way I can describe it is to visualize a slab of ribs. You are using a scalpel to make an incision in the skin to access the meat between the ribs, which you initially bore through with a Kelly surgical tool. Then you use your index finger to widen the hole (you are ripping meat with your finger).

    Yep.

    I haven't had ribs since then.
    Last edited by 30 cal slut; 06-01-21 at 12:31.
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  6. #16
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    Gross anatomy

    In the small amount of spare time at the end of the day the group had the opportunity to open up the thoracic cavity and examine the heart and lungs and nearby structures. These pics pretty much speak for themselves, so I will post them without comment.







    Last edited by 30 cal slut; 06-01-21 at 12:31.
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  7. #17
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    Stress innoculation

    An anatomy course is a rite of passage for medical students. No big deal for them. I guess some people can get accustomed to working with dead bodies but I'm going to go out on a limb here and say that most people aren't. In our (first-world) minds, death is something that happens to other people. Dead people are whisked away and we don't see what goes on behind the scenes in hospital morgues and funeral homes. Death is sanitized for us.

    When working with a cadaver, we are reminded of the fragility and impermanence of life. On top of that, there is the yuck factor – touching and feeling blood, guts, and all the things that horrify the squeamish amongst us. This is not normal.



    Then again, rolling up on an active shooter scene, engaging with deadly force, or getting shot, stabbed, or blown up is not normal.

    I think one of the most valuable things this type of hands-on training provides is a form of stress innoculation. People respond to stress in different ways.

    Stress does funny things to your mind and you don't even realize it. At one point I was prepping the cadaver for emergency limb amputation (with a sawzall) which involved applying two tourniquets and wrapping duct tape around the limb. You'd think that applying the tourniquets would be easy – I've repped tourniquets on myself and others countless times in flat range training.

    Yet, because a part of my brain was quietly freaking out, I screwed up the tourniquet application. I couldn't even explain what I was doing to the instructor … like I had a weird case of the verbal bahabbafabba's. I eventually worked through the problem (amputating the limb was the easy part) but made a mental note to jot this experience down for later reflection.

    Stress makes you do funny things, and in fact in the real world, it's not uncommon for tourniquet placement to be imperfect according to Chris. It happens.



    If you decide to attend this type of training – don't pass up the opportunity to practice something as seemingly mundane as applying a tourniquet to a bleeding cadaver limb. The stress is the missing ingredient when you're doing it on yourself or another uninjured person.

    Here is a vid of my friend Kenny Stretz of Stretz Tactical. As an LEO in one of the country's largest cities, he has seen more than his fair share of death and bad things happening to good people. This is not the first time he's held a tourniquet either. Look at his facial expression in this very unique setting.



    Last edited by 30 cal slut; 06-01-21 at 12:33.
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  8. #18
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    FIRST OPEN ENROLLMENT CLASS

    I believe Chris will be offering more open enrollment cadaver labs in the near future, pending availability of donors and lab time.

    I would not hesitate to jump on these opportunities.

    I will note that cadavers (and lab time) are very expensive – averaging several thousand dollars per cadaver. The tuition for this class was $600/student which for the number of attendees was a breakeven event for the instructor. I would expect future classes to cost more, reflecting underlying economics.

    Is the tuition worth it?

    Absolutely!

    Jump on it. As with many aspects of what we train for, there is no substitute for getting hands-on (and fingers in) with a human being.

    While there are no pre-requisites to attending, I think you'll get more out of this class if you've had some type of Tactical Combat Casualty Care medical training. Chris offers a one-day TECC class which is a very helpful intro.
    Last edited by 30 cal slut; 06-01-21 at 12:33.
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  9. #19
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    IF YOU ATTEND

    Photographs and video were permitted during this class. However, Chris requests some discretion as to where they are posted . Out of respect for the donor's family, it's a good idea to not include personally identifiable features in photos if you can help it. These include the face, the eyes, birthmarks, tattoos, distinct scars, and genitals. For next time, I would recommend that these features be draped prior to photographing. It's much easier to do that than trying to photoshop/edit out personally identifiable features after the fact.

    I feel taking photos, video, and notes are very helpful but as your hands can get kind of messy throughout the day, you'll be changing your protective gear quite a bit. Gloves, gowns, face shields, and booties are provided and there is no limit. I would suggest you also bring a head covering with you when things get a little messy. Your pants from the knees down to the tops of your shoes are not protected so keep that in mind.

    Bring a change of clothes just in case. Next time I think I'll wear scrubs and change into regular clothes afterwards. I had to burn my pants and shoes. But that's a post for another day.
    Last edited by 30 cal slut; 06-01-21 at 13:23.
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  10. #20
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    About The Instructor

    I first met Chris and Detective Mongo of the NYPD over 10 years ago (!!!) while hosting Jason Falla (Redback One) for a carbine class.

    At the time Chris was collaborating with Jason on training projects IIRC.

    We reconnected recently at one of his TECC classes earlier this Spring.

    Chris has an extensive background as a civilian paramedic in NYC. He's actually performed several of the procedures we went over during the lab (example: ~70 career cricothryotomies or something like that).

    He instructs Naval Special Warfare personnel and US Air Force Pararescue in TCCC.

    Here is his bio:

    https://www.conditionredinc.com/about-us/

    Christopher Van Houten

    Owner and Director of Training / Condition Red, Inc.

    Chris is a nationally registered critical care paramedic with 25+ years of New York City Emergency Medical Service experience.

    Chris served as Northeast (Region 1) faculty for the Tactical Combat Casualty Care (TCCC) program, the pre-hospital battlefield medicine course used by all branches of the U.S. military as well as NATO. He instructs TCCC (Tactical Combat Casualty Care) and TECC (Tactical Emergency Casualty Care) courses for local, municipal, and federal high-risk law enforcement teams, as well as branches of the Department of Defense. Part of his obligation as faculty for PHTLS and TCCC is providing oversight, instructor development, and training site evaluations.

    Additionally, Chris provides instruction for new and re-certifying EMT’s and Paramedics. He is also responsible for delivering a Paramedic recertification course for the SOF community, specifically AFSW and NSW, as well as designing custom FMPs and PreDeployment Spinups. Additional instructor certifications include, but are not limited to, EVOC precision and performance driving, NAEMT PHTLS, AMLS & EMS Safety Programs, AHA BCLS, ACLS, PALS, and FEMA general topics instruction. He is also a contracted Wilderness Medicine Instructor.

    Chris provides medical support for numerous local and federal law enforcement agencies. He is currently assisting in developing and delivering custom tactical and austere medical programs for the DoD, Law Enforcement, and EMS agencies that are in the process of developing and enhancing tactical medical response elements. Additionally, he has created “team medical support” training with occupational health components and extended care considerations.

    Lastly, he remains an active pre-hospital clinician providing quality interfacility and 911 specific care.
    Last edited by 30 cal slut; 06-01-21 at 12:36.
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