GSW/Blowout kit.

[Solo1st]

Putting cute little stickers on GSW's does nothing to stop the source of the bleeding. Just the visible signs that you can see.

The bleeding that is of concern occurs along the wound tract, and the organs that are affected. Slapping a cover on the hole does nothing to address the problem, but it makes providers feel better about the situation.

[Hmac]

Yeh, that was my point. I'd rather the EMT-P's that I work with dress those wounds with gauze. And not those POS paper Toppers.

[BaileyMoto]

Yeh, that was my point. I'd rather the EMT-P's that I work with dress those wounds with gauze. And not those POS paper Toppers.

What point? That EMT's aren't surgeons?

This is true, 'POS paper Toppers' don't 'fix' the problem, but neither does gauze, tape, or whatever other method you chose to use to stop external bleeding. The patient needs a surgeon, end of story.

Sure, gauze is perhaps more 'proper', but once again, the end result is the same for prehospital care. And with that, for small caliber holes, I've found ECG electrodes to work as good, if not better than 'proper' gauze and sometimes they do not...just depends. Not sure about yourself, but I've worked more than 1 GSW patient by myself (no partner), and when you're in the midst of taking vitals, starting lines, listening to lung sounds, talking on the radio, setting up the monitor, etc...all while going down some bumpy dirt road in the middle of trailer park heaven, little tid bits of knowledge that they don't teach you in the classroom may come handy one day.

I only mentioned it as a tool that you can file in the back of your brain in case you are one day in a pinch. But, since everything works perfectly on your rigs, just forget I mentioned it.

[Hmac]

What point? That EMT's aren't surgeons?

This is true, 'POS paper Toppers' don't 'fix' the problem, but neither does gauze, tape, or whatever other method you chose to use to stop external bleeding. The patient needs a surgeon, end of story.

Sure, gauze is perhaps more 'proper', but once again, the end result is the same for prehospital care. And with that, for small caliber holes, I've found ECG electrodes to work as good, if not better than 'proper' gauze and sometimes they do not...just depends. Not sure about yourself, but I've worked more than 1 GSW patient by myself (no partner), and when you're in the midst of taking vitals, starting lines, listening to lung sounds, talking on the radio, setting up the monitor, etc...all while going down some bumpy dirt road in the middle of trailer park heaven, little tid bits of knowledge that they don't teach you in the classroom may come handy one day.

I only mentioned it as a tool that you can file in the back of your brain in case you are one day in a pinch. But, since everything works perfectly on your rigs, just forget I mentioned it.

I am usually on the other end of the pre-hospital chain. I'm the guy in the ER with the very puzzled WTF? look on my face as I peel those EKG pads off of that multi-perforated patient.

The only thing that makes Toppers worthwhile is that they're cheap. It would be nice if they could be absorbent too.

You can run your service they way you want to or the way you're told - doesn't affect me or my patients. Me, I'd rather the EMT's cover those holes with real gauze and real tape so we get some idea if and how much blood/air/shit is coming out of them. OTOH, I do recognize that half-assed measures sometimes need to be taken on a dark back road where the shit has hit the fan. I'd certainly accept that as a reason.

[titsonritz]

I run one of these with pretty much the items shown. I use an “H” bandage in lieu of the izzy.

http://www.originalsoegear.com/medtray.html

[NinjaMedic]

We use expired defib pads as chest seals sometimes but we always write on them in sharpie "GSW" and cut the wires off. It is not unusual for you to place extraneous ECG electrodes on a patient for a multitude of reasons and they are the last thing that a hospital will worry about taking off. I think it is a very bad practice to cover wounds, especially ones small enough to cover with a small unmarked electrode, due to the significantly increased likelihood that the discovery of the wound by the hospital ED staff will be delayed. If it isn't doing anything to stop the hemorrhage then who cares that the blood stays in the body, you aren't making a damn bit of difference and are probably delaying that patient's definitive care. It is not and should not be a common medical practice.

[Six Feet Under]

I added about 10-12 feet of duct tape (way better than the crappy first aid tape I had in there at the time, but that was all I had when I put the thing together), six safety pins, and a pair of shears to my kit a few days ago.

What would you guys recommend in lieu of the one topper pad I MIGHT have in there now that I've changed the stuff around... I'll have to look. lol

[The Doc]

Alright, I gotta chime in on a couple things here. First, don't use stuff (IE ECG electrodes) for stuff other than what they are intended for. If you have NO other choice, that's one thing (as in you're in combat and all you have to make a TQ is a t shirt and a paintbrush). But, if you are a medical professional, and work in the EMS, there is absolutely no reason not to have the proper medical equipment for the job. That just comes down to shitty pre-shift checks and not doing your job properly. We all remember the 6 P's, right?
Second, if an ECG electrode is going to cover a GSW, the chances of that occluding a sucking chest wound makes no difference. Air is lazy. It takes the path of least resistance. In order for air to enter and escape from a chest wound, the open diameter of that hole will have to be 2/3 the size of the trachea. If it isn't, the chances of it creating a pneumo are slim (note, I didn't say none, because there are no absolutes in the study of medicine) IMHO, if you want to add something to that kit, 2 Bolin Chest seals are the way to go. Recent studies have found that the flutter valve on the Asherman or on a 3 sided occlusive don't do much to aid in the relief of the tension caused by air trapped between the pleura and the lung. These studies have been verified by the USASOC surgeon. The army bought into Ashermans because it was made and designed by a SF medic who patented the design. They are now going to other designs for occlusive dressings, such as the Bolin and the Hyfin. If you need a couple of Bolin's or Hyfin's gimme a shout via PM. I might be able to help you out

Doc

[Limey-]

There are quite a variety of practitioners here from Rural EMT's to Tactical Medics. While I agree that in the world of professional EMS rolling around in a Rig or in a well stocked Urban ER there is no place for 'ditch' medicine it is also true that Special Operations whether Civilian or Military has always utilised 'field expediant' and multi application equipment. For a large sucking chest wound I have found the occlusive dressing with a 14g flutter valve works best, The Hyfin and the Bolin are the best issued gear currently. I know 22 SAS and SBS medics carry Demolition adhesive pads in their Bergens for the same purpose.

[programmer]

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