The Real-real-real 'horrific Injury Kit".....gunshot Wound-bear/lion Mauling, Etc.

Discussion in 'Emergency Treatment' started by IBME, May 15, 2019.

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  1. IBME

    IBME "ALASKAN"
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    Five and only Five, most important items for a special kit for attempting to save horrific injury victim. No help is coming, No ambulance, No Hospitals, No medical professionals are coming.

    Yes, it would be nice to have 30 or 60 or 90 things.........But pick (5) Five things that you hope like hell are in the kit when someone attempts to save your life after a truly horrific injury. Sorry, no you don't get to know what the injury is, just pick what you hope is in the "Horrific Injury Kit".

    I just ordered more:

    a.) Israeli Bandage Battle Dressing First Aid Compression Bandage, 6 Inch
    b.) CELOX Granular Hemostat Blood-Clotting Crystals, 2 Count
    c.)
    d.)
    e.)
     
    Last edited: May 15, 2019
  2. IBME

    IBME "ALASKAN"
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    My most likely survival challenge would be self stabilization, after being mauled.
     
    Last edited: May 15, 2019
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  3. Pragmatist

    Pragmatist Expert Member
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    It is really a near-completely different kit loadout to save someone versus a kit to save oneself.

    With nighttime visibility at minus zero, you've still got to check if patient/victim is wearing a MedicAlert necklace medallion.......and also still got to worry about the implications. It's usually only the EMTs knowing how to properly help others.
    ......

    In my personal kit, priority goes to my RX prescription Tylenol 4 pills. If I go into shock, all else is OBE - overcome by events.
     
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  4. Oldguy

    Oldguy Master Survivalist
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    Tourniquets
    Large compression bandages
    Suture kit
    Disinfectant
    Sterile tool kit
    Torch

    Avoid blood clotting stuff as you cant sew it in ! it must be cleaned out using lots more water etc.

    Whatever wound, control bleeding, clean it out,and pack, leave 24hours then cleanout again and pack leave 24 hours and clean again, when sure all dirt and non viable tissue is gone start sewing. If really deep sew in layers and at intervals
     
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  5. IBME

    IBME "ALASKAN"
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    Thanks.......Torch.....as in flashlight or torch as in flame to cauterize the wound area...???
    Also Suture as opposed to using staples......???
     
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  6. IBME

    IBME "ALASKAN"
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    Yes........that is accurate. But the cold reality is either way, you got what you got, and you do your best, and pray.
     
    Last edited: May 16, 2019
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  7. randyt

    randyt Expert Member
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    awesome, great question.
     
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  8. GateCrasher

    GateCrasher Expert Member
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    Cheating a little by listing some categories instead of individual items, I'd want these (upgraded blowout kit basically) at the time of the injury for stabilization to get me back to base camp:

    a) Tourniquet (pick your favorite type)
    b) Airway - NPA/OPA (and unless my rescuer is an attractive woman, then a bag valve mask too)
    c) Field Dressings (with hemostatic agent).
    d) Chest seals
    e) Pain relief (Ketamine, Fentanyl, or morphine hopefully, but oxycodone/hydrocodone or just tylenol (paracetamol) and ibuprofen better than nothing)

    With emphasis on the "No help is coming, No ambulance, No Hospitals, No medical professionals are coming." part, then back at base camp, for treatment and so I don't die of shock or infection some hours/days later:

    a) IV fluids. Lactated Ringers, Plasma-Lyte, and/or normal saline, with administration sets and catheters.
    b) Antibiotics (Cipro, Flagyl, Clindamycin, Bactrim, and Augmentin - at least)
    c) Lidocaine, injectable, and syringes
    d) Gauze dressings and bandages (various and lots of them - pads, roller, idoform packing, etc)
    e) Sutures (absorbable and non-absorbable)

    Good thread, waiting to hear what others have to say.
     
  9. Morgan101

    Morgan101 Master Survivalist
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    I guess I am thinking more like average Joe hiker/hunter/ outdoors guy than an EMT. I wouldn't know how to use half of the stuff that is listed here. The Israeli Bandage and Celox are excellent choices. I'm going to include Super Glue and Grain Alcohol. I don't know how to suture, but I can pull a wound together and keep it from coming apart. The alcohol will be used to disinfect, and keep as clean as possible. These are also things that are readily available, and I am more likely to carry. It is more likely I would have vodka than grain alcohol.
     
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  10. IBME

    IBME "ALASKAN"
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    OK.........I want to keep this "On-Track". Just a few things, Not an entire Emergency Room of stuff. Don't worry about what will be needed the next day. Think in terms of keeping yourself or someone alive for hours. Not comfortable.......just alive.
     
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  11. GateCrasher

    GateCrasher Expert Member
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    OK, 5 items only (still cheating on the Trauma Pak, I know), size and weight of kit not an issue, for unspecified horrific injury, keep air going in/out and blood going round and round.

    f1474d03387eb4036f314fb085f45966.jpeg

    Make air go in and out - Bag valve mask and NPA.

    Keep blood going round and round - Adventure Medical Trauma Pak and homemade/modified ratchet strap TQ*.

    EMT shears - Cutting seatbelts for extraction, cut clothing to access wounds without causing further injury, and make occlusive dressings/chest seals with pieces cut from the plastic bag of the trauma pack (and it's included tape).

    *Don't laugh :) I needed 6 TQs when remaking my FAKs a couple years ago and knew $100 for tourniquets wasn't going to fly well with the wife. Figured I'd buy one here and there, but haven't yet obviously.
     
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  12. coffee

    coffee Expert Member
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    Betadine, sterile water, antibiotics, blood clot powders, Israel bandage compression, steri strip bandages, self adhering gauge wrap, THEN a bottle of Liquor for me and/or the patient.
     
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  13. coffee

    coffee Expert Member
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    Do you by chance, live in Virginia???
     
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  14. GateCrasher

    GateCrasher Expert Member
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    Sorry, no. 14 hour drive to Virginia, or something close to that.
     
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  15. IBME

    IBME "ALASKAN"
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    OK........I am not trying to be argumentative, I think that maybe I am not communicating what I hoped, so I can have the five best tools for Catastrophic-horrific injury.

    Situation.........person will be dead soon, maybe minutes, possible a half hour. Is antibiotics and sterile water really critical, or can that wait till tomorrow......???
     
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  16. coffee

    coffee Expert Member
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    okay, to add to your A) & B) above...
    C) a clean/cleanest fabric to tie over the injury,
    D) a tarp, to use like a stretcher to get to help, assuming it is not myself that is injured, and
    E) rope to tie to tarp to pull to injured person to safety/help
     
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  17. Pragmatist

    Pragmatist Expert Member
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    Ref: "5 only items for a special kit ("Horrific Injury Kit")
    Ref: "you don't get to know what the injury is"

    Re: "(...Fentenyl, or morphine...)"

    Gate Crasher, in any special kit would fentenyl be in it ?

    There's a company in Colorado, owned and operated by medical doctors, who tailor special kits to one's anticipated needs.

    If not knowing what the injury is, don't many (most ? [I forgot]) of the pain killers interfere with respiration ?

    To partly digress, leaving the pharma stuff for a moment, a premier wool blanket or if traveling first class a goose down quilt to address hypothermia (spelling?) does wonders when dealing with critical time frames. If the injury is unknown, return to the basics: respiration, stop shock, ......

    Feet Notes:

    Foot Note 1: The Colorado company is - expensive -. Unless one has a sponsor or is ultra-rich, no need to ask me for their address/edress.

    Foot Note 2: Check for any MedicAlert bracelets / pendants on necklace.

    Foot Note 3: If you see a bracelet reading "I am an alcoholic. In case of emergency, get me a beer", check other wrist. Typical enough, the comedians in our society who wear real MedicAlert bracelets, add humor to life with the other one.
     
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  18. IBME

    IBME "ALASKAN"
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    Maybe it is just me.....but I feel like I am not understanding why "Medic Alert" thingie is important.
     
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  19. Pragmatist

    Pragmatist Expert Member
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    Don't administer morphine if bracelet says don't give morphine - and related such as nitroglycerin for heart patients.
     
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  20. IBME

    IBME "ALASKAN"
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    I just want to be clear.........when this horrific injury happens, there it never ever going to be any hospitals (zero) No medical professionals ever, never ever-ever, no ambulance, no help "PERIOD". No help of any kind, any type.....zero.

    Side note: I did a thread on another forum that was kind'a a little like this one, "BUT it was restricted to them suggesting a tourniquet for use by a solo hiker in the wilderness.

    I was shocked that they could NOT comprehend Wilderness. They could not grasp that no help is coming.

    https://www.survivalistboards.com/showthread.php?t=912424

    This was my post #61 of that thread:

    Over the years I have noticed that people don't really grasp (even remotely) the wilderness of Alaska. It is "NOT" just this thread, it is over and over and over, people simply can't comprehend the vast nothingness of Alaska.

    Many of the locations that we guide big game hunters, are places that you simply can't not walk out of, if the bush pilot that dropped you off, does not come and fetch you your bear food.

    Here is a very short story that happened in Wide Bay, down on the Alaska Peninsula. It ended we for myself and the Brown Bear, but had I so much as farted it could have required a tourniquet or a small body bag for the remaining pieces.

    https://www.survivalistboards.com/sh...d.php?t=392026
     
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  21. IBME

    IBME "ALASKAN"
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    How would I have those things.......???
    What is hard to understand......the person has a massive-catastrophic-horrific injury and will be dead in 30 minutes or less if aid is not rendered.

    There are NO lawyers, No litigation, No autopsy.
     
  22. Pragmatist

    Pragmatist Expert Member
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    IBME,

    Some of the comprehension ... or lack thereof ... is generational.

    "Alaska" means the trip on the boat to watch the whales. On return, there's a party with meal at hotel. This constitutes "Alaska".

    It's not just Alaska and comprehension/perception. New York State is more rural than Nevada. America's educational system is in collapse.

    Tourniquets have a history. In the 1950s they were accepted as an important technique. Later, they became verbotten for private citizen emergency practice such as out in the field. Now, they are "back in style" as a good technique.
     
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  23. Pragmatist

    Pragmatist Expert Member
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    Someone mentioned a kit with morphine. I used it as an example.

    If all Hades broke loose and you're trying to say someone - and the bracelet says "No Morphine" (or other pharma), don't interfere with the alert.
     
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  24. IBME

    IBME "ALASKAN"
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    What is real interesting......given that this is a Survival Forum, that largely revolves around Post SHTF, and the total void of any help, as in medical, fire suppression, law enforcement, etc.

    And people can't get past medical bracelets, and litigation, and reference getting the person to help........there is NO Help.

    NO ONE is Coming to SAVE us.

    It is always funny when I drop hunters off in the Alaska bush, they look around and ask, "Sir, if you don't come back, which way should we walk to get help".....???

    Does not matter how I explain they can't walk out......they just don't grasp it.

    I have had them demand to be taken back to civilization.
     
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  25. IBME

    IBME "ALASKAN"
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    This is 100% true.........people live their entire life in an Alaska city, and take drives on the Alaska roads, and think they have seen Alaska.
     
  26. Pragmatist

    Pragmatist Expert Member
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    IBME, I understand your points and have basic agreement with them.

    If someone's body cannot accept a certain pharmaceutical without having a fatal reaction, don't administer the specific pharma. The info could be on the bracelet. An unconscious patient won't be talking about their vital signs and Medicair Part D.

    I know you mean "funny" to be gallows humor. We are an unprepared nation is many aspects.

    Over half my life I worked overseas in the field and offshore. If my people didn't understand how to handle extreme environments, there would be no insurance coverage. Thus, they arrive skilled if wanting to remain on the payroll.
     
  27. Oldguy

    Oldguy Master Survivalist
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    Torch as in headlamp
    Sutures as in needle and thread.

    OH AND SOMEONE OTHER THAN THE PATIENT TO DO THE DEED
    Operating on yourself is Hollywood fiction
     
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  28. TMT Tactical

    TMT Tactical The Great Lizard !
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    IBME, I think you are fighting against the "Ostrich Syndrome" people do not want to face your question and keep skirting around it. I do wonder if sutures would be better than staples. I also like the super glue approach.

    If severely injured and no trained and supplied medical support nearby, chance are you are toast. Even just a compound leg break could easily be fatal. A topical pain killer would be a good choice. No internal pain killers, you need to stay on top of things, so you can actually make good decisions. I would like to deaden the skin before I started suturing up. Being in LaLa land is not a good thing. If somebody else is assisting you, then you need to stay coherent to answer any questions, your helper may ask. pressure bandages would be real good to have. Tourniquet would be nice but a belt can work in a pinch. Water is going to be a key factor. 1) To wash out wound. 2) To keep your self hydrated. Blood loss and infection is what is going to kill you. Solve those two problems first.
     
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  29. IBME

    IBME "ALASKAN"
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    I have a few suture kits. With different size sutures. But I would think that "Staples" would be easier to self administer.

    The other problem is being able to reach the spot that needs closure.

    I have gone six months with zero human contact of any kind, as in no visual or voice. No radio, no record player (yes.....this was long ago).

    I am daily where no one would find me, as I am this summer disassembling my extensive "Cache" program. And it might be one or two months till someone thought to wonder about me even still being alive.
     
    Last edited: May 16, 2019
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  30. Oldguy

    Oldguy Master Survivalist
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    I actually carry an extensive medical kit in my pack allowing me to do many things I hope I never have to do.

    Many things done in the field are based on actually getting to a major medical facility some time soon, if that is not the case what you do in the field may be quite different, so don't be too rigid in any procedures as they may need some tinkering with.
     
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  31. Old Geezer

    Old Geezer Master Survivalist
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    Some suggestions:

    Blood clotting packs
    https://duckduckgo.com/?q=blood+clotting+pack&atb=v140-1&ia=products

    C.A.T. tourniquet and when it comes game time, "High and tight."
    https://t-medical.org/products/combat-application-tourniquet-cat

    Inflatable splints; one can also splint other appendages to mash blood back into body torso = make-do blood transfusion.
    https://duckduckgo.com/?q=Inflatable+leg+arm+splint+stop+hemorrhage&atb=v140-1&iax=images&ia=images

    It's illegal to keep normal saline I.V. bags -- they are prescription. However, I've known whiskey 68s who keep bags and kits in their truck. I knew a guy who got way dehydrated, knew he was in trouble, and started a line on himself.

    You'd better have great communications. You must radio for help. Very bad injuries are going to require multiple liters of fluids and packed red blood cells. Keep your blood type on some identifier method as in dog tags. Otherwise it's gonna be "cross and match" when the doors fly open.
     
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  32. GateCrasher

    GateCrasher Expert Member
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    I recall reading about some prepper doctor companies like that, as for those pain/sedation drugs I mentioned they were more of a wish list since they're all controlled narcotics and difficult to obtain legally (except the oxy/hydrocodone which doctors often prescribe for moderate pain). I don't think any would be part of a standard procedure kit or tray, except maybe when issued to military medics in combat zones. One advantage of ketamine is that it doesn't depress respiratory function, think you're right that almost all opioid drugs do though.


    I don't believe that's entirely true, or at least it is possible to obtain everything to administer an IV online without a prescription or state medical license. The hardest item to obtain without a prescription/license is the fluids, everything else is fairly easy to find but you may need to order from multiple companies to get everything at the best prices. I decided to learn how to administer an IV during the last Ebola scare back in 2014, a lot of studying and watching pros do it, then started with hypodermoclysis (slow infusion of IV fluids under the skin but not in a vein) which is really pretty simple and safe. For learning how to start an IV, I just broke down all the individual steps and studied and practiced each one separately before trying the entire process at one time. I'm certainly no pro, but since I taught myself I had to be my own guinea pig at first so I'm pretty good at starting one using only one hand. This would only be for emergency SHTF "no other option" use, my order being: 1) Pay a doc for treatment. 2) Pay a doc for treatment and provide him the supplies that he doesn't have. 3) Consult with a doctor (phone or radio, as you mentioned) and do what he recommends. 4) Do my best to help and not cause harm.
     
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  33. Old Geezer

    Old Geezer Master Survivalist
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    I didn't even mention "online". This guy's liter of normal saline was stolen. So was the IV line and so was the IV cath. Everything about this was illegal. Who cares?! Don't get caught.

    But you'd better get trained by someone who knows how to do this. Nurses sure do. They are constantly starting IVs.

    For rapid infusion: a) Use a large bore IV catheter like a 16ga even a 14 ga -- 2o ga, 22 ga do NOT EVEN BEGIN TO MEET the flow rates you need. b) Start TWO lines! bilaterally c) Use pressure bags -- these are inflatable bags that the 1.0 liter bags go into, the pressure bag is then inflated to squeeze the IV bags to increase flow rates.

    One thing that will be hard to come by are intraosseous kits ("I/O kits"). If you can't get a peripheral (ex. collapsed veins due to hypovolemia) and you sure aren't in hospital to get a central line, then you gotta drill the bone, superior aspect of tibia, tibial tuberosity (that knobby place at the top of your shin-bone), is a good place; used to, a bunch of guys liked to hit the sternum. Let me look here a minute. Got a great picture!

    ea78da51c5dfacc8015f619a89c5efbb.jpeg

    The battery life (non-replaceable) on these E-Z I/O drills is super long = not to worry. I sh##est thou not; I mean they'll go over 80-90 procedures. The Energizer Bunny is a slouch compared to what's in these drills.

    ea78da51c5dfacc8015f619a89c5efbb.jpeg
    ea78da51c5dfacc8015f619a89c5efbb.jpeg

    You gotta be unimaginable clean when doing I/O lines. Bone infection => septicemia => septic shock => death. Lots of providone iodine to clean and clean and clean.
     
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  34. Snyper

    Snyper Expert Member
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    It's better to wash a wound before it's bandaged, so clean water would be useful and necessary for other purposes too.

    Basic first aid only requires bandages and a means to secure them.

    "Vet Wrap" is one of the easiest things to use for that.

    A tourniquet would be good for severe bleeding but those can be improvised from many items.

    Plastic wrap is helpful for sucking chest wounds, since it makes an airtight seal.

    I once cut my hand severely while in a tree stand, and bound it with surveyor's tape tight enough to stop the bleeding, since that's all I had with me and I didn't want to leave for a while.
     
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  35. GateCrasher

    GateCrasher Expert Member
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    I got all my gear online, the sites for the fluids vary, I've ordered from at least 3 different online medical sites over the years but many others have them as a restricted item. While most bags are marked as "Rx only", nothing illegal about selling (or storing) sterile water and dextrose.

    For the the vein selection, prep steps, and the actual venipunture I studied mostly the phlebotomist techniques, these are the Red Cross/hospital blood donor drawers, that's all they do every day. For most other steps it was the nursing and paramed sites for the actual infusion of fluids and the drip rates. The "Ditch Medicine" book and video by Hugh Coffee was a huge help too, more than anything he gave me the confidence to do it. I started with saline/hep locks, only when I had that pretty well down did I ever spike a bag and start infusing fluid. No experience at all with IO, I'm aiming for a 1950's / 1960's level of care where the procedures are (largely) still in use so familiar to the professionals. If I'm doing this we're at the "Emergency" stage of the Primary-Alternate-Contingency-Emergency (PACE) plan, and if you're my patient your odds of survival probably aren't good. :)

    In most cases the purpose for the IV is for an alternate route of drug administration where oral/subq/IM isn't an option, large bore IVs aren't required for drug admin, fluid maintenance, or nutrition. 23g to 18g catheters is what I store, 18g is difficult enough in a 140-180 pound person for me, how the pros get a 14 into a peripheral vein on an average-sized person is beyond me, especially one may be partially collapsed due to low BP, or in the elderly. The 23g winged/butterfly sets is a good size for the little kids, so I'm told, not like I ever practiced on little kids. The 23g's are what I started with since they're easier to learn with being smaller. The 18g catheters are a two-handed only option for me, and at my limit (mixed success) even with a 180 lb guy with nice veins.

    c78b4080d9d0755e52b95c0ed0ef3408.jpeg

    c78b4080d9d0755e52b95c0ed0ef3408.jpeg

    c78b4080d9d0755e52b95c0ed0ef3408.jpeg

    My first successes, circa 2014, with the cheap digital cam I had at the time.

    c78b4080d9d0755e52b95c0ed0ef3408.jpeg

    c78b4080d9d0755e52b95c0ed0ef3408.jpeg [/quote][/QUOTE]
     
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  36. Oldguy

    Oldguy Master Survivalist
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    If there is no hospital or advanced medical facility it is best to restrict IV's to maintaining the minimum blood pressure needed
    Blood clots are your friend, bringing BP up to normal will blow out most clots, not that you want if you have no facilities!
     
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  37. Pragmatist

    Pragmatist Expert Member
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    Oldguy,

    Also note that even if hospital(s) and medical facilities are on scene, they could probably be over- saturated with patients.

    This is our experience so far.

    Even opening an Advance dLife Support (ALS) field clinic, it's overwhelmed about the same time an emergency public service announcement hits the air waves - if available (SW does get through frequently enough).

    Summary: We still don't have basic adequacy in routine times. Disaster situations do trigger resupply from the cache - presuming the roads are open.
     
  38. Old Geezer

    Old Geezer Master Survivalist
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    513d362a8036c266c78e36e3f16eb4a4.png

    Look at the tremendous difference in flow rates on the charts above. Milliliter per hour; 240 vs 180 vs 90. Those differences spell life or death. That's why the pressure bag! That's why you go bilateral. It smothers me to death thinking about such matters.

    In hospital you as the physician will consider calling for a central line. Fluids, fluids, fluids, then consider a positive inotrope. This patient is going into shock! Do something right damned now!

    In trauma cases, the NUMBER 1 reason for getting a line is to replace fluids and prevent hypovolemic shock. Administering drugs is secondary. This patient is going to die if you don't get fluids into him or her, stat!
     
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  39. Oldguy

    Oldguy Master Survivalist
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    "This patient is going to die if you don't get fluids into him or her, stat! "

    True but only enough to maintain life!
    Many a casualty has survived simply by having just enough fluid to maintain just enough pressure giving just enough time for healing to get underway!
     
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  40. Pragmatist

    Pragmatist Expert Member
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    Good morning Old Geizer,

    That's an excellent chart by EM Note.com
    It's clearly prepared. It's color-coded. It's got some sample pictures.
    It really displays "human factors engineering".

    Thank you.
     
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  41. Joe Stonecipher

    Joe Stonecipher Active Member
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    If you want some good information on medical supplies and skills during a SHTF scenario, go to "Patriot Nurse" on You Tube. She constantly talks about this kind of scenario.
     
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