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Discussion Starter #1 (Edited)
Well, Jason wanted me to start this thread, so here it is.

Basically, this is for those of you who don't know or want to know more about combat medicine and the items in an IFAK. I will compile a list items you should and shouldn't have in your IFAK/Emergency medical kit and how to properly use them. I think Jason will supply me with good quality pictures. I will also give thorough descriptions of the items and how to use them and when to use them. I will also dig up my old PDF's from the corps on this (what we called combat life saver).

I'm not a medic/corpsman/pj/emt etc. I'm an Infantry Marine. I have been through our Combat Life Saver course (taught by Corpsmen), Corpsmen's Pig school (DMOC) which is live tissue training, and obviously combat.

I'll start with bare necessities needed. I will expanded upon needed items/use later on:

Tourniquet, preferably a Nato
Combat Gauze
Quick Clot
Pressure Bandages
Motrin
14 ga needle
Antibiotic
Duct Tape

TQ's are meant for limbs only! You want to place it as high above the cut as possible and crank on it as hard as possible without breaking bones. If time is available (meaning its not an arterial bleed), put gauze/shirt/anything soft under the pinch point of the TQ to aid in comfort. Do not remove the TQ. After 4 hours, loosen it for less than a minute to allow some blood to reach the lower portion of the limb.

Combat Gauze is gauze with quickclot in it. It is designed to stop bleeding and add pressure to the wound. Basically, just stuff it into the wound and wrap up the wound. Pretty easy.

Quick Clot is to be dumped straight into a wound, use the pack and gauze on top of it to shield your hand and push with your hands into the wound to ensure the QC clogs to bleed. It gets HOT. You might sit there applying lots of pressure for 15 minutes to get the bleed to stop. You will be burned and you will be tired.

Pressure bandages...Do I really need to explain? Wrap a wound, make a sling, etc.

Motrin reduces swelling. Wont do much for the pain of a serious wound, but it will keep swelling down.

14ga needle - needle decompression. This needs a lengthy explanation I will save for a different post. But basically, if a chest wound occurs and one side of the chest builds pressure, you use the needle to relieve the pressure.

Duct Tape, a million uses to include closing a sucking chest wound...I will cover that in the needle decompression post.

You will now await for me to compile a complete list and description with photos and pdfs. so suck it.

Edit 1: The only TQ I will buy and I suggest it for everyone - http://www.extremeoutfitters.us/natotourniquet.aspx
 
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Were they still using the quick clot that you dump on? We had patches of a similar thing because that found the shit got in your blood stream. Patches worked similar I guess. Don't mean to jack your thread just wondering. Im not patient.
 

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Great info, thanks...Just wanted to add to make sure the Motrin you are using is about 600-800mg so you can take advantage of its anti-inflammatory action and thus reduce swelling.
 

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There's a ton id like to add but don't want to dilute tommy thread till he gets everything together. If you add something try to add a tag . Just a suggestion.
 

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Discussion Starter #5
There are two types of "dump" powder. Quick clot and Hemacon. Hema con is based from shell fish, so gives people allergic reactions sometimes. Quick clot is sort of a granular type shit. Both can enter the blood stream and burn your veins and other issues. I've never used hemacon. Messed with it, but nothing in a life saving situation. Quick clot works. But it burns the surrounding tissue. So it caused problems for surgeons and thats why combat gauze came about. Don't worry about posting...I'll just keep my updates to the OP
 

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So Would you say that for a really basic and small ifak, the essentials are tourniquet, combat gauze, pressure bandages and a 14 ga needle for pneumo or hemothorax. In case you can't get access to a 14 ga needle then 16 or 18 will work as well although wont be as good as the bigger needle.
 

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Discussion Starter #7
Correct. But you can get antibiotics and needles at any farm supply
 

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Don't forget an NP to create an airway and an Asherman for a sucking chest wound. Sure you can improvise an Asherman with plastic and duct tape, but it won't be as effective.

I would definitely recommend taking a course. I took TCCC/TFR (Tactical Combat Casualty Care/Tactical First Responder) before each deployment. In-depth hands on training and it was an eye opener.

The only thing I would recommend against is loosening the tourniquet if you are NOT a trained pro with equipment standing by. We were told a story about a highway accident in which an 18D (SF Medic) drove by and responded to. The guy had an arterial bleed so he improvised and applied a T-kit. When the paramedics arrived, they berated him for using a t-kit and proceeded to loosen it against his recommendation. As soon as the pressure was relieved, there was a massive surge and he bled out before they could do anything.

I'd rather lose a limb due to a T-kit being left on too long, then bleed out.
 

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Discussion Starter #9
Asherman might be hard to come by. I haven't looked for them. I just know that duct tape and plastic will get you by.

But yes, what Duc said, if you aren't a pro or there isn't one near by, don't mess with the TQ
 

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If you can get access to these antibiotics then vancomycin (IV) ceftriaxone (IM or IV) and flagyll (PO or IV) then you will be sure to not get that GSW infected. ONLY problem is that you need someone around that can administer other by IV. Placing an IV is a relatively easy skill to learn, you just need supplies and a volunteer. Imagine, even heroine addicts can find and inject their veins. The hardest part is threading the catheter.


EDIT: scratch what I said above. Here is the deal with GSW and infection:
1. If its a limb with no fractures then you are ok with either no abx or ampicillin
2. If limb with fracture then either ampicillin or ampicillin plus gentamicin
3. If your hit in your abdomen and your worried about your bowel being perforated and contaminating the rest of your body then you wanna give ceftriaxone and flagyl.
 

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Discussion Starter #11
Any antibiotic will do. As soon as the injury occurs, start it so infection doesn't get a chance

Sent from my DROID X2
 

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Any antibiotic will do. As soon as the injury occurs, start it so infection doesn't get a chanceSent from my DROID X2
Of course in a GSW, infection is not the immediate concern compared to stopping the bleeding but I would have to disagree in that not all abx will work especially if you get hit in your abdomen. For example ampicillin which is a derivative of penicillin as the name suggest will be useless in an abdominal GSW.
 

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To allow air and blood to escape while preventing air and debris from entering the open pneumothorax, take a flat piece of plastic, apply duct/rigger's tape to three sides (leaving bottom or downward side open) and apply over the wound.
 

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On that they taught us to be careful when placing the catheter. Something about a bundle of nerves running along the top of the third rib you don't want to hit. Am I right?
 

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The nerves run below each rib so you want to use each rib as a guide meaning slide catheter or needle above 3rd rib inside the 2nd intercostal space


Edit: what they taught is correcto mundo doods
 

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To allow air and blood to escape while preventing air and debris from entering the open pneumothorax, take a flat piece of plastic, apply duct/rigger's tape to three sides (leaving bottom or downward side open) and apply over the wound.
Ok that makes sense
 

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yes, we were taught to roll them on their side, bullet wound side on top and use mre packing (the metal part, and obviously cleaned) then do a c shape with the duct tape to hold it on someone, the open end facing down to allow seepage if needed
 

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Awesome info so far, thanks for starting this Tommy!
 

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Pretty good refresher. Combat lifesaver (refresher) and green belt were two last things I did before getting out.
 
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