Posted: 1/10/2011 1:50:13 PM EDT
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I am trying to get a general grasp on the nature of different gun shot wounds and what techniques & equipment can be used to prevent asphyxiation and exsanguination...
Here is what I can figure out so far: Limbs: Wounds to the legs arms would be treated w/ elevation and tourniquet and/or pressure at the sight. If the artery is near the surface of the skin some sort of clotting agent may be used or a bandage w/ clotting agent in it. An arterial bleed out may also be able to be stopped w/ a hemostat if you have access Guts: If you are shot below the diaphragm you hope the liver, aorta or vena-cava isn't bleeding out. If the bowels are spurting out (evisceration?) is ocurring you can wrap w/ foil, wax paper or moist bandage. Chest: If you are shot in the heart, aorta or vena cava you are pretty much screwed short of immediate surgery and infustions. If a lung is perforated it is pretty much out of commission till the hospital. But the other lung should work fine so long as there isn't air or blood filling in around the outside of the lung. If the thoracic cavity is perforated air will be drawn through the bullet hole while the diaphragm pulls a vacuum, taking away the ability of the lungs to be inflated by atmospheric pressure. The solution to this is to install a special bandage over the hole that acts as a reed valve, allowing air to escape from the thoracic cavity but not not be drawn into it. What is the name of that bandage? You need a pretty clean dry and low hair surface on which to apply said bandage. YOu might could use duct tape to remove hair from the area if the guy is greek or armenian something. There is some sort of big ass needle you can insert inbetween two specific ribs do help deflate the air pressure that may be trapped in the thoracic cavity outside of the lungs. What is that called? Arterial wounds near the neck/shoulder area may be stopped by pinching said artery w/ hemostat or even fingers if you can get to it. Other: what about other types of puncture wounds to the shoulder, thigh etc that don't puncture any arteries? Would you just use compression and bandage, or would you shove a tampon or some medical device that goes into to a puncture like that? Do you generally leave the bullet where it is at in the field and save that for the hospital? What about use of coagulants? Are there different types? Are there pros and cons to using different one or in general? Are there different type of tourniquets? What would be the best type to get? thanks. |
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Quoted: I am trying to get a general grasp on the nature of different gun shot wounds and what techniques & equipment can be used to prevent asphyxiation and exsanguination... Here is what I can figure out so far: Limbs: Wounds to the legs arms would be treated w/ elevation and tourniquet and/or pressure at the sight. If the artery is near the surface of the skin some sort of clotting agent may be used or a bandage w/ clotting agent in it. An arterial bleed out may also be able to be stopped w/ a hemostat if you have access Pretty much. I wouldn't consider using a hemostat to be a viable option because the other three (pressure, elevation, tourniquet) are all just as effective and won't require you to be able to distinguish between an arterial, venous, or osseous bleed, visualize said artery, and clamp it. "Blackhawk Down” made a big deal of this, but if someone had had a tourniquet in that scene (don't know the real life circumstances)... problem solved. Guts: If you are shot below the diaphragm you hope the liver, aorta or vena-cava isn't bleeding out. If the bowels are spurting out (evisceration?) is ocurring you can wrap w/ foil, wax paper or moist bandage. damaged. They filter your entire blood volume several times per hour, so even one kidney being struck can be catastrophic, because the blood flow to them will not stop, while the return may not be there. Keep guts moist and warm and do NOT try to stuff them back inside. If a lung is perforated it is pretty much out of commission till the hospital. But the other lung should work fine so long as there isn't air or blood filling in around the outside of the lung. If the thoracic cavity is perforated air will be drawn through the bullet hole while the diaphragm pulls a vacuum, taking away the ability of the lungs to be inflated by atmospheric pressure. The solution to this is to install a special bandage over the hole that acts as a reed valve, allowing air to escape from the thoracic cavity but not not be drawn into it. What is the name of that bandage? You need a pretty clean dry and low hair surface on which to apply said bandage. YOu might could use duct tape to remove hair from the area if the guy is greek or armenian something. There is some sort of big ass needle you can insert inbetween two specific ribs do help deflate the air pressure that may be trapped in the thoracic cavity outside of the lungs. What is that called? Pneumo/hemothoraces are not as big a deal as field trauma literature and such make them out to be. Don't me wrong, they are emergencies which require intervention RFN, but treating them in the field is far less involved then people have let it become. 1. Of the thousands of pneumos/hemos I've seen just in 2010... so many of them are so small that you wouldn't be able to hear them in the field. Additionally, these patients saturate just fine breathing room air, so they were only detectable with imaging. Performing a needle thoracotomy on these patients is contraindicated by the above findings. 2. In cases of HUGE pneumos/hemos (of which there were several, but not nearly as many... don't get your hopes up so to speak), they are usually so big that a needle thoracotomy does little to nothing to improve the situation. An anecdote I can give you involved a person shot in the chest saturating around 40% with improvement only to the mid-60s after decompression in the field. When they are that large, the treatment is a chest tube or pigtail catheter insertion in the emergency room or OR, but also with negative pressure applied over a period of at least 24 hours. "Three Kings” comes to mind as another great Hollywood perpetuator of this type of myth: instant relief and outcomes with minimal equipment. I'm not saying that there is no point in needle decompressions in the field. I'm just saying that your hands will usually be tied up with more important treatment because you are unlikely, even as a career medic, to find the dreaded tension pneumo in the field but maybe a couple times in your life. Finally, GSWs to the chest can sometimes be small enough to occlude themselves and require minimal dressing, so fancy chest seals and all that might just be a preference thing. Arterial wounds near the neck/shoulder area may be stopped by pinching said artery w/ hemostat or even fingers if you can get to it. Simplest treatment first. Pressure, Veins are just as important aspressure, pressure. Hemostatic agents if you're feeling fancy and have the time. I'd be concerned more about airway in neck trauma and lung trauma in wounds at or below the clavicle. Remember your ABCs. Other: what about other types of puncture wounds to the shoulder, thigh etc that don't puncture any arteries? Would you just use compression and bandage, or would you shove a tampon or some medical device that goes into to a puncture like that? Do you generally leave the bullet where it is at in the field and save that for the hospital? What about use of coagulants? Are there different types? Are there pros and cons to using different one or in general? Are there different type of tourniquets? What would be the best type to get? Thanks. arteries and they are found in all the same places, so I'd be worried for both, but I wouldn't make that my main focus in field treatment. That's what vascular surgeons are for. I would use pressure and elevation/tourniquets for limbs. Also keep in mind that bone bleeds and that no amount of hemostats is going to fix that. Pressssssure. You shouldn't go rooting around for bullets and their fragments. That will be much less painful, pointless, and infectious in the operating room. I'm not totally sure what you mean by coagulants other than dressings. There are lots of products which can be transfused/infused into a person which replace depleted blood components like clotting factors, but that's a whole different ball park. |
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an "osseous bleed". I gather that is the bone bleed that you mention later in the thread. Didn't know bones could bleed. I understand that there are paths of exchange b/t the marrow and the rest of the body, but I figures that was all small capillary stuff. Are bone bleeds large vessels that go into.
I didn't realize that the kidneys were that much of a potential blood let. BTW, it has been a while since biology...do veins have artery like...parts that contract and are more critical if cut or are the vessels etc that return blue blood all...passive. It is true that blue blood truns red when expose to the air right? Thanks very much. I have zero training besides basic CPR and I am just trying to get an overview, and some reality based refernce to balance what I recall from movies. I understand I can not learn to be an EMT from the interwebs. Also thanks for your service. By anticoagulants I mean compounds that cause rapid coagulation. I understand that some bandages are treated with these. Are these compounds ever somehow applied directly on wounds? Perhaps not. One of our old budo teachers always carried a little vial of cayenne pepper powder. It had a self defense use, but if someone got their nose bloodied he would have them snort it. I think you can by some sort of aluminum salt to put on your face for shaving nicks. There are different types I hear... Here is what I can come up w/ for a kit: -duct tape -bandages and tape -alcohol wipes -maybe one of those reed valve "bandages" -other big sticky pad bandages things -tourniquets. -tampons? What are the main styles of tourniquets, or the best one? |
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Quoted:
an "osseous bleed". I gather that is the bone bleed that you mention later in the thread. Didn't know bones could bleed. I understand that there are paths of exchange b/t the marrow and the rest of the body, but I figures that was all small capillary stuff. Are bone bleeds large vessels that go into. I didn't realize that the kidneys were that much of a potential blood let. BTW, it has been a while since biology...do veins have artery like...parts that contract and are more critical if cut or are the vessels etc that return blue blood all...passive. It is true that blue blood truns red when expose to the air right? Thanks very much. I have zero training besides basic CPR and I am just trying to get an overview, and some reality based refernce to balance what I recall from movies. I understand I can not learn to be an EMT from the interwebs. Also thanks for your service. By anticoagulants I mean compounds that cause rapid coagulation. I understand that some bandages are treated with these. Are these compounds ever somehow applied directly on wounds? Perhaps not. One of our old budo teachers always carried a little vial of cayenne pepper powder. It had a self defense use, but if someone got their nose bloodied he would have them snort it. I think you can by some sort of aluminum salt to put on your face for shaving nicks. There are different types I hear... Here is what I can come up w/ for a kit: -duct tape -bandages and tape -alcohol wipes -maybe one of those reed valve "bandages" -other big sticky pad bandages things -tourniquets. -tampons? What are the main styles of tourniquets, or the best one? Yes, osseous tissues are your bones. Bones are where your red blood cells are actually produced, so there are a great many pathways for blood in and out. Blood is also where bone gets its nutrition delivered from. Bleeds from bone may not be as gross as from large veins, but they can be more persistent and less responsive to bandaging and hemostatics (unless they can be stuck directly to the bone surface. You are also correct that veins do not actively contract or relax like arteries. Veins operate at much lower pressures and rely on muscle contractions and the force of arterial blood behind it to return blood to the heart. While you may bleed out slower from a vein, it's blood just the same. With regard to color... oxygenated (arterial) blood is bright red whereas venous (deoxygenated, it has been given up to your tissues) is darker. This is one way to distinguish the source of a bleed. I shold clarify that I've never served in the military. All of my experiences have been as a clinician in local hospitals. Dressings and bandages impregnated with pro-coagulation/clotting properties are numerous and have varying effectiveness. You are generally limited to their use on extremities and surface-level bleeding, although last-ditch attempts to stop bleeding by packing wounds with bandage-clotting combos have been successful in some cases. There are other conditions where bleeding may be persistent and unresponsive to these types of bandages due to a great loss of blood components which aggregate to form clots or due to certain medications. For these patients, guess what? Pressure. I don't have any product experience with tourniquets, but I have seen many make-shift ones that have worked well (i.e. blood pressure cuffs inflated above systolic pressure). |
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Here is what I can come up w/ for a kit:
-duct tape -bandages and tape -alcohol wipes -maybe one of those reed valve "bandages" -other big sticky pad bandages things -tourniquets. -tampons? What are the main styles of tourniquets, or the best one? All you need for a GSW kit are basics. TQ, Kerlix, ACE Wraps, NPA, Tega-Derm, and maybe a needle-D kit. Kerlix has 4759287345 uses, stuffing into wounds, packing into tougher areas to create pressure, i.e. groin, armpit, wrapping, tying, and even seen it used as a makeshift tourniquet. ACE wraps for pressure, stabilizing fractures, and slings. Tega-Derm for occlusive dressings for chest shots. NPA for maintaining airways. CAT, SOF-T, RMT, Ranger Ratchet are all fantastic tourniquets. Rule of thumb with TQ's, you want one or less moving parts. Drop the tape, tie a knot in it. Less chance of failure. No need for Asherman chest seals, they're expensive and they dont stick to bloddy body parts very well. The best thing out there are hydro-static dressings, but once again cost is a huge issue. No need for prep pads in the field unless your doing IV's which you shouldn't be. And despite Hollywood making tampons look like godsends to bullet wounds, they are terribly ineffective. All the do is swell, plug the hole in the skin and allow bleeding to continue. If the wound is on an extremity, place a tourniquet as high on the limb as possible and tighten til the bright red bleeding stops. Abdomen shots, cover it with rolls of wet Kerlix and carefully wrap with another roll of Kerlix. Upper Torso, if its in the center, forget 'em and move on to the next one. In the lungs, wipe off the blood and apply tega-derm to prevent a pneumo, make sure to check the back for an exit as well, does no good to plug one when there's another. Then last, get 'em the hell out of dodge and to a surgeon with a quickness. YMMV depending on the experiences individuals have. All of mine come from the 7 years I have as a US Army Combat Medic, as well as a DCMT Instructor. Lots of field time and only a little clinical time. |
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thank you so much for you comments and your service.
I see what Terga Derm and occlusive dressing are. It might be nice to have an alderman dressing if you already have build up in the chest I guess but if they haven't sucked too much air I see that just patching the holes asap is key. got two urls when I googled "hydro-static dressing". Nothing relavant. Do you have more info about that? Gratefully Is a needle D kit a needle decompression kit? What is a NPA? Of the TQs you note, are any or all of them good or best for self-application? Gratefully, RWN |
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The hydrostatic dressings are a newish thing we use on the green side to patch up holes that will require closure later. They basically use any fluid present on the body, sweat, blood, water poured on them, to stick, and they stay stuck. Extremely flexible and durable, but the cost is prohibitive.
As for the needle-d kit, it is a needle decompression kit. I prefer the NARP one's because of the way they come packed. All 14g angiocaths are equal, so it's basically just the cool factor. A NPA is a nasopharyngeal airway, what is commonly referred to as a nose hose. It's an airway you can place that bypasses the oropharynx so that even if unconcious they still have a patent airway. All of the TQ's mentioned are very easy to apply to yourself. Just read the instructions and train. |
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