Murph's GSW Blow Out Trauma Kit (Updated Page 2)

[Murph]

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The Latest Update is on Page 2!
Quick link: http://zombiehunters.org/forum/viewtopic.php?p=2105851#p2105851
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Original kit below...
...
...


Here's the outside: Shears, TQ, and Boo-Boo Pouch.


Here's the insides of the Boo-Boo Pouch.


This is the inside of the pouch packed up.


Here's everything from the inside laid out. There is:
Gloves
Various Gauze & 3x3 Pad
Water Proof Tape
Alcohol Wipes
Basic Field Dressings
Izzy Bandage
CPR Face Shield
Emergency Blanket

It's a revamp and revive of an older setup of this pouch I had:
viewtopic.php?p=818197#p818197

Enjoy!

[ki4mus]

Dont take this personal, but I'm gonna tear it apart....comments in red

Here's the outside: Shears, TQ, and Boo-Boo Pouch.
Shears and TQ great... but if its a GSW kit, drop the Boo-boo pouch

Here's everything from the inside laid out. There is:
Gloves
Various Gauze & 3x3 Pad
Water Proof Tape
Alcohol Wipes
Basic Field Dressings
Izzy Bandage
CPR Face Shield
Emergency Blanket

the only thing of real use in this list is the field dressing (which on my phone look like cravats) and the izzy...the real is junk as far as a GSW kit is concerned..

It's a revamp and revive of an older setup of this pouch I had:
viewtopic.php?p=818197#p818197

Enjoy![/quote]

If it where me, i would drop everything i didnt list as good and obtain some form of hemostatic (quick-cot, trama-dex, celox, hemacon, something) some more trauma dressings (not 3x3 gauze pads, real ones at the least abd pads and cravats, or an H-bandage, Izzy's, Olaris bandage, ect...) get a chest seal (ACS, Hifin, Bolin, something) and something competly oclusive to place over the exit wound (expired defib. pad works great!!!)

IF YOUR TRAINED!!
OPA or NPA w/ lube (common adult size)
14,12,or 10gauge needle, 3 or 3.5 inches long, with iodine and 3-way stop-cock

sorry for the spelling, but I'm to lazy to fix it tonight

[rwiklund8]

Kerlex or primed gauze. Maybe some type of occlusive dressing/chest seal.

Npa=good, opa ehh, gsw victims are usually conscious in the beginning with an intact gag reflex so npa would be superior

Needle decompression of a tension pneumothorax if you must. I'd only advise this if you are actually trained. Although the insertion of a cath into the chest cavity of a non-existent pneumo don't have catastrophic side effects, a pneumo is hard to identify without the right training.

[Tac Medic]

Not bad Murph, not bad. Those old green military bandages blow.........He can recognize a tension if he goes off mechanism and patient's ability to complete sentences without becoming SOB. Either way, if a tension is the case, the dude's F'ed unless a trained Medic is there........So, just dart the guy. Go 4th 5th intercostal though mid-axillary, easier to palpate superior to the rib. Away from the veins and artery riding inferiorly.

[Murph]

Thanks guys for the really helpful insights.

Looks like I have more things to consider then I originally anticipated.

[kcor_77]

Here is a linky to a site that has a kit that is kinda close to the one I am issued. Mine has celox, hemacon, decompression needle. among other things. http://www.galls.com/style.html?assort= ... tyle=TK099 There are better one's out there. This will give you a good Idea where to start I hope. If not forget that you ever seen this.

Here is what it contains
1 QuikClot® Combat Gauze™ single dose (4 oz)
1 BDU Pocket Pouch (6"H x 4"W x 1"D)
1 EMT shears
1 Asherman chest seal
2 Pairs of nitrile gloves
1 Blood stopper
1 Vaseline gauze (3" x 9")
1 Co-Flex (2" x 5 yds)
2 ABD Combine pads (5" x 9")
10 Gauze pads (4" x 4", 12 ply)
2 Sani-Dex hand wipes
1 Nylon pouch

[DannusMaximus]

Dont take this personal, but I'm gonna tear it apart....comments in red

Here's the outside: Shears, TQ, and Boo-Boo Pouch.
Shears and TQ great... but if its a GSW kit, drop the Boo-boo pouch

Here's everything from the inside laid out. There is:
Gloves
Various Gauze & 3x3 Pad
Water Proof Tape
Alcohol Wipes
Basic Field Dressings
Izzy Bandage
CPR Face Shield
Emergency Blanket

the only thing of real use in this list is the field dressing (which on my phone look like cravats) and the izzy...the real is junk as far as a GSW kit is concerned..

While you probably could ditch some of these items, why would you? My 'blow out kit' is realistically for range and training use, not for combat ops. Accordingly, a few boo boo items are nice to have. I can think of a legitimate reason for everything in there, especially considering my primary shooting and training area (a semi-private range that is pretty close to several major hospitals). I would probably ditch the 3 X 3 pads pads in favor of 5 X 9 pads, but that's just me.

Looks good, in my opinion.

[ki4mus]

Dont take this personal, but I'm gonna tear it apart....comments in red

Here's the outside: Shears, TQ, and Boo-Boo Pouch.
Shears and TQ great... but if its a GSW kit, drop the Boo-boo pouch

Here's everything from the inside laid out. There is:
Gloves
Various Gauze & 3x3 Pad
Water Proof Tape
Alcohol Wipes
Basic Field Dressings
Izzy Bandage
CPR Face Shield
Emergency Blanket

the only thing of real use in this list is the field dressing (which on my phone look like cravats) and the izzy...the real is junk as far as a GSW kit is concerned..

While you probably could ditch some of these items, why would you? My 'blow out kit' is realistically for range and training use, not for combat ops. Accordingly, a few boo boo items are nice to have. I can think of a legitimate reason for everything in there, especially considering my primary shooting and training area (a semi-private range that is pretty close to several major hospitals). I would probably ditch the 3 X 3 pads pads in favor of 5 X 9 pads, but that's just me.

Looks good, in my opinion.

If it was a first aid kit then okay. but the point (not the main point, the only point) of gsw or blowout kits is to treat a gun shot wound. hemorage contorl, control of sucking chest wounds, and tention phumo/hemothorax. CPR inst even really concidered being as survival rates from a trauma code is <than 1%. if you want a first aid kit then make a good first aid kit. if you want a GSW kit, then make a real GSW kit...making a hybrid only ends in making comprimises between the two...and eventually you will need something that got compramised out.

[Kommander]

I second (or is it third) ditching the field dressings. You never know how old they are and most of the ones I have opened up to play with have simply disintegrated on me. Get Izzys or another modern compression bandage!

[Tac Medic]

When I was aaaaa................let's say YOUNGER Jedi , we had things called "McSwain Darts". MAN !.....those were some badass needles for chest decompression.

[rwiklund8]

North American Rescue makes a foolproof 14g needle system

[DannusMaximus]

If it was a first aid kit then okay. but the point (not the main point, the only point) of gsw or blowout kits is to treat a gun shot wound. hemorage contorl, control of sucking chest wounds, and tention phumo/hemothorax. CPR inst even really concidered being as survival rates from a trauma code is <than 1%. if you want a first aid kit then make a good first aid kit. if you want a GSW kit, then make a real GSW kit...making a hybrid only ends in making comprimises between the two...and eventually you will need something that got compramised out.

Valid points. My range GSW kit is multipurpose. Having some tape, a few bandages, etc., adds no weight, takes little additional space, and these are useful items for a variety of non life threatening injuries. If you are solely creating a GSW kit, they aren't needed.

I still don't think gloves and a space blanket are 'junk' additions, though. A person needs PPE if they're treating other people (I presume Murph isn't just going to watch a person bleed to death during a trip to a range if he has a kit on him that might save their life), and the space blanket could be useful for treatment of shock if transport is delayed. Again, both items take up no space and add no weight.

I don't disagree with your general thoughts on a dedicated GSW kit, though.

[Veritas]

You know, everybody talks about needle decompression and pneumothorax, but nobody mentions a stethoscope. I guess you can improvise, but I would think a GSW kit should have a steth in it. Why don't more people carry them? They aren't expensive compared to the bags people buy...

I don't plan on sticking a needle into somebody without listening to their chest first, and I don't think anybody else should either. I also don't think mechanism of injury and inability to complete sentences w/o becoming short of breath is quite enough to clinically diagnose a tension pneumothorax. Clearly, if you suspect a tension pneumo and have a lot of experience recognizing them, that's one thing, but a lot of people here don't have that kind of experience. Maybe Murph does, I don't know, I'm not trying to insult anyone.

[AnotherVersion]

Needle decompression of a tension pneumothorax if you must. I'd only advise this if you are actually trained. Although the insertion of a cath into the chest cavity of a non-existent pneumo don't have catastrophic side effects, a pneumo is hard to identify without the right training.

Except that you've just put a hole in somebody's chest that air can get into, pretty much creating a pneumo. Granted, you can occlude it, but I'd hate to be the person that has to explain THAT one. I do agree that, on the grand scheme of things, a 14g chest hole is fairly simple to close with some vaseline gauze, but I still don't think being dart-happy is a good approach.

You know, everybody talks about needle decompression and pneumothorax, but nobody mentions a stethoscope. I guess you can improvise, but I would think a GSW kit should have a steth in it. Why don't more people carry them? They aren't expensive compared to the bags people buy...

Came in here to say pretty much the exact same thing. I almost invariably have a BP cuff, too, in every kit I carry. It's great being able to treat things, but even better to have a good assessment to work off of.

I don't plan on sticking a needle into somebody without listening to their chest first, and I don't think anybody else should either. I also don't think mechanism of injury and inability to complete sentences w/o becoming short of breath is quite enough to clinically diagnose a tension pneumothorax. Clearly, if you suspect a tension pneumo and have a lot of experience recognizing them, that's one thing, but a lot of people here don't have that kind of experience. Maybe Murph does, I don't know, I'm not trying to insult anyone.

Determining factors for me, while I'm working, are decreased/absent breath sounds on one side, circulatory compromise (systolic blood pressure <100 mmHg, tachycardia, altered mental status, other obvious signs of shock), or deviated trachea (which is a very late sign, and sometimes doesn't happen) in the presence of SOB, decreasing saturations, possible trauma etiology or obvious traumatic injury. I don't know about anybody else, but I feel that a needle thoracostomy is pretty invasive and much more of a "last ditch effort". YMMV, IANAD.

[Tac Medic]

Everyone has an opinion..................you know the saying. There are Medic's out there at various experience and training levels. No problemo. I will tell you though, if you are AT the scene and this is not some kind of intercept, your shethescope will be almost usless due to background noise. Do not rely on your stethescope.

[AnotherVersion]

Everyone has an opinion..................you know the saying. There are Medic's out there at various experience and training levels. No problemo. I will tell you though, if you are AT the scene and this is not some kind of intercept, your shethescope will be almost usless due to background noise. Do not rely on your stethescope.

Is the saying that they're all like bakeries, and smell of delicious, fresh cinnamon buns? I certainly hope so. I'm just saying, I'm not going to go a-darting unless I'm sure that the dart's benefits will outweigh the inherent risks, and a good set of lung sounds goes a long way- but when does Mr. Murphy ever give his laws a day off?

Back to OT, though, and I have to agree with ki4mus. The shears, Israeli bandage, and the dressings are about the only useful GSW items you have there. Granted, I won't discount the usefulness of a boo-boo pouch in every-day life.

Drop the CPR face shield. If they're pulseless and apneic after a bullet wound, you'd be better served with toe tags in the field without anything but a face shield. I like the blanket and the suggestion of airways - good in case of a delay to definite care to treat shock.

Pick up some vaseline gauze, sterile aluminum foil (yes it exists) or an asherman chest seal. Also, if you have a tourniquet, get a sharpie. Useful for writing when you put the tourniquet on, above it or on their forehead.

Oh, and a good hemostatic agent goes a long way. I'm actually partial to QuikClot bandages, but again, YMMV.

For somebody who's trained, I would suggest a couple of 14G needles, 3 way stopcocks, a heaping of alcohol preps and a stethoscope, but otherwise, I'd keep away from invasive procedures like that in the field unless it's a matter of life or death right then and there.

[Veritas]

Everyone has an opinion..................you know the saying. There are Medic's out there at various experience and training levels. No problemo. I will tell you though, if you are AT the scene and this is not some kind of intercept, your shethescope will be almost usless due to background noise. Do not rely on your stethescope.

That is a poor reason to not have a stethoscope. It is better than nothing, and could potentially prevent a needless procedure. I will agree that there are plenty of other s/s of a tension pneumo and that a stethoscope may not be needed, however you should have one and you should use one, regardless of background noise. I am not a medic and did not receive the training of a medic, so perhaps the theories are different from what I was taught. I guess it's just another opinion...maybe it stinks, maybe it doesn't.

Also, never ever drop PPE, especially a face shield, even if this is for gun shots. Someone could have an MI on top of a gun shot wound, not necessarily due to a gsw.

Also also, I like the idea of a "boo-boo kit," but for a different reason. If you use the kit often, you are more likely to have it with you and have it stocked, as opposed to something that will likely never get used and could potentially be left behind when it is needed.

Btw, I abhor the name "boo-boo kit."

[Murph]

Thanks everyone for the great replies! I've got a lot to chew on and improve for this.

[AnotherVersion]

Also, never ever drop PPE, especially a face shield, even if this is for gun shots. Someone could have an MI on top of a gun shot wound, not necessarily due to a gsw.

If it's a strict "just for gunshots, nothing else" kit, there's no reason to have a pocket mask. I agree with what you're saying, but something like a face shield should be considered EDC or in a more comprehensive kit that has more to it than just a face shield for ventilations.

Plus, AHA is moving away from compressions, anyway. CCR [link] is the new CPR.

[Paragon]

Plus, AHA is moving away from compressions, anyway.

Umm, no they're not.

CCR advocates continuous chest compressions, not the reduction or elimination of them.

Jim

[rwiklund8]

Because CPR would work without chest compression?.....

AHA is teaching hands only now, eliminating rescue breaths either because bystanders weren't giving them adequately or the fact that the survival rate was better with hands only+fast ems response.

[AnotherVersion]

Plus, AHA is moving away from compressions, anyway.

Umm, no they're not.

CCR advocates continuous chest compressions, not the reduction or elimination of them.

Jim

I'll just leave this here.

Our University of Arizona Sarver Heart Center CPR Research Group has published 6 studies with a total of 169 swine with variable durations of ventricular fibrillation arrest before initiation of basic life support (BLS), and various durations of "ideal" standard BLS and chest-compression–only BLS. We found that chest-compression–only BLS and ideal standard BLS resulted in similar 24- or 48-hour normal or near-normal neurological survival and that both were dramatically better than simulated no-bystander–initiated BLS and late arrival of paramedics (Figure 5). Others have confirmed these findings.

These findings were enough for us to encourage bystander continuous-compression CPR without mouth-to-mouth rescue breathing for witnessed cardiac arrest in adults, eg, nonrespiratory cardiac arrests; however, "Guidelines 2000" did not make this recommendation. Although not previously willing to extend such a recommendation for everyone doing bystander-initiated CPR, American Heart Association guidelines have stated that, "If a person is unwilling to perform mouth-to-mouth ventilation, he or she should rapidly attempt resuscitation, omitting mouth-to-mouth ventilation."

The rest of the article goes on to explain the whys. Mostly because it takes at least 5± compressions to get up to a decent cerebral perfusion pressure, and >100 compressions a minute shows drastic increases in out of hospital survival rates. Most adult cardiac arrests aren't respiratory in nature, but sudden cardiac events, meaning the arterial partial pressure of oxygen is still very high. 4-6 minutes of continuous compressions has a much better chance of ROSC according to the literature than standard CPR.

If you'd like to discuss further, I'm sure we can make a thread out of this, since we're way off topic.

And this is just my $0.02.

[Paragon]

Plus, AHA is moving away from compressions, anyway.

Umm, no they're not.

CCR advocates continuous chest compressions, not the reduction or elimination of them.

Jim

I'll just leave this here.

These findings were enough for us to encourage bystander continuous-compression CPR without mouth-to-mouth rescue breathing for witnessed cardiac arrest in adults, eg, nonrespiratory cardiac arrests;

American Heart Association guidelines have stated that, "If a person is unwilling to perform mouth-to-mouth ventilation, he or she should rapidly attempt resuscitation, omitting mouth-to-mouth ventilation."

The rest of the article goes on to explain the whys...

Read the article again - no one, including the AHA, is moving away from compressions.

Most adult cardiac arrests aren't respiratory in nature, but sudden cardiac events, meaning the arterial partial pressure of oxygen is still very high. 4-6 minutes of continuous compressions has a much better chance of ROSC according to the literature than standard CPR.

If you'd like to discuss further, I'm sure we can make a thread out of this, since we're way off topic.

There's really nothing further to discuss -- I think that you're confusing the terms ventilation with compression.

Jim

[Veritas]

Plus, AHA is moving away from compressions, anyway.

4-6 minutes of continuous compressions has a much better chance of ROSC according to the literature than standard CPR.

Something is not right here.