Gunny's First Aid Kit **It is Reborn! Page 4&5 (Pics)**

[Gunny]

That's right folks, tis time for a new series: This time, Gunny's Kifaru GSW/Trauma Kit followed by my First Aid Kit.



Here you're seeing the medical bag I received for x-mas from Sarah (yeah, she's mine). Below it is my Kifaru GSW/Trauma Kit.



In this kit you'll find (starting from the top left)
(5) Pairs of Non-Latex surgical gloves
(2) Pri-Med Gauze packets
(1) Tourni-Qwik
(1) Ascherman Chest Seal for open chest wounds
(1) Israeli 4" compression bandage
(1) SAM splint
(1) Israeli 6" compression bandage with additional sliding pad for exit GSW or puncture wounds.
(1) Extra large Water-Jel burn dressing
(1) Packet, Quik Clot ACS
(1) Big Cinch Abdominal pad



View of aforementioned items packed into an extra large Kifaru pullout.

*************************************************************

Now for the standard carry first aid kit:



Simple picture of my first aid kit with all three zippers open to reveal contents.



Starting with the first pocket:

(2) Tongue Suppressors
(1) Triangular bandage
(1) Instant cold pack
(1) Field dressing, large
(1) Roll of high-quality medical tape
(1) Disposable Scalpel
(2) Rolls of mil-spec gauze
(1) Sharpie Marker



In the second pocket, you'll find (top to bottom):

(30) Alcohol preps
(20) Iodine Preps
(10) Benzine preps
(1) Small packet of burn jel
(1) Roll of clear medical tape
(1) Surgical hand scrubber
(2) Rolls of mil-spec gauze
(10) packets of anti-bacterial cream
(2) 20CC push syrenges
(1) Tube of chap-stik
(3) Tubes of Thera-Tears
(4) Capsules: Mylanta
(1) Loose packet of Asprin
(1) 5CC irrigation syrenge
(40) Anti-biotic pills
(2) Injection needles
(20) Assorted band-aids
(1) Safety pin
(1) Plastic Tweezers



Inside the largest pocket, you'll find:

(1) Large trauma dressing
(1) Splint Board
(2) Packets, CeraLyte70 hydration salts
(1) 16oz bottle of Salene
(40) Hydracodine Pain pills
(20) Asprin Pills (inside film canister)
(10) Immodium AD pill packs
(1) 1.75oz packet of Quik Clot
(1) Set of EMT sheers
(1) Clif-Shot Electrolyte replacement pack
(1) 2" ACE Bandage
(5) Assorted Sterile gauze pads
(1) 6" ACE bandage
(1) Airway device



Inbetween two pouches is a small slit pouch, stuffed with:

(2) Hoo-Ahh sanitary wipes
(2) Forceps
(1) Eyepad
(2) 3-0 Gut sutures
(2) 6-0 Fibre sutures
(1) Handsoap

Not shown:
Adult Epi-Pen
100 Count of Asprin in BOB
New Skin bottle
Neosporin bottle
Goldbond Healing Ointment tube

Alright everyone, let me know your thoughts. What am I missing? Do I have too many of something? Lemmie know.

[Skippman]

That's a hell of a pack my friend.

[Gunny]

Doh, I had two duplicate pictures, updated.

Skippman:

Thanks buddy. I just put in for an EMDOM Fattie WL 6" pouch which will (hopefully) hold all of my medical kit.

[The Ron]

Definitely a nice kit. I like that it seems to be geared toward major emergencies (e.g. you've got a tourniquet and some MAJOR dressings etc.).

Not sure I'd want to rub anything on my body that came out of a package labeled "Hoo-ahhs".

Seriously, for everyday time usage you might want to increase the amount of "normal" stuff. I'm thinking specifically of more band-aids, 4" x 4" gauze pads, a few gauze abdominal and eye pads and more 2" and 4" gauze strips to hold them on with. Those would be light and cheap additions.

Having not one but two kinds of sutures is way cool. I'm told that an instrument called a needle holder makes suturing much much easier than jamming the needle though with your fingers. Some injectable lidocaine for numbing the area beforehand would be great for the suturing thing as well.

Any of the EMT types know where you can buy injectable lidocaine? I need to get some myself.

[BoltAction]

Adult Epi-Pen

Nice : )

Very nice kit gunny! I like how its modular. You seem to have a good amount of stuff in there.

I would add:

-More blood stoppers (IE: gauze pads / bulky dressings).
-A stethoscope & blood pressure kit
-Moleskin


Sarah did a great job on the bag... she is a keeper : )

Any of the EMT types know where you can buy injectable lidocaine? I need to get some myself.

You can't with out a license. I have tried. Chinook medical sells the stuff (cheep too) but you need a practitioners license to buy it.

I slipped some lidocaine on my last order and emailed them the EMT license and they told me no, in fact they said a paramedic license won't work either. The government is really strict about this shit. I have not found anywhere to buy the injectable stuff. You can get the wipe pads though but it’s not the same.

I a few years ago used to have a bottle but it expired and the liquid got cloudy so i had to throw it away : (

Let me know (over PM... don't post it publicly) if you find somewhere that will sell it as i would really like to keep it on hand. I have had to suture myself up twice in my lifetime; once with it and once with out it... let me tell you it really helps!

[jptp0831]

Maxi-pads. They make great cheap bandages. Get unscented. They were originally designed as bandages. Also if in mixed company they have other uses.

[jptp0831]

Also pain relievers. Most doctors are cool with giving a script for pain killers if you tell them it is for backcountry packing. That's also how I got my antibiotics. Be honest with the Doctor and they will be pretty cool about it. Most Doc's understand the need for a kit. Then again most Doc's I know have done a tour in Iraq.

[BoltAction]

Also pain relievers. Most doctors are cool with giving a script for pain killers if you tell them it is for backcountry packing. That's also how I got my antibiotics. Be honest with the Doctor and they will be pretty cool about it. Most Doc's understand the need for a kit. Then again most Doc's I know have done a tour in Iraq.

+1 on this. I don't know about pain meds but when i did my AT hike back in '97 i asked my doctor if he would prescribe me some antibiotics just in case. He also gave me a bunch of medical supplies for the trip like gauze, tape, bandages, etc. You defiantly have to have a good rapport with your doctor and explain things honestly. Also, understand it’s a gray area in medicine prescribing things that you don’t need now, but may later. Because of all the drug scandals and threat of lawsuits, it may be difficult to convince them. Remember, the MD who prescribes a medication is responsible for the patient and any side affects or misuse. The doctor is going out on the line if he helps you and over the past few years things have really changed. I have noticed this change with my own MD even though I have known him most of my life and he is aware of my medical background.

The problem is lawsuits, people who abuse the system, and a government that is more concerned about policy then helping its people. Medicine today is more about laws and money then it is patient care. The funny thing is most MD’s today are making far less then they did years ago because the cost of malpractice insurance has gone through the roof. This is why they say being a PA is a better paying job then a MD. Because of the higher cost and the threat of loosing their insurance (and thus loosing their practice), a lot of MD’s who might have been sympathetic to the cause just can no longer take the risk.

[jptp0831]

It helps if your Doc is a hardcore trekker. I have gone with my favorite MD across the continental divide. I also gave her a lot of tips about hiking in Africa. There are plenty of hardcore trekkers out there who are doctors and understand medical need in remote areas.

[Gunny]

Okay fellas, just got back from freezing my ass off. Going to try to answer a few questions/comments:

Seriously, for everyday time usage you might want to increase the amount of "normal" stuff. I'm thinking specifically of more band-aids, 4" x 4" gauze pads, a few gauze abdominal and eye pads and more 2" and 4" gauze strips to hold them on with. Those would be light and cheap additions.

I have 20 some odd bandaids, but you're very right, I need more sizes/types. I have some newskin for the smaller stuff but I need to grab some more strips. Knuckle bandages and the like.

With regards to the 4x4 pads, I have 4-5 of them, in addition to TONS of gauze rolls. Are you using gauze pads for regular injuries?

I've got two abdominal pads, one in my regular kit and one in the GSW kit. Do you think I need a few more?

Wilco on the gauze strips and eye pads, thanks for the ideas.

Having not one but two kinds of sutures is way cool. I'm told that an instrument called a needle holder makes suturing much much easier than jamming the needle though with your fingers. Some injectable lidocaine for numbing the area beforehand would be great for the suturing thing as well.

The sutures I'm not very happy with. 6-0 is damn tiny (think suturing on your eyebrows or scalp. I'd like to get some 4-0 and 2-0 fiber ones.

The set of forceps on the right has a curved tip which makes suturing easier. I'll look into the holder too in addition to the lidocaine.

I would add:

-More blood stoppers (IE: gauze pads / bulky dressings).
-A stethoscope & blood pressure kit
-Moleskin

Bolt:

Sarah's an EMT-B based out of Houston, one of the busiest cities in the nation. She knows a sound kit when she gets one. She's also training to be a hospital administrator/policy analyist so bring on the free medical stuff (I hope)

Back to the quote: More blood stoppers: I've three other Israeli compression bandages I didn't pack in there. They're the 6" model which are mainly for GSW use. Will these suffice? If not, what would you recommend?

A stethoscope: I would love a cheap one and the training to know how to use one properly. Any ideas? Same with the BP cuff

Moleskin: I have a blister kit (needles, moleskin, adhesive, iodine etc) that I'll put in the kit per your recommendation. I hardly get blisters so I didn't consider it vital. Others though, might want it

Let me know (over PM... don't post it publicly) if you find somewhere that will sell it as i would really like to keep it on hand. I have had to suture myself up twice in my lifetime; once with it and once with out it... let me tell you it really helps!

PM on the way.

Also pain relievers. Most doctors are cool with giving a script for pain killers if you tell them it is for backcountry packing. That's also how I got my antibiotics. Be honest with the Doctor and they will be pretty cool about it. Most Doc's understand the need for a kit. Then again most Doc's I know have done a tour in Iraq.

I have 20 or so tablets of hydracodone, a full 100 count of asprin in addition to 10 loose packs of asprins. What else would you recommend I carry? I can't get the good stuff (think syrets) and wouldn't feel comfortable carrying them w/o proper training.

I'm also sporting some hot-shot antibiotics in the kit, probably more than's needed.

Thanks for the input guys, keep it rolling in.

Brad

[The Ron]

The 4 x 4 you have are probably in individual sealed packages. These are great for when sterility is at a premium like stuffing them inside of a person. I'm thinking more about the more mundane 1" - 3" gashes that are too big for band-aids and don't really warrant the uber-dressings. You might use a couple of 4 x 4 on these type of injuries and may want to replace them a couple times as well as your stock of 5-6 is gone. I'd suggest a bulk pack of 50 from a drugstore. The bulk pack is much cheaper without all of the packaging and you can put 20-some in a ziplock and still take up no room.
Sounds like you are covered otherwise.

[CLEAR CUT]

Nice job there Gunny. How much does all of that stuff weigh? You better hit the gym and pump some iron so you can schlepp all that gear. I know you're not going to be a shit-heel and make Sarah carry all of that.

Where did you get all of that hydracodone? Don't tell me you've got the monkey on your back.

Did you have an elastic bandage or two? Add plain white sports tape and the foam underlayer wrap(I know jamoni doesn't like it but I do). I think it makes tape up and tape removal easier especially for hairy people.

-Benadryl tablets for anaphylactic reactions.
-Syrup of Ipecac to induce vomiting in cases of poisoning.
-Activated Charcoal to neutralize anything left behind that you didn't vomit up.
-I would add some of that soap that Jeriah mentioned for poison oak/ivy/sumac/etc.
-A bottle of calamine lotion to ease the itchiness of bug bites/stings.

I saw you have cold packs and I'm pretty sure you had those little heat packs elsewhere in your B.O.B. I would add a couple of these in your medkit too. How about sunscreen, insect repellent and a small jar of vaseline too?

Just curious but how did you learn to suture anyone? Do you dxpect to learn on the fly? I would suggest the next time you're going to grill a steak you get in some practice. Make a cut in the raw meat and using a clean needle and thread a set of hemostats to hold the needle and another set to wrap and tie your knots. That's how my medic instructor said the docs who don't normally stitch on a regular basis keep up their "chops".

Needle decompression practice can be done with a set of ribs(pork or beef) with a bicycle innertube wrapped in ducttape. Holes are fixed with fix-a-flat. I've done this and it adds an element of realism and is a great way to hone your technique if you're not working in an E.R.

All in all a great job Gunny. I'm just worried about hauling all of that around on foot. Check You Later.Bob

[JRod]

-Syrup of Ipecac to induce vomiting in cases of poisoning.

Every time someone on Frugal Squirrels mentions having Ipecac in their medical kit they get beaten with bibles and MRE's. a lot of people seem to think it does more harm than good. I've taken it off my list of "to buys"

[Gunny]

Clearcut:

The entire medical setup is surprisingly lite. I'd say 8-10lbs tops.

I learned to suture from my aunt who is a DR based out of my hometown. My technique could use quite a bit more practice, but I think I have the bare bones essentials. I'll take your advice and practice on a steak (plentiful in these parts )

I have 10 tablets of benadryl already in the kit which I didn't note for some reason.

The Hydracodone was prescribed when I had all 4 wisdom teeth cut out. I think I took one dose of the stuff and kept the rest.

I have two ACE bandages but no elastic wrap. I'll look into that. I'm damn fuzzy so it might be smart

How big is a bottle of Ipecac?

As far as itches and such, I've found that New Skin works great.

Insect repellent is in the BOB kit, though I totally lack sunscreen. Thanks for reminding me.

What's a good size for needle decompression? I've heard 14g but damn, that's a big hole.

Thanks for the review buddy.

[CLEAR CUT]

It's a very tiny bottle.
The Activated Charcoal is a little bit bigger.

This stuff is mixed in a glass of water and mixed into a slurry. The victim then chugs it down. I'm told it tastes quite horrible.

Check Out this link for the poisoning thing. I hope it helps you all out:
http://www.merck.com/mmhe/sec24/ch297/ch297a.html

As big a needle You can get your hands ona 12ga. in a severe trauma isn't absolutely unheard of. Make a flutter valve by taking the needle/cath and poke it through a single glove's finger. Insert in the second or third intercostal space on a mid-clavicular line and then remove the needle, if done properly you will hear an audible hiss. Be sure to look for clasic symptoms like a deviated trachea before you attempt this and it's a good idea to have some professional training in this regard also.

And you're more than welcome Gunny. Check You Later Bob

[Gunny]

Bob,

Should I apply my chest seal afterwards over the decompression site?

And thanks for the pictures, they're a very big help.

[CLEAR CUT]

No, that's what the "Flutter Valve" is for. It allows for expelling air but will close to prevent air leaking in. This is similar to the treatment of Sucking chest wounds. An occlusive dressing is applied in the form of vaseline gauze or a clean piece of plastic sheeting(Visqueen) and taping it down on three sides.

Check out this link:Sucking chest wound

[Gunny]

Gotcha, I've heard there were issues with the Ascherman Chest Seals not sticking properly. I wonder if some dermabond or superglue would fix that.

Thoughts?

[CLEAR CUT]

This is an emergency that call for a rather low tech approach. You may apply a dressing to a sucking chest wound to absorb some of the blood and froth that will issue from it but the plastic sheeting taped down on three sides( better yet all four but leave a small corner of the improvised dressing untaped to act as a flutter valve) is the way to go.

The reason the wound is sucking is that there is air getting into the chest cavity and this results in that air compressing the lungs. The call of treatment must prevent air seepage into the chest cavity while allowing trapped air to escape by means of this "Flutter valve". Savy?

This is the reason you do a needle decompression in cases of tension pneumothorax. Air is trapped within the chest cavity and is compressing on the lungs. This air must be let out by way of the needle with glove tip flutter valve on it. Again, to allow trapped air to escape but prevent air from reentering the chest cavity.

[Gunny]

Hear ya on that. The ACS is a one way valve which seals off the air entering the cavity while allowing outward pressure/blood to escape. Bascially a hi-tech quick attach flutter valve.

[CLEAR CUT]

Cool. The added sterility of being in a sealed package versus an improvised dressing is a bonus if the victim survives by not having to fight an infection too.

[Gunny]

Ideally, I'll be getting my EMT-B cert this year. While I'm not planning on riding as a paid EMT, I might do some volunteer stints just to learn the ropes.

[BoltAction]

Brad

"A stethoscope: I would love a cheap one and the training to know how to use one properly. Any ideas? Same with the BP cuff"

I have an extra brand new Stethoscope and BP Cuff you can have. The Stethoscope is very decent (It has black tube too!) and the BP cuff is accurate at the very least. If you want i can bring it to ZC for you.

More blood stoppers: I've three other Israeli compression bandages I didn't pack in there. They're the 6" model which are mainly for GSW use. Will these suffice? If not, what would you recommend?

Israeli compression bandages are PERFECT. Pack em' in there!

I hardly get blisters so I didn't consider it vital. Others though, might want it.

Those blisters come when you least expect them. Second, if you get a foot injury like a cut while bathing in a river, apply a small gauze pad and then a bigger piece of moleskin over that; you will be happy you had it on hand.

Gotcha, I've heard there were issues with the Ascherman Chest Seals not sticking properly. I wonder if some dermabond or superglue would fix that.

Thoughts?

Superglue does not eventually dissolve like dermabond or other liquid sutures. Second, the ACS can get clogged up and you really want to be able to remove it if you have to. In general, its not a good idea to be suturing bandages (or anything else for that matter) to the body. Suture skin to skin... thats it, nothing more nothing less! : )

The reason people have problems with it sticking is one of the following: The ACS is old or has not been stored correctly OR they did not wipe off the wounded area and its covered in blood.

Anyway...


I have to finish reading the post but on decompression... whoo.. before we go poking holes in peoples chest, lets discuss this a second. There is a difference between tension pneumothorax and a hemothorax. Unfortunately, for someone who has not been really exposed to both (and even then) it is really difficult to tell the difference between the two conditions. Below is a list of symptoms for each (stolen from wikipedia because its to late and i'm to lazy to type it all out and then spell check it)

Notice something?

Tension pneumothorax
Decreased or absent breath sounds on the affected side
Jugular venous distension
Tracheal deviation towards unaffected side
Hyper-resonance on percussion
Unequal chest rise
Dyspnea
Tachypnea
Tachycardia
Hypotension
Pale, cool, clammy skin
Subcutaneous air
Cyanosis

Tension Hemothorax
Tachypnea.
Dyspnea.
Cyanosis.
Decreased or absent breath sounds on affected side.
Tracheal deviation.
Dull resonance on percussion.
Unequal chest rise.
Tachycardia.
Hypotension.
Pale, cool, clammy skin.
Possibly subcutaneous air.
Narrowing pulse pressure.


If you said the hemo does not have JVD, you would be correct. The thing is this is not always the case and i have heard of someone having a Tension Hemo with JVD. Yes its rare, but it can happen.

In the example above, no matter what they have you will still probably have to decompress... but if you are not ready for the hemo, you (and your patient) are going to be in a world of shit right quick.

Its way to late to go into this now but if you want we can discuss it tomorrow. Also if anyone wants i can do a lecture at ZC06. What would really be nice is someone like clearcut did a lecture as i really think we could all benefit more from a medic's advice, then a simple EMT like myself.

[CLEAR CUT]

Good for you and good luck on it. I hope you find it to be an exciting and eye-opening experience.