Paragon's ACLS Module

[Paragon]

As relatively comprehensive as my STOMP II is, the absence of medical oxygen had been one of the primary areas that I wanted to address. Although the Blackhawk 60KY01 3-piece accessory kit that I added for additional storage capacity would easily allow a D size (425L) oxygen cylinder to be carried horizontally across the bottom of the STOMP II, this option restricted the pack’s ability to open fully without first removing the O2 cylinder. While a smaller O2 cylinder could obviously be placed inside one of the two side pouches, I didn’t really like the idea of giving up the storage space that was currently used for other gear, let alone the limitations associated with a smaller capacity O2 tank.

To resolve these issues I decided to assemble a supplemental module that would not only addresses my desire to have medical oxygen readily available, but also an AED, as well as most of the more common ACLS items in one central location.



The foundation for my ACLS module is a Luxfer M9 carbon composite oxygen cylinder. Although it is physically smaller and lighter than an aluminum D cylinder, it actually has the same capacity (425L) since composite cylinders are designed for a 50% higher working pressure (3,000psi versus 2,000psi).





The Craemer Decker backpack that I picked up is actually sized for a traditional (aluminum) D cylinder, so there is plenty of extra room for a collapsible BVM, Oximizer, nasal cannulas, non-rebreather masks, various airway adjuncts, and associated gear and supplies. With the exception of ACLS drugs (epi, atropine, amiodarone, bretylium, bicarb, etc.) I feel that I probably have most of the items that would be needed to care for allergic reactions, thoracic trauma, or respiratory/cardiac arrest in the post-apocalyptic world:



My laryngoscope, Miller/Macintosh blades, ET tubes/stylets, Positube, and other airway-related gear continue to be carried in the airway accessory pouch of my STOMP II:





In addition to the oxygen cylinder and regulator, the contents of my ACLS module are as follows:


2 x Non-rebreather masks, adult, w/ reservoir for high concentration delivery
2 x Non-flared adult nasal oxygen cannulas, latex free, 7'
Oxymizer (oxygen conserving device for on-demand, low concentration delivery)




Laerdal pocket CPR mask
Philips HeartStart AED defibrillator, spare SMART pads, 4 Year lithium battery, PLP-M5068A


Ambu SPUR II disposable resuscitator, adult


Nonin Onyx digital finger pulse oximeter, #9500
2 x Panasonic industrial batteries, alkaline, AAA (Spare) #AM4PIXC
Pelican Justice Mark II storage case, 5" x 4" x 2"


3M Littmann Master Classic II stethoscope, 27", #2141, black edition
Welch Allyn sphygmomanometer, adult & child cuffs, case, #5098-30, Black


Repro-Med RES-Q-VAC hand vacuum pump w/ .22 micron FSP filter
Repro-Med RES-Q-VAC canister assembly, non sterile, 300 mL
Repro-Med RES-Q-VAC soft yankauer w/ push connector, non sterile, 40fr
Nylon storage sack, white


Rusch dual channel color-coded Berman oropharyngeal airway kit, assorted sizes
Rusch nasopharyngeal airway, sterile, 155mm x 28 Fr (9.3mm) x 7.0mm
KING LT-D supralaryngeal airway, Size 4 (Red Connector)
Monoject® syringe, Luer-Lok tip, 60cc, sterile, autoclavable (for cuff inflation)
Triad lubricating jelly, sterile, water soluble, non-staining, 5g
NARP™ ARS needle decompression Kit, 14ga x 3.25" needle catheter (shown above)


3 x Benadryl Allergy, Diphenhydramide HCl, caplets, 25 mg, 2/Pkg
Primatene® Mist, epinephrine bronchodilator, 10 mg/mL - Epinephrine 0.22 mg/dose, 1/2 oz (15mL)
2 x EpiPen® (Epinephrine) auto injector, 0.3 mg

Additional items that appear in the main photo above include:

Magill forceps, stainless steel, 10"
3 x PR NARP™ Black Talon nitrile gloves, L
2 x Hibistat® antimicrobial skin wipe towelettes
Sklar® EMT shears, 7 1/2", Blue
3M Durapore™ surgical tape, 1" x 10 yds
MEDShield optically clear eye shields
3M 9210 NIOSH respirator mask, N95 particulate, flat packaging
NARP™ CricKit® surgical cricothyroidotomy kit
Rusch Asherman chest seal (ACS™), sterile, 4" Dia
H & H Bolin chest seal (BCS™), sterile, 6” Dia.
Cramer Decker® oxygen system backpack, medium

Obviously the absence of ACL drugs somewhat limits the scope of medical emergencies that can be effectively treated with this module, although without the availability of long-term professional medical attention, the odds don’t really favor someone that codes anyway.

As always your comments, questions, or suggestions are welcome.

Jim

[feuer]

Impressive as usual.

Do you have a disposbale razor in your AED kit for hairy victims?

[JIM]

Nice, I would add your BIG in there, as IV-access often is difficult in a code. Also in case you didn't know, in an emergency you can use your adult pads on peds.

Ow, and for the record: You've got way to much money on your hands

[exon111]

As usual, amazing kit and excellent post. Jim, you got yourself a Philips AED and didn't even let me know? Just kidding... Well if you needs peds pads or any other AED accessories they're available to ZS members at quite a discount.

Can't really think of anything your kit is lacking, but I do second the suggestion to keep a razor with your AED. Also, be careful with that O2 regulator. I bought the same one from Chinook, but the black plastic handle broke off after the a couple days when I knocked the cylinder over. It fell gently the height of a D cylinder onto very padded carpet, so I was a little irked that it cracked so easily. The regulator still works fine, it just takes a pair of pliers to get it off the cylinder now. Just another reason to keep keep a Gerber tool with pliers handy.

[Paragon]

Do you have a disposbale razor in your AED kit for hairy victims?

Yep, although I'm guilty of not listing it, or the second set of EMT shears that are housed in the AED lid. Along those same lines, I also have a couple of nail polish remover towelettes for the SpO2 meter that I didn't show/list.

Good catch though -- thanks.

I would add your BIG in there, as IV-access often is difficult in a code.

Really? I hadn't considered including IV/IO equipment in the ACLS module, as it really just started to be an O2 bag, and kinda grew from there.

I'll have to give some further thought to that idea...

Jim, you got yourself a Philips AED and didn't even let me know? Just kidding...

I had actually planned on having you hook me up with an AED, although when this one became available for an obscene price, I had to snag it before another guy that was looking at bought it.

I'll keep you in mind when I upgrade to the FR2+ ECG.

Also, be careful with that O2 regulator. I bought the same one from Chinook, but the black plastic handle broke off after the a couple days when I knocked the cylinder over.

That sucks. Did you let Chinook know? Did they take care of it?

One thing that should be mentioned regarding the carbon composite cylinder has to do with refilling. Most shops are not equipped to fill cylinders on-site since they generally just exhange aluminum cylinders, so it will take some effort to find a source. Once you locate an on-site refiller, be prepared for them to laugh at you when you explain that you want the cylinder filled to 3,000psi -- most of the places I spoke with are simply not set up for anything over 2,000psi. I went through a dozen or so locations before I finally located a place that could fill my cylinder to 3,000psi on-site.

Jim

[exon111]

Also, be careful with that O2 regulator. I bought the same one from Chinook, but the black plastic handle broke off after the a couple days when I knocked the cylinder over.

That sucks. Did you let Chinook know? Did they take care of it?

Jim

I thought about contacting them, but it's not really their fault because I broke it. However, I'm a little disappointed that they carry a product that breaks so easily. It's not a big deal though because I don't have any reason to remove the regulator from the cylinder (my H cylinder uses a different CGA 540 regulator).

[painiac]

Don't bother keeping a razor with your AED. You do NOT want to be spending the time it takes to shave somebody who needs to be shocked. Chance of survival decreases literally by the second. If they're hairy, slap on some patches and immediately rip them off: they will take most of the hair with them. Then quickly put fresh patches on. This technique takes a fraction of the time it takes to shave somebody. (Oh, yeah, don't forget spare patches!)

[JIM]

Don't bother keeping a razor with your AED. You do NOT want to be spending the time it takes to shave somebody who needs to be shocked. Chance of survival decreases literally by the second. If they're hairy, slap on some patches and immediately rip them off: they will take most of the hair with them. Then quickly put fresh patches on. This technique takes a fraction of the time it takes to shave somebody. (Oh, yeah, don't forget spare patches!)

No it will not work: http://www.youtube.com/watch?v=aNc7mZ05 ... re=related

[feuer]

The reason I mentioned the razor is from applying my limited personal training to personal scenerios.
A close friend of mine and I used to go mountain biking on a regular basis. He's a stout little guy at about 5'3" but he's hairy as hell, but built like tank.
We both enjoy our rich foods too, and we can individually put down a lot of food.

The point is, given a cardiac arrest situation, heavy sweat, and the amount of fur my friend has on his chest, you would simply have no choice but to shave him first. I would go so far as to say he'd need two razors for his thick hair.

I'm no combat medic or anything, but I was a firefighter/first responder, and CPR-C/AED cert just a couple of years ago. I'd rather just carry an ounce of razors than to waste pads, or worse, electrocute(in a bad way) my friend.

[WolfBrother]

I purchased a AA battery powered beard trimmer.

Hairy chest, buzz , no hair = stick

sweat also - after the buzz, wipe with alcohol swab, wipe with 4x4 = stick.

The beard trimmer was FAST.

It worked anywhere I needed to remove hair.

Not that large or heavy. SIGNIFICANTLY faster than using a disposible razor.

[exon111]

Don't bother keeping a razor with your AED. You do NOT want to be spending the time it takes to shave somebody who needs to be shocked. Chance of survival decreases literally by the second. If they're hairy, slap on some patches and immediately rip them off: they will take most of the hair with them. Then quickly put fresh patches on. This technique takes a fraction of the time it takes to shave somebody. (Oh, yeah, don't forget spare patches!)

I have first hand experience with this It didn't work; it only removes a few hairs (maybe 5%). However, it might be a good idea for painful stimulus

[feuer]

I purchased a AA battery powered beard trimmer.

Hairy chest, buzz , no hair = stick

sweat also - after the buzz, wipe with alcohol swab, wipe with 4x4 = stick.

The beard trimmer was FAST.

It worked anywhere I needed to remove hair.

Not that large or heavy. SIGNIFICANTLY faster than using a disposible razor.

Good idea, I forgot about that. A small beard trimmer is a superior option.
And speaking of disposable razors, I refuse to use them. They will butcher the hell out of any skin that isn't like leather already. I shave my entire head regularly with a Mach3 triple and never have nics.

A prep razor might be a better option for removing enough hair:
http://www.buyemp.com/product/1041803.html

[painiac]

Well, I stand corrected.
I've done it once and it worked adequately, but the guy wasn't THAT hairy.

[SpudCrushr]

Jeez man... You must have a heck of a job to be able to afford all that stuff (plus the fully stocked STOMP)

[claren]

And speaking of disposable razors, I refuse to use them. They will butcher the hell out of any skin that isn't like leather already.

They're already dead. A few nicks that need toilet paper on them is the least of their worries.

[Sasha]

I've got a few questions for you.

While your intubation kit is impressive, how do you plan to manage an intubated patient with no paralytics or sedatives? How to you even plan to ventilate them long with one portable O2 tank? The BVM downs it quick.

How do you plan to manage a post arrest patient? They aren't magically okay after ROSC.

Do you plan on getting more Narcan? You don't have nearly enough for the amount of morphine you have, and a major contraindication of morphine administration is the inability to reverse the effects should they overdose.

And should you overdose them, and not be able to reverse it with Narcan (And when you do, watch for the projectile vomiting and violent confusion.) you don't have enough oxygen to ventilate them for very long when the narcotic knocks out their respiratory drive.

You claim it's an ACLS kit, yet you only have an AED and not manual defibrillator. How do you plan to manage patients who require pacing or cardioversion?

-Sasha

[Sasha]

Also, no pediatric masks? No Broselow tape? What's your plan for pediatric patients? They aren't mini adults. Do you have a drug guide? Have you had any IV training?

[The Highwayman]

Nice first two posts, Sasha. Is "wi-red" your fucking twin? Try reading a few more of Paragon's posts, and you will undoubtedly become assured by the other kits that Paragon has, and that they encompass those things whcih you feel are lacking, or explain the lack of thereof (such as no Pedi-stuff, since it's for him and his wife/close family, not any random children roaming the neighborhood)

But, since you used your first two posts to attack a respected member here, without bothering to check into it further, maybe jusy save yourself some time, and GTFO. Kthxbye.

[Sasha]

No, we're not twins, but we probably frequent the same forum where this is being laughed at.

So it addresses the issue of post ROSC management? Continued management of an intubated patient? Not even enough narcan to take the edge off a junkie's heroin OD, much less the 300mg of morphine he's toting around? And some small adults require things like pedi BP cuffs.

I was nice when i asked, I'm generally curious. Please point out to me where he's addressed these issues.

[Ovationman]

Medical Troll? lol

[exon111]

No, we're not twins, but we probably frequent the same forum where this is being laughed at.

So it addresses the issue of post ROSC management? Continued management of an intubated patient? Not even enough narcan to take the edge off a junkie's heroin OD, much less the 300mg of morphine he's toting around? And some small adults require things like pedi BP cuffs.

I was nice when i asked, I'm generally curious. Please point out to me where he's addressed these issues.

What forum is this being discussed on now? I think Light Fighter the last place to run a hit piece on this kit. At least you aren't quite a rude as your "wi-red" twin. Maybe try contributing to the forum a bit before you start criticizing people?

[C*O*R*A]

I didn't think she was attacking him.. I'm sure, the concern is, that "anyone" can get this equipment.. and what would happen if it got into the hands of someone who has no concept of emergency prehospital care. But some of the points are true. All of this equipment is meant for on site, immediate care. The typical EMS vehicle isn't set up to do long term care, should the victim need it.. and I'm afraid, that in a true disaster, where you would NOT be able to have access to a hospital for a long time, possibly months.. Like a nuke attack, or worse.. or a massive earthquake.. You may be better off making them comfortable, but after X period of time, bagging an intubated patient, is going to be futile. In fact, intubating them at all, I wouldn't do. It's hard to give up, short of a goal, but in a real disaster - which the likes of we have yet to see, the goal may never be reached.

May want to look into some Fentanyl patches, instead of so much liquid MS04. Long term, this would probably be better for pain relief.

[Sasha]

No, we're not twins, but we probably frequent the same forum where this is being laughed at.

So it addresses the issue of post ROSC management? Continued management of an intubated patient? Not even enough narcan to take the edge off a junkie's heroin OD, much less the 300mg of morphine he's toting around? And some small adults require things like pedi BP cuffs.

I was nice when i asked, I'm generally curious. Please point out to me where he's addressed these issues.

What forum is this being discussed on now? I think Light Fighter the last place to run a hit piece on this kit. At least you aren't quite a rude as your "wi-red" twin. Maybe try contributing to the forum a bit before you start criticizing people?

How am I criticizing? I'm genuinely curious what his long term plans are, and that is the only reason I joined.

A "hit" isn't being run on this, it was posted by a member of the forum for people to be shocked and amused by. It's a forum for medical professionals.

Many people are caught in the illusion that you just need basic scene stabilization to save someone's life. Scene stabilization is just a small part of a very lengthy process for saving someone's life. The pack is GREAT for scene stabilization, but long term, what is his plan of action? In a true distaster, as the post above me states, you won't have access to a hospital.

It would be far kinder to let people who code (arrest for those who are unfamiliar with the term) or would require active airway assistance (Endotracheal tube, King tube, LMA, OPAs, NPAs, etc.) to die than to revive them for a short time and then die later. It is also far kinder to those in your "group" or "team" to allow them to grieve than to be tugged around by false hope that a team mate has been saved.

You also must thing about your oxygen supply. You have enough to MAYBE run a non rebreather for about an hour, but those suckers suck that down quick! The ones who need the oxygen most drain the tank the fastest!

Fentanyl is a great drug, it's 80x more powerful than morphine and is short acting. It is used extensively in EMS. But it is also a narcotic and the Narcan that is carried in that pack wouldn't even take the edge off.

[throwback]

I think every medical professional who first sets foot in the ZS FA forum freaks out about the scope of practice/ level of training/ administration without prescription issues for a couple of days, then relaxes and gets used to the idea of people carrying more gear than a Vietnam era aid station. I know I was a bit agitated by these issues for my first month or so.

So, who wants to talk about doing the field heart transplant that Terminator showed us we can do?