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Behold, my badass combat pack!


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Hey Dust, wheres my sand?

Haha! Right here on my desk! It takes forever to send anything out of here though. First, I have to get free of patients long enough to go to the main post office on the other side of the base (30 minute drive). Then I have to stand in a line that lasts, at a minimum, two hours to get to the counter. Then they have to inspect the contents of every outgoing package before I can seal it and mail it. Before I do that again, I am waiting to get several packages ready to do at once.

I haven't forgotten you. Should be soon!

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  • 2 weeks later...

Nice set-up!

That said, I would modify it a bit:

Dump the NuTrake in favor of your previously mentioned Shiley hook and scalpel. I don't think these commercial devices are much better than the old fashioned surgical approach.

I'd add some Marcaine (bupivicaine) and opthalmic antibiotic like Ilotycin (erythromycin). Nothing like a few drops of Marcaine to give you 12 hours of relief from a fresh corneal abrasion.

Marcaine is good for lots of stuff, actually. Local wound blocks, digital blocks, and nerve blocks will do much to relieve pain from just about anything.

I'd switch the 1000cc NS bags out with and equal volume of 500cc bags. Gives you more administration options.

I don't know how austere your AO is, but I would consider supplies for purifying water and making fire.

I would add a large pile of Steri-strips and some benzoin swabs. With these, you can get away without suturing a lot of stuff. They will also secure a partially avulsed fingernail.

I would carry several packets of a powdered concentrate of electrolytes for oral rehydration.

Duct tape.

I didn't see much mentioned as far as meds apart from the rocephin. You did say you're mostly set up for trauma. I think you may augment your kit without too much difficulty for certain minor medical issues. You may consider adding some epi, benadryl, and prednisone for allergic reactions, as well as drugs for pain control and sedation. A humongous supply of ibuprophen would be paramount for that population, as well as anti-emetics, anti-diarrheals, and more ibuprophen.

I agree with the Romulan cloaking device and ticket home. If you can't find those, I'd bring an M4, a shovel, and a Ranger battalion.

'zilla

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Doczilla, let me ask you about the corneal abrasion issue you brought up.

If you numb the eye down without patching it so the person won't scratch it could it be possible for the abrasion to get a lot worse and threaten the vision? I got chastised by a Opthamologist who said that we never send the eye numb stuff home due to the patient putting it in their own eye and not realizing they were scratching the eye therefor making the eye injury worse. I sent the med home on orders of the ER physician but he denied it(lying weasel) so I took the fall due to a patient who lost partial vision due to using the med too much. No lawsuit cause my instructions on the discharge were crystal clear but I was shking in my boots.

Just curious as to your thoughts on that.

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You are correct in that you don't send someone home with the numbing drops (usually proparacaine or tetracaine), for the reason you stated as well as the fact that the drops impair healing. A one-time dose will not do much to endanger healing, but I wouldn't want the soldier doing it day after day. This is why I take the Alcaine with me after I do a slit lamp exam. Otherwise it seems to find its way into the patient's pocket. I set them up with plenty of anti-inflammatories and percocet because this injury truly does suck.

Also, patching is controversial. On the one hand, it serves to remind the patient not to rub the affected eye. On the other, it lessens oxygen delivery to the corneal epithelium which is healing.

In the operational environment, the mission may dictate that a soldier not be distracted by the extreme pain and watery discharge that accompanies a corneal abrasion. Numbing it up long enough to get back to the FOB means the operator will remain mission-capable and able to complete tasks and fight off the enemy rather than just tag along. The long duration of action of bupivicaine means that it won't have to be repeatedly readministered.

'zilla

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That was an excellent response doc. Thanks a lot it confirmed what I was thinking. I have my own bottle of alcaine at home that I was given by the same ER doc. You answered it just like I thought was the answer. take care.

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  • 2 weeks later...
  • 4 weeks later...

Well, my image host died, but I found another, so the pics are back up!

And after getting excited about the IO suggestion, I went and tracked down a box of F.A.S.T. 1 intraosseous sets last month. Got to use one a few nights ago on a multiple shrapnel patient who was in circulatory collapse. He's now a triple amputee, but he's alive!

Dump the NuTrake in favor of your previously mentioned Shiley hook and scalpel. I don't think these commercial devices are much better than the old fashioned surgical approach.

Agreed. And the more I carry this monstrosity around, the more I look at dumping things. The heavy intubation kit has now gone in favour of two Combitubes.

I'd add some Marcaine (bupivicaine) and opthalmic antibiotic like Ilotycin (erythromycin). Nothing like a few drops of Marcaine to give you 12 hours of relief from a fresh corneal abrasion.

Marcaine is good for lots of stuff, actually. Local wound blocks, digital blocks, and nerve blocks will do much to relieve pain from just about anything.

Both points taken! A small tube and a small dropper bottle add nothing to the weight, but do indeed cover some serious situations that I might have to deal with for hours.

I'd switch the 1000cc NS bags out with and equal volume of 500cc bags. Gives you more administration options.

I'd love to, but 500's are nearly impossible to come by here, except for the Hespan. It's 1000 or 50, and not much in-between.

I don't know how austere your AO is, but I would consider supplies for purifying water and making fire.

I don't risk austere conditions here at camp, so I am okay there. My only real exposure there is if I were to get shot down while travelling from camp to camp. I carry survival items in my flight vest for that.

I would add a large pile of Steri-strips and some benzoin swabs. With these, you can get away without suturing a lot of stuff. They will also secure a partially avulsed fingernail.

I have specifically tried to stay away from minor "first aid" items and concentrate on lifesaving trauma care. I won't ever be running an aid station out of this bag. Just either caring for casualties on scene until evacuation, or manning a casualty collection point. But yeah... I have attached the little band-aid box to the side of the bag for those little cuts and scrapes that people tend to get when diving into a bunker without watching WTF they are doing.

I would carry several packets of a powdered concentrate of electrolytes for oral rehydration.

Good point! In fact, I do carry a smaller little bag to the bunker with me that contains drinking water, Gatorade packets, energy bars, and a deck of "Iraq Most Wanted" playing cards.

I didn't see much mentioned as far as meds apart from the rocephin. You did say you're mostly set up for trauma. I think you may augment your kit without too much difficulty for certain minor medical issues. You may consider adding some epi, benadryl, and prednisone for allergic reactions, as well as drugs for pain control and sedation. A humongous supply of ibuprophen would be paramount for that population, as well as anti-emetics, anti-diarrheals, and more ibuprophen.

Most of that gets left behind at the aid station because again, this is only for mass casualty events, or being stuck in a bunker with wounded for an extended period. I'll let the headaches wait for the "all clear." But, if time permits, I do grab a couple morphines and fentanyls before I bug out. Versed would be nice, but it's not currently available to me. I would replace the Rocephin with Ancef, but our stock list got "simplified," and now Rocephin is all I have. I think I'm going to appropriate some Ancef from the hospital though and stuff it in my bag.

I agree with the Romulan cloaking device and ticket home. If you can't find those, I'd bring an M4, a shovel, and a Ranger battalion.

I do stay close to my M4! :D And, although they get on my nerves at times, I do find the battalions of Marines surrounding me to be a comfort. Crazy bastards!

Speaking of Marines, I've been using a funky pouch I stole from them on my vest for holding a few Izzy dressings, a couple of HemCons, an Asherman, and a CAT. But I just ordererd a nice Spec-Ops pouch that should arrive in a few days that will match the vest. I'll post a pic when I get it together.

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Looks like you have damn near everything you need out there.. of course, the one thing you need won't be in the bag when you need it. Echoing the others, keep your head down and try not to get shot, ok?!

Good to hear from ya, Dust! :D

Wendy

NREMT-B

CO EMT-B

MI EMT-B

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