I have not used that protocol in any form while serving so far in the US Army as a medic. Fluid is given depending on the wounds and severity. Sometimes if only pain is present but no fluid or blood loss, a line or saline lock will be started anyways for pain management medications.
I do not see the point to discontinue administration of fluids if a pulse returns... I would just say finish up the bag. As I have NEVER ran into a case of fluid overload on a patient. I have only ran into that problem with myself when we were practicing IV sticks / fluid therapy. And I must say it definitely sucks, especially when it seems painful / difficult to breathe.
T-Doc - For my part, I don't worry about it. I'm going to hang fluids if I believe a need for fluids exists and that's it. I had asked half-rhetorically, since in the field there isn't any point in checking ABG on a patient. That's something for the next level of care to worry about.
Creeper - Yes, severe blood loss leads to many bad things. The first concern, before almost anything else, is to control the bleeding. There's not much point in running a line on a patient who's losing fluids faster than they're going in. I think, in terms of LR vs. NS, it really doesn't matter if the patient is in that bad a way. Both are volume-expanders and that's the important bit. Get the bleeding controlled, then try for a stick and get the fluids going.
Personally, I would not stop IV therapy outright just because peripheral pulses were regained (if they were absent to begin with). Pulses are good, it means the blood is circulating. Instead, I'd either ease back the rate of infusion or hang a smaller bag. If it's a patient in hemorrhagic shock, keep the bags hanging. Having them tank again is the last thing you want.
I receive a wilderness medicine newsletter now and then. Two interesting ideas were mentioned for when you are a long way from the ER and can't suture. If there is a large gaping wound Safety pins can be used to close the wound edges temporarily. Second, If a scalp wound needs closing you can take a clump of ten or so hairs and twist them into a string, one on each side of the wound and tie the strings together to close the wound edges.
Of course if you keep your hair high and tight better bring safety pins along.
National Geographic once showed an Amazon Basin medicine man closing a wound with large ants. He would hold the ant(one inch long) by the body,squeeze the wound edges closed and apply the ant to the wound. when the ant bit down he broke the head off. Just like skin staples.
http://ewma.org/fileadmin/user_uploa...Vol_4_No_2.pdf Page 21
http://biotherapy.md.huji.ac.il/biosurgery.htm this technique was apparently widely used but personally I prefer staplers.
Last edited by TraumaDoc; 01-08-2010 at 03:49 PM.
Reason: adding references
These past couple pages have been quite informative. Just wanted to say thanks to you guys for keeping this going. Always something to learn.
+1 on using safety pins to close up eviscerations.
Keeping it in the family
I have a question and think this is the best thread to ask it. I might go to Afghanistan this year and was thinking of having my blood type and NKDA tatooed on a few places on my body. What are the best spots that would help the medics if something happened?
For Queen and Country
As it was explained to me by more than a few medics on my last tour: No medic will take your tattoo as fact. Your blood will be typed and matched at a role 3 facility should you need it. They may not even trust your tags to be correct (you could have had them replaced incorrectly).
Now my opinion; Tatooing your blood type into your elbows ect is almost as FNG, fresh out of basic gay as having a bar-code tatoo of your service number done and then showing it off at the bar while wearing your St Jean platoon shirt with your ID Disks hanging out.Just my opinion though, I could be wrong
Like Sig said, the Medics won't trust what you have written on your kit, or tattooed.. plus they won't be searching your body for a tattooed blood type.. Your get blood typed in KAF while they pump you with O Neg(universal blood type)
Also, you thought about getting your blood type an NKDA tattooed on more than one place on your body?
Anyways, some units have it as SOP to mark kit with blood type, ie on the t-shirt. But, not all.
On a related note, most guys I know that did get blood type tattoos got it done on their inner arm/forearm. An when it comes to kit, most guys tend to mark their blood type on the collar of boots, on the body armour, IFAK, helmet band/helmet cover an some get IR/cloth patches on their sleeves an/or IFAK.
Keeping it in the family
Lol, thanks man. Ill keep asking around but it makes sense.
And you got to hate those "look at how badass i am, im on the pat platoon" types
Very true,Canadian, Among ER Doctors Paranoia is considered a healthy survival trait. Don't even trust yourself to be right if the matter is critical,That's why 2 nurses or a doctor and a nurse check each bag of blood before hanging it.
Originally Posted by Canadian Sig
This is a good reference for "Shock and Resusitation" and includes a bit on Transfusions.
Please note this statement.
[LEFT][SIZE=2][FONT=Palatino-Bold][SIZE=2][FONT=Palatino-Bold]Exsanguinating hemorrhage is the cause of most[/FONT][/SIZE][/FONT][/SIZE]
[SIZE=2][FONT=Palatino-Bold][SIZE=2][FONT=Palatino-Bold]preventable deaths during war. Combat casualties in[/FONT][/SIZE][/FONT][/SIZE]
[SIZE=2][FONT=Palatino-Bold][SIZE=2][FONT=Palatino-Bold]shock should be assumed to have hemorrhagic shock [/FONT][/SIZE][SIZE=2][FONT=Palatino-Bold]until proven otherwise. (Pg 7.3)[/FONT][/SIZE][/FONT][/SIZE]
[SIZE=2][FONT=Palatino-Bold][SIZE=2][FONT=Palatino-Bold]And this one.[/FONT][/SIZE][/FONT][/SIZE][/LEFT]
[SIZE=2][FONT=Palatino-Bold][SIZE=2][FONT=Palatino-Bold][FONT=Palatino-Roman][SIZE=2][FONT=Palatino-Roman][SIZE=2]“Dog tag” blood typing wrong 2%–11% of the time.(Pg 7.9)[/SIZE][/FONT][/SIZE][/FONT][/FONT][/SIZE]
Keeping it in the family
Alright thank you very much, my question is answered
This is a truly AWESOME site. And even better all the books are available in PDF as free downloads. Emergency War Surgery is just one of the available titles.
Main Finn: I agree w / your pts and your insight.
T Doc: TY 4 UR expertise and Op'd in the matter.
Very good inputs on that subject.
Just to make my position clear. I don't support or encourage the minimalist approach described by Dr Mattox. It is good to keep a patient a little on the dry side,the end points described in Chapter 7 of Emergency War Surgery will keep both you and your patient out of trouble.
Originally Posted by Maine Finn
Point. My experience with running fluids beyond a few hours is pretty limited, as the longest I've had a single patient was ten hours. But. Given that patient's chief complaint and general VS, the bags were hanging from the time they came in to the time they went upstairs. I'd figure it's a bit different for medical patients as opposed to trauma patients, though. At least in terms of what fluids they get and how much. I'm at the low end of the hierarchy too, so most times I'm just doing what both my nurse and the doc/PA tell me to, without necessarily having a whole lot of room to think about it.
Originally Posted by TraumaDoc
I haven't yet really bitten into that EWS link, but it looks like a good read.
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