Megadoom's Gunshot wound/post crash management (Official multi-post series)

[EyesWideOpen]

ROFLOL, House, you crack me up, but ya should have put it in purple

As if Doomers wouldn't get that a thread titled "Megadoom's Gunshot wound/post crash management (Official multi-post series)" would be chock-a-block with graphic photos, OMG, I love it!

[April]

Great post as usual, MD. I may have well missed a previous post where you touched on this but.......what equipment would you say is positively necessary to have on hand? Also, I would love an instructional post on just stiches - I have stiched people up before, but I always leave the experience a bit shaken. It is SO much harder than it seems like it would be, and when I was living way out in the bush with medical treatment days away, it was the problem we faced most often. That and dental problems. Not like you haven't done enough, but it would be great.

[Megadoom]

Great post as usual, MD. I may have well missed a previous post where you touched on this but.......what equipment would you say is positively necessary to have on hand? Also, I would love an instructional post on just stitches - I have stitched people up before, but I always leave the experience a bit shaken. It is SO much harder than it seems like it would be, and when I was living way out in the bush with medical treatment days away, it was the problem we faced most often. That and dental problems. Not like you haven't done enough, but it would be great.

Yes, I'm going to include stitches, among other things, as I work on this post. I would positively say a good tourniquet and trauma dressings are essential (these can be made from sticks and clothing if need be). Direct pressure (clothes or dressings), elevate the wound if possible (gravity can reduce blood loss), trauma dressing - pressure dressing as shown, proximal (means closest to wound and above it) pressure points to wound to shunt hemorrhage, and finally a tourniquet if the above doesn't work. I included above the military method to stop a traumatic bleed with a "temporary" tourniquet...but please know what you're doing or distal tissue ischemia (death of the limb) could result if left on too long.

We have a meme in EMS circles for priority of care: Airway, Breathing, Circulation (ABC's), Disability (splinting, assessments), Expose (take the clothes off and look).

I'm going to demonstrate suturing, but if you'd like to get a head start and practice here's a quick video on the easiest suture to learn.

<a href="http://www.youtube.com/v/PFQ5-tquFqY&amp;ap=%2526fmt%3D18&amp;rel=0" target="_blank">http://www.youtube.com/v/PFQ5-tquFqY&amp;ap=%2526fmt%3D18&amp;rel=0</a>

[wordnerd]

Another member of the Megadoom fan club here !!

[April]

Another member of the Megadoom fan club here !!

Ditto - thanks, Megadoom!

[houseoftang]

Just watched those goat videos.  Wondered at first why they were blanking out faces, then realized that if PETA ever saw that. . . they'd be trying it for real on actual humans.

Am I too sentimental to be a doomer when I say, "Poor goats!"  And then say "It's a shame they can't eat them afterward, since they obviously let them die."

Couple questions.  First, it looked like they were a little rough with the goat leg.  Is that usual, and ok?  I guess if you're trying to quickly save someone's life, especially in a battle situation, you can't move the limb with utmost care (and perhaps don't need to).  Also, what of the medical tape?  Would you want to use a new roll for each patient, seeing as you're probably getting blood all over it?  Or again, is that the sort of thing you don't have time for in that situation?

I could NOT do this while eating lunch.  Wow, it's going to take some serious will to be able to do this to a person if I ever have to.  It'd take will to do it to a goat (even if the goat needed it).

The tube thoracostomy, is that what you do when someone's chest is filling with fluid, so they can't breathe?  Pushes the fluid out with each breath?  Like they did to that guy in the movie Three Kings?

Stupid questions on sutures.  The pre-threaded sutures are a good idea, of course, because you might either be unable to thread it in time of need, it'll save you time in any case, and it's easier to thread it and keep it sterile than in a battlefield when you're licking your thread.  But are they using more than one pre-threaded suture in the video, like one for each stitch?  Or are they using the same one, because you're not pulling the loose end all the way tight (but knotting it to the other side instead)?  I'm thinking of how I hand stitch when sewing cloth.  What exactly could you use, aside from goats, to practice sutures on, that's easily available to folks outside the medical establishment?

[Megadoom]

Just watched those goat videos.  Wondered at first why they were blanking out faces, then realized that if PETA ever saw that. . . they'd be trying it for real on actual humans.

Am I too sentimental to be a doomer when I say, "Poor goats!"  And then say "It's a shame they can't eat them afterward, since they obviously let them die."

Couple questions.  First, it looked like they were a little rough with the goat leg.  Is that usual, and ok?  I guess if you're trying to quickly save someone's life, especially in a battle situation, you can't move the limb with utmost care (and perhaps don't need to).  Also, what of the medical tape?  Would you want to use a new roll for each patient, seeing as you're probably getting blood all over it?  Or again, is that the sort of thing you don't have time for in that situation?

I could NOT do this while eating lunch.  Wow, it's going to take some serious will to be able to do this to a person if I ever have to.  It'd take will to do it to a goat (even if the goat needed it).

The tube thoracostomy, is that what you do when someone's chest is filling with fluid, so they can't breathe?  Pushes the fluid out with each breath?  Like they did to that guy in the movie Three Kings?

Stupid questions on sutures.  The pre-threaded sutures are a good idea, of course, because you might either be unable to thread it in time of need, it'll save you time in any case, and it's easier to thread it and keep it sterile than in a battlefield when you're licking your thread.  But are they using more than one pre-threaded suture in the video, like one for each stitch?  Or are they using the same one, because you're not pulling the loose end all the way tight (but knotting it to the other side instead)?  I'm thinking of how I hand stitch when sewing cloth.  What exactly could you use, aside from goats, to practice sutures on, that's easily available to folks outside the medical establishment?

Wow, you ask alot good questions. The video doesn't say what happens to the goat, and I would assume the body was desposed of, but before we get too sentimental let's remember millions of dogs are euthanized and their bodies cremated every year. I'm sure goats are the same.

Roughness, yes, you must be aggressive and quick acting, and it takes a good deal of man-handling and strength to stop an arterial wound.

Tape, yes, a new roll with each patient unless you're famaliar with the victims history and in a bunker type situation (level 1 indefinitely).

Chest tube is used to bleed off blood, fluids, and air, but if all you have is a level 1 situation and no access to a medical OR/MASH, FEMA tent indefinitely, this type of injury is nearly 100% fatal without surgery.

Sutures, get a good suture kit (you can buy them from me if you'd like: gmegacode911@aol.com) and practice on a chicken leg, with skin on of course, or a orange. Incise a laceration with a scapel or knife and practice suturing with hemastats and tweezers. Follow along in the video and check out my next video I'll be publishing this week that demonstrates this, I'll be using a chicken leg. My friend from Pensacola will be practing too.

[houseoftang]

Sutures, get a good suture kit (you can buy them from me if you'd like: gmegacode911@aol.com) and practice on a chicken leg, with skin on of course, or a orange. Incise a laceration with a scapel or knife and practice suturing with hemastats and tweezers. Follow along in the video and check out my next video I'll be publishing this week that demonstrates this, I'll be using a chicken leg. My friend from Pensacola will be practing too.

I'm sure you'll cover this in your video, but what does a good suture kit contain?  I assume you could, in the longer-term, re-use the needle after it's sterilized, and maybe buy a spool of the suture thread for longer-term use.  This is especially appropriate for me, since literally half of my new family (the female half, along with many of fiancee's friends) is in the medical profession, so I expect we'll be patching up a lot of folks when they need it.  Will you cover the basics of actually making a threaded suture (I'm assuming you just do it in a pretty clean environment and then throw it in an autoclave)?

Chicken legs and oranges.  Of course!  And have 'em for dinner afterward!  You could practice with just ordinary thread, right?  No need to waste good suture thread on it?

Tape, yes, a new roll with each patient unless you're famaliar with the victims history and in a bunker type situation (level 1 indefinitely).

Thinking like a post-doom doomer, would it be a bad idea, from a sanitary point of view, to save the roll of tape and use it again for the same person, either for the same injury in a later dressing, or for another injury?  Put it in a bag and save it aside?

The video doesn't say what happens to the goat, and I would assume the body was desposed of, but before we get too sentimental let's remember millions of dogs are euthanized and their bodies cremated every year. I'm sure goats are the same.

I know, I know.  Just seems so wasteful (though I know it's for a good cause--how many lives are saved because medical students get to practice on live goats rather than chicken legs and oranges?).  And I empathize with the goat.  It's why I'd be a crappy nurse or doctor.  Fiancee, on the other hand, and her family. . . I don't know if they CAN empathize.  Doesn't seem like it, when they see something wrong with me and poke and prod to fix it. . . 

[houseoftang]

Eagerly awaiting more!

Another question I thought of, Megadoom.  How long can you leave a tourniquet on for?  Say you don't have time to pack the wound properly before you have to move (like you're taking fire), or have to stop in the middle of the procedure, or just don't have anything even remotely close to the materials it takes on hand?  If the best you can do is tourniquet, how long can you leave it on for?

[Megadoom]

Eagerly awaiting more!

Another question I thought of, Megadoom.  How long can you leave a tourniquet on for?  Say you don't have time to pack the wound properly before you have to move (like you're taking fire), or have to stop in the middle of the procedure, or just don't have anything even remotely close to the materials it takes on hand?  If the best you can do is tourniquet, how long can you leave it on for?

There is no clearcut rule as to how long a tourniquet may be used safely, although various investigators have addressed effects of ischemia on muscle and nerve to define a relatively "safe" period of tourniquet hemostasis. In practice, safe tourniquet time depends greatly on the patient's anatomy, age, physical status, and the vascular supply to the extremity. There is general agreement that for reasonably healthy adults, 90 minutes should not be exceeded without releasing the tourniquet for a short time.

Do what you you've got to do, so in other words, when you've survived the gunfight or retreated to safety get to it. Time is tissue (muscle and organs) is a saying in the medical field - as soon as you can. If by chance you have to leave the victim it's a good idea to take some blood and smear the letter T onto the forehead with the time applied so that any future medical personnel will realize a tourniquet has been applied and when - old Vietnam trick.

As to your other questions regarding the suturing, I'll address many of them in the video. Definitely use clothing thread to practice with since suture kits can be pricey, but you'll need the specially curved needle that comes in the kit. Suture kits come with a needle that is already threaded and tied in to small flat spool, tweezers, scissors, 4x4's, betadine prep, alcohol, cup, sterile gloves, surgical drape, etc.

Hope this helps, still working on the video and the next post.

[eric1]

Disgraceful, absolutely disgraceful. He's a shock poster!!

By the way, when can we see your next pictures Megadoom?!!

[EyesWideOpen]

Eric, Dude! These are not for gawkers but for the educational value post-crash-I see a pop-quiz in your future young man

And Megadoom, since actually I know Eric was asking when the class resumes, add my voice. I've done ring stiching (talk about on the fly), but would like to learn more on both gsw treatment and stiching without leaving the poor patient looking like a new Frankenstein.

[Megadoom]

Eric, Dude! These are not for gawkers but for the educational value post-crash-I see a pop-quiz in your future young man

And Megadoom, since actually I know Eric was asking when the class resumes, add my voice. I've done ring stiching (talk about on the fly), but would like to learn more on both gsw treatment and stiching without leaving the poor patient looking like a new Frankenstein.

Want some pictures, I got some pictures.

OK, first one is a doozy, and you'll be shocked but the guy lived. In a post latoc world, you can hang it up. This guy made the often made mistake of aiming a 357 under the chin loaded with hollow points....never do this, if you want to committ suicide aim to the back of the throat....never ever the chin upwards. All that will do is take the face off, never taking out the brain or the respiratory ganglia. As you can see it's a dreadful mistake.



While this gentleman is shot assasin style. Not survivalable...instant death



Just a sample.... I'll be back tomorrow to discuss suturing, wound cleansing, infection care, and dealing with GSW fractures.

[houseoftang]

OK, first one is a doozy, and you'll be shocked but the guy lived. In a post latoc world, you can hang it up. This guy made the often made mistake of aiming a 357 under the chin loaded with hollow points....never do this, if you want to committ suicide aim to the back of the throat....never ever the chin upwards. All that will do is take the face off, never taking out the brain or the respiratory ganglia. As you can see it's a dreadful mistake.

Wow, are his eyes even still there?  Or are those black things something else?

Is the roof of the mouth upward any sort of a good way to do it?  Or is that what happened in NO with that state trooper?

[Megadoom]

OK, first one is a doozy, and you'll be shocked but the guy lived. In a post latoc world, you can hang it up. This guy made the often made mistake of aiming a 357 under the chin loaded with hollow points....never do this, if you want to committ suicide aim to the back of the throat....never ever the chin upwards. All that will do is take the face off, never taking out the brain or the respiratory ganglia. As you can see it's a dreadful mistake.

Wow, are his eyes even still there?  Or are those black things something else?

Is the roof of the mouth upward any sort of a good way to do it?  Or is that what happened in NO with that state trooper?

No, the eyes are marked out to protect pt. confidentiality. The mouth upward is the hard upper palate twisted superioraly.