"And, really, if someone has a wound so big that you're packing an entire T-shirt into it don't you think you should call for help?"

This sounds like the dark humor from Monte Python and The Holy Grail. "only a flesh wound....no problem" or something like that is how I remember the comments from the knight who just had a couple arms cut off.

I too am bookmarking this thread... thanks for all the great input.

I had a situation where I took a bunch of novice mt bikers for a group ride and one went over the bars and really hamburgered one hand. The other scrapes he got were minor and easy to just rinse off but the hands were bad enough to consume all the bandaids I had with me, so I ended up using the bandaid wrappers. If the bandaids are sterile, so is the inside of their wrappers, so I just kept them clean and used the clean side against the wounds and taped up and tied off where we could to protect from further dirt/contamination.

He then walked back to the car with hands above head to help reduce bleeding and all was well. I was pleased to have the doc in the ER compliment the use of bandages and wrappers... The doc stated the wound was quite clean, so it seems to work (and does not weigh anything extra!)

maybe someone else will find that idea useful, but hopefully it just gets stored and never has to be used (like all the first aid stuff).

i like steri strips to butterflys and super glue. they are my favorite thing to use at work (athletic trainer). the 1/4" ones are easier to use than the 1/8 skinny things. you can get a lot out of them by cutting them in half or in quarters if it is a small but deep thing.

epi pens are not the end all to an allergic reaction, they will need treatment afterward too so if you need to use one then you also need to get help soon too.

i've heard Quick-Clot burns like crazy so make sure they are in serious trouble before cracking that open.

I have a pretty small FAK that has a small amount of the stuff i use the most on the field. gauze, bandaids, steri strips, tape,duct tape, triangle bandage, mylar blanket, advil, benadryl.

having knowledge on treating first aid situations is much more important than having a lot of items. lots of stuff can be improvised.

Thank you Dean!

Very interesting to hear the perspective of someone with your background/expertise.

Love your posts Dean, but for clarification....


The OLD Quik Clot powder (1st generation aka the "big gun" you spoke of) which was used by the military has been replace due to it blowing in peoples eyes causing injury, risk of thrombosis and burns.

BUT...

It was replaced with the NEW Quik Clot (2nd generation) which is a treated gauze. In fact, it is the only product of this type carried by all of the US military branches and is called "QuikClot Combat Gauze". It is extremely safe and effective, doesn't burn and is available retail now as "QuikClot Sport" for small to severe bleeding. It's not just a life threatening, massive bleed product anymore. Hell, they even make it for nose bleeds now. At 25 grams, I would rather have it than not.



And as far as the redundancy of the antibiotic cream and burn creams, the burn cream I was speaking of is a cooling gel that comes in a 3 gram ketchup style package (Water Jel Burn Jel Plus). It's more of a pain management thing because let's face it, burning the tip of your finger cooking can be quite painful especially since we often have sub-13 year old kiddies with us. They don't "man up" as well as we do. If I don't use the burn cream, a paste based toothpaste helps with throbbing burning pain as well. Seriously.

Edited by fiestabuckeye on 06/21/2012 02:19:28 MDT.

Daryl said, "This sounds like the dark humor from Monte Python and The Holy Grail. "only a flesh wound....no problem" or something like that is how I remember the comments from the knight who just had a couple arms cut off."

BUT I'M NOT DEAD YET!

For clarification: "butterfly sutures" and "steri-strips" are nearly synonymous, so yes we're essentially talking about the same thing. The only difference is that the steri-strips are straight whereas the butterfly sutures have wings where they stick to the skin but are narrower over the wound. You can easily leave gaps to allow the wound to drain when placing steri-strips, but for laymen who don't think of that the butterfly sutures have the gaps sort of built-in as it were.

Combat Gauze, yes the military uses that extensively, but we may just have miscommunicated because it is NEVER referred to as "Quik Clot" in the circles in which I work. It is called "Combat Gauze." When you say "Quik Clot (nothing follows)" believe me 99% of military docs will think of the exothermic powder. I didn't even know the same company makes it- the medics carry it and I only remove the stuff when the patient gets to me, and I guess that on the few occasions that I even saw the packaging I didn't pay enough attention. But a quick google search reveals a whole line of Quik Clot products all based upon the Navy research into kaolin-infused gauze (which was carried out because the "old" Quik Clot sucked so much).

OTOH I'm certain that the "old" Quik Clot is off the market, so maybe I should have picked up that you didn't mean that stuff.

Anyway, I have no objections to Combat Gauze. It is certainly pretty light for the capability that it provides, and I can certainly understand the appeal of such a 'magic' hemostatic agent to most people. I had never heard of stuffing it in a nosebleed but the new stuff isn't nearly as exothermic as the old stuff so I see no reason that it wouldn't be safe.

Risk = probability x consequences

For instance (if I may indulge in a reductio) a meteorite strike to your person would have devastating consequences but the probability is so low that the risk is essentially zero, and it is not worth hiking in a full-body kevlar and ceramic suit.

Conversely, re: mountain biking, I imagine that minor injuries are more common than when hiking. I also imagine that most of them are larger-area but shallow abrasions often containing debris. If I were mountain biking I think I'd carry more dressing supplies and a real forcep for removing debris, and possibly a real irrigation device. Heck, I might even carry a SAM splint- they are relatively light.

Mylar blanket? Will you ever not have some sort of better insulation with you, like a down bag? Well, I guess on a day hike... It might be nice in wet conditions where you can't dry the victim off very well, to protect the down in the bag. And I guess that it would add some benefit but is it enough benefit to carry the bulky thing around? ("Bulky" here is a relative term, clearly. I can pack a lot of Motrin in the same volume and get better use out of it, is all I'm saying.)

Regarding my expertise/experience: remember that I'm a SURGEON, not an emergency-medicine doc, and when you're a hammer every problem starts to look like a nail. (Though I did recently join WMS and am trying to learn a bit on the subject.) So I'm pretty facile with traumatic wounds but on most other subjects I'm weak. You don't want me managing your status asthmaticus, for instance. :)

There is an ER doc floating around here somewhere, though, IIRC...

Edited by acrosome on 06/21/2012 09:22:51 MDT.

Dean,
I think you're dead on that it was just a case of miscommunication. I was in long enough to remember the old powder which was a mess and the new combat gauze. The Combat Gauze are not referred to as QuikClot, but the new retail products are which is why the term was used. Also, for the sake of clarification, I use the QuikClot Sport Silver. The Silver version is designed for situations where it could take a while to reach a hospital like we would face in the wilds. Is carrying it overkill? Probably, but my main group of two former Marines generally has one of them armed, some hefty knives and things tend to happen when dealing with Marines.

Also, I agree 100% that there's a fine line of what to carry and what not to. Really, it's an individual thing though. If I were making a kit for just myself, it would weigh about an ounce and would be rather minimalistic. Needing a kit for 3+ people with some often armed or children in the 10-12 year range, I wanted something slightly more robust while still being "light" (sub 5 ounces) and have the ability to stop some bleeding. In my main group of 3 that I always hike with, we split things up. One carries the cooking gear, another carries the water gear and misc group items and I got the medical gear. A 4-5 ounce kit is a net win for me.

And if someone has status asthmaticus with the two of us there, I guess they're screwed. The military weeds out any asthmatic conditions, so it is something RARELY seen and never seen by me in the field.


BTW, I love these discussions and appreciate every bit of knowledge offered.

Edited by fiestabuckeye on 06/21/2012 12:13:03 MDT.

Ryan: "...things tend to happen when dealing with Marines."

I hear ya.

What is the consensus on taking designated oral rehydration salts for treating electrolyte imbalance? Overkill? Is just making sure you have some Gatorade and some salty food packed good enough?

I don't think that you will get a complete concensus. There are too many variables, like weather.

Personally, I use a bit of Gatorade, Vitalyte, Cytomax, or my own custom powder, and I drink the stuff diluted to about 50%. I tend to get a bit of normal sodium chloride salt in my food, plus a bit of potassium chloride.

Salt may be part of the solution (literally) but it is not the whole answer.

Once I was crewing at a 100-mile race on a warm day, and I was at the 62-mile point. An elite runner came in and told his crew what he needed. 50-50 Flat Coke and water with a pinch of salt and one aspirin. The crew served that up to him while they refilled his bottles with water. He gulped down some of that, and he was off.

--B.G.--

Tons of good info! I have to sub to this- my daughter seems to be bleeding some place, just at the thought of hiking! We could go though a box of bandages just on one 2 mile hike!

Adam Thibault asked:

What is the consensus on taking designated oral rehydration salts for treating electrolyte imbalance? Overkill? Is just making sure you have some Gatorade and some salty food packed good enough?

Can't offer a considered medical opinion here, just personal anecdote. With that disclaimer, I find that having some salty food and something with simple sugars in it in my pack enough to treat anything I've had happen to myself so far.

My last trip to Ocala, about three weeks ago, I wound up in the middle stages of heat prostration due to...well, being an idiot, essentially. I didn't carry enough water to cross Farle's Prairie, and it was in the low-nineties with 100% humidity by the time I got there. I ran out of water about two and an half miles from the end, and by the last half mile, I'd stopped sweating (a very bad sign). Water, shade, pepperoni, and candy were enough to get me back together. I was able, after about three hours of cooling off and rehydrating, to walk another ~16 miles back to the car.

Also note that I have issues with absorbing potassium too easily; it manifests about the same as any other electrolyte imbalance--as cramps. So, I try to avoid sport drinks and food that has a lot of potassium in it, which has an effect on my elecrolyte intake choices.

Er, um... well, it depends. Well, actually, if your asking about dedicated rehydration salts I'll say- yes- overkill. In most situations you don't really have to worry about taking in enough salt at all, because you should get enough in your food. I was about to say that the military doesn't do the "scheduled salt tablet" thing any more, but that isn't true- they have started scheduled electrolyte replacement strategies again in Afghanistan, but those are infantrymen going up and down hills in ridiculous heat all day, and whose body armor alone weighs 35 pounds, let alone counting up weapons, ammunition, and basic sustainment load. And at least they learned from their mistakes- they don't use nearly as much as the old Vietnam-era salt tablets.

That said if you're hiking someplace extreme I can certainly see how some sort of sports drink or a little extra salt would help. I ran into a Grand Canyon backcountry ranger recently who told me that she carries extra water and salty snack chips to give to hikers who just don't look right, and it always perks them up very quickly. I carried Nuun tablets on my Grand Canyon hike, and I made them half-strength. I also actually used the flavor packets for my Ramen for possibly the first time ever. I felt great.

But even for hiking around here in Colorado I don't bother with any sort of electrolyte strategy. And let me tell you, Colorado in the summer can be pretty extreme, too.

Yes, Gatorade (and most other sports drinks) was designed for athletes in extreme conditions who are having a LOT of electrolyte loss to sweating- it is too strong for almost any other use. Most of the writing I've seen on the subject of using it for lesser activities or as a medical rehydration fluid say to dilute it with water 1:1 or even 2:1.

Edited by acrosome on 06/28/2012 19:16:38 MDT.

Snacks like Pringles and potato chips are pretty amazing for replacement of salts in extreme conditions. It is something I have experienced a lot. A couple times I have gotten pretty wiped out and a 30 minute rest with salty snacks and a little water did wonders... And it was not a dehydration problem. Salt tablets upset my stomach.

Reading this thread has been very informative. I'm wondering if my first aid kit (3.8oz) has some unnecessary items, specifically:
- a small roll of 1.5" wide gauze (weighs .6oz)
- a small roll of 3m "transpore" medical tape (weighs .3 oz, and I carry some duct tape)
- a couple gauze pads (weighs about .5 oz)

I'm not at a point where 1.5 oz is make or break, but I don't see those items mentioned much.

Also, I wonder how solo hiking might impact the items chosen. Are there different or additional items you might select knowing that you'll need to perform first aid on yourself?

Harris, as I recall, one of the more common serious injuries that backpackers get is when they are trying to step over a downed tree and they get a puncture wound by a dirty piece of wood. Not only does a deep puncture wound need to be cleaned out very well to avoid infection, but you're probably going to need some sterile gauze to cover it, and some tape to hold that.

Now, with that injury in mind, what have you got? You have two forms of gauze, and maybe one would do. If you have medical tape, that would hold it in place. I've had that sort of injury, and I had that sort of stuff to deal with it.

Sometimes, not always, I carry something of a more supportive nature such as an Ace wrap. This would apply especially to anybody susceptible to ankle or knee sprains, and it might apply to anybody in a more remote location.

For group trips, my group first aid kit is slightly smaller than a football, and it weighs 25 ounces or so.

--B.G.--