Subject: Treating for Shock  (added May 22nd, 2006)

                     -by Matt Fauls, EMT-P

Shock

            Shock: A state of inadequate tissue perfusion. Basically this means that for one reason or another not enough oxygenated blood is reaching body tissue. 

   There are 5 types of shock all of them have the same basic signs, symptoms and treatment.  In this article I will try to give some basic information on shock and the things you can do to give aid to someone who may be experiencing it.

  First we will go over the different types of shock:

●         Hypovolemic: Low blood volume, usually caused by trauma ie: broken bones, lacerations, puncture wounds.  The inadequate tissue profusion is caused by a general lack of blood to carry oxygen.

·         Carcinogenic: Loss of pumping ability, caused by a sick or damaged heart.  The inadequate tissue profusion caused by inadequate movement of blood to either pickup oxygen in the lungs, or to circulate blood to the body.

·         Neurogenic: Loss of vascular resistance, this means that the vascular system has relaxed, and therefore larger, usually this is caused by an injury to the spine.  Basically this causes a state of hypovolemia, many times the only way to tell the difference between hypovolemic shock and Neurogenic shock is the injury.  If a person has a large bleeding wound and is in shock it is probably hypovolemic, if they fell and cannot feel their legs it is most likely neurogenic.

·         Septic: Massive infection, there is a long complicated reason that a massive infection will cause shock, I will spare you.  Just remember to keep all wounds clean.

·         Anaphylactic:  A violent almost immediate allergic reaction.  Most people already know what they are allergic to, but there is always the case when someone finds out the hard way. Airway is a big concern here as many people suffering from anaphylactic shock suffer from airway restriction, their throat immediately begins to swell.  This patient need advanced medical care.  The only thing that will truly help is early recognition and treatment with pharmaceuticals.

·         Insulin/Diabetic:  Not really shock but I knew if I didn't cover it someone would say something.  It is caused when a diabetic takes insulin and then doesn't eat properly or in rare cases a person is naturally hypoglycemic and hasn't eaten.  Treating for shock may delay the inevitable, but definitive care means fixing the underlying problem, meaning low blood sugar.  If the person is conscious give them food.  If they are unconscious, and therefore cannot protect their airway this is an emergency they need trained medical personnel with proper equipment to fix this.  DO NOT PUT ANYTHING IN THEIR MOUTH! THEY MAY CHOKE AND DIE!

   Signs and Symptoms:

      Early signs of shock may go unnoticed as they are fairly mild, the patient may be pale and a little cool to touch and actually have an increase in blood pressure up to 20%.  As shock progresses there pulse will increase and the blood pressure will decrease.  They may start complaining of thirst and appear exhausted. In decompensating shock pulse may be absent, blood pressure will be very low.  The patient will be cold to touch.  By this time their color is either ashen or cyanotic(blue).  If still conscious they will be delirious and complaining of severe thirst.    

  Treatment of Shock:

            Preventing shock and treating for shock are identical.  Don't wait for symptoms to occur before treating, if the patient is already showing signs of shock you are fighting an uphill battle.  As soon as any life threatening injuries are treated, you should treat for shock.  Keep the patient warm and dry, place them on their back. Raise their feet 12 inches if head, neck, or back injures, or injures to the legs and hips are not suspected.  If available give supplemental oxygen.  Do not give food or drink.  This patient needs to be evacuated, under ideal situations this means calling 911.  Under less than ideal situations this person needs to be safely moved to the rear of an incident either to an aid station or a field hospital.  Before moving them know were you are going,  on 9/11 the fire department moved the triage station multiple times.  The last thing you want to do is get a patient someplace you think they will get help only to find an empty space.  Also only move a patient if you absolutely have to, if all is well in the world call 911 and let the professionals do it.  They have the proper equipment and training to do it safely.

 

Militiamedic is a Paramedic with a very large, urban Southeastern Michigan EMS. This article is NOT meant to take the place of proper medical care, nor is it intended to replace the advice of a competent physician. You may e-mail the good medic at militiamedic@yahoo.com

 

 

Subject: The Squad Medic Bag Added May 13, 2004

        At this point, we envision four levels of medical readiness. The first level, or kit, is the individual first aid kit listed in the Level One guide. It is basically a small kit with only a handful of what may be the most needed items in a field medical emergency. The next level up would be something that a squad or team medic would carry in the field. This is in ADDITION to any individual first aid gear carried by the medic as part of his own set up, and in ADDITION to the individual gear carried by the medic's team mates. The third level, a platoon + medical kit, is even larger and is designed to be carried in your vehicle, in a tool box or similar large container. This third level, just the platoon box, can be carried if necessary. The fourth level is something akin to Lou's "mobile aid station", and is composed of the squad bag, the platoon kit, and other support vehicle items and can really only be carried in a vehicle.

        We are sure that you will either find some shortcomings with this kit, or find some of its contents excessive or of little use. This kit was designed by an urban paramedic with several years' experience in this field, but if you have a better kit, feel free to issue said kit to your own unit's medical staff. We welcome constructive advice, but we frown strongly upon mindless bashing done for its own sake.

       This kit is designed to be carried in the field by a trained person familiar with the use and application of the contents, but it would make an excellent vehicle first aid kit for everyone. It can also be carried on a bicycle.

       The kit is contained in an older US Army issue medic bag. This is NOT the same as the cheaper, current after-market tri-fold bag. The one we use is a slightly larger, stiffer bag made of rubberized canvas. It was purchased online from Garcia Aviation for about $20. You may choose to get one of the somewhat flimsier nylon tri-fold bags, but you might have trouble fitting in all of the contents, especially the hydrogen peroxide.

 

 

Contents

    Bandaging Unit:

          4 each, large battle dressings (7 1/2 x 8)

        4 each, small battle dressings (4 x 6 1/2)

        1 each, large trauma dressing (12 x 30)

        3 each, triangular bandages (40 x 40 x 56)

        Assorted band-aids in metal box (strips, knuckles bandages, butterfly closures)

        Steri-strips, pack of 10

        3 each, ace wraps

        2 rolls of 2-inch wide medical tape

        6 each, petroleum gauze (3 x 9)

     Equipment

          1 each, reusable heating pad, military type

        1 each, emergency blanket, small folded foil type

        Trauma shears (also called EMT shears)

        Tweezers (splinter forceps)

        Hemostats

        Q-tips, dozen

        Snake bite kit (yes, we may need these in Michigan)

        1 Large airway adjunct (OPA)

        1 Medium airway adjunct

    Medications

          Hydrogen Peroxide, 3% solution, 16 ounce bottle

        Calamine lotion, 6 ounce bottle

         Iodine, 2%, 1 ounce bottle

         Tube of triple antibiotic ointment, 1 ounce

         Aspirin, 100 tablet bottle

         Acetaminophen, 20 tablet bottle or larger

         Stimulant, such as No-Doze, 20 tablets

         Anti-diarrhea tablets, minimum of 12

         Antihistamine tablets, minimum of 12

         Hand sanitizer

    Additional items to be added, if they can fit:

          Small dental repair kit (emergency temporary filling material)

        Small eye-treatment kit (patches and eyewash)

        Glucose tablets

        Cold pack (may replace heat pack)

        As many extra gauze pads and gauze rolls as you can pack in your bag

        Small knife and/or disposable scalpels

        Rubber gloves

        Pen light

        Dust masks

        Large bag of Quick Clot powder (Note: There are packages with smaller doses of Quick Clot powder available, but the nature of this powder is such that if you need it at all, then you need a LOT. If an injury is such that you think you only need a small dose of this, then get a band-aid.)

        Adjust the gear in your bag to fit the items that you think are more important. For example, you can try to find a smaller container for your peroxide in order to fit some of these extra items. Also, you can attach another pouch, like an ammo pouch or two, to the carry strap to hold more bandages or medications or the like. Make it work for you, and don't feel bound by this list here.

       Even if there are some items that you cannot use, remember that on 9/11, there were several medical people on hand whose ability to help was limited because they didn't have any gear with them. Perhaps by having this gear with you, you can help them, too. Having an extra set of bandages and a set of hands to help apply them can make a huge difference in a disaster.

 

Yes, this is a big picture file. Sometimes you need to show a big picture.

Another medic bag. Upper left, actual folding medic bag. Upper right, extra bandaging unit. Lower left, nylon stretcher bag. Lower right, 2 quart canteen.

Subject: Platoon/Support Vehicle First-aid Kit

      -by SMVM Staff

 

In addition to Level One 1st Aid Kit, and Squad Medic Bag:
 

Notes: There is some interchangeability between the squad bag, above, and the platoon kit, below. It will not always be necessary to have trauma shears in both kits, for example.

Heat packs and cold packs are usually not for "emergency" cases, so you can relocate them to your vehicle kit, should you wish.

Wire splints such as those available from REI, can be included with either kit.

Some items might not be available for normal civilian purchase. Get what you can.

Write the date of the next item's expiration on the top of the kit/box. Check your gloves frequently, as they can and do tend to rot.

The following kit is kept in a large, multi-sectional tool box from Meijer's.

Outside Bottom, Easy Access Pouches:

Garbage Bags, 1 Dozen
Latex Gloves, 12 pair

Bottom Section:

Hydrogen peroxide, 3%, 32 ounces
Isopropyl Alcohol, 70%, 16 ounces
Casting tape, 4 packages
Ace bandages, 6
Inflatable leg splint, 1
Garbage bags, 6
Surgical face masks, 6
Sterile burn sheet, disposable
Minor procedure pack, 1 (drape, sponges, wrap, towels)
Surgical scrub brush/sponge
Surgical gloves, sterile, 6 pair
Scalpels, #15, 3
Sutures, individual, assorted, dozen (you cannot buy these)
Multi-trauma dressing, 12"X30"
PPE kit (gown, booties, gloves, hand wipe)
Soap
Hand sanitizer, 1 bottle


Med Tray:

Cough drops, NLT one dozen
Aspirin, one bottle
Antihistamine, NLT one dozen
Anti-diarrhea, NLT one dozen
Rolaids/Tums NLT one dozen
Glucose Tabs, one roll
Sore throat lozenges, NLT one dozen
Caffeine/Stimulant NLT one dozen
Ibuprofen, NLT one dozen
Acetaminophen, NLT one dozen
Other, as needed


Boo-boo Unit, on top, easy access:

Band-aids, assorted
Neosporin packets, NLT one dozen
Handi-wipes, NLT one dozen
Tweezers
1st aid cream, tube
Eye-drops
Alcohol pads, NLT dozen
Iodine, bottle
Cough drops, several


Lid equipment:

Blood pressure cuff and stethoscope
Thermometers, disposable, one package
Medical tape, 3 rolls
Emergency Light
Chem lights, red, 2+
Water purification kit (tablets or drops)
Military surgical kit
Benz-All (to sterilize surgical equipment), one bottle
Ace bandages, two each
EMT shears



Under Lid, Top Section:

Non-adhering dressing, 3"X8", 10 packages of 3 each
4 ounces eye wash
Drainage Dressings, 5"X9", 10
Gauze rolls, one dozen
Surgical tape, 3+ rolls
Latex Gloves, 25 pair
Syringes, irrigation, 6
Gauze pads, 4"X4", 40
Gauze pads, 5"X9", 50



Separate Box, (ex. Tupperware Tote Bin)

Gauze Pads, 5"X9", 50
Gauze Pads, 4"X4", 50
Gauze Rolls, 50
Gloves, latex, 50 pair
Face masks/Dust masks 20
Water, 12 bottles
Garbage bags, dozen
Blanket
Hydrogen Peroxide, one bottle

 

In addition to the above kit, a stretcher, 5 gallons of water, a tarp, and at least two blankets should be included in support vehicles. Refer to support requirements for more information.

Above: Platoon/Support first aid box. This is a toolbox available at Meijer's.

 

 

Subject: Dehydration

Matthew D. Fauls, EMT-P

militiamedic@yahoo.com

      Dehydrate- v. to lose an abnormal amount of water from the body.

      Now what does that mean? It means you are putting out more water than you take in.  Water is the most abundant substance in the human body, 60% of your total body weight is water.  That means in a 154 lb person (come on, there has to be one of you out there that only weighs 154 lbs) there are 11 gallons of water.  Your body wants to keep it that way to.  So for every ounce you take in you have to put one out and vice versa. 

       We take in water in two ways, as a liquid and as solid food, you actually take in just a little more in solid food than you do as liquid.  We lose water mainly in four ways, breathe it out as water vapor, pee it out as urine, sweat it out or lose it through bowel movements.  Your body has two ways to regulate water, first, through a hormone called ADH(anti-diuretic hormone) which tells your kidneys to reabsorb more water and excrete less urine causing the urine to be more concentrated (and thus darker), and secondly, through thirst.

      Now, there are many ways to become dehydrated, but we are only going to deal with the ones you run into an a normally safe camping environment. One is through an increase in insensible loss, or a loss we don't really notice until it's too late.  This includes sweating, and exhaling water vapor from the lungs.  These can be increased in many ways in any weather not just hot.  In fact in cold weather we may be even less aware than in hot.  When you start moving in those heavy coats you sweat and you breathe heavily causing you to blow off more moisture.  Remember in very cold weather the air is very dry, you expel warm moist air and intake dry cold air.  Another quick route to dehydration is diarrhea.  During diarrhea you are expelling many times more fluid in feces than normally.

      What are some of the symptoms of dehydration?  One of the first is thirst, followed by dry mucus membranes, nose and back of the mouth, and concentrated (dark colored) urine.  Later signs are orthostatic hypotension, a rapid fall in blood pressure when you go from lying to standing, you would feel dizzy and possibly pass out. And poor skin turger or the resistance of the skin to deformation, e.g. When you pinch the skin on your arm it stays pinched and doesn't immediately return to flat.

      What do we do about it?  Well like the commercial says “obey your thirst.”  Think about it, if your average Joe needs 8 eight ounce glasses a water a day for just normal body function, how much do you think you need doing just a mild amount of physical activity? So drink plenty of water.  Water is the best defense,  sports drinks are more for once you are burning, and pop and juice may make things worse. Caffeine acts as a diuretic, and sugar requires a great deal of water to digest. In extreme cases IV therapy may be required in order to replace electrolytes.  Also treat diarrhea immediately! Everyone should carry at least two courses of Imodium AD. A course consists of three pills, with the first dose consisting of two pills after at the first lose stool, then one additional pill if there is another loose stool. Periodically check the dates of your anti-diarrhea medicine, and any other medications that you feel the need to carry.

      In parting, remember dehydration will eventually kill you.  Your heart is an electrical pump that gets its electricity from a chemical reaction.  With out the proper hydration the chemicals become unbalanced causing an arrhythmia and eventually death.

 

      This article is for informational use only.  It is not meant to replace the care of a qualified Doctor or common sense.  All information is to be used at your own risk.

Matthew D. Fauls, EMT-P

militiamedic@yahoo.com

(Matt Fauls is a Paramedic with a very large southeastern Michigan EMS department. He is currently Level One qualified until Dec 31st, 2006. He is also one of the original five Level One testers/developers from 1997.)

 

 

 

 

 

 

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