Review of Iron Duck's Ultra Breathsaver | 34018

Ultra Breathsaver | 34018

Simply the best trauma deployment system on the market, this bag was designed by field professionals for efficient storage and fast, error-free deployment of oxygen/resuscitation, airway management, and trauma supplies. Manufactured with top-of-the line materials and exacting workmanship for rugged good looks and durability under the most extreme conditions.
2 fold-down front pockets feature a flat zippered compartment with two rows of elastic. On the opposite side, 2 large open pouches for bulky trauma supplies with a row of wide elastic. Carry hard collars in a full-length, fully-opening rear pocket. Contains 4 gusseted pouches under a row of multi-sized elastic tacking. The left end-pocket offers fast access to a fully assembled “D” tank. Elastic mesh prevents the flap from falling open when in use. A hard plastic flat pocket holds masks and tubing while protecting the regulator. Or, insert a hard plastic wall for a fully functioning pocket. The right end pocket (7”H x 7.5”W x 2”D ~ 105 cu in) is unstructured. Two Extra strong seatbelt grade nylon web handles, adjustable sling-style shoulder strap, molded rubber grab handle above the right end pocket completes the exterior design.

 Standard Nylon Colors: Orange, Red, Royal Blue

 Dimensions: 27"L x 14"W x 12"H ~ 3,763 cu in

How to Relieve a Tension Pneumothorax in the Pre-Hospital Setting

Tension pneumothorax is the progressive build-up of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not to return. Positive pressure ventilation may exacerbate this 'one-way-valve' effect. Progressive build-up of pressure in the pleural space pushes the mediastinum to the opposite hemithorax, and obstructs venous return to the heart. This leads to circulatory instability and may result in traumatic arrest.

Diagnosis

The classic signs of a tension pneumothorax are deviation of the trachea away from the side with the tension, a hyper-expanded chest, an increased percussion note and a hyper-expanded chest that moves little with respiration. The central venous pressure is usually raised, but will be normal or low in hypovolaemic states.

 

Management

Needle Thoracostomy

Classical management of tension pneumothorax is emergent chest decompression with needle thoracostomy. A 14-16G intravenous cannula is inserted into the second rib space in the mid-clavicular line. The needle is advanced until air can be aspirated into a syringe connected to the needle. The needle is withdrawn and the cannula is left open to air. An immediate rush of air out of the chest indicates the presence of a tension pneumothorax. The manoeuver essentially converts a tension pneumothorax into a simple pneumothorax.

Many texts will state that a tension pneumothorax is a clinical diagnosis and should be treated with needle thoracostomy prior to any imaging. Recently this dogma has been called into question. Needle thoracostomy is probably not as benign an intervention as previously thought, and often is simply ineffective in relieving a tension pneumothorax. If no rush of air is heard on insertion, it is impossible to know whether there really was a tension or not, and whether the needle actually reached the pleural cavity at all. Some heavy-set patients may have very thick chest walls.

Needle thoracostomies are also prone to blockage, kinking, dislodging and falling out. Thus a relieved tension may re-accumulate undetected. More importantly is the possibility of lung laceration with the needle, especially if no pneumothorax is present initially. Air embolism through such a laceration is also a real concern.

Combat Application Tourniquet (C-A-T) - Tactical Black

1. Official Tourniquet of the U.S. Army
2. Proven to be 100% effective in occluding blood flow in both upper & lower extremities by the U.S. Army’s Institute of Surgical Research
3. Featuring NAR's Red Tip Technology™ with a red elliptical tip to assist user in locating and threading during application
4. Reinforced windlass clip & highly visible security tab includes a writeable area to record the time of application

Product Review of QuickClot Hemostatic Dressing

How it works:

The Key Ingredient: KAOLIN – A Small Mineral with Huge Stopping Power

How an inert mineral can create a powerful, natural, and stable clot.

QUIKCLOT’s third generation of hemostasis products, each specially engineered for use by healthcare professionals, is based on a naturally occurring, inert mineral, kaolinite. Each of the gauze-based hemostasis products is impregnated with kaolin, a white alumina silicate that has been known for decades to activate blood clotting in vitro. When exposed to human plasma, kaolin activates clotting Factors XI and XII, mobilizing the body’s natural coagulation cascade. Known to foster platelet adhesion at the sound site, kaolin contributes to the formation of an active, natural, and stable clot.

When QUIKCLOT hemostatic dressings go into contact with blood in and around a wound, they quickly assimilate the smaller water molecules found in the blood, leaving behind, in the wound, a highly concentrated mix of larger platelets and clotting factor molecules. This process along with kaolin’s key surface chemistry, promote extremely rapid and natural coagulation and prevents severe blood loss.

Within minutes, QUIKCLOT hemostatic dressings create a natural, stable, and powerful clot without containing any animal or human proteins or botanicals.

Army Corps of Engineers VS. Fire Department - Who has the Tactical Rescue advantage?

 

      VS

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EpiPen as a BLS skill in Israel

The EpiPen^® and EpiPen Jr Auto-Injectors (0.3 and 0.15 mg epinephrine) are used for the injection of epinephrine, the first-line treatment for allergic emergencies (anaphylaxis). EpiPen Auto-Injector is used to treat signs and symptoms of an allergic emergency, some of which include hives, redness of the skin, tightness in the throat, breathing problems and/or a decrease in blood pressure. Allergic emergencies can be caused by triggers such as food, stinging and biting insects, medicines, latex, or even exercise.

What is anaphylaxis?

Anaphylaxis is a severe systemic allergic reaction resulting from exposure to allergens that is rapid in onset and can cause death. Anaphylaxis is triggered by a wide range of allergens including but not limited to foods, insect stings and bites, medications, and latex. While less common, anaphylactic reactions can also be triggered by exercise. When no triggers for an anaphylactic reaction can be identified, a diagnosis of idiopathic anaphylaxis is made. Anaphylaxis occurs most commonly in the community setting, in the absence of a health care professional, so it is essential for patients at risk for anaphylaxis to be identified and prepared in the event of an emergency. Anaphylaxis poses serious health consequences if at-risk patients are not identified and prepared. As such, anaphylaxis should be treated as a preventable, long-term disease for at-risk patients.

EpiPen and EpiPen Jr Auto-Injectors are available in single cartons and 2-Pak cartons. It is important that patients at risk for allergic emergencies carry two doses of epinephrine. EpiPen 2-Pak provides an additional dose if needed during an allergic emergency. More than two doses of EpiPen Auto-Injector should only be administered under direct medical supervision.

Disposable Plastic vs Stainless Steel Laryngoscope Blades in the Pre-Hospital setting



Metal



 

Plastic



Background

Several studies have been published in the literature about intubation methods, but little is available on intubation equipment used in this setting. This is the first prehospital comparison of disposable plastic vs disposable stainless steel laryngoscope blades used by paramedics.

   Study Objective

The objective of this study was to compare prehospital intubation success rates on first attempt and overall number of attempts to obtain intubations using disposable plastic laryngoscopes blades vs disposable stainless steel laryngoscope blades.

   Methods

A retrospective prehospital cohort study was conducted during two 3-year periods. Two-way contingency table and χ² test were conducted to determine if there was a difference between the 2 types of blades. A proportional odds model with calculated 95% confidence interval (CI) and odd ratios were then calculated.

   Results

A total of 2472 paramedic intubations were recorded over the 6-year period. The stainless steel single-use blades had a first attempt success rate of 88.9% vs 78.5% with plastic blades (P = .01; odds ratio, 1.94; 95% CI, 1.17-3.41). The stainless steel single-use laryngoscope blade had a lower number of attempts to successful intubation than the plastic blade (88.8% vs 74.3%, respectively) (P < .01; odds ratio, 1.64; 95% CI, 1.34-2.00).

   Conclusions

In the prehospital setting, stainless steel disposable blades were superior to plastic disposable blades in first attempt and overall number of attempts to intubation. Until further research is done, we recommend use of stainless steel blades for intubations in the prehospital setting by paramedics

Tactical Equipment for the Tactical Medic



SureFire 6P^® LED Defender^®

 



Leatherman Wave Black Oxide Tactical Multi Tool



Benchmade 950SBK ComboEdge



Res-Q-Me Rescue Tool



Comparing Tactical Stethoscopes

615 Tactical by ADC

Puretone PT15 by DRG

3M™ Littmann® Master Classic II

Asherman Chest Seal

Developed for rapid management of open chest wounds in emergency situations. Designed by a Navy SEAL medic for more effective management of gunshot or other chest-penetrating wounds.

Unique Design

·  One-way design allows air to escape pleural space through wound

·  Automatically vents sucking chest wounds

·  Translucent design allows monitoring of wound

Rapid Application

·  Simply center on wound and apply

·  One-step application; self-adhesive unit automatically seals wound

·  Venting begins with the first breath

How to Perform a Field Tracheotomy

A field tracheotomy is emergency tracheal surgery to establish an open airway in someone who has suffered extreme trauma to the tracheal area and cannot breathe. Usually this is done on the battlefield or after a traumatic traffic accident. Only trained medical personnel should attempt such surgery.

Instructions

1. Locate the correct spot in the neck which is the lower part of the neck between the Adam's apple and top of the breastbone.

2.    Make an incision through the neck and separate the tissues and muscles. The thyroid gland should be visible. Cut down the middle of the thyroid gland and separate. The rings of cartilage can now be seen. Cut between the rings into the tough wall into the windpipe.

3.   Insert a tube into the opening which will act as an airway. Anything can be used that is rigid and open at both ends. A ball point pen case or a plastic straw can be used in extreme emergencies in the field.

4.    Perform a field tracheotomy only in severe emergency situations as a last-resort procedure. It is only done if the patient's trachea is obstructed and the situation is life-threatening.

Some more technical info on Combitube:

The Combitube is a twin lumen device designed for use in emergency situations and difficult airways. It can be inserted without the need for visualization into the oropharynx, and usually enters the esophagus. It has a low volume inflatable distal cuff and a much larger proximal cuff designed to occlude the oro- and nasopharynx (1-4).

If the tube has entered the trachea, ventilation is achieved through the distal lumen as with a standard ETT. More commonly the device enters the esophagus and ventilation is achieved through multiple proximal apertures situated above the distal cuff. In the latter case the proximal and distal cuffs have to be inflated to prevent air from escaping through the esophagus or back out of the oro- and nasopharynx.

The Combitube has been used effectively in cardiopulmonary resuscitation (11,14,15). It has been used succesfully in patients with difficult airways secondary to severe facial burns, trauma, upper airway bleeding and vomiting where there was an inability to visualize the vocal cords (9,10,12,13). It can be used in patients whose cervical spine has been immobilized with a rigid cervical collar, though placement may be more difficult(1,7). Ventilation does not seem to be affected by the rigid cervical collar if the Combitube can be placed (6).

The Combitube can only be used in the adult population as no pediatric sizes are available.

Complications of the Combitube include an increased incidence of sore throat, dysphagia and upper airway hematoma when compared to endotracheal intubation and LMA(16). Esophageal rupture is a rare complication but has been described (20-23). Known esophageal disease is a contra-indication to the use of the Combitube. These complications may be partially preventable by avoiding over-inflation of the distal and proximal cuffs (see recommendations below). Compared to intubation with an endotracheal tube under direct laryngoscopy or using the LMA, the Combitube seems to exert a more pronounced hemodynamic stress response (17,18).

Although it is possible to maintain an airway with the Combitube, endotracheal intubation is the preferred method for definitively securing the airway. Either the oral or the nasal route can be used for fiberoptic-guided airway exchange. The Combitube is left in place and the proximal cuff is partially deflated for fiber-optic intubation with an endotracheal tube.

Preparation

Little preparation is needed beyond testing both cuffs for leaks. The pilot balloon of the distal cuff is white and is marked with the number 2. Test the distal cuff by inflating with 15 ml of air. The pilot balloon of the proximal cuff is blue and is marked with the number 1. Test the proximal cuff by inflating with 85 ml of air.

The available sizes are 41 Fr and 37 Fr. The original recommendation by the manufacturer is to use 41 Fr for patients taller than 5ft (152 cm) and 37 Fr for patients below that height. However, the bulky design of the 41 Fr can make it more technically difficult to insert and some authors (3) have reported satisfactory results using the 37 Fr Combitube on taller patients. A redesigned Combitube has been described by creating an enlarged hole in the pharyngeal lumen that allows fiberoptic access, tracheal suctioning, and tube exchange over a guide wire (8). However, this type of Combitube is not available in our department.

Oral Intubation: A Step by Step Guide

The combitube can be inserted blindly without the aid of a laryngoscope. However, use of a laryngoscope has been reported to facilitate placement of the Combitube. It appears that the laryngoscope aids insertion by forcefully creating a greater space in the hypopharynx.

• Induce patient as if for regular intubation.
• Patient head position can be neutral.
• When direct laryngoscopy is attempted and the vocal cords can be visualized, the Combitube should be placed in the trachea and used as a regular endotracheal tube.
• Inflate the distal cuff with just enough air until no leak is present.
• Check for bilateral breath sounds over the lungs and confirm endotracheal placement on the capnogram.
• Connect the breathing circuit to the white connector number 2.
• If the Combitube is placed blindly, the left hand should elevate the chin while the right hand maneuvers the Combitube. Alternatively, more space can be created in the hypopharynx by using a laryngoscope with the left hand. The Combitube should be inserted to such a depth that the upper incisors are between the two black guidelines on the external surface of the tube :
• Inflate the distal cuff with 12 ml.
• Ventilate through the white connector number 2 and listen for gurgling sounds over the epigastrium or breath sounds over the lungs. If breath sounds are heard over the lungs the Combitube has been placed in the trachea and can be used as a regular ETT as described above after confirmation on the capnogram. If gurgling sounds are heard over the epigastrium, the Combitube is located in the esophagus.
• Inflate the proximal cuff with just enough air until either no leak is present or a subjective sensation of increased resistance to cuff inflation is encountered. This is usually achieved by inflating with 50-75 ml of air. This is less than the 85 ml recommended by the manufacturer but has been found to cause less upper airway trauma (1)
• Ventilate through the blue connector number 1, listen for breath sounds over the lungs and confirm ventilation on the capnogram.

Can the use of a Combitube be used as a BLS skill for Intubation?

The Combitube works whether placed in the esophagus or trachea. It requires no restraint. The Combitube comes with two inflation syringes, a suction catheter, and an aspiration deflection elbow. "Roll-up" versions come in space-saving packaging.

Advantages to the Combitube

Prevents aspiration; airtight

Gastric fluids can be suctioned

Allows subsequent endotracheal intubation around the device

Easily inserted blind without head and neck movement or instrumentation

Foam molded quad-fold design helps keep medications organized and at your fingertips. IV catheters, needles, syringes are neatly arranged for simple identification. The “Vial Strand” holds multi dose meds tightly in place with pull tabs for easy removal. Prefilled doses can be organized in the middle section. Considered to be one full cell in the Cellular System.

Exceptional in urban or rural areas where “stay and play” medical protocol is used. Customizable shelving allows superior organization of virtually any combination of equipment and supplies. The advanced harness system helps you tackle daunting flights of stairs and hard-to-reach accident scenes safely and with free hands.

Foam-lined construction maintains pack shape and protects contents

• Main compartment houses three removable sub-packs

   that are held in place with hook-&-loop backing

• Allows a customizable set-up with any combination of StatPacks

   modules including the QuickRoll Intubation, Drug and IV modules

• Quick-zip access to main compartment  to offer fast, smooth action

• Single-buckle top closure allows quick in and out

• Ergonomic, padded shoulder straps, back panel

   and waist belt offer comfort during long transport

• Padded, back panel holds hydration bladder

• Large side pockets allow quick access to equipment

• Webbing loops on outside of pack for various attachments

• Load handle for quick/easy carry

• Silent zipper-pulls for quiet situations

• Special make Camouflage colors are available

   – please contact us for details

• Available Color: Tactical Black

Stealth TAC

Incorporates advanced features of modern outdoor long-haul hiking packs with the realistic needs and governmental requirements of Military, SWAT, and Special Ops medics. Created to help Tactical Medics carry necessary medical equipment in special operation situations

StatPack G1 Load N' Go

Reviewing the Stat Pack G1 Load N' Go.

The ideal pack for fixed wing and critical care transport, ambulance and fire engines. No pack keeps equipment more organized and quickly accessible thanks to thoughtfully designed transparent sleeves, mesh pockets, and elastic holsters that are arranged in three layers.