Backcountry First Aid Kit, By Richard Rhodes

[ffparamedic]

Interesting. I have not seen that study. If you can find a link I’d like to read it.


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CF,

No idea exactly which article Mike might be referring to but I will leave you with this one An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs it states "It can be seen from the Oxford League Table that few analgesics, if any, are better than NSAIDs for acute pain. All NSAIDs have a NNT of 1.6 to 3.0 on the league table. Alternative analgesics like codeine phosphate 60 mg and tramadol 50 mg, which are commonly used, have an NNT of 16 and 8, respectively. Even parenteral morphine 10 mg and pethidine 100 mg have an NNT of only 2.9." and " As a group, NSAIDs are excellent analgesics and are even more efficacious than intramuscular morphine for acute pain. However, it should be noted that the evidence for the efficacy of NSAIDs comes mainly from the study of acute pain conditions."

There is also this one An Overview of Pain Management: The Clinical Efficacy and Value of Treatment which states "In the majority of cases, an NSAID is likely to be the first line of therapy, in part because it has superior efficacy compared with acetaminophen, but does not incur the same degree of risk as some of the more potent drugs. There are risks inherent with NSAID use, but this is also true of acetaminophen—for a typically smaller therapeutic effect—and of opioids, which are associated with a spectrum of concerns of which side effects represent only 1 significant contributor."

 

[cfdjay]

Outstanding. Thank you.


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[COlineman78]

What would be common names for NSAIDs? Aleve?

 

[COlineman78]

CO,

I personally do not recommend it. I won't go so far as to say that you shouldn't, except to say that you should NEVER take anything that you have not taken in the past, AKA your wife's pain meds that you snagged for the hunt as you could have some reactions to that. Other than that I am generally opposed to the idea as narcs can cause some issues with cognitive function and if you're using them for pain management then it stands to reason you're already not functioning well and need all of your senses and judgment to be working properly.

As Mike pointed out most OTC pain control works just as effectively. Think 800mg ibuprofen.

Also, you won't walk out on a true non-splinted broken leg.

I agree that it's not exactly the best situation to be in to be trying out drugs you never had before. Also most narcotics will not sit well on an empty stomach so something else to remember if you do take them or you'll probably just puke them back up.

Maybe I'm just ignorant or missing something. I have no formal training in medicine so forgive the stupid question, but I thought vitamin-I was simply an anti-inflammatory and not a painkiller like Acetaminophen or Naproxin. I too have a high threshold for pain and hate taking opiates, but I find it hard to believe OTC meds can numb pain as well as Oxy after having felt it's effectiveness first hand: I weaning myself off them too quickly after foot surgery and experiencing 15 minutes of excruciating pain waiting for it to kick back in.

Also, I don't however feel like it effects, at least my, cognitive function enough to effect attempts of a self rescue. And maybe that's the real answer is that it depends on how narcotics effect you individually.

 

[Mike7]

Mike,

Thank you for the very detailed and informative post!! Great discussion we have here. Thank you for your service to our country and Marines.

I am not a big fan of antibiotics, especially in the pre-hospita setting.

Very interesting on the saran wrap! I will certainly give that a try, my initial concern would be the trapping of heat? Can you comment on that aspect of using it?

For burns the initial treatment of cooling and cleansing remains unchanged I think, but directly after this when pain and infection (and fluid loss especially with large burns) become the big issues with 2nd degree burns, using the Plastic Wrap instead of 'just' an ointment/cream like Silvadene, decreases the pain level quite amazingly. The plastic wrap is readily available anywhere and much cheaper than the fancy gel burn dressings. I have found this particularly helpful in children. I have never worked on a designated burn unit in my training, and don't know of any studies comparing plastic wrap to more expensive burn dressings and techniques...and since plastic wrap is cheap, I don't expect that studying it is a high priority for anyone.

I learned this trick from another doc who had apparently had experience in burn units and used this very effectively when stuck at sea aboard ship dealing with some very serious burns far from any stateside burn unit. Anecdotally, it works great for the typical burns cared for by Family Medicine, or those that I took care of in the military. I think some of my guys were more comfortable with this treatment in the field, than after they got out of the field and to the hospital or base clinic. But it is difficult though to keep burns clean in the field, appropriately debride more serious burns in the prehospital setting, and a Marine cook for instance with scald burns from boiling water all over his lower extremities is pretty much worthless in the field anyway.

 

[Mike7]

Interesting. I have not seen that study. If you can find a link I’d like to read it.


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I have seen a few studies over the years which all echo the same thing, but they don't make the news when the political pendulum in the medical world happens to be swung over toward the "pain is the fifth vital sign" mantra, and all people should never experience any pain or discomfort at all, especially when they leave your clinic or ER.

But now since the pendulum is swung over more toward "all opioids are the devil", you can see articles like this one below publicizing these types of studies. I try not to pay attention to the political histrionics regarding narcotic pain meds, but rather have always just used them where I felt appropriate, but with great respect and restraint. If people don't like that, then they can go on their way. Just our small population compared to countries in the rest of the world uses by far and away the most opioids for chronic pain...so we might just have a little problem. I still have many people come to me shocked when I tell them my goal is just to safely decrease their pain so that they can function through a variety of different techniques, and some of which might include medication...rather than completely numb them with high dose opioids to everything that is life as they had hoped. Lol.

As epidemic rages, ER study finds opioids no better than Advil and Tylenol | Ars Technica

 

[Lawnboi]

Good stuff. Also a paramedic, though my first aid kit I carry is pretty spartan, I feel that a lot of stuff can be improvised if really needed.

 

[jhayes6405]

I gotta say, as a former medic in the army, this article is spot on, all the way down to the needle for irrigation and the kifaru pouch, my kit is near identical.

 

[ffparamedic]

I gotta say, as a former medic in the army, this article is spot on, all the way down to the needle for irrigation and the kifaru pouch, my kit is near identical.

Thank you sir! I appreciate that!

 

[nrh6.7]

Just wanted to say thanks again to the OP for this article. I just received my supplies from the EMS Store (in his link) and the pricing was incredible. Compared to the local store, this place is really reasonable and shipped quickly.

Thanks for putting this info out there. Doubt I'll need anything else for quite a while.

 

[ffparamedic]

Just wanted to say thanks again to the OP for this article. I just received my supplies from the EMS Store (in his link) and the pricing was incredible. Compared to the local store, this place is really reasonable and shipped quickly.

Thanks for putting this info out there. Doubt I'll need anything else for quite a while.

You are more than welcome! I'm glad Rokslide saw the need and once again undertook the effort to put out some needed info. I appreciate the feedback on your purchase, let me know if I can help you in any way!

 

[lipripr]

Do you think compression straps from your pack could be an effective tourniquet? Thanks for the informative article.

 

[Smash]

Do you think compression straps from your pack could be an effective tourniquet? Thanks for the informative article.

I would say yes as long as you get a stick and put it some of the webbing and twist to tighten down. Most tourniquets go on much tighter than someone pulling on webbing.


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[ffparamedic]

Do you think compression straps from your pack could be an effective tourniquet? Thanks for the informative article.

That's not a simple answer. In short, no. If you used a compression strap it would have to be able to wrap around your limb multiple times to create enough compression to cut off arterial bleeding. A single loop would not stop the bleeding. If you used a strap with no compression and used a stick to create a TQ effect you could.


Another issues with these type straps is the width of the strap, the wider the better. Most compression straps are rather thin.

 

[cfdjay]

Has anyone had success with Zofran ODT? Thought about including in case of beaver fever. I seem to have mixed results from my patients.

 

[ffparamedic]

It seems to have mixed results. If you're going to use ODT Zofran get the dissolving kind, it has a much greater efficacy. In most cases oral zofran is expelled before it can be metabolized.

As a side not I don't recommend using Zofran for beaver fever and prefer to let it run it's course. I use it after a few days and or the risk of dehydration is too great.

 

[ScottParson]

I am currently recertifying on a Advanced Wilderness First Aid Course for my job and the applications that a tourniquet is able to provide besides the one that it is designed for are well worth their weight and space. I will have one in my pack from here on out.

 

[timekiller13]

Has anyone had success with Zofran ODT? Thought about including in case of beaver fever. I seem to have mixed results from my patients.

If actively vomiting (I mean hardcore vomiting, not the occasional up-chuck) then Zofran ODT doesn't work very well. If you are just nauseated, feeling the ole stomach churning and heaving every now and then, then it works pretty well. I keep a few Zofran ODT in my first aid kit. But if you, or your hunting partner is really sick and consistently vomiting every few minutes, then a Phenegran suppository is the best bet. I keep two of these in my first aid kit as well.

NSAIDs are awesome for pain relief. Ibuprofen (Motrin) or Naproxen (Aleve) do wonders, especially for joint pain and back pain. The key is to keep them in your system. You have to keep that anti-inflammatory in you on a consistent basis. Take 400-800mg of Iburpofen every 6-8 hours. Take 500mg of Naproxen every 12 hours. Do not exceed 3200 mg of Ibuprofen in a 24 hour period or 1100mg of Naproxen in a 24 hour period. You can rotate some Tylenol in between doses of NSAIDs just to give you a little more analgesia. When I ruptured a disc in my back a few months ago, I was taking 600mg of Ibuprofen every 6 hours and tossed in 500mg of Tylenol every 4 hours. As long I kept it in my system, the discomfort was manageable and I could go about life. This combination allowed me to work and I never had to take any opiates or other high power pain meds.

Be careful with long term use of NSAIDs. They can cause kidney issues and GI bleeds. Tylenol causes liver toxicity in high doses, so do not exceed 4000 mg in a 24 hour period.

In terms of a tourniquet, anything is better than nothing if you or your partner is truly bleeding out. Compression straps may not be ideal, but in a pinch they would work. Belts can be used as well. Hell, I used a shoe lace on a solider's arm once. We were training locally and he sliced his radial artery. Typical National Guard, no one had a complete medical kit available close by. I wrapped the shoelace around his arm, tightened it down with stick. Stopped the bleeding long enough until someone could go grab an aid bag and apply a real tourniquet. The key is to get it as tight as you can. Use a stick to really tighten that thing down. I carry a combat tourniquet in my first aid kit, along with an Israeli bandage. You can buy all this stuff online or at many local sporting goods or backpack stores.

 

[clbrown23]

I realize this thread is somewhat old, but was curious if anyone had any experience or opinions on the S.T.A.T. Tourniquet? Seems simple to use and a lower weight cost

 

[Bigfootcali]

I realize this thread is somewhat old, but was curious if anyone had any experience or opinions on the S.T.A.T. Tourniquet? Seems simple to use and a lower weight cost

C.a.t is my choice and can be carried on your person for easy access.