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Komodo
Doc

Guide to Life Saving Interventions

Posted 05-14-2022, 10:44 AM
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Komodo's Guide to Life Saving Interventions

Intro
In this thread I will be going over interventions I've used in the Military, EMS, and working at a hospital. I used to teach CLS (Combat Life Saver) courses in the military to my unit. This is a decade's worth of medical information, so I will use laymen's terms in most of the thread to keep it at the simplest level possible. I strongly encourage anyone to give this a skim as one day you might need it.

Disclaimer
Anything said in this thread is Medical Information and facts, I am not a doctor, nor am I treating you in a professional setting. Any medical emergency should be seen immediately by a doctor and taken care of.

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Tourniquets
Probably the most important intervention is a Tourniquet. Extremity bleeding was the largest killers of soldiers and marines in Iraq and Afghanistan, a tourniquet correctly placed could have changed the outcome of multiple GSW casualties. From different windless', straps, loops, and clips Tourniquet's come in all different shapes and sizes. Below is the Gen 7 CAT Tourniquet, probably the most globally used Tourniquet out of them all. You can see how they've changed the loop from a double to a single, while this doesn't seem like much imagine having to lift up a thigh and run the strap through 2 different loops while someone is bleeding out.

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Tourniquets are super easy to use; you put the end of the Tourniquet which is bright red through the loop, tighten the strap as much as you can and velcro it down, then you turn the windless until you can't fit a finger under it anymore or the bleeding stops. Make sure you mark on the Tourniquet the time in which you placed it, this is extremely important for doctors determining treatment for the patient. These types of Tourniquets are always temporary and you should change to a Deliberate Tourniquet as soon as safe. Placement however is the most important step. There are 2 types of Tourniquets, Hasty and Deliberate. I will teach you how to convert a Hasty into a Deliberate below, but for the rest of the guide I will not teach you when to remove a Deliberate. This should only ever be done by a medical professional, and if you could cause further harm to the casualty.

Hasty
Hasty Tourniquets are placed when you immediately need to move someone for instance in combat or the police. Hasty Tourniquets are placed 'high and tight' you put them as high onto the extremity as possible, as tight as possible. These types of Tourniquets are always temporary and you should change to a Deliberate Tourniquet as soon as safe. In the military we called this the 'X', and this is the only intervention we would do before dragging someone out of the combat zone.

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Deliberate
Deliberate Tourniquets are placed 2-3 inches above the injury, never on a joint (If 2-3 inches above the injury is a joint, go 2-3 inches above that joint). The difference between these 2 is a Hasty is cutting off circulation to the entire extremity, Deliberates are honing in on the injury site and giving the best outcome for controlling bloodloss. When converting from a Hasty to a Deliberate, put the Deliberate on first and when secured slowly loosen the Hasty over 15 seconds, if blood starts coming out of the injury tighten it back up and check your Deliberate. Never leave a Hasty and Deliberate on for extended periods of time, this will cause Compartment Syndrome.

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Komodo's Tourniquet Tips:
  • If bleeding isn't stopped from one Tourniquet, add a second directly above it.
  • You can always get one more twist out of the windless.
  • Always tape down your Tourniquets, movement can cause them to loosen.
  • Secure your windless strap, it always comes undone.
  • If your turning the windless more than 3 times, you didn't tighten the strap down enough.
  • Improvised Tourniquets work just as well if thick, and tight enough.

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Combat Gauze
Combat Gauze or Quick Clot is extremely effective towards stopping bleeding. Inside is a chemical agent called Kaolin which makes your blood stick to your fiber netting and being to clot at a much more efficient rate. Back in the day we used to use powdered quick clot, but it would get extremely hot and basically melt all your vein, arteries, and nerves together. Quick clot is a much better alternative to this. Below is the what I've most commonly seen, great design with the easy tear on the top and bottom.

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Combat Gauze is a bit more tricky to use. The first step is determining the injury site, let's say there's a GSW to the right thigh. The first step should be controlling the bleeding with a Tourniquet, combat gauze won't do anything if they're still bleeding out. Once controlled we would need to locate exactly where the bleeding is coming from, the best way if you can't see it is to stick your finger inside and feel around for a pulsing sensation. Once you find your spot, you will start feeding the injury with combat gauze like you would tickets at an arcade. You will always feed going towards the heart, never away from. You always want to put extra gauze on top of your work about 2-3 inches sticking out, any extra blood coming out will get soaked up in this. Hold pressure over the combat gauze for a minimum of 3 minutes, and never change out the dressing once their blood starts coagulating, this will cause them to bleed again.
Below are devices used to secure the combat gauze in place:

Ace Bandages
Always a great choice, it's really just a very stretchy and thick piece of elastic. I prefer the 3" rolls because they cover more area. Just wrap this around the combat gauze as tight as you can, you want as much pressure as possible on top of that combat gauze. Never trust the clips at the end of the ace bandages, always secure with 3" tape as well as the clips.

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Pressure Bandage
Otherwise known as an Israeli Bandage, do the same job as an Ace Bandage, but you can apply way more leverage to it. The pressure bandage has a pressure bar that you feed the end of the bandage through, allowing you to use leverage and your body weight to make the wrap much tighter. Make sure you place the large white pad onto the effected wound and make sure it doesn't move off of the wound when applying tension to the pressure bar.

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Komodo's Combat Gauze Tips:
  • Never pack Combat Gauze into the Thoracic Cavity.
  • Have a helper hold pressure for 3 minutes while you get ready to wrap the Combat Gauze.
  • Don't pack if the casualty is bleeding out, apply a Tourniquet.
  • Make sure your Combat Gauze is dry so it activates correctly.
  • Change the dressing every 1-2 days depending on scenario.

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Occlusive Dressing
This type of dressing is primarily used for Thoracic Chest puncture wounds that are or could cause the casualty to end up in Tension Pneumothorax. Tension Pneumothorax basically means theres a leak of air and the lungs can no longer get a good seal. Causing one side of the lungs to collapse, crush your organs, and not allow your casualty to breathe. To get that seal back we put Occlusive Dressings on top of any puncture wounds in the Thoracic Area, does not matter the size.

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The purpose of the occlusive dressing is to regain the seal of air within your chest cavity and lungs. You want to take the Occlusive Dressing which is extremely sticky and place it over the site of injury upon exhalation. The purpose of this is to have as much air as possible released from crushing the lung and then sealing it up so it can't come back in. You may have to 'burp' the dressing a couple of times to get all the air out, this basically just opening one side of the dressing and replacing upon exhalation to allow more air out.
Occlusive Dressing do not always work, so here is another intervention used for Tension Pneumothorax:

Needle Chest Decompression (NCD)
If an Occlusive Dressing doesn't work, the next step would be releasing the air by using a NCD. An NCD is a 3 and 1/4" length, size 14 catheter, it is one of the largest needles used in medicine. The primary location is directly above the 3'rd rib in the Second Intercostal Space, parallel to the notch in your clavicle (Generally the nipple line). You will insert at an angle parallel to the chest wall, and leave the needle inside for 10 seconds before removing it. Some people say you can hear a 'hiss' as the air escapes the body, but I would just use a stethoscope or listen to the breathing to confirm if the lung is still collapsed.

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Komodo's Tension Pneumothorax Tips:
  • The packaging for a Hyfin Chest Seal can be used as a second Occlusive Dressing as long as you tape all sides around the wound.
  • Always make sure to place a chest seal upon exhalation.
  • Listen to breathing before inserting a NCD, it may not be necessary.
  • Always insert directly above the 3rd rib, there is a bundle of nerves directly below the 2nd rib.
  • Never take out a stabbed object from the Thoracic Cavity unless it is in the way of you doing CPR.

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Airway Interventions
I will use the simplest interventions everyone should know about, I will not go into advanced Airway Interventions here. The airway is very important to keep open when treating a patient, something as simple as their tongue can fall back and they are no longer able to get air into their lungs. The simplest way to open the airway on an unconscious patient is called the 'Head Tilt Chin Lift', basically you're pushing up on their chin and down on their forehead putting them into a neutral position, and maintaining an opening in that airway.

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Nasal Pharyngeal Airway (NPA)
NPA's are used on most unconscious patients in the military and EMS. It's just a very simple way to make sure that the airway is open. It's basically just a tube that goes from your nose to the back of your throat to keep the airway open. This is a very simple but effective way to have a basic airway open. You insert the NPA with the bevel facing towards the septum once it's lubed up, and you keep advancing and spinning if you meet resistance. Secure the NPA with tape to the nose otherwise it will be pushed out.
Sizing an NPA is as easy as making sure it's long enough to reach from the bottom of the ear lobe, to the nose.

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Oral Pharyngeal Airway (OPA)
OPA's are a bit different than NPA's. An OPA's only purpose is to prevent the tongue from covering the epiglottis and keeping the airway open and allowing the patient to breathe. Place the OPA in upside down into the mouth and do a 180 degree turn of the device to insert it in the correct place.
OPA's come in many different sizes and you are supposed to make sure whatever size you grab matches up from the patients earlobe to the side of their lips.

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Komodo's Airway Tips:
  • If you don't have lube, spit or blood will work for an NPA.
  • Be careful of the patient biting down when inserting an OPA.
  • The correct way to insert an OPA is to do a 180 degree turn, if you just shove it in it will do the same thing.
  • All adult males are the same NPA and OPA size.

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Spinal Precautions
I see this get messed up all the time so this is important. Unless you are a doctor, just saw imaging, or are familiar with Canadian C-Spine Rule(CCR), then you will be holding stability of the spinal cord the entire time you are with a casualty you suspect has a Spinal cord injury. C-Spine or Cervical Spine allow many things to happen like Range of Motion(ROM), Passage of blood and Cerebral Spinal Fluid(CSF), and nerves. You could completely paralyze a casualty with a wrong movement. Until either someone takes over you holding stability, or you place a C-collar of correct padding you will not let go of support.

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Preferably you will be holding stability on the ground, but in the event of something like a car crash, you will not remove the casualty unless they are in immediate danger of the car on fire or are in cardiac arrest. Hold the neck so that it's in line with the spinal cord and so the casualty will not move it. The way you hold is completely up to you, so long as the spinal cord is completely straight. You will continue this hold until the casualty is in a C-Collar, completely supported to a backboard or stretcher.

C-Collar
There are many different kinds and types of this collar, but it's primary use is to protect and support your neck. It limits the ability to move the neck and cause further harm to the casualty while they are being assessed and treated.

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Backboards
Backboards are used to completely secure the casualty with straps so movement isn't allowed. It keeps the back as straight as possible, and has pads that go around the head to not allow any movement at all once in a c-collar. Backboards are slowly being phased out of medicine because prolonged exposure to them has been statically shown to pressure ulcers from the body not being able to move and the tissue not being able to perfuse.

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The patient will be log rolled with someone keeping constant stability on the neck and keeping the back straight, then placed down on the backboard and completely secured from head to toe before placing the backboard on a stretcher.

KED Device
The KED Device is used primarily in things like car accidents. It takes a very long time to setup, but the purpose behind it is to completely immobilize not only the neck but the rest of the spinal cord as well. Once completely secure to this device properly, they can be removed through the door or window if need be and the patient will not be harmed.

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Komodo's Spinal Precautions Tips:
  • Lay down on the ground with your forearms completely flat against the ground when you're holding C-Spine, You can see the stabilization of the neck and it's much easier.
  • Any fall further than 15 feet high should be treated as if it's a spinal cord injury.
  • Tape is easier to secure with than the Backboard Chin and Forehead straps.
  • Rolled up towels make great Backboard Head Stabilizers.
  • Do not remove a motorcyclist's helmet during an accident.

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Hypothermia Prevention
This is one of the most important steps of taking care of your patients. During Shock, your body is actively trying to protect your vital organs by doing many things, one of them being temperature regulation. Many injuries will cause your body to stop regulating your temperature correctly and as a result even though it's 80 degrees outside your patient now has Hypothermia.

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Hypothermia will directly effect your ability to treat your patient. The increase in blood pressure and pulse will cause more bloodflow for a trauma patient, meaning they will bleed even more than before. Pair Hypothermia with Hypovolemic Shock and you're in for the fight of your life trying to save this patient. Always keep a blanket and as much clothes on the patient as possible when outside, if you're not sweating wherever you are that means the patient is cold.

Komodo's Hypothermia Prevention Tips:
  • Turn the heat up in the ambulance or ER room to help your patient not be in Hypothermia, we used to use blankets called Ready Heats in the military that had pads on them that would heat up for your casulty.
  • You're not dead until you're warm and dead. If you have a hypothermia patient that is in cardiac arrest, continue doing CPR until their body temperature is back to normal, the cold makes the oxygen in your blood take longer to deplete.
  • Keep any part of your patient not actively being worked on covered up.

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Summary
This is information and tips it took me a decade to learn the best ways to do most of it. I tried to make this as simple as possible, and I genuinely hope some people learn something from it. I used to teach a class called Combat Life Saver (CLS) that was very similar to this to all my platoon in the military so they could help me with medical situations. I will be adding more to this thread at a later time.
05-15-2022, 03:25 PM
This is an awesome post! Not something I'd expect to find on HF, but it still has a lot of great information.