Lightweight First Aid

[Dale Wambaugh]

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!

[Dean F.]

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…

[Ryan Dorn]

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.

[Dean F.]

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

I hear ya.

[Adam Thibault]

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?

[Bob Gross]

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.–

[Angela Alexander]

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!

[John Almond]

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.

[Dean F.]

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.

[Nick Gatel]

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.

[Harris Goldstein]

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?

[Bob Gross]

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.–

[Alan Little]

> Mylar blanket? Will you ever not have some sort of better insulation with you, like a down bag?

I'm late to this discussion, but I did an alpine self-rescue course last weekend with the DAV (German Alpine Club), and this very question came up. The course leader, a member of an alpine Mountain Rescue Team, was very much in favour of having a mylar blanket in the first aid kit even if one is also carrying a bivvy bag and/or sleeping bag. His arguments for it were:

– easier and quicker to throw a mylar blanket over a casualty than to get a – possibly unconscious or seriously injured – casualty into a bivvy bag or sleeping bag
– easy to get a second person under there too to warm the casualty.
– down bag on its own is useless if it's wet
– mylar can also – theoretically at least – be used as heat protection: you might be in a situation where the casualty can't safely be moved into the shade

[David Miles]

For Mountain Rescue some of my favorites are:
-VetWrap
-SAM Splint
-Steri Strips
-Fine tip Foreceps
-Athletic Tape

[steven franchuk]

In regards to Quick Clot, It is my understanding that Celox is the cloting agent used in the current Combat Gauze. Celox does not produce heat when applied and unlike Quick Clot it doesn't need to be removed at a later date. As the wound heals Celox is converted to nutrients which the body uses. When the wound fully heals no Celox remains in the body.

My doctor has put me on blood thinner medication which causes me to bleed longer than most people. So I have added Celox to my first aid kit. IF you are on Asprin therapy you might want to do the same since aasprin is a weak blood thinner.

In regards to super glue, and when I first head of its use in first aid I looked it up. Apparently early experiments involved putting it in the wond. Today a hospitals use Dermabond. It is a supper glue like material that is applied to the skin on both sides of the cut. The wond is then held closed and more Dermabond is applied to bridge the gap between the first two applications. The glue is not applied directly into the wound.

If I get a large cut my current plan is to flush out any dirt with chemically sterilized or boiled water. Then I will use butterfly bandages to hold the wound together. Since butterfly bandages generally fall off before the wound has healed I have added supper glue and fabric strips to my kit. I can then glue the fabric to my skin so that it does the same job as job as a bandage but lasts longer without ever applying glue into the wound.

Naturally for a serious injury I will need medical attention so for that reason I have also added a Personal Locator Beacon so that I can summon help even if I cannot walk or hike out. Just keep in mind that once the beacon is activated it may take at least 12 hours for someone to get to you,

My current dilemma is what to do about snake bites. Small Rattle snakes blend in very well and be hard to spot until you get too close. My brother has almost stepped on one and I have read that others have or have almost stepped on one. In the past It was recommended that to use a knife to cut the skin at the bite and then suck out the venom. However doctors dropped the recommendation due to rick of infection. Companies still sell suction devices but don't recommend cutting the skin. Unfortunately without cutting the skin there is no evidence that suction works.

Anyone have any suggestions for snake bites?

[Ken Thompson]

I find Steri-Strips to be better than butterfly bandages.

Snake bite. Leave the wound alone(cutting wise) and seek medical attention. Watch Venom ER reruns. Leave snakes alone. Don't put your hands and feet where you can't see them.

30 years hiking, never an issue with a snake. Lot and lots of snakes around.

[steven franchuk]

"seek medical attention."

Some rattle snakes such as the Mojave Green have a potent neurotoxin that can kill within hours. Even if the snake doesn't have the neurotoxin in its venom you could easily have a leathal reaction to it. If you are bitten and you are 20 miles from the nearest road you could be dead long before you can reach the nearest road or help. Also it would likely take too long before someone responnds to PLB.

Seek medical attention only works when the nearest phone or road is only an hour away.

Leave snakes alone. Don't put your hands and feet where you can't see them.

Some trails have a lot of brush along side. You could put your foot down within inches of a snake and never see it under the brush. The one time I did get buzzed by one the snake was 4 feet away and he was almost impossible to see on the sand in Joshua tree NP. they blend into the soil very easily. I have seen at least 6 over the years. Also most of the time they don't make the rattle sound. Over the years People have killed most of the rattle snakes they have heard. As a result there is now now a genetic bias for not making the rattle sound.

[Ken Thompson]

20+ years of hiking in the deserts of SoCal. Never bitten or stung. If you time is up it's up. What are you going to do without antivenin? Die maybe.

I've seen dozens of snakes out there. Those Mojave Greens too. Good looking snake.

Snake kits are a dumb idea. A sucker and a razor blade. PLease, be my guest and carve your bitten self or friend up if you think it will really help.

[Nick Gatel]

Most healthy adults are not going to die from a rattlesnake bite — green Mohave excepted.

[Tanner M]

I may have missed it but I didn't see any mention of gloves.

I don't think they are necessary if you are treating people you don't mind swapping body fluids with. For people other than that (even friends) it can be a good idea to carry gloves to prevent blood from getting into any cuts/scratches or etc on the first aid providers hands.

Nothing to be embarrassed or self-conscious about. It isn't rude. If you feel uncomfortable, tell them you are keeping the wound clean.

Bloody odds and ends can be put in some other plastic of some sort that is probably in someone's pack or burned if not plastic. Prb best to just put it in a bag. It may be a bit much to carry a labeled bio-hazard bag… That's bound to make the injured person feel unwelcome.

Nitrile gloves are pretty sturdy things. Latex, of course. Some people may have thoughts about the type of glove. Subway sandwich shop gloves might be better than nothing but not really the proper thing, I think.

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