First Aid Kits ???

[reuben bolieu]

I was wondereing if you guys think a roll of duct tape would be sufficient for day hikes and overnighters?
I don't take any medication not even pain stuff or anti-inf. so what is going to fit in a 1-8 oz. first aid kit that is really gonna save your life?

Do you guys think duct tape will work in place of band aids and mole skin? I am not allergic to anything and don't really care if I get stung and have to walk around like that for a day.

[paul johnson]

Duct tape has so very many uses. It can certainly be used as part of a first aid kit. I probably carry more of it than I need to.

A word of caution about putting it directly on a wound, however. Remember, you need to remove it later and most duct tapes (I use either Nashua 357 or Gorilla brand duct tapes) have a very good adhesive. You're sure to do some tissue damage when removing it from a wound and possibly even "reopen" (take that term looesely) a healing wound. I purposely didn't mention "pain" as you already stated that this is NOT a deciding factor in your Med Kit decisions.

A good use, which i myself have done, is to use duct tape to help hold a bandaid or bandage in place – that just won't stick after some hours of sweating and moving – particularly if the band-aid is near a joint. Just poke some holes in it with a pin first to let it breathe a bit and to keep sweat/perspiration that forms under the tape from loosening it – ever notice those tiny holes in most band-aids no padded adhesive area. Of course tincture of Benzoin works in this capacity also.

Strips of duct tape (again with tiny holes poked through it with a pin/safety-pin) are useful as an alternative to "butterfly" bandages.

Depending upon a number of factors, be careful about totally sealing a wound entirely with duct tape – especially if holes weren't poked in it first.

Obviously, uses for duct tape are NOT limited to one's Med. Kit. Uses for Duct Tape is pretty much only limited by one's imagination!

[Andy Goodell]

I use duct tape all over the place to fix things at home, but I don't carry it in the field anymore. I used to, and just found myself never using it. My first aiid kit has gotten much smaller than it used to be. Right now it's 1.0oz and has 2 bandaids, a chapstick with about a foot of waterproof tape and a foot of cloth tape wrapped aronud it, a laminated notecard with Wilderness First Aid tips on it, and a gauze pad. I've been on trips before where people carry 1-2 pound kits, but of course nothing moer than a bandaid is ever used. Even kits with 10 bandaids are silly, who is really going to use that many?

[Mark Verber]

I used duct tape for a several years as part of my first aid kit, and for lots of lots repair jobs. I think it works ok to prevent hot spots, but once I have a blister, I want something that won't rip the skin up. I switch to using Spyroflex bandages a few years ago and recommend them highly. The have stayed attached much longer than duct tape, peal off easier, and provide a better environment for healing.

I suppose with just day hikes or overnight you could punt on a lot of treatments… but the few times I let someone go, even for a day, on my feet, I regretted it for several days afterwards.

–mark

[Mike Barney]

If you are in need of closing a wound, hot spot, or other sensitive skin area, and only have duct or other high adhesive tape, there is a solution: Tear off a piece the size you need, plus a second smaller piece.

For the part that is going to touch the sensitive skin or wound area, the second smaller piece is placed upside down on the first piece, covering the portion that would touch the wound area. This prevents any adhesive from touching the sensitive area.

For blisters, I still like poping, evacuating the using superglue on it. Stings a little, but works very well.

MikeB

[Brett .]

Reuben, I suppose duct tape could be 'enough to meet the needs of a situation or a proposed end'(i.e. sufficient), if your first aid kit is intended to treat or protect skin injuries and maybe support a sprained tendon. Certainly duct tape has many uses, and I carry it.

But I suggest that you could do a lot more for yourself, or for other hikers, by reading a book called 'Medicine for Mountaineering', then carrying a light but varied first aid kit.

I am not of the "bandaid or helicopter" mindset (eg, the situation requires either one or the other). There are many symptoms and conditions which can be made more comfortable with some basic equipment; and I have helped many people with the small kit always in my pack or daybag.

Of course, it depends where you hike, who you hike with or come across on the trail, as well as your personal desire to either help, or not get involved. I do not know the extent of your medical training, but it is satisfying for me to acquire some medical knowledge; and it has no weight penalty.

[Mitchell Keil]

My 1st Aid kit is fairly simple. (I no longer look to perform open heart surgery in the field — too much chance of infection) So, my kit consists of:
+ 1 cut-down scalpel with cap
+ 2 small foil packets of triple antibiotic (picked up from a MD friend)
+ 1 large finger bandaid and 1 small finger bandaid
+ 1 sheet of steri-strips
+ 2' of silk medical tape
+ 1 woman's stay free menstrual pad (far better than any gauze pad in absorbing fluids and/or blood)
+ 1 extremely sharp pair of surgical forceps (with an soft ear plug capping the sharp end)
+ 1 small dropper of Tears eye wash
+ The Knowledge in my head about wilderness medical emergencies that I get from taking classes in same.

Finally, there is an item I carry because I get awful hangnails that often rip and get infected when I backpack. Don't know why but I do, so I carry a very small cuticle clipper I found in Europe. Weight = .5 oz.

Multi-use items that are also 1st aid items.
1 small dispenser of alcohol gel from my TP kit
1 small container of granular bleach from my kitchen kit

I carry 2 feet of duct tape wrapped on each of my treking poles and use that for blister treatment if needed(but I have not gotten a blister in years).

Total weight of actual 1st aid kit is 3.75oz. When I add the weight of the other items listed above it equals about 5 oz.

[paul johnson]

Mitchell, very nice little kit. I'm going to compare it to my current kit and makes some changes as appropriate.

I think that you are probably already aware of the following, but i'll mention a few things that jumped out at me without much thought when i read your list just for the sake of any newbies:

1. the antiobitic oinment has expiration dates (as do any oral meds – NSAIDS (e.g. ibuprofen, aspirin, naproxen sodium, etc.), Tylenol, Benadryl, Imodium A-D, etc.), so check, discard, and refill as required (which reminds me, i better check mine!!!)

2. superglue works great on the hangnails, loose toesnails, burst blisters (after disinfecting), small cuts (after disinfecting). yeah,… you seal something and there's always a risk. my experience, is that i haven't had a problem doing so, and i've done it many, many times, but then i'm a nut about disinfecting – you'd think i was scrubbing in for surgery! (not that i've ever done surgery)

3. pros & cons to the "m"-word pad. [no, i never minded buying them for my wife when i would do the shopping – just trying to inject a little levity here, that's all]

pro:
very absorbent

con:
a) better to change bandages anywhere from 1-2x per day to at most every other day to reduce chances of infection. obviously, a number of factors come into play here.

b) it's not sterile to begin with (at least i don't think they are – Ladies, please help me out here – my wife is older & the "curse" as she used to call it is now past, so i can't check our bathroom cabinet)

c) you could cut the pad into pieces but the more one handles something, the more contaminated it becomes. That goes for the pad & the scalpel blade – of course, a little alcohol gel will disinfect the blade.

[Jay McCombs]

I'll weigh in on this one because I think its a reasonable discussion. First, to the original poster. I absolutely think duct tape would be sufficient. Lets face it, if you need to treat something its probably going to be one of three things: (just a guess from my own experiences, no actual references though there may be some in Wilderness Medicine)

1) a blister. Pretty straight forward.
2) minor lacerations/abrassions/puncture wounds would be next. Those are best treated w/plenty of clean water (thats what they use in hospitals, think about it) and may be covered or uncovered depending on limits of mobility or risk of further contamination. Steristrips, superglue, and sutures really have no place in the management of back country wounds. Open management is always prefered until you get to a facility that can verify the wound is free of debris, clear of non-viable tissue, and clean then start you on abx for a few days. After that definitive closure can be executed.
3) sprains/strains/fractures. Fractures are less likely in adults as their bones are tougher than the connective tissue. The case is just the opposite in kids. Fractures are much more likely than sprains or strains (I knew a seasoned pediatric ER doc during my training that says they are rare enough that if you think thats your diagnosis, check the films again…valid in the ER only). Bottom line, you can splint most joints with duct tape, especially knees and ankles, the two I'd pick as the most likely to be injured to the point that they need to be treated because they are limiting mobility. I might suggest you take acetaminophen and naproxen, but no more than the maximum daily dose if you only plan a day hike (4 grams of tylanol over 24 hours and 1500 mg naproxen in 2 doses). I like naproxen because its twice daily dosing. These two drugs can go a long way to cutting even significant pain. Both also helpfull if youa ccidentaly get sunburned! Keep in mind I'm just a guy off the internet and you should consult a licensed health care provider that carries a large malpractice liability policy which I make no claims to be :)

I used to take all kinds of stuff with me, because I have some knowledge of medical doings. For a while I was haunted by the scenario of seeing a bleeder in a deep lac that I could have tied off if only I brought my vicryl…I now take a very few bandaids, moleskin, a sterile needle, benedryl (mostly to help me sleep or if the camp fire gives me a stuffy nose, the risk of anaphylaxis with stings is exceedingly low and benedryl would be like whizzing on a forest fire), a couple pepto tablets (has antibacterial properties…immodium may prolong/worsen certain diarrheal illnesses, the key is to remain hydrated!), and the two above mentioned drugs for analgesia. All totals up to negligible weight (an oucne, 2 at the most). For bleeding control I'll just use my cotton hanky that I always have. After that I'll just bleed rather than ruin any of my expensive lightweight gear !!!

PJ,
"sanitary napkins" are not sterile…but nothing is in the woods for very long :) I always look at my hands at the end of trips and laugh that I still cary hand gel. By the end of the first night they are uniformly filthy beyond the aid of the stuff

Once again, please take my advice as that of any other stranger off the internet, and not that of a medical professional

[Mitchell Keil]

PJ:
The "pad" is not sterile but is highly absorbant, more so that any telfa pad or surgical sponge made of gauze. Its the absorbency I am interested in and it is at least clean while still in the plastic packet. Sterility in the field as the last poster commented is a joke. I have the granular bleach and the alki gel to aid in making sure things are as clean as possible. The bleach I use is the kind one gets from the pool store to treat pool water and I love the multiple uses of it. Final rinse for my kitchen stuff. Washing hands and keeping them relatively clean from trips to the potty, fishing and general grubbiness from the trail.
You are so right to comment on the expriation date of medical stuff. I am in the habit of doing so simply because I keep earthquake kits in all of our cars and at the house which must be checked for such things on a regular basis. So I do it for my 1st aid kit, too.

The super glue idea is a great one. I am going to ask an MD friend for some of the surgical glue he uses, but I am also mindful of the "sealing in the bad" issue the last poster raised.

[paul johnson]

Mitchell, regarding the use of superglue, let me reiterate what i had posted earlier:

"superglue works great on the hangnails, loose toesnails, burst blisters (after disinfecting), small cuts (after disinfecting). yeah,… you seal something and there's always a risk. my experience, is that i haven't had a problem doing so, and i've done it many, many times, but then i'm a nut about disinfecting – you'd think i was scrubbing in for surgery! (not that i've ever done surgery)"

regarding in what instances that i was suggesting others might want to consider using superglue, let's condense this a bit, shall we:

hangnails
loose toenails
burst blisters (after disinfecting)
SMALL [added emphasis] cuts (after disinfecting)

i've personally tried it on all of the above with great success. just keep in mind that i didn't mention things such as reattaching severed limbs or decapitated noggins.

i might also add (i've done this quite a bit this winter, once again) it works great on chapped, cracked skin both on the hands, as well as elsewhere to keep the cracks from progressing. it works well on cracks on the feet too should they develop around or in toughened calloused areas, or elsewhere.

[paul johnson]

>>"immodium may prolong/worsen certain diarrheal illnesses, the key is to remain hydrated!"

Jay, good point. However, it sounded like you might be saying that taking Imodium A-D is a bad idea, is that correct?

Not saying you're wrong, and i'm glad you STRESSED keeping "hydrated", but since one is NOT in a clinical setting, the ISSUE of keeping oneself hydrated is more difficult (water, as you are well aware, isn't just a faucet away) which may not be possible if severe runs are permitted to go on (whether Imodium A-D will totally stop them is another story – my wife and i both had Giardiasis some years ago from bad water; glad we were home by the time it hit). As an UL-er, i don't really have the option of carrying 4L when i only brought two 1L containers. Water sources are not always as convenient as one might like. My feeling (and perhaps every case is a bit different, e.g. what is causing the diarrhea, how bad (frequent, watery, volume) is it, how long has one had it, what is one's age and pre on-set physical condition, other med. issues, etc.) is that i can keep myself hydrated better if i'm not loosing as much water from my hintermost parts.

Guess i'd just really like to hear more thoughts from "a guy off the internet" like you on this subject if you are so inclined. Many thanks.

[Jay McCombs]

The concern is possibly causing bacteremia. The truth is for mild to moderate diarrhea in adults its probably a non-issue and I would agree with your points. For severe diarrhea or bloody diarrhea I would definitely avoid them and consider removal from the backcountry as soon as possible (severe diarrhea can cause fluid losses up to 20 liters a day which is near impossible to keep up with, you can't live for long in that state!). The best strategy is always based on rehydration with plugging the works up secondary. Most diarrhea is viral, (I don't know if this applies to backcountry acquired cases), and short lived. As long as you can keep fluids and electrolytes up (even if it means stopping to top off at every water source or laying over for a day) you should be ok.

Kids shouldn't get antidiarrheals according to the APA. There are concerns of HUS and other complications of infectious diarrhea.

It might also depend on your local, so discussing likely pathogens in your part of the world and how to deal with them with someone local might nto be a bad idea.

[Brett .]

Jay, I was surprised again, as I was with the initial poster, that anyone would say as you did:
"I absolutely think duct tape would be sufficient" You did go on to list a few other items you carry, however, so maybe you did not mean it literally.

There are so many syptoms and a few signs, which can be moderated or even temporarily alleviated with a single dose of medication. A few examples are controlling diarrhea (initially, until evacuation) with loperamide, swelling with an NSAID, insulin shock with sucrose, allergies with diphenhydramine, congestion with pseudoephedrine, headaches with acetaminophen, even anaphalactic shock with epinephrine if you know how to administer it, etc.
Another small item I carry which has given immediate relief for bug bites, rashes, etc.. is benzocaine 20%; about the strongest OTC topical analgesic you can get, in the form of Orajel.
I carry one dose of each of these, or more if going with a group.
As for mechanical devices, I carry an MSR splint, tick remover, small syringe for irrigating wounds, and a few bandages.
I would like to learn how to suture; something you mentioned you are prepared to do.

[paul johnson]

Many thanks. up to 20L/day, that would definitely make it difficult to remain hydrated and maintain electrolyte balance by just drinking water (no D5 or other IV fluids) in the backcountry – downright life threatening.

definite dehydration w/o Imodium A-D/loperamide (it might help some) while hiking out for two days vs. possible bacteremia (sure won't be hiking anywhere), i think i'd, generally, opt for being able to hike out under my own power (IF possible with the pain and cramping that sometimes accompanies some of these types of illnesses) and then worry about the "mights" and "possibles" when i'm back at home or in the hospital. but, that's a general statement (as was probably yours???) and not an inviolate dogma.

you mentioned HUS, but also, generally, how likely is toxic megacolon when using anti-diarrheals? (My wife hates these kinds of questions from me, hope you don't mind?)

backcountry, in the USofA – might vary a bit by locale, but usually protozoans is the problem is the general consensus.

interesting that even some aspects of basic med. practice has changed. when i was a kid (pretty much all of the 1950's), we used to get an opioid known as "paragoric" when we had the runs! [yeah, i know Imodium A-D is an opioid receptor agonist, but w/o CNS involvement] my kids (throughout the entire 1980's), mostly received nothing but fluids – water and gatorade when in a similar situation.

Even how simple cuts are treated has changed since then too – iodine and mercurichrome after cleaning with soap and water and usually H2O2 (i was always getting cuts and scrapes as a kid), gave way to Bacitracin and the like after cleaning, now just plenty of forced mechanical irrigation.

What's next, back to various types of poultices? I've heard leeches and maggots (as appropriate) are making a comeback! I guess boring holes through the skull never really went out of vogue though, did it?

This Post now reminds me of something i wrote a number of years ago entitled "Ode to Medieval Medicine" (popped into my head driving home from Church meetings one Sunday) and sung to the tune of a popular Christian Hymn (sung that morning, but NO sacrilege involved, just the melody was borrowed). My wife forbid me to sing it to my kids! Though my kids, when they were older, told me that the song was good enough to be in some Monty Python flick.

well, i digress, so…

thank you again.

[Brett .]

pj,
Wow your post brought back memories. Those were the treatments in my house also, in the 60s, as well as rubbing butter on minor burns. It seemed to work I guess?

I've heard maggots eat only the dead flesh, so we were taught in survival school to seed the wound with maggots, let them eat the gangrenous flesh, then 'flick' them off when they were done. The wound would then close and heal nicely.. or so the theory goes. I recall the source of maggots was letting flies lay eggs in your open wounds. Might be hard to sit still for all that treatment.

[paul johnson]

Brett, one has to give ancient, more primitive man (or, at least non-technological – perhaps that's a better way to phrase it, though we don't often think such of ancient man) a lot of credit. Without the benefits of technology, laboratories, and structured thought, they OBSERVED and LEARNED many things – not always right, but enough was that man survived down through the ages in some very inhospitable climes and situations. That's not to say that some medicines and procedures, etc. developed in more modern times don't work better than some natural remedies – many/most do, but perhaps, not all or in all cases.

Yeah,…that's how maggots are supposed to work – no first hand experience with them, nor with leeches in a medical setting (only in song and and rivers).

[Steve .]

Maggots to the rescue.

[Jay McCombs]

Brett,

My rationale is most people wont encounter those problems you mentioned, and even if you they did you could usually treat them w/a dose of "suck it up" 3 or 4 times daily. Yes, my wife hates me as will my kids one day :)

I would never suture on a backpacking trip and don't bring suture material with me, just to be clear. You can treat hypoglycemia with anything that has carbs. And I question the value of epi as a true anaphylactic reaction likely will require many doses of epi and definitive treatment w/steroids. Epi pens are designed to bridge people until they get to the ER, not to be a one shot cure. I guess its better than none, though.

[Douglas Frick]

>And I question the value of epi as a true anaphylactic reaction likely will require many doses of epi

What's annoying is that there are about ten doses in the Epipen, but you only get one of them. They're happy to sell you two 'pens, of course at twice the price. Hopefully one dose will last long enough for 75mg of Benadryl to kick in… Haven't tried it, hope I don't ever have to.

[Nancy Charlier]

There are other things with epinephrine-like action–never had to try them, but I heard this story from a presenter at a wilderness medicine conference (her topic was field-expedient treatment). She was one of several staff on a river-running trip of a few days, but wasn't permitted to bring her medical supplies as she wasn't licensed in that state. At a lunch stop, the boss, who knew he was allergic to beestings, but too "tough" to carry an Epipen, bit into a lunchmeat sandwich with a yellowjacket in it, and got stung inside his mouth. His airway was compromised almost immediately. The doc set several people to work–one tearing through the personal gear looking for Epipens, albuterol inhalers (very chemically similar to epinephrine, but last longer), Benadryl, etc, one collecting pocketknives, one looking for pens or other tubular items that could be used if she had to do an emergency tracheostomy (actually a cricothyroidotomy, but you know what I mean). They came up with an albuterol inhaler, some tampons, and some Benadryl, and started boiling pocketknives to sterilize them. By now, the victim's unconscious and his mouth and tongue are so swollen that nothing can go that way even if he had been awake. So the doc soaked a tampon with as much albuterol as she could spray on it, and shoved it into his rectum (lots of good absorptive mucus membrane there!). She was just about to cut him when he started to respond. The unfortunate guy woke up surrounded by all his crew and passengers, and was NOT happy, despite having had his life, or at least his brain function, saved.

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