AHA changes every two years. But I see that you googled it and found a headline from 2008 so thanks for trying to double check yourself. I teach the AHA course and yes, literal mouth to mouth is out for obvious reasons (I thought you said ventilations but maybe you went back and changed that as well, if not my bad) Either way, it’s not JUST compressions as pocket mask and other ventilation options are still an important part of the curriculum. I apologize if I came off as rude but your statement was inaccurate and folks online are just too ready to believe anything they read (looking at you Alex Lee).
Not that any of it really matters all that much though honestly. Being intimately familiar with save rates of ALS CPR in an urban environment (see hospitals nearby) I ask my partners not to bother working me. It’d be bad enough already without our last interaction being them cracking my ribs until I bleed out from a traumatic climbing injury. If my pupils are different sizes just tell’m I died on impact!
Ah, the forums, where nobody can take 3 seconds to read and comprehend a 1 sentence post! My post was "Mouth to mouth is out btw, just chest compressions now." (never edited it) and you concede that this was accurate, so I will take your post as a surrender. Tradiban wins again!
Ah, the forums, where nobody can take 3 seconds to read and comprehend a 1 sentence post! My post was "Mouth to mouth is out btw, just chest compressions now." (never edited it) and you concede that this was accurate, so I will take your post as a surrender. Tradiban wins again!
Ah, the forums, where nobody can take 3 seconds to read and comprehend a 1 sentence post! My post was "Mouth to mouth is out btw, just chest compressions now." (never edited it) and you concede that this was accurate, so I will take your post as a surrender. Tradiban wins again!
It’s the “just chest compressions now” part that is wholly wrong my guy.
Tourniquet -- We know these save lives. We know improvisations are not as good. We know maintaining BP's healthy BP and circulation is crucial. But how often will this happen? Worth the weight?
Caveat—I don't climb alpine.
I do, however, keep a bleeding control kit and a CAT tourniquet in my crag pack. Never know what can happen, easy to throw in the top of my pack.
Emergency doc here. It’s probably worth bringing a tourniquet, improvised ones don’t work and the CAT is cheap and small. Also, know how to open someone’s airway with a jaw thrust.
ER Nurse here, not much to add except thinking back through it I am not sure that I have ever seen someone who came to both ER's that I have worked at (both level 1 trauma centers) in traumatic cardiac arrest actually survive. Some make it to the OR and die later. A month ago we stabilized 2 back to back traumatic arrests (gsw and stabbing) and they both made it to the OR and died. The fact that they both made it out of the ER felt like a win. Survival definitely happens, but is extremely rare in the best of circumstances even when care is readily available. CPR after a traumatic arrest in the back-country seems futile and probably does more for the rescuer to feel like they did all they could than any benefit for the victim. Medical arrests, lightening, asphyxiation etc.. are of course different scenarios.
No need to get butt-hurt about it. You mis-read my post, "mouth to mouth is out", and then made an assumption (to save face presumably) that I meant everything else besides chest compressions was out too, "only chest compressions now". It happens all the time on the forums, i forgive you, but i won't go on without pointing it out, that would be poor style.
Anyway, the point I was originally trying to make is that you don't need mouth guards and all that shit because mouth to mouth is out and you can open the airway without any gadgets.
To anyone else reading, don't think you can't do CPR without these items and although is rarely works sometimes it does, miracles DO happen! Just remember that Bee Gees song:
Anyway, the point I was originally trying to make is that you don't need mouth guards and all that shit because mouth to mouth is out and you can ventilate without any gadgets.
The reason one would need a mouth guard IS because mouth to mouth is out. I'm curious how you'd personally go about ventilating a patient without any "gadets".
Ultralight kit: Lighter with 3-5 feet of medical tape Roll of gauze space blanket tiny pencil and a quarter sheet of paper 4 baby asprin 4 acetaminophen 1 diamode
This kit fits into the space blanket bag and barely weighs anything. I carry this the most often, often on day trips or ultralight longer trips. This bag relies much on improvisation if anything major were to occur, but could handle smaller medical and trauma(blisters/cuts) that would occur with ease. Things I might add: Diphen(Benadryl) -- if any allergies Prescription painkiller -- this one is iffy, definitely get a prescription (Vicodin seems popular) Safety pin -- very versatile for the weight
Add all three imo. -Diphenhydramine can't be improvised in the field and an allergic reaction can't easily be predicted. Also backup sleep med. -Opiates: I agreed with the Doc earlier in the thread.....painkillers are a very important self rescue tool if outside rescue is not available. Need to walk out on a broken foot/leg/etc? Even being carried can be extremely painful to the point of not being tolerated by the injured person slowing down movement. Obviously this may allow you to injure yourself worse as pain is a warning signal.... but if the alternative is death by exposure this can speed things up. If your doc will write it I suggest 10mg oxycodone without acetaminophen. The tablets are TINY compare to something like Vicodin and you can give the acetaminophen independently if you want. -Safety pin - sure! -I like to carry an NSAID, but you should know when not to use one if you do. -diamode: Carry more than 1 dose imo Aspirin: Are you keeping this for heart attacks? I actually had a friend have a heart attack ice climbing so its hard to poo poo, but aspirin is a pretty crappy drug for anything else given the bleeding issues.
Light kit: I add these items to the UL kit Non-latex gloves Steristrip larger knife or shears Garmin inreach mini Safety pin
-Consider single use super glue instead of steri-strips. Little bigger but has a million uses including holding cuts closed. -inreach: Best item in your kit. If its not minor first aid to keep you going... everything else in your kit is to bridge you to definitive care/rescue.
This kit expands a little bit upon the ultralight kit as it has better means to clean up larger lacerations and bleeding. I like this kit for when I go skiing or biking and know there is a better chance of getting cut up. The inreach adds a piece of mind when further away from the trailhead or on mountainous terrain when self/partner rescue is not an option. Things I might add: Diphen (Benadryl) -- if any allergies Prescription painkiller -- this one is iffy, definitely get a prescription (Vicodin seems popular) Cravat -- dislocations Glucose -- good fast energy, also critical if someone is a diabetic (I hope they know that) More tape -- I also have duct tape in my repair kit that I feel is sufficient. Alas, you can never have enough tape. Tweezers -- useful for when you need it
Glucose: I mean you can eat it so I guess its not a waste.. But for anything but a car kit this should stay at home unless you know your partner is diabetic...and they should be carrying it.
There are a few items that I left out of this list that I have debated putting into it. These being: CPR mask -- a true lifesaving skill. I'm unsure how handy it would come if you are hours away from ALS/Rescue. Sure rescue breathing or drowning, but at that point, I think its worth it to risk it for the biscuit with mouth to mouth.
-CPR in the backcountry is a bridge to nowhere. You can do it but carrying a mask is an absolute waste of energy/space. Leave that in your car kit.
NPA --- A nasopharyngeal airway could come in handy if you ever needed to leave an unconscious Pt and wanted to make sure you had a secure airway. The airway is important, it's one of the first things you check when you contact a Pt, but is it important enough to lug one of these around?
No. You need to carry multiple sizes, cant use them on facial trauma (one of the only likely unconscious scenarios in the backcountry), and you can just roll them on their sides/jaw thrust, etc.
Tourniquet -- We know these save lives. We know improvisations are not as good. We know maintaining BP's healthy BP and circulation is crucial. But how often will this happen? Worth the weight?
Once again I would never carry one of these. Easily improvised with all the gear carried on an alpine/rock trip. Leave it for the car kit.
Irrigation syringe -- If there is one thing on the list that I have never carried, it's this. I understand that it is really important to keep wounds clean to prevent infection, but if you have a cut/abrasion/whatever that is bad enough to warrant extensive irrigation you are likely coming out of wherever you are.
Agreed. Just pour water on the wound, use soap if you have it.
Sam Split -- this is an awesome tool but takes up a lot of space in a pack and I cannot justify it to be in my pack unless im with a large group on a longer trip. I think splints are one thing that can be easily improvised for things that you already have with you.
I wouldn't carry this in the backcountry, but I actually do take one ice climbing sometimes given the higher likelyhood of lower extremity fractures but it really is kind of a luxury as it can usually be improvised reasonably well most places (less so in AK where I lived until recently though... no trees in lots of places).
There is plenty more to add but I think most everything else belongs in an expedition FAK. For short 0-2 night smash and grab missions usually this is enough. Getting the right training and keeping it current is going to be the best tool in your arsenal. What are you carrying in your kits? What should I add? Or subtract?
For longer trips I like to keep a broad spectrum antibiotic for things like travelers diarrhea, skin infections, and pulmonary infections. Augmentin and Doxycycline are good choices.
Max R wrote: Looks like you know your shit. Nasopharyngeal airways could be useful, but only if your victim is semi-alert and breathing. You also need lube to insert it.
It’s more likely that you would need an oropharyngeal airway. (Completely unconscious), Plus some way to ventilate them- i.e your mouth.
If you have to leave someone with eitherof these airways in, and they vommit, it will funnel directly into their lungs. Although, I find that jaw thrusting is often enough to hold open the airway of someone.
Owen River wrote: Max, I do like the recovery position for leaving a Pt. The NPA would be an add on but does seem redundant, likely best left out of the kit 99% of the time. I didn't even think about the fact that the vomit would go right into their lungs if they did vomit. that is definitely a minus and could cause a lot more problems if you didn't have access to the right equipment.
I don't think the statement about vomit funneling directly into the lungs with an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA) in place is true. Mechanically speaking, the OPA and NPA do not enter the trachea (tube to lungs) and do no enter or open the larynx/vocal folds (entrance from mouth/throat to the lungs). The OPA functions, more or less, to simply stop the tongue from occluding the oral airway, and NPA similarly (without going into too much detail. This is not to advocate for carrying or using an OPA/NPA in the backcountry (I do not), just to clarify misinformation. Both airways have the potential to cause someone to vomit due to gag reflex if they are not unconscious. And an NPA runs the theoretical risk of being inserted into the skull if there is a facial fracture (basilar skull fracture, ect...).
I don't think the statement about vomit funneling directly into the lungs with an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA) in place is true. Mechanically speaking, the OPA and NPA do not enter the trachea (tube to lungs) and do no enter or open the larynx/vocal folds (entrance from mouth/throat to the lungs). The OPA functions, more or less, to simply stop the tongue from occluding the oral airway, and NPA similarly (without going into too much detail. This is not to advocate for carrying or using an OPA/NPA in the backcountry (I do not), just to clarify misinformation. Both airways have the potential to cause someone to vomit due to gag reflex if they are not unconscious. And an NPA runs the theoretical risk of being inserted into the skull if there is a facial fracture (basilar skull fracture, ect...).
if you're not sure if someone is unconscious, try to insert an OPA. they'll let you know real quick :)
I don't think the statement about vomit funneling directly into the lungs with an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA) in place is true. Mechanically speaking, the OPA and NPA do not enter the trachea (tube to lungs) and do no enter or open the larynx/vocal folds (entrance from mouth/throat to the lungs). The OPA functions, more or less, to simply stop the tongue from occluding the oral airway, and NPA similarly (without going into too much detail. This is not to advocate for carrying or using an OPA/NPA in the backcountry (I do not), just to clarify misinformation. Both airways have the potential to cause someone to vomit due to gag reflex if they are not unconscious. And an NPA runs the theoretical risk of being inserted into the skull if there is a facial fracture (basilar skull fracture,
Correct. Perhaps i worded it wrong/overexaggerated. Both airways do have the potential to inhibit your swallow function in the event of vomitting, but neither can cause you to directly aspirate. Leaving an unconscious patient who begins regaining consciousness with an OPA in is my biggest concern. I’ve also seen someone completely aspirate an actual NPA into their airway and nearly die. (Properly sized.)
I also don’t advocate carrying either of these in the backcountry. -RT, adult critical care specialist.
Max R wrote: Correct. Perhaps i worded it wrong/overexaggerated. Both airways do have the potential to inhibit your swallow function in the event of vomitting, but neither can cause you to directly aspirate. Leaving an unconscious patient who begins regaining consciousness with an OPA in is my biggest concern. I’ve also seen someone completely aspirate an actual NPA into their airway and nearly die. (Properly sized.)
I also don’t advocate carrying either of these in the backcountry. -RT, adult critical care specialist.
Good conversation.
curt86iroc wrote: if you're not sure if someone is unconscious, try to insert an OPA. they'll let you know real quick :)
Dakota from North Dakota wrote: Ooh come on it was at least a little funny.
The reason one would need a mouth guard IS because mouth to mouth is out. I'm curious how you'd personally go about ventilating a patient without any "gadets".
Just open the airway and leave ventilation to EMS.
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