Medical. : Intro/Qualifications/Goals

[DoctorDoom]

Really? That has been the standard for several years now.
That is out of the standard Army medic course for sure and according to a member here who was an advanced instructor it was standard period.
The Hyfin chest seal is 100% occlusive, which obviously requires close monitoring. Some units require an NCD after a hyfin is placed.

Yeah man, I'm serious. We've never been taught to place a 100% occlusive dressing, and needle decompression following semiocclusive dressing placement indicates treatment failure. But there's usually a pretty big disconnect between hospital based surgical therapy and current military standard. I took CLS 6 years ago and honestly don't remember if that was even taught.

 

[pardus]

Interesting.
6 years ago was long before the hyfin was standard.
Then again, my unit still doesnt have them.
Our protocols are changing so fast no one knows WTF to do now, doh.

 

[TLDR20]

The standard is a 100% occlusive with Needle D afterwards. I think the thought process behind this is that you are in control of the situation. There will always be a disconnect between the operating room and the battlefield. The reason is the OR is a controlled environment and the battlefield is not. That is why you want to control what you can.

 

[x SF med]

@cback.... Nah, you are just a control freak

Document and control the situation - the keys to a great 18D

 

[pardus]

The standard is a 100% occlusive with Needle D afterwards. I think the thought process behind this is that you are in control of the situation. There will always be a disconnect between the operating room and the battlefield. The reason is the OR is a controlled environment and the battlefield is not. That is why you want to control what you can.

Just for my education, is this still the case as of Jan 2013?

 

[DoctorDoom]

That approach does make sense in the tactical environment as practiced by well trained soldiers/medics. Definitely shouldn't be the standard across the Army though, given the data showing how frequently the diagnosis tension pneumo is missed and how 30-40% of needle decompressions don't penetrate the chest wall.

 

[8654Maine]

That occlusive/semi-occlusive dsg was taught in the mid 80's when I was in. I've done some Pubmed searches and not much reliable evidence shows up. It would be nice to have some trials. My trauma director in residency was one of the Army surgeons involved in the Pope paratrooper burn incident and he couldn't give me any concrete reasons of one over another.

My creds: Force recon, then college, med school, and Emergency residency at a big Level 1 trauma center. I've worked w/ some great folks and teachers. Been practicing 10 years at a Trauma center in Maine. The more I do this, the more questions I have. If you think you know it all, that's when you become dangerous.

Now have a hankering for something else. Am in discussion w/ HH Actual about going to NZ or re-upping as a Reserve Physician. Either way looking for advice and shooting the shit.

The more I do this, the less I think I know. D'oh!!

 

[TLDR20]

Just for my education, is this still the case as of Jan 2013?

Yep...100% occlusive in initial, once you have a chance to diagnose pneumo, needle D. This is from the TMEPS, TCCC and what I teach everyday at the JSOMTC.

 

[pardus]

Yep...100% occlusive in initial, once you have a chance to diagnose pneumo, needle D. This is from the TMEPS, TCCC and what I teach everyday at the JSOMTC.

Thanks.

 

[TLDR20]

That approach does make sense in the tactical environment as practiced by well trained soldiers/medics. Definitely shouldn't be the standard across the Army though, given the data showing how frequently the diagnosis tension pneumo is missed and how 30-40% of needle decompressions don't penetrate the chest wall.

Well in that case you can use MOI and difficulty breathing as justification for a needle D. Training correctly should be preferred over letting guys die because officers are afraid of incorrect placement.

 

[DoctorDoom]

Well in that case you can use MOI and difficulty breathing as justification for a needle D. Training correctly should be preferred over letting guys die because officers are afraid of incorrect placement.

You nailed it. I, like all officers, would rather let guys die because we're afraid of training them right.

I was thinking along the lines of basic medic-level training when I say standard throughout the Army. And that data is among EMT's, not exactly poorly trained yahoos.

But I certainly don't prefer having guys die due to my fear of incorrect placement. Rather, I'm wondering because I don't know for certain, why not go back to using a 3-sided semi-occlusive dressing, and obviate the need for a needle decompression? Is the degree of "control" that much superior that it's worth the risk of creating a tension pneumothorax (an often missed diagnosis despite clinical signs) with a fully occlusive dressing, that is bailed out by a frequently non-efficacious additional intervention even in experienced hands ? Of course, this is the data that is lacking.

 

[TLDR20]

MOI(a GSW for instance) and a pt with difficulty breathing, are the ONLY indicators needed for a needle D. Us training medics to perform IAPPs which can be difficult to perform correctly and can make it difficult to diagnose tension pnuemos is what I am bitching about. We take a basic medic(EMT) and expect him to make a life saving intervention based off of something that MD's often misdiagnose. When in reality, most pts with penetrating chest trauma would benefit from a needle d solely based on there MOI and difficulty breathing.

 

[jcooper.84]

hey guys im a lateral transfer in the austalian army from grunts to medics, im currently half way through my training.

 

[medicchick]

hey guys im a lateral transfer in the austalian army from grunts to medics, im currently half way through my training.

Why don't you pop over to the intro area and make a thread there.

 

[pardus]

hey guys im a lateral transfer in the austalian army from grunts to medics, im currently half way through my training.

Damn Aussies, all crims that wont follow rules!

Post an Intro Digger.

 

[x SF med]

hey guys im a lateral transfer in the austalian army from grunts to medics, im currently half way through my training.

When you signed up for this site you agreed to post an introduction as your first post. Or have they stopped teaching reading comprehension in Australia, I'm sure a few of our senior members from The Southern Hemisphere would be horrified if they had...

Post your intro immediately, or you will not like the consequences.

 

[jcooper.84]

haha sorry guys i have now conformed and followed the rules

 

[Seajack]

Navy Corps School student, wrapping up my last few weeks of training/school. Still have no orders so I haven't a clue of what exactly I'll be doing post-graduation

 

[DA SWO]

Navy Corps School student, wrapping up my last few weeks of training/school. Still have no orders so I haven't a clue of what exactly I'll be doing post-graduation

You enjoying Ft Sam?

 

[Seajack]

You enjoying Ft Sam?

I enjoyed my time at Ft. Sam. The training wasn't all I thought it was going to be, but now I understand why. We have a very broad scope of practice, and our work is pretty subjective to where you ultimately land as far as work goes, in which case you're going to have to learn that specific clinic/hospital's policies and ways of doing things. I've always preferred OJTing and trial by fire myself; I am a total kinesthetic learner so books and dummies will never do me as well as the "watch, do, teach" method.

I'm now working at the mother-infant care center. Learning a lot, very quickly.