pre-action IV line

[Ranger Psych]

Pfft. I agree with your load, you're there for the 3 gets if it's CSAR... get in, get them, get out... fuck treating on the ground, patch minimally and get the hell out of there. let the exfil platform do the lifting, it's not like you're gonna be maxing the airframe out with a case of saline anyway. Boeing and Sikorsky lift heavier shit easier than you or I ever will!

 

[amlove21]

Thats what I am talking about. If we start talking about direct support or some of the other mission sets out there, you can flex. and carry more of what you need.

I do love hearing guys carrying like 5 liters of assorted fluids. That and plenty of cardiac meeds always makes me laugh.

 

[surgicalcric]

<<SNIP>> I do love hearing guys carrying like 5 liters of assorted fluids. That and plenty of cardiac meeds always makes me laugh.

Me too bro.

I also get a good chuckle out of medics who carry all the sniffle meds in their bag.

Not this 18D...I have a self-aid table next to the door of my Med-Shed which contains NSAIDS, foot powder, zyrtec, bandaids, neosporin, etc, etc... with lil ziplock bags, label tape and sharpies, and instructions for use for everything there. Thee guys can help themselves 24 hours a day.

I look at it like this, the weapons guys dont carry my CLP; the Engineers my IDC's, flashbangs, and firing devices; the commo guys my spare batteries so I am not carrying the items which every other guy on the ODA has access to and the ability to package and carry.

 

[kaja]

Thank you guys.

I was skeptical about mentioned procedure, but clarification is always good. I can really see it originated during some pre-action prep rather than from some medical reasoning. "Hey, it really sucked last time I sticked guy in action, so just let's make my life easyer for this one...". As you guys said, and I can't agree more, fluids may help sometimes, but circulating light pink lemonade is not going to make it. I remember, that Brits were quite aggressive with fluids some time ago, but I hope we moved on... ..and we have IOs now:)

Hey, I actually remember one of these medics... "I have 4litres of fluids in my bag, also with 3 diferent strap cutters and tons of other stuff...". It was during field exercise, where guy get hit by BVP-2. Really nasty hematoma, unstable pelvis and shit, so while waiting for MEDEVAC we wanted to start slow drip IV to KVO. Well, that asshole tossed all of his fluids under his bed that morning, because "It was too heavy"... Luckyly I had my first responder bag.
Moral? Don't carry so much stuff that you'll be tempted to throw something away while it gets heavy...

I am not carrying the items which every other guy on the ODA has access to and the ability to package and carry.

Great point. This concept also works great with IFAKs (..so you don't have to lug around shitload of bandages and can carry only specialized items). It also slows unit down, when everyone with blister or small cut goes to see medic to just pull out tape and tape it. During last FTX I spent like 3 rolls of tape just for cuts on fingers... If everyone had just small Boo Boo Kit... (It wasn't my organic unit-I was just assigned for FTX).

 

[Red Flag 1]

RF 1

 

[Muppet]

I always learn something here and I put it forward to the tactical aspect of my career. Thanks all.

F.M.

 

[DoctorDoom]

I'm a badass when it comes to central lines. So pre-emptive IV seems not worth it... but this is not field prep before a DA mission, so perhaps irrelevant.

 

[BearW]

Great thread, BTW guys.
I've had locks put on me before a trg hit just to see if it would stay in. We used a combo of Hydrogel and what looks like a 3M waterproof band aid. Worked okay. I the value in it if you're trying to mainline a guy with NS who is super dehydrated and in shock, but the rate as which fluid is infused kinda makes it not so worth it- all case by case dependant of course. I never found clotting to be an issue, personally.

I've never been on the business end of the BIG/FAST set ups (thank f*&K), but i've seen them in use and they are more effective, IMO. If ambulatory patients can take an IV. Save the BIG/FAST's for litter guys.

I've carried a bag of either with a starter kit to help out and lighten the Grnd Force medic's loadout.

 

[TLDR20]

I'll typically carry 2, max 3 500cc bags of NS for CSAR. 1.5L. And i don't carry hextend- it's single use and expensive. That's my usual loadout. Obviously, I have more available that's carried close in a resupply or more intensive kit, but when I throw on the ruck that's what it has in it.

Before anyone freaks out, cause I am sure there are people that will, this is for a specific mission set. For burns, mass casualty, extended care, MEDEVAC, etc., I get it- it's not enough. And hextend/hetastarch has it's place, but anything I have seen/read/researched just hasn't proven to me that 100% every single time I need to put it in the bag. Just my .02.

I carry less than that in my small aid bag. 2 500cc Hextend. That is it. In the big bag I have more, but that is all I have in my small one.

As for pre cannualating, I don't do it. Was never taught to do it, and it has never been shown to have any real positives that I know of.

 

[amlove21]

I carry less than that in my small aid bag. 2 500cc Hextend. That is it. In the big bag I have more, but that is all I have in my small one.

As for pre cannualating, I don't do it. Was never taught to do it, and it has never been shown to have any real positives that I know of.

Just a question- why only hextend?

 

[DoctorDoom]

Any of you men ever carry the same volume of saline in 250cc bags instead of 500cc? Any experience pro or con?

 

[TLDR20]

Just a question- why only hextend?

Well what am I really getting out of Saline? We are doing hypovolemic resus nowadays, and Saline to me anyways doesn't do much but cure hangovers. I do have NS in the truck bag/range bag/big bag. But real world I carry Hextend.

 

[amlove21]

Well what am I really getting out of Saline? We are doing hypovolemic resus nowadays, and Saline to me anyways doesn't do much but cure hangovers. I do have NS in the truck bag/range bag/big bag. But real world I carry Hextend.

With NS you're getting a flush, a comparable amount of increase in blood pressure for an albeit shorter amount of time- the only thing that hextend has going for is is that it takes the body a long time to break it down at a molecular level, increasing intravenous pressure (secondary to volume increase) up to 8 hours. You cant pass Valium through the same line (it precipitates). You can make a case for both sides, but I will go with the multi use piece of gear before the single use. Just me.

Have you seen or read anything lately that singled any hetastarch product out as the preferred pre-hospital fluid? I know the Feb 2009 TCCC guidelines suggest "no more than a 1000cc bolus for hemmorrhagic shock".

 

[pardus]

"no more than a 1000cc bolus for hemmorrhagic shock".

Of hextend in particular or just any fluid?

 

[amlove21]

Of hextend in particular or just any fluid?

Hextend and other like hetastarch products. 500cc bolus, wait 10-15 minutes, with no improvement and trended vitals, re-administer the other 50cc to get to your 1000cc total. No further hex after that.

The fluid resus question is more of an art than science- some places it will say get peripheral pulses back then titrate, in between 80-100 in some books, patient presentation in some. Hypo resus is the latest and greatest, no more "2 large bore IVs in different big veins with fluids wide open".

 

[pardus]

Thank you for that.

 

[TLDR20]

Hextend and other like hetastarch products. 500cc bolus, wait 10-15 minutes, with no improvement and trended vitals, re-administer the other 50cc to get to your 1000cc total. No further hex after that.

The fluid resus question is more of an art than science- some places it will say get peripheral pulses back then titrate, in between 80-100 in some books, patient presentation in some. Hypo resus is the latest and greatest, no more "2 large bore IVs in different big veins with fluids wide open".

The hypo resus is what I learned last time through SOCMSSC. They were teaching Hextend, so I started carrying it. Haven't had to use it, so really don't have any practical knowledge of it. I do know that we all have different preferences, and as long as no one is getting dead because of them they really are not important.

 

[amlove21]

The hypo resus is what I learned last time through SOCMSSC. They were teaching Hextend, so I started carrying it. Haven't had to use it, so really don't have any practical knowledge of it. I do know that we all have different preferences, and as long as no one is getting dead because of them they really are not important.

I agree 110%.

Yep, I argued the same point (my NS point) at SOCMSSC when I was there, with mixed results. For full disclosure, Hex most certainly is in the TCCC guidelines for hemorrhagic shock. NS is just my personal preference.

Thanks for the input brother. Just wanted to know if I was missing something.

 

[jcooper.84]

I know this post is old guys but im just new to the site, no one has really touched on the increased chance for blood infection due to the direct access to the vein, and if anyone has been in combat you know just how impossible it is to keep anything clean.
This in itself would stop me from wanting to do this.
Please educate me if i am wrong.

 

[TLDR20]

I know this post is old guys but im just new to the site, no one has really touched on the increased chance for blood infection due to the direct access to the vein, and if anyone has been in combat you know just how impossible it is to keep anything clean.
This in itself would stop me from wanting to do this.
Please educate me if i am wrong.

Well that would be a concern, as well as many others that were voiced.