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 Post subject: Allanah's Med Bag V1
PostPosted: Mon Apr 17, 2017 12:35 pm 
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This the current iteration of my home/road trip/outdoor adventure medical bag. My background is in emergency and critical care nursing so I use most of this stuff pretty often. Any critiques or suggestions would be appreciated!

Fox Outdoor Sling Pack
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Left Pouch: Trauma
Emergency Trauma Dressing

Front Pouch: Trauma
CAT Tourniquet
Mini Shears
4x4 Quick Clot
2x2 Quick Clot
Petroleum Gauze
Extra Thick Nitrile Gloves
3in Elastic Bandage

Right Pouch: Airway
OPA x 2
NPA x 3
Lube x 2
CPR Mask
Regular Nitrile Gloves x 2

Outer Zippered Slip Pocket: Bandages/Burns
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3in Rolled Gauze x 2
4in Rolled Gauze
4x4 Burn Dressing
3x8 Non-Stick Dressing
5x9 Abd Pad x 2

Front Zippered Organizer: IV Start Kit
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24g IV Catheter
22g IV Catheter
20g IV Catheter
18g IV Catheter
14g IV Catheter
Extension Tubing
Tourniquet
Tegaderm
Chloraprep Swab Stick
Tape
10ml Saline Flush
AMK Heat Sheet
Hand Sanitizer

Upper Zippered Pocket: Pharmacy
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Glucose Gel
Hydrocortisone Cream
4mg Intranasal Naloxone x 2
Triple Antibiotic Ointment
Albuterol Inhaler
Sublingual Nitroglycerin Tablets
500mg Acetaminophen x 6
200mg Ibuprofen x 10
25mg Diphenhydramine x 6
81mg Chewable Aspirin x 8
25mg Meclizine x 2
20mg Famotidine x 3
Ephedrine/Guaifenesin x 6
Bismuth Subsalicylate x 6

Main Area: Diagnostics, Ortho, Fluids, Eyes
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Stethoscope
Pulse Ox
Electronic Sphygmomanometer
Sharps Container
Digital Oral Thermometer
Glucometer Kit (not pictured)
2in Elastic Bandage
3in Elastic Bandage
4in Elastic Bandage
Triangular Bandage w/ Safety Pins
Ice Pack
Cotton Tipped Applicators
Tetracaine Eye Drops
Eye Wash Ampule x 2
Eye Pad x 2
1L Lactated Ringers
100ml 5% Dextrose
IV Tubing Set
Secondary IV Tubing Set

Back Slip Pocket: Splint
SAM Splint (not pictured)


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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Mon Apr 17, 2017 2:00 pm 
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Ok, this is just to start, I'm doing vet shit right now so busy, don't take any comments personally. In your second picture. Get rid of the scissors and throw a benchmade rescue hook in there, it's easier and quicker when clothes are a bloody mess. Throw more gloves in there. You want to keep cross contamination down with multiple patients. If you insist on OPA's you may as well have a pedi one in there. I hate those things. Throw that scrappy Gen1 CAT out of there and put a neon RATS in there instead. Get rid of the quick clot and put two packs of Celox rapid ribbon in there. Take those two abdominal pads out and get two "Cedderoth" dressings. They are less inclined to stick to burns, and they have free rolls of gauze packed in with them. Get rid of the burnshield crap and I'm guessing your a nurse, so get some silvadene silver ointment. It works on pain and healing once you stop the burning process. You don't need the 14 gauge IV Cath. First, those aren't 3.25 inches so they can't be used for chest decompression, second, please don't stick anyone in an AC with a 14 gauge. Let some dumb ass one year experience paramedics that stupid shit. Put a few 18's in there, you can still do an EJ with an 18 or 20 and deliver good fluid. Put more tegaderms in there and get rid of that 1000cc bag. You don't need it. What's with the little bag of D5? You already have some glucose gel. You planning on piggybacking something?


Last edited by IANMCDEVITT on Mon Apr 17, 2017 6:42 pm, edited 1 time in total.

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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Mon Apr 17, 2017 2:18 pm 
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Hey, and get rid of that automatic BP cuff. You should be ashamed of yourself man.


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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Mon Apr 17, 2017 6:39 pm 
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A couple of suggestions from a paramedic

1. I agree with Iamdmcdevitt, ditch the auto BP machine, you should know how to take a manual blood pressure, you'll save weight and you can use a manual BP cuff for multiple purposes (ran out of IV tourniquets?)

2. ditch the ringer's lactate and go with 500mL saline bags, they are more multipurpose (replacement of fluids, keeping a vein open, irrigating a wound) in addition what are you using the 14G cannula (catheter is for urine over here) for? I use 14G for chest decompression. carry 2 of each size, more tourniquets, more tagederm. you are missing bungs.

3. saline steritubes (10mL injectable) and more pads and bandages, you can never have enough and again with mr Iammcdevitt, gloves (at least 5 pair)

Pros
1. keep the CAT, if you are trained in that and you are happy with it save some money.
2. the pharmacy looks well stocked, I would recommend some 300mg Aspirin so you can better manage cardiac issues
3. keeping the cost down, go to the store and pick up some plastic food wrap for a cheap burn dressing
4. the bag looks good, easy to carry
5. while a benchmade hook is better is SOME aspects...keeping costs down the pair of trauma shears does the job

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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Mon Apr 17, 2017 8:02 pm 
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Thanks for the input, guys. I'll get rid of the 14g, double up on the other IV start supplies, and add more gloves. Keeping the CAT for now since it's what I'm used to, but I'll check out the RAT, Celox rapid ribbon, and Cedderoth dressings next time I order supplies. They look pretty quick and easy to use. The electronic BP cuff takes up a little more space, but automatic readings tend to be more accurate and free up time for other tasks.


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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Tue Apr 18, 2017 4:52 am 
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Automatic readings are actually not really more accurate. They may be more convenient, but not more accurate. Especially if you attempt a pressure during any kind of transport. Any tiny bump to the patient and it will read incorrectly. Not only that, I haven't carried a BP cuff or stethoscope in my first line for humans in a while.


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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Tue Apr 18, 2017 5:01 pm 
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Curious on the Naloxone, is there some off label use for it or is treating an opioid OD a likely possibility? Like the sling pack and the organization. IV fluid warmer, or maybe that's not an issue in your locale?


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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Tue Apr 18, 2017 10:22 pm 
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CrossCut,

My hospital gets about 6-8 ODs a day out of 275ish patients so they are pretty common here and are found at parks, gas stations, public gatherings, or dumped on the side of the road. Most of them are in respiratory arrest on scene based on EMS report. The only other time I've given it has been for people having really nasty reactions to Dilaudid where it's titrated to get rid of the continuous vomiting without fully reversing the analgesic effect, but that is with IV dosing (0.4mg/vial) that can be carefully administered versus the intranasal spray which is 4mg at once.

I'm in southern Florida so fluid temp isn't much of an issue anytime of the year. Our mass transfusion protocol calls for using a warmer, but that's for dumping a lot of refrigerated blood, fast. Fluids at room temperature or above don't appear to be an issue in the volumes generally used for fluid resuscitation.


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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Tue Apr 18, 2017 10:54 pm 
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Allanah wrote:
but automatic readings tend to be more accurate and free up time for other tasks.


:shock: I'm assuming you work in a hospital? if so, then automatic readings (depending on the machine) are useful

but most of the consumer auto BP cuffs (and even the corpuls 3) the result should be taken with a pinch of salt if taken in the field, a bump, knock or movement can affect the reading ( watching the corpuls try to get a reading the fourth cycle sucks)

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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Wed Apr 19, 2017 12:28 am 
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Yes, I'm in a hospital. Any movement during a BP reading, either manual or automatic, will be inaccurate. That one is as accurate as our Phillips monitors at work, side by side. Not to mention, taking accurate manual BPs is a skill, and even with well trained people it isn't as accurate as home blood pressure monitors. Current research shows that automatic monitors in a clinical setting or at home are about dead even for accuracy depending on the study with manual pressures being the least accurate method. Even if a person's manual BP skill is perfect, white coat hypertension is a thing and throws off readings in a substantial portion of the population.


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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Wed Apr 19, 2017 6:56 am 
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Allanah wrote:
I'm in southern Florida so fluid temp isn't much of an issue anytime of the year. Our mass transfusion protocol calls for using a warmer, but that's for dumping a lot of refrigerated blood, fast. Fluids at room temperature or above don't appear to be an issue in the volumes generally used for fluid resuscitation.


Gotcha. Average temps haven't reached room temp here since last Sept, and likely won't again until next month.


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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Wed Apr 19, 2017 7:11 am 
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Allanah wrote:
Not to mention, taking accurate manual BPs is a skill, and even with well trained people it isn't as accurate as home blood pressure monitors. Current research shows that automatic monitors in a clinical setting or at home are about dead even for accuracy depending on the study with manual pressures being the least accurate method. Even if a person's manual BP skill is perfect, white coat hypertension is a thing and throws off readings in a substantial portion of the population.


True, over here (Queensland, Australia) it is important to be able to take a manual blood pressure, in case the machine is unable to or is wildly inaccurate, though my experience is pre-hospital in some pretty crummy situations, so milage may vary.

and who still wears white coats? hospitals over here are going polo shirts

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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Wed Apr 19, 2017 7:58 am 
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Pretentious people, mostly, who are mercilessly made fun of for that decision. :rofl: Polos would be awesome, but administration loves the color coded scrub set up regardless of how much employees hate it and how few pockets they have compared to uniform pants.

In your setting, I imagine using "trust but verify" thinking is important. If the monitor isn't correlating with the clinical picture, it's probably worth doing the manual to double check. I've never seen or used a Corpuls monitor. I think all our medic units county wide have Lifepak 15s which seem to be pretty accurate, even on the move. The readings they report tend to mirror what I get with a difference of less than 10/5 most of the time.


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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Wed Apr 19, 2017 8:03 am 
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Actually, you don't need a blood pressure cuff in your first line. Vitals signs are done in your secondary survey. Your first line should be for BLS......and dude, go off of signs and symptoms of the patient, don't count on a BP.


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 Post subject: Re: Allanah's Med Bag V1
PostPosted: Wed May 03, 2017 9:18 am 
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I'll throw in my two cents, truthfully I like the bag. The BP cuff probably doesn't need to be hiked out on daytrips and whatnot, but I keep one in my trunk bag without fail. Automated vs Manual is going to be all about your preference, so I really wouldn't sweat it. I personally would also keep the shears and add a rescue hook, I have seen benchmade hooks struggle with some super-stretchy yoga type fabrics that shears worked well with. I would also think about adding a 6" ACE for wrapping knees. The 14 ga IV I actually like, because it can be used as a scalpel fairly effectively. I have seen it demonstrated as a last ditch needle cric as well.

Thanks for posting.


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