First Aid

[PurpleFlare]

Hm... I know tourniquet is borderline taboo. But why isn't it even mentioned in here?

 

 

 

 

I mean if we're talking about something that have chance to explode, then there's at least a minor chance that your hand/arm could be blew to shred and if that happen, it is very unlikely it could be repaired.

 

 

 

 

I don't really want to put in any first aid infos, but it kinda surprised me that no one say a thing about tourniquet.

 

 

[PurpleFlare]

OH! Also probably the most important thing anybody here could learn is, STAY CALM! Panicking is probably #1 killer!

[TritonPyro]

All burns should be seen at A and E. don't slather them in creams or lotions......these will have to removed by the A and E doctor. Edited March 29, 2013 by TritonPyro

[NeuroticNurse]

Okay, long post coming up. I havent quoted individual people and because there was so much to read I've just put quotes in quotation marks, rather than quote boxes. Sorry if it makes things a pain for everybody...

[NeuroticNurse]

"TREATMENT OF BURNS:

 

Whenever you get burnt, the smart thing to do is to cool the area that is burnt IMMEDEATLY. What you use, cold water, an ice pack, ice cubes or anything else you might have at hand, doesn't really matter. Keep the cold there for 20 minutes."

 

DO NOT NOT NOT NOT NOT use ice on a burn, without skin there as a layer of protection, particularly to deeper burns, you can cause some real serious cold damage to the underlying tissue, especially to joints.

 

"Water is not the best thing to use on 3rd degree burns, as it tends to dry out the area of damage, something you don't want to happen. In 3rd degree burns, the best thing to do is to cool it with an ice pack or a bag of ice cubes. AFTER this cooling, you can wash the area with mild soap and water to get rid of any shit that might be left in the wound, like potassium oxide, sufur oxides, carbon, and other nastiness. Dry the area carefully."

 

Cool water is the best thing to use, not ice. Your concern is minimising the thermal damage. In a partial or full-thickness burn, leave everything to the critical care staff at your medical facility (you certainly require hospitalisation), and don't soap your wound, soap contains any number of things which makes life that much more difficult.

 

"For all burns, it is smart to put on fatty creme/lotion after the cooling period. This is to keep the skin moist. If your skin dries out, it will not be as flexible, and it might even crack open, destroying even more skin, or stretching the burnt area. Keeping the skin moist(with fat, not water) will also accelerate the rate of healing."

 

There are several dressings which can be used, like Intrasite, but dont dont dont, put fat on a burn. They are a further source of infection, and some can be incredibly damaging, you're right about keeping a wound moist, but a closed wound dressing is better, and for superficial burns, petroleum jelly, not fat.

 

"Painkillers are OK, but in pill form is better that the type you smear on the damaged area(at least for 3rd degree burns)."

 

NEVER put a topical anaesthetic on a full-thickness burn, ever. If you have a full thickness burn you will likely be given a PCA of fentanyl.

 

"If you are so dumb or unlucky that you lost a limb, say a finger, hand or something like that, be sure to find the limb(if you are in condition to), put the limb on ice, so it can be operated on later on. It may not work anyway, but it is better to have that possibility."

 

Wrap it in a waterproof snap-lock bag first, if you put it directly on ice. Don't put it in milk as suggested. Its a source of infections, and the proteins in milk just make it that much harder for the theatre staff.

 

"May I ask under what condition do the doctors go for "skin scrubbing"? As far as I'm aware the dead skin is left on to protect the new tissue that is formed under the burn, scrubbing the skin off would probably leave horific scars."

 

Imagine a combination of a cheese-grater and steel-wool. Crude and disgusting analogy on my part? Yes, but not exactly inaccurate.

 

"Would you rather be restricted on what you can buy or even go to jail for a period of time, or would you rather die from Gangrene or Septicemia?"

"It does, they can still contact the police if its in the intrest of public safety. "

 

No we cant. As medical professionals, we're bound by confidentiality. We don't give a f**k why or how you got it, our job is to give you the best care we can. We are not obliged to tell police about the nature of your injuries unless we are subpoeaned to do so.

The only time we do so, and it is a big judgement call, is if someone says that they intend to do x harm to x person/people, and even then, I would tell my ACSC or CSC and ask them for advice on it. I would never tell the police outright.

 

"Best excuse would be to say you were siphoning petrol or some other liquid and something went wrong. Although if I have fucked up that badly that I need to go to hospital thinking of a good excuse is not something I will paying much attention to."

 

Trust us, we're not silly. We can work things out. What it does do, is makes it all that much harder to spot any contamination of the wound if there is anything because we're looking for something else. What we will do, is think that you're a disingenuous twat, and will treat you accordingly, even if we do want you to get better.

 

"It is actually better and i know it sounds disgusting to put the amputated finger/thumb/hand in your mouth because your saliva has the ability to kill bacteria and if it does kill the bacteria then "

 

If I find the jackass who invented this nonsense, I will personally come after them...

 

"Question for the paramedics here. If someone loses a limb or suffers a serious burn, what are the chances of that person going into shock/losing consciousness/facing a medical emergency other than the obvious physical damage?"

 

Shock is the loss of perfusion. Your chances of shock after a serious burn are almost 100%, because the circulating volume will decrease, reducing the quantity of blood, more likely so than the body's ability to compensate ie, vasoconstriction, increased HR & loss to the peripheries. This is the reason for large stat-dose saline in such instances.

Depending on the loss of a limb and if blood loss is well stopped etc. Although it is quite likely as in the case above, that hypovolaemic shock is going to result. I can't say that I've ever had to deal with a critical case of traumatic amputation, and the only two amputations that I've had to deal with were a rehab patient who had lost a leg but was very stable and was there for rehab, not recovery, and an amputated foot due to diabetes/smoking related complications.

 

We get worried when the Systolic BP falls below 90, but long before then, the HR would be above the MET call criteria of 140BPM and RR would likey be well and truly up... although that said, I have had an elderly man with a BP of 75/32 and a HR of 45 which for him was normal, so it varies from person to person, and one of the MET call criteria is - any situation which you believe to be a medical emergency, which I have used more than once.

 

 

This is all from personal experience on the wards, but I am sure that the EMTs and paramedics will back me up on all of them. If not, This info can all be found from the RGH, WCH and Royal Adelaide protocols pages.

Edited September 18, 2013 by NeuroticNurse

[hindsight]

Providing medical education and delineating emergency care algorithms in a forum is a near impossibility. Staunch the blood flow, if bleeding is present, and seek professional emergency medical assistance immediately. As suggested there are many things one should not do to a burn. And, in all mishaps, pray.

[Arthur]

In your country wherever, there WILL be a community first aid teaching organisation, St John and The Red Cross are two examples, others certainly exist. Take and keep updated their beginners first aid course Wherever you are, know how to call professional emergency aid.

[dagabu]

I love Propofol and Thiopental...

 

Good post Nurse.

[Jonathan]

This thread interests me. I've never been injured badly, but I've dodged some big mistakes.

 

You have to have a feel for your chemicals. For example, ... won't go there.

 

But I still feel you have to have a feel for your chemicals.

 

For example, NaClO3. Sodium Chlorate. Said to be water-absorbing. You can dry it out with a dessicant. Same with any sodium oxidizer. NaNO3 for example. Both when dry are terrific oxidizers.

[hindsight]

Everybody loves propofol. Thiopental (sodium pentothal)...not so much. But anything that takes a suffering soul out their misery for a while can be a desirable drug. A famous singer, whose misery was internal, paid $120,000 a month for an incompetent quack to administer propofol. Without monitoring, without available resuscitative equipment, without a provider with the necessary skills, without even anyone being constantly present, he was given propofol. Ketamine was a common drug used for debridements in the burn unit in the years before the advent of Milk of Amnesia. Even when given with Valium-like drugs, people could still hallucinate from ketamine. Although some people think it's entertaining to hallucinate, being chased through a flaming swimming pool by fluorescent green dragons carrying machine guns is a little unnerving. Edited September 23, 2013 by hindsight

[dagabu]

Yes, hallucinations.... BAD!

 

Propofol... GOOD!

[nater]

Propofol is great in a controlled setting, it gets tricky with all the stimulation from an ambulance ride. Its still a great tool when your patients need it. Ketamine is coming back into favor. For my needs in the field it is good choice when you can't risk the hypoperfusion from benzos. Personally, I like that my medical director trusts our flight and ground crews with a well stocked rig. We have plenty of choices and freedom to chose the best route. Much better than if x then give y.

 

Hindsight, No you cannot offer great medical advice on a forum like this. Much of what we have discussed is the treatment you will get from a professional anyway. I still find it interesting. I'm not the only medic here and I enjoy reading what others like me do wherever they are at. The pyro community is also a highly educated bunch. There are a ton of engineers in this hobby, but a number of medical professionals too. The PGI has a number of medical doctors and at a recent club event I sat around the campfire with an ER doc, a pharmacist and a chemist for an international pharmaceutical company. Lots of great things to learn from fellow members.

Edited September 24, 2013 by nater

[hindsight]

Nater, I concur. This a great place to learn with many unusually intelligent and educated members. Arthur has made a wonderful point, because of the limitations of any forum, that basic training in first aid is a great way for non-medical's to prepare for the worst. (PM me if you would like to talk about benzo's, propofol and ketamine, I would enjoy the discussion.) Edited September 24, 2013 by hindsight

[NeuroticNurse]

Never administered Propofol or been administered propofol so cant say. Although I have heard that it is great. On wards we prefer to use PCAs usually of Fentanyl for pain. I'm no an anaesthetist and I'm not a theatre nurse, so I can't say too much about GAs because they're way outside my area of knowledge and I'd have to defer to you guy on it.

As far as Ketamines go, never administered it or been administered it either. Never seen it even on our ward, but seeing as for pain, we're likely to administer (in order) Codeine/Paracetamol, Tramadol, and finally either oxycodone or Fentanyl/Morphine, I doubt we'll ever get to the stage where Ketamine is administered, because if it gets to the stage where the strong opoids arent treating it, we're more than likely to send them back to ICU or HDU where they came from.

[NeuroticNurse]

Anyone who gets into pyrotechnics should at the very least get a basic first aid certificate, and know how to treat burns and stop serious bleeding. Will it stop you from getting burns or bleeding? No, but there are plenty of bad things that you can do that have been suggested, and that are common misconceptions, like putting ice on burns, or trying to neutralise strong acid burns with baking powder, rather than flushing straight with water.

 

There are plenty of first aid training providers out there, and in this country at least, they're all accredited and have to pass that accreditation yearly. So its unlikely you'll get taught any bullshit in them.

[nater]

I can only speak for us, we use ketamine and propofol to facilitate intubation in the field along with other drugs. Both have their pros and cons. The ICUs use propofol to maintain sedation on vented patients. It is so great because the effects are short lasting once the drip is stopped.

 

We use dilaudid, morphine, fentanyl and toradol most often for pain on the trucks. I am not as familiar with how things are used outside my world of 911, ER and ICU transports. I also don't know what medics outside the US generally do.

Edited September 24, 2013 by nater

[Arthur]

While ER/ITU technology is essential, most techniques cannot be administered for lack of materials or permissions or training, by a typical pyro person.

 

First Aid is, by my training, to preserve life til the patient reaches professional care. This is where we all can and should play a part.. The basic first aid course will prepare you to attend to most typical injuries in preparation for the arrival of paramedic ambulance. Only if you live or work really hours away from help do you need to do further training and carry equipment to account for paramedic/ER help being hours or days away..

 

DO that first aid course NOW!

 

I'll suggest St John and The Red Cross as two bodies available in much of the world to provide training, Perhaps our Medic members could add to the list of community first aid trainers available in various parts of the world.

[nater]

Here in NE Indiana most of the community first aid courses are offered through the Red Cross. They are okay classes, but don't expect too much. Basic treatments have already been discussed, just ignore the old wives tales that have been repeated here.

[NeuroticNurse]

There are First Aid courses taught in many places, the larger organisations, St Johns and Red Cross teach them, but its also possible to learn all the same, identical skills cheaply at a Surf Lifesaving Club, often for free if one volunteers, or the like. There are also many Registered Training Offices here which teach them. As I said before, I would recommend that EVERYBODY, not just people with potentially dangerous hobbies learn these skills, because you might just save a life one day. It is also to avoid misconceptions, such as those I previously posted about.

Again, we should all hope we never have to use them, but just in case we need to have them ready.

Especially pertinent to this hobby are in order, Burns/Scalds, Bleeding (leading to) -----> Shock, and Poisoning.

There is a lot of rubbish out there. Some of them based on old/outdated information, some of them based on pure bullshit. But the facts sheets about these conditions are available free of charge from the St Johns Website (URL provided below).

 

http://www.stjohn.org.au/index.php?option=com_content&view=article&id=22&Itemid=36