defibrillator?

[BrokeSomeRibs]

I'm not gonna yank, it's just for an open puncture.

Tampons are expressly NOT recommended for puncture wounds. It's an old wives' tale that needs to die. They are not designed for trauma, they are designed to staunch menstrual flow for hygienic purposes. Stuffing a tampon into the wound cavity of a penetrating injury is just going to clog up the wound (in a bad way) with cotton debris and make healing harder and infection more likely. Cover the wound with a trauma dressing, apply direct pressure if/where possible, immobilize the injury site, and evacuate. That's it.

[Lindahl]

I carry tampons for other reasons... broken noses

[tBatt]

It's actually for puncture wounds

Tampons are designed to expand as they absorb blood, right? Wouldn't removing a soaked tampon tear out the blood clot with it?

[Meadow Skipper]

Tampons are designed to expand as they absorb blood, right? Wouldn't removing a soaked tampon tear out the blood clot with it?

Maybe, but the working theory is that when that occurred you'd be in a medical care facility, and there would likely be some internal damage that'd need to be seen to. It's not a band-aid - it's a tamponade.

I'd be curious about what the actual doctors that post here think. Or paramedics. But our medical director and the paramedics I work with haven't brought up any objections.

[Bunion 2020]

^^^ Well I wouldn't go around poking tampons in every puncture wound I came across.

And in 30+ years I have yet to see one large enough to bother with, that the patient wasn't already pretty much fucked.

But then again I didn't assume MS was going around willy nilly with tampons, inserting them in every gaping wound he saw either.

Just another tool in the tool box.

[Meadow Skipper]

^^^ Well I wouldn't go around poking tampons in every puncture wound I came across.

And in 30+ years I have yet to see one large enough to bother with, that the patient wasn't already pretty much fucked.

But then again I didn't assume MS was going around willy nilly with tampons, inserting them in every gaping wound he saw either.

Just another tool in the tool box.

I haven't dropped any OPAs either, but I carry them too, and I've never used the epinephrine and syringe either.

[cmcrawfo]

Tampons are not a good option for treating puncture wounds, if you are thinking that far ahead you should just pack a proper pressure dressing. While you may not feel very mcgiver about using it, pressure dressing are far more versatile and effective than tampons.

Inserting a tampon in a wound will not stop bleeding, tampons are designed be placed in a vagina, the mechanisms that cause a vagina to bleed are much different that the mechanisms that cause a traumatic wound to bleed... Tampons jammed in wounds are more likely to cause further damage and infection than they are to stop severe bleeding...

[sfotex]

Just buy some QuickClot gauze......

[BaNosser]

a defibrillator will only work if there is some oxygen in the cardiac cells for them to begin working again... that's why compressions.. quality compressions (100/min) are so vital to give the heart a chance to kick start again... It's why the most recent data suggest to not stop compressions to give breathes.. stopping even for a few seconds drops the perfusion pressure (a minimum level is needed for oxygen to enter cardiac cells).. compressions build up the perfusion pres and allow O2 to cross back into the cardiac muscle.. stopping compressions drops the pp back down to ineffective levels.. you have to start all over again... That's why the quicker you can get an AED the better... seconds count..

Now if someone keels over by you on the hill.. and they have no pulse.. pull that AED out and save them

[summit]

a defibrillator will only work if there is some oxygen in the cardiac cells for them to begin working again... that's why compressions.. quality compressions (100/min) are so vital to give the heart a chance to kick start again... It's why the most recent data suggest to not stop compressions to give breathes.. stopping even for a few seconds drops the perfusion pressure (a minimum level is needed for oxygen to enter cardiac cells).. compressions build up the perfusion pres and allow O2 to cross back into the cardiac muscle.. stopping compressions drops the pp back down to ineffective levels.. you have to start all over again... That's why the quicker you can get an AED the better... seconds count..

You are correct that we want to minimize interruptions of compressions.

You are not correct that we always give continuous compressions. That is what is done by professionals once a SGA or ETT is in place or what is taught to many lay rescuers (because it is easier, because they were pausing too long ,or avoiding CPR altogether because of the breaths part).

What you have to remember is that most of the general recommendations for treatment of out of hospital adult cardiac arrest (where we see compression only CPR) are based on the following assumptions:
1. primary cardiac etiology where there is still sufficient oxygen in the blood
2. or an etiology where ventilation is not going to reverse the problem
3. short EMS response times

In avalanche accidents, cardiac arrests are primarily asphyxia / HHH. The heart stopped secondary to lack of O2 in the blood. That is the problem you need to reverse while also restoring pressure. We want to give these patients breaths just as you would a drowning or pediatric. Of course, if you aren't willing to because you don't have a CPR mask, by all means do hands only CPR instead of doing nothing at all.

[snoqpass]

a defibrillator will only work if there is some oxygen in the cardiac cells for them to begin working again... that's why compressions.. quality compressions (100/min) are so vital to give the heart a chance to kick start again... It's why the most recent data suggest to not stop compressions to give breathes.. stopping even for a few seconds drops the perfusion pressure (a minimum level is needed for oxygen to enter cardiac cells).. compressions build up the perfusion pres and allow O2 to cross back into the cardiac muscle.. stopping compressions drops the pp back down to ineffective levels.. you have to start all over again... That's why the quicker you can get an AED the better... seconds count..

Now if someone keels over by you on the hill.. and they have no pulse.. pull that AED out and save them

A defibrillator only works if you have a shockable rhythm

[BaNosser]

You are correct that we want to minimize interruptions of compressions.

You are not correct that we always give continuous compressions. That is what is done by professionals once a SGA or ETT is in place or what is taught to many lay rescuers (because it is easier, because they were pausing too long ,or avoiding CPR altogether because of the breaths part).

What you have to remember is that most of the general recommendations for treatment of out of hospital adult cardiac arrest (where we see compression only CPR) are based on the following assumptions:
1. primary cardiac etiology where there is still sufficient oxygen in the blood
2. or an etiology where ventilation is not going to reverse the problem
3. short EMS response times

In avalanche accidents, cardiac arrests are primarily asphyxia / HHH. The heart stopped secondary to lack of O2 in the blood. That is the problem you need to reverse while also restoring pressure. We want to give these patients breaths just as you would a drowning or pediatric. Of course, if you aren't willing to because you don't have a CPR mask, by all means do hands only CPR instead of doing nothing at all.

that is who I am mostly talking to on this forum.. those who know correct CPR tech or 2 person tech already know it

[BaNosser]

A defibrillator only works if you have a shockable rhythm

yes..

[snoqpass]

yes..

Good CPR is still an important component to a successful resuscitation but trauma induced cardiac arrest has a success rate around 1%. I've found it interesting how many people go on about how fast you need to pull out your transceiver but how few BC travellers know basic first aid

[summit]

Good CPR is still an important component to a successful resuscitation but trauma induced cardiac arrest has a success rate around 1%.

Indeed... and that is all traumatic OHCA, it's worse for blunt trauma, and even worse for wilderness, such that many agencies won't work a traumatic arrest except maybe a 3 hole punch.

I've found it interesting how many people go on about how fast you need to pull out your transceiver but how few BC travellers know basic first aid

Agree. I encourage all avalanche students to take a WFA or WFR and CPR class. I discuss a scenario or two with them for about 5 minutes during the rescue portion of class as I lay myself contorted in the hole they dug during strategic shoveling. A lot of wide eyes as they realize they have no idea what to do at that point... I then tell them that they are far more likely to need what is in a WFA in the course of their lives than what they just learned about their beacon/shovel/probe.

[Meadow Skipper]

A defibrillator only works if you have a shockable rhythm

As was mentioned in post #2.

I've found it interesting how many people go on about how fast you need to pull out your transceiver but how few BC travellers know basic first aid

^This.