Tourniquets and Typeset

Hopefully the changes at blog-city will allow me to do some neat special effects. We will see.

As for tourniquets; I guess the comments in the preceding post jinxed me. First, We had a lecture presented by a surgeon who is a reservist, and has done tours both in Afghanistan and in Iraq. Part of what he said was that he was not a fan of the use of tourniquets until he spent some time in Iraq. According to him, the leading cause of death for our troops is exsanguination ("Bleeding to death" for all of you who are unimpressed with 50 cent words). He says that the use of tourniquets has been invaluable on the battlefield for saving lives, even if there is no chance of saving the limb.

As an aside, it was an awesome lecture. He managed to address a whole lot of issues and handled them in a very professional and intelligent manner. He described the kinds of wounds suffered by different calibers, and how blast wounds differed from fragmentation wounds, and how land mines caused different wounds than mortar rounds. Besides the different types of wounds which are seen almost exclusively on the battlefield, he also went into the changing form of battlefield medicine, and what it has become in today's age. He also talked about what one had to do in such an environment. If I may go on a tangent a bit further, he said that if you asked him what three things he would take with him on such a deployment, he listed three intangibles: Courage, Thinking outside the box, and medical history. He said you need courage to try things that you were not trained for, specifically procedures where you were only familiar with the theory of how they were done, but where you probably had not actually seen one done. You needed to think outside the box to come up with solutions in an environment where you would never have everything you wanted, and pftentimes did not have everything you needed. He said that medical history, was invaluable because, in an environment where you did not have access to X-rays, labs, or MRI scanners, you had to approach your patient more like a physician in the 1940's than a physician today.

Back to tourniquets.

I also applied a tourniquet to a patient on call. Hew had sustained a gunshot wound to the upper arm. When he came in, it wasn't bleeding much. Once we got his pressure up above about 60 systolic, and infused a few units into him, he started to bleed. He started to bleed a lot. Even though the wound was covered in gauze and kerlix, it soaked through and started to litterly just pour out. So, using a technique learned in the Marine Corps, I took a length of kerlix, tied it high around the arm, and slipped the end of a yankauer under it. Then, I started twisting the yankauer like a one-bladed propeller, until it was so tight, I was afraid it would snap. Then I taped the other end of the yankauer down to the elbow, to keep it in place. The bleeding stopped in pretty short order. I got props from the vascular surgeon who reconstructed his brachial artery. Said surgeon decided to pimp me on the different layers of the artery. I answered one of the questions, but they could tell I was not 100% certain of my answer. So, they then said "would you still be so sure if 95% of your classmates had a different answer, or would you change your answer?" I thought about it a moment, and then answered "No." I said that "either I am right, or I need to study more."

I was right. The Chief who was with us on the case gave out a laugh, and said, "This is why I like Marines; they don't try to equivocate."

So, I got rare praise from a chief who is known for being a jerk to his underlings. 

Anyway, in all, the night was again quite eventful. I also was told that the next day I was to give a presentation, and had to sacrifice the little sleep I could have gotten in order to accomplish that mission. It really sucked, but I managed to put together a good presentation, especially in light of the circumstances (No home computer; no access to my library). SO, I spent the next day and last night sleeping like it was going out of style. I am working on the truck first aid kit, and hope to have that posted either tomorrow or the next day.

Respectfully submitted,

doc Russia