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pa4ortho
02-20-08, 11:19
Here is what I carry in my remote field hospital set for splinting care.

-4" elastic wrap, as I can make any size splint with this size wrap
-4" coban or vet wrap, get it at the feed store, great outer wrap after the major swelling comes and goes makes it more water resistant and durable, dont wrap too tight, dont use to wrap plaster that is setting up.
-4" plaster rolls, long shelf life but not for the novice as it molds so well that any dents from fingers can make a sore easily
-4" kerlex, invaluble for bleeding but also folded 4 layers think and wraped in a spiral pattern as a bulky jones dressing, roll in the palm for hand injuries.
-4" synthetic webroll, place next to skin and over plaster to keep it from adhearing to the kerlex and elastic wrap so it can be removed easily
-18ga 1 1/2" needle, for drawing from bottles and aspirating
-25ga 1 1/2" needle, for local anestetic or hematoma blocks, use 22ga if you aspirate as part of your technique.
-betadine swabs
-scrub brush, irrigation, complex wound care not in this section of the kit.
-sam splints and ace wraps are in the tactical trauma bag along with kerlex
-fiberglass has the advantage of durability, light weight, more forgiving of poor molding technique, water resistant, can make functional ankle and wrist splints, etc... down side is cost, poor shelf life, even a pin prick in the wrapping and it gets hard, I only carry a small amount of orthoglass pre cut 4X 30 and a few rolls of (you guesed it 4") fiberglass casting tape. Avoid 3m precut splints as it molds terrible. orthoglass or royce medical make good stuff. 3m casting tape is good.
Many fractures can be treated with good splinting alone without a full cast.

A roll of 2" or 3 " athletic tape can be torn into 1" and 1 1/2" size as you spool it off the roll. Coban works as under wrap great, tincture of benzoin can help prevent the tape from shifting. tape comes in a variety of quality look for a high thread count. athletic tape is worthless for dressings.
silk style cloth tape sticks to dressings better and can be used to prevent elastic wraps from shifting again 3" is the universal size as it can be torn down into smaller sizes. It also works great as a note pad if you stick it on your thighs in trauma care and then stick your "note" to the patient when you transport.
------------------ Gotta go to work ----------------- More later

James Huffaker
02-20-08, 11:35
Thanks for posting, What do you transport this in? To make it portable. Regards, Jim

Austerenurse
02-20-08, 14:05
Great post!

What quantity of materials do you carry for your initial load out?

Do you pack anything to cut the plaster off with in case you get swelling, screw it up, need to fly, or suspect compartment syndrome? Maybe add a manual plaster cast saw and plaster cast spreader? They serve the extra purpose of taking off other people crappy cast work when they show up at your clinic (if you are working in that environment, and not a truly remote environment). I have found in some part of the world "doctors" are keen to cast even with open wounds underneeth, and these people show up to clinic complete with pussy casting.

I agree plaster is much better in the field than fiberglass. I have had luck with placing a layer of duct tape (well... gaffer's tape, a stronger version of duct tape) over the plaster cast once it has dried as a method of protection and adding to the water resistance.

Once again, great post... thanks.

AN

pa4ortho
09-13-08, 09:08
sorry I have been off line for monthes. That's the problem with remote medicine.
I use a variety of bags to transport gear.
I have a large iron duck bag that disasembles into hanging wall mounted pannels with clear pockets. It is usually shipped to the destination hotel or embasy as it is a 2 person lift.
many trips I go lighter with just sam splints and a roll or two of plaster. I have a london bridge backpack for a mobile vehicle based trauma kit.
I use a sked pack for sick call meds with insulated sub compartments.
long term med storage is in mylar sealed bags with oxygen absorber packets. these type of med packs can be pushed out for team use with radio consult remotely. meds are loaded for what an individual would use.
for tactical use I use a kids school backpack $20 on sale. Its the single diagnol strap kind that I can swing to the front sidewase and access without setting it down. it can quickly be accesses and put away.
I don't cast in remote settings as most injuries can be definitavely tx with a molded splint. and due care. I use emt shears, large bandage scissors, an old school hand held plaster cutter (imagine a cast saw blade on a stainless handle. imagine an hour rubbing a cast off. ok if you can hand it to the patient and do something else for a while.) aviator tinsnips and gerber multi tools can help. If all else. another tip to speed things along is to soak the plaster prior to your attack with wet rags or if no open wound dunk it.
hope this helps.

pa4ortho