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M.O.L.L.E. MEDIC BAG Purpose •The purpose of this tutorial is to familiarize the student with the Modular Light Weight Load Bearing Equipment (MOLLE) Medic Bag and its equipment. Components • The MOLLE Medic Bag consist of: – Eight external pouches. – Two detachable flaps. – One detachable IV bandoleer. – Approx. weight 22 lbs. full load – Physical characteristics: – Length – 22 in. – Width – 16 in. – Height – 12 in. EIGHT EXTERNAL POUCHES DETACHABLE FLAP DRESSING, BURN 4X16 SATURATED WITH WATER/GEL • Purpose- specifically intended for the use in treating white phosphorus burns (WP). DRESSING, CHEST WOUND SEAL • Purpose- treating sucking chest wounds. LARYNGOSCOPE Purpose- for introducing endotrachael tubes. The set contains a handle with fiber optic light and two blades (curved and straight). CHEMICAL COLD PACK, REUSABLE, DUAL ICE • Purpose- for use on sprains and blunt trauma injuries. The packs can be used in the field where ice is not available. BASIC CORPSMAN ENT KIT • • • • • • • Otoscope. Speculums. Fiberoptic nose light. Red light lens. Cobalt blue light. Flour-I strips. Fiberoptic wands. • Vortec Headlamp/red lens. VORTEC HEADLAMP • Purpose- provides no-hands way of lighting the area to examine battle injuries. Packing/Configuration of the M.O.L.L.E. Bag • • • • • • • • Type of Mission. Duration of Mission. Environment (Urban, Jungle, Desert, Mountain). Casualty estimation. CASEVAC time. Resupply. Level of training. Weather (Cold, Hot) The Field Medical Card DD 1380 Purpose • Furnishes the attending physician with essential information about the diseases, injuries and treatment provided to the casualty during evacuation through the various echelons of care. • Records disposition of patient, including death. • Utilized by all U.S. and NATO Forces. Disposition of the DD Form 1380 • Transferred Cases – Remains with the patient when transferred from one MTF to another. – It should be attached to the patient or with established health record until the patient reaches hospital, dies, is buried, or returns to duty. Carbon Copies • In the U.S., the Senior Command Surgeon prescribes the use of these through the SOP or the administrative or logistics order. • Overseas commands they are used as the Senior Command Surgeon prescribes. Accuracy • The DD Form 1380 is the first and sometimes the only record of combat casualty treatment. • Accuracy and completion is of utmost importance. Required Information on the DD Form 1380 Block #1 • Personal Identification: – Name. – Rank. – SSN. – Sex. – Specialty Code. – Religion. Block #2 • Unit Information: – Unit. – Nationality. – Force. Block #3 • Injury identification: – Mark appropriately on diagram. Block #4 • Level of Consciousness: – Mental status. – AVPU. Block #5 • Pulse: – Record time. – Pulse characteristics and location. Block #6 • Tourniquet: – Indicate with yes or no and time if applied . Block #7 • Morphine: – Record dose and time . Block # 8 • IV: – When. – Where. – What size IV catheter Block #9 • Treatment/Observations/Medications/Allergies /NBC Antidote Block #10 • Disposition of the patient , I.e. SIQ, light duty, MEDEVAC’d Block #11 • Provider Signature. The backside of the DD-1380 is used for reassessment and follow-up. STANDARD ISSUE PHARMACEUTICALS Morphine (MSO4) Accountability • During time of war, HM’s will be issued Morphine injectors under very strict controlled procedures. • Possession is a medical responsibility and must not be taken lightly. Indications include: • Relief of severe pain. Contraindications • • • • • • Allergy to morphine or any other opiate. Airway and respiratory related injuries. Head injuries. Loss of consciousness, Altered mental status. Massive hemorrhage. Evidence of severe or deepening shock. Dosage • Adult dosage: 10mg Q4hrs • Autoinjector is given intramuscularly which may be repeated, if necessary, in no less than 4 hours. NOTE: • In the past, morphine came in the form of a syrette (similar to a small toothpaste tube). • Dosage was 16mg (1/2 grain). • NO LONGER USED !!! AUTOINJECTOR Syrette Procedures • Remove the safety cap and inject into a large muscle, i.e thigh or buttocks. Hold in place 10 seconds. • Massage the area in which the morphine was injected to increase the absorption into the circulatory system. • After the morphine has been administered it is important to attach the spent injector to the pocket flap of the uniform blouse or blouse lapel. This is to show conspicuously that morphine has been given. Procedures (cont’d) • The letter “M” and the Time that the morphine was administered must also be written on the patient’s forehead. • Lastly, it is important to document the administration of morphine on the DD-1380 in Block 7. Morphine Poisoning • Constricted pupils. • Slowed respirations less than 12. • Progressive fall in blood pressure. Treatment: • Oxygen. • Pain stimulants. • Administer Narcan. Narcan: • • • • • Drug of choice. Located in the BAS . Adult dosage is 0.4 mg, I.V. repeated every 2 -3 minutes. Can be given SQ M.O.L.L.E. Medic Bag Standard Issue Drugs Diphenhydramine Hyrdochloride (Benadryl) • Is a antihistamine drug with anti-cholinergic (drying) and sedative effects. • In oral form it is effective in the treatment in the following indications: »Skin allergies. »Anaphylactic reactions. »Food allergies. »Motion sickness. Contraindications • Hypersensitivity to diphenhydramine hydrochloride and other antihistamines of similar chemical structure. Dosage and Administration • A single oral dose of 50mg is quickly absorbed with maximum activity occurring in approximately one hour. Epinephrine Injection, USP 1:1000 (Ana-Guard) • The most valuable drug for the emergency treatment of severe allergic reactions is epinephrine Principle Indications • Allergic reactions. Anaphylactic shock. • Severe reactions due to allergy injections. • Exposure to pollens, dust, molds, foods, drugs or unknown substances. • Severe, life threatening asthma. • Other symptoms: – bronchoconstriction, – wheezing, – sneezing, – erythemia and pruritis Contraindications • Cardiogenic, traumatic, or hemorrhagic shock. • Cardiac dilation. • Cerebral arteriosclerosis. • Organic brain damage. Dosage and Administration • Epinephrine Injection USP 1:1000 – 1 ml syringe, designed to deliver 2 doses of 0.3 ml each • ( 0.3 ml - 0.5 ml recommended dose ) • Intended for SQ or IM. Dosage and Administration • Epinephrine Injection USP 1:1000 also comes in a Auto-Injector, which delivers a 0.3 ml dose. • Also called an EpiPen. • You may see both types of Epinephrine in the Supply system. Atropine • Is the drug of choice for treating nerve agent poisonings. Atropine will dry secretions (including those in the airway), reduce bronchoconstriction, and decreases gastrointestinal motility. Indications • Exposure to a nerve agent Contraindications • None for emergencies Characteristics and Components of the Individual First Aid Kit (IFAK) Old – 1-Eye Patch Dressing – 1-Battle Dressing with Tie Ends – 1-Bottle of Iodine Water Purification Tablets – 1-Bottle of Wound Disinfectant – 1-Lip Balm 2-Cravat’s – 10-Adhesive Bandages New – 1-Packet of Adsorbent Hemostatic Agent (QuikClot) – 1-Package of Burn Gel (Water-Jel) – 1-Bottle of Iodine Water Purification Tablets – 1-Bottle of Wound Disinfectant – 1-Tourniquet – 2-Pressure Dressings – 2-Bulky Gauze Rolls – 10-Adhesive Bandages Components and Characteristics • 1-Packet Adsorbent Hemostatic Agent – Granular mineral powder – Sterile – Stops high volume venous and arterial bleeding through rapid absorption of liquid – Clot remains in the wound until removed by medical personnel – Food and Drug Administration (FDA) approved Quikclot Precautions • Adsorption is physical, not chemical in nature • (Adsorption-physical adhesion/ Absorptionchemical reaction) • In presence of normal blood, this absorption causes only a slight body temperature increase to approximately 109-114 degrees F • In presence of very non-viscous/adhesive liquids like WATER, MORE EXTREME HEAT CAN BE GENERATED by this adsorption. This reaction lasts approximately 4 to 5 seconds and then ENDS! Quikclot Precautions (cont.) • Once granules have adsorbed all of the liquid possible, they go INERT. • Prior to application, REMOVE water and excess blood from wound area. • Caregivers hands should not be wet. • Exothermia (production of heat) is controlled by adjusting the balance between volume of water and volume of product. Quikclot Precautions (cont.) • Exothermic reaction and adsorption can be instantly arrested by flooding the granules with water. • If blood is extremely diluted, the exothermic reaction can be more extreme! • Quikclot may be applied in small amounts, rather than dumping all at once if blood is extremely diluted. Components and Characteristics (Cont) • 1-Bottle of Wound Disinfectant – Betadine solution – Cleansing of Minor Wounds Components and Characteristics (Cont) • 1-Tourniquet – One Handed Use – Use on arterial and venous blood – For Moderate to Severe Bleeding only – For use on Extremities only Components and Characteristics (Cont) • 2-Pressure Dressings – Vacuum Packed – 8” x 10” Absorbent Pad – 4” Wide elastic wrap with Velcro strip on both ends – Coated Steel tension hook for individual application Components and Characteristics (Cont) • 2-Bulky Gauze Rolls – Gauze roll – Absorbent Material Components and Characteristics (Cont) • 1-Package 4”x16” Sterile Burn Dressing (Water-Jel) – Extinguishes white phosphorous burns – Cools burn area – Reduces chance for hypothermia – Prevents burn from further progression – Protects against infection and eases pain – FDA approved – Do not use for other than intended use Components and Characteristics (Cont) • 1-Bottle of Iodine Water Purification Tablets – To purify non potable water for consumption – After handling the tablets, wash hands thoroughly. If eyes come in contact with the tablets or residue, it could cause temporary blindness