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What is a Nasal Pharyngeal Airway?

Taking care of someone who is unconscious can be daunting, especially if you don’t know what you are doing. Trauma to the head, or even a massive loss of blood can cause your casualty to lose consciousness.

When unconscious, the casualty loses their ability to protect their airway and their tongue may fall to the back of their throat and close (occlude) the airway.

If not managed properly, this can cause your casualty to expire, or at the very least, cause complications. Since this isn’t our goal, we need to have a plan for helping the casualty keep their airway clear.

A Nasal Pharyngeal Airway (NPA) is a soft rubber tube that is inserted into the nostril of the casualty to keep the tongue out of the way and allow a clear path of oxygen to enter the lungs.

Most NPAs are packaged dry and might, (or might not) include a small packet of lubricant to aid in the insertion. As a new Corpsman attached to Marine Corps combat units, I was told that saliva, blood, or anything else available can be used as a lubricant in the event you don’t have any.

Times, and gear change, thankfully…

The Mountain Man Medical NPAs are sourced from Combat Medical and come pre-lubricated so you don’t have to worry about carrying extra packets or taking the time to apply it to the NPA before insertion.

Our NPAs come in the standard size of 28 French, the most common size for application on the average American warrior, and might not work well on very small adults, or children.

How to Insert

  1. Position yourself at the head of the casualty lying on their back.
  2. Open the NPA package and remove the tube. Be careful not to lose your grip. It’s pre-lubricated and slippery.
  3. Ensure the bevel of the NPA is facing inward, towards the septum of the nose.
  4. Insert the NPA straight down with a firm, gentle, slow pressure.
  5. Do not force it. If you meet resistance, gently twist the NPA, and re-try and it should continue to slide back.

What if:

The casualty gags after you’ve inserted the NPA?

Pull the NPA out slightly about one inch. It may be too deep, and this should help.

  • The casualty vomits?

Roll the casualty over onto their side to allow the vomitus to drain and keep the airway clear.

  • The casualty wakes up?

If the casualty regains consciousness, they won’t want to leave the NPA in place. They will often pull it out as soon as they wake up. This is ok, since they are now awake, they can protect their own airway and no longer need the NPA in place. If they lose consciousness again, just re-insert the tube.

  • The NPA won’t advance?

Sometimes, due to the internal structures of the nostrils, the NPA won’t fit. Deviated septums are the most common cause of problems. If this occurs, try to insert the NPA into the other nostril with the same procedure as above.

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4 Styles of Pressure Dressings Explained

Tourniquets enjoy too much of the spotlight. With all the glorious combat saves a good TQ has, the hardworking pressure dressing gets forgotten in civilian emergency preparedness.

Yes, of course TQs are important, but they only count for approximately ¼ of your body. There are other places where a wound would be life-threatening, but untreatable with most tourniquets.

That’s where a good pressure dressing and wound packing comes in. It handles the bleeding that TQs miss.

Pressure dressings share a broad category of what is more technically known as elasticized bandages. This means there is elastic that is providing a circumferential compression on the limb to assist in bleeding control. Or, the stretchiness of the material makes it tight and helps stop bleeding.

Bleeding control comes more from wound packing since the gauze material is placed on top the bleeding artery. A pressure dressing adds an extra layer of protection and allows the medic a degree of confidence that the wound packing material will remain where they want it.

This also frees the medic up from having to hold the wound packing material in place and then can move to focus attention on other wounds or survivors.

Here are the 4 that we carry here at Mountain Man Medical because these are the ones I trust for use on my own family.

The Israeli Style Pressure Bandage

This is perhaps the most widely known pressure bandage since it was the first to utilize a method for applying additional pressure over the wound site via the clip. This style comes in two primary sizes, 4” and 6”.

It can be a little bulky, so I don’t often see these in small individual trauma kits, but tend to see them more in larger aid bags like the kind medics would carry.

While the clip of this bandage does a good job of applying additional pressure, it isn’t intuitive to use since most people I see applying this bandage don’t do it right. Most don’t know to go through the clip, then back over the top and reverse direction with the wrap.

Its important to train and know how to use all the items in your kit, so make sure that if you do decide the Israeli style is the right choice, you know what you’re doing.

The Israeli Style pressure bandage is a workhorse and if I pull one out of a kit, I’d be glad to see it.

The OLAES Modular Pressure Bandage

 Innovative in the simplest way, the OLAES combines wound packing material along with your bandage. This cuts down on space since you are carrying one item instead of two, and both are in easy reach for life saving.

The OLAES has a way of increasing pressure over the wound site but goes about it differently than the Israeli style dressing. Instead of a clip, the OLAES is fitted with a shallow plastic cup. When the bandage is stretched tight around the wound, the cup increases pressure for improved bleeding control.

The OLAES Hemostatic Bandage is very similar, but the wound packing material has been replaced with ChitoGauze, a hemostatic that helps the blood to clot more quickly and further improve bleeding control. A great item to have in your kit for extending your resources and increasing efficiency and effectiveness.

The Emergency Trauma Dressing (ETD) 4 in.

The ETD is produced by North American Rescue one of the most trusted producers of trauma gear in the US. I consider this to be a universal dressing intended for smaller wounds. It will help to keep the wound clean and dry while also decreasing the bleeding.  

I might also use this dressing in a pinch to make an improvised sling/swath, or to keep a splint in place.

Elastic Bandages

Yet one more item that has multiple uses. This type of bandage is better known by the brand name ACE Wrap and can be used as a pressure dressing in the exact same way as the ETD above.

Be sure you have some sort of absorbent materials on hand if you are planning to use it for wounds. I recommend some small rolls of gauze. You might also use this to wrap sprains and strains, or anything else you can think up uses for it.

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If You Don’t Already Know, Here’s the Theory on Pressure Dressings:

If you have a good understanding on how to use your gear, it frees you up to think outside the box and come up with solutions to problems you might face in an emergency.

Everyone wants to be that person who saves the day, calm, cool, and collected while the world goes to hell around them. It’s an admirable trait and one anyone can cultivate with a little practice.

Part of that journey includes having a good understanding of your gear. If you know how to use what you’ve got, your effectiveness and efficiency (both essential for saving lives) skyrocket.

Here’s a brief run-down of what a pressure dressing is and why you need one (or a dozen) in your trauma kit:

Pressure dressings are elastic and normally have an absorbent pad which is placed over the wound site. The stretchy material provides circumferential compression when wrapped and pulls the pad down tight to increase direct pressure and help control bleeding.

Extremities

Pressure dressings are great for treating mild to moderate bleeds on the arms and legs. If the bleeding is so severe you’re worried the victim will die, don’t bother with the pressure dressing. Just go straight to the tourniquet (TQ), it’s the most efficient and best choice.

If the level of bleeding is not concerning and you feel the wound can be properly controlled with a pressure dressing, use it instead. Don’t wrap too tightly. The dressing should be snug, but not cut off all blood supply to the arm or leg like a TQ would.

Be sure to closely observe the bandage to ensure bleeding is controlled. If you see blood seeping through the bandage, bleeding has not been controlled and you should immediately upgrade to a tourniquet placed above the pressure dressing.

Junctional Wounds

Junctional wounds however, (wounds to the armpits, groin, or neck) can’t be controlled with a TQ. Knowing how to pack a deep wound with gauze is an essential skill and can be learned quickly. This is where most of the bleeding control comes from.

The pressure dressing acts to keep the gauze packed in tight around the severed artery and maintain control of the bleed. Without a pressure dressing to assist, you’re stuck holding the gauze in place until EMS can arrive to take over.

If I’m confident I’ve controlled ALL life-threatening bleeding with the application of a tourniquet, I may decide to wrap the wound in a pressure dressing to keep it clean and add an additional layer of bleeding control in the event there’s a problem with the TQ.

However, since bleeding should be adequately controlled with the proper application of a TQ, I would ONLY do this if:

  1. Time and the situation allow.
  2. I’m certain I don’t have other casualties that might need that resource.
  3. I’m unlikely to receive more casualties before I can restock my kit.

The Wrap Up

Those of you who are experienced will know that I’m leaving out an important use: converting a TQ to a pressure dressing if casualty evacuation is likely to be delayed past the point advisable for leaving said TQ secured.

This is an attempt to reduce the chance of the limb being amputated and is dangerous for the casualty, even if done correctly, so it shouldn’t be attempted unless you’ve been properly trained, and the situation calls for it.

I decided not to get into it because you probably won’t need this technique since most Americans have access to rapid transport to surgical centers and it will require more discussion than I have time for here.

Come back next week where I'll be talking about a head to head with the two most popular pressure dressings on the market, the OLAES Modular Pressure Bandage vs. the Israeli Style Pressure bandage. One is better than the other in my opinion, but I'll leave that up to you to decide.

If you’re interested in how to convert a tourniquet to a pressure dressing, leave a comment below and I’ll go over it.

If you'd like to purchase some pressure dressings for yourself, click here.

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New and Improved CAT Clone? The Recon Medical TQ Review

I’ve never thought more about tourniquets then I have in this job. Bleeding control being such an important topic of discussion means devoting a good amount of time to all the various ways people have developed to save lives.

It takes some time to run through all the various options out there, and this week we’re looking at the Gen 4 Recon Medical Tourniquet.

But first, before we get into all the little details, we have to address something important.

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The BEST Way Stop Bleeding W/o a Tourniquet

We can’t be prepared all the time. Even if you’re the kind of person who has every pocket full of life saving materials, you still need to shower at some point and when that day comes you may very well find yourself having to save a life without any gear at all.

Tourniquets are normally your best bet for controlling severe bleeding from an arm or a leg, but that leaves a large portion of the human body where a TQ won’t work.

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The Best Type of Flashlight for Emergency

It would be nice for emergencies to happen in the very best locations. A well-lit ER is a great place to have an emergency if you happen to be in one at the time. But Emergencies don’t happen like that. Usually it’s cold, wet, and dark, and with no help available.

Emergencies are especially scary because, you’re “it.” The casualty might be relying on you because no one else is willing or able. And if it’s dark and you don’t have help, it’s nice to be able to use your hands AND see what you’re doing.

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Trauma Gear: The 1 Item That’s Worth 5

Working as a Corpsman and EMT, I wasn’t given the choice of what medical gear I used. People with much more experience, training and education decided ahead of time what was acceptable and what wasn’t.

As a result, I only used gear that was issued and available to me and I never thought about if there might be a better option because it wouldn’t matter if there was. It would go against SOPs (Standard Operating Procedures) and that was always strictly forbidden.

Now that I’m free to explore and look into other life saving equipment, I’m given the opportunity to search out the answers for myself and question my reasons for doing what I do.

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Extending Your Resources: TOP 5 Multi-Use Trauma Gear

An emergency usually means you have little or no resources available to recover from a bad situation. Being able to extend the life of precious resources like trauma gear might become an essential skill set, and it happens to be one that medics pride themselves in.

Unless you're heading out to do errands in a fully stocked ambulance, you aren’t going to be able to carry all the things you might need for trauma control. And the situation only gets worse for multiple casualties.

Some things you just can’t get around, like carrying tourniquets for life threatening bleeds or seals for chest wall punctures. But if possible, carrying items that can be used for more then one type of injury is good for extending the number, and different kinds of emergency trauma you might encounter.

Here’s a list of items that can handle more than one job:

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The Essentials: How to Build a Mass Casualty Trauma Kit

File:Boston Marathon explosions (8654021280).jpg - Wikimedia Commons

A few years ago, I had the opportunity to work as a security consultant for organizations looking to be proactive for active shooter incident (ASI) or mass casualty events. It was a great experience that I thoroughly enjoyed since I was able to use hard learned skills I acquired from the military.

One of my focuses when working with a new client, was asking them to show me what medical gear they had on hand to treat any injuries. Usually what I found was pretty dismal.

After a lot of rummaging around, they would drag out an old sun faded EMT bag with most of the important things missing, or bring out a small plastic kit half full of Band-Aids and Motrin packets.

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An Extremely Biased Review: The Mountain Man Medical “Mass Casualty Trauma Kit”

Full disclosure: I’m the one that decides what gear should go in our kits. And if it isn’t obvious already, I receive a financial kick back for talking about the MMM kits.

But I’m also confident this is an excellent trauma kit full of top-of-the-line gear and priced better than any comparable kit on the market. I take a lot of pride in the value we offer, and it’s my hope that more trauma gear is placed where it can save more lives.

One of my favorite jobs during my career in the medical field has been teaching trauma classes to organizations looking to be proactive in preparing for a disaster, either natural or manmade.

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