How to Improvise: Tourniquet, Chest Seal, Splint

How to Improvise: Tourniquet, Chest Seal, Splint


how’s it going guys my name’s Sam and welcome back to pragmatic as you can see I am not in my usual surroundings I’m actually traveling for the channel working on a project with the company but until that video releases I figured I’d take this time to show you guys how to improvise a couple life-saving pieces of medical equipment [Music] so on this channel in the past we’ve talked about a couple piece of medical equipment a lot and those are tourniquets chest seals packing gauze and splints and today on the channel I want to show you guys how to improvise this if you don’t have a commercial device out there these are some techniques you can use to accomplish the same objective I would like to point out that this should never be your plan a anybody that carries a strip of cloth in their first aid kit and a little stick saying well I’m just gonna do a makeshift tourniquet I would not recommend that at all in the Boston bombing there were a lot of makeshift tourniquet supplied and what they found is that a vast majority of them were ineffective now you might be thinking well what’s the problem with a tourniquet that’s not 100% effective and I’ll tell you so if you have a tourniquet that is not completely tight as not including blood flow 100% all you’re actually doing is including the vascular return in the leg not the arterial discharge so you will still have bleeding from the artery but now you’ve stopped any vascular turn into the body so they’re not getting any of that blood back and you can actually speed up blood loss so it’s really important that if you use this technique you do it right you know the same thing goes for chest seals chest seals are actually pretty easy to make but they take a lot of time so all of these things I’m showing you you should practice you should make sure you’re proficient in them if you foresee a situation where you might have to do it you know having this knowledge is something that’s good but you have to understand that there are limitations to it and plan a should always be a commercial device because quite frankly they’re more effective and they’re quicker to apply so let’s start with tourniquets so to make a makeshift tourniquet you just need three things and right here I have a cravat which is a triangular bandage it doesn’t have to be this it can be any kind of fabric and you’re going to need two strips so this is just a cut-up t-shirt that I’m going to be using and then you need something to act as a windless so I’m gonna be using my ex shears for this however this can be anything this can be a stick it can be a piece of silverware what-have-you it just needs to be something that can have a lot of force exerted on it and not break so to make a makeshift tourniquet the first thing you’re going to do is you’re going to take your main most sturdy piece of and you’re going to make sure it’s pretty wide you want this cloth kind of as wide as you can get it and put it over the arm or the leg that’s bleeding so you want it above the injury so they’re saying two to three inches above the injury site just not over a joint you’re going to wrap it around the leg and you’re going to tie just an over-under knot right across the leg we’re gonna do it on the leg for this scenario then you’re gonna put your makeshift wind list inside that you’re going to tie another knot on top of that and potentially a second one depending on how well that fabrics holding then you’re going to take your makeshift windlass and you’re just going to start turning it it’s the same concept as a softy wide or another windlass tourniquet that you can buy commercially you’re gonna turn that until blood flow stops at that point you need to hold that windlass right there you’re gonna take the second piece of cloth and put it across and feed it through that wind list and what that’s doing is that’s keeping it from turning back and loosening all the way once you have that secured make sure that all the blood flow is stopped if it hasn’t stopped completely try tightening the windlass one or two more turns if that’s not working prepare to put a second tourniquet on there now ideally I wouldn’t even go for this technique I would actually try to do wound packing first if you can that’s because it’s going to be a little bit more effective and it’s a lot quicker it takes time to set up a makeshift tourniquet you know if you don’t have a cravat right here it’s gonna take time to get a t-shirt ready to do it you can do it with a whole t-shirt you can cut strips but just be aware that those are all seconds wasted so try to pack the wound first and that brings me to the second thing we’re going to talk about for improvising and this is the one thing that honestly you can improvise and it doesn’t bother me at all it’s not going to take you a whole lot more time you can pack a wound with basically any kind of fabric you know you don’t have to worry about it being sterile or anything like that I get a lot of comments about like oh why aren’t your gloves sterile on the ambulance that’s because nothing is sterile in the emergency environment whatever cut them was definitely not sterile so it doesn’t really matter what we’re putting in the wound they’re probably going to get an infection going to get broad-spectrum antibiotics regardless so all we have to do is make sure that blood stops so that they can live long enough to get that infection and to get those antibiotics so for the wound packing just take anything you have and you can just pack the wound like normal like you would with regular guys that’s completely fine all right so the third thing we’re going to talk about today is going to be a chest seal so the first thing you have to do when you come across somebody that has a sucking chest wound is have yourself or a bystander take their hand and put it on top of that injury that’s going to form a very effective occlusive dressing keep in mind that if it’s a bullet hole or penetrating trauma make sure you’re looking for an exit wound as well ideally you’re gonna have a bystander do that and that will give you time to set up your makeshift chest seal so you can choose to make an improvised chest shield two different ways number one is you take the plastic bag and you’re going to tape all four sides down and put it on top of the wound all that’s doing is creating what’s called an occlusive dressing which means that it won’t allow air in or out now the second way to do it is you can tape three sides and leave the third side that’s facing down open what this will create is a flutter valve so in theory if they start developing a tension pneumothorax that tension won’t be able to build because it will be released through that valve that being said there won’t be any air that’s able to come back into the lungs so it’s still accomplishing the objective now I will tell you that there’s no science to support a vented chest seal over a non-vented chest seal I found non-vented chest seals tend to adhere over the wound a little bit better than a vented one so that’s what I opted to do just be aware if you do that and they start to develop signs of attention in the thorax you can just lift one corner of that chest seal and burp it all right so the final piece of improvised medical equipment we’re going to talk about today are going to be splints for this all you need is some kind of brochure or magazine and either tape some kind of fabric or a pressure dressing of some kind now to do this all you do is you take the magazine and you fold it into kind of a boat shape there you take their arm and for this example we’ll do a wrist and you’re going to put it on their arm just like you would a SAM splint once that’s up and it’s bowed up this will not be able to flex up and down which makes it an ideal splint because it’s also not something that’s completely rigid like a stick or a board or something like that after that you’re going to take your tape or your fabric or pressure dressing and you’re going to secure it above and below the injury site you want to make sure that if it’s a joint injury you are splinting the long bone above and below and if it’s a long bone you’re splinting the joint above and below obviously this gets a little bit more complicated when it comes to elbows or ankles however most of the time if you’re improvising a splint it’s going to be for a wrist because that’s one of the most commonly broken bones in the body so I want to drive this point home really quick improvising medical equipment should never be your plan a this is your plan C or D ideally you’re going to have commercial devices that you can use because quite frankly these are going to be a lot quicker to use and they’re going to be a lot more effective for your patients that being said we might be in a situation where multiple devices might need to be used or we’ve run out or we just didn’t have something on us and we have to be able to think on our feet and intervene for that patient so these are good skills to have just please please please practice them before you have to do it in the real world because that’s going to make all the difference for your patient that’s all I have for this video guys if you have any questions please leave them in the comments down below and I will see you next week [Music]

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