LAS VEGAS — Improvised medical care can be lifesaving in settings where the closest medical facility may be hours or even days away, Dr. Eric A. Weiss told attendees of the meeting.
With just some basic medical supplies, the usual backcountry gear, and a few key additional items – safety pins and duct tape – physicians can often devise temporary, makeshift treatments for commonly occurring conditions, such as lacerations and fractures, he said.
Airway Opener
In unconscious patients, safety pins can be used to keep the airway open by pinning the tongue to the lower lip, according to Dr. Weiss of the departments of surgery and emergency medicine, and director of the Wilderness Medicine Fellowship at Stanford (Calif.) University.
This technique can be especially useful in cases of trauma, given the need to avoid neck hyperextension, and it also keeps the physician's hands free when they would otherwise be tied up performing a jaw thrust.
“This works very effectively – minimal bleeding, opens the airway,” he said.
“I know what you are thinking: This sounds kind of harsh. It's really not. If you are putting a safety pin through somebody's tongue, they are obviously unconscious [and] unresponsive.”
Barrier for Rescue Breathing
When performing rescue breathing in a noninstitutional location, physicians may not have conventional barrier devices to reduce their risk of contracting infection from the patient.
In this case, Dr. Weiss recommended making a slit in the middle finger of an examination glove, placing the glove fingers in the patient's mouth, and stretching the rest of the glove over the mouth and nose.
“Now you can blow air right through there and very effectively ventilate. As air goes in, it comes out this slit. To allow for exhalation, just remove the nasal part, allowing the victim to exhale, and then put it back for ventilation once again,” he explained.
“Any back pressure, like vomiting, will cause that slit to collapse and you don't get slimed,” he added.
Surgical Airway
To create a surgical airway (cricothyroidotomy) without the usual instruments, physicians can use a knife or other sharp object to make a vertical incision in the skin over the cricothyroid membrane.
“Horizontal incisions are fine,” Dr. Weiss said. “But I like vertical ones because sometimes you are a little bit off target and once you get through the skin, you can stick your gloved finger in there and you will find it a little bit easier [to get oriented], and you may have to move north or south.”
A variety of items can be inserted through the cricothyroid membrane and into the trachea to permit ventilation: a hollow pen tube, the cut barrel of a 3-cc syringe, or the spike that comes with standard macro IV tubing, after the drip chamber has been cut in half.
If the spike is used, “you don't even have to make an incision through the skin: This spike is so sharp, you just plunge that right into the cricothyroid membrane,” he said. “You have the fastest cricothyroidotomy the world has ever seen.”
An added, serendipitous benefit is that the chamber end of the spike “fits beautifully right onto an Ambu bag,” he noted.
Pleural Decompression
In the patient with a tension pneumothorax, most physicians are familiar with the practice of inserting a needle into the pleural space to achieve pleural decompression.
But Dr. Weiss additionally recommended putting the needle through a cut finger of an examination glove to create a one-way Heimlich valve.
“When the person takes a big breath in, the negative pressure causes the glove to collapse,” he explained. “But when he exhales out, it allows air to escape.”
Posterior Nasal Packing
Persistent posterior nasal bleeding, as might occur in facial trauma, can be stopped with a Foley catheter, according to Dr. Weiss.
The catheter is advanced through the nose until it can be seen in the back of the throat. “Blow up the balloon with 30 cc of air,” he advised.
“Most people use air because there is theoretical concern that if you put water in there, which works a little better actually, if it ruptures there could be aspiration.”
The catheter should then be withdrawn until the balloon is seated in the posterior nasopharynx, where resistance can be felt. The exiting part of the catheter is then taped to the nose with duct tape.
Fracture Diagnostic
As a stand-in for x-rays, a stethoscope and tuning fork can be used to diagnose fractures in long bones, such as the tibia. The principle at work here is that intact bone is a good transmitter of vibratory sound.