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Trauma and Egress Kit

Why you should carry a first aid kit

This adult airway takes 5 minutes to learn how to use and is “almost” idiot proof. A $0.20 piece of plastic that can save a trauma victim with an obstructed airway. Beyond this, you’re talking advanced techniques that are unlikely to be available or used properly.

Do no harm is definitely a primary goal and no way am I recommending a layman try to utilize advanced airway techniques. The doctors are right in that even ALS guys can have trouble implementing.

On the other hand, a backcountry pilot should have basic first aid supplies aboard, particularly for remote and/or overnight excursions. If not for oneself then for passengers. A decently comprehensive kit weighs less than 16 oz. and can handle many issues. That weight equivalent of 1/6 gallon of avgas might be the difference between an enjoyable trip and a day or two of misery.

Example: Minor burns and lacerations (most common camping injuries) can often be handled on site, but if they aren’t handled properly those wounds can quickly become infected and then move from minor inconveniences to possible major concerns. Would you want to give up the last three days of a weeklong moose hunt you’d been waiting for all year because your buddy refused to properly clean, treat and bandage a first day 1” gash in his hand? (Just rub some dirt in it - it’ll be fine...)

Example 2: your passenger and fishing buddy becomes lethargic, confused and seems to have a case of the “umbles.” (Stumbles, grumbles, mumbles, tumbles, etc). You know they’re diabetic but don’t know what their medication/care regimen is; however, you know that no harm will be done by giving them sugar, so you grab the sugar source you keep in your first aid kit, administer, and 20 minutes later he’s taking care of himself. You’re now freed up for the task of flying home.
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Hospital care and field care are different. Neither the in-hospital Docs, nor the field EMTs and Paramedics should confuse the two. Analogously, a mishap scenario where rescue is imminent, and where it is a day or two off, are different in their requirements for injuries. Blanket generalizations that blend the two raise caution flags. I'm speaking from the perspective of being a former fire department EMT in Ak. I distinctly remember a highly respected local Doc there saying essentially the same thing in an EMS training session.

Edit: I have no idea where that smiley at the top came from, and I can't seem to delete it. So please ignore it!

Edit again: I'm going to run my mouth here, but - - - For you anesthesiologists- You seem to denigrate field care - both by amateurs and by professional field medics. Your profession and that of EMTs and Paramedics are worlds apart. I strongly suggest that you do a ride-along with a fire department ambulance crew for a few days, and begin to acquaint yourselves with the nature of field medicine. You seem to focus on airway management. Well, some Paramedics do just fine with intubation, while some Docs are klutzes. My wife is a Critical Care Charge-Nurse, and my son is a Fire Dept Lead-Paramedic: they would each corroborate that. I have great respect for your profession, and you, in turn, should have great respect for field medicine.

There - I've shot my mouth off enough for one day. Thanks for listening.
 
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Ex medic here...I'm with the Docs on this. You need to know how to use the stuff in your kit, and not from a youtube video. Steve, I'd throw away that decompression needle. You can kill someone with that and no Good Samaritan law is going to protect an untrained person when they stick a 3" needle in someone's chest. Toss the NPA too. That's the rubber hose that you jam up your patient's nose. Those things are pretty useless. Do you have individual KY packs for that? It isn't going in without lube, and spitting on it is poor form. The recovery position is the best way to secure an airway in the field anyway. You said the tourniquet is self explanatory...it's not really. You need to go get some training on that. Look for a "Stop the Bleed" course.

I'd call that a penetrating trauma kit. Trauma is either penetrating or blunt force, and most of what you see on the market is for penetrating trauma for 2 reasons: First, you can't really do anything about blunt force trauma in the field other than treat shock. Second, everyone is worried about the "active shooter", which unless you're a cop or soldier is really the last thing you should be worrying about, but that's for another day. Anywho, get some hands on training.

There's an awesome dude named Mike Simpson who has a podcast that I listen to. Doc Simpson was 18D (SF Medic) and then went to med school and became an ER doc. He's the real deal. Anyway, he just had a podcast where he went through his vehicle first aid kit. It's worth a listen.
 
a mate of mine crashed in his glider in the mountains, broke 17 bones including some vertebrae (IIRC), he was well prepared, had a PLB and cell phone safely stored in the side pocket of the cockpit, on the other side he had his spare water and a space blanket and some basic medical stuff..... so after crashing he was hell bent on getting out of the cockpit (and this is where we can apply this to motor plane flying, often, very often your very first priority is to get OUT and away from the AVGAS leaking), so he manages to mangle himself out of the glider - running on pure adrenaline from the crash - the cockpit was over a couple of rocks he when he tumbled out of the cockpit he couldn't reach the edge to pull himself back up - his PLB, cell phone, water, first aid now all completely useless lying in the cockpit 3 feet away, him too incapacitated to get back up into the cockpit.

my point is that these sort of survival kits should be on your body, at least a minimum. I am also not a fan of a huge bulky jacket bulging with kit that in itself stops you from being able to egress, but it needs to be with you somehow.
 
Ex medic here...I'm with the Docs on this. You need to know how to use the stuff in your kit, and not from a youtube video. Steve, I'd throw away that decompression needle. You can kill someone with that and no Good Samaritan law is going to protect an untrained person when they stick a 3" needle in someone's chest. Toss the NPA too. That's the rubber hose that you jam up your patient's nose. Those things are pretty useless. Do you have individual KY packs for that? It isn't going in without lube, and spitting on it is poor form. The recovery position is the best way to secure an airway in the field anyway. You said the tourniquet is self explanatory...it's not really. You need to go get some training on that. Look for a "Stop the Bleed" course.

I'd call that a penetrating trauma kit. Trauma is either penetrating or blunt force, and most of what you see on the market is for penetrating trauma for 2 reasons: First, you can't really do anything about blunt force trauma in the field other than treat shock. Second, everyone is worried about the "active shooter", which unless you're a cop or soldier is really the last thing you should be worrying about, but that's for another day. Anywho, get some hands on training.

There's an awesome dude named Mike Simpson who has a podcast that I listen to. Doc Simpson was 18D (SF Medic) and then went to med school and became an ER doc. He's the real deal. Anyway, he just had a podcast where he went through his vehicle first aid kit. It's worth a listen.
I realize the limitations in this kit is my lack of knowledge. I do continue to carry it because I fly with people who are qualified to use it. Was at a fly-in several years ago and was surprised at the number of qualified EMTs and Docs that jumped into action when there was a serious accident. The kit doesn't weigh much.
 
What you have is a civilian version of the IFAK (individual first aid kit). It’ll treat/ stopgap most preventable causes of death on the battlefield, massive hemorrhage, airways compromise, pneumothorax. Adding a spaceblanket would cover the 4th, hypothermia.

Like any tool, if you don’t train with it and maintain the kit, it’s useless.

i was an SF medic for 7 years, now a PA. Feel free to PM anytime.
 
The civilian versions the IFAK either come with cheap item made in China, or are overpriced as a kit.

I would suggest sourcing the items below:
2-4 SOF-T wide tourniquets
4x 3 or 4” acewraps
4-6 rolls of kerlex (gauze, doesn’t need to be impregnated, read the data)
4x occlusive chest dressing (plastic and tape yourself or spend big bucks on the hyfin)
1x roll of medical tape (or duct tape)
1x airway adjunct (nasopharyngeal)
1x trauma shears
1x spaceblanket
1x seatbelt cutter

all of this can be carried on you or in a blowout pouch with survival gear and tools. It covers the basics.

Id save the needles for decompressing a pneumothorax for someone trained. The literature shows EMS and regular army medics do not accurately place them when it counts. May be newer data out though.

same goes for surgical cric kit. Get some training with real anatomy first.

deployedmedicine is a great website to learn more about the basics of tactical combat casualty care, very applicable to a backcountry crackup.

The combat pill pack consisting of moxifloxicin (antibiotic), mobic 10mg(pain reliever), and Tylenol 500mg (fever/ pain) would be worth carrying if you were injured and had a delayed evacuation.
 
The things we do in the platinum Ten and the Golden hour oftentimes is much more important that what the anesthiologist does in an air conditioned OR.

Granted, I appreciated all the training with CRNAs/ anesthiologists on how to secure an airway...
 
Great thread on emergency preparedness. I'm a first time poster but have been a forum stalker for a bit :). I'm curious, do the folks that mentioned carrying an AED (automated external defibrillator) have a recommendation on a specific device? I'd be interested to find a compact/lightweight AED (under 4-5 lbs), but it seems like that's a little tough to find.

Thanks in advance.
 
Great thread on emergency preparedness. I'm a first time poster but have been a forum stalker for a bit :). I'm curious, do the folks that mentioned carrying an AED (automated external defibrillator) have a recommendation on a specific device? I'd be interested to find a compact/lightweight AED (under 4-5 lbs), but it seems like that's a little tough to find.

Thanks in advance.

I will look into the particular AED we have. Our local EAA chapter purchased a couple and we put them in a couple different planes when we go out on EAA get togethers. We always brief on who has them and on the general route of flight etc. So far we have not had to use them, but we do have a lot of older folks in the group and they seem happy to know that we have them along just in case.

I carry a pretty decent kit in my plane, truck, boat, side x side and snowmachine. At one time I had just one that I would swap around, but all to often I would forget to grab it from one mode of transport to the other. Thankfully I have not had to use it due to a major accident, however, I have used many of the items do to me or someone in my party being dumb and careless when stopped for lunch etc. A careless swing of the axe, stupidity when cutting a hot dog stick, digging razor clams, dealing with fishing lures embedded in places they should never be etc. The first aide kit is not just used for a major catastrophe where guts are hanging out and bone is sticking out of the skin. Too many are focusing on trauma where you more than likely need a priest and not a dr.
 
I will look into the particular AED we have. Our local EAA chapter purchased a couple and we put them in a couple different planes when we go out on EAA get togethers. We always brief on who has them and on the general route of flight etc. So far we have not had to use them, but we do have a lot of older folks in the group and they seem happy to know that we have them along just in case.

I carry a pretty decent kit in my plane, truck, boat, side x side and snowmachine. At one time I had just one that I would swap around, but all to often I would forget to grab it from one mode of transport to the other. Thankfully I have not had to use it due to a major accident, however, I have used many of the items do to me or someone in my party being dumb and careless when stopped for lunch etc. A careless swing of the axe, stupidity when cutting a hot dog stick, digging razor clams, dealing with fishing lures embedded in places they should never be etc. The first aide kit is not just used for a major catastrophe where guts are hanging out and bone is sticking out of the skin. Too many are focusing on trauma where you more than likely need a priest and not a dr.

Regarding the AED, great, thank you for looking into it. I've been looking at these machines so far:

Cardiac Science G3 Plus AED
Philips Heartstart Onsite AED
Philips Heartstart FRx AED
Philips HeartStart FRx AED Aviation Package
ZOLL AED Plus AED

The second to last one listed there appears to be specific to aircraft use, although I haven't studied it enough to understand any meaningful differences.

That makes total sense on the emergency kit usage and is so true. They are so valuable and important beyond major trauma and often under appreciated. Glad to hear you've been on top of it.

Thanks again for your help!
 
I'm a doctor. The kit below is what I came up with for my Maule. It's definitely overkill for most people, but if there is a serious injury at a campsite or elsewhere, I'd be the one taking care of it. I have also added a suture instrument kit and neck collars (2). I have a much lighter kit for my SuperCub - it has a lot of the same kind of stuff, only not as many duplicated items.

https://www.amazon.com/gp/product/B08WNJXCJH/ref=ppx_yo_dt_b_asin_title_o01_s00?ie=UTF8&psc=1
 
So I tried to sit back and keep my mouth shut but I just can't do it. My brother used to beat me up every day because I never learned. Let me try to defend the anesthesiologists under attack here. First off I have been through 14 years of college learning my job. I have spent 33 years taking care of trauma patients at a Level I trauma center. ( In Billings we are Level 2 but the nearest Level 1 is Denver or Salt Lake so in essence we are defacto Level 1. I take care of trauma patients every week. I have attended Trauma Morbidity and Mortality review conference with paramedics, flight nurses and surgeons on a monthly basis for the last 33 years. During my career I have 5 patients that I have transfused more than 75 units of blood that lived. The number of transfusions over 50 are too numerous to count. That means replacing all the blood in ones body from 5-8 times. I know when I have one of these cases while driving to work the next day they will be asking for volunteers for blood donation over the radio. On a couple of these cases we had to fly our plane to Denver to get more as we ran out in town. I have attended many field traumas as first on site. One interesting one was a self inflicted GSW from the base of the tongue up through the top center of the head. The police and fire arrived first with their useless first aid kits. Then the paramedics arrived who greeted me with a hey how are you doing because they knew me, I had helped with their training. Guess who intubated that one. On another MVA the EMTs arrived to find me with a 3 year old the only survivor of 3 total. The EMT tried to explain to me that they did not feel comfortable taking care of children. Hell I've done anesthesia for heart surgery on children that weigh less than 2 pounds. That is just a couple of the many times I was first on scene. Oh and for those that are not aware trauma operating rooms are hot because hypothermia kills. Remember one trauma surgeon with sweat sloshing around in the sleeves of his gown. Anesthesiologists are experts at resuscitation and oh yeah as a side light I can secure an airway. So as it goes on the internet there are some that pretend to be experts and others that actually are. I do not intend to demean any first responders in any way, we are all a team. NoFlaps I honor your service to this country if read through the lines correctly, Thanks. I just think you don't have any idea what I do on a daily basis. Hope to have a beer with you one day I am sure we could tell some stories.
 
Krines,
I’ll buy the first round. You are a true master of your craft. The anesthesiologist I worked with on my last deployment was too. That guy forgot more than I’ll ever hope to learn!


Sent from my iPad using SuperCub.Org
 
Aren’t you the guy who claimed, “I carry no first aid kit in my plane” (your first posting)? That’s some poor advice right there.

I realize this conversation started with trauma and egress, but there’s so much more to flying in remote areas. Having to leave a wilderness site because of minor common ailments or injuries easily treatable with a basic kit is not good personnel management.

I’ve deployed alongside SF and other ops medics for three tours, and treated folks in the backcountry as an expedition medic for 16 years, and have never come across a competent wilderness or combat leader who didn’t have equipment and/or a plan to treat minor medical issues in the field. I agree with you that major issues may not be effectively managed but that doesn’t mean we should recommend no capability otherwise.

We’re all pretty much back to basics without the fancy equipment, determining field treatable or evac. But, all of us should be able to treat minor issues right there and then to keep them from becoming major issues that require that evac or early departure.

Pardon the break. Back to the trauma discussion...



So I tried to sit back and keep my mouth shut but I just can't do it. My brother used to beat me up every day because I never learned. Let me try to defend the anesthesiologists under attack here. First off I have been through 14 years of college learning my job. I have spent 33 years taking care of trauma patients at a Level I trauma center. ( In Billings we are Level 2 but the nearest Level 1 is Denver or Salt Lake so in essence we are defacto Level 1. I take care of trauma patients every week. I have attended Trauma Morbidity and Mortality review conference with paramedics, flight nurses and surgeons on a monthly basis for the last 33 years. During my career I have 5 patients that I have transfused more than 75 units of blood that lived. The number of transfusions over 50 are too numerous to count. That means replacing all the blood in ones body from 5-8 times. I know when I have one of these cases while driving to work the next day they will be asking for volunteers for blood donation over the radio. On a couple of these cases we had to fly our plane to Denver to get more as we ran out in town. I have attended many field traumas as first on site. One interesting one was a self inflicted GSW from the base of the tongue up through the top center of the head. The police and fire arrived first with their useless first aid kits. Then the paramedics arrived who greeted me with a hey how are you doing because they knew me, I had helped with their training. Guess who intubated that one. On another MVA the EMTs arrived to find me with a 3 year old the only survivor of 3 total. The EMT tried to explain to me that they did not feel comfortable taking care of children. Hell I've done anesthesia for heart surgery on children that weigh less than 2 pounds. That is just a couple of the many times I was first on scene. Oh and for those that are not aware trauma operating rooms are hot because hypothermia kills. Remember one trauma surgeon with sweat sloshing around in the sleeves of his gown. Anesthesiologists are experts at resuscitation and oh yeah as a side light I can secure an airway. So as it goes on the internet there are some that pretend to be experts and others that actually are. I do not intend to demean any first responders in any way, we are all a team. NoFlaps I honor your service to this country if read through the lines correctly, Thanks. I just think you don't have any idea what I do on a daily basis. Hope to have a beer with you one day I am sure we could tell some stories.
 
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Sorry to link to another site but...

https://backcountrypilot.org/knowledge-base/safety-and-survival/177-the-survival-vest-philosophy

I watched this video several times and really enjoy this guy’s presentation and thoughtfulness. I made myself a vest with many of the items he recommends, adding/subtracting for my know how and locale. I used the extras to make an extra trauma/first aid kit that just lives in the airplane.
a half hour to learn how to properly prep and use a tourniquet and an Israeli bandage and I feel reasonably prepared for a somewhat serious problem. Am I ready for ANYTHING? Absolutely not. Better than nuthin’
definitely worth a watch.
 
As I stated earlier I do not carry a first aid kit in my plane and that is the way I do it. After my last post you get some idea of where I come from. To all you military guys I also get it. You guys play in a war zone, I do not. The original post specifically mentions TRAUMA which I know all to well. There is also mention of carrying a needle for decompression of tension pneumothorax which is very serious business. I would only attempt that reluctantly if someone was dying before my eyes and I am well experienced in taking care of major trauma patients. Same goes for cricothyroidotomy to secure an airway. Let's not confused trauma with simple first-aid kind of things. Let me also say that simple problems can turn bad quickly. If you are out there and get say a four inch gash in your leg and you take care of it with your basic first aid kit and feel like you don't need to leave you could be making a huge mistake. Overnight you could become septic and completely incapacitated. The time to leave is now. Almost every day I see patients that have made that mistake with dire consequences. And heck we have a plane that can extract us quickly. Sepsis can only be treated with intravenous antibiotics. Finally I would like to say so there it goes communicating on the internet. NoFlap as it turns out you are one of my brothers, fighting the good fight helping others and you didn't even punch me in the nose. I should have read between the lines a little deeper as I figured you are military but I didn't get the air-conditioning shot. Now I realize you got to go to one of those warm exotic countries courtesy of Uncle Sam. You got to work in the heat while the anesthesiologist worked in the AC. Now I understand the shot and would have laughed it off all day long had I been there with you. Here's to you brother, punch me in the nose any day. Cheers
 
Sorry to link to another site but...

https://backcountrypilot.org/knowledge-base/safety-and-survival/177-the-survival-vest-philosophy

I watched this video several times and really enjoy this guy’s presentation and thoughtfulness. I made myself a vest with many of the items he recommends, adding/subtracting for my know how and locale. I used the extras to make an extra trauma/first aid kit that just lives in the airplane.
a half hour to learn how to properly prep and use a tourniquet and an Israeli bandage and I feel reasonably prepared for a somewhat serious problem. Am I ready for ANYTHING? Absolutely not. Better than nuthin’
definitely worth a watch.

Yow! I can just about guarantee the vast majority of pilots would not wear a vest with that much junk in it. As Greg says in the video....suit yourself on contents. But, I have seen too many vests hanging on a hook in the hangar or on the seat back of the plane because they were just too bulky or uncomfortable.

MTV
 
Yow! I can just about guarantee the vast majority of pilots would not wear a vest with that much junk in it. As Greg says in the video....suit yourself on contents. But, I have seen too many vests hanging on a hook in the hangar or on the seat back of the plane because they were just too bulky or uncomfortable.

MTV
Mike I agree, and as stated I kept it to what I felt I need. Also, I don’t wear it on every flight. Only cross country over or into inhospitable terrain far from help. Otherwise I have the kit that lives in the airplane. Could there perhaps be some overlap where I might maybe could not have everything I could want? Sure. Am I happy with my current risk exposure? Yup.
 
One thing I carry I didn’t see mentioned was a couple of israeli bandages. I also carry a Sams Splint and both Quit Clot gauze and powder, caution using the powder if it’s windy as it could get in someone’s eyes.
Being on dual anti-platelet therapy (now for life) I could bleed-out after a shave. Last week, I pinched/nicked a finger tip pretty good that wouldn’t stop bleeding after 7 minutes of pressure (and yes I set my watch timer) so while I continued pressure on it with a gauze pad under a finger I opened a tube of quick clot powder (NOTE TO ALL, take all your critical stuff out of the damn store anti-theft packaging as soon as you get it home) and having not used it on a real bleed before I pulled the saturated gauze pad off and as it started flowing again so I squirted a bit of the powder on the outside of the wound and put a bandage on it and all I can say is WOW that stuff works, the heavy cloth band-aid didn’t even spot... If you don’t carry this stuff you should.

Kirby
 
Kirby-
Your points are the perfect example of why folks should conduct a pre-departure briefing when flying/hunting/fishing/adventuring together that covers not only the flight profile, weather, etc., but also particular medical circumstances that could dramatically affect outcomes.
We always cover med history, including menstruation (can bring in the bears) before taking people out into wilderness settings.

Glad you shared this. Thanks.

JR

Being on dual anti-platelet therapy (now for life) I could bleed-out after a shave. Last week, I pinched/nicked a finger tip pretty good that wouldn’t stop bleeding after 7 minutes of pressure (and yes I set my watch timer) so while I continued pressure on it with a gauze pad under a finger I opened a tube of quick clot powder (NOTE TO ALL, take all your critical stuff out of the damn store anti-theft packaging as soon as you get it home) and having not used it on a real bleed before I pulled the saturated gauze pad off and as it started flowing again so I squirted a bit of the powder on the outside of the wound and put a bandage on it and all I can say is WOW that stuff works, the heavy cloth band-aid didn’t even spot... If you don’t carry this stuff you should.

Kirby
 
I overhauled my vest last fall. It was a useful exercise as it hadn't been touched in quite a few seasons. Downsized/replaced/upgraded a few things and had a good laugh about others. Especially my medical kit. Stained band aids and a couple of ace wraps....

A buddy is a former SF navy corpsman and I asked him for his input on a basic trauma kit for flying. He thought about it and gave me a basic list. Very basic stuff to deal with what I'm most likely to encounter. It all fit neatly in one pocket of my trusty old Vietnam era surplus AF survival vest. While I was at it I made up another one for snowmobiling and put it in a small molle 8 by 6. I also have a LightningX 8 by 6 in the car, which has a few more items and can also be tossed in the Cub/attached to my vest.

https://www.amazon.com/gp/product/B01NB16RSB/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1
 
Out and about again after covid isolation and more aware of medical emergencies these days. Learned about AEDs in First Aid class quite a while back, but have just started trying to find them in various locations I might visit. I suppose its time for a refresher course--I recently heard about AED use in the context of the "chain of survival".
 
I think investing in an AED is important, as it can potentially save a life in the event of a medical emergency. Having one on airplanes is especially beneficial, as they allow passengers to receive timely and immediate care if needed. Remember to include checking your AED is onboard and ready to go with your preflght checklist.
Aircraft need FAA approved devices. Three brands I know of that are approved for aircraft (including helicopters 😆) are:
Zoll (AED Plus Aviation package),
Defibtech (View), and
Philips (HeartStart FRx and FR3 )
When it comes to finding the best AEDs for sale, online is probably the best bet. you'll want to consider things like type of battery, size and weight, ruggedness specs, etc. There are deals on refurbished models; if you go this route make sure you are buying from a reputable source and that the machine and accessories are fully updated/refreshed.

 
A couple of times in this thread there has been mention of "potent pain killers", which is something I'd like to add to my first aid kit. I suppose this means something a whole lot stronger than Tylenol. So my question is this: How does one go about getting some of the "potent" stuff, which is likely to be in the "restricted" category (at least in this country - Canada)?

I'm not sure what kind of reaction I would get from a doctor if I were to ask for a bunch of opioids, or even if he would be allowed to supply me with some.

Not sure of the legality of this but curious nonetheless. Perhaps it's simply a non-starter.
 
Just finished a few weeks ago my wilderness medic recert for the next three years. Discussion arose about this topic of effective pain relief. None of the following is medical advice and I'm not responsible if you utilize the information:
General consensus is that aceteminophen + ibuprofen is about as effective as some opioids. Be sure to follow precautions for both medicines, particularly acetaminophen overdosage and ibuprofen GI issues. Also, ibuprofen has proven to be an effective blood thinner, so if you have a bleeder exercise caution.

Here's a study Ibuprofen Plus Acetaminophen Equals Opioid Plus Acetaminophen for Acute Severe Extremity Pain | AAFP

Ibuprofen blood thinner discussion Is ibuprofen (Advil) a blood thinner? (drugs.com)
 
Two weeks out from yet another surgery, my perspective on OTC pain relievers vs opioids? Not even close. Hydrocodone and Oxycodone are fantastic pain killers but the danger in an outdoor survival situation would be that they make me sleepy. Same for Tramadol. That’s a fine feature in a pain reliever in the appropriate setting but not good if you’re cold and wet and alone. Make good choices.

My doctors and nurses have made it very clear that it’s important to stay ahead of pain rather than to try to respond to it. They strongly suggest taking the pain meds before the pain gets bad. It’s a very good strategy. If you get behind the pain it takes a full day to bring it under control. At least that’s been true for me. Know your body, know your meds, know your situation.
 
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