Page 123 - JSOM Winter 2021

TABLE 1 Cont.
Equipment (Quantity) Indication/Uses Notes
Ioban antimicrobial drape, 35 × 35 cm (1) Temporary closure for damage control
laparotomy or thoracotomy
Chest tube, 36 French (1) Tube thoracostomy; abdominal drainage for
temporary abdominal closure
Surgical towels (4) Temporary abdominal closure
Laparotomy sponges (10) Hemorrhage control during damage control
surgery
Sharps container (1) Safe disposal of contaminated sharps
Items listed:
TACMED Surgical Set/Advanced (TACMED Solutions, https://tacmedsolutions.com/products/tacmed-surgical-set); Argyle vascular shunts (Car-
dinal Health, https://www.cardinalhealth.com/en/product-solutions/medical/surgical/cardiothoracic/perfusion-products/argyle-carotid-artery
-shunt-kits.html); HemCon Guardcare Pro (Tricol Biomedical,https://tricolbiomedical.com/product/hemcon-guardacare-pro/); Sam Splint (SAM
Medical, https://www.sammedical.com/products/sam-splint?variant=32444250292333); Leatherman Raptor Shears (Leatherman, https://www
.leatherman.com/raptor-rescue-51.html; portable pulse oximeter (Nonin Medical, https://www.nonin.com/technologies/pulse-oximetry/), Ioban
antimicrobial drape (3M, https://www.3mcanada.ca/3M/en_CA/p/d/v000058041/).

FIGURE 1 Layout of the entire surgical equipment set. TABLE 2 Organization of Equipment: Ultramobile Surgical Set
Carried on person Rescue shears
Rescue knife
Front compartment Nonsterile gloves (5 pairs)
Headlight with extra batteries
Permanent marker
Secured externally 14-gauge angiocatheter (2)
Rear compartment Chest tube (36F)
Cervical collar
Debakey aortic clamp (10.5 in)
Internal compartment 1 IV start kit (2)
(resuscitation/accessories) CPDA-1 whole blood collection
bag (2)
Parachute cord (6.5 in) for measuring
collection bag
Sharps container
infrahepatic inferior vena cava can be exposed using a right-
sided medial visceral rotation followed by compression proxi- 2-inch silk tape
mal and distal to the injury. Repair can be accomplished using Warming blanket
3-0 Prolene versus ligation (ensure communication of inferior Internal compartment 2 Topical hemostatic dressing (4)
vena cava (IVC) ligation to next role of care to ensure proper (hemorrhage control) Esmarch bandage
management and performance of lower extremity fasciotomies, Kerlix gauze (4)
if deemed necessary). Packing can be performed as outlined Coban 4 in dressing
above for hepatic injuries. Resection for any significant injuries Internal, sides Combat, self-applied tourniquets (4)
to the spleen or either kidney can be performed using blunt Skin stapler
mobilization of the solid organ, clamping of the hilum, and su-
ture ligation of the pedicle using either 0-Vicryl or 0-Silk suture Internal compartment 3 Nasopharyngeal airway (1)
(airway/breathing)
ligation with a second 0-Silk free tie. Hollow visceral injury 6-0 endotracheal tube
can be managed with temporary repair using 2-0 Vicryl or skin Portable pulse oximeter
staples. Alternatively, bowel can be resected after achieving 14-gauge angiocatheter (2)
proximal and distal control of the bowel using umbilical tape Chest seal (2)
and clamping, and suture ligation of the associated mesentery. Internal compartment 4 SAM splint (2)
(orthopedic care) 4-inch ACE wrap (4)
Unstable Pelvic Injuries: Pelvic stabilization can be performed Internal compartment 5 TACMED surgical set with added
using a manufactured pelvic binder, which can be carried by (surgical supplies-A) items (see Table 1)
another member of the surgical team or ODA. If there is con- Sterile gloves (2 pair)
cern for ongoing hemorrhage or in the setting of combined Ioban drape
abdominal and pelvic hemorrhage, hemostatic or Kerlix gauze Surgical towels (4)
can be used to perform preperitoneal packing.
Internal compartment 6 Laparotomy sponges (10)
(surgical supplies-B) Skin stapler
Traumatic Arrest: This subject remains controversial, as out-
comes from the past 20 years of Combat Casualty Care and
anecdotal reports support attempts at resuscitation of patients extension is performed using #10 blade scalpel, trauma sheers,
sustaining injury and traumatic arrest when resources allow. 9–12 and/or a rescue knife. Pericardiotomy is made with a scal-
Resuscitative left anterolateral thoracotomy with clamshell pel to relieve tamponade and the heart is delivered from the

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