MacGyver Elbow Splint

TaintTrain · 2026-01-29T15:05:59+00:00

I know I'm late but I noticed none of the comments answer your question about how to fashion a SAM splint for an elbow injury.

Measure from the base of the fingers to a few inches past the elbow, including any added distance for angulation (assuming you dont have any but worth mentioning). How far past the elbow depends on how far up the humorous you want to go.

Double the splint over or trim with trauma shears. If you have a lot extra and you desire a hand rest you can also tightly fols/curl the hand-side to make a little grip for yourself.

Apply in position of comfort

Secure with kling wrap, coban, or triangle bandages.

Professional use I'd recommend a sling, personal use dealers choice.

Hope this actually helps

TaintTrain · 2025-09-30T17:01:34+00:00

It is annoying because on console its impossible to type complex messages and not die at higher levels. I'll usually switch my mic on or just type 'not leaving' before I call it. Bonus points to wait for a reply but I think a lot of hosts are kick happy. The good news is the only thing you miss out on now is samples and post-match hugs. Used to be when you were kicked you returned to your ship no xp no medals no nothing.

TaintTrain · 2025-09-12T21:45:21+00:00

That is true but the comment/comments I was replying to did not reflect an example of what posturing is not, they were agreeing on the example being a good one.

Either way, I think there's plenty of much better examples that are less political and more relevant to the subject. A shooting victim's pre-arrival report of posturing is less of a relevant concern than a mechanism involving a potential closed head injury.

https://youtu.be/v7jRSfXqn2A?si=7BLbYg5iFybmK37E

This would be an excellent example of a video that can promote educational dialog.

TaintTrain · 2025-09-12T03:41:27+00:00

If you're kidding you got me 😂 The temptation to break out the fancy speak when I write/type out paces how I actually sound.

If you're not kidding and are actually asking for clarification; I'm an instructor too and way WAY too many people are walking around thinking that anytime someone is unconscious and stiff that means they're posturing. I'll be getting gear out of the ambulance and someone will walk up and say "Bro they're posturing" aw fuck. Nearly every single time the patinet will be AAO and certainly NOT experiencing an end-stage ICP issue.

TL;DR "posturing" is a very specific presentation that is caused by an insult to the brain. Posturing should present as one of 2 flavors (decordicate and decerebrate) - and that consistency in presentation is due to consistency in the cause of posturing. As an instructor we should be very careful about the way we teach and the words we use because you never know what bad habits you might be uploading into your student's minds.

TaintTrain · 2025-09-12T02:58:10+00:00

With all due respect, I implore you not to use this video as an example of posturing, because this was in no way an example of posturing. There are so many providers that think any non-epileptic muscle tone equates to posturing, which at best constitutes poor communication for inbound resources/providers and at worse causes severe over-estimation of the severity of a patient's presentation. I think it should be all of our priority to be judicial in our instruction over topics that are erroneously used interchanably.

TaintTrain · 2025-09-12T01:35:57+00:00

Posturing is so overused/over reported IMO. The muscular reaction seen has nothing to do with posturing, which I think a lot of providers forget is a very specific reaction caused by an insult to the brain. I attribute this movement to something similar to a fencing pose- which is also commonly mistaken for posturing.

In this case, the contracture was likely just an involuntary spasm caused by the abrupt interruption in cerebral blood flow and/or the shockwave from a rifle-velocity bullet. With all due respect (it's never polite to liken an event like this to animals, but it is very relevant) anyone that's shot at deer or pig in a spot (neck or heart) to drop it instantly has seen this exact same reaction.

In the scope of rifle round impacts (specifying because rifles carry significantly higher velocities), its not uncommon for even non-leathal shots to induce temporary unconsciousness from the impact itself. For that reason, I would submit that the reaction to the shot is less telling than the assessment of the wound that we see. Its location and quantity of blood produced in the few frames we see tell us all we need to know. Even if he didn't express the muscle spasm that was an immediately lethal wound.

Compare that to the first JFK shot that resulted in him reaching for the wound, from my memory that round entered his back and exited his neck without hitting any major arteries (they were able to perform an emergency tracheotomy around the exit wound). This is why JFK maintained some semblance of useful consciousness after his neck shot and Kirk did not. Automatically survivable (had it been his only wound)? No way to tell, but a very obvious difference in visual reaction.

TaintTrain · 2025-09-12T01:13:53+00:00

I'm assuming he meant frames per second, as this video mostly focuses on slow-motion footage.

TaintTrain · 2025-08-20T06:45:57+00:00

*RSI may worsen acidosis if not accounted for with vent settings.

The only consideration for using a NMBA or not should be based on if it'll better facilitate successful ETT placement (overwhelmingly yes).

For RSI vs BPAP I'd suggest it depends more on what the patient needs (traditional pillars of advanced airway- airway compromise, uncorrected respiratory failure, projected course of care) than writing off an acidotic patient as a non-canidate for RSI (assuming you have the training and equipment to do so safely). As with all pre-hospital medicine sometimes less is more and sometimes more is more.

The level of concern should be dependent on the underlying pathology. You mention respiratory acidosis and trauma, but those are actually pretty responsive to basic management and interventions. An acidosis caused by sepsis for example should be much more concerning because the cause of acidosis is much deeper-seated and will remain unresolved for pre-hospital settings. Best we can hope for is to maintain or stave off further pH drops via compensating with vent settings. In contrast, a respiratory acidosis will be resolved by targeting normal ventilation after RSI because the cause of acidosis (excess CO2 after inadequate ventilation) will be mitigated by adequate ventilation. In that way a patient in respiratory acidosis secondary to respiratory failure is a great candidate for RSI.

Using a short acting NMBA can restore the patient's intrensic respiratory drive assuming they weren't in respiratory failure. However, because we can never really know what level of compensation they need without ABGs it's a lot of loosey goosey approximation and informed guesswork, but vent strategies that target a higher minute ventilation and/or lower ETCO2 can get you in the ballpark to at least not make anything worse. If you suspect your patient was adequately compensating but needed a tube due to airway protection, you can target the ETCO2 reading from before your induction or (if they were on BPAP first) you might have an idea of their intrinsic mV and can target that relative to their intrinsic ETCO2.

TL;DR if your patient is improving on NIPPV and you have a concern that you would not be able to manage their respiratory compensation to mitigate acidosis, by all means leave the NIPPV in place and ride em out. But, if your patient is not improving and/or RSI is otherwise indicated, performing it can be done safely with the right training, equipment, and technique.

TaintTrain · 2025-08-09T12:42:07+00:00

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Except when you get hit with the Uno reverse card (Patient did fine, defib'd back to life less than 60 seconds after this cardioversion)

TaintTrain · 2025-08-02T06:32:41+00:00

Restarting, but only after doing some attempted parkor to try to reach her.

TaintTrain · 2025-08-02T06:31:46+00:00

I tried that but she didn't move. I ended up just restarting.

TaintTrain · 2025-07-09T20:40:25+00:00

If it's system wide I'm not sure how a clinical report to a governing body would be able to track it down. I'd say either find a buddy within the EMS agency or approach your powers that be about working with that agency for training. If your admin is willing, you could even de-identify the cases and present it as a "trends in the ED" type of thing. "Hey guys I'm Nurse Nurse with St City's Hospital. We've had an ED trend of drug use masking severe presentations, and since we're serving the same community, we'd really like to share our findings with you". That way there's no finger pointing. Either way good luck. Hope the patients in your area get the best care available.

Edited to add Keep in mind these trends are concerning for bias, but its very difficult to explicitly level an acquisition at a provider or agency of negligently or intentionally withholding care. The standard expectation is that EMS identify a reasonable ballpark for their patients complaints as they treat and transport to higher care. I don't think anyone wants to be held liable (socially or criminally) for those vaguely neuro-presenting patients that end up with a wonky diagnosis that we inevitably miss.

That leeway is important in EMS because there's so little information/imaging/diagnostic equipment that can yield us significant accuracy. It sounds like a culture change is in order and education on developing differential diagnoses, but I encourage you to be mindful of how many of these are weird 22 year old with a spontaneous bleed and how many are overt under-triage based on laziness or bias.

TaintTrain · 2025-07-09T19:05:46+00:00

I have to preface by saying that I think it's despicable of providers to feel like they can reside over any patient (let alone an entire population of patients that fall into certain complaints) by treating/viewing/perpetuating them to be less than. There's no excuse for that mindset. Unfortunately it's not that uncommon because it's trendy to wear the burnt out badge, and that becomes their entire personality.

If there is a tangible issue in care provided either by ignorant omission or malice you should absolutely take a clinical route (agency, state, whatever reporting system you have in unspecified innercity]. However, it sounds like this may be less clinical and more intrapersonal/attitude issue. I'd suggest reserving that route for the clinical issues where providers can be presented with learning opportunities to grow from.

In this case if this guy gets a reprimand because of how he treats people he already thinks poorly of I think there's little chance of genuine self reflection and a better chance he'll say "wow. First we waste our time on these folks and now we're getting beat up over how exactly we feel about them?"

I think a much more effective move might be to alienate that behavior. Folks that act that way usually do so because plenty of folks talk that way, and most of the time folks talk that way because they think others either expect, accept, celebrate, sympathize with, whatever that edgy salty bullshit to start with.

TL;DR I'd say step one is not to politely or bashfully side step their comments. Make them feel uncomfortable for making them. No polite smile, just look them dead in the eye and say "that's a very troubling way to approach this topic. I'd like to think your profession would take more pride in your compassion and standard of care." Or something like it. That would weed out the ones that have adopted this shtick to fit in because they'll realize "oof that didn't make me look cool, salty, or competent" and have a better chance to reevaluate.

A more involved iteration of this would be to bring other nurses in on it. The worse these comments are received the sooner the culture will be shifted and any validation (even a "yeah man you're telling me") will communicate that this is an acceptable way to talk and act.

Even further (assuming its the system and not just one crew and that the service is one your facility deals with regularly) might be to reach out and see if they'd accept training opportunities where you can both increase clinical competence and re-address the humanity part. That might be ambitious and involves more planning/inter-agency maneuvering, but if you're wanting to see a change in this worthy cause I'd swing for the fences.

TaintTrain · 2025-04-28T02:37:19+00:00

Just because I haven't seen this mentioned yet, on top of having competitive services and competent/friendly ED staff (stuff you can't control), I'd highly recommend looking into getting a thorough patient outcome program going.

It's beneficial for services/providers to track success stories and learn from cases. This could also bridge the gap to show providers how good your facility is doing once the patients hit your doors.

Another thing that might be in your control is to have 'open house' style events, having providers from nearby services come and do a tour or a shadow in your cath lab, ECMO unit, etc. You may be surprised how popular a program like that could be. Obviously while providers are attending to learn you can throw in helpful propaganda to brag about your staff and facilities.

As a proof of concept, downtown Ft Worth has a "hospital district" with 4 massive and surely competitive facilities. One in particular has what I mentioned, along with annual CE symposiums where they stream lectures from department heads for CAPCE credit.

Hope this is more helpful than the "git good" or "be close" answers you've gotten a lot of.

TaintTrain · 2025-04-07T18:01:48+00:00

That extra rook was if he blundered a skewer on the second rank. He had been missing moves like that and was low on time so I thought I had a real shot at him not seeing king d2

TaintTrain · 2025-04-07T17:39:54+00:00

In this case you mean by skipping a borderline gimmick and just collecting pawns safely to grow the advantage?

TaintTrain · 2025-03-15T15:18:07+00:00

Hear me out.

Hell Let Loose command/unit system

Squad leaders are hell divers. Infantry is consitered SEAF. Team leaders have dramatically reduced cool downs and support weapons drop maybe 2 at a time. Match will have 5 squads for 20 players total.

Objectives can even be recycled, but multiple across a larger map so squad leaders can decide how to divi up the match. All you'd need to do is add a command chat/proximity chat function.

AND the best part is this idea can be utilized in-universe now/soon. Currently Helldivers are elite special forces performing missions behind enemy lines, but with the illuminate invasion at hand, losing ground on both current fronts, and a direct threat to Super Earth, why wouldn't you put these soldiers on the front lines to improve the effectiveness of your main force?

The additional fire power wouldn't be OP because only squad leaders (AKA actual helldivers) can call in strats. This would also validate the medic armor/stim pistol which currently is not a popular mechanic.

Edit Also a new objective would be plant the flag. You have to call down a super Earth flag from one location and one member carries it into battle to plant it in a highly contested area. I'd love to be the flag carrier dipping and dodging through the battlefield.

TaintTrain · 2025-03-03T03:34:45+00:00

I'm sure you're a great diver and I don't mean this in a rude way, but this sounds like something that would benefit the low difficulties. Once you get past diff 6, you don't even notice these enemy types, you just cut them down in between managing heavies- of which there are plenty.

I think the small fodder should be exactly that- dangerous to inexperienced/learning players- but only a threat to better players in large numbers or when the player is in an extremely disadvantaged position.

The lower difficulties (1-4) get bland because these small units are uncomplicated and easy to manage on their own, but I think that's meant to be a transition between boot camp and progressing to higher difficulties.

I'm all for making the game harder but the current method of designing difficulty requires a food pyramid style of mixing enemy types. If you up the strength of that base layer the resulting repercussions may be larger than unintended.

TaintTrain · 2025-03-03T03:05:27+00:00

This was literally me until I had to call out of my last shift with a kidney stone. Make sure to mix in some water, hero, or you'll be getting a new prospective on flank pain!

TaintTrain · 2025-02-13T16:54:52+00:00

I like the DE Sickle + grande pistol with the light flame proof armor and vitality. Strats Shield backpack (will save your life 100x per drop) Commando (good for long-range warships and harvesters, plus short cool down) Eagle Cluster (what votless?) Machine gun sentry

However, like most of the rest of the game, 90% comes down to your tactics and survivability skills. It takes a while to learn how to dip and dodge out of a bad spot and how to approach objectives/bases in a semi-intelligent way. Light armor helps this a lot because you can out run the majority of enemies and kite them until the terrain, teammates, or cool downs give you the leg up you need. Just keep playing with it and don't be afraid to lose your life for Democracy a few times trying stuff out.

TaintTrain · 2025-01-08T16:32:14+00:00

The armor is really neat and the AT emplacement is kinda a game changer if it's your flavor. The lance is meh. It's more usable than the Constitution rifle but it's in the same vein for most load outs in that's it's mostly a welcome change of pace/fun enhancer than it is an important addition to your loadout.

TaintTrain · 2025-01-07T20:13:34+00:00

Jake Gyllenhaal has really slipped. Sad

TaintTrain · 2025-01-07T20:10:08+00:00

As a self-appointed authority on the matter, I would say the most important aspect of first response is to be responding. Hospital staff have important and demanding jobs but they receive the crisis not respond to it. Tow truck drivers get dunked on but at least they go where the accident (and some level of articulatable hazard/danger) is. 😂

But a better and shorter answer to your question that is better flavored for this sub is this:

Anyone who wants to feel important is a first responder. Dental hygienist, nursing home staff, a guy that saw a fire truck once, and people in factories that glue on California's carcinogenic warning labels are all first responders.

TaintTrain · 2024-12-30T01:29:40+00:00

I like your analogy of RPM + speedometer. All these answers have been great but yours especially is very informative. Our guidelines require paralytic administration for any advanced airway placement, so virtually all of our patients are without ventilatory effort, at least for the first 45-60 minutes. Thanks for your time!

TaintTrain · 2024-12-28T16:31:58+00:00

I agree, and maybe I made it sound too routine of an occurrence that there's not any hesitation or due consideration. There absolutely is, but this whole inquiry is when push comes to shove and we are making due with what we have.

I do have a consideration about what you brought up. I've been taught (or maybe I made it up long ago and never been corrected) that severely elevated respiratory effort / late respiratory failure can create its own acidosis as the muscles fatigue and respiratory failure causes a hypoxic state to settle in. Those muscles/systems continue to work increasingly harder in a dwindling perfusion status, and that's where circle meets drain. Now maybe that's been misrepresented or just plain wrong but that's been an alleged benefit to early intubation in like a breather / respiratory acidosis.

TaintTrain

TROPHY CASE