Prolonged Field Care Podcast

In this episode of the PFC Podcast, the speakers discuss the state of medics in Special Operations Medicine and offer recommendations for improvement. They highlight the importance of regular and realistic medical training at the unit level, as well as the need for feedback and accountability. The speakers also address specific issues such as lack of familiarity with protocols, equipment shortfalls, and training scars. They emphasize the need for critical thinking and individualized patient care rather than relying on algorithms. Overall, the podcast aims to improve the quality of medical training and performance among medics in Special Operations. Takeaways Regular and realistic medical training at the unit level is crucial for improving the skills and performance of medics in Special Operations. Feedback and accountability are essential for medics to identify and address their shortcomings. Familiarity with protocols, equipment, and drug administration is crucial for effective medical care. Training should focus on critical thinking and individualized patient care rather than relying on algorithms. Unit leaders and commanders should prioritize and support medical training to ensure the readiness of their medics. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠ or ⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In this conversation, Dennis, Doug, and Justin discuss the development of a Sepsis Clinical Practice Guideline (CPG) for prolonged field care. They highlight the importance of early recognition and antibiotic administration in sepsis management. They also discuss the use of scoring systems like QSOFA and NEWS2 to aid in the identification of septic patients. The conversation covers the role of lactate monitoring and the potential confounding factors. They emphasize the need for a comprehensive assessment of the patient and the importance of not relying solely on one marker or number. The conversation also touches on the importance of proper catheter insertion and the consideration of prophylactic catheter replacement in austere environments. They discuss the use of fluids as the first-line treatment in septic patients and caution against over-resuscitation. The conversation concludes with a reminder to pay attention to the patient's response and not blindly adhere to formulas or protocols. In this conversation, the speakers discuss various aspects of sepsis management, including fluid resuscitation, the use of colloids, the importance of monitoring urine output, and the decision to initiate vasopressors. They also touch on the use of antibiotics and wound management in sepsis cases. The conversation provides valuable insights and practical tips for healthcare providers in austere environments. Takeaways Early recognition and timely administration of antibiotics are crucial in sepsis management. Scoring systems like QSOFA and NEWS2 can aid in the identification of septic patients. Lactate monitoring can be confounded by various factors, and a comprehensive assessment of the patient is necessary. Proper catheter insertion and prophylactic catheter replacement should be considered in austere environments. Fluids are the first-line treatment in septic patients, but over-resuscitation should be avoided. Pay attention to the patient's response and use clinical judgment rather than blindly following formulas or protocols. In sepsis cases, fluid resuscitation is crucial, and the choice of fluid depends on availability. Balanced electrolyte solutions like Ringer's lactate or plasma light are preferred, but normal saline can be used if that's all that's available. Colloids may be used in sepsis patients with high output losses or compartment syndrome. Options include FFP, albumin, or freeze-dried plasma. Monitoring urine output is important in assessing the response to fluid resuscitation. If urine output increases, it indicates a positive response. However, if urine output remains high despite fluid administration, it may indicate over-resuscitation. When considering the use of vasopressors, the decision should be based on the patient's blood pressure and mental status. If the patient remains hypotensive and shows no improvement after a substantial amount of fluid, vasopressors may be initiated. Antibiotics should be given empirically in sepsis cases, and the choice of antibiotic depends on the suspected source of infection. Wound management, including effective debridement and irrigation, is crucial in preventing infection. Regular assessment of wounds is important to identify any signs of infection or non-viable tissue. In austere environments, it may be necessary to make treatment decisions based on the patient's clinical presentation and endemic risk, even without confirmatory tests. The conversation highlights the importance of collaboration and mentorship in developing clinical practice guidelines and acknowledges the contributions of healthcare professionals in the field. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠ or ⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In this episode, Doug and Dennis discuss the appropriate use of vasopressors, specifically epinephrine and norepinephrine, in the management of shock. They highlight the importance of fluids in sepsis resuscitation and the potential dangers of using high concentrations of epinephrine. They also discuss the different effects of epinephrine and norepinephrine on heart rate and blood pressure, and the potential side effects of epinephrine, such as arrhythmias and lactic acidosis. The conversation concludes with a discussion on the use of epinephrine in anaphylaxis and the importance of individualizing treatment based on the patient's response. Takeaways Epinephrine is commonly used as a vasopressor in the management of shock, but it should be used with caution due to its potential side effects. Norepinephrine is often preferred over epinephrine in sepsis resuscitation due to its more selective vasoconstrictive effects and lower risk of arrhythmias. Fluid resuscitation is an important component of sepsis management and should be prioritized before initiating vasopressor therapy. Monitoring the patient's response to vasopressor therapy, including blood pressure, heart rate, and organ perfusion, is crucial in determining the effectiveness and safety of the treatment. Individualizing treatment based on the patient's specific needs and response is essential in optimizing outcomes in shock management. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠ or ⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In this podcast episode, Dennis and Andrew Fisher discuss the process of setting up a walking blood bank in a military setting. They emphasize the importance of practicing and adapting the process to specific needs. They recommend conducting ABO testing for all potential donors and identifying low-titer O donors as a preferred option. They also discuss the logistics of preparing supplies and coordinating with multiple units. The podcast concludes with a reminder of the importance of communication and planning in order to execute the process effectively. Takeaways Practicing and adapting the process of setting up a walking blood bank is crucial Conduct ABO testing for all potential donors and identify low-titer O donors Prepare supplies and coordinate with multiple units Effective communication and planning are key to executing the process successfully Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠ or ⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this conversation, Dennis interviews Victor about his experiences in Burma and his work with Free Burma Rangers. Victor discusses the changing dynamics of the conflict in Burma and the progress made by ethnic forces. He also talks about his role as a medic and the challenges of teaching combat medicine to indigenous groups. Victor emphasizes the importance of focusing on the basics and tailoring training to the specific needs of the students. He shares his experiences with teaching pressure points, tourniquets, casualty drags, and blood collection. Victor also reflects on the challenges of triage and decision-making in a mass casualty situation. During the conversation, Victor shares several lessons learned from his trip to Burma. He discusses the importance of going back to the basics and relying on ground reconnaissance when operating without ISR capabilities. He also highlights the need for movement and noise discipline to avoid detection by the enemy's reconnaissance planes and jets. Victor emphasizes the significance of good topside cover and concealment to protect against airstrikes and mortar attacks. He also talks about the challenges of providing prolonged field care and the importance of being mentally sharp and prepared for the continuous cycle of problems that arise during operations. Victor mentions the disbursement of medical equipment and the need for contingency plans in case of CCP destruction. Overall, the conversation provides valuable insights into the realities and complexities of operating in a hostile environment with limited resources. Takeaways The ethnic forces in Burma have been gaining ground and achieving significant victories in the conflict. Teaching combat medicine to indigenous groups requires focusing on the basics and tailoring training to their specific needs. Training on pressure points, tourniquets, casualty drags, and blood collection were essential for the indigenous groups in Burma. Triage and decision-making in a mass casualty situation can be challenging, but it is important to prioritize casualties based on their chances of survival. Rely on ground reconnaissance and basic skills when operating without ISR capabilities Maintain movement and noise discipline to avoid detection by enemy aircraft Seek good topside cover and concealment to protect against airstrikes and mortar attacks Be mentally sharp and prepared for the continuous cycle of problems during operations Disburse medical equipment strategically and have contingency plans in case of CCP destruction Here are some clips from Victor's experiences: https://youtu.be/dBkTziMluyk?si=DIwvc-SAHCJ81hSM https://youtu.be/wNKHL_OJ4TMsi=vC1WoJWH_hhKme1h Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠ or ⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

This podcast episode focuses on the importance of measuring urine output as a cheap and effective method for monitoring hemodynamics in prolonged field care. The hosts discuss the benefits of using a Foley catheter for urine measurement and emphasize the need for proper sterility during the procedure. They also touch on the topic of hypotensive resuscitation and the challenges of managing patients with low blood pressure in a prolonged field care setting. Takeaways Measuring urine output is a simple and cost-effective way to monitor a patient's hemodynamic status in a prolonged field care setting. A Foley catheter is a reliable tool for measuring urine output and can provide valuable information about a patient's overall health. Proper sterility is important when inserting a Foley catheter to prevent infections. Hypotensive resuscitation is a complex topic that requires further discussion and consideration in the context of prolonged field care. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠ or ⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In this conversation, Dennis and Doug discuss crush syndrome and the challenges it presents in dynamic environments such as natural disasters or man-made incidents. They emphasize the importance of scene safety and the need to assess and stabilize any other traumatic injuries before addressing crush syndrome. They also discuss the use of tourniquets and the potential risks and benefits associated with their application. The conversation covers the management of crush syndrome, including fluid resuscitation, monitoring for cardiac complications, and the use of calcium and sodium bicarbonate. They highlight the need for a comprehensive approach to diagnosis and treatment, considering factors such as time of response and the presence of other injuries. In this conversation, Dennis and Doug discuss the management of crush syndrome in a resource-limited setting. They cover topics such as tourniquet use, fluid resuscitation, potassium management, and the use of sodium bicarbonate. They also touch on wound management and the importance of antibiotics. The conversation concludes with a discussion on the use of insulin and dextrose, as well as albuterol, in managing cardiac instability. Overall, the conversation provides a comprehensive overview of the management of crush syndrome in a challenging environment. Takeaways Scene safety is paramount in crush syndrome situations, and rescuers should be aware of potential hazards such as secondary devices, unstable structures, and chemical releases. Assessing and stabilizing any other traumatic injuries is crucial before addressing crush syndrome. The use of tourniquets in crush syndrome is a topic of debate, and a protocol should be in place to reassess their necessity and remove them as soon as possible. Fluid resuscitation is important in managing crush syndrome, and the amount and rate of fluid administration should be based on the patient's condition and available resources. Monitoring for cardiac complications, such as arrhythmias and acidosis, is essential, and interventions such as calcium and sodium bicarbonate may be necessary. A comprehensive approach to diagnosis and treatment is necessary, considering factors such as time of response and the presence of other injuries. Tourniquets can be used to manage crush syndrome in the lower extremities, but there is a risk of unnecessary amputations. Fluid resuscitation is important in stabilizing the patient and increasing urine output. Sodium bicarbonate can be used to manage metabolic acidosis and improve the effectiveness of vasopressors. Calcium can be given to stabilize cardiac rhythm, and insulin and dextrose can be used to manage high potassium levels. Albuterol can be used to treat respiratory acidosis, but it may be challenging to administer in a resource-limited setting. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠ or ⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In this episode of the Prolonged Fuel Care Podcast, Dr. Ben Abo and Jordan Benjamin discuss snake envenomation. They debunk common myths about snakebite treatment, such as using tourniquets, extractors, ice, or cutting into the wound. They emphasize the importance of preparing for deployment in snake-infested areas by researching the local hazards and having the appropriate equipment. They provide a standardized snake bite assessment method, which involves a bottom-up top-down approach to identify the type of venom and the severity of the envenomation. They also discuss the decision-making process for airway management and the use of antivenom. The solution to snakebite envenomation is early and appropriate treatment with antivenom. It is important to irrigate the bite site and dilute the venom as quickly as possible. The use of tourniquets is not recommended, and if one is already applied, it should be slowly released. Pain management is crucial, and opioids and ketamine are effective options. Monitoring the progression of symptoms is more important than assigning a grade to the envenomation. Early intervention and proper training in snakebite management can lead to better outcomes. Takeaways Do not use tourniquets, extractors, ice, or cutting into the wound for snakebite treatment. Research the local hazards and have the appropriate equipment when deploying to snake-infested areas. Use a standardized snake bite assessment method to identify the type of venom and the severity of the envenomation. Make decisions about airway management based on the patient's symptoms and use tools like capnography and pulse oximetry. Antivenom is the key treatment for snake envenomation, and there are no absolute contraindications to its administration. The solution to snakebite envenomation is early and appropriate treatment with antivenom Irrigate the bite site and dilute the venom as quickly as possible Avoid using tourniquets, but if one is already applied, slowly release it Pain management is crucial, and opioids and ketamine are effective options Monitor the progression of symptoms rather than assigning a grade to the envenomation Early intervention and proper training in snakebite management can lead to better outcomes Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠ or ⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In this podcast episode, Dennis interviews Pete, a former Navy Special Warfare medic with experience in maritime operations. They discuss the unique challenges of providing medical care in a maritime environment, including the need for self-extraction and the difficulties of working on an unstable platform. Pete emphasizes the importance of realistic training and self-reliance in maritime medicine. They also touch on the training of Ukrainian forces and the misconceptions surrounding tourniquet use. Overall, the conversation highlights the need for constant adaptation and a focus on patient survivability in maritime medical operations. Takeaways Providing medical care in a maritime environment presents unique challenges, including the need for self-extraction and working on an unstable platform. Realistic training and self-reliance are crucial in maritime medicine, as medical professionals must be prepared to adapt to the dynamic nature of the environment. Training Ukrainian forces in medical skills requires expectation management and prioritizing the most essential knowledge and skills within a limited timeframe. Misconceptions surrounding tourniquet use in Ukraine highlight the importance of proper training and understanding of when and how to apply tourniquets. In maritime medical operations, constant adaptation and a focus on patient survivability are key to providing effective care. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠ or ⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

Ricky and Justin discuss their research on the administration of calcium in hemorrhagic shock. They explain how they became interested in the topic and the gaps they identified in current medical knowledge. They discuss the importance of calcium in the clotting cascade and the potential role of citrate in contributing to hypocalcemia. They also explain the protocol for administering calcium in the field and the different forms of calcium that can be used. They discuss the risks of overcorrection of hypocalcemia and the need for further research on the topic. Overall, their research aims to improve patient outcomes and reduce mortality in hemorrhagic shock. Takeaways Calcium plays a crucial role in the clotting cascade and may be important in the treatment of hemorrhagic shock. Hypocalcemia is common in trauma patients and may contribute to increased mortality. The administration of calcium, along with blood products, can help prevent hypocalcemia and improve patient outcomes. The protocol for administering calcium in the field includes giving one gram upfront and one gram every four units of threshold blood. There is a risk of overcorrection of hypocalcemia, which can lead to hypercalcemia and increased mortality. Further research is needed to determine the optimal timing and dosage of calcium administration in hemorrhagic shock. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠ or ⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care