Prolonged Field Care Podcast

In this podcast episode, Dennis interviews Steve Schauer about his calcium study in trauma patients. Steve provides an introduction to himself and his background in emergency medicine and research. He explains that the study aims to determine the prevalence of calcium derangement in trauma patients upon arrival at the trauma center. The study is being conducted at three different trauma centers and has completed enrollment. Steve also discusses the challenges of extrapolating research findings from military trauma to civilian trauma. They also touch on the limitations of the Injury Severity Score (ISS) in assessing military trauma. The conversation then delves into the logistics of the study, including the collection of calcium levels and the potential impact of pre-hospital blood transfusions on calcium levels. They discuss the importance of timing and accuracy in collecting calcium levels and the need for better documentation in trauma care. They also explore the administration of calcium and the differences between calcium gluconate and calcium chloride. Steve emphasizes the importance of administering calcium slowly to avoid adverse effects. They also discuss the timing of calcium administration in relation to blood transfusions and the challenges of determining the optimal calcium levels in trauma patients. The episode concludes with a discussion on the need for iStat machines in trauma centers to monitor calcium levels in real-time. In this conversation, Dennis and Steven Schauer discuss the administration of calcium in trauma patients. They explore the role of calcium in the coagulation cascade and its potential benefits in improving hemodynamics. They also discuss the challenges of administering calcium in the field and the need for further research to determine its efficacy. The conversation highlights the importance of prioritizing blood and tranexamic acid (TXA) administration before considering calcium. Overall, the conversation provides valuable insights into the use of calcium in trauma care. Takeaways The study aims to determine the prevalence of calcium derangement in trauma patients upon arrival at the trauma center. Extrapolating research findings from military trauma to civilian trauma poses challenges due to differences in injury mechanisms. The Injury Severity Score (ISS) has limitations in assessing military trauma. Timing and accuracy are crucial in collecting calcium levels in trauma patients. Calcium administration should be done slowly to avoid adverse effects. Determining the optimal calcium levels in trauma patients is challenging. iStat machines can be valuable in monitoring calcium levels in real-time. Calcium is a cofactor in the coagulation cascade and may play a role in improving hemodynamics in trauma patients. The administration of calcium should be prioritized after blood and tranexamic acid (TXA) in trauma care. The optimal method of calcium administration, such as infusion plus drip, is still under investigation. Further research is needed to determine the efficacy of calcium in trauma care. The availability of resources and logistics may influence the choice of calcium formulation for administration. 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, Jim discusses the importance of adapting to the changing world and the need to prioritize the well-being of soldiers. He emphasizes the need for commanders and medical providers to understand the risks and challenges faced by the national treasure, the sons and daughters of the nation. Jim highlights the changing nature of warfare and the need to adapt to austere and rapidly evolving environments. He also discusses the importance of whole-of-government approaches and the need for joint, inter-organizational, and multinational collaboration. Jim encourages listeners to develop adaptive thinking and to be prepared to win in a complex world. Takeaways The well-being of soldiers should be the top priority for commanders and medical providers Adapting to the changing world and the challenges of warfare is crucial Whole-of-government approaches and collaboration are essential for success Developing adaptive thinking and being prepared to win in a complex world is necessary 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 Alex McDonald, a medical student and member of Tactical Medicine New Zealand, about the republishing of the book 'Guerilla Surgeon.' The book tells the story of Dr. Lindsay Rogers, a New Zealand-born surgeon who served with the Special Operations Executive in Yugoslavia during World War II. The conversation covers topics such as the challenges of providing medical care in resource-limited environments, building trust with local forces, and the importance of cultural competency. Alex also discusses the mission of Tactical Medicine New Zealand and their partnership with the Special Operations Medical Association (SOMA) to republish the book. Takeaways The book 'Guerilla Surgeon' tells the story of Dr. Lindsay Rogers, a New Zealand-born surgeon who served with the Special Operations Executive in Yugoslavia during World War II. Providing medical care in resource-limited environments requires improvisation and making the most of available resources. Building trust with local forces is crucial for successful medical operations in foreign nations. Cultural competency is important for effective communication and collaboration with partner forces. Tactical Medicine New Zealand aims to promote and advance tactical medicine in New Zealand and has partnered with SOMA to republish 'Guerilla Surgeon.' 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

Dr. Van Wyk discusses updates in traumatic brain injury (TBI) management, focusing on the CRASH 3 trial and the use of tranexamic acid (TXA). He explains that TXA is safe and reduces head injury-related death, particularly in patients with moderate and mild TBI. He also discusses the use of hypertonic saline and recommends considering higher concentrations, such as 23.4%, which have been shown to be safe and effective. Dr. Van Wyk mentions the use of sodium bicarbonate as an alternative and emphasizes the importance of clinical judgment in determining the appropriate treatment. He also discusses monitoring options for cerebral edema and increased intracranial pressure, such as optic nerve sheath diameter measurements. Finally, he touches on the topic of decompressive hemicraniectomy and the considerations for performing this procedure in austere environments. Takeaways Tranexamic acid (TXA) is safe and reduces head injury-related death in patients with moderate and mild traumatic brain injury (TBI). Higher concentrations of hypertonic saline, such as 23.4%, may be considered as they have been shown to be safe and effective. Sodium bicarbonate can be used as an alternative to hypertonic saline, particularly in austere environments. Optic nerve sheath diameter measurements can be used to monitor cerebral edema and increased intracranial pressure. Decompressive hemicraniectomy may be considered in severe TBI cases, and general surgeons may be trained to perform the procedure in the absence of a neurosurgeon. 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

Summary: In this conversation, Dennis and Ian discuss the new high altitude Clinical Practice Guideline (CPG) in the Joint Trauma System. They cover topics such as acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). They discuss the pathophysiology, symptoms, diagnosis, and treatment options for these conditions. They also touch on pre-treatment strategies and the use of portable hyperbaric chambers. Overall, the conversation provides a comprehensive overview of altitude-related illnesses and their management. In this conversation, Dennis and Ian discuss the treatment options for altitude illness, specifically AMS, HAPE, and HACE. They cover the use of pharmacologic therapy, oxygen, and portable hyperbaric chambers to stabilize and bring down patients with altitude illness. They also discuss the use of dexamethasone as the primary treatment for HACE and the potential use of hypertonic saline for extreme cases. They touch on the side effects of dexamethasone and the importance of protecting the airway. They also mention the use of acetazolamide for prophylaxis and the benefits of intermittent hypoxic exposure. Finally, they discuss the importance of good nutrition and hydration and the new medic encounter form for recording data on altitude illness. Takeaways: Acute mountain sickness (AMS) occurs when the body does not have enough time to acclimatize to the physiological stress of altitude. High altitude cerebral edema (HACE) is characterized by ataxia and can occur even without AMS symptoms. High altitude pulmonary edema (HAPE) is characterized by decreased exercise tolerance and tachypnea. Assessment of vital signs, such as heart rate and respiratory rate, can help differentiate between altitude illnesses. Portable hyperbaric chambers can be used to stabilize patients with altitude illnesses until they can be brought down to lower altitudes. Pharmacologic treatments, such as acetazolamide and dexamethasone, can be used for prophylaxis and treatment of altitude illnesses. Improvement in symptoms of HAPE can be rapid with oxygen therapy. Pre-treatment strategies, such as using acetazolamide, can help acclimatize the body to altitude before ascent. Pharmacologic therapy, oxygen, and portable hyperbaric chambers can be used to stabilize and bring down patients with altitude illness. Dexamethasone is the primary treatment for HACE, and hypertonic saline may be considered for extreme cases. Side effects of dexamethasone include increased sugar, gastric erosions, gastric bleeding, and adrenal suppression. Acetazolamide can be used for prophylaxis, and intermittent hypoxic exposure may help with acclimatization. Good nutrition, hydration, and iron status are important for preventing altitude illness. The new medic encounter form is a valuable tool for recording data on altitude illness. 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, Jay Baker discusses the topic of SOF surgical support in Special Operations Forces (SOF). He compares the different types of missions that soft surgical teams might be called upon to support and describes the gap that exists in institutional experience for surgical support in the setting of unconventional warfare. Baker highlights the lessons learned from surgical support in World War II and emphasizes the need to prepare for providing surgical support in more challenging environments. He also discusses the efforts being made to improve soft surgical support, including the development of RSOF surgical teams and the Prolonged Field Care initiative. Takeaways Sof surgical support in Special Operations Forces (SOF) is an evolving problem set that requires preparation for providing surgical support in more challenging environments. Lessons can be learned from surgical support in World War II, where surgeons provided care in dangerous and challenging environments. Efforts are being made to improve soft surgical support, including the development of RSOF surgical teams and the Prolonged Field Care initiative. Training and experience in caring for critical patients over longer periods of time, performing tactical evacuations, and developing innovative solutions to resupply challenges are important for soft surgical teams.

Maggot therapy, also known as maggot debridement therapy (MDT), is a treatment that uses live maggots to clean and heal wounds. The therapy has a long history, dating back thousands of years, and has been used in various settings, including war zones and modern hospitals. Maggots are effective in wound healing because they eat necrotic tissue, have antimicrobial properties, and promote the growth of new tissue. The therapy is cost-effective and can be used in low-resource settings. It can be applied directly to the wound or placed in a mesh bag. Maggot therapy is often used as an adjunct to antibiotics and other wound treatments. Takeaways Maggot therapy is a cost-effective and efficient treatment for wound healing. Maggots eat necrotic tissue, have antimicrobial properties, and promote the growth of new tissue. The therapy can be used in various settings, including war zones and low-resource environments. Maggot therapy can be used as an adjunct to antibiotics and other wound treatments. 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

Exploring the use and significance of End-tidal CO2 monitoring in medical practice, particularly for trauma patients and those with severe traumatic brain injuries. Emphasizing the role of ETCO2 in confirming endotracheal tube placement and monitoring ventilation during surgery. Stressing the importance of clinical judgment in conjunction with ETCO2 monitoring for comprehensive patient care. Discussing the value of other resuscitation markers, such as lactate levels, in certain scenarios.

In this episode, Dennis interviews John and Paul about the Abdominal Aortic and Junctional Tourniquet (AAJT). They discuss the background and reasons for inventing the AAJT, including the need to control bleeding in the pelvis. They also talk about the first application of the AAJT and the positive results seen in combat situations. The conversation then moves on to study data and research on the device, including some negative studies that have been conducted. They also discuss the pressure levels used with the AAJT and the potential for extending the application time. Finally, they address the negative consequences of high pressure and the comfort level of wearing the device. The conversation explores the application and function of the Abdominal Aortic Junctional Tourniquet (AAJT) and its potential use in pre-hospital care. It discusses the challenges of prolonged application and the risks associated with it. The conversation also delves into alternative techniques and future developments in the field. The importance of reperfusion and monitoring is highlighted, along with the impact of the AAJT on breathing and inspiratory pressure. The discussion touches on the considerations for reducing pressure during reperfusion and the duration of application. The risk-benefit analysis of heroic interventions is examined, emphasizing the need for rapid hemorrhage control. The limitations and risks of Roboa are discussed, and a cadaveric study on the AHAT is presented. The conversation concludes with the role of the AHAT in preparing for future wars and its potential use in traumatic cardiac arrest. Takeaways The AAJT was invented to control bleeding in the pelvis and junctional areas. The device has been successfully used in combat situations and has saved lives. There have been several studies conducted on the AAJT, with mixed results. The device applies pressure to occlude blood flow, but the pressure levels are safe and well-tolerated. The Abdominal Aortic Junctional Tourniquet (AAJT) is a fielded device that can be used for rapid hemorrhage control in non-compressible torso hemorrhage. Prolonged application of the AAJT should be avoided, and it is important to consider the risks and benefits of its use. Alternative techniques and future developments, such as foams, are being explored for the treatment of non-compressible torso hemorrhage. Reperfusion and monitoring are crucial considerations when using the AAJT, and the pressure can be reduced during transfusion to mitigate ischemic change. The AAJT has shown promising results in traumatic cardiac arrest and can be a valuable tool in pre-hospital 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 podcast episode, Dennis and Ian discuss heat injuries and illnesses. They cover the background science of body heat and heat transfer, as well as the different types of heat injuries, including heat cramps, heat syncope, heat exhaustion, and heat stroke. They emphasize the importance of hydration and urine color as indicators of hydration status. The treatment for heat stroke involves cooling the body as quickly as possible, with immersion in ice water or the use of ice sheets being the most effective methods. They also discuss the importance of acclimatization to heat and the need for prompt evacuation in cases of heat stroke. Takeaways Heat injuries and illnesses can range from minor heat cramps to life-threatening heat stroke. The body dissipates heat through radiation, conduction, convection, and evaporation. Hydration is crucial in preventing heat injuries, and urine color can be used as an indicator of hydration status. Heat stroke is a medical emergency that requires immediate cooling of the body. Acclimatization to heat and proper planning can help prevent heat injuries. 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