Prolonged Field Care Podcast

In this podcast episode, Dennis talks with Doug (an ICU doctor) about acute kidney injury. They discuss the causes and types of acute kidney injury, how to recognize it, and the treatment options available. They also cover the recovery and prognosis of acute kidney injury, as well as the crush injury protocol and managing potassium levels. The episode provides valuable insights for healthcare practitioners dealing with acute kidney injury in prolonged field care situations. Takeaways Acute kidney injury can be caused by a drop in perfusion to the kidneys, blockage of urine flow, or toxic injury to the kidneys. Recognizing acute kidney injury is important, and urine output and laboratory tests can help in the diagnosis. Treatment of acute kidney injury involves preventing further injury, ensuring adequate volume replacement, and adjusting medication dosages. Most young healthy kidneys will recover from a hypoxic type of injury, but toxic injuries may cause irreversible damage. The crush injury protocol includes bicarbonate, albuterol, insulin, and glucose to manage potassium levels. Monitoring and adjusting treatment is crucial, and Lasix may be used in certain cases of acute kidney injury. 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

In this podcast episode, Dennis interviews David Hardin, a general surgeon with experience in austere environments. They discuss the differences between surgeons in first-world and austere environments, the importance of improvisation, training and manpower considerations, supplies and procedures in austere surgery, moving patients in austere environments, preparing for austere surgery, making decisions in austere environments, logistics and equipment, dealing with loss, preparing for unknowns, coping with emotional stress, and finding joy in austere surgery. Takeaways Austere surgery requires improvisation and resourcefulness due to limited supplies and equipment. Training and teamwork are crucial in austere surgery, and having a resilient and adaptable team is important. In austere environments, decisions must be made based on available resources and the best interest of the patient. Preparing for austere surgery involves pre-planning, understanding the environment, and being mentally and physically prepared. Coping with loss and emotional stress is a challenge in austere surgery, and supporting and insulating team members is important. Finding joy in the work and being grateful for the opportunity to help others can sustain surgeons in austere environments. 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

In this podcast episode, Dennis talks with Mark, a trauma surgeon, about lower extremity trauma and limb salvage. They discuss the decision-making process for determining if a limb is salvageable or not, the risk vs reward of tourniquet approximation, assessing motor function and arterial supply, the importance of preserving limb length, and the use of traction in pelvic fractures. They also touch on the struggles medics face in making these decisions and the importance of training and experience.Takeaways Assessing motor function and arterial supply are key factors in determining if a limb is salvageable or not. Preserving as much length and soft tissue as possible is important for future prosthetic use. The risk vs reward of tourniquet approximation should be carefully considered, weighing the potential for continued bleeding against the need to preserve tissue. In cases of pelvic fractures with concomitant femur fractures, traction may be necessary but should be monitored to prevent skin necrosis. Training and experience are crucial in making informed decisions about limb salvage in traumatic injuries.

In this podcast episode, Dennis and Antonio discuss the challenges and friction points that arise when working with providers from different countries. They explore how to iron out these issues efficiently to provide good care. The conversation covers topics such as common friction points on the ground, resolving conflicts and revamping protocols, establishing leadership, and learning from local providers. They also discuss the importance of adapting to different practices and resolving conflicts during handovers. Antonio shares insights from his own experiences and highlights the need for effective communication and collaboration in international healthcare settings. Takeaways Working with providers from different countries can lead to friction due to different protocols and approaches. Resolving conflicts and ironing out issues early on is crucial for providing good care. Effective communication and collaboration are key to navigating challenges in international healthcare settings. Learning from local providers and adapting to different practices can enhance patient care and 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

In this podcast episode, Dennis and Doug discuss the importance of team dynamics in critical care, specifically when dealing with critically injured patients. They highlight the challenges that arise when team members work individually and fail to communicate effectively. The conversation explores the team dynamics at Baltimore Shock Trauma, where roles and positions are protocolized to ensure efficient patient care. The role of the team leader is emphasized as crucial in overseeing the entire resuscitation process and preventing crucial details from being missed. The episode concludes with a discussion on training for team dynamics in both solo medic scenarios and mass casualty situations. Takeaways Effective team dynamics are crucial in critical care settings to ensure efficient and comprehensive patient care. Protocolizing roles and positions within a team can help streamline the resuscitation process and prevent crucial details from being missed. The team leader plays a vital role in overseeing the entire resuscitation process and maintaining a global perspective. Training for team dynamics should be conducted in both solo medic scenarios and mass casualty situations, with an emphasis on empowering all team members to contribute and communicate effectively.

In this podcast episode, Dennis interviews JR Pickett, an ER physician and EMS medical director, about excited delirium. They discuss the definition and history of excited delirium, the challenges faced by law enforcement and medical providers in managing these cases, and the importance of timely intervention. They also explore the differences between excited delirium and other conditions, such as combative patients in combat situations. The conversation highlights the need for proper assessment and observation of patients exhibiting excited delirium and the selection of appropriate medications for sedation. The podcast concludes with a discussion on the criminalization of medical care and the impact it may have on patient outcomes. Takeaways Excited delirium is a complex condition characterized by a disturbed state of mind, violent behavior, and physiological elevation. It has a long history and has been associated with various names over the years. Law enforcement and medical providers face challenges in managing patients with excited delirium, as they must balance the need to protect the individual and others with the potential risks of sedation. Differentiating excited delirium from other conditions, such as combative patients in combat situations, can be challenging but is crucial for appropriate management. Proper assessment and observation of patients exhibiting excited delirium are essential for determining the most appropriate interventions and medications for sedation. The criminalization of medical care is a concerning trend that may discourage medical providers from engaging in high-risk situations and could have negative consequences for patient 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

Dr. Mark Shapiro discusses resilience and teamwork in the medical field during the COVID-19 pandemic. He highlights the differences between the civilian medical system and the military's approach to stress and resilience training. Dr. Shapiro emphasizes the importance of identifying and teaching resilience in medical professionals, as well as integrating stress inoculation into medical education. He also discusses the challenges of working in a crisis and the need for effective team composition and communication. Dr. Shapiro concludes by sharing his hopes for the future of the medical system and the lessons learned from the current pandemic. Takeaways Resilience and stress inoculation are crucial in the medical field, but are often lacking in the civilian medical system. Teaching resilience and stress management should be integrated into medical education to prepare medical professionals for high-stress situations. Effective team composition and communication are essential in crises to ensure the best patient care. Experience and exposure to stress and difficult situations can help medical professionals develop resilience and adaptability. 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

Today I chat with the Godfathers of PFC and discuss the concept of Prolonged Field Care (PFC) and its importance in military and civilian medical settings. It highlights the need for PFC in situations where evacuation is delayed or not possible, and the challenges faced by medics in providing care in such scenarios. The conversation also explores the civilian analog of PFC and the importance of risk management and training. It emphasizes the principles and evidence-based medicine behind PFC and the need for creativity and improvisation. The conversation concludes with gratitude towards the community involved in advancing PFC.Takeaways Prolonged Field Care (PFC) is essential in situations where evacuation is delayed or not possible, and medics need to provide extended care to patients. The concept of PFC is not limited to the military and has applications in civilian medical settings as well. Risk management and training are crucial in preparing medics for PFC scenarios. Principles and evidence-based medicine form the foundation of PFC, and creativity and improvisation are key in finding solutions in resource-limited environments. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org

Dr. Ryan Maves discusses clinical medicine topics, specifically malaria and other tropical diseases. He emphasizes the importance of preventing infections when traveling in tropical and remote areas through vaccination, hand hygiene, malaria prophylaxis, insect repellents, and safer sex habits. He also provides resources for pre-deployment information. Dr. Maves shares a cautionary tale of a Marine Corps Lance Corporal with severe malaria and highlights the need for vigilance in diagnosing and treating tropical diseases. He discusses major tropical diseases, the workup of febrile travelers, and treatment options for malaria on deployment. He concludes by emphasizing the importance of improving care for infections in prolonged field care.Takeaways Preventing infections is crucial when traveling in tropical and remote areas, and measures such as vaccination, hand hygiene, malaria prophylaxis, insect repellents, and safer sex habits should be followed. Vigilance is necessary in diagnosing and treating tropical diseases, especially malaria, which can have severe consequences if not promptly addressed. Major tropical diseases to be aware of include malaria, dengue, zika, chikungunya, yellow fever, meningococcus, and cholera. The workup of febrile travelers should include a detailed chronology of illness, assessment of exposures and syndromes, and appropriate diagnostic tests. Treatment options for malaria on deployment include Malarone and Coartem, with Coartem being the preferred oral antimalarial therapy. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org

In this podcast episode, Dennis and Jeff discuss anoxic brain injury, its causes, progression, and treatment. They emphasize the importance of preventing anoxic brain injury by following the March algorithm and maintaining blood flow, airway patency, and oxygenation. They also discuss the role of monitoring and airway management in identifying and treating anoxic brain injury. The podcast covers the decision-making process for airway management and the importance of maintaining adequate oxygenation and blood pressure. The hosts also highlight the need to prevent secondary problems, such as pain, agitation, and seizures, and discuss resuscitation goals for anoxic brain injury. Takeaways Preventing anoxic brain injury is crucial and can be achieved by following the March algorithm and maintaining blood flow, airway patency, and oxygenation. Monitoring and airway management are essential in identifying and treating anoxic brain injury. The decision-making process for airway management should consider the patient's condition, available resources, and the provider's proficiency. Maintaining adequate oxygenation and blood pressure is crucial in preventing and treating anoxic brain injury. Preventing secondary problems, such as pain, agitation, and seizures, is important in the management of anoxic brain injury. Resuscitation goals for anoxic brain injury include maintaining a systolic blood pressure of 120-140 and a pulse oximetry saturation of at least 90%. Collaboration with neurocritical care specialists can help optimize fluid management and prevent further brain injury. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org