Prolonged Field Care Podcast

If you sit on a patient long enough, infection has a greater chance of  taking hold and progressing to sepsis, or you may receive a patient who  has already been sick for days. Doc Jabon Ellis walks us through the  full spectrum from infection and SIRS to sepsis, shock and death.  Despite firm CoTCCC and ICRC recommendations for early antibiotics, in  the past we may have foregone that luxury because of lighting fast  evacuation times, maybe even thinking, ‘they’ll take care of it at the  next echelon.’  A great medic should not only treat their patient but  set them up for success at the next echelon, as sepsis is a testament to  how poor care during the TCCC phases of care can cost our patients days  and weeks in a hospital later.  But what if you are your own next echelon?  Point of injury to Role 1+  could be your own team house or single litter aid station.  Go down the  checklist on the right side of the PFC trending chart and make sure you  are taking care of anything that could result in an infection.  Have you  given those antibiotics?  How is your airway and respiratory care?    Did you replace any dirty IV or IO sites you placed in the field?  Are  you doing all your procedures an as aseptic manner as much as possible?   When will you debride?  Are you doing everything you can to prevent  pressure ulcers?  When will you call for a telemedical consult?  When your patient  develops a fever?  Blood pressure falling?  Altered mental status?   Do you know how to dilute your 1:1000 epinephrine to use as a push dose  pressor?  (It’s in the Tactical Medical Emergency Protocols) Is an Epi  drip appropriate, why or why not?  How much fluid will you give to help  prop up that BP? All questions that the medic prepared for PFC should be  looking to answer.    For more content, visit www.prolongedfieldcare.org

Today, I talk with Eric Bauer from Flight Bridge ED on Anaphylaxis and cover how bad and how fast this can overcome your patient. You can hear more about critical care flight on Eric's Podcast Flight Bridge ED. https://podcasts.apple.com/us/podcast/the-flightbridgeed-podcast/id595147712

Non-Governmental Organizations, Non-Profits and Volunteers have been  providing critical services on the battlefield for millennia.  Historically the traditional view of medical care in conflict zones was  that the military focused on victory and everything else was ancillary,  even care of their own wounded. Only in the last few centuries has there  been an evolution of care as another focus after completing the  mission. Through all of this it was often family members, clergy and  Volunteers providing aid to those left to rot on historic battlefields. These NGOs and Volunteers have recognized this gap and organized  themselves into powerful coalitions that are able to go where  traditional militaries cannot or will not due to political pressures.  Sometimes however, there exists an overlap of traditional military  presence and NGO response as the situation matures or devolves. Alex Potter and Global Response Management positioned themselves far  forward on the front lines of the battles for Mosul when times were  tough and the International military and humanitarian response to ISIS  was in its infancy. Thank you GRM for your hard work and dedication. We  are extremely proud of what your team accomplished and maybe even a  little jealous in the bittersweet way that only those who have  experienced the horrors of armed conflict can comprehend.   www.prolongedfieldcare.org

As a follow-up to the podcast on tension pneumothorax, how about simple pneumothorax? Dennis speaks with Doug on when you need to treat pneumothorax/hemothorax.

Dennis and the guys from the "Dustoff Medic podcast", discuss optimizing  your patient for evacuation. We go over the common mistakes and some of  the decision making processes of Load and go or Stay and Play when it  comes to the more invasive procedures.

In preparation for SOMSA, Dennis speaks with Ricky D. on how to give a great presentation. Remember to check out www.specialoperationsmedicine.org for SOMSA 2023 info.

Prolonged Field Care is back with a new episode on a long awaited topic,  traumatic ventilation.  We were finally able to corner a real, live  anesthesiologist who was actually more than happy to sit down and talk  about ventilation after his years of experience working at the heads of  thousands of patients.  This episode starts right off with a difficult  scenario discussion that includes a hypovolemic patient with a GSW to  the pelvis, RR 35  As they work to get the patient stabilized, Dr. Kopp recommends an end  tidal CO2 Capnograph as the single best patient monitor for this  situation.  A SAVE2 vent is discussed along with the ARDSnet recommendations for a  lung protective vent strategy including the preferred tidal volume of  6-8ml/kg of ideal bodyweight based on patient height.  This is to reduce  barotrauma and over-ventilation that can lead to other problems.  This  begins with attempting to match the patients physiologic respiratory  rate to prevent acidosis by giving too few breaths.  The beginning Positive End Expiration Pressure (PEEP) recommendation  should start somewhere around 5 to keep alveoli open and recruited,  prior to increasing oxygen levels if available.  PIP or Peak Inspiratory Pressure or the maximum pressure of each breath  which has a default setting of 30 corresponding with the ARDSnet  protocol.  For an uninjured patient in the Operating Room, Dr. Kopp  would start at 20-22 and then titrate from there.  While we are working on an Airway Clinical Practice Guideline with the  Joint Trauma System and Army Institute of Surgical Research, this will  go along with our earlier posted PFC WG Airway recommendations (April,  14) until we can get a consensus on the CPG and get it published. www.prolongedfieldcare.org

In this episode Dennis speaks with Andy about tension pneumothorax, interventions, and training scars.

When you can’t take cold stored whole blood with you and not all of your  soldiers are titered, a walking blood bank can mean the difference  between life and death for a patient in hemorrhagic shock.  With the  mounting evidence suggesting early blood is essential and not just a  good idea, you need to have a plan in order to hit the 30 minute target.   I have seen students struggle for hours trying to get access in both  the patient and the donor.  An emphasis on early recognition and early  access will save lives.  This episode expands upon our latest JTS  Clinical Practice Guideline on Remote Damage Control Resuscitation with  Dennis interviewing the primary author Andy Fisher. For more content, visit www.prolongedfieldcare.org

Dennis speaks with Bill about Ultrasound in the austere environment.