Case Discussion #1: GSW w/TQ
Just as a rehearsal of a tactical operation will prepare the operator to better deal with contingencies, discussing and talking through realistic, hypothetical, medical scenarios will give the medic a good idea to how he might respond should a similar situation arise in real life. We encourage participation in the discussion by all levels of medic, nurse and provider. Constructively thinking through worst-case illness and injuries, through multiple perspectives, will open the eyes of those on the other side of the wire, no matter which side that may be. If you have an idea or concern, throw it out there. Don’t be scared…
Some Ground Rules:
Cases will be intentionally vague.
There is no “right” answer, it’s a discussion.
You will have each patient for 24 to 72 hours.
Plan for the worst-case scenario. Murphy’s Law is in effect.
No crazy CT or MRI studies. You might possibly, maybe, have an ultrasound. You are in an austere environment and have what a medic would bring. If you aren’t familiar, search the site for “PFC Pelican Packing List” for a basic layout. (It’s at the bottom of that page.)
We want to improve morbidity as well as mortality. Imagine the patient is your own family member.
You will likely have to fly with your patient for 8 hours on a “slick” (no med crew or equipment) aircraft. Be sure to consider both patient and equipment preparation.
You have one junior medic and a handful of non-medics as helpers.
Local blood supply and pharmacy are questionable at best. The primitive lab in town has a turn-around of at least 4 hours for the most basic tests.
Feel free to address the “no-evac-possible” scenario.
Scenario # 1: GSW w/TQ
A U.S. service member sustains a GSW to the upper calf when the host nation soldier fails to clear his weapon properly. The soldier had no tourniquet on the range and bled for approximately 5 minutes. With vascular injury to the popliteal artery, the SOF medic can only gain complete hemorrhage control with a well-positioned tourniquet, although the patient has already lost a significant amount of blood. This patient may appear to be an easy TCCC case, but consider how this can spiral out of control…