RAVINES Mnemonic: A Practical Approach to Prolonged Field Care

The RAVINES Mnemonic was created to help the medical provider on the ground in an austere environment with a very sick patient. Most medics will do a decent TCCC MARCH survey and when they get to the end of that, get vital signs to begin trending and repeat the MARCH sequence while adding E-PAWS-B

  • E for Eyes
  • P for Pain
  • A for Antibiotics
  • W for Wounds
  • S for Splinting
  • B for Burns round out the MARCH-E-PAWS-B mnemonic.

At some point the provider may run out of things to do or could get lost in the immensity of the work which needs done. This is a great place for a therapeutic pause to gather oneself and think of what could be done while moving on to a secondary or detailed exam from which to make a problem list and care plan. This will help keep the thought process moving in the right direction and in an appropriate order while serving as a reminder of some critical steps that we have identified such as reducing tourniquets to pressure dressings and making a telemedicine/evac call along with others that may be overlooked such as nursing care and environmental considerations. Mnemonics should be just cheesy enough but memorable in any situation so remember this; RAVINES or deep draws are places that a small unit would hide a patrol base while in enemy territory to rest and prepare for the next leg of the mission. Just as draws and RAVINES offer relative piece of mind in a dire situation, so too should this memory aid:

MARCHE your PAWS to the RAVINES…

  • Resuscitation with fresh whole blood, Reduce Tourniquets as soon as possible (within 4 hours)

PFC WG Fluid Therapy Recommendations (December, 2014)

Emergency Whole Blood Protocol

PFC Fresh Whole Blood Transfusions FAQ

PFC WG Tourniquet Conversion recommendations (June, 14)

  • Airway and Cric care package including Capnography, Sedation drip, Sterile suctioning, Heat moisture exchanger/Filter, Check cuff Pressure, Tube depth

PFC WG Airway recommendations (April, 14)

Post Cric Checklist

PFC WG analgesia and sedation comments (Feb, 14)

  • Ventilate or oxygenate- Positive pressure with PEEP using a lung protective strategy

Why we need PEEP valves on BVMs

Scott Weingart’s Dominating the Ventilator Handout

  • Initiate telemedicine and evacuation early

Telemed Script Cheat Sheet

Medical Planning Tool

  • Nursing care including Monitoring and trending of vitals and ins and outs especially urine output, Positioning patient up, DVT Prophylaxis massage, turn patient 30 degrees to the sides, Passive ROM exercises, Oral Hygiene. This is where our nursing care checklist and the nursing mnemonic HITMAN can help remind you of nursing care priorities.
  • Hydration
  • Infection
  • Tubes
  • Medications
  • Analgesia
  • Nutrition

Everything You Need to Know About Foley Catheters

  • Environmental Considerations – Hypo/Hyperthermia, Ear plugs for flight, Sun screen and chapstick, Padding the litter and pressure points, Motion sickness prophylaxis
  • Surgical Procedures – Cricothyroidotomy, Thoracostomy, Escharotomy, Fasciotomy, Lateral Canthotomy, Amputation, Debridement, Delayed Primary Closure, Shunting

************************************

4 things You Should Do Before Packing an Aidbag,” Article By Next Generation Combat Medic Admin Max

Did you forget anything?

-Shoot back

Primary weapon, Secondary weapon, Smoke Grenades

Tubular Nylon, Litters,

-Massive Bleeding

Extremity Tourniquets, Wound Packing, Junctional Tourniquets, Pelvic Binders, Hemostats, Ace wrap, XStat, Suture kit, Stapler,

-Airway

Recovery Position, Nasopharyngeal Airway, Cricothyroidotomy kit, IGel, Intubation kit, BVM, PEEP valve, Portable suction device

-Respirations

Occlusive Dressings, 10g Needle cath, Finger thoracostomy kit, Chest tube, Heimlich valve, Ioban

-Circulation

Interosseous starter Kit, IV starter kit, Eldon blood typing kit, Fresh whole blood transfusion kit, Portable blood cooler Freeze Dried Plasma, Plasmalyte, TXA, Calcium,

-Head Injury

Fowlers Positioning, Oxygenation/SpO2 above 95, Resuscitate with Plasma or fresh whole blood, 3% hypersonic saline, Keppra, Neuro exam card, GCS card,

-Hypothermia

HPMK, Sleeping bag, Beanie cap,

-Vital Signs and Assessment

Portable Ultrasound, Capnograph, Pulse Ox, Stethoscope, BP Cuff, Penlight, Foley Catheter, Otoscope Opthalmoscope, Thermometer, Blood Glucose Monitor, Head lamp, Watch, Timer, DD1380, PFC Flowchart, Sharpie, Grease Pencil, Trauma shears,

-Eye Injuries

Lateral Canthotomy Kit, Fox Eye Shield, Erythromycin Ointment, Tetracaine Drops, Flourisceine paper, Cobalt lens light, Artificial tears,

-Pain Control and Sedation, Drugs

Tylenol, Oral Transmucosal Fentanyl, Ketamine, Lidocaine, Midazolam, Fentanyl, Dilaudid, Morphine, RASS card, Zofran, Glycopyrrolate, Benadryl, Epinephrine, Solumedrol, Dexamethasone, Dexamethasone, Prednisone,

-Antibiotics/Antimicrobials

Ertapenam, Doxycycline, Amoxicillin, Ciprofloxacin, Metronidazole, Mebendazole, Artesunate, Praziquantel,

-Wounds

Stapler, Suture kit, Dakins Solution irrigation kit, Gigli saw,

-Splints

Sam splint, Traction splint, Sling and swath,

Burns

Silverlon Dressings, Silvadene, Ringers Lactate solution, Burn care flowsheet,

Resuscitation and Reduce Tourniquets

Fresh whole blood transfusion kits, Freeze dried plasma, Wound packing, Pneumatic tourniquet,

Airway care

Suction, Ballenger In-line Suction device,

-Ventilations and Oxygenation

-Initiate Early Telemedical Consult

Call script, Cell Phone, Sat phone, Radio

-Nursing Care

-Environmental Considerations

Sunscreen, Chapstick, Mosquito netting, Clothing, Waterless soap,

-Surgical Procedures

Scalpel, Hemostats, Metzenbaum Scissors, Tissue forceps, Gigli Saw, Chlorhexidine, Iodine, Drapes, Gowns, Hat, Surgical masks, Sterile gloves,

Author: Staff

Medic

5 thoughts on “RAVINES Mnemonic: A Practical Approach to Prolonged Field Care”

  1. Paul – This is great. This is going to be my mantra for 1SFG medics…but I am going to add “and Teach” to the end as a reminder that this is also one of the roles of the 18D…something we have lost the bubble on…Thanks – Ramey

    1. Thanks Sir. I equate it to priorities of work. Once in nursing care you can then use the popular HITMAN mnemonic or Scott Weingart’s FAST HUGS IN BED… search Emcrit.org for that one.

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