Podcast Episode 33: TIVA: Another Look at Pre-Hospital Analgesia and Sedation

Rick Hines has spent the last 20+ years in service to his country much of it deployed to combat zones and other unstable, austere environments and is dedicated to improving SOF Medicine.  He made it a point to spend a fair amount of time with surgical teams when possible and has gained quite a bit of real world knowledge that we hope to pass on to a wider audience here. Continue reading “Podcast Episode 33: TIVA: Another Look at Pre-Hospital Analgesia and Sedation”

Podcast Episode 31: CBRN for Dummies By COL Missy Givens

In this live recording, guest lecturer COL Missy Givens shares the CBRNe knowledge she has learned while working as a clinical toxicologist, among many other positions, around the world including as the SOCAFRICA Command Surgeon where she personally helped prepare members of 10th SFG(A) to deal with some of the most venomous snakes in the world.


  • Mask
  • Antidote
  • Rapid Spot Decon
  • Counter Measures
  • Head Injury and Hypothermia
  • Evacuation

CRESS for chemical agent identification

  • level of Consciousness
  • Respirations
  • Eyes (miosis)
  • Secretions
  • Skin (blisters)

We will also post the PPT slides as soon as we can.

Download Here

Additional Reading

Analgesia and Sedation JTS/PFC Clinical Practice Guideline


TheJoint Trauma System joined up with us and several of our working group members to bring you this, our third CPG, for PFC.As with every PFC CPG, this is the time that goes beyond TCCC. With this specific CPG you are expected to provide appropriate analgesia and/or sedation

Continue reading “Analgesia and Sedation JTS/PFC Clinical Practice Guideline”

Podcast Episode 16: Sedation

Being able to calm and sedate patient in operational or prolonged field care situations may be a valuable skill.  Here are our thoughts on sedating your patients when patient comfort and safety are an issue?

Glasgow Comma Scale

Get your GCS before sedating you patient so that you can track trends later during your sedation wake-ups/holidays.


GCS Cheat sheet


If you are doing sedation it is highly recommended that you prepare by going through the MSMAID acronym detailed in a previous post and podcast.  This will ensure you have the minimum equipment, drugs and personnel required for the job.

MSMAID Post and Podcast

MSMAID Handout

Circle of Awareness

This is the same circle of awareness from last episode.  Once you have your MSMAID plan for anesthesia you should monitor your patient and level of sedation using the circle of awareness ever 5 minutes until they have been off of anesthetic agents for an hour.  Anytime you are giving drugs that can alter the patient’s respiration rate or hemodynamics you should have someone at the head of the patient monitoring the components of the circle of awareness.  If you are using a push dose or bolus you should know how long the onset for the drug is and check the circle accordingly.  It will keep you out of trouble.

  • Sedation level (RASS)
  • Airway Patency (Including ventilator if being used)
  • Breathing Rate
  • Circulation Rate
  • Report Patient Status to the Surgical Team
  • Record on Anesthesia Form 517
  • Tasks

Richmond Agitation and Sedation Scale(RASS)

The Richmond Agitation and Sedation Scale is a standard scale used to quantify a patient’s level of consciousness.  Tracking a RASS is another way to trend a patients condition while sedated.  Hang this, along with the GCS card, next to your patient bed in your aid station for easy reference.




Doug’s Basic ICU Neuro Exam for a lightly sedated and Intubated or Criced patient:

Check Motor Cortex: Can the patient wiggle all toes and fingers or give the thumbs up

Check Frontal , Temporal and Occipital Lobes: check that both pupils are equal, reactive and accommodating with a pen light

Check Deep Brain Reflexes: Illicit a cough by suctioning the airway down to the carina with a sterile suction catheter like the Ballard inline suction

Check Brain Stem: Is the patient breathing spontaneously?  If ventilated are they breathing more than the set rate.

Along with a GCS score, this exam will tell you in simple terms if the geographic areas of the brain are intact.  It’s extra information in the case that you call

Take our sedation quiz and see if you are prepared to sedate your patient…

Further Reading

A protocol of no sedation for critically ill patients receiving mechanical ventilation

SLEAP paper


How to make labels to practice Medication administration:

Prolonged Field Care

Tactical Trauma Casualty Care(TCCC) and Prolonged Field Care can be heavy on the medication administration, but during training we can’t really give our real role player patients or even our mannequins a bunch of narcotics and other controlled substances, so it’s often verbalized in training. Not training on the medication they carry downrange, far from providers, can lead to improper Continue reading “How to make labels to practice Medication administration:”

GSW to Lower Extremity: PFC Case Discussion 7

Our case discussions are provided to get you, the medic or provider, to think about treatment and logistical issues.  The following case is a ‘simple’ scenario constructed to get you thinking about long term pain control

Continue reading “GSW to Lower Extremity: PFC Case Discussion 7”