Eye Emergencies in Prolonged Field Care

Open Globe Injury

Eye emergencies are one of the big 3 concerns; life, limb or eye sight.  This will be the first of many installments on PFC specific eye recommendations, Open Globe Injuries.  It is presented in a Power Point presentation for easy down load and printing for future reference.  This was submitted out of the blue while we were at SOMSA 2014 by a PFCWG partner and a welcomed addition to our reference material.

Download Open Globe Injury Guidelines

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Topics for Prolonged Field Care Training wanted

Here is a message from one of our brothers serving in Germany. I copy and pasted verbatim so that you don’t miss any nuances. My thoughts will be pasted as a new comment after the post to get some discussion going.  Please speak up and let us know what we forgot!

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What is a Cuff Manometer and should we be using it? (Yes)

During a break from the lectures at the last SOMSA one of the first issues identified was the lack of knowledge of PEEP and the absence of PEEP valves on BVMs.  Within a few weeks the paper Why we need PEEP valves on BVMs was written, edited and posted for distribution.  Our unit ordered the extremely inexpensive valves and they were distributed down to the medics.  It is now standard to be using PEEP valves and considered less-than-best practice without.

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PFC Scenario Script

This script is a customizable situation that any provider should be able to pick up and immediately understand.  I will post a link to download it in full as well as the text of it here.  This will allow you to download it to your eReader or tablet right now or read through it and make comments and suggestions at the end.  Please read it and please comment! What other scenarios do you want to see? Do you have any for us? Are yours different? How so? Are we missing something? Was this page easy enough to access?  If you are not able to answer questions with positive feedback we have failed in getting the proper information to the end user, the medic on the ground in the worst place in the world in the worst situation of his life.


Click to Download PFC Scenario NOW

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Case Discussion #3: Fall With Lung injury

Fall

Carl sustains a Blunt LUNG injury from a fall from height. He complains of rib pain, but no obvious fractures. Other than tachycardia, his initial vital signs are within normal parameters.  Four hours into the situation, he has an obvious decrease in his pulmonary status (i.e. increasing RR, decreasing SpO2, increase work of breathing, etc.). 

Beside the rules we have already been using you will have Carl as your patient for 48 hours including an 8 hour evac flight on a “slick” C-130. Just you and Carl…

Will the medic opt to put in a chest tube? 

When the chest tube does not help, what are his next actions?

If he does put in a chest tube, is he prepared to put one in properly with clean technique? 

Does he know how to troubleshoot the tube? 

Is he prepared to intubate?

Cric?

What medications will he use? 

Is he ready to Bag the patient for 48 hours with PEEP?

What will his report sound like if he calls for help?

Will he use a Telemed Script Cheat Sheet?

Closed Head Injury From ATV Crash: Prolonged Field Care Case Discussion 2

I usually start any PFC lecture I give with a common case such as this in order to drive home the realities of the operational context; a small team operating in the middle of nowhere dealing with a critically ill patient with little to no support.

Remember the “Rules”

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Case Discussion #1: GSW w/TQ

Indiginous force

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 Continue reading “Case Discussion #1: GSW w/TQ”