Podcast Episode 36: ROLO to SOLO: The Logistics of Fresh Whole Blood Transfusion

A Special Operations Battalion Surgeon explains how to easily navigate the logistics of setting up a battalion wide blood transfusion program.

The Trauma Hemostasis and Oxygenation Research (THOR) Network including the 75th Ranger Regiment, NORNAVSOF, and others have led the way in re-implementing type-O, low titer fresh whole blood far forward with the Ranger type-O Low titer(ROLO) program. Continue reading “Podcast Episode 36: ROLO to SOLO: The Logistics of Fresh Whole Blood Transfusion”

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.

TCCC+MARCHE(2) for CBRNe

  • 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

PFC Grand Rounds Talk at UC Davis Health

Here is a great video on PFC and the cases we helped collect from Airforce MAJ Eric DeSoucy, DO doing a Grand Rounds talk for the Department of Surgery at UC Davis.

 

Here is a great video on PFC and the cases we helped collect from Air Force MAJ Eric DeSoucy, DO doing a Grand Rounds talk for the Department of Surgery at UC Davis.

Here is the study he referenced in the video which he also happened to head up for our working group and the Joint Trauma System.

54 pfc cases 20171121DeSoucy

Podcast Episode 28: Critical Skills for Prolonged Field Care Providers

Training materials were the number 1 most requested item from our SOMSA AAR.  We have put out other training recommendations in the past but wanted to also highlight some important skills that will help you identify gaps in your PFC training program, plan future training and measure progress.

Training materials were the number 1 most requested item from our SOMSA AAR.  We have put out other training recommendations in the past but wanted to also highlight some important skills that will help you identify gaps in your PFC training program, plan future training and measure progress.  We will get more into this cycle in the future however, this should be a good place to start.  Many thanks go out to Andrew who labored over many versions of the list over the past few months.  One last thing, be sure that you are already at 100% T for Trained on your TCCC task list.  There is no use in getting into PFC training prior to mastering TCCC.  If you see something we may have overlooked and would like to see it on future versions, please comment below and let us know.

Prolonged Field Care Critical Task List Final

Teaching and Training Recommendations from March 2014

 

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.

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GCS Cheat sheet


MSMAID

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.

RASS Pics

RASS

Guidelines-Pain-Agitation-Delirium


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