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Prolonged Field Care Podcast

Prolonged Field Care Podcast

By Dennis

This podcast and website is dedicated to the healthcare professional who needs to provide high quality care in a very austere location.

For more content: www.prolongedfieldcare.org

Consider supporting us on: patreon.com/ProlongedFieldCareCollective
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Prolonged Field Care Podcast 100: The Past, Present, and Future of PFC

Prolonged Field Care PodcastApr 29, 2022

00:00
01:02:34
Prolonged Field Care Podcast 172: Gas Anesthesia

Prolonged Field Care Podcast 172: Gas Anesthesia

This conversation explores the topic of gas anesthesia, its historical background, and its use in various environments. The conversation covers the shift to the TIVA technique, the importance of the anesthesia machine and equipment, and the training required to administer gas anesthesia. It also discusses the combined techniques used in the operating room and the stages of anesthesia. The conversation highlights the advantages and disadvantages of ether and chloroform as anesthetics. It emphasizes the need for vigilant monitoring and the use of IV induction agents for safety. The conversation concludes by discussing the duration of gas anesthesia and the importance of witnessing wakeups.

Takeaways
Gas anesthesia has a long history and is still used today in various environments.
The TIVA technique is a popular approach to gas anesthesia, especially in field environments.
The anesthesia machine and equipment play a crucial role in administering gas anesthesia.
Vigilant monitoring is essential during gas anesthesia to ensure patient safety.
Witnessing the stages of anesthesia, including wakeups, is important for understanding the process.
Ether and chloroform were popular anesthetics in the past but have been replaced by safer alternatives.
IV induction agents are used to quickly transition patients through the stages of anesthesia.
The duration of gas anesthesia depends on the amount and length of use.
Observing gas anesthesia in the operating room provides valuable insights into its application.

Thank you to Delta Development Team for in part, sponsoring this podcast.
⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠


For more content go to ⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠
Consider supporting us: ⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠ or ⁠www.lobocoffeeco.com/product-page/prolonged-field-care



Mar 18, 202459:18
The Basics: En Route Casualty Care
Mar 15, 202439:04
Prolonged Field Care Podcast 171: Chest Trauma

Prolonged Field Care Podcast 171: Chest Trauma

In this conversation, Dennis and John discuss chest trauma management, specifically the use of chest seals and the sequence of interventions. They explore the overuse of chest seals and the potential complications they can cause. They also discuss the importance of assessing the patient and determining if a chest seal is necessary. John shares his insights on the use of finger thoracostomy and the technique for performing it. They also touch on the revision of the TCCC algorithm and the need to prioritize hemorrhage control. The conversation explores the challenges and approaches in operational medicine, emphasizing the need to align policy and guidelines with the experiences of field practitioners. It highlights the importance of preserving the rich experience and lessons learned by experienced personnel. The discussion also delves into the management of chest trauma, specifically focusing on emergent situations and the challenges in current practices. The conversation concludes with the anticipation of future discussions and the potential for further exploration of the topics. Takeaways Chest seals should be used specifically for sucking chest wounds or open pneumothorax. Chest seals can cause tension pneumothorax if used inappropriately. The decision to use a chest seal should be based on the patient's breathing status and the nature of the injury. Negative suction can be beneficial in re-inflating the lung and improving oxygenation in patients with chest trauma. The TCCC algorithm may need revision to prioritize hemorrhage control. Operational medicine requires a balance between algorithmic approaches and the practical experiences of field practitioners. Preserving the experience and lessons learned by experienced personnel is crucial for the development of effective policies and guidelines. Chest trauma management involves various emergent situations, including tension pneumothorax, hemothorax, and pneumothorax. Challenges in chest trauma management include the use of occlusive dressings and the need for surgical interventions. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠

For more content go to ⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠ or ⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

Mar 13, 202455:02
Prolonged Field Care Podcast 171: Chest Trauma

Prolonged Field Care Podcast 171: Chest Trauma

In this conversation, Dennis and John discuss chest trauma management, specifically the use of chest seals and the sequence of interventions. They explore the overuse of chest seals and the potential complications they can cause. They also discuss the importance of assessing the patient and determining if a chest seal is necessary. John shares his insights on the use of finger thoracostomy and the technique for performing it. They also touch on the revision of the TCCC algorithm and the need to prioritize hemorrhage control. The conversation explores the challenges and approaches in operational medicine, emphasizing the need to align policy and guidelines with the experiences of field practitioners. It highlights the importance of preserving the rich experience and lessons learned by experienced personnel. The discussion also delves into the management of chest trauma, specifically focusing on emergent situations and the challenges in current practices. The conversation concludes with the anticipation of future discussions and the potential for further exploration of the topics. Takeaways Chest seals should be used specifically for sucking chest wounds or open pneumothorax. Chest seals can cause tension pneumothorax if used inappropriately. The decision to use a chest seal should be based on the patient's breathing status and the nature of the injury. Negative suction can be beneficial in re-inflating the lung and improving oxygenation in patients with chest trauma. The TCCC algorithm may need revision to prioritize hemorrhage control. Operational medicine requires a balance between algorithmic approaches and the practical experiences of field practitioners. Preserving the experience and lessons learned by experienced personnel is crucial for the development of effective policies and guidelines. Chest trauma management involves various emergent situations, including tension pneumothorax, hemothorax, and pneumothorax. Challenges in chest trauma management include the use of occlusive dressings and the need for surgical interventions. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠

For more content go to ⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠ or ⁠www.lobocoffeeco.com/product-page/prolonged-field-care

Mar 11, 202455:02
The Basics: Blood Storage
Mar 08, 202434:30
Prolonged Field Care Podcast 170: Medical Education

Prolonged Field Care Podcast 170: Medical Education

In this conversation, Dennis and Mike discuss the process of providing medical care and education in austere environments. They emphasize the importance of understanding the requirements and asking the right questions to ensure success. They also discuss the significance of analyzing the environment, finding reliable sources of information, and building relationships with partners and friends. Planning and preparation are highlighted as crucial steps, along with effective teaching methods and the use of the Learning to Listen, Listening to Teach technique. The conversation concludes with a discussion on measuring performance and effectiveness, and the importance of flexibility and focusing on the student. Takeaways Understand the requirements and ask the right questions to ensure success in providing medical care and education in austere environments. Analyze the environment and find reliable sources of information to make informed decisions. Build relationships with partners and friends to enhance understanding and collaboration. Plan and prepare thoroughly, focusing on the basics and acquiring the necessary knowledge. Use effective teaching methods and the Learning to Listen, Listening to Teach technique to engage and educate students. Measure performance and effectiveness to assess the impact of the medical care and education provided. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective

Mar 04, 202453:06
The Basics: Pain Control Lessons Learned

The Basics: Pain Control Lessons Learned

In this conversation, Dennis and Justin discuss lessons learned in analgesia and sedation. They emphasize the importance of understanding medications and dosages, as well as having a plan for drug administration. They share case studies and examples of the wrong drug being used in the wrong situation. They also highlight the need for a strong foundation in medication knowledge and the importance of setting measurable goals for pain control. They caution against following trends and emphasize the importance of individual patient responses and safety measures.
Takeaways

Understand the medications and dosages you are using
Have a plan for drug administration and set measurable goals for pain control
Avoid using the wrong drug for the situation
Build a strong foundation in medication knowledge
Avoid following trends and focus on individual patient responses and safety measures


Thank you to Delta Development Team for in part, sponsoring this podcast.
⁠⁠⁠deltadevteam.com⁠⁠⁠

For more content go to ⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠
Consider supporting us: ⁠⁠⁠patreon.com/ProlongedFieldCareCollective

Mar 01, 202442:55
Prolonged Field Care 169: GSMSG in Urkraine
Feb 26, 202445:40
The Basics: Acute Kidney Injury
Feb 23, 202438:59
Prolonged Field Care Podcast 168: Austere Surgery

Prolonged Field Care Podcast 168: Austere Surgery

In this podcast episode, Dennis interviews David Hardin, a general surgeon with experience in austere environments. They discuss the differences between surgeons in first-world and austere environments, the importance of improvisation, training and manpower considerations, supplies and procedures in austere surgery, moving patients in austere environments, preparing for austere surgery, making decisions in austere environments, logistics and equipment, dealing with loss, preparing for unknowns, coping with emotional stress, and finding joy in austere surgery. Takeaways Austere surgery requires improvisation and resourcefulness due to limited supplies and equipment. Training and teamwork are crucial in austere surgery, and having a resilient and adaptable team is important. In austere environments, decisions must be made based on available resources and the best interest of the patient. Preparing for austere surgery involves pre-planning, understanding the environment, and being mentally and physically prepared. Coping with loss and emotional stress is a challenge in austere surgery, and supporting and insulating team members is important. Finding joy in the work and being grateful for the opportunity to help others can sustain surgeons in austere environments. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠deltadevteam.com⁠ For more content go to ⁠www.prolongedfieldcare.org⁠ Consider supporting us: ⁠patreon.com/ProlongedFieldCareCollective⁠

Feb 19, 202442:23
The Basics: MSK Trauma

The Basics: MSK Trauma

In this podcast episode, Dennis talks with Mark, a trauma surgeon, about lower extremity trauma and limb salvage. They discuss the decision-making process for determining if a limb is salvageable or not, the risk vs reward of tourniquet approximation, assessing motor function and arterial supply, the importance of preserving limb length, and the use of traction in pelvic fractures. They also touch on the struggles medics face in making these decisions and the importance of training and experience.Takeaways

  • Assessing motor function and arterial supply are key factors in determining if a limb is salvageable or not.
  • Preserving as much length and soft tissue as possible is important for future prosthetic use.
  • The risk vs reward of tourniquet approximation should be carefully considered, weighing the potential for continued bleeding against the need to preserve tissue.
  • In cases of pelvic fractures with concomitant femur fractures, traction may be necessary but should be monitored to prevent skin necrosis.
  • Training and experience are crucial in making informed decisions about limb salvage in traumatic injuries.


Feb 16, 202439:07
Prolonged Field Care Podcast 167: Working Together
Feb 12, 202430:19
The Basics: Team Dynamics

The Basics: Team Dynamics

In this podcast episode, Dennis and Doug discuss the importance of team dynamics in critical care, specifically when dealing with critically injured patients. They highlight the challenges that arise when team members work individually and fail to communicate effectively. The conversation explores the team dynamics at Baltimore Shock Trauma, where roles and positions are protocolized to ensure efficient patient care. The role of the team leader is emphasized as crucial in overseeing the entire resuscitation process and preventing crucial details from being missed. The episode concludes with a discussion on training for team dynamics in both solo medic scenarios and mass casualty situations.
Takeaways

Effective team dynamics are crucial in critical care settings to ensure efficient and comprehensive patient care.
Protocolizing roles and positions within a team can help streamline the resuscitation process and prevent crucial details from being missed.
The team leader plays a vital role in overseeing the entire resuscitation process and maintaining a global perspective.
Training for team dynamics should be conducted in both solo medic scenarios and mass casualty situations, with an emphasis on empowering all team members to contribute and communicate effectively.



Feb 09, 202427:51
Prolonged Field Care Podcast 166: Excited Delirium

Prolonged Field Care Podcast 166: Excited Delirium

In this podcast episode, Dennis interviews JR Pickett, an ER physician and EMS medical director, about excited delirium. They discuss the definition and history of excited delirium, the challenges faced by law enforcement and medical providers in managing these cases, and the importance of timely intervention. They also explore the differences between excited delirium and other conditions, such as combative patients in combat situations. The conversation highlights the need for proper assessment and observation of patients exhibiting excited delirium and the selection of appropriate medications for sedation. The podcast concludes with a discussion on the criminalization of medical care and the impact it may have on patient outcomes. Takeaways Excited delirium is a complex condition characterized by a disturbed state of mind, violent behavior, and physiological elevation. It has a long history and has been associated with various names over the years. Law enforcement and medical providers face challenges in managing patients with excited delirium, as they must balance the need to protect the individual and others with the potential risks of sedation. Differentiating excited delirium from other conditions, such as combative patients in combat situations, can be challenging but is crucial for appropriate management. Proper assessment and observation of patients exhibiting excited delirium are essential for determining the most appropriate interventions and medications for sedation. The criminalization of medical care is a concerning trend that may discourage medical providers from engaging in high-risk situations and could have negative consequences for patient outcomes. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Feb 05, 202447:56
The Basics: Resiliency And Teamwork
Feb 02, 202449:56
Prolonged Field Care Podcast 165: 10 Years of PFC

Prolonged Field Care Podcast 165: 10 Years of PFC

Today I chat with the Godfathers of PFC and discuss the concept of Prolonged Field Care (PFC) and its importance in military and civilian medical settings. It highlights the need for PFC in situations where evacuation is delayed or not possible, and the challenges faced by medics in providing care in such scenarios. The conversation also explores the civilian analog of PFC and the importance of risk management and training. It emphasizes the principles and evidence-based medicine behind PFC and the need for creativity and improvisation. The conversation concludes with gratitude towards the community involved in advancing PFC.Takeaways

  • Prolonged Field Care (PFC) is essential in situations where evacuation is delayed or not possible, and medics need to provide extended care to patients.
  • The concept of PFC is not limited to the military and has applications in civilian medical settings as well.
  • Risk management and training are crucial in preparing medics for PFC scenarios.
  • Principles and evidence-based medicine form the foundation of PFC, and creativity and improvisation are key in finding solutions in resource-limited environments.

Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com

For more content go to www.prolongedfieldcare.org

Jan 29, 202455:01
The Basics: Tropical Medicine

The Basics: Tropical Medicine

Dr. Ryan Maves discusses clinical medicine topics, specifically malaria and other tropical diseases. He emphasizes the importance of preventing infections when traveling in tropical and remote areas through vaccination, hand hygiene, malaria prophylaxis, insect repellents, and safer sex habits. He also provides resources for pre-deployment information. Dr. Maves shares a cautionary tale of a Marine Corps Lance Corporal with severe malaria and highlights the need for vigilance in diagnosing and treating tropical diseases. He discusses major tropical diseases, the workup of febrile travelers, and treatment options for malaria on deployment. He concludes by emphasizing the importance of improving care for infections in prolonged field care.Takeaways

  • Preventing infections is crucial when traveling in tropical and remote areas, and measures such as vaccination, hand hygiene, malaria prophylaxis, insect repellents, and safer sex habits should be followed.
  • Vigilance is necessary in diagnosing and treating tropical diseases, especially malaria, which can have severe consequences if not promptly addressed.
  • Major tropical diseases to be aware of include malaria, dengue, zika, chikungunya, yellow fever, meningococcus, and cholera.
  • The workup of febrile travelers should include a detailed chronology of illness, assessment of exposures and syndromes, and appropriate diagnostic tests.
  • Treatment options for malaria on deployment include Malarone and Coartem, with Coartem being the preferred oral antimalarial therapy.

Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com

For more content go to www.prolongedfieldcare.org



Jan 26, 202428:35
Prolonged Field Care Podcast 164: Anoxic Brain Injury

Prolonged Field Care Podcast 164: Anoxic Brain Injury

In this podcast episode, Dennis and Jeff discuss anoxic brain injury, its causes, progression, and treatment. They emphasize the importance of preventing anoxic brain injury by following the March algorithm and maintaining blood flow, airway patency, and oxygenation. They also discuss the role of monitoring and airway management in identifying and treating anoxic brain injury. The podcast covers the decision-making process for airway management and the importance of maintaining adequate oxygenation and blood pressure. The hosts also highlight the need to prevent secondary problems, such as pain, agitation, and seizures, and discuss resuscitation goals for anoxic brain injury. Takeaways Preventing anoxic brain injury is crucial and can be achieved by following the March algorithm and maintaining blood flow, airway patency, and oxygenation. Monitoring and airway management are essential in identifying and treating anoxic brain injury. The decision-making process for airway management should consider the patient's condition, available resources, and the provider's proficiency. Maintaining adequate oxygenation and blood pressure is crucial in preventing and treating anoxic brain injury. Preventing secondary problems, such as pain, agitation, and seizures, is important in the management of anoxic brain injury. Resuscitation goals for anoxic brain injury include maintaining a systolic blood pressure of 120-140 and a pulse oximetry saturation of at least 90%. Collaboration with neurocritical care specialists can help optimize fluid management and prevent further brain injury. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org

Jan 22, 202431:33
The Basics: Death of the Golden Hour

The Basics: Death of the Golden Hour

In this podcast episode, Dennis discusses the history and evolution of medical support in guerrilla warfare. He explores the role of unconventional warfare in the Army and provides examples of guerrilla warfare campaigns. Dennis also delves into the importance of surgical teams and the challenges of providing medical care in prolonged field care scenarios. He highlights the shift from the golden hour concept to the need for prolonged care in remote areas. Dennis concludes by discussing the future of medical support in guerrilla warfare and the importance of reevaluating medical norms.

Takeaways

  • Unconventional warfare (UW) has always been a challenge for the Army, but it plays a crucial role in achieving strategic objectives.
  • Surgical teams are essential in guerrilla warfare scenarios, providing medical care to both indigenous forces and American personnel.
  • The concept of the golden hour, where medical care is provided within 60 minutes, has been a significant development in recent conflicts.
  • In the future, medical support in guerrilla warfare may require a focus on prolonged field care, local care, and the use of organic surgery capability.


Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com

For more content go to www.prolongedfieldcare.org

Jan 19, 202427:47
Prolonged Field Care Podcast 163: pREBOA

Prolonged Field Care Podcast 163: pREBOA

In this podcast episode, Dennis interviews Eric and Ted from Prytime Medical about the P-REBOA catheter. They discuss the training process in Ukraine, the differences between the P-REBOA and the original REBOA catheter, the benefits of the P-REBOA in terms of balloon times and blood product use, and the complications and monitoring for reperfusion injury. They also address the placement of the catheter and the challenges of using it in the field. The episode concludes with information about future plans and research, as well as contact information for Prytime Medical. Takeaways The P-REBOA catheter is used to stabilize patients with severe hemorrhage in the field, particularly in situations where immediate surgical intervention is not possible. Training for the P-REBOA catheter involves a combination of didactic instruction and hands-on practice with simulation devices. The P-REBOA catheter has a semi-compliant balloon that allows for partial occlusion, maintaining some blood flow below the balloon and reducing the risk of reperfusion injury. The P-REBOA catheter can be used to extend the time window for surgical intervention, allowing for stabilization and transport of critically injured patients. Securing the P-REBOA catheter during transport involves suturing or using a catheter clamp to prevent dislodgement. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org

Jan 15, 202442:54
The Basics: Spinal Trauma With Ian Wedmore

The Basics: Spinal Trauma With Ian Wedmore

In this podcast episode, Dennis interviews Ian, an ER physician with experience in wilderness medicine, about spinal trauma. They discuss the initial approach to spinal trauma, the process of clinically clearing the spine, the neuro exam for spinal trauma, and the treatment of neurogenic shock. They also cover the goals of fluid resuscitation, the use of vasopressors, and the prevention of complications such as pressure injuries and hypothermia. The episode concludes with a discussion on the use of steroids in spinal cord injuries. Takeaways The initial approach to spinal trauma involves utilizing the MARCH algorithm and maintaining C-spine precautions until the patient can be clinically cleared. The neuro exam is crucial in determining the grade of spinal trauma and whether neurogenic shock is present. Treatment of neurogenic shock involves fluid resuscitation and the use of vasopressors to maintain blood pressure. Nursing care for spinal trauma includes preventing pressure injuries, monitoring for respiratory complications, and preventing hypothermia. Steroid use is not recommended in spinal cord injuries due to the associated risks.

Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com

For more content go to www.prolongedfieldcare.org

Consider supporting us: patreon.com/ProlongedFieldCareCollective

Jan 12, 202427:54
Prolonged Field Care Podcast 162: Subterranean Rescue

Prolonged Field Care Podcast 162: Subterranean Rescue

In this episode, Sean McKay discusses the challenges and considerations of subterranean mobility and rescue. He emphasizes the importance of understanding the geology and environmental pathology of underground environments, as well as the need for continuous training and innovation in equipment usage. McKay also highlights the significance of risk assessment and uncertainty management in rescue operations. Additionally, he explores the complexities of communication and coordination in subterranean environments. In this conversation, Sean discusses the complexity of rescue operations and emphasizes that there is no one-size-fits-all approach. He highlights the importance of considering various factors, such as team capabilities, training, and environmental conditions. Sean also emphasizes the need for continuous training and seeking weaknesses in order to improve. He encourages rescuers to innovate and find solutions that fit their specific mission and team. Additionally, he emphasizes the importance of knowing and understanding the equipment and being comfortable with improvisation when necessary. Takeaways Understanding the geology and environmental pathology of underground environments is crucial for effective subterranean mobility and rescue operations. Continuous training and innovation in equipment usage are essential for adapting to the challenges of subterranean environments. Risk assessment and uncertainty management play a vital role in planning and executing rescue operations. Communication and coordination are key factors in successful subterranean mobility and rescue operations. Rescue operations are complex and there is no one-size-fits-all approach. Consider factors such as team capabilities, training, and environmental conditions when planning a rescue. Continuous training and seeking weaknesses are crucial for improvement. Innovate and find solutions that fit your specific mission and team. Know and understand your equipment, and be comfortable with improvisation when necessary. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Jan 08, 202401:14:03
The Basics: Setting Up a Clinic

The Basics: Setting Up a Clinic

In this podcast episode, Nate, a Special Forces Detachment Commander, discusses the importance of incorporating medical training into team operations. He shares his journey of realizing the limitations of his own medical knowledge and the need to improve his personal medical capabilities. Nate emphasizes the importance of creating formalized Standard Operating Procedures (SOPs) for team clinics and the need to test and refine these plans. He also highlights the need for training medical reps in realistic scenarios and standardizing medic training. Nate encourages commanders and medics to be honest about their medical capabilities and to communicate effectively with higher command. He concludes by seeking feedback on clinic setup from the wider PFC community. Takeaways Incorporating medical training into team operations is crucial for commanders to understand the limitations and capabilities of their medical resources. Creating formalized Standard Operating Procedures (SOPs) for team clinics is essential to reduce friction and improve efficiency in medical operations. Testing and refining medical plans is necessary to ensure they are effective and realistic in austere environments. Training medical reps in realistic scenarios and standardizing medic training can improve the overall medical capabilities of the team.

Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com

For more content go to www.prolongedfieldcare.org

Consider supporting us: patreon.com/ProlongedFieldCareCollective

Jan 05, 202425:00
Prolonged Field Care Podcast 161: Fentanyl

Prolonged Field Care Podcast 161: Fentanyl

In this episode, Dennis and Brad discuss the use of fentanyl in medical settings. They provide an overview of the background and development of fentanyl, highlighting its reliability and predictability as an opioid. They explain the characteristics and benefits of fentanyl, including its rapid onset, peak effect, and short duration. The conversation also covers the side effects and considerations of fentanyl, such as respiratory depression and histamine release. The appropriate administration and dosage of fentanyl are discussed, along with its use for sedation and procedures. The use of fentanyl lollipops and patches is explored, as well as the importance of proper administration and monitoring. The episode concludes with final thoughts on the use of fentanyl and the need for further education and understanding of its use. In this conversation, Brad discusses the use of ampules for protection in combat medicine. He explains various methods of using ampules and emphasizes the importance of protecting them. The conversation concludes with Dennis providing closing remarks and directing listeners to the Prolonged Field Care website and social media channels.

Takeaways

  • Fentanyl is a reliable and predictable opioid with a rapid onset, peak effect, and short duration.
  • It is important to understand the side effects and considerations of fentanyl, such as respiratory depression and histamine release.
  • Fentanyl is commonly used for pain control and sedation, and it is particularly effective in trauma scenarios.
  • Proper administration and dosage of fentanyl are crucial, and it is important to monitor patients closely for respiratory depression.
  • Fentanyl lollipops and patches have specific uses and considerations, and their administration should be carefully managed. Ampules can be used in various ways for protection in combat medicine.
  • It is important to protect ampules to ensure their effectiveness.
  • Listeners are directed to the Prolonged Field Care website and social media channels for more information.

Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Jan 01, 202448:31
#1 Top Tens Podcasts of 2023: Ground Truth in Ukraine

#1 Top Tens Podcasts of 2023: Ground Truth in Ukraine

Dennis is interviewing Dr. John Quinn who's on the ground working Role 1 medical operations for an NGO somewhere in Ukraine. The lessons being learned by John and others during the early days of this conflict and the past 8 years can be used to help those on the ground now and into the future. This is an amazing opportunity to stay informed of current events and prepare ourselves by narrowing expectations and tweaking training. During the interview John stated that anything that can be done to further enable FWB availability and knowledge would be greatly appreciated. In particular, when asked what we could translate, he asked for: Damage Control Resuscitation guidelines to be translated, Prehospital Blood guidelines, anything on Damage Control Surgery for non-surgeons (they have a lot of OB/GYNs and others like OMFS functioning as DCS surgeons at Role 2s). He also stated that they're seeing a TON of TBI "walking wounded" and anything on mild to moderate TBI management would be great. When asked about a trauma registry, John stated that the Ministry of Health is attempting to catalogue all civilian casualty numbers. The Ministry of Defense is VERY close-hold with any info and it would be very hard to elicit the ground-truth there for the time being. John stated that many organizations are using the TCCC cards and all documentation is trying to be written in BOTH Ukranian and English, due to the large number of non-native providers helping in country. They LOVE the DeployedMedicine app, the translation of TCCC and Emergency War Surgery and absolutely look to US and NATO standards of care. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Dec 29, 202301:06:12
#2 Top Tens Podcasts of 2023: MASCAL Lessons Learned

#2 Top Tens Podcasts of 2023: MASCAL Lessons Learned

Today, I'm joined by Rick, a senior medic with 18 years of experience in AFSOC and the Green Berets. We dive into lessons learned from mass casualty events, focusing on reactive and proactive scenarios. Rick recounts a harrowing mission in Eastern Afghanistan, where planning mishaps led to a challenging situation. They had to adapt on the fly, dealing with casualties and limited resources. Rick emphasizes the importance of improvisation, quick thinking, and knowing your available assets. He also discusses the need for effective communication and maintaining composure in high-stress situations. A must-listen for anyone in the field. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Dec 27, 202301:27:47
#3 Top Ten Podcasts of 2023: Ketamine Deep Dive

#3 Top Ten Podcasts of 2023: Ketamine Deep Dive

Merry Christmas...Today, we're diving into the nitty-gritty of ketamine – that mind-bending stuff, you know? So, ketamine's like this receptor blocker, messing with your brain's signals. It's a mixed bag, really. In low doses, it kills pain like a champ. But crank it up, and bam! You're in a world of dissociation. Picture it: brain's top half talking gibberish with the bottom half, and you're floating in a weird dream world.

Thank you to Delta Development Team for in part, sponsoring this podcast.

deltadevteam.com

For more content go to www.prolongedfieldcare.org

Consider supporting us: patreon.com/ProlongedFieldCareCollective

Dec 25, 202353:03
#4 Top PFC Podcasts of 2023: PFC in Ukraine

#4 Top PFC Podcasts of 2023: PFC in Ukraine

Write

Dec 22, 202301:07:37
#5 Top PFC Podcasts of 2023: Ukraine Update

#5 Top PFC Podcasts of 2023: Ukraine Update

This Podcast was from June of this year. This is Dennis, and today I'm joined by Anri, a Ukrainian medic who will share some lessons learned from the battlefield. Anri talks about how wound patterns change in urban versus rural areas, with urban areas having more trauma from shrapnel and secondary trauma from debris. He mentions the challenges medics face in treating these complex wounds, including fractures and extensive tissue damage caused by multiple waves of explosions. Anri also discusses the impact of seasonal variations and the difficulties in evacuation due to artillery shelling, long distances, and the use of unconventional methods by the enemy. He emphasizes the importance of adapting medical techniques, such as splinting and triage, to the unique conditions on the front lines. Anri also mentions the use of blood products, saline, and telemedicine for prolonged field care. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Dec 20, 202301:07:37
#6 Top PFC Podcasts of 2023: What's the Best Airway?

#6 Top PFC Podcasts of 2023: What's the Best Airway?

In the latest episode of the PFC podcast, I spoke with Evan and Doug about airway management. As experienced airway takers in both pre-hospital and hospital settings, they had some valuable insights. We discussed the controversy over intubation versus cricothyrotomy. Evan and Doug raised some valid points, such as the need for suctioning and the difficulty of obtaining post-intubation sedation medication in resource-limited environments. We also talked about the importance of ongoing training to maintain skills and the need for better difficult airway education in training programs. Overall, it was a great discussion. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Dec 18, 202301:16:10
#7 Top PFC Podcasts of 2023: Improvised Med

#7 Top PFC Podcasts of 2023: Improvised Med

In today's podcast, I chat with Aebhric OKelly the founder and Dean Emeritus of the College of Remote and Offshore Medicine (COROM) about Improvised medicine. I will be the first to say, as cool as it is to learn Improvised techniques, this is an emergency plan, not a way to lighten your ruck. We run through items for MARCH and principles to apply to this problem. This is only part one, so plenty more in the next episode, when we go through PFC and improvised gear. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Dec 15, 202301:06:58
#8 Top PFC Podcasts of 2023: Combat Anesthesia
Dec 13, 202348:29
#9 Top PFC Podcasts of 2023: Tension Pneumothorax

#9 Top PFC Podcasts of 2023: Tension Pneumothorax

Now, let's dive into treating tension pneumothorax. Joined by Andy Fisher, our favorite surgery resident and social media provocateur. We're talking IFAC essentials and the needle decompression debate. Andy's been stirring the pot, suggesting ditching Needle D's from the IFAC due to lack of official backing. The IFAC's about saving lives for non-medics, but is it hemorrhage, not tension, we should focus on? Special ops pushed decompression needles, but is it justified? Andy questions the success rate of needle decompressions and suggests focusing on actual tension physiology. Training rush may play a role. Is sticking needles in pre-emptively smart? Well, let's focus on true tension signs instead. I mention tension either shows up or it doesn't, and hemodynamic changes trigger action. Thoracic trauma, mostly hemothorax, outweighs tension pneumothorax deaths. Andy, if king for a day, would adjust chest injury treatment. Surgical insights, plain talk, only on the PFC podcast. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Dec 11, 202349:52
#10 Top PFC Podcasts of 2023: Simple thing no one does

#10 Top PFC Podcasts of 2023: Simple thing no one does

For the rest of the month, every Mon, Wed, and Fri, I will be posting the top 10 podcasts of '23. I will resume with the regular schedule on New Year's Day. Happy Holidays. This podcast discusses the importance of patient positioning in prolonged field care. The guest, Ethan Miles, a board-certified family medicine physician with extensive military experience, emphasizes that patient positioning is a forgotten aspect of medical training and that simple, low-cost interventions are often overlooked. Miles states that patient positioning is especially crucial in prolonged field care and can help in treating patients with traumatic brain injury, manage airways, and improve oxygenation. However, patient positioning can also have downsides, such as orthostatic hypotension, and should be reassessed regularly. Miles suggests that improvised things can also work well when pre-made things are unavailable. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Dec 08, 202337:41
Prolonged Field Care Podcast 160: MDMA for PTSD
Dec 04, 202335:24
The Basics: CBRNE for Dummies

The Basics: CBRNE for Dummies

Dr. Givens talks about dealing with CBRNE patients in the field. They discuss the need for standardized approaches and clinical guidelines. I'm all about simplifying things and making them user-friendly. The hot zone requires quick thinking and auto injectors for CBRNE agents. They emphasize the importance of TCCC and teamwork. Dr. Givens covers various agents like nerve agents, cyanide, chlorine, and more, offering practical insights for handling them. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Dec 01, 202338:21
Prolonged Field Care Podcast 159: IV Lidocaine for Acute Pain
Nov 27, 202355:27
The Basics: Triage decisions in the future fight

The Basics: Triage decisions in the future fight

Dennis hosts two special guests, Stacy Shackelford and Doc Rush, to discuss rethinking triage. They emphasize the need for a shift in the way medics are trained and how triage is approached. They challenge traditional triage algorithms and encourage a more flexible, data-driven approach that prioritizes time-sensitive interventions such as hemorrhage control and airway management. The conversation also touches on the importance of training medics in trauma care, the role of team leaders in risk management, and the need for preparation and rehearsal in managing large-scale casualties. Ultimately, they stress the importance of sticking to basic principles while being prepared to adapt in dynamic situations.


Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Nov 24, 202359:44
Thanksgiving Special: Burn care CPG

Thanksgiving Special: Burn care CPG

Just in case....

Nov 23, 202329:13
Prolonged Field Care Podcast 158: Ketamine and Seizures

Prolonged Field Care Podcast 158: Ketamine and Seizures

Dennis and guest Jeff Siegler, an assistant professor of emergency medicine, discuss the use of ketamine in managing status epilepticus. Status epilepticus is a prolonged seizure lasting more than five minutes, which can be life-threatening. They explore the challenges of treating seizures in the field and the role of benzodiazepines in initial treatment. Ketamine, while generally considered an excitatory drug, is being studied as a potential option when seizures become refractory to standard treatments. The podcast highlights the need for further research and individualized care plans while considering the limitations of pre-hospital settings and state regulations. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Nov 20, 202334:58
The Basics: Confined Space Rescue

The Basics: Confined Space Rescue

Dennis and guest Shawn McKay discuss the basics of confined space rescue. They touch upon the importance of understanding the environment and potential risks, the need for monitoring equipment, and the selection of the right personnel for specific tasks during rescue operations. They also mention the relevance of NFPA standards and the importance of choosing appropriate equipment. The conversation emphasizes the significance of training and preparedness in handling complex rescue situations. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Nov 17, 202301:05:35
Prolonged Field Care Podcast 157: Nubain

Prolonged Field Care Podcast 157: Nubain

Dennis and Brad discuss the use of Nubain, also known as Bufene. Nubain is a non-controlled narcotic that was FDA-approved in 1979 and gained popularity in the 1980s and 1990s. It is similar in strength to morphine but lacks some of its side effects like respiratory depression. Nubain's unique properties include its ability to reverse itching caused by other narcotics and its use as an adjunct to ketamine or other pain management drugs. Dennis emphasizes the importance of monitoring respiratory rates and adjusting doses accordingly. Overall, Nubain is a valuable tool for managing pain in a field environment. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Nov 13, 202346:15
Not so basic: Far-Forward Surgical Support

Not so basic: Far-Forward Surgical Support

Jay Baker, a brigade surgeon with limited special operations experience, discusses the evolving landscape of surgical support in Special Operations Forces (SOF). He highlights the differences between traditional trauma care provided during the Global War on Terror and the potential challenges of unconventional warfare. Drawing from historical examples of surgeons supporting resistance movements in World War II, he emphasizes the need for adaptable and resourceful surgical teams capable of extended missions in hostile environments. Baker also discusses the concept of prolonged field care (PFC) and the development of SOF surgical teams to meet future mission requirements. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Nov 10, 202318:30
Prolonged Field Care Podcast 156: Training the Ventilator

Prolonged Field Care Podcast 156: Training the Ventilator

Dennis and Josh discuss ventilator training on the PFC Podcast. Josh, a former ranger medic now working in a level one ICU, shares insights. They emphasize the importance of proper ventilation in the field and address common mistakes, like setting inappropriate rates that lead to patient agitation. Josh advises cautious opioid use, balancing sedation with patient needs. They delve into adjusting PEEP, flow, and waveform, emphasizing patient synchronization. Josh highlights the significance of addressing pain, resuscitation, and lung disease simultaneously. He clarifies end-tidal CO2 readings and the role of kidneys in metabolic acidosis. Josh also stresses IV maintenance and patient assessment. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Nov 06, 202358:02
The Basics: Ventilations in Trauma

The Basics: Ventilations in Trauma

Dennis and Doug discuss the fundamentals of ventilatory management in trauma cases. They emphasize the distinction between the need for an airway and the need for a ventilator. Patients requiring an airway may have issues like swelling or trauma obstructing their airway, while those needing a ventilator typically have respiratory failure. They explain the importance of monitoring compliance, tidal volume, minute ventilation, and peak and plateau pressures. Additionally, they touch on the importance of supporting blood pressure during intubation and the need for continuous resuscitation in trauma cases. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Nov 04, 202345:26
Prolonged Field Care Podcast 155: Arctic TCCC

Prolonged Field Care Podcast 155: Arctic TCCC

Dennis interviews Thomas Trust Have, a former Danish Special Forces operative turned doctor, discussing the challenges of providing medical care in Arctic environments. Thomas emphasizes the extreme conditions, highlighting a hypothetical scenario involving a special operations team enduring frigid temperatures and harsh winds. He underscores the importance of preparation, teamwork, and proper gear in these situations. Thomas also addresses medical considerations such as tourniquet use, fluid warming, and the complexity of providing care in cold conditions. The episode sheds light on the unique challenges faced by healthcare providers in remote, freezing environments. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Oct 30, 202351:15
The Basics: Team Dynamics

The Basics: Team Dynamics

Dennis and Doug discuss the critical importance of effective team dynamics when dealing with critically injured patients. They highlight the challenges faced by medical teams who often work in silos, failing to communicate and coordinate efficiently. Doug, drawing from his experience at Baltimore Shock Trauma, emphasizes the value of well-organized roles and protocols in high-volume trauma facilities. He underscores the need for designated positions and a clear team leader to oversee the patient's care. The conversation also touches on adapting such practices to operational environments, stressing the importance of training, teamwork, and constant vigilance in providing life-saving care. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Oct 27, 202327:51
Prolonged Field Care Podcast 154: Tourniquet Conversion

Prolonged Field Care Podcast 154: Tourniquet Conversion

In today's episode, we're diving into the topic of tourniquet conversion. With conflicts happening globally, it's crucial to understand the difference between tourniquet conversion and replacement. Conversion means finding an alternative to control bleeding when the tourniquet is no longer needed. Replacement involves swapping a tourniquet for a more effective one. Conversion timing depends on the tactical situation and patient's resuscitation status. You should consider resuscitating the patient before converting, ensuring they're warm, non-coagulopathic, and ideally have a systolic blood pressure above 90. Science-wise, the two-hour rule may have originated from studies in cooler environments. Converting tourniquets in austere settings requires confidence and proper patient assessment. Crush syndrome, re-bleeding, and metabolic changes can be concerns when converting tourniquets. Use bicarb cautiously to mitigate potential acidosis. Calcium can also help, but pay attention to the specific calcium source and dosing. The goal is to save lives while minimizing limb loss. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Oct 23, 202349:01
The Basics: Planning to Succeed

The Basics: Planning to Succeed

Today, we're diving into the crucial topic of medical contingency planning. Evan and I discuss the importance of planning for medical emergencies in various scenarios, emphasizing that timely evacuation is often more effective than improvised solutions.

We stress the significance of conducting thorough risk assessments, considering factors like location, climate, endemic diseases, and enemy threats. It's essential to evaluate local healthcare resources and potential evacuation options, even in remote areas.

We debunk the idea of one-size-fits-all pace plans, emphasizing that planning should be proportionate to the situation's criticality. We also highlight the need for rehearsals and practical evaluations to uncover plan weaknesses.

Lastly, we advise against overloading aid bags with unnecessary supplies, and we stress the importance of adapting to the circumstances, keeping in mind that helicopters may not always be available.

Remember, preparation is key, and flexibility is vital in ensuring the success of your medical contingency plans.

Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Oct 19, 202301:00:07
Prolonged Field Care Podcast 153: What is a SOF Medic
Oct 16, 202301:17:58