Prolonged Field Care Podcast

Summary:

In this conversation, Dennis and Ian discuss the new high altitude Clinical Practice Guideline (CPG) in the Joint Trauma System. They cover topics such as acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). They discuss the pathophysiology, symptoms, diagnosis, and treatment options for these conditions. They also touch on pre-treatment strategies and the use of portable hyperbaric chambers. Overall, the conversation provides a comprehensive overview of altitude-related illnesses and their management. In this conversation, Dennis and Ian discuss the treatment options for altitude illness, specifically AMS, HAPE, and HACE. They cover the use of pharmacologic therapy, oxygen, and portable hyperbaric chambers to stabilize and bring down patients with altitude illness. They also discuss the use of dexamethasone as the primary treatment for HACE and the potential use of hypertonic saline for extreme cases. They touch on the side effects of dexamethasone and the importance of protecting the airway. They also mention the use of acetazolamide for prophylaxis and the benefits of intermittent hypoxic exposure. Finally, they discuss the importance of good nutrition and hydration and the new medic encounter form for recording data on altitude illness.

Takeaways:

Acute mountain sickness (AMS) occurs when the body does not have enough time to acclimatize to the physiological stress of altitude.

High altitude cerebral edema (HACE) is characterized by ataxia and can occur even without AMS symptoms.

High altitude pulmonary edema (HAPE) is characterized by decreased exercise tolerance and tachypnea.

Assessment of vital signs, such as heart rate and respiratory rate, can help differentiate between altitude illnesses.

Portable hyperbaric chambers can be used to stabilize patients with altitude illnesses until they can be brought down to lower altitudes.

Pharmacologic treatments, such as acetazolamide and dexamethasone, can be used for prophylaxis and treatment of altitude illnesses.

Improvement in symptoms of HAPE can be rapid with oxygen therapy.

Pre-treatment strategies, such as using acetazolamide, can help acclimatize the body to altitude before ascent. Pharmacologic therapy, oxygen, and portable hyperbaric chambers can be used to stabilize and bring down patients with altitude illness.

Dexamethasone is the primary treatment for HACE, and hypertonic saline may be considered for extreme cases.

Side effects of dexamethasone include increased sugar, gastric erosions, gastric bleeding, and adrenal suppression.

Acetazolamide can be used for prophylaxis, and intermittent hypoxic exposure may help with acclimatization.

Good nutrition, hydration, and iron status are important for preventing altitude illness.

The new medic encounter form is a valuable tool for recording data on altitude illness.

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

In this podcast episode, Jay Baker discusses the topic of SOF surgical support in Special Operations Forces (SOF). He compares the different types of missions that soft surgical teams might be called upon to support and describes the gap that exists in institutional experience for surgical support in the setting of unconventional warfare. Baker highlights the lessons learned from surgical support in World War II and emphasizes the need to prepare for providing surgical support in more challenging environments. He also discusses the efforts being made to improve soft surgical support, including the development of RSOF surgical teams and the Prolonged Field Care initiative.

Takeaways

Sof surgical support in Special Operations Forces (SOF) is an evolving problem set that requires preparation for providing surgical support in more challenging environments.

Lessons can be learned from surgical support in World War II, where surgeons provided care in dangerous and challenging environments.

Efforts are being made to improve soft surgical support, including the development of RSOF surgical teams and the Prolonged Field Care initiative.

Training and experience in caring for critical patients over longer periods of time, performing tactical evacuations, and developing innovative solutions to resupply challenges are important for soft surgical teams.

Maggot therapy, also known as maggot debridement therapy (MDT), is a treatment that uses live maggots to clean and heal wounds. The therapy has a long history, dating back thousands of years, and has been used in various settings, including war zones and modern hospitals. Maggots are effective in wound healing because they eat necrotic tissue, have antimicrobial properties, and promote the growth of new tissue. The therapy is cost-effective and can be used in low-resource settings. It can be applied directly to the wound or placed in a mesh bag. Maggot therapy is often used as an adjunct to antibiotics and other wound treatments. Takeaways Maggot therapy is a cost-effective and efficient treatment for wound healing. Maggots eat necrotic tissue, have antimicrobial properties, and promote the growth of new tissue. The therapy can be used in various settings, including war zones and low-resource environments. Maggot therapy can be used as an adjunct to antibiotics and other wound treatments.

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

In this podcast episode, Doug discusses the use of End-tidal CO2 monitoring in medical practice. End-tidal CO2 is used to monitor the percent of carbon dioxide in blood that has been returned to the lungs. It is commonly used to confirm the placement of an endotracheal tube and to monitor ventilation during surgery. In the field, End-tidal CO2 monitoring is particularly useful for trauma patients and those with severe traumatic brain injuries. However, it is important to note that End-tidal CO2 should be used as part of a comprehensive approach to patient care, and clinical judgment is still crucial in making treatment decisions. Takeaways End-tidal CO2 monitoring is used to confirm the placement of an endotracheal tube and to monitor ventilation during surgery. In the field, End-tidal CO2 monitoring is particularly useful for trauma patients and those with severe traumatic brain injuries. End-tidal CO2 should be used as part of a comprehensive approach to patient care, and clinical judgment is still crucial in making treatment decisions. Other markers of resuscitation, such as lactate levels, may provide more valuable information in certain 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 or www.lobocoffeeco.com/product-page/prolonged-field-care

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

Write

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

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

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

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

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

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

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

Just in case....

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

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

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