Prolonged Field Care Podcast
By Dennis
For more content: www.prolongedfieldcare.org
Consider supporting us on: patreon.com/ProlongedFieldCareCollective
Prolonged Field Care PodcastJul 13, 2021
Prolonged Field Care Podcast 173: Deep Dive on Pelvic Injury
In this episode, Dennis and Alex discuss the truth about pelvic binders and their relevance in trauma care. They explore the background and experience of Alex, who has extensive knowledge in trauma surgery. They delve into the anatomy and injury patterns of pelvic fractures, as well as the different phases of damage control surgery. They also discuss the importance of understanding research and the levels of evidence. The conversation highlights the contradictory evidence surrounding the use of pelvic binders and emphasizes the need to critically evaluate citations and research findings. This conversation covers blast injuries, types of pelvic fractures, mortality rates, considerations for prolonged field care (PFC), the flow of care in PFC, normalization and observation, initial stabilization, massive transfusion protocol, futile transfusions, clinical decision making, pelvic binder design, imaging challenges, ultrasound for pelvic fracture assessment, duration of pelvic binder use, preventing pressure sores, consulting with medical professionals, proper application of pelvic binder, retroperitoneal hemorrhage, the role of telemedicine, critical care and decision making, and resources for further learning. Takeaways Understanding the anatomy and injury patterns of pelvic fractures is crucial in trauma care. The levels of evidence in research range from high-quality studies to expert opinions. The use of pelvic binders in trauma care is a topic of debate, with conflicting evidence and opinions. It is important to critically evaluate citations and research findings to make informed decisions in patient care. Understanding blast injuries and the different types of pelvic fractures is crucial in providing effective care in PFC. Mortality rates for pelvic fractures vary depending on the severity of the injury and associated injuries. Clinical decision making in PFC requires a thorough understanding of the patient's condition and available resources. Proper application and duration of pelvic binder use are important considerations in PFC. Consulting with medical professionals and seeking skeptics' opinions can help in making informed decisions in PFC. 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
The Basics: How to do Research
Differentiate between causative research papers and retrospective observational studies when reading research papers.
Read the methods section to determine the validity of the research and understand the inclusion and exclusion criteria, statistical analysis, and potential biases.
Avoid common mistakes when reading research papers, such as relying solely on the title and abstract.
Consider the challenges of conducting pre-hospital research, including data collection and controlling for environmental factors.
Extrapolate research findings to pre-hospital practice by discussing and collaborating with other providers.
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
Prolonged Field Care Podcast 172: Gas Anesthesia
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
The Basics: En Route Casualty Care
This episode of the PFC podcast focuses on in-route casualty care. The guest, Nikki, shares her background and experience in the Navy and explains why she started an in-route care training course. The conversation covers common mistakes in preparing patients for flight, securing lines and equipment, and the importance of constant assessment and monitoring. Nikki also discusses the training scenarios she uses to prepare nurses and corpsmen for in-route care. The episode concludes with a discussion on effective handovers, monitoring endotracheal tube placement, and the importance of collaboration in in-route care.
Takeaways
Proper planning and assessment are crucial in in-route casualty care.
Securing lines and equipment and packaging the patient appropriately are important considerations for flight.
Constant assessment and monitoring are essential during in-route care.
Effective handovers and communication are critical for patient care during transport.
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
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
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
The Basics: Blood Storage
In this podcast episode, Dennis interviews Monte from Delta Development about the need for a small blood refrigerator for prolonged field care. Monte shares his military background and experiences in Afghanistan and Iraq, where he realized the importance of carrying blood products in the field. They discuss the challenges of storing and transporting blood, including temperature control and cumulative time. Monte explains how Delta Development's blood refrigerator solves these issues and can even be used to run a mini blood bank. They also touch on the future possibilities of resupplying blood in the field. Overall, the podcast highlights the critical role of blood in prolonged field care and the importance of proper storage and transport methods.
Takeaways
- Carrying blood products in the field is crucial for prolonged field care.
- Temperature control and cumulative time are key factors in blood storage and transport.
- Delta Development's blood refrigerator provides a solution for maintaining proper blood temperature in austere environments.
- The device can be used to run a mini blood bank and facilitate blood resupply 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
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
The Basics: Pain Control Lessons Learned
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
Prolonged Field Care 169: GSMSG in Urkraine
GSMSG focuses on training partners rather than providing services.
Tourniquet use is vital in combat situations and should not be removed from the treatment algorithm.
Planning for different phases of war, including defensive, static, and offensive actions, is crucial for effective medical support.
There is a need for more surgeons and better medical training in combat situations.
Transportation challenges in combat zones require innovative solutions.
GSMSG can be contacted through their website, www.gsmsg.org.
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
The Basics: Acute Kidney Injury
In this podcast episode, Dennis talks with Doug (an ICU doctor) about acute kidney injury. They discuss the causes and types of acute kidney injury, how to recognize it, and the treatment options available. They also cover the recovery and prognosis of acute kidney injury, as well as the crush injury protocol and managing potassium levels. The episode provides valuable insights for healthcare practitioners dealing with acute kidney injury in prolonged field care situations.
Takeaways
- Acute kidney injury can be caused by a drop in perfusion to the kidneys, blockage of urine flow, or toxic injury to the kidneys.
- Recognizing acute kidney injury is important, and urine output and laboratory tests can help in the diagnosis.
- Treatment of acute kidney injury involves preventing further injury, ensuring adequate volume replacement, and adjusting medication dosages.
- Most young healthy kidneys will recover from a hypoxic type of injury, but toxic injuries may cause irreversible damage.
- The crush injury protocol includes bicarbonate, albuterol, insulin, and glucose to manage potassium levels.
- Monitoring and adjusting treatment is crucial, and Lasix may be used in certain cases of acute kidney injury.
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
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
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.
Prolonged Field Care Podcast 167: Working Together
In this podcast episode, Dennis and Antonio discuss the challenges and friction points that arise when working with providers from different countries. They explore how to iron out these issues efficiently to provide good care. The conversation covers topics such as common friction points on the ground, resolving conflicts and revamping protocols, establishing leadership, and learning from local providers. They also discuss the importance of adapting to different practices and resolving conflicts during handovers. Antonio shares insights from his own experiences and highlights the need for effective communication and collaboration in international healthcare settings. Takeaways Working with providers from different countries can lead to friction due to different protocols and approaches. Resolving conflicts and ironing out issues early on is crucial for providing good care. Effective communication and collaboration are key to navigating challenges in international healthcare settings. Learning from local providers and adapting to different practices can enhance patient care and 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
The Basics: Team Dynamics
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.
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
The Basics: Resiliency And Teamwork
Dr. Mark Shapiro discusses resilience and teamwork in the medical field during the COVID-19 pandemic. He highlights the differences between the civilian medical system and the military's approach to stress and resilience training. Dr. Shapiro emphasizes the importance of identifying and teaching resilience in medical professionals, as well as integrating stress inoculation into medical education. He also discusses the challenges of working in a crisis and the need for effective team composition and communication. Dr. Shapiro concludes by sharing his hopes for the future of the medical system and the lessons learned from the current pandemic.
Takeaways
- Resilience and stress inoculation are crucial in the medical field, but are often lacking in the civilian medical system.
- Teaching resilience and stress management should be integrated into medical education to prepare medical professionals for high-stress situations.
- Effective team composition and communication are essential in crises to ensure the best patient care.
- Experience and exposure to stress and difficult situations can help medical professionals develop resilience and adaptability.
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
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
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
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
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
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
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
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
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
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
#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
#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
#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
#4 Top PFC Podcasts of 2023: PFC in Ukraine
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#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
#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
#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
#8 Top PFC Podcasts of 2023: Combat Anesthesia
Dennis and Kevin Worth talk about combat anesthesia. The podcast discusses the four pillars of anesthesia, which are amnesia, analgesia, akinesia, and autonomic stability. The focus is on the importance of autonomic stability in combat situations. The best medication for amnesia in a downrange environment is Midazolam or Versed, and ketamine is a potent analgesic. The podcast also covers the MAP (mean arterial pressure) and how to maintain it in trauma patients. Finally, the podcast discusses various scenarios that require different types of sedation or analgesia, including the administration of fentanyl or calcium.
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
#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
#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
Prolonged Field Care Podcast 160: MDMA for PTSD
Thank you to Delta Development Team for in part, sponsoring this podcast.
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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
Prolonged Field Care Podcast 159: IV Lidocaine for Acute Pain
Dennis interviews Sandeep, an anesthesiologist with military experience, about the use of IV lidocaine for acute pain management. Sandeep explains that IV lidocaine can be a useful opioid-sparing option, especially in austere environments with limited resources. While it has a narrow therapeutic window, proper dosing can provide analgesia and reduce opioid consumption. Sandeep emphasizes the importance of safety considerations, including patient selection and monitoring for side effects. He also discusses the potential benefits in the context of trauma and surgery. Overall, IV lidocaine could be a valuable tool when managed carefully 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
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
Thanksgiving Special: Burn care CPG
Just in case....
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
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
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
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
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
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
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
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
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