This podcast covers medical care targeted to the Special Operations medical community with a focus on providing prolonged care in austere environments.
Prolonged Field Care Working Group
Sometimes it's good to go over the basics again. Doug gives us the run down on who needs vent management and how to get started.
Everyone knows how hard it is to do good ventilation management using our gear. If the patient is spontaneously breathing in any way it can be next to impossible. Are paralytics the answer? Dennis speaks Evan (ER Doc) and Josh (ICU Doc) about the use of paralytics in vent management.
With bleeding from the "Box" causing such a large portion of the potentially survivable deaths, can we go in there? A better question probably "should we?". Stacy goes over how large the actual problem is and better yet, "What can be done", and "what does it take to do it?"
We're beyond explaining that blood is better than water, when it comes to resus and trauma. Now let's start talking about HOW to do it better. How to collect it faster and give it faster in the austere environment. How can we use the gear we have and optimize this life saving process.
Usually, we are sending our patients to a higher level of care. What do you do with the patients you can't? Dennis and Ian go over a timely topic.
Jon does this for a living. Dennis discusses some more practical aspects of analgesia and sedation, such as how to assess for pain when your patient is unconscious. Jon also discusses the practicality using IV lidocaine in an austere environment. This is another podcast from the study discussed on IV lidocaine. http://www.oxfordjournals.org/podcasts/bjaed_intravenous_lidocaine_vol_16_issue_9.mp3
Sometimes our patients are too sick to recieve the care they need. Dennis and Mark discuss the decision points of who goes to surgery and when.
Dennis and the guys from the "Dustoff Medic podcast", discuss optimizing your patient for evacuation. We go over the common mistakes and some of the decision making processes of Load and go or Stay and Play whan it comes to the more invasive procedures.
Sometimes it's not an easy decision to turn around and go home. I talk with Dr. Moon, about taking care of a patient with AMS, HAPE, and or HACE in a PFC environment and when is it worth the consequences to evac the patient.
I discuss overventilation with Jeff. Should we be using a pediatric bvm?
Dennis and Doug break down the pretty complex issue of dealing with an AKI in the austere environment.
Dennis along with Doug and Justin discuss the latest PFC CPG on Sepsis Management in the austere environment.
Dennis discusses the acute abdomen with Ian and Tim, but ER docs working in some very remote locations.
Dennis discusses a recent trip to Antarctica with Ian and Tim.
Dennis and Scott discuss what to do after the life threats have been addressed and the healing begins.
Dennis talks with Mark on the importantce of nutrition in critically injuried patients.
Dennis and Dave deep dive into TBI and the various types of herniation. Hint...the most common is not the one we have been trained on.
Dennis talks with Josh and Jeremy about the Special Operations Medic Coalition, what they are doing for the community, and what's in store for the future.
Dennis and Mark discuss considerations in MSK trauma in a PFC environment.
This was a big one. Dennis, Evan, Ricky, and Brock all chimed in on the topic of SOF medics and the transition to civilian practice.
Dennis and David discuss when is the right time to use corticosteroids.
Dennis, Doug, and Jeremy discuss a new course by the Society of Critical Care that has a focus on the resource limited environment,
Dennis and Collin discuss the long overdue PFC Airway CPG.
Dennis nerds out with Justin and Ricky on calcium, clotting cascade, and RDCR.
In this podcast Sean goes over the new Austere COVID 19 Clinical Practice Guideline.
On this podcast Dennis and Mark talk about Resiliency and teamwork during Mark's time working in the ICU during the COVID 19 pandemic in New Jersey.
Sean and Dennis discuss considerations for confined space rescue.
https://www.snakebitefoundation.org/
Doug reviews a NEJM article on prolonged proning.
After a few discussions with JJ who has also appeared in several Element Rescue podcasts, Doug and Dennis talk about using evidence based medicine whenever possible and what to do when no prospective randomized controlled trials exist for a specific problem you face. With such a wide scope of practice while deployed and a lack of protocols SF medics are often faced with unique situations in which they must actually weigh the evidence, best practice, guidelines and expert consensus against the given situation. This is a great responsibility not entrusted to many other combat arms troops. In order to weigh the evidence you must first be aware it exists and how to interpret what you are reading. This will help get you on the right path in making informed decisions.
Not all PFC is trauma. Malaria, Dengue, Chikungunya and others will take you out of the fight if given the chance. In this episode CAPT Ryan Maves talks about some of the more concerning and prevalent diseases encountered by deployed military personnel and partner forces and what you can do about it before an infection becomes life threatening. . A few things to remember from the episode: History and assessment are key in identifying tropical diseases. Remember to consider both history of exposures as well as the accompanying syndromes in formulating a differential diagnoses. Malaria treatment consists of Malerone, Coartem or both. No one dies without Doxycycline!
Why do we care about sepsis in prolonged field care? What can we do about septic shock with what we are normally carrying on a deployment? How do you mix an epinephrine drip? Dr. Maves lays it all out in about 20 minutes.
So what is different than what we already have in the THOR recommendations, the JTS DCR clinical Practice Guideline and the Ranger Regiment TDCR? No hextend?! Calcium with the 1st unit of blood?! TXA slow push?! What if the patient is not responding to resuscitation efforts? This is a guideline truly written for the Medic working despite lack of help or resources in an austere environment...
When properly and safely administered regional anesthesia can augment your limited supply of narcotics and ketamine. It can also preserve your patient's mental status while providing targeted pain relief. This can be accomplished using a nerve stimulator and the techniques found in the Military Advanced Regional Anesthesia and Analgesia Handbook. If you have a portable ultrasound machine and a little practice you can also use the techniques found in the videos made available in by the New York School of Regional Anesthesia.
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