Prolonged Field Care Podcast Dennis

In this podcast episode, Dennis interviews Pete, a former Navy Special Warfare medic with experience in maritime operations. They discuss the unique challenges of providing medical care in a maritime environment, including the need for self-extraction and the difficulties of working on an unstable platform. Pete emphasizes the importance of realistic training and self-reliance in maritime medicine. They also touch on the training of Ukrainian forces and the misconceptions surrounding tourniquet use. Overall, the conversation highlights the need for constant adaptation and a focus on patient survivability in maritime medical operations.

Takeaways



Providing medical care in a maritime environment presents unique challenges, including the need for self-extraction and working on an unstable platform.

Realistic training and self-reliance are crucial in maritime medicine, as medical professionals must be prepared to adapt to the dynamic nature of the environment.

Training Ukrainian forces in medical skills requires expectation management and prioritizing the most essential knowledge and skills within a limited timeframe.

Misconceptions surrounding tourniquet use in Ukraine highlight the importance of proper training and understanding of when and how to apply tourniquets.

In maritime medical operations, constant adaptation and a focus on patient survivability are key to providing effective care.


Thank you to Delta Development Team for in part, sponsoring this podcast.
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For more content go to ⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠

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Ricky and Justin discuss their research on the administration of calcium in hemorrhagic shock. They explain how they became interested in the topic and the gaps they identified in current medical knowledge. They discuss the importance of calcium in the clotting cascade and the potential role of citrate in contributing to hypocalcemia. They also explain the protocol for administering calcium in the field and the different forms of calcium that can be used. They discuss the risks of overcorrection of hypocalcemia and the need for further research on the topic. Overall, their research aims to improve patient outcomes and reduce mortality in hemorrhagic shock.

Takeaways



Calcium plays a crucial role in the clotting cascade and may be important in the treatment of hemorrhagic shock.

Hypocalcemia is common in trauma patients and may contribute to increased mortality.

The administration of calcium, along with blood products, can help prevent hypocalcemia and improve patient outcomes.

The protocol for administering calcium in the field includes giving one gram upfront and one gram every four units of threshold blood.

There is a risk of overcorrection of hypocalcemia, which can lead to hypercalcemia and increased mortality.

Further research is needed to determine the optimal timing and dosage of calcium administration in hemorrhagic shock.


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

For more content go to ⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠

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Consider supporting us: ⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠ or ⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In this podcast episode, Dennis interviews Steve Schauer about his calcium study in trauma patients. Steve provides an introduction to himself and his background in emergency medicine and research. He explains that the study aims to determine the prevalence of calcium derangement in trauma patients upon arrival at the trauma center. The study is being conducted at three different trauma centers and has completed enrollment. Steve also discusses the challenges of extrapolating research findings from military trauma to civilian trauma. They also touch on the limitations of the Injury Severity Score (ISS) in assessing military trauma. The conversation then delves into the logistics of the study, including the collection of calcium levels and the potential impact of pre-hospital blood transfusions on calcium levels. They discuss the importance of timing and accuracy in collecting calcium levels and the need for better documentation in trauma care. They also explore the administration of calcium and the differences between calcium gluconate and calcium chloride. Steve emphasizes the importance of administering calcium slowly to avoid adverse effects. They also discuss the timing of calcium administration in relation to blood transfusions and the challenges of determining the optimal calcium levels in trauma patients. The episode concludes with a discussion on the need for iStat machines in trauma centers to monitor calcium levels in real-time. In this conversation, Dennis and Steven Schauer discuss the administration of calcium in trauma patients. They explore the role of calcium in the coagulation cascade and its potential benefits in improving hemodynamics. They also discuss the challenges of administering calcium in the field and the need for further research to determine its efficacy. The conversation highlights the importance of prioritizing blood and tranexamic acid (TXA) administration before considering calcium. Overall, the conversation provides valuable insights into the use of calcium in trauma care.



Takeaways

The study aims to determine the prevalence of calcium derangement in trauma patients upon arrival at the trauma center.

Extrapolating research findings from military trauma to civilian trauma poses challenges due to differences in injury mechanisms.

The Injury Severity Score (ISS) has limitations in assessing military trauma.

Timing and accuracy are crucial in collecting calcium levels in trauma patients.

Calcium administration should be done slowly to avoid adverse effects.

Determining the optimal calcium levels in trauma patients is challenging.

iStat machines can be valuable in monitoring calcium levels in real-time. Calcium is a cofactor in the coagulation cascade and may play a role in improving hemodynamics in trauma patients.

The administration of calcium should be prioritized after blood and tranexamic acid (TXA) in trauma care.

The optimal method of calcium administration, such as infusion plus drip, is still under investigation.

Further research is needed to determine the efficacy of calcium in trauma care.

The availability of resources and logistics may influence the choice of calcium formulation for administration.




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 episode, Jim discusses the importance of adapting to the changing world and the need to prioritize the well-being of soldiers. He emphasizes the need for commanders and medical providers to understand the risks and challenges faced by the national treasure, the sons and daughters of the nation. Jim highlights the changing nature of warfare and the need to adapt to austere and rapidly evolving environments. He also discusses the importance of whole-of-government approaches and the need for joint, inter-organizational, and multinational collaboration. Jim encourages listeners to develop adaptive thinking and to be prepared to win in a complex world.



Takeaways

The well-being of soldiers should be the top priority for commanders and medical providers

Adapting to the changing world and the challenges of warfare is crucial

Whole-of-government approaches and collaboration are essential for success

Developing adaptive thinking and being prepared to win in a complex world is 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 or www.lobocoffeeco.com/product-page/prolonged-field-care

In this podcast episode, Dennis interviews Alex McDonald, a medical student and member of Tactical Medicine New Zealand, about the republishing of the book 'Guerilla Surgeon.' The book tells the story of Dr. Lindsay Rogers, a New Zealand-born surgeon who served with the Special Operations Executive in Yugoslavia during World War II. The conversation covers topics such as the challenges of providing medical care in resource-limited environments, building trust with local forces, and the importance of cultural competency. Alex also discusses the mission of Tactical Medicine New Zealand and their partnership with the Special Operations Medical Association (SOMA) to republish the book.

Takeaways



The book 'Guerilla Surgeon' tells the story of Dr. Lindsay Rogers, a New Zealand-born surgeon who served with the Special Operations Executive in Yugoslavia during World War II.

Providing medical care in resource-limited environments requires improvisation and making the most of available resources.

Building trust with local forces is crucial for successful medical operations in foreign nations.

Cultural competency is important for effective communication and collaboration with partner forces.

Tactical Medicine New Zealand aims to promote and advance tactical medicine in New Zealand and has partnered with SOMA to republish 'Guerilla Surgeon.'


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

Dr. Van Wyk discusses updates in traumatic brain injury (TBI) management, focusing on the CRASH 3 trial and the use of tranexamic acid (TXA). He explains that TXA is safe and reduces head injury-related death, particularly in patients with moderate and mild TBI. He also discusses the use of hypertonic saline and recommends considering higher concentrations, such as 23.4%, which have been shown to be safe and effective. Dr. Van Wyk mentions the use of sodium bicarbonate as an alternative and emphasizes the importance of clinical judgment in determining the appropriate treatment. He also discusses monitoring options for cerebral edema and increased intracranial pressure, such as optic nerve sheath diameter measurements. Finally, he touches on the topic of decompressive hemicraniectomy and the considerations for performing this procedure in austere environments.



Takeaways



Tranexamic acid (TXA) is safe and reduces head injury-related death in patients with moderate and mild traumatic brain injury (TBI).

Higher concentrations of hypertonic saline, such as 23.4%, may be considered as they have been shown to be safe and effective.

Sodium bicarbonate can be used as an alternative to hypertonic saline, particularly in austere environments.

Optic nerve sheath diameter measurements can be used to monitor cerebral edema and increased intracranial pressure.

Decompressive hemicraniectomy may be considered in severe TBI cases, and general surgeons may be trained to perform the procedure in the absence of a neurosurgeon.


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