Prolonged Field Care Podcast Dennis

In this conversation, Dennis and Doug discuss crush syndrome and the challenges it presents in dynamic environments such as natural disasters or man-made incidents. They emphasize the importance of scene safety and the need to assess and stabilize any other traumatic injuries before addressing crush syndrome. They also discuss the use of tourniquets and the potential risks and benefits associated with their application. The conversation covers the management of crush syndrome, including fluid resuscitation, monitoring for cardiac complications, and the use of calcium and sodium bicarbonate. They highlight the need for a comprehensive approach to diagnosis and treatment, considering factors such as time of response and the presence of other injuries. In this conversation, Dennis and Doug discuss the management of crush syndrome in a resource-limited setting. They cover topics such as tourniquet use, fluid resuscitation, potassium management, and the use of sodium bicarbonate. They also touch on wound management and the importance of antibiotics. The conversation concludes with a discussion on the use of insulin and dextrose, as well as albuterol, in managing cardiac instability. Overall, the conversation provides a comprehensive overview of the management of crush syndrome in a challenging environment.

Takeaways

Scene safety is paramount in crush syndrome situations, and rescuers should be aware of potential hazards such as secondary devices, unstable structures, and chemical releases.

Assessing and stabilizing any other traumatic injuries is crucial before addressing crush syndrome.

The use of tourniquets in crush syndrome is a topic of debate, and a protocol should be in place to reassess their necessity and remove them as soon as possible.

Fluid resuscitation is important in managing crush syndrome, and the amount and rate of fluid administration should be based on the patient's condition and available resources.

Monitoring for cardiac complications, such as arrhythmias and acidosis, is essential, and interventions such as calcium and sodium bicarbonate may be necessary.

A comprehensive approach to diagnosis and treatment is necessary, considering factors such as time of response and the presence of other injuries. Tourniquets can be used to manage crush syndrome in the lower extremities, but there is a risk of unnecessary amputations.

Fluid resuscitation is important in stabilizing the patient and increasing urine output.

Sodium bicarbonate can be used to manage metabolic acidosis and improve the effectiveness of vasopressors.

Calcium can be given to stabilize cardiac rhythm, and insulin and dextrose can be used to manage high potassium levels.

Albuterol can be used to treat respiratory acidosis, but it may be challenging to administer in a resource-limited setting.




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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In this episode of the Prolonged Fuel Care Podcast, Dr. Ben Abo and Jordan Benjamin discuss snake envenomation. They debunk common myths about snakebite treatment, such as using tourniquets, extractors, ice, or cutting into the wound. They emphasize the importance of preparing for deployment in snake-infested areas by researching the local hazards and having the appropriate equipment. They provide a standardized snake bite assessment method, which involves a bottom-up top-down approach to identify the type of venom and the severity of the envenomation. They also discuss the decision-making process for airway management and the use of antivenom. The solution to snakebite envenomation is early and appropriate treatment with antivenom. It is important to irrigate the bite site and dilute the venom as quickly as possible. The use of tourniquets is not recommended, and if one is already applied, it should be slowly released. Pain management is crucial, and opioids and ketamine are effective options. Monitoring the progression of symptoms is more important than assigning a grade to the envenomation. Early intervention and proper training in snakebite management can lead to better outcomes.

Takeaways



Do not use tourniquets, extractors, ice, or cutting into the wound for snakebite treatment.

Research the local hazards and have the appropriate equipment when deploying to snake-infested areas.

Use a standardized snake bite assessment method to identify the type of venom and the severity of the envenomation.

Make decisions about airway management based on the patient's symptoms and use tools like capnography and pulse oximetry.

Antivenom is the key treatment for snake envenomation, and there are no absolute contraindications to its administration. The solution to snakebite envenomation is early and appropriate treatment with antivenom

Irrigate the bite site and dilute the venom as quickly as possible

Avoid using tourniquets, but if one is already applied, slowly release it

Pain management is crucial, and opioids and ketamine are effective options

Monitor the progression of symptoms rather than assigning a grade to the envenomation

Early intervention and proper training in snakebite management can lead to better outcomes



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 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.
⁠⁠⁠⁠⁠⁠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

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