Prolonged Field Care Podcast

Dennis
  • 4.9 (65)
  • Education

Become a Paid Subscriber: https://creators.spotify.com/pod/show/dennis3211/subscribe This podcast and website is dedicated to the healthcare professional who needs to provide high quality care in a very austere location. For more content: www.prolongedfieldcare.org Consider supporting us on: patreon.com/ProlongedFieldCareCollective

  1. 7h ago

    301: MARCH Works - Wound Care and TBI are NEXT Layer

    Stacey Shackelford retired from the Air Force after serving as Joint Trauma System chief and trauma medical director in Colorado Springs. She now works at the Center for Combat Medicine at the University of Colorado. Dennis brings her on to walk through the 2021 case-control analysis of prehospital death and prolonged field care survival from U.S. combat operations between 2007 and 2015. The study pulled patients with documented prehospital care lasting four to seventy-two hours and an AIS of two or greater. Roughly 3,200 casualties met the criteria out of a larger pool where only about 20% had any prehospital documentation. Average time from injury to evacuation was seven hours. Ninety percent of deaths occurred before the four-hour mark. The most common interventions among those with documentation were advanced airway (about a quarter), mechanical ventilation (about 18%), and tourniquets (about 9%). Blood transfusion in the first 24 hours occurred in roughly a quarter of the cohort; prehospital transfusion capability itself was still very limited during those years. The conversation then turns to what still holds and what needs to move forward. MARCH remains the foundation. Wound care for contaminated injuries within about six hours and tourniquet conversion become higher priorities once patients survive the first hours. TBI is expected to stay common; the practical steps are a real GCS, head elevation, ETCO2 control, and limited hypertonic saline. Training is the remaining gap. Prolonged care is largely hospital care done in the field. PFC Podcast · prolongedfieldcare.org · @prolonged_field_care Takeaways Most deaths still happen early. In the 2007–2015 cohort, 90% of deaths occurred before four hours. Average prehospital time among those who reached four to seventy-two hours was seven hours.Documentation was the bottleneck. Only about 20% of the larger trauma registry cohort had usable prehospital records. The study could only analyze the documented cases.The top interventions matched the basics. Advanced airway, mechanical ventilation, and tourniquets were the most common. Blood in the first 24 hours mattered, but prehospital transfusion capability was still rare during the study window.MARCH still applies; the next layer is wound care and TBI. Contaminated wounds need advanced care within about six hours. TBI management requires a real GCS, head elevation, ETCO2 35–40, and limited hypertonic saline.Clinical exposure is the training gap. Prolonged field care is hospital care moved forward. Mannequin time is not enough. Use the nursing CPG appendix procedure list so hospital proctors know what medics actually need to practice.Chapters 00:00 Welcome and Stacey’s background (JTS, trauma medical director)01:01 The 2021 case-control study (2007–2015 data)02:41 Why prolonged field care was uncommon in GWOT yet still present in the registry02:50 Inclusion criteria: 4–72 hours prehospital, AIS ≥2, documented care03:21 Average time to evacuation: seven hours04:02 Cohort size: ~3,200 cases from a larger pool with only ~20% documentation06:32 What actually mattered: airway, ventilation, tourniquets07:43 Limited prehospital transfusion capability during the study years08:29 Blood within the first 24 hours09:14 90% of deaths before four hours; survivors may be less severely injured10:26 MARCH still the foundation going forward11:05 Drone and blast patterns versus IED patterns12:43 What happens after the first seven hours13:15 Wound care for contaminated injuries within about six hours13:47 Tourniquet conversion and longer-duration consequences37:16 Limb salvage considerations (pulse, sensation, motor)38:34 TBI assessment and management40:09 GCS ≤8 as severe TBI; head elevation and ETCO2 targets41:46 Hypertonic saline limits without labs45:18 Final thoughts: master the basics, more clinical exposure48:41 Nursing CPG appendix procedure list for hospital rotations

    301: MARCH Works - Wound Care and TBI are NEXT Layer

  2. 4d ago

    Neck Junctional Injuries: Zones, Pressure, and Placement

    Max and Dennis walk through neck and upper-chest junctional injuries, the pattern he expects more of with top-down penetrating trauma. The neck is divided into three zones for a reason. Zone 1 (sternal notch to cricoid) raises immediate concern for chest involvement and the need for sternotomy or similar exposure. Zone 2 (cricoid to the angle of the jaw) is the most accessible surgically; the anterior border of the sternocleidomastoid is the landmark for the trail of safety. Zone 3 (angle of the jaw to the base of the skull) is difficult to control because vessels dive into the skull and space for packing is limited. The subclavian and axillary vessels run deep under the clavicle toward the deltopectoral groove; proximal control is not quick. Prehospital priorities stay simple and sequential. Get a third person whose only job is to hold pressure or pack with a finger. Protect the airway early, because hematoma can compromise it and force a cycle of pressure and release. Once the airway is secure, reassess whether external pressure is effective. If the hole is small and bleeding is not massive, a whip stitch may buy time. If pressure is failing and the hematoma is large, the wound may need to be enlarged for packing. The Kentucky Ballistics video is used as an open-source example of effective finger packing in a zone-1 injury that held long enough to reach the operating room. PFC Podcast · prolongedfieldcare.org · @prolonged_field_care Takeaways Neck and upper-chest junctional injuries are harder to control than groin injuries. Anatomy is tighter, vessels are deeper, and proximal control is not a quick maneuver.Know the three zones. Zone 1 (sternal notch to cricoid) implies possible chest involvement. Zone 2 is the most accessible. Zone 3 dives into the skull and is difficult to pack.The landmark is the anterior border of the sternocleidomastoid. Medial is safer for airway work. Lateral is where the major vessels and nerves run.Use a three-person battle drill. One person is the finger (pressure or packing). The medic secures the airway, then addresses access, blood, and chest tube as needed.Airway comes early. Expanding hematoma can obstruct the airway. Get it before you are forced into cycles of pressure and release. The Kentucky Ballistics case shows effective finger packing can hold a zone-1 injury long enough for surgical control. Chapters 00:00 Welcome and introduction to Max00:51 Top-down penetrating trauma and neck/upper-chest injuries01:20 Anatomy of the small corridor between shoulder and head03:25 Neck zones overview03:55 Zone 1: sternal notch to cricoid; chest involvement concern05:31 Zone 2: cricoid to angle of jaw; trail of safety and SCM08:49 Zone 3: angle of jaw to base of skull; control challenges10:12 Subclavian and axillary vessels; deltopectoral groove59:46 Three-man battle drill: patient, medic, and the finger01:00:05 Sequence: pressure first, then airway, then access and blood01:02:27 Decision to whip-stitch versus enlarge for packing01:03:45 Blunt trauma, hematoma, and airway compromise01:07:48 Kentucky Ballistics video as a zone-1 finger-packing example01:09:02 Father places patient’s finger into the wound and holds01:11:04 Hospital transition: packing swap and immediate airway

    Neck Junctional Injuries: Zones, Pressure, and Placement

  3. Oct 26

    300: What Are We Missing? SOF Medics on Veteran Suicide

    17.7 veterans die by suicide every single day. Almost everyone listening knows someone. Episode 300 of the PFC Podcast puts three retired special operations medics in the room to talk about why the people who looked fine still did it, and what the rest of us can actually do. Justin is a retired Special Forces medic who went back to school and now practices as a clinical social worker. Mike spent just under 27 years as a special operations medic and has been a contractor at the special operations medical training facility on Fort Bragg for more than a decade. Rick Hines is a retired Special Forces medic with 29 years in the Army who has taught at the Joint Special Operations Medical Training Center for the last ten. They start with the impossible question. Desperate thoughts are common when someone is in a bad stretch — PTSD, depression, a life that just blew up, even a bad flu. Having the thought is not the same as having a plan. The job is to stay calm, ask directly if you can ask, and not spiral the person further by panicking. Practical moves that come up repeatedly: stop the drinking for the time being, and reduce access to lethal means while the crisis is hot. Those two things are fast and high-yield. This is not a clinical protocol. It is four people who have lost people trying to be useful to the next person who notices something. PFC Podcast · ⁠prolongedfieldcare.org⁠ · @prolonged_field_care Takeaways Ask the direct question if you have the relationship to ask it. “Are you thinking about killing yourself?” is not a trick. It has to come from someone the person trusts, and it has to be followed by staying, not by panic. Desperate thoughts are common in a bad stretch. PTSD, depression, a collapsed life, or even severe illness can produce them. Normalize the conversation without minimizing it. Do not tell someone other people have had it worse. Two fast moves: stop the alcohol and reduce access to lethal means. Both are high-yield while the person is in crisis. Functional does not mean fine. The answer “I’m good” does not clear the person. Keep an index of suspicion when life has just blown up. Watch sleep, isolation, and the period right after a hospital discharge — that window is high-risk and the team has to stay close. Match the help to the tribe when you can. Generic civilian programs can feel wrong to operators. Aftercare is a road, not an urgent-care visit. Chapters 00:21 Justin, Mike, and Rick introduce themselves 02:08 The VA statistic and the impossible question 05:04 Rethinking Suicide by Dr. Craig Bryan and the STRIVE program 06:29 Should you just ask the direct question? 07:08 Desperate thoughts, burden, and not making it worse 10:09 Stop the drinking. Then talk about lethal means. 11:09 Trust and keeping an index of suspicion 12:10 How to bring it up when life is falling apart 14:02 Recognizing the vulnerable person matters more than a perfect answer 16:09 Ask other questions first 20:03 Sleep and why short-acting sleep meds can backfire 28:03 A personal loss and the guilt that follows 32:06 Stabilizing someone who is still unstable 36:07 How the narrative gets used by other people 40:09 You do not have to smile. You do have to continue. 44:01 Did I do what I could do? 48:00 It is still another human being 52:01 Other causes of death that sit next to this one 56:01 First responders and the same stressors 01:00:04 Teammates calling it when someone is off 01:04:03 Sleep, alcohol, and thinking more clearly 01:06:19 What counts as problem drinking in this culture 01:08:04 Programs built for the tribe, and the authorization problem 01:10:02 Post-hospitalization risk and hunkering down 01:10:50 Defining problem drinking when the person still functions 01:12:19 Binge patterns that do not fit civilian models 01:15:35 Resources: 988, crisis lines, Military OneSource 01:18:20 Military OneSource stays off command radar unless harm is discussed

    300: What Are We Missing? SOF Medics on Veteran Suicide

  4. Oct 22

    When does Nursing Care start?

    Kevin is a nurse anesthetist with more than a decade of bedside nursing. Dennis brings him on to talk about the part of prolonged field care that the CPG describes but does not time: nursing care. The conversation starts with a practical definition. Life-saving interventions finish, and the patient is stabilized. That is when nursing begins. In a hospital, this is the handoff to the floor, PACU, or ICU. In the field, it is the moment after the tourniquet is converted, the amputation is complete, or the chest tube is in, and you are no longer chasing the next immediate threat. From there, Kevin walks through what nurses actually do: continuous assessment and vital signs, documentation that keeps the provider from flying blind, pulmonary toileting, turning, skin care, dressing changes, medication administration, and monitoring every tube and line that has been placed. All of it is time-consuming. Training advice is blunt. Mannequins do not show you the standard. Weekend ICU shifts do. You need to know what right looks like before the field degrades it. Evacuation remains the primary plan. Prolonged field care is the emergency option in the PACE plan, not the default. Kevin points to Desperate Surgery in the South Pacific and the simple observation that every platform that brought troops forward also brought them back. History already solved versions of the time problem. The risk is treating patients as expectant who are not, then letting the absence of basic nursing care finish them before they reach a surgeon. PFC Podcast · prolongedfieldcare.org · @prolonged_field_care Takeaways Nursing starts when life-saving stops. Once the patient is stabilized and you are no longer performing immediate interventions, nursing care begins. That is the practical handoff point in the field.Data gathering is the foundation. Assessment, vital signs, neuro checks, and documentation of every tube, dressing, and intervention are what let a provider manage the patient. Without it the provider is blind.The majority of prolonged field care is nursing. Turning, pulmonary toileting, skin care, dressing changes, medication administration, and line care are the work. They are also the first things dropped when patient numbers rise.Train against a known standard. Weekend ICU shifts show you what right looks like. Mannequins do not. You will degrade in the field; you need to know what you are degrading from.Evacuation is still the primary plan. Treat prolonged field care as the E in the PACE plan. History (South Pacific, WWII) already solved versions of the time problem. Do not label patients expectant and withhold basic nursing care unless the injury is clearly unsurvivable. Chapters 02:10 When does prolonged field care nursing start?03:59 After life-saving interventions: the handoff point04:29 What nurses actually do: assessment and data gathering06:47 Interventions: turning, pulmonary toileting, skin care, lines07:30 How to train it: know the standard before the field degrades it08:17 Weekend ICU shifts beat mannequins10:48 Prioritizing when you are solo12:00 Assessment frequency and catching change early24:00 Sedation, movement, and the unstable patient28:00 IV and line care in the field32:00 Cleaning and dressing sites with limited supplies40:00 Calling the provider and the cost of interruptions44:00 Perfusion and the trauma patient54:40 Evacuation as the P in the PACE plan55:08 The time math: one ICU nurse versus twenty patients57:00 Prolonged field care as the emergency option58:20 GWOT spoiled us on rapid evacuation59:12 Desperate Surgery in the South Pacific01:00:01 How they moved casualties without air superiority01:02:35 Expectant category and not withholding nursing care01:04:15 Low-titer whole blood and learning from history

    When does Nursing Care start?

  5. Oct 19

    299 - TCCC Analgesia: After the Opioids Left

    We covered the new analgesia guidelines from TCCC, now lets talk about how to get it done. Ryan Knight — emergency physician and Deep, Army anesthesiologist now at UNC, walk the new battlefield analgesia list. Ryan’s views are his. Not the committee’s What is on the card: acetaminophen, meloxicam, suzetrigine, ketamine, S-ketamine. Can you treat a combat wound with that? Both say yes — because ketamine is versatile and APAP plus a COX-2 actually work on traumatic pain. Suzetrigine is the unknown. Published data is bunionectomies and abdominoplasties. Onset is about two hours. Nobody in this room has used it on the X. Ketamine is the bridge. Dennis asks the medic question: ketamine is almost harmless, so why not just repeat 25 mg IV or 100 mg IM until the pain stops? Deep’s answer is toxicology. The dose makes the toxin. Escalate and you lose the airway reflexes that made ketamine feel safe. Secretions plus an irritant is the laryngospasm pathway. Ketamine is a direct myocardial depressant; catechol-depleted, bleeding, hypoxic patients do not get the usual bump. Shock liver and hypothermia mean you metabolize less and clear norketamine slower — same milligrams, longer and harder effect. A stable high-pain patient may need stacked doses. A wrecked one may need 5–10 mg at a time. Guidelines try to arm you at the edge of your skill and still survive a draw-up error. Training reps and real clinical time build better guardrails than a thinner formulary. Top 5 takeaways You can run analgesia on the new card — ketamine does the real work. APAP + a COX-2 cover some traumatic pain. Suzetrigine is unproven in combat and slow (~2 hours, elective-surgery data). Do not plan the first 30 minutes around it.Ketamine is not a free refill. 25 mg IV / 100 mg IM is a start. Stacking in a stable, high-pain patient is expected. The same printed dose in hemorrhage, hypoxia, hypothermia, or shock lasts longer and hits harder.High-dose ketamine loses the features that made it “safe.” Airway reflexes blunt. Secretions rise. Laryngospasm is uncommon, not imaginary. Direct myocardial depression shows up when catechol reserve is gone. Dysphoria used to have midazolam. That tool is off the guideline.Opioids left more because of the market than a vote. OTFC and Dsuvia/sufentanil products went away. A lozenge is hard to 4×. A syringe is not. They remain the literature’s breakthrough-pain standard. Acute addiction is the director’s problem; respiratory depression is the medic’s.Best care and safest care are both the job. Directors backstop with logistics (1 mg vs 5 mg hydromorphone) and fight for calendar time. Senior medics own reps. Deep: high-fidelity / real clinical time builds better guardrails than a protocol written by people who no longer push the drug.Chapters 01:59 New analgesia card: suzetrigine, S-ketamine, more removed than added02:46 Can you treat a combat wound with APAP, meloxicam, suzetrigine, ketamine, S-ketamine?03:38 Suzetrigine: bunion/abdominoplasty data, ~2-hour onset04:10 Deep: untested drugs, ketamine side-effect kit, midazolam gone05:13 Opioids as context-specific adjunct, one-iteration concern06:06 French prehospital RCT — ketamine non-inferior to morphine, less nausea09:15 Stable high-pain vs bleeding/hypoxic — same printed dose, different patient11:04 Norketamine, shock liver, hypothermia — same milligrams, longer hit12:04 Ryan: the catastrophic effects are rare — context still matters44:11 Breakthrough pain in the literature is still an opioid45:18 Is addiction the medic’s problem on the X?47:14 Side effects and hemodynamics, not just addiction47:38 The market removed OTFC and Dsuvia49:34 Are guidelines best care or safest care?51:06 Ryan as 75th / XVIII Airborne medical director — arm them, backstop the mistake53:21 Training reps beyond Table VIII / SOCM / 18D refreshers54:33 Deep: guardrails come from training and real clinical time

    299 - TCCC Analgesia: After the Opioids Left

  6. Oct 15

    SOMA '26 - Lessons Learned: Humanitarian Field Hospitals in Syria and Gaza

    Recorded live at SOMA 26 Dr. Sam, an orthopedic and surgical oncologist, shares hard-won lessons from humanitarian deployments in Syria, Ukraine, and Gaza. Operating in underground basements under airstrikes, he describes mass-casualty events that overwhelm capacity (hundreds arriving at once, patients dying on the doorstep), the deliberate targeting of marked hospitals and medical personnel, and the practical realities of war surgery when blood, space, evacuation, and supplies are exhausted. Core messages include leaving high-energy extremity wounds open, the decisive role of blood logistics over pure surgical skill, the impossibility of saving everyone in true MASCALs, and the long-term weight of moral injury for both patients and providers. Sponsored by the Special Operations Medical Association. Takeaways Marked medical facilities and personnel are targets. Hospitals in Syria were driven underground; killing a medic or destroying an ambulance removes a community’s capacity for hope and future care.Leave war wounds open. High-energy blast and missile injuries continue to declare dead muscle for days; closing too early traps infection. Wait for a cleaner environment before definitive closure.Logistics (especially blood) save more lives than technical skill alone. Arbitrary quotas, unreliable cold chains, and no ability to escalate care render even correct triage useless.True MASCALs (dozens to a hundred patients) force binary decisions: choosing one patient means another dies. You cannot save everyone; the goal is to train so you do it wrong less often.War surgery is technically straightforward (debridement, amputation, fasciotomy, crash thoracotomy) but operationally and psychologically extreme: hostile environment, no gloves/gowns/evacuation, 20-hour days, and constant moral injury.Psychological resilience has no universal protocol. Many providers function while deployed and struggle afterward; moral injury (watching children die, body-bagging patients in cartoon pajamas, colleagues losing entire families) requires deliberate preparation and recovery. Chapters 00:00 – Introduction and controlled vs. humanitarian environments01:50 – Purpose of the talk: war does not discriminate02:30 – Medical facilities as targets (Syria, Ukraine, Gaza)04:00 – Underground hospitals and mass-casualty realities in East Aleppo06:40 – War surgery is technically simple; the environment and psychology make it hard07:10 – Leave war wounds open: case progression and rationale08:30 – You cannot save everyone: triage under extreme resource limits09:10 – Chaos of body bags and declaring the dead10:00 – Blood protocols, logistics, and the limits of escalation20:50 – Case examples: blood quotas, open fractures, and failed resuscitations22:00 – Moral injury in the OR and among local staff23:00 – Starvation, maggots, compartment syndrome, and unhealable psychic scars24:30 – Providers as casualties: double-taps and personal losses25:20 – Scenes from Gaza: resource decisions and morgue realities27:20 – Final take-home points and psychological resilience29:00 – Why the work matters and closing remarks Listen / follow: podcast → prolongedfieldcare.org → @prolonged_field_care

    SOMA '26 - Lessons Learned: Humanitarian Field Hospitals in Syria and Gaza

  7. Oct 12

    -40 Changes MARCH: Arctic TCCC

    A healthy person lying in the snow at -30 or -40 dies of hypothermia. Add a gunshot wound, wet clothes, and twenty minutes on the X while the team finishes the fight, and the cold competes with the bleeding. Thomas spent nine years as a Danish Special Forces operator and medic. His view is that TCCC still applies, but the sequence does not survive contact with that climate unchanged. Stripping a chest or abdomen to “do MARCH” on the snow makes the patient colder, more coagulopathic, and more acidotic. Massive hemorrhage still gets a tourniquet, over the clothing, because it is fast. Airway obstruction gets a roll to prone. Everything else waits for a semi-controlled heated shelter. That shelter is not a rock. It is a tent, a stove, and enough security to put both up. Clothing changes the tools. A CAT may not reach a thigh under five layers. Mittens make the windlass clumsy, and taking them off at these temperatures is a frostbite problem in minutes. Train with the gloves you will wear. Inside the tent, two multi-fuel burners on a stable platform, a vapor barrier, and active heat come before a full secondary survey. Drugs he keeps close: ketamine, morphine, prefilled syringes rather than ampules, and an IV antibiotic. Plastic IV bags leak and contaminate when they thaw. Crystalloid and albumin in glass survive better. Blood products are still plastic. Freeze-dried plasma can work, but it needs fluid and time. PFC Podcast · prolongedfieldcare.org · @prolonged_field_care Takeaways Hypothermia is a whole-team threat, and it outruns a lot of procedures. At these temperatures a down patient, especially a bleeding one, does not have a normal MARCH window on open snow.Tourniquet over the clothing. Then get to heat. Do not strip chest or abdomen on the X. Airway obstruction gets prone positioning. Tactical field care starts in a heated, semi-controlled shelter, not behind a rock.Gloves stay on. Test the tourniquet on the real clothing. Layer bulk can force a second tourniquet. Bare hands at minus forty are a frostbite injury in minutes. Practice the application you will actually do.Cold kills the kit. Batteries die. Plastic IV bags leak when they thaw. Prefer glass vials and glass crystalloid. Freeze-dried plasma is possible if you have fluid and minutes. Prefilled syringes beat ampules with numb fingers.The first shelter is a planning problem, not a terrain feature. You need time and security to pitch a tent and light a stove. Ten minutes down at minus twenty-five was enough to drop consciousness in a non-trauma patient. Wool, a stove you can start in mittens, and a tent you can pitch fast are medical equipment.Chapters 00:19 Thomas — Danish SOF medic, anesthesiologist, Brightbird, Greenland03:03 How extreme cold changes TCCC06:08 Hypothermia plus injury, frozen fluids, dead batteries06:43 Treatment on the snow makes him colder, coagulopathic, acidotic07:55 Hypothermia is patient care and a team threat08:16 Tactical field care waits for a heated shelter08:48 MARCH on the X: hemorrhage first, clothing in the way12:03 Do not start full MARCH until the environment is semi-controlled14:01 Tourniquet over the clothing, prone if the airway is obstructed22:00 Vapor barrier first, stop further heat loss24:00 Tent up, stove running, then the secondary work28:00 Warming drugs against the body32:00 Cold drugs and product degradation36:00 What cold does to the kit outside37:27 Ketamine, morphine, prefilled syringes, IV antibiotics38:11 Plastic IV bags leak on thaw. Glass crystalloid. Blood is still plastic.38:46 Freeze-dried plasma: possible, needs fluid and time39:26 How far to the first shelter41:21 A tent needs security. Thirty minutes is already long.43:07 Greenland expedition: ten minutes down, consciousness dropping, no new injury45:39 Wool, tested gear, stoves you can light in gloves49:11 Warm at all costs. Hemorrhage because it is fast.49:38 Afghanistan heat versus minus forty

    -40 Changes MARCH: Arctic TCCC

  8. Oct 5

    When is When: Withdrawing Interventions in PFC

    Medics add interventions easily. Prolonged field care is where those interventions start charging rent. Dave walks the unwind. A cut endotracheal tube used as a cric can come out if the patient no longer needs it. Unhook the bag. Moving air through the tube, following commands, and a normal breathing pattern are good signs. Cuff down: if he cannot breathe around it, edema or a flap may be waiting, and pulling can lose the airway. Suction above the cuff first. Dress the site after. Do not pull the bookmark on a partial responder still in shock just to save narcotic. Uncomfortable and awake beats a lost airway. Chest-tube logic is the same. Serous output and stable oxygen are a pull conversation. Blood, pus, or a leak plus climbing crepitus means the tube stays. Heimlich is enough for many. Suction, if used, is about 20 cm of water — a straw, not wall suction. No underwater seal is a sucking chest wound you created. A chest wall you cannot seal is bagged. A prophylactic fasciotomy without wound-care capacity can bleed and fluid-shift the patient you were trying to save. PFC Podcast · prolongedfieldcare.org · @prolonged_field_care Takeaways A cric can come out if the patient no longer needs it. Positive pressure off, breathing through the tube, follows commands, normal pattern, cuff down and air moving around the tube. Fail that last test and you may be looking at edema or a flap.Suction before you drop the cuff. Dress after you pull. Whatever is sitting on the balloon goes into the lungs. Occlude the site for cough and speech. If he obstructs again, adjuncts first, then back in.Do not trade the airway bookmark for narcotic savings in a partial responder. Shock patients who drop their GCS after you pull are a different problem than the isolated femur you over-sedated. Uncomfortable and awake beats lost airway.Chest tube suction is 20 cm of water, not wall suction. Heimlich is enough for many. Serous and stable oxygen is a pull conversation. Blood, pus, or a kazoo plus climbing crepitus means the tube stays. No seal equals a sucking chest wound you created.Some interventions you should not start if you cannot finish them. An unsealable chest wall is bagged, not endlessly patched. A continuous leak with crepitus is surgical. A prophylactic fasciotomy without wound-care capacity can bleed and fluid-shift a patient you were trying to save. Chapters 01:17 Adding interventions is easy. Unwinding them is the PFC problem.02:17 The oversedated femur: ketamine, narcotic, snoring, cric03:46 Same patient in a trauma bay — RSI, then do they still need the tube?05:19 Yes, you can pull a cric — if the airway is not the problem you are about to recreate06:29 Off the bag, follows commands, breathing pattern07:10 Cuff down: can he breathe around it?09:01 Suction above the cuff before you deflate09:42 Ketamine no-man’s-land between analgesia and sedation10:41 Fentanyl for the cuff, not another snow14:05 If the airway is quiet, leave it until everything else is mitigated14:16 Do not pull the bookmark in a partial responder28:07 What is coming out — serous vs blood vs pus28:30 Empyema tubes that stay for months28:33 Air leak on a Heimlich: kazoo is fine, crepitus is not29:02 SpO2, mental status, oxygen need before a pull29:37 Heimlich vs three-bottle suction30:51 Improvised single-bottle underwater seal31:16 No seal, and you just made a sucking chest wound33:34 Chest wall you cannot seal: positive pressure, or a cric35:41 Finger thor converts tension to open. The tube is a valve and a measuring cup.37:36 Continuous air leak and climbing crepitus — second tube, surgical problem39:25 Sudden crepitus with an advanced airway: dislodged cric vs tracheobronchial injury42:11 Fasciotomy: indication vs the wound you cannot dress

    When is When: Withdrawing Interventions in PFC
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Become a Paid Subscriber: https://creators.spotify.com/pod/show/dennis3211/subscribe This podcast and website is dedicated to the healthcare professional who needs to provide high quality care in a very austere location. For more content: www.prolongedfieldcare.org Consider supporting us on: patreon.com/ProlongedFieldCareCollective

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