Prolonged Field Care Podcast Dennis

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

Summary:

In this conversation, Dennis and Ian discuss the new high altitude Clinical Practice Guideline (CPG) in the Joint Trauma System. They cover topics such as acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). They discuss the pathophysiology, symptoms, diagnosis, and treatment options for these conditions. They also touch on pre-treatment strategies and the use of portable hyperbaric chambers. Overall, the conversation provides a comprehensive overview of altitude-related illnesses and their management. In this conversation, Dennis and Ian discuss the treatment options for altitude illness, specifically AMS, HAPE, and HACE. They cover the use of pharmacologic therapy, oxygen, and portable hyperbaric chambers to stabilize and bring down patients with altitude illness. They also discuss the use of dexamethasone as the primary treatment for HACE and the potential use of hypertonic saline for extreme cases. They touch on the side effects of dexamethasone and the importance of protecting the airway. They also mention the use of acetazolamide for prophylaxis and the benefits of intermittent hypoxic exposure. Finally, they discuss the importance of good nutrition and hydration and the new medic encounter form for recording data on altitude illness.

Takeaways:

Acute mountain sickness (AMS) occurs when the body does not have enough time to acclimatize to the physiological stress of altitude.

High altitude cerebral edema (HACE) is characterized by ataxia and can occur even without AMS symptoms.

High altitude pulmonary edema (HAPE) is characterized by decreased exercise tolerance and tachypnea.

Assessment of vital signs, such as heart rate and respiratory rate, can help differentiate between altitude illnesses.

Portable hyperbaric chambers can be used to stabilize patients with altitude illnesses until they can be brought down to lower altitudes.

Pharmacologic treatments, such as acetazolamide and dexamethasone, can be used for prophylaxis and treatment of altitude illnesses.

Improvement in symptoms of HAPE can be rapid with oxygen therapy.

Pre-treatment strategies, such as using acetazolamide, can help acclimatize the body to altitude before ascent. Pharmacologic therapy, oxygen, and portable hyperbaric chambers can be used to stabilize and bring down patients with altitude illness.

Dexamethasone is the primary treatment for HACE, and hypertonic saline may be considered for extreme cases.

Side effects of dexamethasone include increased sugar, gastric erosions, gastric bleeding, and adrenal suppression.

Acetazolamide can be used for prophylaxis, and intermittent hypoxic exposure may help with acclimatization.

Good nutrition, hydration, and iron status are important for preventing altitude illness.

The new medic encounter form is a valuable tool for recording data on altitude illness.




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, Jay Baker discusses the topic of SOF surgical support in Special Operations Forces (SOF). He compares the different types of missions that soft surgical teams might be called upon to support and describes the gap that exists in institutional experience for surgical support in the setting of unconventional warfare. Baker highlights the lessons learned from surgical support in World War II and emphasizes the need to prepare for providing surgical support in more challenging environments. He also discusses the efforts being made to improve soft surgical support, including the development of RSOF surgical teams and the Prolonged Field Care initiative.

Takeaways

Sof surgical support in Special Operations Forces (SOF) is an evolving problem set that requires preparation for providing surgical support in more challenging environments.

Lessons can be learned from surgical support in World War II, where surgeons provided care in dangerous and challenging environments.

Efforts are being made to improve soft surgical support, including the development of RSOF surgical teams and the Prolonged Field Care initiative.

Training and experience in caring for critical patients over longer periods of time, performing tactical evacuations, and developing innovative solutions to resupply challenges are important for soft surgical teams.