FIELD MEDICAL SUSTAINMENT TRAINING. Terminal Learning Objectives Reacquaint Corpsmen with basic triage and lifesaving skills. Reacquaint Corpsmen with

FIELD MEDICAL SUSTAINMENT FIELD MEDICAL SUSTAINMENT TRAINING TRAINING

Terminal Learning Terminal Learning Objectives Objectives

Reacquaint Corpsmen with basic Reacquaint Corpsmen with basic triage and lifesaving skills. triage and lifesaving skills.

Recognize potential life threatening Recognize potential life threatening injuries, treat and prevent shock.injuries, treat and prevent shock.

In a field environment treat and In a field environment treat and asses combat casualties and prepare asses combat casualties and prepare for MEDEVAC.for MEDEVAC.

Properly insert and secure an Properly insert and secure an intravenous catheter.intravenous catheter.

TRAIN HARD, FIGHT TRAIN HARD, FIGHT EASY… AND WIN.EASY… AND WIN.

TRAIN EASY, FIGHT TRAIN EASY, FIGHT HARD AND DIE.HARD AND DIE.

SHOCK SHOCK

DEFINITION – A state of inadequate DEFINITION – A state of inadequate tissue perfusion, which causes tissue perfusion, which causes cellular metabolic oxygen demands cellular metabolic oxygen demands to exceed the supply to exceed the supply

HYPOVOLEMIC SHOCKHYPOVOLEMIC SHOCK

DEFINITION – A type of shock DEFINITION – A type of shock characterized by an inadequate characterized by an inadequate perfusion of the body due to volume perfusion of the body due to volume loss within the circulatory system. loss within the circulatory system. This is the most common form of This is the most common form of shock seen in the combat / field / shock seen in the combat / field / tactical environment. tactical environment.

CAUSES: CAUSES:

External loss of whole blood – i.e. External loss of whole blood – i.e. hemorrhage hemorrhage

Loss of plasma – i.e. severe burns Loss of plasma – i.e. severe burns Loss of extra cellular fluids – i.e. Loss of extra cellular fluids – i.e.

gastrointestinal fluids lost through vomiting gastrointestinal fluids lost through vomiting or diarrhea or diarrhea

Internal hemorrhage Internal hemorrhage Third Space losses – fluid moves from Third Space losses – fluid moves from

vascular system into the tissues, i.e. edemavascular system into the tissues, i.e. edema

SIGNS / SYMPTOMS SIGNS / SYMPTOMS Signs and symptoms seen with hypovolemic shock are Signs and symptoms seen with hypovolemic shock are

usually linked with the amount of fluid lost. However, these usually linked with the amount of fluid lost. However, these parameters are only guidelines and should not be taken as parameters are only guidelines and should not be taken as absolute amounts. absolute amounts.

Class I – Initial Stage Class I – Initial Stage

1) The circulatory blood volume is decreased but not 1) The circulatory blood volume is decreased but not enough to cause serious effects.enough to cause serious effects.

2) Blood volume reduction up to 10% or approximately 2) Blood volume reduction up to 10% or approximately

500 cc’s 500 cc’s

3) Clinical Findings 3) Clinical Findings (a) No clinical findings (a) No clinical findings

Class II – Compensatory Class II – Compensatory Stage Stage

Although the circulating blood Although the circulating blood volume is reduced, compensatory volume is reduced, compensatory mechanisms are able to maintain mechanisms are able to maintain blood pressure and tissue perfusion blood pressure and tissue perfusion at a level sufficient to prevent at a level sufficient to prevent cellular damage cellular damage

Blood volume reduction from 15 – Blood volume reduction from 15 – 25% or approximately 750 – 1250 25% or approximately 750 – 1250 cc’s cc’s

Clinical Findings Clinical Findings

Minimal tachycardia (heart rate up to Minimal tachycardia (heart rate up to 100 – 105) 100 – 105)

Slight decrease in blood pressure Slight decrease in blood pressure Mild evidence of peripheral Mild evidence of peripheral

vasoconstriction with cool hands and vasoconstriction with cool hands and feet feet

Class III – Progressive Stage or Class III – Progressive Stage or Decompensated Shock Decompensated Shock

At this point, unfavorable signs begin At this point, unfavorable signs begin to appear. The body’s compensatory to appear. The body’s compensatory systems can no longer maintain systems can no longer maintain adequate perfusion with the adequate perfusion with the continued blood loss. continued blood loss.

Blood volume reduction from 25 – 35 Blood volume reduction from 25 – 35 % or approximately 1250 - 1750 cc’s % or approximately 1250 - 1750 cc’s

Clinical Findings: Clinical Findings:

Tachycardia (heart rate 105 – 120 Tachycardia (heart rate 105 – 120 beats per minute) beats per minute)

Decrease in pulse pressure Decrease in pulse pressure Systolic pressure, 70 – 100 mm Hg Systolic pressure, 70 – 100 mm Hg Restlessness Restlessness Increased Sweating Increased Sweating Pallor Pallor Oliguria (decreased urine output) Oliguria (decreased urine output)

Class IV – Irreversible Stage Class IV – Irreversible Stage

Even though the blood volume may Even though the blood volume may be restored and vital signs stabilized, be restored and vital signs stabilized, death is imminent death is imminent

Blood volume reduction from 35 to Blood volume reduction from 35 to 50% or approximately 1750 – 2500 50% or approximately 1750 – 2500 cc’s cc’s

Clinical Findings Clinical Findings

Tachycardia over 120 beats per minute Tachycardia over 120 beats per minute Blood pressure below 60 mmHg Blood pressure below 60 mmHg

systolic and frequently unobtainable by systolic and frequently unobtainable by cuff cuff

Mental stupor Mental stupor Extreme pallor Extreme pallor Cold extremities Cold extremities Anuria (no urine output) Anuria (no urine output)

TREATMENT: TREATMENT:

Identify the source of the fluid loss Identify the source of the fluid loss and correct the problem and correct the problem

Control gross bleeding – direct Control gross bleeding – direct pressure, pressure bandaging, pressure, pressure bandaging, pressure points, tourniquets pressure points, tourniquets

Anti-emetics to control vomiting Anti-emetics to control vomiting Anti-diarrhea medications to control Anti-diarrhea medications to control

diarrhea diarrhea

TREATMENT:TREATMENT:

Restore intravascular volume Restore intravascular volume Fluid and electrolyte replacement (3 cc’s Fluid and electrolyte replacement (3 cc’s

of a crystalloid fluid (LR, NS) for every 1 cc of a crystalloid fluid (LR, NS) for every 1 cc of blood lost) – available at the BAS. of blood lost) – available at the BAS.

Whole blood replacement Whole blood replacement – 1 cc of whole – 1 cc of whole blood for every 1 cc of blood lost) blood for every 1 cc of blood lost)

Blood Substitute Product replacement – Blood Substitute Product replacement – i.e. Hespan. Dosing is 250 - 500 cc’s at a i.e. Hespan. Dosing is 250 - 500 cc’s at a time. Maximum allowable in 24 hours is time. Maximum allowable in 24 hours is 1500 cc’s. 1500 cc’s.

TREATMENTTREATMENT

Elevate lower extremities Elevate lower extremities

Trendelenburg positioning Trendelenburg positioning

Keep the patient warm Keep the patient warm

BURNSBURNS

Thermal burns are not an uncommon Thermal burns are not an uncommon injury on the modern battlefield. injury on the modern battlefield. They can result from exposure to They can result from exposure to flame weapons and devices (napalm flame weapons and devices (napalm and white phosphorous), or from and white phosphorous), or from explosions from fuel sources explosions from fuel sources (gasoline, diesel, and jet fuel). (gasoline, diesel, and jet fuel).

BURNSBURNS

The severity of the burns The severity of the burns experienced by the patient will vary experienced by the patient will vary greatly, depending on the source of greatly, depending on the source of the burn, the amount of time the the burn, the amount of time the patient was exposed to the agent, patient was exposed to the agent, and the location of the burn. and the location of the burn.

CLASSIFICATIONS OF BURNS CLASSIFICATIONS OF BURNS

Burns can be categorized by two Burns can be categorized by two methods:methods:

1) The depth of the burn1) The depth of the burn

2) Total Body Surface Area (TBSA)2) Total Body Surface Area (TBSA)

affected by the burn affected by the burn

First Degree Burn / Superficial First Degree Burn / Superficial Burn Burn

Definition – a burn that involves Definition – a burn that involves only the epidermisonly the epidermis

Sign / Symptoms Sign / Symptoms

Skin is dry and erythematous Skin is dry and erythematous

Pain to site Pain to site

The burned area blanches with The burned area blanches with pressure pressure

Edema (if present) will be minimal Edema (if present) will be minimal

Second Degree Burn / Partial Second Degree Burn / Partial Thickness Burns Thickness Burns

Definition – a burn in which the Definition – a burn in which the epidermis is burned through and epidermis is burned through and the dermis is damagedthe dermis is damaged


Deep, intense pain Deep, intense pain Skin is moist Skin is moist Skin will be hyperemic in color Skin will be hyperemic in color Blister formation Blister formation Edema will be moderate Edema will be moderate

Third Degree Burn / Full Third Degree Burn / Full Thickness Burn Thickness Burn

Definition – a burn in which all Definition – a burn in which all the layers of the skin are the layers of the skin are damaged damaged


Skin has a dry, leathery appearance Skin has a dry, leathery appearance The skin can range in color from pale The skin can range in color from pale

yellow to cherry red, brown, or carbon yellow to cherry red, brown, or carbon black black

Severe pain around periphery of burn, Severe pain around periphery of burn, but little to no pain near center of burn but little to no pain near center of burn

Will see First and Second Degree burns Will see First and Second Degree burns surrounding the Third Degree Burn surrounding the Third Degree Burn

Total Body Surface Area (TBSA) Total Body Surface Area (TBSA) affected by the burn affected by the burn

Burns can be categorized by the Burns can be categorized by the percentage of body surface damaged percentage of body surface damaged by the burn by the burn

Two Methods for Estimating the Total Two Methods for Estimating the Total Body Surface Area (TBSA) affected Body Surface Area (TBSA) affected by Burns: RULE OF NINES and RULE by Burns: RULE OF NINES and RULE OF PALMS OF PALMS

Rule of Nines (RON) Rule of Nines (RON) The Rule of Nines divides the TBSA The Rule of Nines divides the TBSA

into areas compromising 9% or into areas compromising 9% or multiples of 9%, except for the multiples of 9%, except for the peritoneum which is equal to 1% peritoneum which is equal to 1% TBSA. TBSA.

The Rule of Nines is an estimate and The Rule of Nines is an estimate and is most useful for adults and children is most useful for adults and children over the age of 10 over the age of 10

The Rule of Nine’s is helpful for The Rule of Nine’s is helpful for estimating the TBSA of large or estimating the TBSA of large or regularly shaped burnsregularly shaped burns

The Rule of Palm’s assumes that the The Rule of Palm’s assumes that the palm size of the patient represents palm size of the patient represents approximately 1% of the TBSA. TBSA approximately 1% of the TBSA. TBSA is then estimated by approximating is then estimated by approximating the number of “palms” it would take the number of “palms” it would take to completely cover the burn to completely cover the burn

The rule of Palm’s is helpful for The rule of Palm’s is helpful for estimating the TBSA of small or estimating the TBSA of small or irregularly formed burns irregularly formed burns

Rule of Palm’s (ROP) Rule of Palm’s (ROP)

TYPES OF BURNS TYPES OF BURNS

INHALATION BURNSINHALATION BURNS

THERMAL BURNSTHERMAL BURNS

INDUSTRIAL OR CHEMICAL BURNS INDUSTRIAL OR CHEMICAL BURNS

ELECTRICAL BURNS ELECTRICAL BURNS

INHALATION BURNS INHALATION BURNS

Definition – burns in the upper and Definition – burns in the upper and lower airways, caused by the lower airways, caused by the inspiration of heat, toxic, chemicals, inspiration of heat, toxic, chemicals, smoke, or other gases smoke, or other gases

Cause: Cause:

1. Heat inhalation 1. Heat inhalation

2. Inhalation of toxic chemicals or smoke 2. Inhalation of toxic chemicals or smoke

3. Inhalation of carbon monoxide gas 3. Inhalation of carbon monoxide gas

Signs / Symptoms Signs / Symptoms

Dyspnea Dyspnea Tachypnea Tachypnea CoughingCoughing Stridor Stridor Hoarseness Hoarseness Sooty Sputum Sooty Sputum Abnormal Lung Sounds – crackles,Abnormal Lung Sounds – crackles,

wheezeswheezes, or , or rhonchirhonchi may be present may be present


Burns to the oral and/or pharyngeal Burns to the oral and/or pharyngeal mucous membranes mucous membranes

Singed nasal hairs Singed nasal hairs Facial burns Facial burns Tachycardia Tachycardia

Treatment Treatment

Maintain the patient’s ABC’s Maintain the patient’s ABC’s Adjunctive airways may be used if Adjunctive airways may be used if

respiratory distress occurs respiratory distress occurs Endotracheal intubation for severe Endotracheal intubation for severe

respiratory distress respiratory distress Emergency cricothyroidotomyEmergency cricothyroidotomy if edema if edema

causes airway obstruction causes airway obstruction Administer humidified oxygen if available Administer humidified oxygen if available Place the patient in an upright position Place the patient in an upright position EvacuateEvacuate

THERMAL BURNS THERMAL BURNS

Definition – tissue injury caused by Definition – tissue injury caused by exposure to extreme radiant heat exposure to extreme radiant heat

Causes Causes

1. Scalding liquids 1. Scalding liquids

2. Steam or other hot gases 2. Steam or other hot gases

3. Contact with hot objects 3. Contact with hot objects

4. Fire 4. Fire


Signs and symptoms with thermal Signs and symptoms with thermal burns are the same as for First, burns are the same as for First, Second, and Third degree burns Second, and Third degree burns

Treatment Treatment Remove the patient from the source of injury Remove the patient from the source of injury Maintain the patient’s ABC’s Maintain the patient’s ABC’s Remove any material that could continue the Remove any material that could continue the

burning process (oils, burned clothing, etc.) burning process (oils, burned clothing, etc.) First degree burns – immersion in cool water or First degree burns – immersion in cool water or

the application of cool compresses the application of cool compresses Second degree burns – initially, place in cool Second degree burns – initially, place in cool

water or apply cool compresses. Dry, bulky water or apply cool compresses. Dry, bulky dressing can be applied later. dressing can be applied later.

Administer oxygen therapy if available Administer oxygen therapy if available Protect the patient from heat loss and possible Protect the patient from heat loss and possible

hypothermia hypothermia Treat for shockTreat for shock

INDUSTRIAL OR CHEMICAL INDUSTRIAL OR CHEMICAL BURNS BURNS

Definition – occur when the patient Definition – occur when the patient comes in direct contact with caustic comes in direct contact with caustic chemical agents chemical agents

Cause:Cause:Acids /Alkalies Acids /Alkalies Petroleum Based Products Petroleum Based Products

Military Causes: Military Causes: Napalm Napalm White PhosphorousWhite Phosphorous


Sign / Symptoms are influenced by the Sign / Symptoms are influenced by the length of contact, the concentration of length of contact, the concentration of the chemical, and the amount of the chemical, and the amount of chemical chemical

Erythema Erythema Edema Edema Blisters Blisters Tissue necrosis Tissue necrosis Pain at exposure site Pain at exposure site

Treatment Treatment

Irrigate burned area with copious Irrigate burned area with copious amounts of water amounts of water

Burns due to concrete or lime should Burns due to concrete or lime should not be irrigated with water. The not be irrigated with water. The mixture of these powders with water mixture of these powders with water creates a corrosive substance that creates a corrosive substance that will further burn the patient. Brush will further burn the patient. Brush the powder off the patient instead.the powder off the patient instead.

TreatmentTreatment Burns due to phenol (carbolic acid) Burns due to phenol (carbolic acid)

should not be irrigated with water should not be irrigated with water since phenol is not water soluble. since phenol is not water soluble. Instead, irrigate with a lipid-soluble Instead, irrigate with a lipid-soluble solvent (i.e. polyethylene glycol) solvent (i.e. polyethylene glycol)

Hydrofluoric acid burns (used in glass Hydrofluoric acid burns (used in glass etching, dental laboratories, industry, etching, dental laboratories, industry, and electronic plants) are potentially and electronic plants) are potentially life threatening. Evacuate the life threatening. Evacuate the patient as quickly as possiblepatient as quickly as possible

White Phosphorous White Phosphorous

Ignites with air contact – therefore, Ignites with air contact – therefore, cover wound with a wet dressing cover wound with a wet dressing

A solution of sodium bicarbonate may A solution of sodium bicarbonate may be used to rinse the wound to help be used to rinse the wound to help neutralize the resulting phosphoric neutralize the resulting phosphoric acid acid

White phosphorous wounds may be White phosphorous wounds may be identified by using a fluorescent blue identified by using a fluorescent blue light – the white phosphorous will light – the white phosphorous will fluoresce and glow bright white fluoresce and glow bright white

ELECTRICAL BURNS ELECTRICAL BURNS

Definition – electrical current, Definition – electrical current, including lightning, can cause severe including lightning, can cause severe damage to the body. The skin is damage to the body. The skin is burned where the energy enters the burned where the energy enters the body and where it flows into a body and where it flows into a ground. Along the path of this flow, ground. Along the path of this flow, tissues are damaged due to heat tissues are damaged due to heat

ELECTRICAL BURNSELECTRICAL BURNS

CauseCause

1. Exposure to electrical current 1. Exposure to electrical current (either AC or DC) (either AC or DC)

2. Lightning Strike 2. Lightning Strike

Sign / Symptom Sign / Symptom

Burns where the energy enters and exits Burns where the energy enters and exits the body the body

Difficulty breathing or respiratory arrest Difficulty breathing or respiratory arrest Irregular heartbeat or cardiac arrest Irregular heartbeat or cardiac arrest Muscle tenderness Muscle tenderness Fasiculations Fasiculations Convulsions Convulsions Fractured bones Fractured bones Visual difficultiesVisual difficulties

Treatment Treatment

Maintain the patient’s ABC’s Maintain the patient’s ABC’s Care for shock Care for shock Administration of oxygen therapy if Administration of oxygen therapy if

available available Application of cool compresses to Application of cool compresses to

burn areas burn areas Dry, sterile dressings to burns Dry, sterile dressings to burns EvacuateEvacuate

TREATMENT OF BURNS TREATMENT OF BURNS (GENERAL PRINCIPLES) (GENERAL PRINCIPLES)

Maintaining the patient’s ABC’s always Maintaining the patient’s ABC’s always takes precedence. takes precedence.

Remove the patient from the Remove the patient from the environment where the burn occurred environment where the burn occurred

Remove any substance which will Remove any substance which will continue to burn the patient continue to burn the patient

Initially, most burns can be irrigated Initially, most burns can be irrigated with cool water. with cool water.

Cover with a dry, sterile, bulky dressing Cover with a dry, sterile, bulky dressing Evacuate ImmediatelyEvacuate Immediately

11stst Degree Burn Degree Burn

22ndnd Degree Burn Degree Burn

33rdrd Degree Degree

Heat InjuriesHeat Injuries

HEAT INJURIES HEAT INJURIES

Heat Cramps Heat Cramps

Definition – slow, painful, skeletal Definition – slow, painful, skeletal muscle cramps and spasms usually in muscle cramps and spasms usually in the muscles most heavily used, and the muscles most heavily used, and last for 1 to 3 minutes last for 1 to 3 minutes

Cause – Salt depletion that occurs when Cause – Salt depletion that occurs when fluid losses are replaced by water alone fluid losses are replaced by water alone


The muscles are tenderThe muscles are tender The skin is usually moistThe skin is usually moist Core temperature may be normal or Core temperature may be normal or

slightly elevatedslightly elevated There is always a history of vigorous There is always a history of vigorous

activity preceding the onset of activity preceding the onset of symptomssymptoms

Treatment Treatment

Rest in a cool environmentRest in a cool environment Drink an oral saline solution (0.9% Drink an oral saline solution (0.9%

Normal Saline solution, Gatorade)Normal Saline solution, Gatorade) Rest for 2 –3 days with no exertional Rest for 2 –3 days with no exertional

activitiesactivities

Heat Syncope Heat Syncope

Definition – a sudden episode of Definition – a sudden episode of unconsciousness resulting from unconsciousness resulting from cutaneous vasodilation and cutaneous vasodilation and subsequent hypotension.subsequent hypotension.

Cause: Cutaneous vasodilation Cause: Cutaneous vasodilation

Hypotension Hypotension


Systolic blood pressure usually less Systolic blood pressure usually less than 100 mm Hgthan 100 mm Hg

Pulse is weakPulse is weak Skin is cool and moistSkin is cool and moist Core temperature is normal or mildly Core temperature is normal or mildly

elevatedelevated

Treatment Treatment

Place patient in a recumbant positionPlace patient in a recumbant position

Rest in a cool placeRest in a cool place

Administration of fluids either by Administration of fluids either by mouth or intravenouslymouth or intravenously

Heat Exhaustion Heat Exhaustion

Definition – A systemic reaction to Definition – A systemic reaction to prolonged heat exposure (hours to prolonged heat exposure (hours to days) and is due to sodium depletion days) and is due to sodium depletion and dehydration and dehydration

Cause: Salt depletion through intense Cause: Salt depletion through intense sweating. sweating.

Prolonged heat exposure. Prolonged heat exposure. Replacement of body fluids Replacement of body fluids

with with water and not water and not electrolytes. electrolytes.


ThirstThirst FatigueFatigue NauseaNausea OliguriaOliguria GiddinessGiddiness DeliriumDelirium Gastrointestinal flu like symptomsGastrointestinal flu like symptoms

Signs / SymptomsSigns / Symptoms

The skin is moist, flushedThe skin is moist, flushed Rectal temperature is usually over Rectal temperature is usually over

37.8 degrees C (100 degrees F)37.8 degrees C (100 degrees F) Heart rate is elevatedHeart rate is elevated Signs of heat syncope and heat Signs of heat syncope and heat

cramps may accompany heat cramps may accompany heat exhaustionexhaustion

Treatment Treatment

Rest in a cool environmentRest in a cool environment Provide adequate fluid hydration, Provide adequate fluid hydration,

either orally or intravenouslyeither orally or intravenously Salt replacementSalt replacement Restriction of activities for the next Restriction of activities for the next

few daysfew days

Heatstroke Heatstroke

Definition – a severe, life-threatening Definition – a severe, life-threatening failure of thermoregulatory failure of thermoregulatory mechanisms, resulting in an mechanisms, resulting in an excessive rise in body temperature excessive rise in body temperature

Cause: Impaired heat loss Cause: Impaired heat loss mechanismsmechanisms


Core body temperature greater than Core body temperature greater than 41 degrees C (105.8 degrees F)41 degrees C (105.8 degrees F)

Absence of sweatingAbsence of sweating Loss of consciousnessLoss of consciousness DizzinessDizziness WeaknessWeakness Emotional labilityEmotional lability Nausea and vomitingNausea and vomiting


ConfusionConfusion DeliriumDelirium Blurred visionBlurred vision ConvulsionsConvulsions ComaComa Skin is hot, flushed, and drySkin is hot, flushed, and dry

Treatment Treatment

Maintain an adequate airway and Maintain an adequate airway and ventilation ventilation

Rapidly reducing the body core Rapidly reducing the body core temperature temperature

Care must be taken that the cooling Care must be taken that the cooling methods used do not produce methods used do not produce vasoconstriction or shivering which vasoconstriction or shivering which would decrease the cooling rate and would decrease the cooling rate and increase heat production increase heat production

METHODS OF COOLING THE METHODS OF COOLING THE BODY BODY

DIRECT COOLING DIRECT COOLING Items are placed around the body to Items are placed around the body to

assist in the dissipation of excess heat assist in the dissipation of excess heat Examples include:Examples include:

Applying ice bags to vascular areas of Applying ice bags to vascular areas of the body (axilla, groin, scalp, and neck the body (axilla, groin, scalp, and neck regions)regions)

Wrapping the body in a cooling blanketWrapping the body in a cooling blanket

IMMERSION IMMERSION

Immerse the patient in a bathtub filled Immerse the patient in a bathtub filled with cool room temperature water. Do with cool room temperature water. Do not immerse the extremities not immerse the extremities

Requires constant monitoring of the Requires constant monitoring of the patient during the procedure patient during the procedure

This method is slow (10-40 minutes). This method is slow (10-40 minutes). May cause hypothermia if the patient May cause hypothermia if the patient

is left in the water for too long is left in the water for too long

IMMERSION IMMERSION

The use of cold water must be avoided The use of cold water must be avoided

It could cause vasoconstriction, which It could cause vasoconstriction, which would impede the rate of heat loss would impede the rate of heat loss

It could cause shivering, which would It could cause shivering, which would increase heat production increase heat production

ROOM TEMPERATURE WATER ROOM TEMPERATURE WATER MISTING MISTING

Spray or mist a semi-nude heat Spray or mist a semi-nude heat casualty on a mesh hammock casualty on a mesh hammock applying a film of water on skin applying a film of water on skin

A fan may also be utilized to increase A fan may also be utilized to increase the effectiveness of this method the effectiveness of this method

Advantages Advantages

Method is fast (3-10 minutes)Method is fast (3-10 minutes) Requires minimal monitoring of Requires minimal monitoring of

patient.patient. This method does not require cold or This method does not require cold or

ice water. Ambient air temperature ice water. Ambient air temperature water is all that is required.water is all that is required.

Can treat multiple casualties Can treat multiple casualties simultaneously.simultaneously.

EVACUATION EVACUATION

Heat stroke patients in a field Heat stroke patients in a field environment must be medically environment must be medically evacuated to a medical treatment evacuated to a medical treatment facility. During medevac, douse the facility. During medevac, douse the patient with water and maintain free patient with water and maintain free movement of air over the wet casualtymovement of air over the wet casualty

In an ambulance, leave doors and In an ambulance, leave doors and windows open to promote circulation. windows open to promote circulation. In a helicopter, fly at cooler altitudes In a helicopter, fly at cooler altitudes and leave doors open, if possible and leave doors open, if possible

EVACUATIONEVACUATION

Sedative drugs should be avoided Sedative drugs should be avoided because they disrupt an already because they disrupt an already malfunctioning heat regulating malfunctioning heat regulating mechanism. If convulsion occurs, mechanism. If convulsion occurs, Valium may be administered Valium may be administered intravenously intravenously

RESPIRATORY RESPIRATORY TRAUMA AND TRAUMA AND DISORDERS DISORDERS

Rib Fractures Rib Fractures

Definition – a break in the integrity of Definition – a break in the integrity of any of the rib bonesany of the rib bones

Causes:Causes:

Blunt trauma to the rib cage Blunt trauma to the rib cage

Crushing injuries to the chest Crushing injuries to the chest


Pain at the site Pain at the site Pain with inspiration / exhalation Pain with inspiration / exhalation Shortness of breath Shortness of breath Deformity Deformity Crepitus Crepitus Subcutaneous emphysema Subcutaneous emphysema Ecchymosis Ecchymosis

Treatment Treatment

Place patient on affected side Place patient on affected side Pain medications Pain medications Simple fractures of 1 to 2 ribs usually Simple fractures of 1 to 2 ribs usually

require no more treatment require no more treatment Multiple fractures can be immobilized with Multiple fractures can be immobilized with

a sling and swathe. a sling and swathe. Oxygen therapy if available Oxygen therapy if available Encourage coughing and deep breathing Encourage coughing and deep breathing

to prevent atelectasis to prevent atelectasis

Flail Chest Flail Chest

Definition – when many ribs are Definition – when many ribs are fractured, especially at multiple sites, fractured, especially at multiple sites, a portion of the chest wall may a portion of the chest wall may become mechanically unstable. become mechanically unstable. When negative intrathoracic pressure When negative intrathoracic pressure is developed during inspiration, the is developed during inspiration, the unstable (flail) segment moves unstable (flail) segment moves inward and reduced the amount of inward and reduced the amount of air taken in air taken in

Causes Causes

Blunt trauma to the chest wall Blunt trauma to the chest wall Signs / Symptoms Signs / Symptoms Pain with respirations Pain with respirations Paradoxical chest wall movement Paradoxical chest wall movement Dyspnea or respiratory distress Dyspnea or respiratory distress

Treatment Treatment

Administer oxygen if available Administer oxygen if available Endotracheal intubation – if Endotracheal intubation – if

respiratory condition deteriorates respiratory condition deteriorates Administer analgesics (morphine Administer analgesics (morphine

may be given for this condition) may be given for this condition) External chest wall supports (taping, External chest wall supports (taping,

binding) are not required and may be binding) are not required and may be harmful to the patient harmful to the patient

Pneumothorax Pneumothorax

Definition – a collection of air in the Definition – a collection of air in the pleural space which causes the lung pleural space which causes the lung to collapse to collapse

Causes:Causes:Penetrating trauma – from either Penetrating trauma – from either chest wall injury or abdominal chest wall injury or abdominal injuries that cross the diaphragm injuries that cross the diaphragm

Blunt trauma Blunt trauma Spontaneous causesSpontaneous causes


Sudden, sharp chest pain Sudden, sharp chest pain Difficulty breathing Difficulty breathing Decreased chest wall motion Decreased chest wall motion Tachypnea Tachypnea Tachycardia Tachycardia Diaphoresis Diaphoresis


Hypotension Hypotension Hyper-resonance with percussion on Hyper-resonance with percussion on

affected side affected side Absent or diminished breath sounds Absent or diminished breath sounds

on affected sideon affected side Pallor or Cyanosis Pallor or Cyanosis

Treatment Treatment

Place patient in Fowler’s position Place patient in Fowler’s position Administer oxygen if available Administer oxygen if available Analgesics Analgesics Needle thoracentesis if symptoms Needle thoracentesis if symptoms

are severe are severe If caused by a wound, applying an If caused by a wound, applying an

occlusive dressing to the site occlusive dressing to the site Evacuation Evacuation

Hemothorax Hemothorax

Definition – an accumulation of blood Definition – an accumulation of blood and fluid in the pleural cavity, and fluid in the pleural cavity, between the visceral and parietal between the visceral and parietal pleura pleura

Causes:Causes:

Penetrating trauma to the chest wall, Penetrating trauma to the chest wall, great vessels, or the lung great vessels, or the lung

Blunt trauma (less common)Blunt trauma (less common)


Chest pain Chest pain Difficulty breathing Difficulty breathing Decreased chest wall motion Decreased chest wall motion Tachypnea Tachypnea Tachycardia Tachycardia Hypotension Hypotension Dullness on percussion to affected side Dullness on percussion to affected side Diminished or absent breath sounds on Diminished or absent breath sounds on

affected side affected side

Treatment Treatment

Place patient in Fowler’s position Place patient in Fowler’s position Administer oxygen if available Administer oxygen if available Analgesics (aspirin and motrin should be Analgesics (aspirin and motrin should be

avoided because of their anti-thrombolytic avoided because of their anti-thrombolytic actions) actions)

Chest tube insertion to remove the Chest tube insertion to remove the accumulated blood (if at BAS or higher accumulated blood (if at BAS or higher echelon of care) echelon of care)

Insertion of two large bore IV’s Insertion of two large bore IV’s Evacuation Evacuation

Hemopneumothorax Hemopneumothorax

Definition – an accumulation of air, Definition – an accumulation of air, blood, and fluid with in the pleural blood, and fluid with in the pleural cavity, causing the lung to collapse.cavity, causing the lung to collapse.

Causes:Causes:

Penetrating trauma to the chest Penetrating trauma to the chest wall, wall, the great vessels, or the lungthe great vessels, or the lung

Signs / Symptoms – same as for Signs / Symptoms – same as for hemothorax and pneumothorax hemothorax and pneumothorax

Treatment Treatment

Place patient in Fowler’s position Place patient in Fowler’s position Administer oxygen if available Administer oxygen if available Analgesics Analgesics Endotracheal intubate if signs/symptoms Endotracheal intubate if signs/symptoms

become severe become severe Chest tube insertion to remove accumulated Chest tube insertion to remove accumulated

air, blood, and fluids (if at BAS or echelon of air, blood, and fluids (if at BAS or echelon of care) care)

Two large bore IV’s Two large bore IV’s Evacuation Evacuation

Tension Pneumothorax Tension Pneumothorax

Definition – is a life threatening lung Definition – is a life threatening lung injury. Air enters the pleural space on injury. Air enters the pleural space on inspiration, but the air cannot escape inspiration, but the air cannot escape on expiration. Rising intrathoracic on expiration. Rising intrathoracic pressure collapses the lung on the pressure collapses the lung on the affected side causing a mediastinal affected side causing a mediastinal shift that compresses the heart, great shift that compresses the heart, great vessels, trachea, and ultimately, the vessels, trachea, and ultimately, the uninjured lung. Venous return is uninjured lung. Venous return is impeded, cardiac output falls, and impeded, cardiac output falls, and hypotension results. hypotension results.

Causes Causes

Open chest injuries Open chest injuries Closed chest injuries Closed chest injuries


Signs of pneumothorax with Signs of pneumothorax with worsening symptoms worsening symptoms

Distended neck veins Distended neck veins Tracheal deviation – a shift towards Tracheal deviation – a shift towards

the unaffected side the unaffected side

Treatment Treatment

Cover the open wound with an occlusive Cover the open wound with an occlusive dressing sealed on three sides dressing sealed on three sides

Needle thoracentesis Needle thoracentesis Administer oxygen therapy if available Administer oxygen therapy if available Administer analgesics Administer analgesics Two large bore IV’s Two large bore IV’s Chest tube insertion (if at a BAS or Chest tube insertion (if at a BAS or

higher echelon of care) higher echelon of care)

Open Pneumothorax or Open Pneumothorax or “Sucking Chest Wound” “Sucking Chest Wound”

Definition – a pneumothorax Definition – a pneumothorax resulting from a wound through the resulting from a wound through the chest wall. Air enters the pleural chest wall. Air enters the pleural space both through the wound and space both through the wound and the trachea. the trachea.

Causes:Causes:

Large, penetrating trauma to the Large, penetrating trauma to the chest chest wall wall

Signs / Symptoms Signs / Symptoms Sudden chest pain Sudden chest pain Dyspnea Dyspnea Difficulty breathing Difficulty breathing Decreased chest wall motion Decreased chest wall motion Hypotension Hypotension Tachycardia Tachycardia Tachypnea Tachypnea Open sucking wound on inspiration Open sucking wound on inspiration Diminished or absent lung sounds on Diminished or absent lung sounds on

affected side affected side

Treatment Treatment Cover the wound with an occlusive Cover the wound with an occlusive

dressing. dressing. Needle thoracentesis may be indicated Needle thoracentesis may be indicated

to correct the pneumothorax if signs or to correct the pneumothorax if signs or symptoms are severe. symptoms are severe.

Administer oxygen if available. Administer oxygen if available. Administer analgesics Administer analgesics Two large bore IV’s Two large bore IV’s Evacuation Evacuation

EMERGENCY EMERGENCY CRICOTHYROIDOTOMY CRICOTHYROIDOTOMY

DEFINITION – An emergency surgical DEFINITION – An emergency surgical procedure where an incision is made procedure where an incision is made through the skin and cricothyroid through the skin and cricothyroid membrane which allows for the membrane which allows for the placement of an endotracheal tube placement of an endotracheal tube into the trachea when airway control into the trachea when airway control is not possible by other methods is not possible by other methods

INDICATIONS FOR EMERGENCY INDICATIONS FOR EMERGENCY CRICOTHYROIDOTOMY CRICOTHYROIDOTOMY

Obstructed airway – an obstructed Obstructed airway – an obstructed object will usually prevent the passage object will usually prevent the passage of an endotracheal tube through the of an endotracheal tube through the airway. Therefore, a surgical airway airway. Therefore, a surgical airway distal to the obstruction is required. distal to the obstruction is required. Causes of an obstructed airway include Causes of an obstructed airway include

Trauma to the head and neck which Trauma to the head and neck which would preclude the use of an ambu-would preclude the use of an ambu-bag, oropharyngeal airway, bag, oropharyngeal airway, nasopharyngeal airway, and nasopharyngeal airway, and endotracheal tube insertionendotracheal tube insertion

CONTRAINDICATIONS FOR CONTRAINDICATIONS FOR CRICOTHYROIDOTOMY CRICOTHYROIDOTOMY

Massive trauma to the larynx or Massive trauma to the larynx or cricoid cartilage – damage to the cricoid cartilage – damage to the affected structures will make it affected structures will make it impossible to perform the procedure impossible to perform the procedure properly properly

Contraindicated if another means of Contraindicated if another means of establishing an airway have not been establishing an airway have not been attempted (i.e. nasotracheal or attempted (i.e. nasotracheal or orotracheal intubations) orotracheal intubations)

COMPLICATIONS ASSOCIATED COMPLICATIONS ASSOCIATED WITH CRICOTHYROIDOTOMY WITH CRICOTHYROIDOTOMY

HEMORRHAGE HEMORRHAGE ESOPHAGEAL PERFORATION OR ESOPHAGEAL PERFORATION OR

TRACHEOESOPHAGEAL FISTULA TRACHEOESOPHAGEAL FISTULA Definition – the creation of a hole between the Definition – the creation of a hole between the

esophagus and trachea esophagus and trachea Causes: Causes: Creating an incision too deep through the Creating an incision too deep through the

cricothyroid membrane cricothyroid membrane Forcing the endotracheal tube through the Forcing the endotracheal tube through the

cricothyroid membrane and into the esophagus cricothyroid membrane and into the esophagus Treatment requires surgical repair at higher Treatment requires surgical repair at higher

echelon of careechelon of care

Documents

FIELD MEDICAL SUSTAINMENT TRAINING. Terminal Learning Objectives Reacquaint Corpsmen with basic triage and lifesaving skills. Reacquaint Corpsmen with