29.12 Principles of Prolonged Field Care

Question 1

Reasons for PFC

Answer 1

(a)Long evac times
(b)Indigenous capabilities
(c)Requires different skills
(d)Different environments

Question 2

gear carried to furthest point usually by medical personnel

Answer 2

RUCK

Question 3

additional gear carried in vehicles

Answer 3

TRUCK

Question 4

gear available to IDC/Medical personnel however, can only realistically be maintained at house/tent/FOB or support site. “highest level of care unit has

Answer 4

HOUSE

Question 5

planning stage to consider how casualties will be moved

Answer 5

PLANE

Question 6

Three Phases of PFC

Answer 6

• Evaluation phase
• Resuscitation Phase
• Transport Phase

Question 7

Which phase of PFC
(a)Systematic approach priority to treat life threats in order of severity
1)Resuscitation and lifesaving procedures
2)Treat shock
3)Completion or MARCH and
4)Upgrading stopgaps (intubating, cricothyrotomy, chest tubes, etc.)
5)Initiate evacuation plan

Answer 7

Evaluation phase

Question 8

Which phase of PFC
(a)During this time procedures and steps taken to normalize vitals and reverse physiological effects based on skill set available
(b)Shock
(c)Lethal triad addressed – hypothermia, acidosis, coagulopathy + sepsis
(d)Re-evaluate for life, limb, eyesight conditions and re-evaluate resuscitationefforts
(e)Nursing care – hydration, tubes, meds, padding
(f)Telemedicine

Answer 8

Resuscitation Phase

Question 9

Which phase of PFC
(a)Prevent hypothermia,
(b)Secure patient and litter,
(c)Splinting,
(d)Monitors and cuffs,
(e)Emergency meds,
(f)Sedation pain,
(g)Secure tubing
(h)Documentation of patient condition, response to therapy and treatment rendered

Answer 9

Transport Phase

Question 10

10 Core Capabilities of PFC

Answer 10

(1) Monitor – in order to obtain a trend in vital signs
(2) Resuscitate beyond basic crystalloid
(3) Ventilate and Oxygenate the patient
(4) Airway management – if patient requires a definitive airway (inflated cuffed tube below the trachea) gain control of the airway and be able to maintain sedation.
(5) Sedation and pain management - In order to provide appropriate long term airway management adequate knowledge and skills to provide sedation and analgesia are required.
(6) Ability to use physical exam and advanced diagnostics to further evaluate.
(7) Nursing care – incorporate hygiene, nursing care and comfort measures.
(8) Advanced surgical interventions
(9) Telemedicine consult
(10) Prepare patient for flight. Imperative to have higher training prior to deployment ormission. (joint in-route care course, OJT with ERC nurse)

Question 11

There are no documents cases of permanent tissue damage, nerve damage or vascular injury from properly applied TQ in place for less than how many hours

Answer 11

2 hours

Question 12

When should you not convert a TQ into a pressure dressing

Answer 12

Should not be attempted for TQ’s in place longer than 6 hours unless it occurs at definitive care facility

Question 13

When converting a TQ into a pressure dressing, why should you add a loose TQ?

Answer 13

If the TQ that is already in place breaks during the conversion process, there is already a backup in place ready to be tightened. (TQs carried exposed to the environment are subject to degradation based on this exposure)

Question 14

Timing of TQ conversion into pressure dressing

Answer 14

a)<2 hours is considered safe (attempt conversion)
b)2-6 hours is likely safe (attempt conversion)
c)>6 hours require caution (conversion not advised in PFC)

Question 15

What is the goal UOP for PFC

Answer 15

0.5-1 mg/kg/hr

Question 16

Fresh whole blood (FWB) is the fluid of choice for patients in hemorrhagic shock. To mitigate risks in PFC recommendations are as follows:

Answer 16

a)MAP of 65mmhg
b)Adequate UOP (at least 0.5cc/kg/hr)
c)Adequate mentation

Question 17

The selection of maintenance or resuscitation (bolus) fluid should be guided by the patient’s clinical condition:

Answer 17

a)If UNSTABLE with inadequate intravascular volume, resuscitate with bolus fluid.
b)If STABLE with adequate intravascular volume, use maintenance fluid. A general target is to achieve a urine output of at least 0.5mL/kg/hour

Question 18

`Ketamine – is an excellent medication if the IDC understands the effects, dosing and pitfalls. Three ranges

Answer 18

1)Effective pain range with little to no mental status effects,
2)Mid-range still awake however are agitated and hallucinating, and
3)The dissociated range where patient is dissociated and sedated
4)Decide what effect your patient needs and go high or low dose. Avoid the mid-range

Question 19

Dose ranges for ketamine

Answer 19

a)Low dose pain 10-20mg IV titrate to effect repeating doses every 10minutes as needed for desired effect.
b)Mid-range – AVOID – 0.3-1mg/kg IV
c)High dose dissociative – 2.0 mg/kg IV and should also include Versed to avoid vivid dreams which can lead to lifelong dreams and PTSD.
d)Can also be given IM if needed however much higher doses are required.