Principles of Prolonged Care Flashcards

1
Q

Beyond TCCC and exceeds doctrinal planning guidelines. “Begins when evac doesn’t”

A

Prolonged field care

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2
Q

Prolonged field care started in:

A

2013 with SOMSA extended care working group

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3
Q

Reasons for prolonged field care

A
  • Long evac times
  • Indigenous capabilities
  • Requires different skills
  • Different environments
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4
Q

Gear carried to furthest point usually by medical personnel

A

Ruck

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5
Q

Additional gear carried in vehicles

A

Truck

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6
Q

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”

A

House

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7
Q

Planning stage to consider how casualties will be moved

  • MEDEVAC
  • CASEVAC
A

Plane

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8
Q

Three phases of prolonged field care

A

Evaluation phase

Resuscitation Phase

Transport phase

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9
Q

During this time procedures and steps taken to normalize vitals and reverse physiological effects based on skill set available

A

Resuscitation phase

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10
Q

Systematic approach priority to treat life threats in order of severity

A

Evaluation phase

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11
Q

10 core capabilities of prolonged field care

A
  • Monitor
  • Resuscitate beyond basic crystalloid (FWB)
  • Ventilate and Oxygenate the patient
  • Airway management
  • Sedation and pain management
  • Ability to use physical exam and advanced diagnostics to further evaluate
  • Nursing care
  • Advanced surgical interventions
  • Telemedicine consult
  • Prepare patient for flight
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12
Q

There are no documented cases of permanent tissue damage, nerve damage or vascular injury from properly applied TQ in place for less than __ hours.

A

2 hours

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13
Q

TQ conversion should not be attempted for TQ’s in place longer than __ hours unless it occurs at definitive care facility

A

6 hours

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14
Q

Fluid of choice for patients in hemorrhagic shock as well the capability to provide a transfusion should be a basic capability of any clinician providing PFC.

A

Fresh whole blood

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15
Q

The best fluid in prolonged field care is:

A

The one that’s available

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16
Q

The goal for adequate urine output is:

A

0.5-1 mg/kg/hr

17
Q

Corrects water/electrolyte deficits due to pathologic volume loss. Usually given as continuous IV infusion (lose from burns, GI illness, head trauma, DI, shock)

A

Replacement fluid

18
Q

Given as nutrition to provide water/electrolytes lost via ongoing sweat, urination, stool output as well as glucose required mainly for brain metabolism.

A

Maintenance fluid

19
Q

Made of large molecules that attract fluid into the intravascular space from interstitial.

A

Colloids

20
Q

500ml of Hetastarch (common colloid) will give approximate equivalent volume of _______ml NS

A

2000ml NS

21
Q

Will also have longer lasting effect given only 25% of crystalloid will remain intra-vascular at one hour

A

Colloids (hetastarch)

22
Q

Initial volume expansion in hemorrhagic shock while provision of blood is being arranged

Resuscitation of perfusion to dysfunctional organs or unstable hemodynamics in non-hemorrhagic shock states

Reducing crystalloid requirements in burn patients at risk for over- resuscitation, and peripheral or abdominal compartment syndromes

A

Colloids

23
Q

Work to expand intravascular volume however only appx 25% remain within vasculature at 1 hour therefore when given as a resuscitation fluid large volume bolus are required.

A

Crystalloid

24
Q

Complications of large volume crystalloid resuscitation include:

A

Compartment syndrome

Acute respiratory distress syndrome

Dilutional coagulopathy

Acidosis

25
Q

Caution in resuscitation with crystalloids. “Unbalanced” fluid with a supra-physiologic concentration of chloride therefore can produce hyperchloremic metabolic acidosis. This can worsen inflammation and decrease kidney function

A

NS

26
Q

Fresh whole blood (FWB) is the fluid of choice for patients in hemorrhagic shock.

To mitigate risks in PFC recommendations are a MAP of ___mmhg

A

65mmHg

27
Q

If UNSTABLE with inadequate intravascular volume, resuscitate with ____ fluid.

A

Bolus

28
Q

If STABLE with adequate intravascular volume, use _______ fluid.

A general target is to achieve a urine output of at least 0.5mL/kg/hour

A

Maintenance

29
Q

Medications given which produce a diminished sensation to pain without producing a loss of consciousness

A

Analgesic

30
Q

Depression of a patient’s awareness to the environment and reduction of responsiveness. Various levels including minimal, moderate and deep.

A

Sedation

31
Q

Any procedure that involves sedation should also include monitoring the patient, ideally with:

A

End-tidal CO2

Pulse Ox

32
Q

PFC medication

Stable patients can get:

A

Morphine

33
Q

PFC medication

Hemodynamically unstable patients should get:

A

Fentanyl or ketamine

34
Q

Three ranges of ketamine

A

Effective pain range with little to no mental status effects

Mid-range; still awake however are agitated and hallucinating

Dissociated range

35
Q

What ketamine range do you want to avoid?

A

Mid-range

36
Q

Low dose pain range for ketamine

A

10-20mg IV

37
Q

Mid-range dosing for ketamine (AVOID)

A

0.3-1mg/kg IV

38
Q

High dose dissociative range for ketamine

A

2.0 mg/kg IV

39
Q

Has synergistic effect with opioids and Ketamine and can cause over- sedation, respiratory compromise and drop in BP

A

Versed