ACE3 Medical Guide

## Cardiac Arrest

Cardiac arrest is the technical term for when a casualty is unconscious, does not have a pulse, and has no blood pressure. The treatment for cardiac arrest involves the administration of epinephrine, CPR, defibrillation with an AED, and potentially the administration of IV fluid. Care post-resuscitation involves close monitoring, potentially more fluid administration, and the administration of adenosine. When encountering a patient in cardiac arrest, use one of the following algorithms:

### Defibrillator Present

1. Check heart rate to confirm the patient is in cardiac arrest.
2. Administer 1 (one) dose of epinephrine.
3. If the patient has more than "some blood", administer the correct amount of fluid (generally at least 1000 ml).
4. While the fluid is being administered, perform CPR via the Advanced Treatments menu.
5. Immediately after CPR is complete, check for a pulse
	1. If a normal pulse is present, do not perform more CPR. Go directly to step 7.
	2. If a normal pulse is not present, continue to step 6.
6. Once enough fluid has been administered (the medical menu does not say "lost a fatal amount of blood", at the very least), go to the Advanced Treatments menu and use the defibrillator.
7. Perform post-resuscitation care.
	1. If in a safe location, able to do so, and you have no other casualties, immediately PAK the patient.
	2. Vital sigs
	3. Adenosine administration, if necessary
	4. Fluid administration, if necessary
	5. Stitching, if necessary

### No Defibrillator Present

1. Check heart rate to confirm patient is in cardiac arrest.
2. Administer 1 (one) dose of epinephrine.
3. If the casualty has more than "some blood", administer the correct amount of fluid (generally at least 1000 ml).
4. While the fluid is being administered, perform CPR via the Advanced Treatments menu.
5. Immediately after CPR is complete, check for a pulse
	1. If a normal pulse is present, do not perform more CPR. Go directly to step 6.
	2. If a normal pulse is not present, repeat steps 4 and 5.
6. Perform post-resuscitation care.
	1. If in a safe location, able to do so, and you have no other casualties, immediately PAK the patient.
	2. Vital signs
	3. Adenosine administration, if necessary
	4. Fluid administration, if necessary
	5. Stitching, if necessary

## Triage

### Definitions and Background

Triage is the process of determining a casualty's priority based on the severity of thier injuries, and using that information to guide who is to be treated first. Triage, as a process, is seperate from the actual treatment itself, and is used to get a picture of the status of the team's wounded. At Sigma Security Group, we use a (heavily) modified real-life triage algorithm.

* Green: Team member has suffered no wounds, and has normal vital signs.
* Yellow:
	+ Patient has suffered relatively minor wounds AND/OR
	+ Patient has minorly abnormal vital signs
* Red:
	+ Patient has suffered major wounds AND/OR
	+ Patient has very abnormal vital signs OR
	+ Patient is in cardiac arrest AND you have no other patients that need medical care
* Black:
	+ Patient has suffered wounds so severe you don't believe you'll be able to save them AND/OR
	+ Patient has very severe wounds and you have other patients to care for AND/OR
	+ Patient is in cardiac arrest AND you have other patients to care for

### The Process of Triage

Triage can take two forms. The first method is via ACEREPS (or CASREPS) that you should be asking for, and receiving, from your teammates through the operation. The second method is via physically examining any injured teammates to determine their status. Be sure to take into account both their vital signs as well as the amount of wounds they have received. Triage can be a very inexact science at times, but it's generally fairly obvious when a patient moves from Yellow to Red The line between Red and Black can be a bit more fuzzy, and you are advised to use your judgement in those scenarios.

## Fluid Administration

When administering fluid, there are two variables to consider. They are blood pressure and volume status. A normal blood pressure is 120/80, and anything below that requires either additional fluid administration or the administration of medication to raise the heart rate and blood pressure. Volume status is based off the text in the medical menu that states how much blood the patient has lost, and the categories are as follows:

* Total volume of blood in ACE medical is 6.0 liters
* Lost some blood
	+ Loss of less than 15% of total blood volume
	+ Loss of less than 750 ml
* Lost a lot of blood
	+ Loss of 15-30% of total blood volume
	+ Loss of 750-1500 ml
* Lost a large amount of blood
	+ Loss of 30-40% of total blood volume
	+ Loss of 1500-2000 ml
* Lost a fatal amount of blood
	+ Loss of greater than 40% of total blood volume
	+ Loss of greater than 2000 ml