Battlefield Cricothyroidotomy Military medics have a 33% failure rate when performing this procedure. This is the most technically difficult procedure we ask medics, Corpsmen, and PJs to do. The problem with cricothyroidotomy is that it is hard to do. Historically, combat medics have often failed to get it right on the battlefield. Video: An Actual Cricothyroidotomy Using Standard Open Surgical Technique This is video of a cricothyroidotomy performed in an actual emergency situation after an attempt to intubate failed. Even in the Emergency Department cricothyroidotomy is a very difficult, time-consuming procedure. Click on the photo to play the video. Preferred Surgical Airway Technique Cric-Key evaluation Fifteen military medics with minimal training performed one Cric-Key technique and one open surgical technique on cadavers. Medics were able to insert the Cric-Key in significantly less time (34 sec vs 65 sec.) Though not statistically significant, there were three failures with the open surgical technique, and none with the Cric-Key. Under test conditions, medics were faster and more successful using the Cric-Key technique compared to the open surgical technique.
Alternate Site for Needle Decompression An acceptable alternate site is the 4th or 5th intercostal space at the anterior axillary line. The 5th intercostal space is located at the level of the nipple in young, fit males. The AAL is located at approximately the lateral aspect of the pectoralis major muscle. The 5th intercostal space at the anterior axillary line is more remote from the heart and great vessels, and using this site may reduce the risk of complications from needle decompression. In a tactical situation, the lateral approach may be faster and safer given body armor configuration and ability to reassess. The procedure is the same as used at the 2nd intercostal space at the mid-clavicular line. Remember!!! Tension pneumothorax is a common but easily treatable of preventable death on the battlefield. Diagnose and aggressively! DO NOT MISS THIS INJURY! Needle Decompression Works Video courtesy Dr. Oleksandr Linchevskyy Medical Director, Patriot Defence Ukraine This video presents a pleuroscopic view of a needle decompression performed on a trauma victim with tension pneumothorax and a collapsed lung. The of the collapsed lung is dramatic. The catheter may inflict a little trauma on the lung before it gets bent over, but this is acceptable given the benefit accrued from the removal of air from the pleural space and the returned function of the re-inflated lung.
XSTAT 30 Indications For Use 30 is a temporary device for use up to four hours until surgical care is acquired. It should only be used for patients at high risk for immediate life-threatening bleeding from hemodynamically significant, junctional wounds when definitive care at an emergency care facility cannot be achieved within minutes. XSTAT 30 is NOT indicated for use in: the thorax; the pleural cavity; the mediastinum; the abdomen; the retroperitoneal space; the sacral space above the inguinal ligament; or tissues above the clavicle. XSTAT 30 is appropriate for wounds in the axilla, below the clavicles outside the rib cage, and in the groin distal to the inguinal ligaments when limb tourniquets, junctional tourniquets, and hemostatic dressings cannot be effectively applied. 30’s Technical Characteristics 30 is composed of compressed mini-sponges coated with chitosan – a compound designed to stop bleeding. Upon contact with blood, the mini-sponges absorb blood and, expand to 10 - 12 times their compressed volume within approximately 20 seconds. A radiopaque marker is embedded into each of the to make them detectable by X-ray. Read the text. XSTAT 30 Applicator Main body approximately 92 mini-sponges. Telescoping Handle Bifurcated silicone tip allows to exit. The XSTAT 30 applicator is six inches long (10.5 inches with the handle extended) and 30 mm in diameter.
Junctional Hemorrhage This term refers to bleeding from wounds to the: Groin Buttocks Perineum Axillae Base of the neck Extremities at too proximal for a limb tourniquet The where the neck and the limbs join the torso are “junctional” areas. Hemorrhage from wounds in these areas cannot be controlled by application of standard tourniquets like the C.A.T. Junctional Tourniquets The recent conflicts in Afghanistan and Iraq went on for 13 years. So why did it take until 2011 to add a junctional tourniquet to TCCC? Read text. Dr. John Holcomb’s Brief to Defense Health Board 2011 Increasing Amputation Rates in the period Sep-Dec 2010 In the last months of 2010, US Forces in Afghanistan experienced an increase in limb amputations.
IEDS: Iraq vs Afghanistan Iraq amount of explosives – recycled 155 shells Command or vehicle-detonated Designed to destroy vehicles Afghanistan Smaller amount of explosives Homemade explosives Personnel pressure-detonated Designed to maim IEDs were configured and used differently in the two theaters. In Afghanistan, they were aimed at soldiers on dismounted patrol. These tactics led to high rates of Dismounted Complex Blast Injury (DCBI). Dismounted Complex Blast Injury (DCBI) DCBI causes junctional hemorrhage. By 2011, junctional hemorrhage was the leading of death from external hemorrhage. The proximal thigh and the groin are the most common site of junctional hemorrhage DCBI is characterized by a combination of high thigh amputations with genital injury associated with dismounted patrolling. DCBI may also include abdominal and upper extremity injuries and TBI. The junctional hemorrhage attending DCBI illuminated the need for junctional tourniquets. Superficial Anatomy of the Groin A review of the anatomy of the groin helps to show where you should place a junctional tourniquet in this area.