Questions? Intraosseous (IO) Access If unable to start an IV and fluids or meds are needed urgently, insert a sternal I/O line to provide fluids. The current IO device in most military medical sets is the Pyng The FAST1® was selected due to concerns about multiple extremity trauma precluding adequate site selection for extremity IV devices. Body armor use also generally protects the sternal insertion site. Hand out the FAST1® device. You’ll go through the contents on the next slide. IO Device Go through the various components of the FAST1® as shown.
FAST1® Warnings FAST1® NOT RECOMMENDED IF: Patient is of small stature: Weight of less than 50 kg (110 pounds) Less than 12 years old Fractured manubrium/sternum – flail chest Significant tissue damage at site – trauma, infection Severe osteoporosis Previous sternotomy and/or scar NOTE: INFUSION TUBE SHOULD NOT BE LEFT IN PLACE FOR MORE THAN 24 HOURS A few things to be aware of about the FAST1®. FAST1® Flow Rates 30-80 ml/min by gravity 120 ml/min utilizing pressure infusion 250 ml/min using syringe forced infusion How fast do fluids flow through the FAST1®? Note that IO space connects directly with the intravenous space. Use pressure to force in the Hextend fluid bolus, for instance, that we will discuss later.
TXA FDA approved Possible side effects: Nausea, vomiting, diarrhea Visual disturbances Possible increase in risk of post-injury blood clots Hypotension if given as IV bolus Do not be deterred by possible side effects. The important thing is to stop the bleeding and save the life of the casualty. TXA Storage and Handling Recommended temperature range for storage: F Must protect this drug from environmental extremes Store and transport in air conditioned spaces On missions, carry in small insulated container In very cold temperatures, carrying TXA next to the body on missions will protect from cold Carriage in aid bag also acts as insulator against temperature extremes Return to room temperature storage each mission Review each point
NEW HPMK This is the new Hypothermia Prevention and Management Kit with a Ready-Heat Blanket and a Heat Shell. The HRS will help to retain the heat produced by the Ready-Heat blanket. It has an incorporated hood and Velcro closures down each side to allow exposure of an arm or a leg. Such exposure allows the medic to attend to IVs and tourniquets. Hypothermia Prevention Key Point: Even a small decrease in body temperature can interfere with blood clotting and increase the risk of bleeding to death. Casualties in shock are unable to generate body heat effectively. Wet clothes and helicopter evacuations increase body heat loss. Remove wet clothes and cover casualty with hypothermia prevention gear. Hypothermia is much easier to prevent than to treat! Here we’re not talking hypothermia in the usual sense, which is dying from cold exposure. Here we are talking about keeping your blood clotting system working! Hypothermia is a problem for casualties with hemorrhagic even with warm ambient temperatures. Prevention of hypothermia is the key; once established it is difficult to reverse.
Ketamine Ketamine is recommended for battlefield analgesia in: The Military Advanced Regional Aesthesia and Analgesia handbook USSOCOM Tactical Trauma Protocols Ranger Medic Handbook Pararescue Procedures Handbook Single surgical anesthesia in austere settings and developing countries Special operations communities have experience ketamine in settings. Ketamine – Safety Very favorable safety profile Few, if any, deaths attributed to ketamine as a single agent FDA Insert: "Ketamine has a wide margin of safety; several instances of unintentional administration of overdoses of ketamine (up to ten times that usually required) have been followed by prolonged but complete recovery.” Read text