Page 22 - ATP-P 11th Ed

(e) If a casualty with an altered mental status due to suspected TBI has a weak
or absent radial pulse, resuscitate as necessary to restore and maintain a
SECTION 1 (f) Reassess the casualty frequently to check for recurrence of shock. If shock
normal radial pulse. If BP monitoring is available, maintain a target systolic
BP between 100–110mmHg.
recurs, re-check all external hemorrhage control measures to ensure that
they are still effective and repeat the fluid resuscitation as outlined above.
(g) Refractory Shock
• If a casualty in shock is not responding to fluid resuscitation, consider
untreated tension pneumothorax as a possible cause of refractory shock.
Thoracic trauma, persistent respiratory distress, absent breath sounds,
and hemoglobin oxygen saturation <90% support this diagnosis. Treat
as indicated with repeated NDC or finger thoracostomy/chest tube inser-
th
tion at the 5 ICS in the AAL, according to the skills, experience, and
authorizations of the treating medical provider. Note that if finger tho-
racostomy is used, it may not remain patent and finger decompression
through the incision may have to be repeated. Consider decompressing
the opposite side of the chest if indicated based on the mechanism of
injury and physical findings.
(h) Given increased risk for a potentially lethal hemolytic reaction, transfu-
sion of unscreened group O fresh whole blood or type specific fresh whole
blood should only be performed under appropriate medical direction by
trained personnel.
7. Hypothermia Prevention
a. Take early and aggressive steps to prevent further body heat loss and add external
heat when possible for both trauma and severely burned casualties.
b. Minimize casualty’s exposure to cold ground, wind and air temperatures. Place insu-
lation material between the casualty and any cold surface as soon as possible. Keep
protective gear on or with the casualty if feasible.
c. Replace wet clothing with dry clothing, if possible, and protect from further heat
loss.
d. Place an active heating blanket on the casualty’s anterior torso and under the arms in
the axillae (to prevent burns, do not place any active heating source directly on the
skin or wrap around the torso).
e. Enclose the casualty with the exterior impermeable enclosure bag.
f. As soon as possible, upgrade hypothermia enclosure system to a well-insulated en-
closure system using a hooded sleeping bag or other readily available insulation
inside the enclosure bag/external vapor barrier shell.

12 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 13