Page 26 - ATP-P 11th Ed

o. If a casualty appears to be partially dissociated, it is safer to administer more ket-
amine than to use a benzodiazepine.
SECTION 1 a. Recommended for All Open Combat Wounds
11. Antibiotics:
b. If able to take PO meds:
i. Moxifloxacin (from the CWMP), 400mg PO once a day
c. If unable to take PO (shock, unconsciousness):
i. Ertapenem, 1g IV/IM once a day
12. Inspect and dress known wounds
a. Inspect and dress known wounds.
b. Abdominal evisceration – [Control bleeding]; rinse with clean (and warm if pos-
sible) fluid to reduce gross contamination. Hemorrhage control – apply combat
gauze or CoTCCC recommended hemostatic dressing to uncontrolled bleeding.
Cover exposed bowel with a moist, sterile dressing or sterile water-impermeable
covering.
i. Reduction: do not attempt if there is evidence of ruptured bowel (gastric/intes-
tinal fluid or stool leakage) or active bleeding.
ii. If no evidence of bowel leakage and hemorrhage is visibly controlled, a single
brief attempt (<60 seconds) may be made to replace/reduce the eviscerated
abdominal contents.
iii. If unable to reduce; cover the eviscerated organs with water impermeable non-
adhesive material (transparent preferred to allow ability to re-assess for ongo-
ing bleeding); examples include a bowel bag, IV bag, clear food wrap, etc.
and secure the impermeable dressing to the patient using adhesive dressing
(examples: ioban, chest seal).
iv. Do NOT FORCE contents back into abdomen or actively bleeding viscera.
v. The patient should remain NPO.
13. Check for Additional Wounds
14. Burns
a. Assess and treat as a trauma casualty with burns and not burn casualty with injuries.
b. Facial burns, especially those that occur in closed spaces, may be associated with
inhalation injury. Aggressively monitor airway status and oxygen saturation in
such patients and consider early surgical airway for respiratory distress or oxygen
desaturation.
c. Estimate total body surface area (TBSA) burned to the nearest 10% using the Rule
of Nines.
d. Cover the burn area with dry, sterile dressings. For extensive burns (>20%), con-
sider placing the casualty in the Heat-Reflective Shell or Blizzard Survival Blanket
from the Hypothermia Prevention Kit in order to both cover the burned areas and
prevent hypothermia.

16 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 17