Page 29 - ATP-P 11th Ed

2. Massive Hemorrhage (same as Tactical Field Care – see page 6)
3. Airway Management
Endotracheal intubation may be considered in lieu of cricothyroidotomy if trained.
4. Respiration SECTION 1
Most combat casualties do not require supplemental oxygen, but administration of oxy-
gen may be of benefit for the following types of casualties:
a. Low oxygen saturation by pulse oximetry
b. Injuries associated with impaired oxygenation
c. Unconscious casualty
d. Casualty with TBI (maintain oxygen saturation >90%
e. Casualty in shock
f. Casualty at altitude
g., Known or suspected smoke inhalation
5. Circulation (same as Tactical Field Care – see page 9)
6. Traumatic Brain Injury
a. Casualties with moderate/severe TBI should be monitored for:
i. Decreases in level of consciousness
ii. Pupillary dilation
iii. SBP should be >90mmHg
iv. O sat >90
2
v. Hypothermia
vi. End-tidal CO (If capnography is available, maintain between 35 and 40mmHg)
2
vii. Penetrating head trauma (if present, administer antibiotics)
viii. Assume a spinal (neck) injury until cleared.
b. Unilateral pupillary dilation accompanied by a decreased level of consciousness
may signify impending cerebral herniation; if these signs occur, take the following
actions to decrease intracranial pressure:
i. Administer 250mL of 3% or 5% hypertonic saline bolus.
ii. Elevate the casualty’s head 30°.
iii. Hyperventilate the casualty.
(a) Respiratory rate 20
(b) Capnography should be used to maintain the end-tidal CO between 30 and
2
35mmHg.
(c) The highest oxygen concentration (FiO ) possible should be used for
2
hyperventilation.
(d) Do not hyperventilate the casualty unless signs of impending herniation
are present. Casualties may be hyperventilated with oxygen using the bag-
valve-mask technique.

18 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 19