Page 42 - ATP-P 11th Ed

Additional Considerations
• When in a PCC environment, simple monitoring technologies are able to be used by
SECTION 1 oxygen delivery. Peripheral oxygen saturation can be measured using a pulse oximeter
most providers in each of the provider categories to ensure adequate gas exchange and
which provides a measurement of hemoglobin saturation and, by inference, the effec-
tiveness of measures to oxygenate a patient. Ventilation can be monitored with end-tidal
carbon dioxide. The use of these tools together in a PCC environment provides estimates
of oxygen transport to the cells, tissue metabolism, and adequacy of ventilation.
• Providers in the PCC environment can adopt, implement, monitor, and sustain respira-
tion using concepts of manipulating minute ventilation (respiratory rate multiplied by
tidal volume). Put simply, it is the number of times a patient is breathing each minute
multiplied by the amount of air breathed in with each breath.
• Support of adequate minute ventilation can be performed in an escalating algorithm with
rescue breathing, bag valve mask assisted ventilation, and mechanical ventilation. Each
of these methods may require escalation of airway management skills and respiratory
skills. Manipulation of any of the variables of minute ventilation will alter gas exchange.
Therefore, medical providers in the PCC environment at all levels will need to be com-
petent with the monitoring devices appropriate to their level of training. At a minimum,
all providers with specific medical training should be competent to use and interpret the
previous paragraph’s monitoring devices.
• The causes of respiratory failure can overlap and become confusing. When in doubt and
whenever possible, initiate a Telemedicine Consultation for further guidance and input.

Circulation and Resuscitation

Background
PCC presents a unique challenge for implementing damage control resuscitation (DCR) as
defined by the JTS guideline. PCC goes beyond DCR and should bridge the gap between
the prevention of death, the preservation of life, and definitive care. The goals are a return
to a normal level of consciousness (LOC), increase and stabilization of systolic blood pres-
sure at 100–110mm Hg when appropriate, and stabilization of vital signs – Heart rate,
respiratory rate, oxygen saturation, etc.

32 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 33