Page 44 - ATP-P 11th Ed

Table 5 Cont.
PCC Level for Circulation and Resuscitation
SECTION 1 T T Role 1a
C
C • Re-assess tourniquets and wound dressings as noted in above tier recommendations.
C
C • Convert tourniquets per TCCC guidelines.
C
- C - » In less than 2 hours if bleeding can be controlled with other means.
» DO NOT remove a tourniquet that has been in place more than 6 hours.
C C • Initiate hypothermia prevention measures.
M P • If present, assess pelvic compression device and verify placement and tightness.
C P • IV or intraosseous (IO) access if not already initiated in MARCH interventions:
» If the casualty remains in hemorrhagic shock or at significant risk of shock.
» If the casualty needs medications but cannot take them by mouth.
• Initiate resuscitation with fluid replacement:
» For casualties in hemorrhagic shock.
» Give blood products per DCoT and TCCC guidelines.
» Give calcium per TCCC guidelines.
» If not already done, give TXA per TCCC guidelines.
» Re-assess the casualty after each unit of blood and note on PCC FC vitals tracker.
• The goals of resuscitation:
» Return to a normal LOC.
» Return of palpable radial pulse
» Continue resuscitation until:
« Minimum: palpable radial pulse or improved mental status
« Better: SBP >90mmHg
« Best: SBP between 100–110mmHg.
» Stabilization of vital signs – Heart rate, respiratory rate, oxygen saturation.
• If the patient has signs of ongoing shock despite hemorrhage control:
» Re-assess look for bleeding!
» Consider alternate causes of shock – hypovolemic (burn, sepsis, diarrheal illness and
other causes of non-hemorrhagic shock), obstructive (tension pneumothorax or cardiac
tamponade), distributive (spinal cord injury, sepsis, anaphylaxis, etc.).
» If shock is not hemorrhagic, then treat for alternate cause of shock: judicious crystalloid
for sepsis and burns, chest tube for tension pneumothorax; crystalloid and vasopressors*
for evidence of spinal cord injury with neurogenic shock.
• If resuscitation goals can all be met, maintain crystalloid IV or discontinue IV/IO resuscita-
tion and have the casualty orally rehydrate (avoid free water due to risk of hyponatremia)
until 0.3–0.5mL/kg/hr. UOP is achieved.
• Initiate hypothermia prevention measures.
• Differentiate between transient responder, non-responder, and refractory shock.
• Communicate evacuation and re-supply requirements (i.e., blood resupply/speedball).
Roles 1b/1c
• Continue and/or initiate above circulation and resuscitation interventions.
• Manage IV or IO access for ongoing resuscitation.
• Initiate hypothermia prevention measures.
• Differentiate between transient responder, non-responder, and refractory shock.
• Communicate evacuation and re-supply requirements (i.e. , blood resupply/speedball).
• Initiate teleconsultation to medical control.
(continues)

34 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 35