Page 147 - Journal of Special Operations Medicine - Fall 2015

b. If unable to take PO (shock, unconsciousness): at the expense of compromising the mission or deny-
– Cefotetan 2g IV (slow push over 3 to 5 minutes) or ing lifesaving care to other casualties.
IM every 12 hours 19. Documentation of Care
OR Document clinical assessments, treatments rendered, and
– Ertapenem 1g IV/IM once a day changes in the casualty’s status on a TCCC Casualty Card
16. Burns (DD Form 1380). Forward this information with the ca-
a. Facial burns, especially those that occur in closed spaces, sualty to the next level of care.
may be associated with inhalation injury. Aggressively
monitor airway status and oxygen saturation in such
patients and consider early surgical airway for respira-
tory distress or oxygen desaturation.
b. Estimate total body surface area (TBSA) burned to the
nearest 10% using the Rule of Nines.
c. Cover the burn area with dry, sterile dressings. For ex-
tensive burns (>20%), consider 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.
d. Fluid resuscitation (USAISR Rule of Ten)
– If burns are greater than 20% of TBSA, fluid re-
suscitation should be initiated as soon as IV/IO ac-
cess is established. Resuscitation should be initiated
with lactated Ringer’s, normal saline, or Hextend.
If Hextend is used, no more than 1000mL should
be given, followed by lactated Ringer’s or normal
saline as needed.
– Initial IV/IO fluid rate is calculated as %TBSA ×
10mL/hr for adults weighing 40 to 80kg.
– For every 10kg ABOVE 80kg, increase initial rate
by 100mL/hr.
– If hemorrhagic shock is also present, resuscitation
for hemorrhagic shock takes precedence over re-
suscitation for burn shock. Administer IV/IO fluids
per the TCCC Guidelines in Section 7.
e. Analgesia in accordance with the TCCC Guidelines in
Section 13 may be administered to treat burn pain. Attention Exhibitors! Please plan to join us for the 2015
f. Prehospital antibiotic therapy is not indicated solely SOMA Symposium (formerly known as mini-SOMA)
for burns, but antibiotics should be given per the December 14-16, 2015 in San Marcos, Texas.
TCCC guidelines in Section 15 if indicated to prevent
infection in penetrating wounds. Each 10x10 booth will include pipe and drape, one line
g. All TCCC interventions can be performed on or identification sign and two (2) booth representatives.
through burned skin in a burn casualty.
h. Burn patients are particularly susceptible to hypother- Booths will be assigned on a first-paid, first-served
mia. Extra emphasis should be placed on barrier heat basis.
loss prevention methods and IV fluid warming in this
phase. Preference will be given to Symposium supporters and
17. The Pneumatic Antishock Garment (PASG) may be useful exhibitors who also sign up for the SOMA Scientific
for stabilizing pelvic fractures and controlling pelvic and Assembly 2016 (SOMSA), to be held May 23-26, 2016
abdominal bleeding. Application and extended use must in Charlotte, North Carolina.
be carefully monitored. The PASG is contraindicated for
casualties with thoracic or brain injuries. Companies who commit to register for SOMSA 2016
18. CPR in TACEVAC Care when registering for the 2015 SOMA Symposium will
a. Casualties with torso trauma or polytrauma who have receive a $250 discount on their Scientific Assembly
no pulse or respirations during TACEVAC should have
bilateral needle decompression performed to ensure Exhibit fee and two (2) additional booth representa-
they do not have a tension pneumothorax. The proce- tives for the Exhibit Hall at SOMSA.
dure is the same as described in Section 2a above.
b. CPR may be attempted during this phase of care if the For complete details visit the Exhibitors/Sponsors page
casualty does not have obviously fatal wounds and of the SOMA website located under the Meetings/Events
will be arriving at a facility with a surgical capability menu. Early registration deadline is September 29!
within a short period of time. CPR should not be done

TCCC Updates 135