Page 152 - 2020 JSOM Winter

Most combat casualties do not require supplemental oxy- – Do not hyperventilate the casualty unless signs of
gen, but administration of oxygen may be of benefit for the impending herniation are present. Casualties may
following types of casualties: be hyperventilated with oxygen using the bag-
• Low oxygen saturation by pulse oximetry valve-mask technique.
• Injuries associated with impaired oxygenation 7. Hypothermia Prevention (same as Tactical Field Care)
• Unconscious casualty 8. Penetrating Eye Trauma (same as Tactical Field Care)
• Casualty with TBI (maintain oxygen saturation >90% 9. Monitoring (same as Tactical Field Care)
• Casualty in shock 10. Analgesia (same as Tactical Field Care)
• Casualty at altitude 11. Antibiotics (same as Tactical Field Care)
• Known or suspected smoke inhalation 12. Inspect and dress known wounds (same as Tactical Field
5. Circulation (same as Tactical Field Care) Care)
6. Traumatic Brain Injury 13. Check for additional wounds (same as Tactical Field
a. Casualties with moderate/severe TBI should be moni- Care)
tored for: 14. Burns (same as Tactical Field Care)
• Decreases in level of consciousness 15. Splint fractures and recheck pulses (same as Tactical Field
• Pupillary dilation Care)
• SBP should be >90mmHg 16. Cardiopulmonary resuscitation (CPR) in TACEVAC
• O sat >90 a. Casualties with torso trauma or polytrauma who have
2
• Hypothermia no pulse or respirations during TACEVAC should have
• End-tidal CO (If capnography is available, maintain bilateral needle decompression performed to ensure
2
between 35 and 40mmHg) they do not have a tension pneumothorax. The pro-
• Penetrating head trauma (if present, administer cedure is the same as described in Section (4a) above.
antibiotics) b. CPR may be attempted during this phase of care if the
• Assume a spinal (neck) injury until cleared. casualty does not have obviously fatal wounds and
b. Unilateral pupillary dilation accompanied by a de- will be arriving at a facility with a surgical capability
creased level of consciousness may signify impending within a short period of time. CPR should not be done
cerebral herniation; if these signs occur, take the follow- at the expense of compromising the mission or deny-
ing actions to decrease intracranial pressure: ing lifesaving care to other casualties.
• Administer 250mL of 3% or 5% hypertonic saline 17. Communication
bolus. a. Communicate with the casualty if possible. Encour-
• Elevate the casualty’s head 30 degrees. age, reassure, and explain care.
• Hyperventilate the casualty. b. Communicate with medical providers at the next level
– Respiratory rate 20 of care as feasible and relay mechanism of injury, in-
– Capnography should be used to maintain the end- juries sustained, signs/symptoms, and treatments ren-
tidal CO between 30 and 35mmHg. dered. Provide additional information as appropriate
2
– The highest oxygen concentration (Fio ) possible 18. Documentation of Care (same as Tactical Field Care)
2
should be used for hyperventilation.

150 | JSOM Volume 20, Edition 4 / Winter 2020