Page 35 - 2022 Spring JSOM

TABLE 16 Ancillary Medications
Minimum Better Best
Airway Albuterol MDI Albuterol (Neb) Albuterol (Neb) + Atrovent (Neb)
Suctioning: Sterile water or 0.9% saline
Antipyretic* Meloxicam Acetaminophen PO/PR or Acetaminophen IV/IO or
Ibuprofen Ketoralac IM/IV/IO
Anxiety/Behavioral See “Pain and Sedation”
DVT Prophylaxis Aspirin PO Heparin SQ Lovenox SQ
Hydration (PO) Water Water + salt + sugar Water + Gatorade (or other
oral rehydration salt)
Hydration (IV/IO) 0.9% Saline or Lactated Ringers Plasma-Lyte
Nausea/Vomiting Alcohol Pad (inhale vapor) Ondansetron PO or ODT Ondansetron IV/IO or
Promethazine Metoclopramide IV/IO
GI Medications Ranitidine PO Prilosec PO Protonix IV/IO
H1/H2 Blockers IV/IO
GI - Constipation Bisacodyl PO Mirilax PO
Glycerin Suppository Senna PO
Sleep Melatonin PO Diphenhydramine PO Zolpidem PO
Temazepam PO
Other Medications:
• Oral Care (toothbrush/tooth paste and chapstick)
• Eye drops (intubated/sedated)
• Multi-Vitamins (PO daily)
• Animal Bites: Rabies Vaccine and Rabies Immunoglobulin
• HIV Prophylaxis (exposure from combat: civilians or enemy forces): PEP Guidance
• Regional Medications: Ensure continuing prophylaxis (malaria, etc)
*Antipyretic: Use caution with NSAIDs with urgent or priority patients. Ensure patient can void normally (no impaired renal function).
*Link to Infection Prevention in Combat-related Injuries, 27 Jan 2021 CPG 18
*Link to Sepsis Management in Prolonged Field Care, 28 Oct 2020 CPG 19

included as a PCC Guidelines Appendix. (Also located in JTS ■ White phosphorous fragments ignite when exposed to air. Clothing
18
Nursing Intervention in Prolonged Field Care CPG, 22 Jul 2018 ). may contain white phosphorous residue and should be removed.
Fragments embedded in the skin and soft tissue should be irrigated
Pre-deployment, Mission Planning, and
Training Considerations out if possible or kept covered with soaking wet saline dressings
or hydrogels.
■ Hands-on experience is optimal; simulation is a reasonable substitute ■ Seek early consultation from the USAISR Burn Center (DSN 312-
■ Practice with minimal technology so you are prepared when you 429-2876 (BURN); Commercial (210) 916-2876 or (210) 222-
lose access to electricity, water
■ Regular monitoring, reassessment, and intervention is lifesaving 2876; email burntrauma.consult.army@mail.mil).
but can be resource-intensive Electrical Burns
■ Utilize the Recommended Nursing Skill Checklist for Clinical Ro- ■ TCCC ASM and CLS personnel should remove the patient from
tations included in Appendix B to maximize training opportunities. the electricity source while avoiding injury themselves.
■ For cardiac arrest due to arrhythmia after electrical injury, follow
Splinting and Fracture Management – PCC (see Table 18) advanced cardiac life support (ACLS) protocol and provide hemo-
dynamic monitoring if spontaneous circulation returns.
Burn Treatment – Dr Laura Tilley, Walter Engle, ■ Small skin contact points (cutaneous burns) can hide extensive soft
CPT Steven Benavides (see Table 19)
tissue damage.
Background ■ Observe the patient closely for clinical signs of compartment
■ Interrupt the burning process syndrome.
■ Address any life-threatening process based on MARCH assessment ■ Tissue that is obviously necrotic must be surgically debrided.
as directed by TCCC. NOTE: Escharotomy, which relieves the tourniquet effect of circum-
■ A burned trauma casualty is a trauma casualty first ferential burns, will not necessarily relieve elevated muscle compart-
■ All TCCC skills can be performed through burned tissue ment pressure due to myonecrosis associated with electrical injury;
therefore, fasciotomy is usually required.
Burn Characteristics
■ Superficial burns (1st degree) appear red, do not blister, and blanch ■ Compartment syndrome and muscle injury may lead to rhabdomy-
readily. olysis, causing pigmenturia and renal injury.
■ Partial thickness burns (2nd degree) are moist and sensate, blister, ■ Pigmenturia typically presents as red-brown urine. In patients with
and blanch. pigmenturia, fluid resuscitation requirements are much higher than
■ Full thickness burns (3rd degree) appear leathery, dry, non- blanching, those predicted for a similar-sized thermal burn.
are insensate, and often contain thrombosed vessels ■ Isotonic fluid infusion should be adjusted to maintain UOP 75–
100 mL/hr. in adult patients with pigmenturia.
Special Considerations in Burn Injuries ■ If the pigmenturia does not clear after several hours of resusci-
Chemical Burns tation consider IV infusion of mannitol, 12.5 g per liter of lac-
NOTE: Refer to the JTS Inhalation Injury and Toxic Industrial Chem- tated Ringer’s solution, and/or sodium bicarbonate (150 mEq/L
ical Exposure CPG for additional information. in D5W). These infusions may be given empirically; it is not nec-
■ Expose body surfaces, brush off dry chemicals, and copiously irri- essary to monitor urinary pH. In patients receiving mannitol (an
gate with clean water. Large volume (>20L) serial irrigations may osmotic diuretic), close monitoring of intravascular status via CVP
be needed to thoroughly cleanse the skin of residual agents. Do not and other parameters is required.
attempt to neutralize any chemicals on the skin. ■ Seek early consultation from the USAISR Burn Center (DSN 312-
■ Use personal protective equipment to minimize exposure of medi- 429-2876 (BURN); Commercial (210) 916-2876 or (210) 222-
cal personnel to chemical agents. 2876; email burntrauma.consult.army@mail.mil).
Prolonged Casualty Care Guidelines | 33