Page 8 - JSOM Summer 2022

n this issue, the JSOM Critical Care Supplement provides consider in theaters with extended evacuation times and lim-
an up-to-date guide to critical care medicine in an array of ited local medical assets. Although blood loss is often associ-
Iarticles on timely issues. ated with settings of acute traumatic hemorrhage in military
medicine, there is the possibility for other hematologic com-
Management of Severe Crush Injuries in Austere Environ- promises. The authors provide a brief review of hemoglobin
ments: A Special Operations Perspective: Crush injuries function and composition, and presentation and management
present a challenging case for medical providers and require considerations of anemia, to assist medics in their treatment
knowledge and skill to manage the subsequent damage to mul- efforts. We also address specific concerns for battlefield and
tiple organ systems. In an austere environment, in which re- atraumatic presentations.
sources are limited and evacuation time is extensive, a medic
must be prepared to identify trends and predict outcomes based FIGURE 1 Possible outward signs of hemopathies involving anemia.
on the mechanism of injury and patient presentation. (A) Scleral icterus and jaundice. (B) Petechial rash.
Progression of crush injury.

A
Images obtained through open
access at:
https://commons.wikimedia.org
/wiki/File:Scleral_Icterus.jpg
and https://commons.wikimedia
Pain is one of the most common complaints of battlefield casu- .org/wiki/File:Petechial_rash.JPG. B
alties, and unique considerations apply in the tactical environ-
ment when managing the pain of wounded service members.
The resource constraints commonly experienced in an opera- Thrombocytopenia is a common condition characterized by a
tional setting, plus the likelihood of prolonged casualty care low platelet count, typically less than 150,000/μL. Principles
by medics or corpsmen on future battlefields, necessitates a and Considerations in the Early Identification and Prehospital
review of analgesia and sedation in the prehospital setting. Treatment of Thrombocytopenia outlines key considerations
for field medical providers to effectively identify the early signs
Analgesia and Sedation in the Prehospital Setting: A Critical of thrombocytopenia and treat different etiologies in the pre-
Care View provides four clinical scenarios highlight the spec-
trum of analgesia and sedation that may be necessary in this hospital environment.
prehospital and/or austere environment. Purpura and petechiae in a patient suffering from consumptive
coagulopathy.
The triad consists of increase in systolic blood
pressure (SBP) and pulse pressure, reduction in
heart rate (HR), and irregular respiratory rhythm
and rate (RR). Cushing triad is only seen in
patients with intracranial hypertension, and it
indicates a high probability of imminent herniation
and death. Although not part of the triad, a blown
pupil may be seen.

In Prehospital Traumatic Brain Injury Management: Clinical
Pearls and Pathophysiology, the authors provide a case and
discuss prehospital patient management, including adequate
oxygen saturation and blood pressure, early recognition of
TBI, frequent exams, detailed charting and hand-off, and fast
transport to the next echelon of care.
Source: National Heart, Lung, and Blood Institute; National Institutes of
Shock is a life-threatening condition carrying a high mortality Health; U.S. Department of Health and Human Services.
rate when untreated. The consequences of shock are cellular
and metabolic derangements, which are initially reversible. The critical regulatory functions of electrolytes such as so-
Shock and Vasopressors presents the case of a Servicemember dium, potassium, calcium, and glucose require medics oper-
who sustained mortar shrapnel wounds that resulted in shock ating in these environments to have a strong, fundamental
knowledge of the principles, manifestations, and initial sta-
Prehospital Anemia Care: A Review of Symptoms, Evaluation, bilization measures to aid their patients prior to, or in lieu
and Management: Prehospital care is even more important to of evacuation. Continued development and access to point of

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