Page 9 - JSOM Summer 2022

care testing in increasingly forward deployed settings further all of which can quickly progress in a prolonged field care envi-
enables medics to perform these tasks. Prehospital Electrolyte ronment. These conditions present complex problems to emer-
Care: A Review of Symptoms, Evaluation, and Management gency department and intensive care unit teams worldwide.
provides a brief review of these vital electrolytes, as well as
additional kidney function evaluation considerations, to assist
medics in their treatment efforts. Specific concerns for battle- Use of low tidal volume prevents overexpansion of the lungs and
healthy alveoli.
field and atraumatic presentations are addressed.
Management of burn patients in the prehospital and pro-
longed field care environments presents complex patient care
and logistical challenges. Burn injuries often co-occur with
mechanical trauma and require scarce specialty resources
over prolonged periods for definitive care. Effective manage-
ment of this patient population requires an understanding of
the underlying pathology, methods to assess extent of the in-
jury, resources to provide supportive care, and access to ex-
pert consultation. The long-range ocean rescues that US Air
Force pararescuemen have performed in recent years provide
a framework in Pathophysiology and Treatment of Burns for
medical providers to enhance their clinical decision-making.

Airway Management With Noninvasive Positive Pressure
Ventilation: Noninvasive positive-pressure ventilation (NPPV)
is a form of ventilatory support that does not require the
placement of an advanced airway. The authors discuss the use
of NPPV on patients who will likely benefit. The use of NPPV Coagulopathy Associated With Trauma: A Rapid Review for
has reduced the need for patients to require intubation and/or Prehospital Providers: The coagulopathy associated with
mechanical ventilation in some cases, as well as benefits. trauma is a complex and convoluted process that is still poorly
understood. However, there are recognized contributors to
Mechanical ventilation is machine-delivered flow of gases acute traumatic coagulopathy (ATC) and trauma induced co-
to both oxygenate and ventilate a patient who is unable to agulopathy (TIC) that are universal. They are hypothermia,
maintain physiological gas exchange, and positive-pressure acidosis, and coagulopathy, also known as the lethal triad.
ventilation (PPV) is the primary means of delivering invasive Recently, with new understanding of hypocalcemia’s role in
mechanical ventilation. Mechanical Ventilation: A Review trauma mortality, the term lethal diamond has been coined
for Special Operations Medical Personnel reviews invasive to underscore calcium’s importance. Prehospital providers
mechanical ventilation to give the Special Operations Force often unknowingly exacerbate ATC and TIC with excessive
medic a comprehensive conceptual understanding of a core crystalloid administration and poor hypothermia prevention.
application of critical care medicine. This article will serve as an overview of the physiologic and
iatrogenic drivers of ATC and TIC, and will discuss how they
The respiratory circuit. can be prevented, assessed, and treated.
The Future of Prehospital Critical Care: As technology im-
proves, the capabilities of prehospital providers increase. Inno-
vations and realizations from military counterparts are being
transitioned to civilian emergency care with the same hopes
of increasing survivability of patients. Looking to the future,
the incorporation of drone aircraft in the critical care field will
likely impact the way medicine is practiced. Education is the
key to improving outcomes in the prehospital setting.

Septic children are among the most challenging and re-
source-intensive patients that clinicians see around the world
daily. These patients often require a broad range of therapies
and assessment techniques, frequently relying on expertise
across multiple specialties such as radiology and laboratory
services. Many clinicians globally face the unique challenge of
Management of Acute Lung Injuries and Acute Respiratory caring for septic children in resource-deprived and austere set-
Distress Syndrome in the Tactical and Prolonged Field Care tings including areas recovering from natural disasters, remote
Setting examines two acute lung injuries that can occur in the villages, and conflict zones; Management of Pediatric Sepsis:
tactical setting – positive pressure pulmonary edema and inha- Considerations for the Austere Prehospital Setting provides
lation injury – as well as acute respiratory distress syndrome, a guide.

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