Page 118 - JSOM Spring 2023

decreased SpO . While this may have been precipitated by in training for medical emergencies to supplement the already
2
worsening infarction, it was suspected that the cause was iat- robust trauma training such teams receive. Additionally, an
rogenic due to fluid administration and a heparin bolus. Diure- emphasis on the principles of, and preparation for, PCC during
sis was considered, but concern remained for right ventricular pre-deployment training is advised. All providers in the chain
compromise making this patient’s physiology especially depen- of care must be familiar with not only the medical interven-
dent on preload. Also, this occurred in the early stages of a 10- tions required, but also with the resources are available at their
hour flight with limited resources. Had the patient responded location, as well as those that may be needed during transport.
too strongly to diuresis and required fluids, supplies may have
been depleted. The patient was sat straight up with self-ad- Disclosures
ministered suction for his secretions, and his respiratory status The authors are military service members or federal/con-
improved significantly after several minutes. tracted employees of the United States government. This work
was prepared as part of their official duties. Title 17 U.S.C.
Only two D cylinder oxygen tanks were brought for this long 105 provides that “copyright protection under this title is not
trip, as it was planned to use the aircraft’s oxygen supply if available for any work of the United States Government.” Title
needed. A MEDEVAC aircraft may or may not be equipped 17 U.S.C. 101 defines a U.S. Government work as work pre-
with therapeutic oxygen. Its presence is a key planning factor pared by a military service member or employee of the U.S.
for treatment teams and planners, and a backup solution needs Government as part of that person’s official duties.
to in place in the event of system failure. Unfortunately, the
oxygen on the aircraft did not supply sufficient flow rates to Funding
be effective. The oxygen tanks were continuously adjusted be- None.
tween 0.5 and 2 liters per minute to maintain an SpO greater
2
than 88%. The D cylinders held approximately 340 liters of Conflicts of Interest
oxygen. At a rate of 2 liters per minute, a cylinder will last None.
2 hours and 50 minutes. With the lower rates, the cylinders
lasted the entire trip. Disclaimer
The views expressed herein are those of the authors and do
This critical cardiac patient stands as a reminder that while it not necessarily reflect the official policy or position of the De-
is not ideal, PCC is something that every team in an austere partment of the Navy, Department of Defense, or the United
environment must be prepared for at any given time. In AORs States Government.
as large as Africa, medical teams often cover great distances,
and the amount of time providing patient care while await- References
ing MEDEVAC and during flight can be significant. The Joint 1. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC
Trauma System addresses PCC (previously termed Prolonged Guideline for the Management of Patients with Non-ST-Eleva-
Field Care (PFC)) in no less than 10 Clinical Practice Guide- tion Acute Coronary Syndromes: a report of the American Col-
3
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Practice Guidelines [published correction appears in J Am Coll
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4
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for the core capabilities of PCC in a similar format. These jacc.2014.09.017.
5
recommendations are largely dependent on environment, team 2. Cox AT, Lentaigne J, White S, et al. A 2-year review of the gen-
personnel, equipment, and supplies. In terms of personnel, eral internal medicine admissions to the British Role 3 Hospi-
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tient benefited greatly from the expertise of the intensive care Jun 3. PMID: 26040570.
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platform, this case illustrates the necessity of training to PCC 2020.
best practices at every level of care. 4. Nursing Interventions in Prolonged Field Care. 22 July 2018. Joint
Trauma System Clinical Practice Guideline 70. https://jts.amedd.
army.mil/assets/docs/cpgs/Nursing_Intervention_Prolonged_Field_
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in the remote deployed environment. We propose an increase

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