Page 103 - JSOM Spring 2024

• The iTClamp does not require additional direct pressure, either when used alone or in combination with other hemo-
static adjuncts.
• If the iTClamp is applied to the neck, perform frequent airway monitoring and evaluate for an expanding hematoma
that may compromise the airway.
• Consider placing a definitive airway if there is evidence of an expanding hematoma.
• DO NOT APPLY on or near the eye or eyelid (within 1cm of the orbit).
d. Perform initial assessment for hemorrhagic shock (altered mental status in the absence of brain injury and/or weak or
absent radial pulse) and consider immediate initiation of shock resuscitation efforts.
4. Airway Management
a. Assess for unobstructed airway.
b. If there is a traumatic airway obstruction or impending traumatic obstruction, prepare for possible direct airway
intervention.
c. Allow a conscious casualty to assume any position that best protects the airway, to include sitting up and/or leaning
forward.
d. Place an unconscious casualty in the recovery position: head tilted back, chin away from chest.
e. Use suction if available and appropriate.
f. If the previous measures are unsuccessful, and the casualty’s airway obstruction (e.g. facial fractures, direct airway injury,
blood, deformations or burns) is unmanageable, perform a surgical cricothyroidotomy using one of the following:
• Bougie-aided open surgical technique using a flanged and cuffed airway cannula of less than 10mm outer diameter,
6–7mm internal diameter, and 5–8cm of intratracheal length.
• Standard open surgical technique using a flanged and cuffed airway cannula of less than 10mm outer diameter, 6–7mm
internal diameter, and 5–8cm of intra-tracheal length.
• Verify placement with continuous end-tidal Co (EtCo capnography.
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2)
• Use lidocaine if the casualty is conscious.
g. Frequently reassess Spo , EtCo , and airway patency, as airway status may change over time.
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2
h. Cervical spine stabilization is not necessary for casualties who have sustained only penetrating trauma.
5. Respiration/Breathing
a. Assess for tension pneumothorax and treat, as necessary.
• Suspect a tension pneumothorax and treat when a casualty has significant torso trauma or primary blast injury and one
or more of the following:
– Severe or progressive respiratory distress
– Severe or progressive tachypnea
– Absent or markedly decreased breath sounds on one side of the chest
– Hemoglobin oxygen saturation <90% on pulse oximetry
– Shock
– Traumatic cardiac arrest without obviously fatal wounds
■ If not treated promptly, tension pneumothorax may progress from respiratory distress to shock and traumatic
cardiac arrest.
• Initial treatment of suspected tension pneumothorax:
– If the casualty has a chest seal in place, burp or remove the chest seal.
– Establish pulse oximetry monitoring.
– Place the casualty in the supine or recovery position unless he or she is conscious and needs to sit up to help keep the
airway clear as a result of maxillofacial trauma.
– Decompress the chest on the side of the injury with a 14-gauge or a 10-gauge, 3.25-inch needle/catheter unit.
• Either the 5th intercostal space (ICS) in the anterior axillary line (AAL) or the 2nd ICS in the mid-clavicular line (MCL)
may be used for needle decompression (NDC). If the anterior (MCL) site is used, do not insert the needle medial to the
nipple line.
• The needle/catheter unit should be inserted at an angle perpendicular to the chest wall and just over the top of the lower
rib at the insertion site. Insert the needle/catheter unit all the way to the hub and hold it in place for 5–10 seconds to allow
decompression to occur.
• After the NDC has been performed, remove the needle, and leave the catheter in place.
– If a casualty has significant torso trauma or primary blast injury and is in traumatic cardiac arrest (no pulse, no
respirations, no response to painful stimuli, no other signs of life), decompress both sides of the chest before discon-
tinuing treatment.
• The NDC should be considered successful if:
– Respiratory distress improves, or
– There is an obvious hissing sound as air escapes from the chest when NDC is performed (this may be difficult to
appreciate in high-noise environments), or
– Hemoglobin oxygen saturation increases to 90% or greater (note that this may take several minutes and may not
happen at altitude), or
– A casualty with no vital signs has return of consciousness and/or radial pulse.
• If the initial NDC fails to improve the casualty’s signs/symptoms from the suspected tension pneumothorax:
– Perform a second NDC on the same side of the chest at whichever of the two recommended sites was not previously
used. Use a new needle/catheter unit for the second attempt.

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