Page 107 - PJ MED OPS Handbook 8th Ed
P. 107
PHASE 2: IMMEDIATELY PRIOR TO EXTRICATION
10. Immediately prior to extrication, apply tourniquets to crushed extremities, if possible.
Phase 2 Recommended Additional Resuscitative Drugs
a. Sodium bicarbonate – give 1mEq/kg IV immediately prior to extrication (Bristojet 1–2
amps). Additional dosing of sodium bicarbonate may be required if dysrhythmias or cardiac
arrest persist after giving calcium chloride or gluconate.
PERFORM EXTRICATION
PHASE 3: IMMEDIATELY FOLLOWING EXTRICATION
Cardiac Dysrhythmias or Arrest
11. CPR should be initiated if cardiac arrest develops following extrication.
12. If extrication is greater than 4 hours OR in the presence of dysrhythmias OR peaked T-waves
(sign of hyperkalemia), administer calcium gluconate (1gm, 10mL of 10% solution).
WARNING Calcium should not be given in bicarbonate containing solutions due to precipitation
of calcium carbonate.
13. Additional dosing of sodium bicarbonate may be required if dysrhythmias or cardiac arrest
persist after giving calcium gluconate.
14. Be prepared to treat hyperkalemia following extrication and as tourniquets are released.
DISPOSITION:
1. Urgent Surgical evacuation.
Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 105
