Page 20 - PJ MED OPS Handbook 8th Ed

NOTE: If a vented chest seal is not available, use a non-vented chest seal. Monitor the casu-
alty for the potential development of a subsequent tension pneumothorax. If the casualty de-
velops increasing hypoxia, respiratory distress, or hypotension and a tension pneumothorax
is suspected, treat by burping or removing the dressing or by needle decompression.

Circulation – Reassess hemorrhage control, diagnose shock, initiate resuscitation
• Reassess bleeding control interventions.
• Assess pelvis once for stability by applying compression along illiac crests bilaterally, DO NOT
ROCK.
• Diagnose Shock (declining AVPU, radial/carotid pulse, assess skin, cap refill).
• Treatments: pelvic binder, IV/IO access, treat per shock protocol. See Shock section in MTPs.
• Hemorrhagic shock: Tranexamic Acid (TXA), calcium, blood/blood product resuscitation
• Non-hemorrhagic shock/burns: Use LR for resuscitation.
• In patients requiring shock or burn resuscitation, record urine output and report this infor-
mation as part of circulation.

Head – Rule out severe intracranial pressure (TBI) by identifying mental status, pupils, posturing or
snoring respirations (Document Glasgow Coma Scale Score on TBI patient)
• Treatment:
○ Keep systolic BP >100
○ Keep O2 sat >90%
○ 23.4% hypertonic saline through an IO or excellent peripheral IV
○ Elevate head 30° if not in shock
Hypothermia – Dry patient, insulate from ground, place hat, utilize hypothermia blankets

NOTE: While performing the primary assessment, the MARCH interventions are performed
when an indication is found.

Secondary Assessment
Vital Signs – Record set of vitals: (AVPU, HR, RR, BP, SpO2, Temperature, pain score)
Obtain an SAMPLE history
Head-to-Toe Examination
• Head: inspect/palpate skull/scalp, face jaw, ears, eyes, nose, mouth
• Neck: inspect/palpate, assess JVD, subcutaneous air, hematoma, C-spine deformity/tenderness
• Chest: look, listen, feel again
• Abdomen: normal = soft, flat, non-tender
• Pelvis: Assess pelvis, if not already done, document status of genitals if lower limb amputa-
tions (intact, absent, or mangled) or if blood at urethral meatus. Perform DRE for blood if
GSW from knees to groin and no exit.
• Extremities: look and feel; DCAPBTLS, color, cap refill, PMS, strength and ROM
• Spine: inspect, palpate, and percuss

18 n Pararescue Medical Operations Handbook / 8th Edition