Page 21 - PJ MED OPS Handbook 8th Ed

• Neurologic: If no TBI, confirm speech and comprehension intact, moves all four extremities,
and walking ok; perform a detailed neuro exam (PJ neuro exam) for TBI, stroke, dive medi-
cine, etc.

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

Pain – Pain meds: trauma-pill pack, fentanyl, ketamine; Toradol for significant musculoskeletal in-
jury; Dilaudid for PFC
Antibiotics (medications) – Antibiotics for open combat wounds, administer other medications
as indicated. PO if patient is awake and can swallow without serious abdominal injury, otherwise
IV/IO/IM, for all open combat wounds.

Wounds – Clean and Cover: Remove debris, irrigate, and cover with sterile or clean dressings.
Splint – Perform orthopedic related care, use rigid eye shield for penetrating eye trauma.

Tourniquet Conversion

Indications: Limb and junctional tourniquets should be converted to hemostatic or pressure dress-
ings as soon as possible (or tactically appropriate) unless the patient is in shock, the wound can’t be
monitored for re-bleeding, or the tourniquet is placed for an amputation.

Timing for TQ Conversion:
• Less than 2 hours after application is considered safe (attempt conversion)
• 2–6 hours is likely safe, but the upper safe limit has not been scientifically determined (at-
tempt conversion)
• More than 6 hours requires caution (field conversion not advised due to reperfusion injuries/
kidney failure risk) and management with the Crush Syndrome Protocol
Procedure:
• Add one loose TQ above the original TQ in case the original breaks during conversion.
• Slowly release pressure from the TQ windlass, unwinding a half turn every 10 seconds. Con-
tinually monitor for wound bleeding throughout and after conversion. Dress wound with a
pressure bandage.
• If conversion fails and the wound bleeds, move the original TQ as close to the wound as possi-
ble and retighten. If bleeding continues, additionally tighten the extra TQ that is still in place.
• Attempt the conversion every 10 or 15 minutes if able. Document the number of attempted
conversions.

Chapter 3. PJ Patient Assessment and Treatment n 19