Page 24 - PJ MED OPS Handbook 8th Ed

Tactical field care and tactical evacuation

Rx:
1. Prevent hypoxemia
a. provide supplemental oxygen to maintain SpO2>92%
b. If unable to maintain SpO2>92%, perform endotracheal intubation
c. use a ventilator for GCS<9 (goal: EtCO2 30–35mmHg)
2. Prevent hypotension – keep sys BP 100–110mmHg
3. Decrease metabolic demand
a. maintain normothermia (95–99.5°F or 35–37.5°C)
b. Treat seizures with midazolam 5mg IV/IO/IM q15min
c. Treat agitation/combative behavior
i) Midazolam 2mg IV/IO/IM q15min and/or
ii) Ketamine 20mg IV/IO/IM q15min
4. Give TXA 2g IV/IO if within 3 hours of injury
5. Give antibiotics for penetrating brain injury – ertapenem 1g IV/IO q24hr
6. Identify and treat herniation (Dx lines 3–7)
a. Elevate the head 30° in the absence of shock if tactically feasible
b. Remove constricting/tight braces around the neck/loosen cervical collar, if applicable
c. Give 30mL of 23.4% hypertonic saline over 10 minutes through excellent IV or IO (cannot
allow extravasation)
d. If time needed to perform above interventions, may hyperventilate at 1 breath every 3 sec-
onds to an EtCO2 of 25mmHg for no more than 20 minutes.
7. Spinal motion restriction for blunt or blast trauma

Prolonged field care
1. Continue to prevent hypoxemia and hypotension and decrease metabolic demands as described
above
a. avoid fever using acetaminophen 1g q6–8hr and surface cooling measures
2. Treat seizures, agitation/combative behavior as above, additionally:
a. Give Levetiracetam 1,000mg IV/IO over 20 minutes for seizures, GCS ≤8, or depressed skull
fracture (repeat 1,000mg q12hr)
3. Monitor blood glucose and treat hypoglycemia: goal 140–180
4. If not already done, Give TXA 2g IV/IO if within 3 hours of injury
5. Continue antibiotic therapy for penetrating brain injury
a. ertapenem 1g IV/IO q24hr
b. or, if available, give ceftrioxone 2g q8hr; add metronidazole 500mg IV/IO q8hr for heavily
contaminated wounds
6. If signs of herniation present, continue giving 30mL of 23.4% Saline over 10 minutes q3hr
7. Feeding not necessary

NOTE: Document GCS and neuro exam.

22 n Pararescue Medical Operations Handbook / 8th Edition