Page 26 - PJ MED OPS Handbook 8th Ed

Thoracic Trauma
Dx:
1. Chest trauma
2. Respiratory distress
3. Other physical findings if time and tactics permit
Rx:
Perform these in order until patient experiences relief and improved VS:
1. Needle Decompression (ND) × 2 attempts at 4th or 5th intercostal space (ICS) in the anterior
axillary line
2. Finger thoracostomy and/or chest tube in the 5th ICS in the mid-axillary line
3. Positive pressure ventilation (BVM, nu-mask and blow, ventilator)
4. O2 if available
Acute Abdomen
Dx: can be from trauma or medical problem
1. Rigidity
2. Rebound tenderness or severe focal tenderness
3. Distension
Rx:
1. NPO
2. IV access. NS (normal saline) if medical; or blood and TXA hemorrhagic shock
3. Ertapenem
4. NG tube for PFC
5. Fentanyl for pain
6. Zofran for nausea
7. Acetaminophen PO with sips of water for fever

Burns – 9, 10, 20, 30 Principle
Dx:
1. TBSA (total body surface area) – there are 11 “9”s: 2 front torso, 2 back torso, 1 each upper ex-
tremity, 2 each lower extremity, 1 head
Rx:
1. Use Rule of 10 to start fluid resuscitation (10mL/hr × % TBSA, add 100mL/hr for each 10 kg above
80 kg)
2. Start fluid resuscitation with LR if >20% TBSA burned with second degree or greater burns
3. Adjust IV fluids to maintain urine output 30–50mL/hr
4. Treat per pain management protocol
5. No antibiotics unless other indication is present (i.e. penetrating wounds, fever, etc.)
6. Perform surgical airway for stridor or respiratory distress (this is generally gradual)
7. Use dry sterile dressings to cover burns. If exfil is >12 hours, debride dead skin once
8. Put dry gauze between burned digits
9. Escharotomy PRN for circumferential burns with progressive pain and tension to palpation
NOTE: If LR not available, begin fluid resuscitation with NS up to 2–4L.

24 n Pararescue Medical Operations Handbook / 8th Edition