Page 270 - PJ MED OPS Handbook 8th Ed

2) Consider, based on the mechanism of injury and physical findings, whether decom-
pression of the opposite side of the chest may be needed.
v) If the initial NDC was successful, but symptoms later recur:
1) Perform another NDC at the same site that was used previously. Use a new needle/
catheter unit for the repeat NDC.
2) Continue to re-assess!
vi) If the second NDC is also not successful:
1) Proceed to finger or tube thoracostomy.
b. All open and/or sucking chest wounds should be treated by immediately applying a vented
chest seal to cover the defect. If a vented chest seal is not available, use a non-vented chest
seal. Monitor the casualty for the potential development of a subsequent tension pneumo-
thorax. If the casualty develops increasing hypoxia, respiratory distress, or hypotension and a
tension pneumothorax is suspected, treat by burping or removing the dressing or by needle
decompression.
c. Initiate pulse oximetry. All individuals with moderate/severe TBI, trauma, shortness of breath
should be monitored with pulse oximetry. Readings may be misleading in the settings of
shock or marked hypothermia.
d. Casualties with moderate/severe TBI should be given supplemental oxygen when available to
maintain an oxygen saturation >90%.
e. If smoke inhalation is suspected, administer oxygen and monitor EtCO2 if available
6. Circulation:
a. Bleeding:
i) A pelvic binder should be applied for cases of suspected pelvic fracture:
1) Severe blunt force or blast injury with one or more of the following indications:
i. Pelvic pain
ii. Any major lower limb amputation or near amputation
iii. Physical exam findings suggestive of a pelvic fracture
iv. Unconsciousness
v. Shock
ii) Reassess prior tourniquet application. Expose the wound and determine if a tourniquet
is needed. If it is needed, replace any limb tourniquet placed over the uniform with one
applied directly to the skin 2–3 inches above the bleeding site. Ensure that bleeding is
stopped. If there is no traumatic amputation, a distal pulse should be checked. If bleeding
persists or a distal pulse is still present, consider additional tightening of the tourniquet or
the use of a second tourniquet side-by-side with the first to eliminate both bleeding and
the distal pulse. If the reassessment determines that the prior tourniquet was not needed,
then remove the tourniquet and note time of removal on the TCCC Casualty Card.
iii) Limb tourniquets and junctional tourniquets should be converted to hemostatic or pres-
sure dressings as soon as possible if three criteria are met: the casualty is not in shock; it is
possible to monitor the wound closely for bleeding; and the tourniquet is not being used
to control bleeding from an amputated extremity. Every effort should be made to convert
tourniquets in less than 2 hours if bleeding can be controlled with other means. Do not
remove a tourniquet that has been in place more than 6 hours unless close monitoring
and labs are available.
iv) Expose and clearly mark all tourniquets with the time of tourniquet application. Note
tourniquets applied and time of application; time of re-application; time of conversion;
and time of removal on the TCCC Casualty Card. Use a permanent marker to mark on the
tourniquet and the casualty card.

268 n Pararescue Medical Operations Handbook / 8th Edition