Page 272 - PJ MED OPS Handbook 8th Ed

iv. Discontinue fluid administration when one or more of the above end points has
been achieved
4) Reassess the casualty frequently to check for recurrence of shock. If shock recurs,
re-check all external hemorrhage control measures to ensure that they are still ef-
fective and repeat the fluid resuscitation as outlined above.
e. Refractory Shock
i) If a casualty in shock is not responding to fluid resuscitation, consider untreated ten-
sion pneumothorax as a possible cause of refractory shock. Thoracic trauma, persistent
respiratory distress, absent breath sounds, and hemoglobin oxygen saturation <90%
support this diagnosis. Treat as indicated with repeated NDC or finger thoracostomy/
chest tube insertion at the 5th ICS in the AAL, according to the skills, experience, and
authorizations of the treating medical provider. Note that if finger thoracostomy is used,
it may not remain patent and finger decompression through the incision may have to be
repeated. Consider decompressing the opposite side of the chest if indicated based on
the mechanism of injury and physical findings.
7. Hypothermia Prevention:
a. Take early and aggressive steps to prevent further body heat loss and add external heat
when possible for both trauma and severely burned casualties.
b. Minimize casualty’s exposure to cold ground, wind and air temperatures. Place insulation
material between the casualty and any cold surface as soon as possible. Keep protective gear
on or with the casualty if feasible.
c. Replace wet clothing with dry clothing, if possible, and protect from further heat loss.
d. Place an active heating blanket on the casualty’s anterior torso and under the arms in the
axillae (to prevent burns, do not place any active heating source directly on the skin or wrap
around the torso).
e. Enclose the casualty with the exterior impermeable enclosure bag.
f. As soon as possible, upgrade the hypothermia enclosure system to a well-insulated enclo-
sure system using a hooded sleeping bag or other readily available insulation inside the en-
closure bag/external vapor barrier shell.
g. Pre-stage an insulated hypothermia enclosure system with external active heating for transi-
tion from the non-insulated hypothermia enclosure systems; seek to improve upon existing
enclosure system when possible.
h. Use a battery-powered warming device to deliver IV resuscitation fluids, in accordance with
current CoTCCC guidelines, at flow rate up to 150mL/min with a 38°C output temperature.
i. Protect the casualty from exposure to wind and precipitation on any evacuation platform.
8. Penetrating Eye Trauma:
a. If a penetrating eye injury is noted or suspected:
i) Perform a rapid field test of visual acuity and document findings.
ii) Cover the eye with a rigid eye shield (NOT a pressure patch.)
iii) Ensure that the 400mg moxifloxacin tablet is taken, otherwise ertapenem IV/IO/IM
9. Monitoring:
a. Initiate advanced electronic monitoring if indicated and if monitoring equipment is available.
10. Analgesia:
a. Analgesia on the battlefield should generally be achieved using one of three options:
i) Option 1
1) Mild to Moderate Pain
Casualty is still able to fight

270 n Pararescue Medical Operations Handbook / 8th Edition