Page 292 - PJ MED OPS Handbook 8th Ed

1. Declining consciousness
2. Asymmetric/fixed and dilated pupil
3. Posturing or weakness on one side of body
4. Irregular, snoring respirations
5. Cushing's triad (HTN, bradycardia, irregular/depressed
respirations)
Rx:
1. In addition to “Moderate” Rx, give 30mL 23.4% hypertonic
saline
Basilar Skull Demonstrate knowledge Dx:
Fracture of the diagnosis and 1. Raccoon eyes
treatment of the protocol 2. Battle signs
based on the Task 3. CSF rhinorrhea or otorrhea (clear fluid from the nose or ears)
Standard and the PJ Med 2
Handbook Rx:
1. None
2. Document GCS
3. Transport to neurosurgeon
Oro-pharyngeal Demonstrate knowledge Dx:
Hemorrhage of the diagnosis and 1. Massive, uncontrolled bleeding coming from the mouth or throat
treatment of the protocol in a casualty with neck or facial trauma
based on the Task
Standard and the PJ Med Rx (if not responding to sit up and lean forward):
Handbook 1. Sedate and local anesthesia if able
2. Cric 2
3. Pack the oropharynx with combat gauze – leave a tail for each rol
outside the mouth
4. Maintain complete sedation
Thoracic Demonstrate knowledge Dx:
Trauma of the diagnosis and 1. Chest trauma
treatment of the protocol 2. Respiratory distress
based on the Task 3. Decreased breath sounds, if time and tactics permit stethoscope
Standard and the PJ Med use
Handbook 2
Rx:
1. ND ´ 2 in lateral site
2. Finger or tube thoracostomy
3. PPV
4. Supplemental O2
5. Vented chest seal during wound care
Acute abdomen Demonstrate knowledge Dx: Can be from trauma or medical problem
of the diagnosis and 1. Rigidity
treatment of the protocol 2. Rebound or percussion tenderness, severe focal tenderness
based on the Task 3. Distension
Standard and the PJ Med
Handbook Rx:
1. NPO
2. IV access. NS (normal saline) if medical, or combat shock 2
protocol if trauma and hemorrhagic shock
3. Ertapenem
4. NG tube in PFC for intractable vomiting (unresponsive to
Zofran)
5. Fentanyl or hydromorphone for pain
6. Zofran for nausea
7. Tylenol by mouth with water for fever
Burns Demonstrate knowledge Dx (9, 10, 20, 30 principle):
of the diagnosis and 1. TBSA (total body surface area) - there are 11 “9”s: 2 front torso,
treatment of the protocol 2 back torso, 1 each upper extremity, 2 each lower extremity,
based on the Task 1 head
Standard and the PJ Med
Handbook Rx:
1. 10mL/hr LR ´ % TBSA (adjust if >80kg) 2
2. Start fluid resuscitation for >20% TBSA
3. Target urine output to 30–50mL/hr
4. Treat per pain management protocol
5. No antibiotics unless wounds present
6. Secure airway for stridor or respiratory distress
7. Dry sterile or clean dressings to cover burns
8. Escharotomy as needed
Penetrating Eye Demonstrate knowledge Rx:
Trauma of the diagnosis and 1. Field vision test
treatment of the protocol 2. Rigid eye shield 2
based on the Task 3. Antibiotics
Standard and the PJ Med
Handbook
290 n Pararescue Medical Operations Handbook / 8th Edition