Page 34 - PJ MED OPS Handbook 8th Ed

6. Analgesia
a. See Pain Management under Tactical Medical Emergency Protocols.
b. Frequently reassess casualty’s mental status, vital signs and analgesic response. Re-dose as
necessary.
c. When applicable, use local anesthetics or regional nerve blocks, if trained and supplied.
d. Use immobilization and soft cushioning when able to increase comfort and reduce medica-
tion requirements.
7. Orthopedic/Compartment Syndrome Management
a. Beware for injured extremities with pain out of proportion to physical findings and pain with
passive motion.
b. See Fasciotomy Protocol.
c. Only leg (below the knee) fasciotomy is approved.
8. Special Blast Injury Considerations
a. Tympanic membranes:
i) Inspect for perforation if possible.
ii) Presume perforation in the setting of post-blast hearing loss.
b. Lungs:
i) Pulmonary overpressure may result in delayed lung injury.
ii) Monitor patients closely for respiratory deterioration for at least 6 hours post-blast.
c. Abdomen:
i) Blast overpressure may result in bowel injury and delayed perforation.
ii) Acute abdominal pain, especially with evidence of peritoneal irritation, within 72 hours of
blast exposure should be presumed to be a bowel perforation. If patient develops severe
pain, rigidity, or rebound tenderness perform the Acute Abdomen Protocol.
d. Spine:
i) Patients involved in vehicular blasts or thrown by explosions are at high risk for spinal injury.
ii) Perform spinal motion restriction as indicated.
iii) Document Pararescue Neurologic Exam and clear C-spine if appropriate.
iv) Beware of undetected TBI with a blunt spine injury from a fall or crash.
v) Pad back boards and collars on bony prominences.
vi) Maintain a high index of suspicion for spinal injury: unconscious patients, blast, rollovers,
falls >10 feet, any midline neck or back pain.
e. Soft tissue defects/amputations:
i) Remove gross debris, irrigate, and debride. Debride ONLY obviously dead tissue.
ii) Cover and secure all soft tissue defects and amputations, even if not sterile: e.g., cravats,
chucks, T-shirts, space blanket, etc. and duct tape.
9. Communications
a. Routinely rehearse telemedicine consultations with your unit medical director. Give report
using AT MIST format.
b. Pre-plan for multiple telemedicine/communication options (audio only; audio/visual; A/V/
medical telemetry; email; text; etc.).
c. Obtain medical C2 and consultation.
d. Communicate urgency of evacuation.

32 n Pararescue Medical Operations Handbook / 8th Edition