Page 98 - PJ MED OPS Handbook 8th Ed

Occult Abdominal Injury

1. Abdominal or testicular pain
2. Nausea or urge to defecate
3. Gross blood in stools or on digital rectal examination
4. Bloating, distension, or expansion of abdominal girth
Management:
1. Careful inspection for penetrating trauma
2. Fluid resuscitation following TCCC guidelines if necessary
3. Antibiotics for open wounds or findings consistent with acute abdomen and/or fever
DISPOSITION:
1. Urgent evacuation for any hemodynamic abnormality at any time.
2. Priority evacuation for any other symptoms or signs of occult intra-abdominal injury.

Symptoms and Signs of Occult Head Injury
1. Loss of consciousness, alteration of consciousness, post-traumatic amnesia, or persistent apathy
2. Speech that is not fluid and effortless
3. Abnormal grip strength, examination for pronator drift, or Romberg or tandem Romberg test
4. Results of Military Acute Concussion Evaluation (MACE) that indicate need for consultation with
a provider
Management:
1. Careful inspection for penetrating trauma of eyes and cranium
2. Follow TCCC guidelines for moderate or severe traumatic brain injury (TBI)
3. Maintain pulse oximetry >90% if supplemental oxygen is available
4. Maintain systolic blood pressure >90mmHg if measured or maintain presence of radial pulse
if not

DISPOSITION:
1. Urgent evacuation for GCS score ≤12; declining level of consciousness; abnormal level
of consciousness and pupillary asymmetry; asymmetrical motor or sensory examination.
2. Priority evacuation for loss of consciousness >30 minutes, if that is only abnormality.
3. Routine evacuation for symptoms in one or more areas persistent beyond 72 hours.
a. Physical: headache, dizziness, balance problems, nausea, fatigue, sleep disturbance,
blurred vision, sensitivity to light or noise, hearing deficit, ringing in the ears, transient
motor abnormalities, numbness, tingling.
b. Cognitive: problems with attention, concentration, memory, speed of processing,
judgment, executive control.
c. Behavioral: apathy, depression, anxiety, agitation, irritability, impulsivity, aggression.

96 n Pararescue Medical Operations Handbook / 8th Edition