Page 160 - 2022 Ranger Medic Handbook

BLOOD
Class: Blood Product
Indications: IAW Tactical Damage Control Resuscitation Protocol
Interactions: Do not administer in same line as calcium or with calcium containing fluids
Considerations: Whole blood should be stored at 1–6°C and can be stored for 21 days using anticoagulant CPG or
35 days using anticoagulant CPDA-1. Fresh Whole Blood (FWB) can be stored at room temperature and is suitable
for use up to 24 hrs. If FWB is refrigerated within 8 hrs of collection, it becomes Stored Whole Blood (SWB). Must
maintain a temp tolerance device on SWB. Once SWB is out of temp tolerance it must be transfused within 4 hrs or
must be destroyed.

BUPIVACAINE (MARCAINE)
Class: Local anesthetic
SECTION 4 Action: Decreases the neuronal membrane’s permeability to sodium ions, this results in inhibition of depolarization,
blocking conduction
Dose: 0.25% infiltrated locally (max: 400mg of bupivacaine/d); note: aspirate before every injection
Onset/Peak/Duration: Onset is fast/Peak 30–45 minutes/Duration 2–8 hours; note: epinephrine reduces the rate of
absorption and peak plasma concentration of bupivacaine
Indications: Local or regional anesthesia; diagnostic and therapeutic procedures
Contraindications: Hypersensitivity to bupivacaine hydrochloride; amide-type local anesthetics; note: do not use as
intravenous regional anesthesia, may cause cardiac arrest and death, pregnancy category consider alternative use
during pregnancy and may use while breastfeeding
Adverse/Side-effects: Most effects are dose related, often due to accelerated absorption: Bradycardia, cardiac ar-
rest, heart block, hypotension, palpitations, ventricular arrhythmias, anxiety, dizziness, restlessness, nausea, vomiting,
hypersensitivity reaction, weakness, blurred vision, miosis, tinnitus, apnea
Interactions: Blood pressure–lowering medications may be enhanced; enhances other local anesthetic effects
Mission Impact: GROUNDING medication for personnel on flight status

CALCIUM GLUCONATE *
Class: Mineral - Calcium Salt
Action: Essential component and participant in the clotting cascade and ionotropic and vasopressor effects.
Dose: Calcium Gluconate 1g after 1st unit in blood transfusion and after every 4 units
Indications: Blood transfusion
Contraindications: Hypersensitivity to drug/class, hypercalcemia, caution with systemic illness or arrhythmias; preg-
nancy category category may use during pregnancy and while breastfeeding
Adverse/Side Effects: Arrhythmias, extravasation necrosis, flushing, dizziness
Interactions: Minimal prehospital interaction

146 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY