Page 209 - 2022 Ranger Medic Handbook

7. Hypothermia: Dry the animal’s coat as much as possible. Prevent loss of body heat using warming blankets. Use
fluid warming devices if saline lock initiated. Protect against wind and elements.
AND
Head Trauma: The most common cause for head trauma/TBI may occur with blast injuries. Of the six blast injuries sus-
tained so far by our MPCs, two died immediately and the other four did not report any issues related to head trauma and
returned to duty. Suspect head trauma/TBI if the MPC is in close proximity to explosions/blasts or other nearby Rangers
are affected. Altered consciousness and pupillary function (equality and reactivity) are vital when assessing the patient.
a. Key to field management is prevention of hypoxia (maintain SpO 2 > 90, preferably > 95) and hypotension (maintain
systolic > 90mmHg). Maintain an airway and ventilate at 12–20bpm with approximately 400–500mL tidal volume.
Do not hyperventilate.
b. Elevate the head/body upward 30° if hemodynamically stable. Keep the body and neck in a straight line by placing
the patient on a board or litter and propping up the end toward the head. Do not place material directly under the
head causing a bend in the neck, which may decrease venous return to the heart.
c. Levels of consciousness: Alert, obtunded (verbal), stuporous (pain), and comatose (unconscious) is similar to
AVPU. An obtunded animal should still respond to noise or touch. Stupor indicates a loss of consciousness (LOC);
they respond only to noxious stimuli (pinch across the toes with fingers). Comatose dogs exhibit no response to
repeated noxious stimuli.
d. Perform a full exam for other injuries, especially thoracic auscultation, and perform regularly throughout the mis-
sion. Treat subsequent injuries as needed.
e. Ruptured tympanic membranes require veterinary-specific otic cones to diagnose. The canine ear canal is ex-
tremely long and has a 90° bend.
f. All blast injuries and/or suspected head trauma/TBI require follow-up with a veterinarian for monitoring, thoracic
radiographs, and TM assessment
RAC (Only on the Stuporous or Unconscious MPC)
Always try to consider what is killing the animal and treat that first. Use the algorithm when you are not sure.
Ten of 18 combat deaths in Ranger MPCs involved penetrating wounds to the thorax, making up 55% of all our KIAs.
These wounds are 35% of all combat-related injuries sustained by Ranger MPCs. No Ranger MPC has survived a pen-
etrating chest wound to date. Dogs often die quickly from chest wounds because they have no functional body armor,
a larger heart (dog at 7g/kg bwt, so 223g vs a human at 5g/kg bwt and a 247g heart), and they are almost always shot SECTION 6
through both sides of their chest, which doubles the chance of pulmonary vessel involvement. Half of our MPC combat-
related deaths are because they bleed out into their chests. In contrast, 4/29 MPC combat-related injuries were to the
extremities alone and none of those animals died. This deviation in protocol from M 3 ARCH is one attempt to save more
dogs with a penetrating GSW to the thorax wound pattern. We are also awaiting the development of lighter and more
flexible, thoracic body armor.
The new algorithm is used only in the stuporous or unconscious dog (both indicate LOC). Check pulse and breathing
for signs of life before wasting resources and time on a dead animal. If the animal is apneic and pulseless – perform a
bilateral finger thoracostomy in the 6th or 7th ICS, look for blood and reassess.
1. Respirations (Alive)
The goal is to identify any chest or neck (neck wounds often communicate with the chest wounds in our MPCs) wound
while also paying attention to respirations during your search. If there is no wound in the chest or neck, move back to
M 3 ARCH. If there is an assistant, have them look for massive hemorrhage while you roll through RAC. If there is a wound
in the chest, make a mental note, check for the exit wound, but do not bother covering them with a chest seal in this
algorithm. A thoracic wound with either progressively rapid shallow breathing or no breathing with a distended/swelling
chest needs decompressed with a 14G needle. This enters at the 6th or 7th ICS on the highest point/mid-point (of the
chest). If the first NCD needle fails, try once more on the opposite side of the chest and move on to airway. Place chest
tubes, if necessary, only after airway and circulation have been addressed.

2022 RANGER MEDIC HANDBOOK 195