Page 210 - 2022 Ranger Medic Handbook

2. Airway
Obviously look for an airway obstruction and clear it if present or if it is possible. To date,
the Regiment has had one significant MPC airway obstruction, it never lost consciousness,
never received a tracheotomy, and survived. The idea in this algorithm is to quickly secure an
airway in an apneic canine patient that has been shot in the chest. Intubation is much faster
and easier in a dog than a tracheotomy. In the unconscious animal insert a 10mm ET tube
using your large Rochester Curved Carmalt (or Penn) forceps (found in your chest tube kits)
to flip the epiglottis down. Visualize the arytenoids with a head lamp and insert the ET tube
to the level of the thoracic inlet. If carried, place a roll of Coflex or Elastikon over the end of
the ET tube to the back of the mouth and tape in place with athletic
tape to create a bite block. If the animal wakes up this will prevent him
from chewing through the tube until you can sedate him. Apply your
Emma and bag when indicated. If bagging is necessary (Apneic, EtCO 2
above 50mmHg) – be sure to pay attention to bag compliance (you do
not want to push through a pneumothorax). If the animal is breathing
move on to circulation. If the animal is apneic while intubated and there
is resistance to bagging, consider NCD or finger thoracostomies for
pneumo/hemothorax. Finger thoracostomies would require bagging
the apneic patient and likely require assistance in a canine patient that is breathing.
3. Circulation
By this point you have already checked a femoral pulse and know whether it is weak or not. An unconscious dog with
a penetrating chest wound automatically makes the animal a candidate for hypovolemic shock and should be treated
for it. IV catheterization > IO. TXA may be given (5mL or 500mg IV) in the flush once followed by canine blood > canine
fresh frozen plasma > Plasmalyte A or LR > 0.9% saline. Give 1 unit of blood or a quarter shock dose of crystalloids (app
700mL) and reassess. After RAC, move back to MARCH.
NO HUMAN BLOOD WILL BE ADMINISTERED TO MPC.
Antibiotic Therapy for Penetrating Wounds: There are very little data on the use of ertapenem (Invanz) in dogs.
Plumb’s recommended dose is 15mg/kg IV or IM so about 450mg IV/IM (4.5mL once reconstituted) twice a day.
SECTION 6 Canine Casualty Card: Medics must complete a casualty card provided by the handler or found on the unit portal under
the RMED/RVET section. Send casualty assessment and AAR through appropriate channels with inclusion of the RVET
and Bn Vet Tech. MPC casualties are stored in the PHTR the same as Rangers’.
Evacuate: Evacuate to a veterinary treatment facility with surgical capabilities or human equivalent (FH, FST) depending
on MEDEVAC times and patient precedence. Canine casualties may be evacuated with human casualties. A MEDEVAC/
CASEVAC plan MUST be worked out for the dog during mission planning. Make sure either the handler or platoon Medic
briefs what facility will be used during the mission brief so the GFC and MEDO know where to send it. There is ALWAYS
confusion with what evacuation asset will be used and where a dog casualty will go after extracted from combat. Most
commanders are not willing to risk the lives of air crewmen for a lone dog casualty on a hot LZ. This means the MPC of-
ten extracts with unit. Make sure the driver or pilot of the CASEVAC platform knows where to take dog casualties before
the mission starts. Ensure the MEDO relays line 4 information (e.g., canine blood!) to the receiving veterinarian. Ensure
any handler not on the mission knows he needs to take a (spare) MPC to the veterinarian in case blood is needed. Finally
make sure everyone has the veterinarian’s contact information and calls them immediately.
4. Handlers or a trained representative should always escort MPC casualties.
5. Conscious canines are difficult to evacuate on human litters (even if strapped down). Most handlers carry canine
specific litters.
Splinting/bandaging: Immobilize fractures when packaging for MEDEVAC to alleviate pain and reduce further soft tis-
sue damage. One joint above and one joint below the fracture require stabilization to be effective.
1. This effectively limits splinting to fractures below the elbow and the stifle.
2. Use a Telfa on open wounds followed by white conforming gauze or kerlix to hold in place. Leave the center two toes
exposed. Always start bandaging at the toes and wrap proximally, regardless of the fracture location.
3. Place a second layer over the holding gauze (second roll of Kerlix, cast padding, or cotton). Compress (do not con-
strict) with Coflex (or VetWrap) leaving a ½" of the gauze exposed on each end. A final wrap around the chest or pelvis
(usually with Elastikon carried by the handler) will help hold in place.
4. Place a SAM splint, or equivalent devise, the entire length of the leg. Place on the lateral aspect of the limb from the
toes to above the shoulder or hip joint.
196 SECTION 6 MPC/CANINE TRAUMA & TACTICAL MEDICAL EMERGENCY PROTOCOLS