Page 74 - 2022 Ranger Medic Handbook

Extended Care Considerations (cont.)
Breathing/Respiratory Management: If ventilation support is required, place patient on SaVE or SaVE 2 mini-vent or
ventilate with BVM. Consider alternating between SaVE and BVM to conserve battery strength. Continue needle decom-
pressions as indicated and change chest seals as required to ensure occlusion. Establish thoracostomy as required. If
chest tube established, routinely check, reinforce, and suction as needed.
■ ■ Good: BMV with PEEP
Better: Supplemental oxygen
SECTION 2 ■ Wound Management: Particular emphasis must be placed on several aspects of long-term wound care to achieve ideal
Best: Portable ventilator
Physical Examination:
■ outcomes for wound management in extended care.
° Inspection of the wound and surrounding tissues for necrosis/infection
° Passive/active range of motion
° Ultrasound
° Labs
■ Irrigation/Debridement
° Clean water from bottles or canteens may be used to washout wounds.
■ Dressing Changes/Reassessments
° Tourniquets and dressings should be checked and reinforced. Convert tourniquets to pressure dressing as soon
as possible.
■ Splinting/Reduction of fractures
■ Telemedicine
Damage Control Resuscitation (DCR): The goal is to maintain a systolic blood pressure of 90–100mmHg and patient
mentation. Continue fluid resuscitation IAW appropriate protocols. A Foley catheter should be placed as soon as pos-
sible. Record I/O and shoot for 30–50mL/hr (0.5–1mg/kg/hr).
Pain Management/Sedation: It is important to have an understanding of your goals with pain management and sedation.
1. Keep the casualty alive. Do not give analgesia or sedation if there are no other priorities.
2. Sustain adequate physiology to maintain perfusion. Avoid medications that cause hypotension/bradypnea for pa-
tients with hemorrhagic shock or respiratory distress.
3. Relieve pain first.
4. Maintain safety. Agitation and anxiety may result in damage to interventions/equip ment/patient
5. During painful procedures amnesia may be required. Titrate to effect and duration with a limited amount of medica-
tion, the Medic must get the most out of what he/she carries. Start low and go slow, the less blood volume means less
medication to achieve desired effects. Utilize regional anesthesia when able and trained appropriately.
■ Background Pain: the pain that is always present because of an injury or wound. Keep the patient comfortable at
rest and do not impair breathing/circulation/mentation.
■ Breakthrough Pain: acute pain from movement/manipulation. Manage as needed.
■ Procedural Pain: associated with a procedure. Anticipate and medicate appropriately both before, during, and after
the procedure.
Nursing Care: Utilize passive movement of uninjured extremities to prevent DVT or PE (BPT to manage as applicable).
Also, consider position change on the litter and padding of pressure points. Hypothermia management will remain a
constant concern for the traumatized patient. Apply the HITMAN pneumonic when remembering nursing care:
■ Hydration
■ Infection
■ Tubes
■ Medications
■ Analgesia
■ Nutrition
Equipment & Battery Management: Check battery strengths every time equipment is activated. Consider alternating
between manual and mechanical VS check or ventilation for periods of time. Turn on devices only when needed. Keep
devices as clean and protected as possible. Ensure you train with equipment you plan on using in potential extended
care scenarios. Understand how to troubleshoot your equipment.
Documentation: Maintain Consistent and Accurate Documentation. Upon eventual evac uation, your management
and interventions will be critical to receiving medical facilities. Record vital signs trends and all fluids infused along with
estimations of blood loss and urine output.

60 SECTION 2 PRIMARY TRAUMA PROTOCOLS