Combat Casualty Care

Latest Episodes:

Emergency General Surgery in Deployed Settings Dec 20, 2018

Show notes

A discussion about the JTS Emergency General Surgery CPG with CDR Jacob Glazer, MD, a Navy Trauma & Critical Care Surgeon and Maj Andrew Hall, MD from USAF CSTARS.

Not all casualties are trauma patients on the battlefield. Listen to this podcast about the considerations for emergency surgery in the deployed setting that may seem like routine surgery but requires unique decisions.

The following topics are discussed:

Overall need and purpose for a emergency general surgery
Surgical decision-making in the deployed environment
Common non-trauma conditions requiring emergency surgery
Various surgical patient populations in the deployed setting
Approaches to surgical decision-making with limitations on diagnostics and reliance on physical exams
Decision matrix in the CPG
Identification of emergent versus urgent surgical patients
Decisions based on follow-on care needs
Integrating surgical decision-making with command and mission requirements
Post-surgical and evacuation decision-making

Listen on Deployed Medicine at: https://deployedmedicine.com/market/29/content/552

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Always find the latest on Combat Casualty Care at: www/deployedmedicine.com or download the mobile app “Deployed Medicine”.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. For more information, please visit https://creativecommons.org/.

Orthopedic Trauma: Extremity Fracture Clinical Practice Guideline Nov 01, 2018

Show notes

Listen to COL Mark Pallis, Orthopedic Surgery Consultant for the US Army Surgeon General, discuss the Orthopedic Trauma Extremity Fracture Clinical Practice Guideline (CPG).

Upwards of 70-80% of combat injuries involve extremity fractures. The podcast discusses the importance of fracture management for all providers in the deployed environment. With protective equipment worn on today’s battlefield, the survivability of wounding patterns increases the likelihood of fracture management. In austere environments, assessment equipment can be limited, and evacuation routes can be lengthy in time. The following topics are discussed by COL Pallis:

Treatment of the casualty with awareness of austere constraints
Treatment options in far-forward environments before evacuation
Initial management of extremity fractures
Options for stabilizing fractures before and during evacuation
Fracture management in sequence of care for multi-injury casualties
Antibiotics in early fracture management
Documentation and marking of splints
External versus internal fixation in the austere environment
External fixator resources for the austere environment
Considerations for the external fixator frame placement
Splints versus fixator considerations
Differences between management of upper and lower extremity fractures
Factors to consider in austere scenarios

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. For more information, please visit https://creativecommons.org/.

Battle and Non-Battle Injury Documentation Oct 10, 2018

Show notes

In this podcast, Col Stacy Shackelford, USAF, MC, Chief of Performance Improvement with the Joint Trauma System, discusses the Battle and Non-Battle Injury Documentation Clinical Practice Guideline (CPG). Listen to Col Shackelford as she explains the documentation process for the Trauma Resuscitation Record.

Importance of documentation
Documentation referenced in this CPG is specific to Role 2 and Role 3 levels of care
Documentation requirements for trauma patients
Continuity of the resuscitation record as the patient transitions to different levels of care
Uploading records into the Theater Medical Data Store (TMDS)
Documentation requirements in addition to the Trauma Resuscitation Record
Determining which patients require a Trauma Resuscitation Record
Steps to ensure records are transmitted to the Trauma Registry
Where can providers find the Trauma Resuscitation Record template?

Always find the latest on Combat Casualty Care at: www/deployedmedicine.com or download the mobile app “Deployed Medicine”.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. For more information, please visit https://creativecommons.org/.

Airway Management CPG Update and Review Aug 16, 2018

Show notes

Listen to CDR Joshua Tobin, MC, USN, Chief of Trauma Anesthesiology at the University of Southern California and LTC Cord Cunningham, MC, USA, Emergency Medicine Physician and Chair of the JTS Committee on En Route Casualty Care (ERCCC) discuss the changes found within the current Airway Management Clinical Practice Guideline (CPG). In this podcast our subject matter experts expand on the implications of the following changes:

Ketamine for Rapid Sequence Intubation (RSI)
Principles of apneic oxygenation (pre-oxygenation)
End tidal CO2 monitoring and waveform capnography
Surgical airway options – cricothyroidotomy or tracheostomy
Standardized RSI and intubation pathway for all patients. Separate Traumatic Brain Injury (TBI) algorithm not required.
Recommendations for pediatric airway management and intubation
Team approach to trauma airway management

Always find the latest on combat casualty care at www.deployedmedicine.com

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. For more information, please visit https://creativecommons.org/.

Hyperkalemia and Dialysis in a Deployed Setting Jul 19, 2018

Show notes

Listen to LtCol Ian Stewart, USAF, MC, Associate Professor of Medicine at the Uniformed Services University of the Health Sciences and a practicing Nephrologist at the David Grant United Airforce Medical Center explain the “Hyperkalemia and Dialysis in a Deployed Setting” Clinical Practice Guideline (CPG). The following topics are discussed by LtCol Stewart in this podcast:

Primary causes of Acute Kidney Injury (AKI) & Hyperkalemia in the deployed setting
Risk factors for AKI and Hyperkalemia in combat casualties
Rhabdomyolysis
Use of Renal Replacement Therapy prior to transport to a higher echelon of care
Monitoring practices in casualties with AKI
Criteria for transfer to a higher echelon of care for casualties with AKI
Current Research on AKI
Initial Treatments for AKI and hyperkalemia
Acute Peritoneal Dialysis
Methods available for Renal Replacement Therapy at different echelons of care
NxStage® System One ^TMRenal Replacement Therapy system
Catheter placement
Replacement fluids and rates
UltraFiltration
Difference between NxStage® System One ^TMand peritoneal dialysis
Performance improvement monitoring

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. For more information, please visit https://creativecommons.org/.

Burn Care JTS Clinical Practice Guideline Jul 05, 2018

Show notes

This podcast is a discussion with LTC Mario A. Rivera of the Army Nurse Corps and COL Jennifer Gurney from the U.S. Army Institute of Surgical Research (USAISR). COL Gurney is a critical care trauma surgeon at USAISR and Chief of Trauma Systems Development with the Joint Trauma System. Learn more on the following topics as you listen to LTC Rivera and COL Gurney discuss the Burn Care Clinical Practice Guideline.

Burn Injury Assessment
Resuscitation
Wound Care
Scenarios including chemical and electrical injuries

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. For more information, please visit https://creativecommons.org/.

Amputation Evaluation & Treatment CPG Jun 13, 2018

Show notes

This podcast is a discussion with LTC Benjamin K. Potter, Chief of Orthopedics at Walter Reed National Military Medical Center. Learn more on the following topics as you listen to LTC Potter share his experience as the chief orthopedic surgeon for the amputee care program.

Indications for amputation / Amputation criteria
Classifications of Amputations
Trauma assessment and prioritization of care in the context of amputation
Amputation vs. limb salvage decisions in the OR
Preparing the limb for amputation
Ipsilateral fractures and amputations
Skin and tissue flap challenges
Amputations near joints
Open initial wound management
Postoperative care of amputations
Negative pressure wound therapy

Always find the latest at www/deployedmedicine.com

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. For more information, please visit https://creativecommons.org/.

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) CPG May 10, 2018

Show notes

This podcast is a discussion with Lt Col Jason Paisley MD, USAF, the director of Physician Education at the Center for Sustainment of Trauma and Readiness Skills (CSTARS). The podcast reviews the updated Clinical Practice Guideline (CPG) on REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) for advanced providers. Specifically, it addresses the newer equipment that allows for easier insertion and talks about the way REBOA is being used in various clinical scenarios that may have otherwise required more invasive methods.

Always find the latest on Combat Casualty Care at: www/deployedmedicine.com or download the mobile app “Deployed Medicine”.

Neurosurgery and Severe Head Trauma CPG Apr 20, 2018

Show notes

A discussion with Dr Don Marion about the Neurosurgery and Severe Head Injury Clinical Practice Guideline (CPG) from the Joint Trauma System (JTS). Dr Marion is the Senior Clinical Consultant, Clinical Affairs Division of Defense and Veterans Brain Injury Center.

For more information about the JTS, check out www.deployedmedicine.com or http://jts.amedd.army.mil/

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. For more information, please visit https://creativecommons.org/.

Intro to the Committee on SURGICAL Combat Casualty Care (CoSCCC) Jan 12, 2018

Show notes

A discussion with Col Stacy Shackelford, MD about the Committee on SURGICAL Combat Casualty Care (CoSCCC), a new component of the Joint Trauma System (JTS). Listen to it here, through your podcast service or download our app “Deployed Medicine” The Joint Trauma System (JTS) is the Department of Defense Center of Excellence for Trauma providing...

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