Prolonged Field Care Podcast

In this podcast episode, Dennis interviews Alex McDonald, a medical student and member of Tactical Medicine New Zealand, about the republishing of the book 'Guerilla Surgeon.' The book tells the story of Dr. Lindsay Rogers, a New Zealand-born surgeon who served with the Special Operations Executive in Yugoslavia during World War II. The conversation covers topics such as the challenges of providing medical care in resource-limited environments, building trust with local forces, and the importance of cultural competency. Alex also discusses the mission of Tactical Medicine New Zealand and their partnership with the Special Operations Medical Association (SOMA) to republish the book. Takeaways The book 'Guerilla Surgeon' tells the story of Dr. Lindsay Rogers, a New Zealand-born surgeon who served with the Special Operations Executive in Yugoslavia during World War II. Providing medical care in resource-limited environments requires improvisation and making the most of available resources. Building trust with local forces is crucial for successful medical operations in foreign nations. Cultural competency is important for effective communication and collaboration with partner forces. Tactical Medicine New Zealand aims to promote and advance tactical medicine in New Zealand and has partnered with SOMA to republish 'Guerilla Surgeon.' Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠www.prolongedfieldcare.org ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care

Dr. Van Wyk discusses updates in traumatic brain injury (TBI) management, focusing on the CRASH 3 trial and the use of tranexamic acid (TXA). He explains that TXA is safe and reduces head injury-related death, particularly in patients with moderate and mild TBI. He also discusses the use of hypertonic saline and recommends considering higher concentrations, such as 23.4%, which have been shown to be safe and effective. Dr. Van Wyk mentions the use of sodium bicarbonate as an alternative and emphasizes the importance of clinical judgment in determining the appropriate treatment. He also discusses monitoring options for cerebral edema and increased intracranial pressure, such as optic nerve sheath diameter measurements. Finally, he touches on the topic of decompressive hemicraniectomy and the considerations for performing this procedure in austere environments. Takeaways Tranexamic acid (TXA) is safe and reduces head injury-related death in patients with moderate and mild traumatic brain injury (TBI). Higher concentrations of hypertonic saline, such as 23.4%, may be considered as they have been shown to be safe and effective. Sodium bicarbonate can be used as an alternative to hypertonic saline, particularly in austere environments. Optic nerve sheath diameter measurements can be used to monitor cerebral edema and increased intracranial pressure. Decompressive hemicraniectomy may be considered in severe TBI cases, and general surgeons may be trained to perform the procedure in the absence of a neurosurgeon. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care

Summary: In this conversation, Dennis and Ian discuss the new high altitude Clinical Practice Guideline (CPG) in the Joint Trauma System. They cover topics such as acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). They discuss the pathophysiology, symptoms, diagnosis, and treatment options for these conditions. They also touch on pre-treatment strategies and the use of portable hyperbaric chambers. Overall, the conversation provides a comprehensive overview of altitude-related illnesses and their management. In this conversation, Dennis and Ian discuss the treatment options for altitude illness, specifically AMS, HAPE, and HACE. They cover the use of pharmacologic therapy, oxygen, and portable hyperbaric chambers to stabilize and bring down patients with altitude illness. They also discuss the use of dexamethasone as the primary treatment for HACE and the potential use of hypertonic saline for extreme cases. They touch on the side effects of dexamethasone and the importance of protecting the airway. They also mention the use of acetazolamide for prophylaxis and the benefits of intermittent hypoxic exposure. Finally, they discuss the importance of good nutrition and hydration and the new medic encounter form for recording data on altitude illness. Takeaways: Acute mountain sickness (AMS) occurs when the body does not have enough time to acclimatize to the physiological stress of altitude. High altitude cerebral edema (HACE) is characterized by ataxia and can occur even without AMS symptoms. High altitude pulmonary edema (HAPE) is characterized by decreased exercise tolerance and tachypnea. Assessment of vital signs, such as heart rate and respiratory rate, can help differentiate between altitude illnesses. Portable hyperbaric chambers can be used to stabilize patients with altitude illnesses until they can be brought down to lower altitudes. Pharmacologic treatments, such as acetazolamide and dexamethasone, can be used for prophylaxis and treatment of altitude illnesses. Improvement in symptoms of HAPE can be rapid with oxygen therapy. Pre-treatment strategies, such as using acetazolamide, can help acclimatize the body to altitude before ascent. Pharmacologic therapy, oxygen, and portable hyperbaric chambers can be used to stabilize and bring down patients with altitude illness. Dexamethasone is the primary treatment for HACE, and hypertonic saline may be considered for extreme cases. Side effects of dexamethasone include increased sugar, gastric erosions, gastric bleeding, and adrenal suppression. Acetazolamide can be used for prophylaxis, and intermittent hypoxic exposure may help with acclimatization. Good nutrition, hydration, and iron status are important for preventing altitude illness. The new medic encounter form is a valuable tool for recording data on altitude illness. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care

In this podcast episode, Jay Baker discusses the topic of SOF surgical support in Special Operations Forces (SOF). He compares the different types of missions that soft surgical teams might be called upon to support and describes the gap that exists in institutional experience for surgical support in the setting of unconventional warfare. Baker highlights the lessons learned from surgical support in World War II and emphasizes the need to prepare for providing surgical support in more challenging environments. He also discusses the efforts being made to improve soft surgical support, including the development of RSOF surgical teams and the Prolonged Field Care initiative. Takeaways Sof surgical support in Special Operations Forces (SOF) is an evolving problem set that requires preparation for providing surgical support in more challenging environments. Lessons can be learned from surgical support in World War II, where surgeons provided care in dangerous and challenging environments. Efforts are being made to improve soft surgical support, including the development of RSOF surgical teams and the Prolonged Field Care initiative. Training and experience in caring for critical patients over longer periods of time, performing tactical evacuations, and developing innovative solutions to resupply challenges are important for soft surgical teams.

Maggot therapy, also known as maggot debridement therapy (MDT), is a treatment that uses live maggots to clean and heal wounds. The therapy has a long history, dating back thousands of years, and has been used in various settings, including war zones and modern hospitals. Maggots are effective in wound healing because they eat necrotic tissue, have antimicrobial properties, and promote the growth of new tissue. The therapy is cost-effective and can be used in low-resource settings. It can be applied directly to the wound or placed in a mesh bag. Maggot therapy is often used as an adjunct to antibiotics and other wound treatments. Takeaways Maggot therapy is a cost-effective and efficient treatment for wound healing. Maggots eat necrotic tissue, have antimicrobial properties, and promote the growth of new tissue. The therapy can be used in various settings, including war zones and low-resource environments. Maggot therapy can be used as an adjunct to antibiotics and other wound treatments. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care

Exploring the use and significance of End-tidal CO2 monitoring in medical practice, particularly for trauma patients and those with severe traumatic brain injuries. Emphasizing the role of ETCO2 in confirming endotracheal tube placement and monitoring ventilation during surgery. Stressing the importance of clinical judgment in conjunction with ETCO2 monitoring for comprehensive patient care. Discussing the value of other resuscitation markers, such as lactate levels, in certain scenarios.

In this episode, Dennis interviews John and Paul about the Abdominal Aortic and Junctional Tourniquet (AAJT). They discuss the background and reasons for inventing the AAJT, including the need to control bleeding in the pelvis. They also talk about the first application of the AAJT and the positive results seen in combat situations. The conversation then moves on to study data and research on the device, including some negative studies that have been conducted. They also discuss the pressure levels used with the AAJT and the potential for extending the application time. Finally, they address the negative consequences of high pressure and the comfort level of wearing the device. The conversation explores the application and function of the Abdominal Aortic Junctional Tourniquet (AAJT) and its potential use in pre-hospital care. It discusses the challenges of prolonged application and the risks associated with it. The conversation also delves into alternative techniques and future developments in the field. The importance of reperfusion and monitoring is highlighted, along with the impact of the AAJT on breathing and inspiratory pressure. The discussion touches on the considerations for reducing pressure during reperfusion and the duration of application. The risk-benefit analysis of heroic interventions is examined, emphasizing the need for rapid hemorrhage control. The limitations and risks of Roboa are discussed, and a cadaveric study on the AHAT is presented. The conversation concludes with the role of the AHAT in preparing for future wars and its potential use in traumatic cardiac arrest. Takeaways The AAJT was invented to control bleeding in the pelvis and junctional areas. The device has been successfully used in combat situations and has saved lives. There have been several studies conducted on the AAJT, with mixed results. The device applies pressure to occlude blood flow, but the pressure levels are safe and well-tolerated. The Abdominal Aortic Junctional Tourniquet (AAJT) is a fielded device that can be used for rapid hemorrhage control in non-compressible torso hemorrhage. Prolonged application of the AAJT should be avoided, and it is important to consider the risks and benefits of its use. Alternative techniques and future developments, such as foams, are being explored for the treatment of non-compressible torso hemorrhage. Reperfusion and monitoring are crucial considerations when using the AAJT, and the pressure can be reduced during transfusion to mitigate ischemic change. The AAJT has shown promising results in traumatic cardiac arrest and can be a valuable tool in pre-hospital care. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care

In this podcast episode, Dennis and Ian discuss heat injuries and illnesses. They cover the background science of body heat and heat transfer, as well as the different types of heat injuries, including heat cramps, heat syncope, heat exhaustion, and heat stroke. They emphasize the importance of hydration and urine color as indicators of hydration status. The treatment for heat stroke involves cooling the body as quickly as possible, with immersion in ice water or the use of ice sheets being the most effective methods. They also discuss the importance of acclimatization to heat and the need for prompt evacuation in cases of heat stroke. Takeaways Heat injuries and illnesses can range from minor heat cramps to life-threatening heat stroke. The body dissipates heat through radiation, conduction, convection, and evaporation. Hydration is crucial in preventing heat injuries, and urine color can be used as an indicator of hydration status. Heat stroke is a medical emergency that requires immediate cooling of the body. Acclimatization to heat and proper planning can help prevent heat injuries. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care

In this episode, Dennis and Alex discuss the truth about pelvic binders and their relevance in trauma care. They explore the background and experience of Alex, who has extensive knowledge in trauma surgery. They delve into the anatomy and injury patterns of pelvic fractures, as well as the different phases of damage control surgery. They also discuss the importance of understanding research and the levels of evidence. The conversation highlights the contradictory evidence surrounding the use of pelvic binders and emphasizes the need to critically evaluate citations and research findings. This conversation covers blast injuries, types of pelvic fractures, mortality rates, considerations for prolonged field care (PFC), the flow of care in PFC, normalization and observation, initial stabilization, massive transfusion protocol, futile transfusions, clinical decision making, pelvic binder design, imaging challenges, ultrasound for pelvic fracture assessment, duration of pelvic binder use, preventing pressure sores, consulting with medical professionals, proper application of pelvic binder, retroperitoneal hemorrhage, the role of telemedicine, critical care and decision making, and resources for further learning. Takeaways Understanding the anatomy and injury patterns of pelvic fractures is crucial in trauma care. The levels of evidence in research range from high-quality studies to expert opinions. The use of pelvic binders in trauma care is a topic of debate, with conflicting evidence and opinions. It is important to critically evaluate citations and research findings to make informed decisions in patient care. Understanding blast injuries and the different types of pelvic fractures is crucial in providing effective care in PFC. Mortality rates for pelvic fractures vary depending on the severity of the injury and associated injuries. Clinical decision making in PFC requires a thorough understanding of the patient's condition and available resources. Proper application and duration of pelvic binder use are important considerations in PFC. Consulting with medical professionals and seeking skeptics' opinions can help in making informed decisions in PFC. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care

In this podcast episode, Dennis and Ricky discuss how to pick and evaluate research papers to inform medical practice. They differentiate between causative research papers and retrospective observational studies, emphasizing the importance of reading the methods section to determine the validity of the research. They also highlight the common mistakes people make when reading research papers, such as relying solely on the title and abstract. The conversation delves into the challenges of conducting pre-hospital research and the difficulties in applying research findings to practice. Ricky also shares his experiences in mentoring aspiring medical school applicants and launching a new podcast.Takeaways Differentiate between causative research papers and retrospective observational studies when reading research papers. Read the methods section to determine the validity of the research and understand the inclusion and exclusion criteria, statistical analysis, and potential biases. Avoid common mistakes when reading research papers, such as relying solely on the title and abstract. Consider the challenges of conducting pre-hospital research, including data collection and controlling for environmental factors. Extrapolate research findings to pre-hospital practice by discussing and collaborating with other providers. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠ or ⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠