The PJ Med Director and the PJ Medical Programs Manager discuss Ten key changes to the new handbook.

The handbook is being formatted and then out for print with the Journal of Special Operations Medicine.

DO NOT INSTITUTE THESE UNTIL THE HANDBOOK IS RELEASED OR YOUR FLIGHT DOC DIRECTS YOU TO.

1. Updated MARCH assessment to align w/ JTS TCCC guidelines
   1. Moved pelvic binder to circulation, specified how/how not to assess pelvis
2. Combat/Hemorrhagic Shock and blood protocol
   1. TXA – 2gm (1 minute slow IV push)-also used for suspected TBI
   2. cold stored type 'O' whole blood>fresh low titer-'O' whole blood >PRBCs and plasma>plasma alone>PRBCs alone>non-titered type ‘O’ fresh whole blood>non-titered type specific fresh whole blood
   3. added 10mL of 10% calcium gluconate
3. “bougie assisted cric” method
4. Added vent troubleshooting and adjustment guide
5. General fluid guidance
   1. Omitted Hextend
   2. LR is primary crystalloid for non-hemorrhagic shock casualties (may still carry 100CC for med recon)
   3. Removing 3% Saline (see TBI protocol update)
6. TBI
   23. Replaced 3% Saline with 30mL of 23.4% hypertonic saline (learn the technique first)
   24. Versed for active seizures, Keppra for prophylactic (depressed skull fx/penetrating head wounds)
7. Procedural Sedation
   1. Replaced procedural analgesia w/ procedural sedation and provided protocol
   2. No longer promoting ketamine/fentanyl/versed rotation
      1. Dilauded f/ long term pain control in hemodynamically stable
      2. Ketamine for unstable
   3. Medications added to formulary to support ATP small unit care capability/modified TMEPS
      1. Famotidine (Pepcid) – Zantac replacement
      2. Amoxicillin
      3. Azithromycin
      4. 1% Hydrocortisone cream
      5. Metronidazole (Flagyl)
      6. Malarone/primaquine
      7. Ciprofloxacin
      8. 4% saline
   4. Medications removed
      1. Albumin
      2. Ranitidine (Zantac)
   5. CBRNE updates
      1. Added CRESS acronym (Consciousness, Respirations, Eyes, Secretions, Skin)-NATO method
      2. Added MARCH Squared
      3. Updated Cyanide Antidote
         1. Hydroxycobalimin, Sodium thiosulfate and activated charcoal

Doc Dorsch then gives us an ATP update amongst other intel.

THAT OTHERS MAY LIVE

Insightful discussion with Brian and Aaron from Ones Ready. Hear about the podcast and insights from their careers and time at A & S.

Support our Operators at: PararescueFoundation.org

Follow instagram pjrqmed, and on the internet at pjmed.com

THAT OTHERS MAY LIVE

CAPT (RET) Butler received this award from the American College of Surgeons.

Thanks for pushing this podcast over 1 million downloads!

Think of krazy / super glue for painful cracks in the heels and around nail beds.

THAT OTHERS MAY LIVE

PJ Jon discusses the mission, stroke and it relevance to sTBI management.

THAT OTHERS MAY LIVE

This discussion represents an excellent primer into how ketamine and fentanyl are interacting with the brain.

Thanks to Dr Perusine and for her work at neurovationlabs.com

Dr Jen Perusini explains her discovery with the labs she has worked at on some of the basic brain biochemistry of PTSD. She discusses basic science research establishing localization of increase in distinct pathways in the fear center of the brain, the amygdala.

I am posting this unusual basic science discussion because Dr Persuini explains it a meaningful way. She discusses where they are in the effort to begin human clinical trials. In discovering the the possible mechanistic target for PTSD, they are able to begin to craft a trageted therapeutic response. Hear about the promising work Dr Perusini is doing on behalf of our Warriors.

It covers information that is the prelude to next weeks podcast re: some of the actions related with ketamine and fentanyl.

Find out more:

neurovationlabs.com

THAT OTHERS MAY LIVE

Chris discusses providing extremely remote medical support in up to 80-100 degrees below zero.  Med planning, Evac, etc.

The program is through the University of Texas Medical Branch and the Center for Polar Medical Operations. They support the National Science Foundation.

Note- Chris is not officially representing the Univ of Texas or in any other official capacity. He is sharing his experience and letting our community know about this unique contracting opportunity.

Find info at :

https://www.utmb.edu/polar

THAT OTHERS MAY LIVE