In this episode, Dennis and Brad discuss the use of fentanyl in medical settings. They provide an overview of the background and development of fentanyl, highlighting its reliability and predictability as an opioid. They explain the characteristics and benefits of fentanyl, including its rapid onset, peak effect, and short duration. The conversation also covers the side effects and considerations of fentanyl, such as respiratory depression and histamine release. The appropriate administration and dosage of fentanyl are discussed, along with its use for sedation and procedures. The use of fentanyl lollipops and patches is explored, as well as the importance of proper administration and monitoring. The episode concludes with final thoughts on the use of fentanyl and the need for further education and understanding of its use. In this conversation, Brad discusses the use of ampules for protection in combat medicine. He explains various methods of using ampules and emphasizes the importance of protecting them. The conversation concludes with Dennis providing closing remarks and directing listeners to the Prolonged Field Care website and social media channels. Takeaways Fentanyl is a reliable and predictable opioid with a rapid onset, peak effect, and short duration. It is important to understand the side effects and considerations of fentanyl, such as respiratory depression and histamine release. Fentanyl is commonly used for pain control and sedation, and it is particularly effective in trauma scenarios. Proper administration and dosage of fentanyl are crucial, and it is important to monitor patients closely for respiratory depression. Fentanyl lollipops and patches have specific uses and considerations, and their administration should be carefully managed. Ampules can be used in various ways for protection in combat medicine. It is important to protect ampules to ensure their effectiveness. Listeners are directed to the Prolonged Field Care website and social media channels for more information. 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

Dennis is interviewing Dr. John Quinn who's on the ground working Role 1 medical operations for an NGO somewhere in Ukraine. The lessons being learned by John and others during the early days of this conflict and the past 8 years can be used to help those on the ground now and into the future. This is an amazing opportunity to stay informed of current events and prepare ourselves by narrowing expectations and tweaking training. During the interview John stated that anything that can be done to further enable FWB availability and knowledge would be greatly appreciated. In particular, when asked what we could translate, he asked for: Damage Control Resuscitation guidelines to be translated, Prehospital Blood guidelines, anything on Damage Control Surgery for non-surgeons (they have a lot of OB/GYNs and others like OMFS functioning as DCS surgeons at Role 2s). He also stated that they're seeing a TON of TBI "walking wounded" and anything on mild to moderate TBI management would be great. When asked about a trauma registry, John stated that the Ministry of Health is attempting to catalogue all civilian casualty numbers. The Ministry of Defense is VERY close-hold with any info and it would be very hard to elicit the ground-truth there for the time being. John stated that many organizations are using the TCCC cards and all documentation is trying to be written in BOTH Ukranian and English, due to the large number of non-native providers helping in country. They LOVE the DeployedMedicine app, the translation of TCCC and Emergency War Surgery and absolutely look to US and NATO standards of 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

Today, I'm joined by Rick, a senior medic with 18 years of experience in AFSOC and the Green Berets. We dive into lessons learned from mass casualty events, focusing on reactive and proactive scenarios. Rick recounts a harrowing mission in Eastern Afghanistan, where planning mishaps led to a challenging situation. They had to adapt on the fly, dealing with casualties and limited resources. Rick emphasizes the importance of improvisation, quick thinking, and knowing your available assets. He also discusses the need for effective communication and maintaining composure in high-stress situations. A must-listen for anyone in the field. 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

Merry Christmas...Today, we're diving into the nitty-gritty of ketamine – that mind-bending stuff, you know? So, ketamine's like this receptor blocker, messing with your brain's signals. It's a mixed bag, really. In low doses, it kills pain like a champ. But crank it up, and bam! You're in a world of dissociation. Picture it: brain's top half talking gibberish with the bottom half, and you're floating in a weird dream world. 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

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This Podcast was from June of this year. This is Dennis, and today I'm joined by Anri, a Ukrainian medic who will share some lessons learned from the battlefield. Anri talks about how wound patterns change in urban versus rural areas, with urban areas having more trauma from shrapnel and secondary trauma from debris. He mentions the challenges medics face in treating these complex wounds, including fractures and extensive tissue damage caused by multiple waves of explosions. Anri also discusses the impact of seasonal variations and the difficulties in evacuation due to artillery shelling, long distances, and the use of unconventional methods by the enemy. He emphasizes the importance of adapting medical techniques, such as splinting and triage, to the unique conditions on the front lines. Anri also mentions the use of blood products, saline, and telemedicine for prolonged field 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

In the latest episode of the PFC podcast, I spoke with Evan and Doug about airway management. As experienced airway takers in both pre-hospital and hospital settings, they had some valuable insights. We discussed the controversy over intubation versus cricothyrotomy. Evan and Doug raised some valid points, such as the need for suctioning and the difficulty of obtaining post-intubation sedation medication in resource-limited environments. We also talked about the importance of ongoing training to maintain skills and the need for better difficult airway education in training programs. Overall, it was a great discussion. 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

In today's podcast, I chat with Aebhric OKelly the founder and Dean Emeritus of the College of Remote and Offshore Medicine (COROM) about Improvised medicine. I will be the first to say, as cool as it is to learn Improvised techniques, this is an emergency plan, not a way to lighten your ruck. We run through items for MARCH and principles to apply to this problem. This is only part one, so plenty more in the next episode, when we go through PFC and improvised gear. 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

Dennis and Kevin Worth talk about combat anesthesia. The podcast discusses the four pillars of anesthesia, which are amnesia, analgesia, akinesia, and autonomic stability. The focus is on the importance of autonomic stability in combat situations. The best medication for amnesia in a downrange environment is Midazolam or Versed, and ketamine is a potent analgesic. The podcast also covers the MAP (mean arterial pressure) and how to maintain it in trauma patients. Finally, the podcast discusses various scenarios that require different types of sedation or analgesia, including the administration of fentanyl or calcium. 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

Now, let's dive into treating tension pneumothorax. Joined by Andy Fisher, our favorite surgery resident and social media provocateur. We're talking IFAC essentials and the needle decompression debate. Andy's been stirring the pot, suggesting ditching Needle D's from the IFAC due to lack of official backing. The IFAC's about saving lives for non-medics, but is it hemorrhage, not tension, we should focus on? Special ops pushed decompression needles, but is it justified? Andy questions the success rate of needle decompressions and suggests focusing on actual tension physiology. Training rush may play a role. Is sticking needles in pre-emptively smart? Well, let's focus on true tension signs instead. I mention tension either shows up or it doesn't, and hemodynamic changes trigger action. Thoracic trauma, mostly hemothorax, outweighs tension pneumothorax deaths. Andy, if king for a day, would adjust chest injury treatment. Surgical insights, plain talk, only on the PFC podcast. 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

For the rest of the month, every Mon, Wed, and Fri, I will be posting the top 10 podcasts of '23. I will resume with the regular schedule on New Year's Day. Happy Holidays. This podcast discusses the importance of patient positioning in prolonged field care. The guest, Ethan Miles, a board-certified family medicine physician with extensive military experience, emphasizes that patient positioning is a forgotten aspect of medical training and that simple, low-cost interventions are often overlooked. Miles states that patient positioning is especially crucial in prolonged field care and can help in treating patients with traumatic brain injury, manage airways, and improve oxygenation. However, patient positioning can also have downsides, such as orthostatic hypotension, and should be reassessed regularly. Miles suggests that improvised things can also work well when pre-made things are unavailable. 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

Dennis discusses MDMA therapy for PTSD with guest Emily, a pharmacist. They explore how MDMA is being researched as a treatment for combat-related PTSD, especially when conventional medications like SSRIs and SNRIs fall short. MDMA offers a unique approach by providing stimulating effects while fostering empathy and helping patients reprocess traumatic memories. Emily emphasizes the importance of integration in therapy. Clinical trials have shown promising results, with 67% of participants achieving remission from PTSD. The episode also touches on the challenges and progress in getting MDMA therapy approved and accessible to patients. 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

Dr. Givens talks about dealing with CBRNE patients in the field. They discuss the need for standardized approaches and clinical guidelines. I'm all about simplifying things and making them user-friendly. The hot zone requires quick thinking and auto injectors for CBRNE agents. They emphasize the importance of TCCC and teamwork. Dr. Givens covers various agents like nerve agents, cyanide, chlorine, and more, offering practical insights for handling them. 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

"Correction: The correct initial dose of lipid emulsion is 1.5mL/kg, not 1 mL/kg" Dennis interviews Sandeep, an anesthesiologist with military experience, about the use of IV lidocaine for acute pain management. Sandeep explains that IV lidocaine can be a useful opioid-sparing option, especially in austere environments with limited resources. While it has a narrow therapeutic window, proper dosing can provide analgesia and reduce opioid consumption. Sandeep emphasizes the importance of safety considerations, including patient selection and monitoring for side effects. He also discusses the potential benefits in the context of trauma and surgery. Overall, IV lidocaine could be a valuable tool when managed carefully in the field. 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

Dennis hosts two special guests, Stacy Shackelford and Doc Rush, to discuss rethinking triage. They emphasize the need for a shift in the way medics are trained and how triage is approached. They challenge traditional triage algorithms and encourage a more flexible, data-driven approach that prioritizes time-sensitive interventions such as hemorrhage control and airway management. The conversation also touches on the importance of training medics in trauma care, the role of team leaders in risk management, and the need for preparation and rehearsal in managing large-scale casualties. Ultimately, they stress the importance of sticking to basic principles while being prepared to adapt in dynamic situations. 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

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Dennis and guest Jeff Siegler, an assistant professor of emergency medicine, discuss the use of ketamine in managing status epilepticus. Status epilepticus is a prolonged seizure lasting more than five minutes, which can be life-threatening. They explore the challenges of treating seizures in the field and the role of benzodiazepines in initial treatment. Ketamine, while generally considered an excitatory drug, is being studied as a potential option when seizures become refractory to standard treatments. The podcast highlights the need for further research and individualized care plans while considering the limitations of pre-hospital settings and state regulations. 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

Dennis and guest Shawn McKay discuss the basics of confined space rescue. They touch upon the importance of understanding the environment and potential risks, the need for monitoring equipment, and the selection of the right personnel for specific tasks during rescue operations. They also mention the relevance of NFPA standards and the importance of choosing appropriate equipment. The conversation emphasizes the significance of training and preparedness in handling complex rescue situations. 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

Dennis and Brad discuss the use of Nubain, also known as Bufene. Nubain is a non-controlled narcotic that was FDA-approved in 1979 and gained popularity in the 1980s and 1990s. It is similar in strength to morphine but lacks some of its side effects like respiratory depression. Nubain's unique properties include its ability to reverse itching caused by other narcotics and its use as an adjunct to ketamine or other pain management drugs. Dennis emphasizes the importance of monitoring respiratory rates and adjusting doses accordingly. Overall, Nubain is a valuable tool for managing pain in a field environment. 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

Jay Baker, a brigade surgeon with limited special operations experience, discusses the evolving landscape of surgical support in Special Operations Forces (SOF). He highlights the differences between traditional trauma care provided during the Global War on Terror and the potential challenges of unconventional warfare. Drawing from historical examples of surgeons supporting resistance movements in World War II, he emphasizes the need for adaptable and resourceful surgical teams capable of extended missions in hostile environments. Baker also discusses the concept of prolonged field care (PFC) and the development of SOF surgical teams to meet future mission requirements. 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

Dennis and Josh discuss ventilator training on the PFC Podcast. Josh, a former ranger medic now working in a level one ICU, shares insights. They emphasize the importance of proper ventilation in the field and address common mistakes, like setting inappropriate rates that lead to patient agitation. Josh advises cautious opioid use, balancing sedation with patient needs. They delve into adjusting PEEP, flow, and waveform, emphasizing patient synchronization. Josh highlights the significance of addressing pain, resuscitation, and lung disease simultaneously. He clarifies end-tidal CO2 readings and the role of kidneys in metabolic acidosis. Josh also stresses IV maintenance and patient assessment. 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

Dennis and Doug discuss the fundamentals of ventilatory management in trauma cases. They emphasize the distinction between the need for an airway and the need for a ventilator. Patients requiring an airway may have issues like swelling or trauma obstructing their airway, while those needing a ventilator typically have respiratory failure. They explain the importance of monitoring compliance, tidal volume, minute ventilation, and peak and plateau pressures. Additionally, they touch on the importance of supporting blood pressure during intubation and the need for continuous resuscitation in trauma cases. 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

Dennis interviews Thomas Trust Have, a former Danish Special Forces operative turned doctor, discussing the challenges of providing medical care in Arctic environments. Thomas emphasizes the extreme conditions, highlighting a hypothetical scenario involving a special operations team enduring frigid temperatures and harsh winds. He underscores the importance of preparation, teamwork, and proper gear in these situations. Thomas also addresses medical considerations such as tourniquet use, fluid warming, and the complexity of providing care in cold conditions. The episode sheds light on the unique challenges faced by healthcare providers in remote, freezing environments. 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

In today's episode, we're diving into the topic of tourniquet conversion. With conflicts happening globally, it's crucial to understand the difference between tourniquet conversion and replacement. Conversion means finding an alternative to control bleeding when the tourniquet is no longer needed. Replacement involves swapping a tourniquet for a more effective one. Conversion timing depends on the tactical situation and patient's resuscitation status. You should consider resuscitating the patient before converting, ensuring they're warm, non-coagulopathic, and ideally have a systolic blood pressure above 90. Science-wise, the two-hour rule may have originated from studies in cooler environments. Converting tourniquets in austere settings requires confidence and proper patient assessment. Crush syndrome, re-bleeding, and metabolic changes can be concerns when converting tourniquets. Use bicarb cautiously to mitigate potential acidosis. Calcium can also help, but pay attention to the specific calcium source and dosing. The goal is to save lives while minimizing limb loss. 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

Today, we're diving into the crucial topic of medical contingency planning. Evan and I discuss the importance of planning for medical emergencies in various scenarios, emphasizing that timely evacuation is often more effective than improvised solutions. We stress the significance of conducting thorough risk assessments, considering factors like location, climate, endemic diseases, and enemy threats. It's essential to evaluate local healthcare resources and potential evacuation options, even in remote areas. We debunk the idea of one-size-fits-all pace plans, emphasizing that planning should be proportionate to the situation's criticality. We also highlight the need for rehearsals and practical evaluations to uncover plan weaknesses. Lastly, we advise against overloading aid bags with unnecessary supplies, and we stress the importance of adapting to the circumstances, keeping in mind that helicopters may not always be available. Remember, preparation is key, and flexibility is vital in ensuring the success of your medical contingency plans. 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

Dennis hosts a discussion with various military medics. They explain the role of Special Operations Forces (SOF) medics, emphasizing their training and responsibilities. Each guest represents different SOF units, such as Rangers, Navy SEALs, and Special Forces. They discuss the extensive training, medical capabilities, and the need for trust and support from other team members and medical professionals. The conversation highlights the unique challenges SOF medics face, as they often operate in austere environments with limited resources. Overall, the podcast sheds light on the crucial role these medics play in the continuum of patient care during missions. Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective

In this podcast, Dennis discusses cold weather injuries, particularly frostbite and non-freezing cold injuries like trench foot. He highlights their historical significance, citing examples from military campaigns. Prevention is emphasized, including proper clothing, buddy checks, and staying hydrated. Dennis explains the stages of frostbite, the importance of rapid rewarming, and the risks of refreezing or overheating. He also mentions the Kachi classification system to assess severity. Antibiotics aren't used prophylactically, and debridement is avoided. Dennis concludes by stressing the need for prompt treatment and staying vigilant for symptoms, especially in cold, wet conditions. 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

Dennis welcomes his friend Pac to discuss S-Ketamine. Pac, an anesthetist with extensive experience, shares insights on using S-Ketamine in various medical settings. He highlights its potential advantages, such as improved analgesia and reduced hallucinogenic effects in mid-doses. They discuss its use in austere environments, especially during military operations, and Pac emphasizes the importance of adapting dosages based on transportation methods and patient conditions. They touch on the role of ketamine in managing seizures, refractory seizures, and its potential benefits for asthmatic patients. The podcast provides valuable insights into ketamine's applications in medical 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

Welcome back to the PFC Podcast. Mark and I chat about feeding the critically ill. Now, look, when you're done stitching folks up and pumping them with antibiotics, there's a point you'll need to feed them. Mark shed light on how crucial nutrition is, whether you're in a remote outpost or a high-end trauma center. Nutrition aids in healing, plain and simple. We dove into the nitty-gritty – feeding patients with head injuries, burns, and other nasty stuff. And hey, feeding ain't just about the belly. Got a tube? Use it wisely. Remember, everything we do has its ups and downs. But, here's the deal, the human body, is just trying to get back to square one. Lastly, be mindful of that re-feeding syndrome - it's nasty. Bottom line? Understand your patient, feed smartly, and keep learning. 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

Today, we've got Brett, a paramedic legend from El Paso County Search and Rescue. The mountains? Tricky business. One moment it's beach weather, the next it's a frigid winter wonderland – and that’s in the summer! Know what you're packing; it's not a weekend getaway! And those space blankets? Not the lifesavers you might think. Weight's your enemy up there, but be smart. And remember, it's not just about the med kit; weather's unpredictable, avalanches are sneaky, and a good medic knows that it’s not always about the medicine. 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

Today, on the PFC Podcast, we dived deep into altitude illness with the experienced Dr. Moon from Duke University and Patrick O'Boyle, a senior medical instructor. Dr. Moon's been to Everest Base Camp, studies altitude physiology, and works with the Navy. He shared that altitude illness, including symptoms like nausea, vomiting, and insomnia, is not fully understood. The dangerous forms like cerebral edema (brain swelling) and pulmonary edema (fluid in lungs) can be deadly. Rapid altitude changes and the body's reaction to lowered oxygen levels play a role. If you're feeling symptoms, descend ASAP and administer oxygen if possible. And folks, while some meds can help, the real gold standard is descending and getting to a safer altitude. That's altitude illness in a nutshell. 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

Here's the lowdown from the PFC Podcast episode 150 with Dennis and Alex, diving into ETCO2. Dennis chats with Alex, who's had a colorful career, from being a 68 Whiskey and a paramedic to now working with Massimo. They discuss the Emma capnograph, a handy gadget that monitors exhaled CO2. It's essential to keep everything sealed, or the readings might be off. The device runs on batteries with different lifespans, depending on the type. Calibration? It's a must, but hold the buttons longer than feels right, or you might mess it up. This tool can be a lifesaver, giving insights into cardiac output and more. Just remember, if you're seeing weird numbers, there might be leaks or other issues. It's a nifty piece of kit but, like all tools, make sure you familiarize yourself with it outside of emergencies. 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

Bryce joined the podcast to share insights on training non-medics. Why bother? Well, Bryce emphasized the value of cross-training within teams. While it's not always easy to motivate folks to grasp medical tasks, it's a lifesaver. Literally. The key? Make it competitive! And remember, it's not just about the skills, but the trust built within the team. If teammates can handle tasks without needing constant supervision, it makes everyone more effective. But, it's not just about having a skill; understanding the 'why' is crucial. Bryce's advice to new medics? Be good at your job, and immerse yourself in continuous learning. Get out of the office and train. It's all about being proactive and ensuring everyone's prepared for any situation. 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

This is part 2 of our 2.5 hour conversation with Aebhric OKelly the founder and Dean Emeritus of the College of Remote and Offshore Medicine (COROM) about Improvised medicine. I will be the first to say, as cool as it is to learn Improvised techniques, this is an emergency plan, not a way to lighten your ruck. We run through items for PFC when the gear starts running out. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org

Today, we're diving deep into pneumothorax and hemothorax. Pneumothorax can quickly become an emergency, especially when it's not about the pressure but the declining SPO2. But where's the line between tension and hemothoraces? Our ICU doc expert clarifies that it's all about the impaired blood return to the heart. When your preload drops, it affects the cardiac output. If vitals are stable, though, it's not tension physiology. Also, did you know there are folks walking around with untreated pneumothoraces? The literature suggests only treating those affecting over 30% of the thoracic cavity. And, oh boy, many pneumothoraces come from trauma, but spontaneous cases exist. Especially with COVID, the lung scarring has made things fragile. Add trauma and narcotics, and things can get dicey. But remember, before deciding to treat a pneumothorax, be sure it's the right move. Better safe than sorry! 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

Today's podcast is part one of a 2.5 hr chat with Aebhric OKelly the founder and Dean Emeritus of the College of Remote and Offshore Medicine (COROM) about Improvised medicine. I will be the first to say, as cool as it is to learn Improvised techniques, this is an emergency plan, not a way to lighten your ruck. We run through items for MARCH and principles to apply to this problem. This is only part one, so plenty more in the next episode, when we go through PFC and improvised gear. 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

Now, let's dive into treating tension pneumothorax. Joined by Andy Fisher, our favorite surgery resident and social media provocateur. We're talking IFAC essentials and the needle decompression debate. Andy's been stirring the pot, suggesting ditching Needle D's from the IFAC due to lack of official backing. The IFAC's about saving lives for non-medics, but is it hemorrhage, not tension, we should focus on? Special ops pushed decompression needles, but is it justified? Andy questions the success rate of needle decompressions and suggests focusing on actual tension physiology. Training rush may play a role. Is sticking needles in pre-emptively smart? Well, let's focus on true tension signs instead. I mention tension either shows up or it doesn't, and hemodynamic changes trigger action. Thoracic trauma, mostly hemothorax, outweighs tension pneumothorax deaths. Andy, if king for a day, would adjust chest injury treatment. Surgical insights, plain talk, only on the PFC podcast. 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

Welcome back, folks! Had a chat with Ephraim Matto, who's seen the thick of things in Burma. He spent the last six months there, amidst security crises and medical emergencies. Burma's ethnic minorities are resisting subjugation, and the mountainous borders provide relative safe areas. Still, things are pretty dire. On top of internal conflicts, there's interference from the Russians and Chinese. On the medical front, there's a dire need. His crew operates ambulances and boats to get folks the care they need, and of course, the logistics! The rainy season and challenging terrain make things tough. Tragically, the Burma army isn't holding back. Just recently, 17 villagers, including children, were brutally murdered. It's heavy stuff, and the situation demands attention. 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

Let's cut to the chase about field blood transfusion. Dr. Andrew Cap came on the PFC Podcast to drop some knowledge. We talked about a high-stakes op in Afghanistan where two soldiers suffered intense injuries. First patient? Lost both legs and showed clear signs of shock. Second guy? Shot in the gut and leg, started strong but slowly faded out. Dr. Cap then gave us the rundown on resuscitation. Key points: control bleeding first, whole blood is the MVP for treatment, but sometimes, there ain't enough to go around. So we talked alternatives like starches and crystalloids. However, normal saline? Originally for cholera, not ideal for trauma. Oh, and calcium plays a bigger role than you might think. TXA? Super useful for clot stability, but blood circulation's the real deal. Prioritize, act fast, and always be prepared to adapt. 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

Today's episode, is all about "Versed." We've got Kevin and Paul here, chatting about patient positioning and the intricacies of using Versed, a benzodiazepine, for sedation. They touch on how different patients react to the drug, emphasizing the art of medicine over strict calculations, especially in challenging scenarios. The podcast delves into dosing strategies, dealing with hemodynamically unstable patients, and the complexities of maintaining sedation during procedures. Remember, every patient is unique, so adapt the approach accordingly. 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

Today, I'm chatting with Colin about the new Prolonged Fieldcare Airway CPG. Basically, it's a guideline for managing airways in tough situations. Colin's a special ops medic and he helped put this thing together. CPGs are like gold for medics, so Google "PFC CPG" for info. Airway's vital, but sometimes overlooked. We're diving into the details, from procedures to training. It's not just about sticking a tube in; it's a whole process. Training's key – keep practicing. Units need to back it up too. 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

Welcome back to the PFC podcast! Today, it's Dennis here with Casper and Paul. We're discussing a leadership tool called the Tactical Timeout, which helps teams ensure everyone is on the same page. Casper, a NATO Special Operations combat medic, gives a shout-out to the timeout used in the medical community, ensuring correct procedures. Using the Tactical Timeout, they discuss the tactical situation, security, and evacuation plans, ensuring efficient shift changes and patient updates. It fosters cohesion, especially with non-medical personnel. Dennis emphasizes the importance of contingency planning and clear communication, while Paul urges junior medical team members to ask questions to avoid confusion. Stay tuned for more on the PFC podcast! 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

Kevin schools me up on Ketamine and it's use in the field.

Hey there, it's Dennis from the Prolonged Field Care Podcast, episode 144. Today, Winston and I dive into pain pathways. You know, those definitions of pain like visceral or psychogenic, they've never helped me treat pain practically. So, understanding the nervous system might just boost my pain management skills. The pain pathway consists of transduction, where energy turns into nerve impulses, ascending pathways, spinal cord travel, brain processing, and descending pathways. Remember, understanding the whole system aids better pain management. 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

Today, I'm joined by Brad, a former special operations medic and instructor, to talk about a harrowing experience during a night raid in Afghanistan. They faced a barricade shooter situation and multiple casualties. Despite the danger, their medical training and preparedness shone through. Brad emphasizes the importance of casualty training and incorporating it into every mission. They stress the need for repetition and selecting the right equipment for efficient treatment. The podcast covers various medical aspects, and Brad commends the use of 16-gauge catheters and pressure infuser pumps for better blood flow and control. Remember, be prepared, train well, and stay on the bleeding edge of combat medicine! 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

Welcome back to the PFC Podcast. Today, we've got Regan on the show discussing her thesis on unconventional medical networks. She's an emergency medicine physician with extensive experience in special operations and unconventional warfare scenarios. Her thesis delves into the difficulties in the establishment and operation of medical networks in challenging environments. They explore historical examples like the Yugoslavian resistance, highlighting the importance of proximity to the frontline and adaptability. Regan emphasizes the need for cognitive agility and understanding local resources when providing medical aid. Cooperation with allies and partners is vital for interoperability and empowering them to effectively respond to conflicts. 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

Hey there, folks! Welcome to the Prolonged Field Care Podcast. Today's episode is all about Crush Syndrome and how to handle tourniquet conversion. Our speaker, Doc Jamie Riesberg, is a pro in this field, so listen up! Crush Syndrome happens when muscle tissue leaks into the bloodstream, causing trouble. We're entering a new era of war with limited evacuation and medical supplies, so we gotta be prepared. Field care providers need to know the best practices to manage this challenging condition. We'll cover some controversies too. Stay tuned for more discussions on this crucial topic.

Hey, welcome back to the PFC podcast! This is Dennis, and I'm here with Aaron, an emergency medicine physician and medical toxicologist. We discuss carfentanil, a synthetic opioid used in the 2002 Moscow hostage rescue. Carfentanil can cause CNS depression, pinpoint pupils, respiratory depression, and decreased gut motility. Reversing its effects may require higher doses of naloxone. However, its potency and unknown modifications make it challenging to combat. We're still waiting for better treatments and auto-injectors. In the field, it's crucial to differentiate opioid overdoses from other injuries, considering opioids' widespread use and potential for weaponization. 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