Hey there, folks! Welcome back to the PFC Podcast. Today's episode is a special one, recorded live at the JSOMTC during the joint trauma system teleconference. Dr. Doug Powell, a battalion surgeon in a special forces group, joins us to talk about providing critical care in austere environments. With the increasing trend of sending smaller teams to more places, it's crucial for SOF medics to be prepared for initial critical care and stabilization. Dr. Powell emphasizes the importance of conferences like this in training our special operations medics. The podcast covers topics such as prolonged field care stages, vital signs trending, checklists, teleconsultation, improvisation techniques, and nursing care. Remember to visit ProlongedFieldCare.org for free downloads. 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 with Dennis and guest JR, discussing their work on the border. Dr. JR Pickett, the Chief Deputy Medical Director for Austin, Texas, describes the rugged, rural regions they cover, far from major cities. The area experiences scorching temperatures, and many migrants pass through, making it crucial to provide medical assistance. They encounter accidents, venomous snakes, and challenging terrain. The team uses various vehicles and equipment, including ATVs and a walking blood donor program, to navigate and provide care. Training and collaboration are essential since most agents aren't dedicated medics. BLS skills and effective planning play a vital role in delivering 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

This Clinical Practice Guideline was written by a fellow 18D with input from around the surgical community. It reconciles the differences between wound care done in a role 2 or 3 facility, such as serial debridements, with what is taught in the 18D Special Forces Medical Sergeant Course with regards to delayed primary closure. One way is not "right" while the other wrong, it has more to do with the amount of time and resources available to the medic or other provider. The remainder of the blog post and podcast is meant to be a refresher for those who have already been taught these procedures. It is also meant to be informational for those medical directors who may not be exactly certain of what has been taught as far as wound care and surgery. If you haven't been trained to do these procedures before going ahead with them, it is very likely that you may do more harm to the patient than good. 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, welcome back to the PFC podcast! I'm Dennis, and today I'm joined by David and Tim. We'll be discussing the topic of Return to Duty and the important work these guys are doing for our service members. They hope to spread the word and get more people involved in helping out. David shares his background, mentioning his experience as a combat medic and his transition into the field of endoscopic spine treatment. He talks about his own spine injury and how it led him to realize the need for better options for military members. They formed a network of trusted surgeons and started informally helping others. We discuss the challenges service members face in accessing timely and appropriate treatment, and how they aim to bridge that gap. They highlight their unique skill set in advocating for spine care and their collaboration with experienced surgeons who understand the needs of tactical athletes. They also mention the importance of early intervention, proper diagnosis, and tailored treatment plans. They're dedicated to providing top-notch care to all service members, regardless of their location. Overall, their goal is to make a lasting impact and ensure that service members receive the care they deserve. 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, welcome back to ProlongedFieldCare.org. I'm Paul, and today I want to talk about the importance of documentation in prolonged field care situations. Before you head out, make sure you have a checklist and all the necessary equipment, including medications, fresh whole blood kits, blood typing cards, fluids, specialty equipment, power supply, cables, and filled oxygen bottles. Ensure your team is trained in tactical medicine and prolonged field care, and have a telemed plan in place. Plan for multiple evacuation platforms. Use the 10 essential Prolonged Field Care capabilities worksheet to determine what you need to bring. When you arrive, secure your medications and distribute supplies among the available platforms. Set up your aid station and familiarize your team with the equipment and layout. Have a communication plan in place and double-check all contact information. For documentation, use brain sheets similar to those used by ICU nurses. Consider using PFC casualty cards to track vital signs, injuries, treatments, and plans for each patient. Trend vitals regularly and communicate changes to the team. Prioritize treatments and share care plans with the entire team. Use specialty flow sheets and checklists for specific conditions like burns, fluid administration, and ketamine drips. Finally, consider using the multi-patient evacuation chart for organizing and tracking multiple patients. By implementing these documentation practices, you can improve patient care and enhance efficiency in prolonged field care 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

Welcome back to the PFC Podcast with Dennis and Winston discussing the "Green Whistle". Methoxofluorine, a volatile hydrocarbon similar to modern anesthetics, was used in general anesthesia until 2005 due to renal toxicity risks. However, it continued to be used in Australia, New Zealand, and recently in the UK for pre-hospital care and burns units. In low doses, it acts as an analgesic, while higher doses have an anesthetic effect. The Green Whistle, containing methoxofluorine, is a mouthpiece with an activated carbon chamber to reduce contamination. It provides pain relief for severe pain lasting 30 to 60 minutes. Patient control and comfort are important during its use. Could this be an alternative to the fentanyl lollipop? 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 have a diverse group of individuals discussing their experiences in Ukraine. Kasha, an emergency pre-hospital critical care expert, spent several months there, while Denys, a physician and medical course director, has extensive experience in training medics for the Ukrainian armed forces. Kevin, a former special agent and tactical paramedic, is currently embedded in a Ukrainian army unit conducting MEDEVAC operations. They emphasize the importance of prolonged field care (PFC) in modern warfare, cautioning against applying strategies from previous conflicts to new battlefields. They share anecdotes about challenging situations and highlight the need for medical leadership, telemedicine, proper training, and logistics in PFC. The discussion emphasizes that PFC is not limited to the military and is relevant to all medical professionals in challenging 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

Welcome back to the PFC Podcast. 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, paralytics, 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

Dennis is hosting the PFC podcast with Monty as his guest. Monty is a former army medic who has multiple rotations in Afghanistan and Iraq. He is now part of Delta development, which created a battery-powered blood refrigerator that can store blood between 1 and 6 degrees Celsius, which is vital for prolonged field care. The device can keep blood for up to 10 days on battery power and has a temperature log for easy record-keeping. The goal is to push blood forward to the front lines and eventually back to role three to ensure that blood is available when needed. 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're discussing some important topics that have come up recently. One of them has been going on for 10 years, while the other has been around even longer, related to irregular warfare. We're exploring how these two subjects can inform each other. Now, before we begin, I want to clarify that the views and opinions expressed here are solely mine. I also want to mention some disclosures about my upcoming internship and the Prolonged Field Care Collective. If you want more content like this, visit Prolongedfieldcare.org. There are operational environments where the training we provide in the Prolonged Field Care Collective can benefit medics and other providers. We have trained numerous individuals from various special operations and international communities, as well as conventional forces. The challenge lies in the training and the operational context. We adhere to doctrinal timelines for casualties, which vary based on the severity of injuries. It's important to understand the complexity of the operating environment and tailor care accordingly. In the past, there have been issues with overclassifying all patients as urgent, leading to adverse outcomes. While there are ongoing discussions and efforts to standardize terminology and lexicons, we will continue our work and problem-solving under the Prolonged Field Care name. PFC encompasses robust planning, hands-on training, and a strategy for palliative care. Education and training are different, and it's crucial to get hands dirty to truly understand the challenges. We have encountered complex problems in our field and collaborated with various stakeholders, including the Morpheus Group, to crowdsource solutions. Irregular warfare medical support shares similarities with prolonged field care, and there are similar activities worldwide. The aim is to strengthen countries' capabilities to stand on their own during conflicts or degraded civilian infrastructure situations. Training opportunities abound, even in busy schedules, and it's important to optimize and utilize available resources. Feedback and lessons learned from different entities are invaluable. Additionally, initiatives like National Stop the Bleed Month contribute to increased resiliency and readiness, both domestically and internationally. However, it's crucial to understand the legal and operational aspects of medical support in different regions. Humility is key when approaching international missions, as we can learn from past mistakes. By simplifying the complex landscape and using self-guided assessments, we can identify areas for improvement. Global health engagement plays a significant role, as Special Forces have been involved in improving medical care in underserved populations. Civil Affairs and SF have historically been engaged in global health initiatives, and it remains an important aspect of our work. So, despite ongoing discussions and potential changes in terminology, the focus remains on providing effective care in prolonged field care scenarios. 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

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 introduces the Prolonged Field Care (PFC) Podcast 130, welcoming Alex as his guest speaker. Alex, Dan, and Rick are working on a project for the upcoming SOMSA, where they will present the idea of defining the different phases of care in PFC, just like TCCC. They believes that the medics should think about March for taking care of their patients, where they would continue to think about March irrespective of the setting, but maybe through a different lens when they're in PFC. Alex talks about the phases of care in prolonged field care, which are preparation, stabilization, normalization, observation, and transportation, (PSNOT) and compares them to the thought process of doctors in damage control surgery. Dennis and Alex discuss the importance of SOF medics finding time to be good at SOF medicine, and how they need to understand their true capabilities and reach out to others for help when needed. Thank you to Delta Development Team for sponsoring this podcast in part. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

In this episode, the we discuss the unique challenges and considerations involved in providing medical care in extreme cold weather conditions. They cover topics such as hypothermia, frostbite, cold injuries, and equipment and supplies needed for arctic operations. They also provide tips and resources for medical personnel preparing for arctic deployments. So, if you're interested in learning more about arctic combat medicine, give this podcast a listen! For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

In this podcast, the Dennis and Doug discuss the challenges of treating traumatic cardiac arrest in the field and the importance of early intervention to improve outcomes. They also cover various topics such as identifying reversible causes, utilizing resuscitative thoracotomy, and managing hypovolemia. For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

In this podcast, Dennis and Berger Langda discuss austere dentistry, specifically how to handle dental emergencies in an austere environment. They discuss the importance of preventive preparation, such as motivating participants to have a dental checkup and using high fluoride toothpaste, as well as preparing oneself with an adequate dental kit. They also discuss common dental procedures and complaints that may arise in an austere environment, such as broken fillings and impacted wisdom teeth, and how to approach treating patients with limited time and resources. Finally, they touch on the importance of a team approach and distributing medications and antibiotics efficiently. For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

This is Dennis from the Prolonged FieldCare podcast. In this episode, we have a group running an austere emergency care course in Norway. They discuss the challenges of providing medical care in remote or austere environments where evacuation to a medical facility may not be possible for several hours or even days. The course focuses on changing people's mindsets and creating a team approach to caring for patients. They discuss the importance of checklists and the challenges of communicating with non-medical responders in emergency situations. The podcast is available on various platforms, including YouTube, and you can find more information about the Prolonged FieldCare course on their website and social media channels. Thanks for listening! For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

In this episode, Dennis and Dr. Cancio discuss the dangers and treatment of white phosphorus burns, which can be extremely painful and even fatal. They also talk about the challenges of providing medical care in combat situations and the importance of being prepared for any situation. It's an informative and interesting listen, so if you're interested in military medicine or emergency care, check it out!

I talk with Dr. Moon about taking care of a patient with AMS, HAPE, and/or HACE in a PFC environment and when is it worth the consequences to evac the patient. Altitude illness is a condition that can occur when someone goes to high altitudes, such as in the mountains, and experiences symptoms like headaches, nausea, and fatigue. The podcast explains how altitude illness occurs and provides tips on how to prevent it, such as slowly acclimating to high altitudes and staying hydrated.

Dennis speaks with a logistics expert, who has experience working in Ukraine with an NGO during the conflict. The conversation centers around the logistical challenges faced by refugees and the aid organizations that work to support them. The number of refugees in Ukraine fluctuates, and the population is highly mobile, which presents challenges for aid workers trying to provide services such as shelter, bedding, and medical care. The supply chain for aid is not streamlined and is often self-defeating due to duplication of effort and shortages of necessary items. Logistics are further complicated by the lack of fresh water and infrastructure in certain areas of the country. The conversation highlights the importance of efficient distribution of aid and communication between aid organizations to ensure that the needs of refugees are met.   Please consider supporting us: patreon.com/ProlongedFieldCareCollective

This Clinical Practice Guideline was written by a fellow 18D with input from around the surgical community.  It reconciles the differences between wound care done in a role 2 or 3 facility, such as serial debridements, with what is taught in the 18D Special Forces Medical Sergeant Course with regards to delayed primary closure.  One way is not "right" while the other wrong, it has more to do with the amount of time and resources available to the medic or other provider.  The remainder of the blog post and podcast is meant to be a refresher for those who have already been taught these procedures.  It is also meant to be informational for those medical directors who may not be exactly certain of what has been taught as far as wound care and surgery.  If you haven't been trained to do these procedures before going ahead with them, it is very likely that you may do more harm to the patient than good. Please consider supporting us: patreon.com/ProlongedFieldCareCollective

As superpowers begin moving into the artic circle, as medics we need to be prepared to treat patients in a very different environment they we have in recent past. Jacob and Eric speak about their experiences in the arctic. Please consider supporting us: patreon.com/ProlongedFieldCareCollective

If you sit on a patient long enough, infection has a greater chance of  taking hold and progressing to sepsis, or you may receive a patient who  has already been sick for days. Doc Jabon Ellis walks us through the  full spectrum from infection and SIRS to sepsis, shock and death.  Despite firm CoTCCC and ICRC recommendations for early antibiotics, in  the past we may have foregone that luxury because of lighting fast  evacuation times, maybe even thinking, ‘they’ll take care of it at the  next echelon.’  A great medic should not only treat their patient but  set them up for success at the next echelon, as sepsis is a testament to  how poor care during the TCCC phases of care can cost our patients days  and weeks in a hospital later.  But what if you are your own next echelon?  Point of injury to Role 1+  could be your own team house or single litter aid station.  Go down the  checklist on the right side of the PFC trending chart and make sure you  are taking care of anything that could result in an infection.  Have you  given those antibiotics?  How is your airway and respiratory care?    Did you replace any dirty IV or IO sites you placed in the field?  Are  you doing all your procedures an as aseptic manner as much as possible?   When will you debride?  Are you doing everything you can to prevent  pressure ulcers?  When will you call for a telemedical consult?  When your patient  develops a fever?  Blood pressure falling?  Altered mental status?   Do you know how to dilute your 1:1000 epinephrine to use as a push dose  pressor?  (It’s in the Tactical Medical Emergency Protocols) Is an Epi  drip appropriate, why or why not?  How much fluid will you give to help  prop up that BP? All questions that the medic prepared for PFC should be  looking to answer.    For more content, visit www.prolongedfieldcare.org

Today, I talk with Eric Bauer from Flight Bridge ED on Anaphylaxis and cover how bad and how fast this can overcome your patient. You can hear more about critical care flight on Eric's Podcast Flight Bridge ED. https://podcasts.apple.com/us/podcast/the-flightbridgeed-podcast/id595147712

Non-Governmental Organizations, Non-Profits and Volunteers have been  providing critical services on the battlefield for millennia.  Historically the traditional view of medical care in conflict zones was  that the military focused on victory and everything else was ancillary,  even care of their own wounded. Only in the last few centuries has there  been an evolution of care as another focus after completing the  mission. Through all of this it was often family members, clergy and  Volunteers providing aid to those left to rot on historic battlefields. These NGOs and Volunteers have recognized this gap and organized  themselves into powerful coalitions that are able to go where  traditional militaries cannot or will not due to political pressures.  Sometimes however, there exists an overlap of traditional military  presence and NGO response as the situation matures or devolves. Alex Potter and Global Response Management positioned themselves far  forward on the front lines of the battles for Mosul when times were  tough and the International military and humanitarian response to ISIS  was in its infancy. Thank you GRM for your hard work and dedication. We  are extremely proud of what your team accomplished and maybe even a  little jealous in the bittersweet way that only those who have  experienced the horrors of armed conflict can comprehend.   www.prolongedfieldcare.org

As a follow-up to the podcast on tension pneumothorax, how about simple pneumothorax? Dennis speaks with Doug on when you need to treat pneumothorax/hemothorax.

Dennis and the guys from the "Dustoff Medic podcast", discuss optimizing  your patient for evacuation. We go over the common mistakes and some of  the decision making processes of Load and go or Stay and Play when it  comes to the more invasive procedures.

In preparation for SOMSA, Dennis speaks with Ricky D. on how to give a great presentation. Remember to check out www.specialoperationsmedicine.org for SOMSA 2023 info.

Prolonged Field Care is back with a new episode on a long awaited topic,  traumatic ventilation.  We were finally able to corner a real, live  anesthesiologist who was actually more than happy to sit down and talk  about ventilation after his years of experience working at the heads of  thousands of patients.  This episode starts right off with a difficult  scenario discussion that includes a hypovolemic patient with a GSW to  the pelvis, RR 35  As they work to get the patient stabilized, Dr. Kopp recommends an end  tidal CO2 Capnograph as the single best patient monitor for this  situation.  A SAVE2 vent is discussed along with the ARDSnet recommendations for a  lung protective vent strategy including the preferred tidal volume of  6-8ml/kg of ideal bodyweight based on patient height.  This is to reduce  barotrauma and over-ventilation that can lead to other problems.  This  begins with attempting to match the patients physiologic respiratory  rate to prevent acidosis by giving too few breaths.  The beginning Positive End Expiration Pressure (PEEP) recommendation  should start somewhere around 5 to keep alveoli open and recruited,  prior to increasing oxygen levels if available.  PIP or Peak Inspiratory Pressure or the maximum pressure of each breath  which has a default setting of 30 corresponding with the ARDSnet  protocol.  For an uninjured patient in the Operating Room, Dr. Kopp  would start at 20-22 and then titrate from there.  While we are working on an Airway Clinical Practice Guideline with the  Joint Trauma System and Army Institute of Surgical Research, this will  go along with our earlier posted PFC WG Airway recommendations (April,  14) until we can get a consensus on the CPG and get it published. www.prolongedfieldcare.org

In this episode Dennis speaks with Andy about tension pneumothorax, interventions, and training scars.

When you can’t take cold stored whole blood with you and not all of your  soldiers are titered, a walking blood bank can mean the difference  between life and death for a patient in hemorrhagic shock.  With the  mounting evidence suggesting early blood is essential and not just a  good idea, you need to have a plan in order to hit the 30 minute target.   I have seen students struggle for hours trying to get access in both  the patient and the donor.  An emphasis on early recognition and early  access will save lives.  This episode expands upon our latest JTS  Clinical Practice Guideline on Remote Damage Control Resuscitation with  Dennis interviewing the primary author Andy Fisher. For more content, visit www.prolongedfieldcare.org

Dennis speaks with Bill about Ultrasound in the austere environment.

While no single clinic setup will work for every situation, a common  baseline and checklist can make it far easier in customizing a clinic in  similar circumstances. This is not professed to be THE way but it is A  way in which ONE experienced team has created, tested, revised and  rehearsed a clinic with different casualties. Their pictures and  diagrams are provided in the hopes that this audience will help refine  and finalize a common baseline which any medic can use in he future.  Please leave comments on your thoughts.   This builds upon clinic setups in SOCM, SFMS and other courses such as  SOFACC and combines all into a single, ergonomic clinic in which all  members of a team can easily assist the primary medic or in the worst  case, effectively treat the wounded medic. For more content, visit www.prolongedfieldcare.org

Sean and Dennis talk about the Shock Index, how it relates to our treatment decisions, and how it can guide our training. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057268/

Upgrading  your airway kit with a portable end tidal CO2 monitor can help  in a  couple situations. While it has its limitations, it is essential  for   quickly determining if your tube is in the trachea during an  intubation.  This can be accomplished most accurately via a device with a   quantitative waveform such as the Emma Capnograph. If you can’t get  your  hands on an Emma, the qualitative colormetric device that changes  color  when exposed to acid in the exhalations. False positives can  occur due  to other acids in the airway such as vomitus or even if the  patient has  recently had a carbonated beverage. While those are rare,  you should be  aware of the possibility. Having a visual indication of  tube placement  can be extremely helpful during loud transports such as  on aircraft. Another time that ETCO2 monitoring is very useful is during CPR.  There  will likely be a very low reading despite high quality CPR. If  the heart  begins to beat spontaneously, you should see an immediate  increase of  the numbers on the display of your device. ETCO2 can also  be used as a  prognostic indicator. If the ETCO2 remains below 10mmHg  for 20 mins of  CPR this may indicate that the patient has a very poor  prognosis. After  you listen to our podcast, Check out Scott Weingart’s  EMCrit podcast on  the subjects to hear his thoughts on this. ETCO2 is also useful the intubated TBI patient. Per our clinical   practice guideline, ETCO2 in a patient with moderate to severe TBI   should be kept between 35-40mmHg. In a patient with herniation, you can   temporarily increase ventilators rate in order to vasoconstrict the   blood vessels in the brain, thus reducing swelling. This can only be   done for a short time because hyperventilation worsens cerebral   ischemia. Also avoid hypoventilation (EtCO2 45mmHg or more) that will   increase ICP. For more content, visit www.prolongedfieldcare.org

Kevin schools me up on real world use of Ketamine.

Justin, JJ, and I go over the Woundcare CPG.

Well, maybe emergency laparotomies are not for field medics, but there are a lot of other interventions that are 100% in our court. Dennis and Sean discuss what can be done.

Dr. Van Wyke and Dennis go over what can be done when managing a severe TBI in an austere environment.

Can controlling pain alone have an effect on PTSD? If so, how much? We  deep dive into analgesia and sedation and it's effect on the body and  the mind.

It's getting to be that time of year again, Ian schools us treating cold weather injury.

One more piece of advice.

Being ready for an emergent airway is more complicated than you probably think. Dennis talks with Kevin about the ENTIRE process of getting it done.

Urine output is the gold standard for adjusting any resuscitation, Dennis and Doug talk about the beans and what to do when things go wrong.

I know our listeners want to stay on the bleeding edge of medicine, but with today's "publish or die" environment, flashy titles can lead you down a wrong path. Ricky and Dennis go through how to properly read a research paper and be able to sift through the BS and find the good stuff to base your practice on.

Dennis nerds out with Justin and Ricky on the importance of calcium during fresh whole blood transfusion.

Recommended medications are always being updated in the guidelines, but  the formulary does not change nearly as fast. This is the right way to  get things changed.