Dennis and Mark discuss tourniquet conversion and pelvic fracture with associated mid-shaft femur fracture. For more content visit, www.prolongedfieldcare.org

Death is an unfortunate part of medicine, but what do you do after the patient dies? Rick and Dennis discuss what to do if your patient can not be saved.

It's not always trauma that gets you, Dennis and Ryan discuss fever of unknown origin.

Transfusion reactions are generally rare, but some are not as rare as you think? Combine that with other risk factors and you have a problem that you had better be prepared for. Don't worry Evan and Dennis walk through the the whole thing.

It's that time of year. Dennis and Ian talk about every medic favorite training injuries.

When it comes to dealing with crush syndrome, guys are super motivated to push sodium bicarb, but is it actually doing anything?

Dennis and Doug speak about everyone's favorite...Evidence Based Medicine...., but what do I do if there is none on what I'm researching?

Nate gives his views on observed training gaps.

Evan goes through what it takes to get to be a master of the airway.

Today, I speak with Dr. Shackleford and Dr. Rush about the realities of triage currently and moving into the future.

I speak with Jay Baker on Far Forward Surgical Support.

In this episode, I speak with Stacy Shackleford and Andy Fisher the need for surgery on the battlefield and what to do about it.

In this episode, I speak with Bryce about the importance of medical team training. What to teach and how to get involvement.

Despite our best efforts, endless training, and reading, some of our patients will die.  This has been a taboo subject that is difficult to broach in the best of times.  We aim to start a conversation here with the hope that it continues with your Medical Director, PA, Surgeon and fellow Medics before you are ever faced with this difficult situation out on your own.  Often prolonged field care involves treating the most critically sick or injured patients longer than you expect to.  Inevitably some of these “sickest-of-the-sick” will not make it to see definitive care and you will be left to ease the suffering during end of life care alone.  While you may have to deliver end of life care by yourself, you may not have to make all the decisions alone. In this episode Dennis and Doc Powell discuss how to treat expectant patients.  This could be as part of a multi-patient MASCAL or a happen to a single patient who is critically ill or injured.  If it happens during a MASCAL, once you are done treating your urgent patients, what do you do when you go back to your expectant patients?  It’s common to skip over discussing and training on losing patients…  Taboo even.  The fact is that it will eventually happen to some of us; No matter how good of a medic we are, patients will die.  Doc Powell has spent innumerable hours in Intensive Care Units with the best and brightest medical teams a patient could hope for.  Even in this setting the top notch care, medicines and interventions are not enough and patients code and die.  This is part of medicine whether we talk about it openly or not and while many of these situations will be complicated and stressful we hope to give you a few tools to help manage the situation in a more professional manner. How do you decide if your critically ill patients are expectant, when alone in a tactical or resource strained environment? After that decision is made, what can we still do? How is telemedicine different for curative vs. palliative cases, if at all?

In this episode I speak with Dr. De Mello, a retired anesthesiologist from the UK, with a lot of experience with burn patients both in the civilian hospital and military. Dr. De Mello is also a professor for the College of Remote and Offshore Medicine (CoROM) Masters in Austere Critical Care program. https://corom.edu.mt/ Lots of tidbits for you to refine your game. Enjoy

Dennis, Doug, and Paul talk through the PFC Analgesia and Sedation CPG

Dennis had the honor of 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.

This is our 100th episode! Today I speak with the Godfathers of the  Prolonged Fieldcare Working Group and talk about how things got started  and where things are going in the future.

Jamie, Paul, and Dennis, discuss a difficult scenario with a crush injury patient.

Coadministration of Ketamine and Versed has been practice for quite awhile, but is it best practice? 

I realized there are some really good podcasts that haven't seen the light of day in a long while. The is no exception, Jamie discusses crush syndrome and lays out very well how to get it done. I will continue to label all of the reruns and continue to get new podcast out to you guys every two weeks. Enjoy

Of course you could pack the kitchen sink, but....Why? How about we start learning what labs are important, so that we can plan and pack better.

This is one of those areas that we do not get the oppertunity to practice as much as we would like. Anytime we can learn from someone else, we should listen. 

We all know the indications to secure the airway, but when the time comes....we hesitate. Should I take the airway or should I wait. Do I have what I need? Today, I spoke with another medic about a situation he found himself in.

Hope is not a plan.....Dennis speaks with Evan on medical planning.

Dr. Cooper discusses how all of these are linked and what can be done to help ourselves and eachother.

Sometimes it's good to go over the basics again. Doug gives us the run down on who needs vent management and how to get started.    For more content visit www.prolongedfieldcare.org

Everyone knows how hard it is to do good ventilation management using  our gear. If the patient is spontaneously breathing in any way it can be  next to impossible.  Are paralytics the answer?    Dennis speaks Evan (ER Doc) and Josh (ICU Doc) about the use of paralytics in vent management.

With bleeding from the "Box" causing such a large portion of the  potentially survivable deaths, can we go in there? A better question  probably "should we?". Stacy goes over how large the actual problem is and better yet, "What can be done", and "what does it take to do it?"

We're beyond explaining that blood is better than water, when it comes  to resus and trauma. Now let's start talking about HOW to do it better.  How to collect it faster and give it faster in the austere environment.  How can we use the gear we have and optimize this life saving process.

Usually, we are sending our patients to a higher level of care. What do you do with the patients you can't? Dennis and Ian go over a timely  topic.

Jon does this for a living. Dennis discusses some more practical aspects  of analgesia and sedation, such as how to assess for pain when your  patient is unconscious. Jon also discusses the practicality  using IV  lidocaine in an austere environment. This is another podcast from the study discussed on IV lidocaine.   http://www.oxfordjournals.org/podcasts/bjaed_intravenous_lidocaine_vol_16_issue_9.mp3

Sometimes our patients are too sick to receive the care they need.  Dennis and Mark discuss the decision points on who goes to surgery and  when.

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.

Sometimes it's not an easy decision to turn around and go home. 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.

On this podcast, I talk with Jeff about the problem with overventilation. Should we switch to a pediatric bvm for adults?

Dennis and Doug break down the pretty complex issue of dealing with an AKI in the austere environment.

Dennis discusses the new Sepsis in the PFC environment CPG with Justin and Doug.

Dennis, Tim, and Ian go through the diagnosis of the acute abdomen.

Dennis discusses the medical aspects of a trip to Antarctica.

Dennis and Scott discuss what to do after the life threats have been addressed and the healing begins.

Dennis talks with Mark on the importance of nutrition in critically injured patients.

Dennis and Dave deep dive into TBI and the various types of herniation.  Hint...the most common is not the one we have been trained on.

Dennis talks with Josh and Jeremy about the Special Operations Medic  Coalition, how they're helping the community, and what they have planned  for the future.    For more content, go to www.prolongedfieldcare.org

Dennis and Mark discuss tourniquet conversion and pelvic fracture with associated mid-shaft femur fracture.    For more content visit, www.prolongedfieldcare.org

Dennis discusses medics transitioning to a civilian medical career.

Dennis and David discuss when is the right time to use corticosteroids.

Dennis, Doug, and Jeremy discuss the newest edition to the Society of Critical care courses.