hetastarch

[james]

In the US Army they tell us if a pt. is suspected of hemorrhagic shock you should give 500cc of 6% hetastarch and 1500cc NS. Does that sound right to you? Or what would you recommend?

 

[KEVD18]

well id reccomend that you follow the protocols set by the army to the letter without the slightest deviation.

in the civilian world, people dont often go to jail behind bending protocols. they might get fined, lose their job and probably their ticket, but unless reckless abandon was shown, they usually dont end up in prison. however, in the military, im inclined to believe that that could be construed as failure to obey a lawful order or something similiar. now from what i understand of the military, isnt that a pretty serious offfense?

 

[mdtaylor]

well id reccomend that you follow the protocols set by the army to the letter without the slightest deviation.

I completely agree. On the other hand, I disagree with treating suspected conditions and lean towards treating observable MOI & signs and symptoms. Pushing fluids without monitoring something to regulate dosage just doesn't seem right to me...

 

[Ops Paramedic]

Are you refering to the patient (Soldier) being injured in the battlefield?? Care under fire, or in safe area?? These are two total different environments and situations. The advice posted so far is sound, i recommend as well that you follow protocol.

Try posting your thread on the Military/Tactical/Wilderness discussion forum for more specialised answers...

 

[james]

I am talking about Care under fire. It just dont seem right to treat a suspected condition, but thats just my thoughts on it. Thanks for your input on the Question.

 

[akflightmedic]

Hate to say it, but with the proper training and most importantly, the education, there would be no suspecting/guessing whether or not a patient is in hemorrhagic shock.

Either they are or they aren't; and based on MOI and your assessment, it is pretty simple to diagnose.

Hetastarch is nice, but most of us do not carry it over here. You will find it in the clinics and hospitals, but not routinely in a CLS bag.

 

[Ops Paramedic]

Thanks for clearing that up james. Now the answer to your original question changes abit. I am by no means a tactical/military specialist, but have done our TEMS course (The only one currently available in SA).

When treating a patient in the "Care under fire" scenario, the last treatment is IVs, by that i mean, pushing fluids or establishing a hep block port. Your first treatment is to ensure your own safety to get to the patient. Once there you need to move to a safer area. Do not forget to encourage Self Rescue, more so when the bullets are flyng and you can not get to the patient. It may sound odd, but the first treatment (Post ABC, for heamoraging only) is to stop the bleeding either with a pressure bandage or with a tourniquet (You can consider putting up a hep block here if it is safe). Then the patient is moved to the pre arranged Safe Zone. Only then do you start with your IV fluids. The choice of fluids??

That is where you would have to follow your protocol. You mentioned starch and saline. I would rather opt for 2000cc of ringers, followed by 500cc of colloid, which ever colloid you use. You should now be in the Safe Zone where you may be able do a bit more, such as a blood pressure. Use the blood pressure and other signs and symptoms to titriate against effect.

PS- we did duty in JHB CBD on new years eve, and we had to apply our TEMS knowledge. It worked as we got shot at, beer bottles thrown at us as well as double seater couches from high rises. The evening was fairly busy, and we treated and transported 9 red code patients. We worked in a armourpiercing vehicle.

Hoping it helped a bit.

 

[AZFF/EMT]

sounds right to me. you hould be able to dx the hem shock easily. Most of your combat injury's will be penetrating trauma(gsw, shrapnel). Or concussive injury 2nd to IED's. follow what you have been taught and what you continue to learn from guys who have done it in your unit or others near your aor. Be confident in your skills, hopefully you don't have to use them. Initial battlefield care savs a lot of lives along with forward aid stations, cash's and air evacs.

 

[paramedix]

That is where you would have to follow your protocol. You mentioned starch and saline. I would rather opt for 2000cc of ringers, followed by 500cc of colloid, which ever colloid you use. You should now be in the Safe Zone where you may be able do a bit more, such as a blood pressure. Use the blood pressure and other signs and symptoms to titriate against effect.

I think protocol is the best. Good to try, but remember it's YOUR license and someone's LIFE. (Don't get me wrong, I'm not shooting the idea down). Our protocol, provided its safe and you are able to it, bolus of Ringer's and then, a colloid.

 

[akflightmedic]

Hate to say it, but with the proper training and most importantly, the education, there would be no suspecting/guessing whether or not a patient is in hemorrhagic shock.

Either they are or they aren't; and based on MOI and your assessment, it is pretty simple to diagnose.

Hetastarch is nice, but most of us do not carry it over here. You will find it in the clinics and hospitals, but not routinely in a CLS bag.

Guess I should of clarifed the "over here" in my above post. I am in Afghanistan, have been for quite a bit now.