HNcorpsman
Forum Lieutenant
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hey so, while in the navy i have had the opportunity to go to OEMS (operational emergency medical skills) this course has been by far the BEST course i have ever attended in my entire life!!! im not exaggerating... the BEST... the class was taught by a retired army COL. his name is Dr. Hagmann. the class is also staffed with ALL Special forces medics... Navy seals, 18Delta, and SAS... anyways i cant really go into details to much about the class but there was alot of learned tips and i would like to share some of them... some of you guys probably already know all this stuff but hey, if i can get to some of the other guys i have done something right? here it is...
*this is specifically for combat medics, and corpsman*
PT assessment
M-massive bleeding
A- airway
R- respiratory
C- circulation
H- head inj/hypothermia
O- open wound/infection
N- no pain/anesthesia
tension pneumo thorax in a combat setting is VERY common, be aware that a classic sign is grunting upon exhalation... also the absence of bilateral chest rise and fall... JVD and tracheal deviation can happen up to two hours after the tension, so dont rely on it. you dont have to do needle decompression on the PTs chest.. you can also do it on the PTs axillary area... about a palms width from the armpit... (better if PT is wearing a flak jacket.) dont ventilate a PT with tension Pneumo either, it will make it worse.
chest tubes must be done CLEAN!!! speed is NOT important... if you cant keep it clean, or dont have time. DONT DO IT!!
IVs- only give an IV if you can no longer feel the PTs radial pulse.... this is when the PTs blood pressure is so low that they MUST have IV fluids... this method is called hypotensive resuscitation. the idea is that giving fluids to a trauma PT with loss of blood will only make things worse... it will raise their blood pressure causing them to bleed more, and it will dilute their blood with water... either NS or LR... they are essentially the same thing. once they regain that radial pulse discontinue the IV. dont use 14g either... 16 or 18 is fine. use the fast 1 if you have it... it dosnt hurt THAT bad, i have had it done to me... in the sternum...
evisceration, if evac is longer than 2 hours put guts back in... if less than 2 taco.
these are just SOME of the things we learned... there is much more, much more... we also got to do IVs in the jugular using back pressure. IVs in the femoral using back pressure, FAST 1 IO (fun), we got to use lidocaine extensively while doing IVs and numbing the area in prep for a chest tube.
*this is specifically for combat medics, and corpsman*
PT assessment
M-massive bleeding
A- airway
R- respiratory
C- circulation
H- head inj/hypothermia
O- open wound/infection
N- no pain/anesthesia
tension pneumo thorax in a combat setting is VERY common, be aware that a classic sign is grunting upon exhalation... also the absence of bilateral chest rise and fall... JVD and tracheal deviation can happen up to two hours after the tension, so dont rely on it. you dont have to do needle decompression on the PTs chest.. you can also do it on the PTs axillary area... about a palms width from the armpit... (better if PT is wearing a flak jacket.) dont ventilate a PT with tension Pneumo either, it will make it worse.
chest tubes must be done CLEAN!!! speed is NOT important... if you cant keep it clean, or dont have time. DONT DO IT!!
IVs- only give an IV if you can no longer feel the PTs radial pulse.... this is when the PTs blood pressure is so low that they MUST have IV fluids... this method is called hypotensive resuscitation. the idea is that giving fluids to a trauma PT with loss of blood will only make things worse... it will raise their blood pressure causing them to bleed more, and it will dilute their blood with water... either NS or LR... they are essentially the same thing. once they regain that radial pulse discontinue the IV. dont use 14g either... 16 or 18 is fine. use the fast 1 if you have it... it dosnt hurt THAT bad, i have had it done to me... in the sternum...
evisceration, if evac is longer than 2 hours put guts back in... if less than 2 taco.
these are just SOME of the things we learned... there is much more, much more... we also got to do IVs in the jugular using back pressure. IVs in the femoral using back pressure, FAST 1 IO (fun), we got to use lidocaine extensively while doing IVs and numbing the area in prep for a chest tube.