# Crips weekly Question



## x SF med (Jan 2, 2007)

to the Mod that moved this - you are evil!! I like that!!!

Yoohoo, Crip,Crip,Crip-- come out and plaaaay!!!

But let's go with a little better - just gimme the Dx, Tx, Px for Pneumococcal Pneumonia. (the variety from H. Infuenzae is real bitch, and I need to start off slow.)

You are in a field setting, resupply takes 3 days, You have the 2 M-5's on the team for now, medevac available same timeframe as resupply - complication - Pt is febrile 103, resp incr to 125/min, grunting is noted onset 2 days ago, nausea and vomiting present, rales and decr breath sounds bilat.

go for it, grasshopper!
http://soforp.com/vb/showthread.php?t=2189


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## Polar Bear (Jan 3, 2007)

Well I tried to clean up the tread but lost it in neverneverland. People do not post in this thread unless you ask a question, about the question, or answer the question, any questions. 

This is a Learning thread for some, refresher to others, and common knowledge to a few. Do not clutter it with crap

Thank You

Crip I lost your last post in this thread could you post again.


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## surgicalcric (Jan 4, 2007)

I was simply saying since we are gonna do Q&A we may as well make it beneficial to a broader populace here by discusing combat medicine as opposed to sick call/medical subjects.  I believe our time will be better spent talking about scenarios centered around things guys on here may see and be able to treat such as arterial bleeding, amputations, dyspnea after blunt/penetrating trauma to chest/abdomen, and the list goes on, as opposed to talking about the difference(s) in pneumococcal, staphlococcal, myoplasmic, and streptococcal Pneumoniae just to name a few, or the difference(s) between African and American Trypanosomiasis.  

Besides, of the 128 case studies every good Delta knows the two deciding factors in any med illness is a fever and a petechial rash.   

And with that,

Basics of Pneumococcal Pneumonia

Pneumococcal pneumonia is caused by Streptococcus pneumoniae (pneumococcus). Generally appears after an URI-V damages airway defenses which allows bacteria (staph in this case) to infect the area.

Pneumococcal pneumonia, although usually treatable, can be fatal, especially in the very young, the very old, and those people who have other severe illnesses (caveat for most disease prognosis). It can lead to pneumococcal septicemia or pneumococcal meningitis if left untreated. 


*C/C:*   Shaking and chills, with associated fever, productive cough-sputum brown, dyspnea, and chest pain w/ respiration, on the affected side. N&V and general malaise are also common.

*HOPI:*  Preceeded by Cold or Flu generally.

*Symptoms:*  sudden shaking chills, N&V, rapid onset fever, pluritic type C/P, SOB, productive cough w/ blood tinged sputum, malaise and myalsia.  

*Signs:*  Appears in distress, BBS decreased on affected side/lobe(s) or may have rales, hyporesonant over same, tachycardic, tachypnic, HTN. high fever (100.4-105F), SAO2 </=96% RA, cyanosis.

*Labs:* CXR: infiltrate/consolidation PP usually presents w/ single lobe involvement as opposed to multiple lobes.
                 WBC/Diff:  Leukocytosis >13,000 with L shift (Bands/Segs)
                 Gram stain: Gram +, diplococci chains and pairs

*Diff Dx1*:  Bronchitis
*Diff Dx2:*  TB
*Diff Dx3:*  Viral Pneumonia
*Diff Dx4:*  PE

*Tx:* Admit to clinic if indig soldier/evac US soldier, Pen V 500mg QID x 7 days or Clindamycin 300mg QID x 7days (if treating empirically Erythromycin is DOC), supp. care, O2(if SAO2<94%). Repeat CXR/WBC/Gram stain x 7 days or PRN until resolved.

*Prognosis* Good (>90%) with PT compliance to treatment regime.

Well that covers the "off the top of my head" info on PP.    

Crip
(long day of dental medicine...)


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## x SF med (Jan 4, 2007)

Look ma, our boy's all growed up and smart one too!!

No question next week lil bro - SHOT!

Keep up the studies and blow this off if you need more book time, or PT time, or sleep.


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## surgicalcric (Jan 4, 2007)

Thanks, P.  Late night last night as you can see...

I would like to open the discussion to other members of the board.  

Are there topics that you guys would like to discuss?  I would prefer to keep it in the area of trauma.  If there are, we could form a list and I will get to one or two a week, as the SFQC permits. 

The floor is open.

Crip


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## Polar Bear (Jan 4, 2007)

I would start simple...example Auto wreak what do we look for?
Your kid falls 20 feet out of a tree? 
etc....
Your studies come first though


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## x SF med (Jan 4, 2007)

Crip-
sounds good - get all the 18Ds to chime in here, open questions for trauma, and training injuries (aren't you an expert on that, hmmmm):eek:


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## surgicalcric (Jan 4, 2007)

Polar Bear said:


> ...Your studies come first though



No problem there.  Last written test is tomorrow morning.  The real test wont come til this Nov...

So, you guys name what you want to see.  Or I can work up scenarios based on current feedback from the Sandbox and I can ask the questions and give pos/neg feedback.  

How many other SF or SOCM medics are on the board?

Crip


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## Polar Bear (Jan 5, 2007)

I think 3 and DR Doom


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## RustyShackleford (Jan 15, 2007)

surgicalcric said:


> How many other SF or SOCM medics are on the board?



I'm neither, but I am an EMT-T who's basic cert. expires in three months.


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## rangerpsych (Jan 15, 2007)

no socm for me, just alot of OJT and some extra courses courtesty of various units...


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## Looon (Jan 15, 2007)

Ok, if this is educational and informative, can you medical types give a laymens explanation? Im sorry, but my ignorant ass can't even understand most of what was written.


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## surgicalcric (Jan 16, 2007)

RL:

The initial question was more of x_SF_med proding me than it was meant to be educational for you guys.  I will be more than glad to break down the future ones to non-med speak.

Crip


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## DoctorDoom (Jan 16, 2007)

I'm not Special Operations anything, but do have civilian trauma training and Army training.


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## RescueSig (Jul 30, 2007)

*yeah, it's old*

I don't mean to bring up these old posts, but I'm a FNG to this site and like this area.  I think pimping each other on our medicine is awesome.  But like the responses listed, lets bring in some trauma, not just medicine.  PJs are a little rusty on that, I'll have to bust out the old Paramedic books.  However, we can be called out to a ship for some illness and medic questions will keep me in the know.  Bring it...


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## HeloMedic1171 (Jul 31, 2007)

I like this too.  I'm not SF med, just a 68W trying to go to 300FW6... and maybe SOCM later on.  bring the trauma.

what kinda scenarios you got, Crip?


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## Boondocksaint375 (Jul 31, 2007)

Crip is in the Q right now, so you're gonna have to rack SF med's brain


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## HeloMedic1171 (Jul 31, 2007)

I do have one question though - at DCMT @ Ft Sam they preach gatifloxacin for everything.  if he gets shot, Gat.  if he has an avulsed abdomen, Gat.  etc... but here I got Rocephin, other guys mention Gentamycin, Erythromycin, Cipro, etc...  can you give me 3-5 antibiotics to keep in my trauma bag?  uses/reasoning to have them?


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## HeloMedic1171 (Jul 31, 2007)

fuck.  :)  thanks, Boon.


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## AWP (Jul 31, 2007)

I think he is at Robin Sage right now.


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## Gypsy (Jul 31, 2007)

He is indeed.


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## x SF med (Aug 1, 2007)

HeloMedic1171 said:


> I do have one question though - at DCMT @ Ft Sam they preach gatifloxacin for everything.  if he gets shot, Gat.  if he has an avulsed abdomen, Gat.  etc... but here I got Rocephin, other guys mention Gentamycin, Erythromycin, Cipro, etc...  can you give me 3-5 antibiotics to keep in my trauma bag?  uses/reasoning to have them?



Have your unit purchase you a copy of the PDR, and then get a 5 year old copy of an ABX Theory book.  You have to use what you get from S-3 / MedCap, and be prepared to have stuff that's close to expiration.  In most cases (barring GSW/ABD Trauma/known epidemics) start with the lowest spectrum ABX for the Dx - increase spectrum as needed.  The use of the biggest gun ABX on the simplest diseases has caused some Frankengerms - don't allow yourself to become part of the problem.  Don't prescribe it if you don't know the spectrum, whether it is Gram specific, if the Pt can tolerate it, and if it is the right class for the Tx.

Oh, yeah. Stay away from me if I ever get sick.

Your Question  - find 5 ABX to carry at all times that could cover everything you encounter in the field.  answer - ask 100 medics/doctors - get 100 different answers.  What can your teammates / squaddies tolerate?  Where are you working? what are the endemic non parasitic/nonviral diseases? (If you ever give ABX as the 1* Tx for a viral, you should be shot, only give them if there is a 2* bacterial infection).

Sorry if this seems harsh - but you really didn't understand what they were telling you, did you?  You are not a doctor, you are not trained to prescribe anything, you have drug protocols, set out by the US Army Medical Corps that you are to follow.  SF Medical Sergeants spend more time on Pharmacology in their training than you spent getting MOS qualified - *DO NOT PRESCRIBE ANYTHING WITHOUT PHYSICIAN ORDERS UNLESS IT IS PART OF YOUR STANDARD PROTOCOL OF TREATMENT AS AUTHORIZED BY YOUR MEDICAL OFFICER.  YOU ARE A 68W, NOT A DOCTOR.*


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## pardus (Aug 1, 2007)

Word


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## HeloMedic1171 (Aug 1, 2007)

x SF med said:


> Oh, yeah. Stay away from me if I ever get sick.
> 
> Sorry if this seems harsh - but you really didn't understand what they were telling you, did you?



whoa, killer, slow your roll.  I still re-read my handouts from 68W school from time-to-time, just to maintain the knowledge I picked up, and I paid attention in school.  I'll make sure I get a copy of the books you mentioned also.  I'm not asking in order to prescribe, I understand my scope of practice well.  but some doctors/PAs (you touched on this) have differing opinions, namely the opinion that any ABX will work, as a prophylactic measure against possible infection - the idea being that no wound in combat is ever going to be clean.  My PA's are fine with using just about anything, their preference being Rocephin and Gatifloxacin.  Most of the Docs, however, being civilians when they aren't here, prefer Doxy by mouth everyday to begin with, and then Gatifloxacin at the POI, and Rocephin instead if there is a suspected head injury.  I'm asking Crip, and since he's unavailable, YOU, because I ASS-U-ME that you have a MUCH broader range of education and experience and can explain to me WHY this discrepancy or difference of opinion exists, not so I can become a barracks MD.  as part of our SOP we're authorized to give a limited number of drugs, most of which are little more powerful than OTC meds: Motrin, Naproxen,  Tylenol, etc; and others (flexoril, Doxy, Tramadol, etc.) are significantly more potent.  I still ask my PA or Doc beforehand both to cover my ass, and to cover theirs as well.  but I thought it would be good to have a better reason, especially when my patients ask, than "that's what the Doc/PA says."  Thanks for the input, I'll read it on my own.  out here.


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## rangerpsych (Aug 1, 2007)

Remember where you are.
Remember who we are.
Remember who YOU are.

Telling a former SF Medic "Woah, Killer, Slow your roll" is probably not going to be a prudent course of action.

As for the question you posed, pack what they give you, because that's what is going to be approved. The sandbox isn't the place to throw new things into the equation because the enemy is already doing that enough. Go with what you know, provided you do know what you're going with.


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## HeloMedic1171 (Aug 1, 2007)

rangerpsych said:


> pack what they give you, because that's what is going to be approved.



that's what I'm doing, and will continue to do so until the approval or SOP changes.  I was under the impression that this thread was in hypotheticals, i.e. "what would you/should you do if..." in order to broaden the minds of the interested.  If I'm wrong, then I apologize, and I'll just continue to lurk this thread.  in the mean time, thanks for the insight.


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## x SF med (Aug 1, 2007)

HeloMedic1171 said:


> I was under the impression that this thread was in hypotheticals, i.e. "what would you/should you do if..." in order to broaden the minds of the interested.  If I'm wrong, then I apologize, and I'll just continue to lurk this thread.  in the mean time, thanks for the insight.



You didn't pose your question that way at all:

"





> I do have one question though - at DCMT @ Ft Sam they preach gatifloxacin for everything. if he gets shot, Gat. if he has an avulsed abdomen, Gat. etc... but here I got Rocephin, other guys mention Gentamycin, Erythromycin, Cipro, etc... can you give me 3-5 antibiotics to keep in my trauma bag? uses/reasoning to have them?


"


From- http://www.cs.amedd.army.mil/68w/news/news.htm

_



			NEW - 68W Transition Pathway - Effective 1 March 2006 

PHASE 1 - EMT-Basic Course (80 Hour Bridge or 110 Hour Full Course) 

PHASE 2 - Combat Medic Advanced Skills Training (CMAST)

CMAST

The Combat Medic Advanced Skills Training (CMAST) course was developed to provide the 68W soldier medic with an overview of the stark contrast between garrison and combat trauma care. The foundation of CMAST is the concept and principles of Tactical Combat Casualty Care (TC-3). CMAST takes the basic knowledge and skills the soldier medic attained in the Emergency Medical Technician - Basic (EMT-B) course and addresses the unique aspects of applying emergency medical care to casualties on the battlefield. The management of the airway, chest trauma, hemorrhage, and hypovolemic shock of the battlefield casualty are all addressed. Triage and evacuation, as well as the treatment of detainees under international law are also discussed. This course contains a 25-question pre-course self-assessment written examination and culminates in several practical examinations and a 50-question written examination. This course is a minimum of 30 hours in length.

If this training is to be conducted for 68W Transition (Y2 Removal), the training unit must have an approved US Army EMS Training Site Code approved by the US Army EMS Program Manager and US Army EMS Medical Director, DCMT, AMEDDC&S.
		
Click to expand...

_


If you can show me where questioning a DOCTOR's ABX therapy is included in 68W, I will: "whoa, killer, slow your roll."   If you want to be able to prescribe - get your 18D (in limited purview), go to PA school, become a Doctor.  You are currently a combat medic, be the best 68W - I'm all for learning, but ABX therapy can kill as well as heal - are you prepared to take that responsibility because you want to be high speed?  all it takes is one PCN, TCN, Sulfa, etc. reaction from something outside protocol that you gave another soldier or a civilian in theater - and you will spend a really long time in the Kansas Hilton, with Bubba.  I gave you some ideas for your own education in the first post, use them.  You have an attitude, if you keep it, you probably won't last long here, quit being a thin skinned, arrogant, smartass and soldier up.

When did you graduate 68W?


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## rangerpsych (Aug 1, 2007)

When we did sick call and the Surg or PA RX'ed some wacky ass shit, I would question the reasoning in a learning context.  We had a SOP as to what a pt got if he got a GSW, if he did this, if he did that... standing orders were thorough but also allowed in cases where on-the-ground judgement calls could make a difference, allowed for some leeway for that medic to make a judgement call.

I learned about MRSC, gram positive or negative, and other things while working in the aid station... I learned about them.. enough to know you get tests done so you have a definitive answer as to WTF is going on, so you can target that problem with the smallest caliber that will be able to do the job, instead of calling in a MOAB on a single rifleman...

if you look at some foreign medicine protocols, it's interesting to see the difference, and how there isn't superbugs over there vs here... throwing antibiotic, antithis anti that at every little thing isn't a good thing because guess what, you only kill the weak!!!!

sounds like any good selection process in any other context, but this can lead to life or death, amputation, etc.

Let your doctor do his job. Learn about wtf he's doing and why, but don't try to make their decision for them.


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## HeloMedic1171 (Aug 1, 2007)

x SF med said:


> You didn't pose your question that way at all:
> 
> ""
> 
> ...



You're right, I didn't pose my question that way.  from now on, if I ask a question, I'll make sure I put the appropriate qualifiers instead of making an ass of myself because I failed to communicate correctly.  I'm not interested in prescribing right now, I'm still learning  a lot of the basics.  it seems as many ways as there are to stop bleeding and manage a patient, there a dozen more methods to achieve the same end.  it's all in preference and familiarity.  I graduated 68W in May 06.... the new TC3 curriculm was brand new, and AFAIK....  I'm one of the first several hundred guinea pigs in the conventional Army to take it to the sandbox.  big learning curve.  Like I said earlier, I'll take your advice, and read for myself to find out what I need to know.  (because what i WANT to know won't cut it, you mentioned that, and you're right.)  and when I have questions, I'll phrase them better.  thanks for the education.


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## x SF med (Aug 2, 2007)

Ah, Grasshopper, you are learning, there was never any disrespect meant on my part - since you are in the sandbox, I was using a double edged blade - if you ask a question (esp. of the indig.) phrase it that way, part of the fault lies in training the guys going to Derka Derkastan - the military gets guys up to speed on their jobs, but leaves them culturally bereft - a really bad thing for medics, who need to know how to interact with not only their own, but with the locals and HN and allied soldiers - all of whom have different facilities with common languages.  As long as you are clear in your communication, and stay within the scope of your job, you will develop into an outstanding soldier and medic.  In a couple of years, who knows, maybe you'll get the 'bug' that no ABX can cure...  and decide to try SF.

Always learn, check your ego, and keep your team/ buddies healthy - you're on your way.


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## HeloMedic1171 (Aug 2, 2007)

Thanks :)  that means a lot coming from you.  And yes, they really leave it up to the gaining unit to train us up.  the problem comes when you have guys like me in the guard, who deploy with a non-combat arms or medical unit....  you have MEDDAC guys training field medics.  this doesn't work well, by and large.  so we have to go elsewhere to get our learning on.  so far while I've been here, I've been going to the SIMmen training aids to practice m assesments/interventions, and it seems to be sticking with me, but that's the reason I'm going active duty.  I want to train and learn and grow as a Medic.  I work with a lot of HN here, but very few Allied forces and almost no indig. pop.  My job here is kinda cool, but while I won't call it a waste, I could've done more good or at least learned more elsewhere.  se la vi.  I'll have plenty of sandbox time in future deployments to pick it up.  thanks again.


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## rangerpsych (Aug 2, 2007)

TCCC isn't brand new... it's just newly adopted by the big army ;)


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## HeloMedic1171 (Aug 2, 2007)

rangerpsych said:


> TCCC isn't brand new... it's just newly adopted by the big army ;)



Very true.  Note my previous Statement:



Helomedic1171 said:


> several hundred guinea pigs in the * conventional * Army to take it to the sandbox.



As with most cool concepts it seems, you guys (SF) had first dibs, tried it, it worked, and passed it down to us.  I like it because it's easy to follow and makes logical sense.

The guys that run the sim lab here are ex 18D's.  One is a retired 18D, the other retired 18D and SERE instructor.  They teach something ELSE that seems is even newer (or at least, new to me) they call the MARCH concept.  it uses the same principles of TC3 in so far as Care under fire is what it is - you have what's on you, you're being shot at, and your fire support may be needed, etc.  apply tourniquets and shoot back.  but then in the TFC phase, instead of somewhat mirroring the EMT trauma eval, (HABCDEFG etc.)  it's M A R C H:  Massive hemmorhaging, Airway, Respiration, Circulation, Head injury/Hypothermia.  They teach this stuff to Joes that aren't even medically related or CLS.  by the time they leave a 4 hour block, these guys go from clueless to CLS-enhanced. i.e., they're cric'ing under the appropriate circumstances, and pushing hextend to hemodynamically deficient patients.  It's really good stuff.  Do you guys know anything about it?  I can explain more if necessary, I was just trying to keep the post concise.


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## DoctorDoom (Aug 18, 2007)

March is all the rage these days... makes sense in a combat environment, and in some sense hashad its advocates in civilian trauma mangement for a few decades down in Parkland under Mattox... a good way to approach combat pre-hospital care to my hospital based trauma eyes... Not really that new, but the extension to training Joe's who are not medical at all is a huge step forward...


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