SOF Combat medic question

[x SF med]

Outstanding. We can get back to the nurses while cursing out the Gunney for interrupting our party.

although - after the initial assessment when we found out his wounds were minor (for a Marine)... we could have hit him in the head with a brick for anesthesia, given him an aspirin for analgesia, placed a sandbag on his chest for the flail, and dumped a Lister bag full of ice water on him to keep him damp until Helo medic got there to transport him... (not really, but the mechanics are pretty close).

Amlove gets the first pick in nurses when we get back to the party.

 

[Muppet]

Holy fucking mackrel........that was awesome. I need C.M.E.'s for that. Who needs cold steel. All that needed to be done was done. I am sure proud to be associated with medical professionals such as those listed. Am I considered a strap-hanger?

F.M.

 

[Muppet]

oh! me first!

Get helo medic on the horn to exfil ASAP as we approach the Gunny.

18D starts at the head with c-collar, airway and interview, rapid assessment of breathing, and a dart to the affected flail side. Flail controlled with large bulky NON circumferential wrap. Full assessment of possible barotrauma for blast, to include poss. TBI (hard to tell, cause Gunny was already a little, um, off).

PJ starts at the feet with reflex and general survey, with special attention to pelvis (blast injury calls for pelvic instability to be life threat numeral dos) and a quick assessment of that nasty testicular torsion problem. 18D and PJ meet at the abdomen with a quick back brief of what they got, and a report to the Navy Corpsman, who has been getting out the hypo kit, spiking 2 liter bags Lactated Ringers (choice for burns) and 1 500ml of hextend (for blood loss and possible hemorrhage) along with the backboard. Parkland Burn Formula (%Bsa burn x wtKg x 4cc) would give us 2L fluid for the first 8 hours to get us to 32L total x 24 hr period. After 1st 24, maintain a 2L maintenance dose. Im guessing that the Gunny is a steely eyed barrel chested square jawed death dealing pork eating freedom fighter, weighing in at 100kg.

Patient is URG SURG. Helomedic reports as such requesting bird w/o seats and ZERO medic transport personnel (you're fucking right i'm going on the bird, get off).

18D assess need for intubation/field RSI/crich, PJ applies MAST and clears legs and lower spine, HM1 wraps, straps, checks, and clears PT for ride, applying appropriate eyes and ears for PT comfort. Helomed checks flight plans for change in altitude, and necessary adjustments (ET tube with saline, pressure infusers being titrated, drip rates monitored).

As the helo lands, 1gm Ertapenem on board, 2 16g Large bores running LR wide open, pain meds as req (Gunny has still been talking shit, asking where the fuck all his REAL warriors, his marines, are and why all these dork sister services are doing all the treatments), so all he gets is some Toradol from the 18D. Kidding. If youre awake Gunny, you get the 1200mcg fentanyl taped to your finger. If youre going in and out, nubain or morphine, with a naloxone chaser on hand of course, just in case youre a light weight.

Ride out with a call to local Trauma 1 with blood typed and crossed on standby, bright lights and cold steel on standby.

What did i miss?

L.R. wide open. Whats happen to the hypotension rescus. thing?:) M.A.S.T. still being used in the service?

F.M.

 

[amlove21]

are you kidding about the mast pants? For the love of pete- they have "military" in the actual freaking title!!!! REGARDLESS of whether or not their efficacy has been proven- it hasnt, and some would argue that while increasing periphrovascular resistance assists in BP maintenance, it actually stresses the trauma pt's heart- the military bought WAY too many of these things after vietnam. Lowest bidder, biggest supply, least amount of negative research (and in this specific case, NO research is equal to "no bad findings") wins most times.

As for the hypotensive resus- you know, for this specific case, i would argue that the systemic insult due to severe dehydration due to burns and straight up trauma would outweigh the possibility of his ICP becoming an issue. Let alone the fact that most likely his BP is in the shitter anyway and wide open is really just making him pump clear fluid anyway. Its the classic "Which kills first? The extreme dehydration pulling fluid from the tissues or the extra fluid being deposited in the brain case due to swelling?" Hell, we may even wanna go around a couple times about the possibility that his body trying to compensate for the loss of fluid in the 80% burn could even KEEP HIS ICP IN CHECK!

But if his ICP was the issue, you can forget about the hextend, monitor the blood pressure to stay between 80-110 (sure, 90 is the book answer for keeping ICP under wraps and not blowing clots), and monitor for the cushings. Shit can the osmotic diuretics (CE for both the burn and ICP now).

And for the record MAST pants are ridiculous and i cant think of any real world pt i would consider using them on. I mean, really.

 

[x SF med]

MAST - used without full pressure., will act as a vapor barrier and keep the pt from dehydrating - a survival blanket would also work.

Since it appeared to be an all clear from trauma other than burns - keeping moisture on the burned skin is an A-1 priority - use what you have - in this case - MAST trousers as a vapor barrier could be considered - as a BP stabilizer, notsomuch (IMHO) - we are talking about a pt losing lots of fluids quickly, transpoort is the best hope - major burn stabilization for extended periods (over 3hrs) is nearly impossible in the field under the best conditions - get em cool,damp and covered, then get them gone is going to give the best chance at survival.

 

[Muppet]

are you kidding about the mast pants? For the love of pete- they have "military" in the actual freaking title!!!! REGARDLESS of whether or not their efficacy has been proven- it hasnt, and some would argue that while increasing periphrovascular resistance assists in BP maintenance, it actually stresses the trauma pt's heart- the military bought WAY too many of these things after vietnam. Lowest bidder, biggest supply, least amount of negative research (and in this specific case, NO research is equal to "no bad findings") wins most times.

As for the hypotensive resus- you know, for this specific case, i would argue that the systemic insult due to severe dehydration due to burns and straight up trauma would outweigh the possibility of his ICP becoming an issue. Let alone the fact that most likely his BP is in the shitter anyway and wide open is really just making him pump clear fluid anyway. Its the classic "Which kills first? The extreme dehydration pulling fluid from the tissues or the extra fluid being deposited in the brain case due to swelling?" Hell, we may even wanna go around a couple times about the possibility that his body trying to compensate for the loss of fluid in the 80% burn could even KEEP HIS ICP IN CHECK!

But if his ICP was the issue, you can forget about the hextend, monitor the blood pressure to stay between 80-110 (sure, 90 is the book answer for keeping ICP under wraps and not blowing clots), and monitor for the cushings. Shit can the osmotic diuretics (CE for both the burn and ICP now).

And for the record MAST pants are ridiculous and i cant think of any real world pt i would consider using them on. I mean, really.

Yep. Forgot about the burns. I agree. I.C.P./M.A.P. with a SYS/BP. of 90/p should be cool. I guess we can also consider Rhabdo. with the severe trauma and burns and the fluids would also help as long as all bleeders are controlled.

I am hurt also. I am not considered a strap hanger?:doh::)

F.M.

 

[Muppet]

MAST - used without full pressure., will act as a vapor barrier and keep the pt from dehydrating - a survival blanket would also work.

Since it appeared to be an all clear from trauma other than burns - keeping moisture on the burned skin is an A-1 priority - use what you have - in this case - MAST trousers as a vapor barrier could be considered - as a BP stabilizer, notsomuch (IMHO) - we are talking about a pt losing lots of fluids quickly, transpoort is the best hope - major burn stabilization for extended periods (over 3hrs) is nearly impossible in the field under the best conditions - get em cool,damp and covered, then get them gone is going to give the best chance at survival.

I agree also S.F. I did not think of the MAST being used in the point you are thinking. In the civ. world, they are being phased out for the obvious.......... Good points all around. Bring this all to my group please. Good learning experience.

F.M.

 

[amlove21]

no, you are definitely a strap hangar, FM. A sensitive one, at that. You big baby!

 

[Muppet]

Thanks alot.....................:doh:

F.M.

 

[HeloMedic1171]

Just don't make me come down and open up the clinic after hours. And xSF, remember "shitfaced" just isn't a good diagnosis for the triage tag

bullshit. it's right next to SPAW. Status Post Ass Whooping.

Ok, let's get back on track... Gunney can still blow up the ammo dump, but we have to move the party to the aid station and drink the medical alcohol instead of stealing beer from the Commo guys.

deal. WAIT - how the fuck did you know about the "cough medicine"? ??

Not bad - but you, as the patient/casualty are currently unconscious, so you need to stay quiet or we let HeloMedic work on you, even better - Racing Kitty will be allowed to create one of her explosive pieces of art and wire it to your jaw...

hey hey hey.... I provide top-notch modern-day battlefield medical care to the masses... though, it IS 0126... you're gonna have to take this one, I gotta hold someone's hand out to a bomb site. RK left and they sent a couple idiots to replace her and her professionals. :uhh:

How about full thickness burns over 80%, a flail chest, and crush wound to left testicle...but thats only assuming he survived the blast in the first place and long enough to crawl, hobble, or hitch a ride to the aid tent where the debauchery is ensuing to seek help from the paragods with superglue in hand.

fair enough. but why a spoon, cousin? why not an axe or a knife....

oh! me first!

Get helo medic on the horn to exfil ASAP as we approach the Gunny.

done..... but you don't have much time. i give you 10 mikes before I'll need smoke, signal, or signage..... wait.... I see the conflagrated ammo dump. meet me on the SW side, upwind, and I'll be feet first close to the MAS.

Patient is URG SURG. Helomedic reports as such requesting bird w/o seats and ZERO medic transport personnel (you're fucking right i'm going on the bird, get off).

fuck you! I'm not cleaning this mutherfucker after you make me walk back.... hop in gramps, and give me some pointers, but this is my bitch, and you better hold the fuck on. (i ain't givin you my seat when there's a perfectly medically useless marine that might have to ride door gunner)

18D assess need for intubation/field RSI/crich, PJ applies MAST and clears legs and lower spine, HM1 wraps, straps, checks, and clears PT for ride, applying appropriate eyes and ears for PT comfort. Helomed checks flight plans for change in altitude, and necessary adjustments (ET tube with saline, pressure infusers being titrated, drip rates monitored).

alt is fine, we're riding low, fast and clean. just watch him, keep him warm, and check check and recheck. eyes and ears won't stay on unless you tape them, rotors are unforgiving and absolute on the demand for plastic sacrifices.

As the helo lands, 1gm Ertapenem on board, 2 16g Large bores running LR wide open, pain meds as req (Gunny has still been talking shit, asking where the fuck all his REAL warriors, his marines, are and why all these dork sister services are doing all the treatments), so all he gets is some Toradol from the 18D. Kidding. If youre awake Gunny, you get the 1200mcg fentanyl taped to your finger. If youre going in and out, nubain or morphine, with a naloxone chaser on hand of course, just in case youre a light weight.

negative. 1 gm Rocephin, and ditch the MAST. I have blankets on board. fuck his real warriors, they fainted at the sight of blood. as for awake - lollipops are fine, but if you cric him or RSI him I'd rather you just let me pop him with 10mg of Morphine or more, as needed, he won't scream that way and he'll be a lot less able to rip things out of him enroute. besides, I know you have narcan, mine's in the bag, next to the morphin AI's.

Ride out with a call to local Trauma 1 with blood typed and crossed on standby, bright lights and cold steel on standby.

What did i miss?

got a friend at 10th CSH, they're already prepped and impatient. sounds good to me. :)

Thanks alot.....................

F.M.

don't worry..... it's that south philly nature to be sensitive and caring....

 

[Muppet]

Thanks Helo. Gotta a problem "wit" that?

F.M.

 

[HeloMedic1171]

neh, ya fuggin jergoff.

 

[Muppet]

Now thats what I call S. Phila. :cool:

F.M.

 

[x SF med]

Why do I see HeloMedic dressed as Corporal Agarn, singing "Up, Up, and Away in my beautiful balloon..." during take off and landings?:doh:

 

[Muppet]

Why do I see HeloMedic dressed as Corporal Agarn, singing "Up, Up, and Away in my beautiful balloon..." during take off and landings?:doh:

:eek::):)

F.M.

 

[HeloMedic1171]

only because I don't have a "balloon" at the moment..... but when I do, I just might

though, I think "thunderstruck" is the unofficial AVN Theme song.... :uhh:

 

[x SF med]

FM-
F-Troop, and the gayest song ever - they fit for Helo, the whole Cavalry Comedy, and gayness thing...

 

[HeloMedic1171]

says the guy with the naked troll av-a-tar!!!! :uhh:

guess it take one to know one, huh, Trollmaster?

 

[Muppet]

says the guy with the naked troll av-a-tar!!!! :uhh:

guess it take one to know one, huh, Trollmaster?

SHENANAGAINS!!!!!

F.M.

 

[Sicarii]

While we are nationally registered paramedics (a huge difference, considering 18D, corpsman and SOAR medics are ATP certified, and not P recognized), it is not our only focus.

My PJ brother. I was an instructor at the Special Operations Medical Training Center at Ft Bragg in the late 90s. At that time PJ students did attend the SOCM course (they had two instructors on the staff). In that course all (SF students, Marines, Rangers, and PJs) participated in the NREMT-P training. The AF students were not, repeat not required to pass the EMT-P standard; they were only required to attain EMT-I. Granted this was 10+ years ago, but I wanted to counter you point (if I clearly understood it...:doh:). All SOF Medics are "P" recognized, and SF Medics have to recert every two years.

...guess I should have kept reading the post... this string didn't go where I thought it was going...