Battlefield critical care

S
Battlefield Critical Care Steven Podnos MD
Airway Control         ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
BURNS ,[object Object],[object Object],[object Object],[object Object]
Chest Wounds ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Traumatic Brain Injury-? high ICP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Failure to Ventilate or Oxygenate?          ,[object Object],[object Object],[object Object],[object Object]
SHOCK ,[object Object],[object Object],[object Object],[object Object],[object Object]
PEA-Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ventilator Settings ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Vasopressors ,[object Object],[object Object],[object Object],[object Object]
Norepinephrine - LEVOPHED ®    Alpha receptor & Beta-1 agonist. Used to maintain BP in hypotensive states. Most potent vasoconstrictor (Norepi >>> phenylephrine).  Dosage  (initial): 8 to 12 mcg/min -titrate to BP (Usual target: SB:80-100 or MAP=80). Usual maintenance: 2 to 4 mcg/min. Note: doses as high as 0.5 to 1.5 mcg/kg/min for 1-10days have been used in septic shock.  Note: Norepinephrine dosage is stated in terms of norepinephrine base and intravenous formulation is norepinephrine bitartrate. Norepinephrine bitartrate 2 mg = Norepinephrine base 1 mg.  Usual range: 8-30 mcg/minute. Range used in clinical trials: 0.01-3 mcg/kg/minute. ACLS dosage range: 0.5 to 30 mcg/minute. Administer into large vein to avoid the potential for extravasation.  Calculation of drip rate 8 mg/ 250 ml (ml/hr) = mcg/min x 1.875.  Supplied: Injection (soln): 1 mg/ml - 4 ml
Phenylephrine - NeoSynephrine ®   Alpha agonist. May be given IM,SC, IV push, or by continuous infusion.  Treat mild/moderate hypotension, also PSVT.  IV infusion :  usual initial rate : 0.1 to 0.18 mg/min (100 to 180mcg/min) (titrate).  Usual maintenance rate: 40-60 mcg/min.  Maximum rate (range): infusion rates as high as 8 to10 mcg/kg/min may be required in shock. [Usual maximum dosing range reported: 0.4 to 9.1 mcg/kg/minute ]. IV bolus therapy :  0.1 to 0.5 mg/dose every 10-15 minutes as needed (initial dose should not exceed 0.5 mg)  PSVT: 0.5 mg rapid IV push, subsequent doses may be increased in increments of 0.1 to 0.2mg. Calculation of drip rate  (40 mg/250) (ml/hr) = (mg/min) x 375.
Dopamine  Used to support BP, CO and renal perfusion in shock.  Dosing (Adult):  Refractory CHF : initial dose: 0.5 to 2 mcg/kg/min.  Renal : 1 to 5 mcg/kg/min.  Severely ill patient : initially 5 mcg/kg/min, increase by 5 to 10 mcg/kg/min (q10 to 30 min) up to max of 50 mcg/kg/min.  Cardiac life support  (initial): 2 to 5 mcg/kg/min - titrated to effect. Infusion may be increased by 1-4 mcg/kg/minute at 10 to 30 minute intervals until optimal response is obtained. If dosages >20-30 mcg/kg/minute are needed, a more direct-acting pressor may be more beneficial (ie, epinephrine, norepinephrine). [0.5 to 2 mcg/kg/min-dopa; 2-10-dopa/beta; >10-primarily alpha.]  Calculation of drip rate  (ml/hr) 400mg/250 ml: wt(kg) x mcg/min x 0.0375.
Sedation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
War Surgery in Afghanistan and Iraq, a Series of Cases, 2003-2007  (2008) - describes the management of nearly 100 cases of acute combat trauma, conducted in the forward austere operative environment of war in the 21st century. Presented with vivid surgical photos, the cases encompass the spectrum of trauma that characterizes war today, as well as the medical interventions constantly evolving to treat these wounds. Publisher: Department of Defense, Office of The Surgeon General, US Army, Borden Institute. 2008: 442 p.; ill.  Please note: several of the files are large and may take a few minutes to download. Emergency War Surgery  (2004) - Although called the 3rd US Revision, this edition of Emergency War Surgery represents an entirely new Handbook. All material is new and revised to reflect lessons learned from ongoing American involvement in Southwest Asia. The Handbook takes a bulleted manual style in order to optimize its use as a rapid reference. Drafted by subspecialty experts, it was then updated by surgeons returned from yearlong deployments in Iraq and Afghanistan. A collaborative effort of the Borden Institute and the AMEDD Center & School, this Handbook is an essential tool for the management of forward combat trauma.  MORE INFO Emergency War Surgery zipped file for quick Download http://www.bordeninstitute.army.mil/other_pub.html
1 sur 16

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Battlefield critical care

  • 1. Battlefield Critical Care Steven Podnos MD
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12. Norepinephrine - LEVOPHED ®   Alpha receptor & Beta-1 agonist. Used to maintain BP in hypotensive states. Most potent vasoconstrictor (Norepi >>> phenylephrine). Dosage (initial): 8 to 12 mcg/min -titrate to BP (Usual target: SB:80-100 or MAP=80). Usual maintenance: 2 to 4 mcg/min. Note: doses as high as 0.5 to 1.5 mcg/kg/min for 1-10days have been used in septic shock. Note: Norepinephrine dosage is stated in terms of norepinephrine base and intravenous formulation is norepinephrine bitartrate. Norepinephrine bitartrate 2 mg = Norepinephrine base 1 mg. Usual range: 8-30 mcg/minute. Range used in clinical trials: 0.01-3 mcg/kg/minute. ACLS dosage range: 0.5 to 30 mcg/minute. Administer into large vein to avoid the potential for extravasation. Calculation of drip rate 8 mg/ 250 ml (ml/hr) = mcg/min x 1.875. Supplied: Injection (soln): 1 mg/ml - 4 ml
  • 13. Phenylephrine - NeoSynephrine ®  Alpha agonist. May be given IM,SC, IV push, or by continuous infusion. Treat mild/moderate hypotension, also PSVT. IV infusion : usual initial rate : 0.1 to 0.18 mg/min (100 to 180mcg/min) (titrate). Usual maintenance rate: 40-60 mcg/min. Maximum rate (range): infusion rates as high as 8 to10 mcg/kg/min may be required in shock. [Usual maximum dosing range reported: 0.4 to 9.1 mcg/kg/minute ]. IV bolus therapy :  0.1 to 0.5 mg/dose every 10-15 minutes as needed (initial dose should not exceed 0.5 mg)  PSVT: 0.5 mg rapid IV push, subsequent doses may be increased in increments of 0.1 to 0.2mg. Calculation of drip rate (40 mg/250) (ml/hr) = (mg/min) x 375.
  • 14. Dopamine Used to support BP, CO and renal perfusion in shock. Dosing (Adult): Refractory CHF : initial dose: 0.5 to 2 mcg/kg/min. Renal : 1 to 5 mcg/kg/min. Severely ill patient : initially 5 mcg/kg/min, increase by 5 to 10 mcg/kg/min (q10 to 30 min) up to max of 50 mcg/kg/min. Cardiac life support (initial): 2 to 5 mcg/kg/min - titrated to effect. Infusion may be increased by 1-4 mcg/kg/minute at 10 to 30 minute intervals until optimal response is obtained. If dosages >20-30 mcg/kg/minute are needed, a more direct-acting pressor may be more beneficial (ie, epinephrine, norepinephrine). [0.5 to 2 mcg/kg/min-dopa; 2-10-dopa/beta; >10-primarily alpha.] Calculation of drip rate (ml/hr) 400mg/250 ml: wt(kg) x mcg/min x 0.0375.
  • 15.
  • 16. War Surgery in Afghanistan and Iraq, a Series of Cases, 2003-2007 (2008) - describes the management of nearly 100 cases of acute combat trauma, conducted in the forward austere operative environment of war in the 21st century. Presented with vivid surgical photos, the cases encompass the spectrum of trauma that characterizes war today, as well as the medical interventions constantly evolving to treat these wounds. Publisher: Department of Defense, Office of The Surgeon General, US Army, Borden Institute. 2008: 442 p.; ill. Please note: several of the files are large and may take a few minutes to download. Emergency War Surgery (2004) - Although called the 3rd US Revision, this edition of Emergency War Surgery represents an entirely new Handbook. All material is new and revised to reflect lessons learned from ongoing American involvement in Southwest Asia. The Handbook takes a bulleted manual style in order to optimize its use as a rapid reference. Drafted by subspecialty experts, it was then updated by surgeons returned from yearlong deployments in Iraq and Afghanistan. A collaborative effort of the Borden Institute and the AMEDD Center & School, this Handbook is an essential tool for the management of forward combat trauma. MORE INFO Emergency War Surgery zipped file for quick Download http://www.bordeninstitute.army.mil/other_pub.html