201021U. S. Special Operations Command (USSOCOM)

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BAROTRAUMA SPECIAL CONSIDERATIONS: 1. Pulmonary Over-Inflation Syndrome (POIS) may occur from ascent from depth if compressed air was used or exposure to blast overpressure. 2. The most commonly affected site is the middle ear and tympanic membrane, but paranasal sinuses and teeth may be affected. 3. Pulmonary barotrauma occurs when compressed air is breathed at depth followed by ascending with a closed airway (i.e. breath-holding), and can cause pneumothorax or arterial gas embolism. SIGNS AND SYMPTOMS: 1. Pain in the ear(s), sinuses, teeth. 2. Pulmonary over-inflation syndrome may present with chest pain, dyspnea, mediastinal emphysema, subcutaneous emphysema, pneumothorax, and arterial gas embolism (AGE). . MANAGEMENT: 1. Middle ear A. If a tympanic membrane rupture is present or suspected, protect the ear from water or further trauma. B. Moxifloxacin (Avelox) 400mg PO qd if contamination is suspected. C. Pseudoephedrine (Sudafed) 60mg PO q 4 – 6 hr prn D. DO NOT use ear drops. E. Refer to higher level of care when feasible. 2. Paranasal Sinus barotraumas. Pseudoephedrine (Sudafed) 60mg PO q 4 - 6 hr prn Pulmonary barotraumas to include subcutaneous emphysema: A. If no respiratory distress, monitor patient closely. Use pulse oximetry if available B. If respiratory distress occurs – Treat per Spontaneous Pneumothorax Protocol. 3. If arterial gas embolus is suspected, administer 100% oxygen and 1 liter normal saline IV 150cc/hr. Urgent evacuation to recompression chamber. If an unpressurized airframe is used, avoid altitude exposure greater than 1000ft. 4. Treat per Pain Management Protocol. (Avoid narcotics if recompression is anticipated.) DISPOSITION: 1. Urgent Evacuation for cerebral arterial gas embolus or pneumothorax with respiratory distress, 2. Mild to moderate middle ear, sinus, or pulmonary barotraumas without respiratory distress, observation and Routine evacuation. 3. Routine evacuation for consultation for Tympanic Membrane rupture. A14 Journal of <strong>Special</strong> <strong>Operations</strong> Medicine
BEHAVIORAL CHANGES (INCLUDES PSYCHOSIS, DEPRESSION AND SUICIDAL IMPULSES) SPECIAL CONSIDERATIONS: 1. In a tactical setting consider sleep deprivation as a cause. 2. Etiologies are numerous and will often dictate the management; thus mental status changes could be caused by head trauma, metabolic and endocrine disease processes, environmental toxins, infections, combat stress disorder, hypoxia, hyperthermia, hypothermia, pharmaceutical agent use (i.e. mefloquine) or withdrawal. 3. Consider diabetic hypoglycemia as a cause of altered mental status. SIGNS AND SYMPTOMS: 1. Acute behavioral changes include withdrawal, depression, aggression, confusion, or other behavioral patterns atypical for the individual. 2. Psychosis is an acute change in mental status characterized by altered sensory perceptions that are not congruent with reality: A. Auditory and/ or visual hallucinations B. May include violent or paranoid behavior C. Disorganized speech patterns are common D. May include severe withdrawal from associates MANAGEMENT: 1. Remove all weapons or potential weapons from patient AND treating Medic. 2. Check pulse oximetry. 3. Place patient in safe environment under continuous surveillance 4. Give contents of 1 sugar packet sublingually to treat for possible hypoglycemia. 5. Take Temperature A. If Temperature is below 95 degrees, treat per Hypothermia Protocol. B. If Temperature is above 101 degrees, treat per Meningitis Protocol. C. If Temperature is above 103 degrees, treat per Meningitis and Hyperthermia Protocols. D. IF MENINGITIS IS SUSPECTED OR IF THERE IS A DECREASE IN MENTAL STATUS, USE VALIUM WITH CAUTION, DUE TO POSSIBLE RESPIRATORY DEPRESSION, HYPOTENSION, AND MASKING OF PROGRESSION OF DISEASE RELATED ALTERED MENTAL STATUS. 6. For acute agitation, combativeness, or violent behavior, restrain patient with at least four individuals and give diazepam (Valium) 10mg IM. Repeat after 30 minutes prn. OR Midazolam (Versed) 5mg IM. 7. If sedated or restrained, maintain constant vigilance for a change in the hemodynamic status or loss of airway reflexes. DISPOSITION: Urgent Evacuation Winter 2010 Training Supplement TMEPS A15
Page 1 and 2: Training Supplement Winter 10 Journ
Page 3 and 4: U.S. SPECIAL OPERATIONS COMMAND TAC
Page 5 and 6: HIV Post Exposure Prophylaxis 45 Hy
Page 7 and 8: Changes for 2009: A. Crush Protocol
Page 9 and 10: ABDOMINAL PAIN SPECIAL CONSIDERATIO
Page 11 and 12: ALTITUDE ILLNESS SPECIAL CONSIDERAT
Page 13 and 14: ANAPHYLACTIC REACTION SPECIAL CONSI
Page 15: BACK PAIN SPECIAL CONSIDERATIONS: M
Page 19 and 20: Winter 2010 Training Supplement TME
Page 25 and 26: BRONCHITIS/ PNEUMONIA SPECIAL CONSI
Page 27 and 28: CHEST PAIN SPECIAL CONSIDERATIONS:
Page 29 and 30: CONSTIPATION/ FECAL IMPACTION SPECI
Page 31 and 32: CORNEAL ABRASIONS/ CORNEAL ULCERS/
Page 33 and 34: CRUSH SYNDROME PROTOCOL SPECIAL CON
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Page 37 and 38: DENTAL PAIN SPECIAL CONSIDERATIONS:
Page 39 and 40: EAR INFECTION (INCLUDES OTITIS MEDI
Page 41 and 42: EPISTAXIS SPECIAL CONSIDERATIONS: 1
Page 43 and 44: FUNGAL SKIN INFECTION SPECIAL CONSI
Page 45 and 46: HEADACHE SPECIAL CONSIDERATIONS: 1.
Page 47 and 48: HIV POST EXPOSURE PROPHYLAXIS SPECI
Page 49 and 50: HYPERTHERMIA SPECIAL CONSIDERATIONS
Page 51 and 52: INGROWN TOENAIL SPECIAL CONSIDERATI
Page 53 and 54: K-9 EVALUATION AND TREATMENT VITAL
Page 55 and 56: HYDRATION STATUS: 1. Normal Hydrati
Page 57 and 58: K-9 HIGH ALTITUDE SICKNESS AND PULM
Page 59 and 60: K-9 TRAUMA MANAGEMENT SPECIAL CONSI
Page 61 and 62: C. Chest tube and needle thoracente
Page 63 and 64: MALARIA SPECIAL CONSIDERATIONS: 1.
Page 65 and 66: NAUSEA AND VOMITING SPECIAL CONSIDE
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SEIZURE SPECIAL CONSIDERATIONS: 1.
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SMOKE INHALATION SPECIAL CONSIDERAT
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SPECIAL CONSIDERATIONS: None SUBUNG
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MILD TRAUMATIC BRAIN INJURY (MTBI)
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URINARY TRACT INFECTION SPECIAL CON
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Additional Contributors to Earlier
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Joint Special Operations Tactical M
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Pregnancy Category X Studies in ani
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o Increased fluid intake is require
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Pregnancy Category B Side-effects:
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Dosage of atovaquone/proguanil in p
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o Hepatitis Immune system disorder
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o o Gastroenteritis Protocol Urinar
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Benadryl® - See Diphenhydramine HC
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Pregnancy class: Generally consider
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2nd generation: Diminished Staph au
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o o o o o o o o Vomiting Diarrhea
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Dextrose - See Glutose Diamox® - S
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o o o Contact Dermatitis Protocol E
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o Hypersensitivity to other carbape
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o Days 3 to 7: Instill 1 drop in af
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o Renal impairment o Not for use in
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o Heme and lymphatic system Anemia
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on the label. DO NOT use solutions
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o Sodium depletion o Transient volu
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Abdominal pain Fatigue Loss of ap
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o Sedation in combination with anal
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o Ileus o Urinary retention TMEP Us
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o Swelling o Contact dermatitis o I
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Indications: o HAPE prophylaxis/tre
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o Ventilatory support o Intravenous
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Motion sickness: The average adult
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o GI: Nausea, vomiting, anorexia, d
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o Dry mouth o Nausea o Vomiting Adv
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o Respiratory: throat irritation, a
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Metabolism and nutrition disorders
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decrease the efficacy of tadalafil
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Acute renal failure Nephrogenic di
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Common Name Nomenclature AHFS Categ
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dextrose tablets 45gm multi-use squ
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plastic bag 12s (Hespan) 12s ibupro
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moxifloxacin hydrochloride (Avelox)
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Primaquine Phosphate tablets USP 15
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2009 Joint Formulary Authors U.S. S
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Pediatric Vital Signs Respiratory R
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systems. Through the medical threat
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Where do you foresee taking casualt
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Medics Advanced providers Casualty
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After Action Review in Training or
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Access to evacuation routes (foot,
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Winter 2010 Training SupplementTact
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Winter 2010 Training SupplementTact
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- Patient Treatment & Monitoring on
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• Open HMMWV / GMV • Unit speci
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REHEARSALS Drive routes to hospital
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SEVERITY Minor: o partial thickn
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(Retrieved from http://www.nda.ox.a
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NOTES: Winter 2010 Training Supplem
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Winter 2010 Training Supplement 181
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201021U. S. Special Operations Command (USSOCOM)

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