201021U. S. Special Operations Command (USSOCOM)

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DETERMINATION OF DEATH / DISCONTINUING RESUSCITATION SPECIAL CONSIDERATIONS: 1. Immediate determination of death is appropriate in a trauma patient without pulse or respirations in the setting of multiple casualties when resuscitative efforts would hinder the care of more viable patients. 2. Patients that are struck by lightening, have hypothermia, cold-water drowning, or intermittent pulses may require extended cardiopulmonary resuscitation. 3. It is assumed that personnel do not have access to ECG, or other monitoring equipment to evaluate heart rhythm, or deliver countershocks. SIGNS AND SYMPTOMS: 1. Obvious Death -– Persons who, in addition to absence of respiration, cardiac activity and neurologic reflexes have one or more of the following: A. Decapitation B. Massive crushing and / or penetrating injury with evisceration of the heart, lung or brain C. Incineration D. Decomposition of body tissue E. Rigor mortis or post-mortem lividity MANAGEMENT: 1. In the setting of obvious death, resuscitative efforts should not be initiated. 2. If resuscitative efforts have been initiated, discontinuation should be considered A. After 15 minutes (if the cause is unknown or due to trauma) or after 30 minutes (when the cause is due to hypothermia, electrical injury, lightning strike, cold water drowning, or other cause known to require a prolonged resuscitative effort) when: 1) There is persistent absence of pulse and respirations despite assuring airway and ventilation as well as administration of resuscitative fluids and medications. 2) Pupils are fixed and dilated. 3) No response to deep pain above or below the clavicles. 4) Absence of end-tidal CO2, (either colorimetric or wave form) from a correctly placed endotracheal tube or alternative airway. 3. If there is any question as to the discontinuation of resuscitative efforts, then a medical officer should be contacted for guidance. DISPOSITION: 1. Evacuation of the remains when tactically feasible. 2. In the event of return of spontaneous circulation, Urgent Evacuation. A36 Journal of <strong>Special</strong> <strong>Operations</strong> Medicine
EAR INFECTION (INCLUDES OTITIS MEDIA AND OTITIS EXTERNA) SPECIAL CONSIDERATIONS: 1. Infection of the middle or external ear may be viral or bacterial in etiology. 2. Increased pressure in the middle ear may cause intense pain and may result in rupture of the tympanic membrane (characterized by sudden decrease in pain and drainage from ear canal.) SIGNS AND SYMPTOMS: 1. Ear pain MANAGEMENT: 1. Moxifloxacin (Avelox) 400mg PO qd for 10 days OR Azithromycin. (Z-pac) 500mg PO initially followed by 250mg PO qd x 4 days. 2. Treat per Pain Management Protocol. 3. If external canal exudate is present, Gatifloxacin (Zymar) drops, 5 drops tid – qid until symptoms remain resolved for 48 hours. 4. If water immersion is anticipated, use ear plugs to prevent cold water entry which will cause vertigo. DISPOSITION: 1. For uncomplicated cases, no evacuation is necessary. 2. Routine evacuation for complicated cases not responding to therapy. Winter 2010 Training Supplement TMEPS A37
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 and 16: BACK PAIN SPECIAL CONSIDERATIONS: M
Page 17 and 18: BEHAVIORAL CHANGES (INCLUDES PSYCHO
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
Page 35 and 36: DEEP VENOUS THROMBOSIS (DVT) SPECIA
Page 37: DENTAL PAIN SPECIAL CONSIDERATIONS:
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
Page 67 and 68: SEIZURE SPECIAL CONSIDERATIONS: 1.
Page 69 and 70: SMOKE INHALATION SPECIAL CONSIDERAT
Page 71 and 72: SPECIAL CONSIDERATIONS: None SUBUNG
Page 73 and 74: MILD TRAUMATIC BRAIN INJURY (MTBI)
Page 75 and 76: URINARY TRACT INFECTION SPECIAL CON
Page 77 and 78: Additional Contributors to Earlier
Page 79 and 80: Joint Special Operations Tactical M
Page 81 and 82: Pregnancy Category X Studies in ani
Page 83 and 84: o Increased fluid intake is require
Page 85 and 86: Pregnancy Category B Side-effects:
Page 87 and 88: Dosage of atovaquone/proguanil in p
Page 89 and 90:
o Hepatitis Immune system disorder
Page 91 and 92:
o o Gastroenteritis Protocol Urinar
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Benadryl® - See Diphenhydramine HC
Page 95 and 96:
Pregnancy class: Generally consider
Page 97 and 98:
2nd generation: Diminished Staph au
Page 99 and 100:
o o o o o o o o Vomiting Diarrhea
Page 101 and 102:
Dextrose - See Glutose Diamox® - S
Page 103 and 104:
o o o Contact Dermatitis Protocol E
Page 105 and 106:
o Hypersensitivity to other carbape
Page 107 and 108:
o Days 3 to 7: Instill 1 drop in af
Page 109 and 110:
o Renal impairment o Not for use in
Page 111 and 112:
o Heme and lymphatic system Anemia
Page 113 and 114:
on the label. DO NOT use solutions
Page 115 and 116:
o Sodium depletion o Transient volu
Page 117 and 118:
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
Page 133 and 134:
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
Page 139 and 140:
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
Page 153 and 154:
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
Page 161 and 162:
Medics Advanced providers Casualty
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After Action Review in Training or
Page 165 and 166:
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
Page 173 and 174:
• 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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