DUSTOFF Medic Podcast

Dr. Jeffrey Siegler joins us to discuss the SMOG Airway Confirmation guideline. The first half of this episode follows the SMOG, then we pivot to discuss "the sledgehammer." Dr. Siegler has conducted important research on the excessive tidal volumes delivered by the "adult" BVM. After you've listened to this episode, watch his presentation to the Joint Trauma System, and read 

• Siegler, J., Kroll, M., Wojcik, S., & Moy, H. P. (2017). Can EMS providers provide appropriate tidal volumes in a simulated adult-sized patient with a pediatric-sized bag-valve-mask?. Prehospital Emergency Care, 21(1), 74-78.

Trevor mentions the difficulty of effective lung auscultation. StatPearls has a good summary.

We've posted a great ETCO2 waveform reference from the PFC Airway Management CPG under 'Resources' at dustoffmedicpodcast.com. Use the cheat sheet, but read the CPG too—it's an excellent document.

Ultrasound may be a faster method to confirm airway placement that end-tidal capnography. Take a look a this recent article:

• Chowdhury, A. R., Punj, J., Pandey, R., Darlong, V., Sinha, R., & Bhoi, D. (2020). Ultrasound is a reliable and faster tool for confirmation of endotracheal intubation compared to chest auscultation and capnography when performed by novice anaesthesia residents-A prospective controlled clinical trial. Saudi Journal of Anaesthesia, 14(1), 15.

Finally, ultrasound is proven to be safe and effective for use inside helicopters. The earliest reference we can find for this is below, and many studies since have bolstered this.

• Lichtenstein, D., & Courret, J. P. (1998). Feasibility of ultrasound in the helicopter. Intensive care medicine, 24(10), 1119.

MAJ Lani Pineda, RN, joins Max and Wayne to discuss Clinical Practice Guideline 27, Interfacility Transport of Patients Between Theater Medical Treatment Facilities.

Wayne mentions several studies that preceded the most recent update to this CPG. These include:

• JROCM 026-12, Tactical Critical Care Transport DOTMLPF Change Recommendation (click 'Resources,' at dustoffmedicpodcast.com)
• Mabry, R. L., Apodaca, A., Penrod, J., Orman, J. A., Gerhardt, R. T., & Dorlac, W. C. (2012). Impact of critical care–trained flight paramedics on casualty survival during helicopter evacuation in the current war in Afghanistan. Journal of Trauma and Acute Care Surgery, 73(2), S32-S37.
• Dickey, N. W. (2015). Combat trauma lessons learned from military operations of 2001-2013. Defense Health Agency/Defense Health Board Falls Church United States.
• Dickey, N. W. (2011). Tactical Evacuation Care Improvements Within the Department of Defense. Defense Health Agency/Defense Health Board Falls Church United States.

The entire Clinical Practice Guideline library is on the Joint Trauma System website. We've got a link to it under 'Links' at dustoffmedicpodcast.com.

Dr. Jennifer Gurney joins us to discuss the SMOG Multiple Trauma guideline.

Dr. Gurney discusses challenges in military pre-hospital documentation. Schauer, et al discuss this at length: Schauer, S. G., April, M. D., Naylor, J. F., Oliver, J. J., Cunningham, C. W., Fisher, A. D., & Kotwal, R. S. (2017). A descriptive analysis of data from the Department of Defense Joint Trauma System Prehospital Trauma Registry. US Army Medical Department Journal.

Dr. Gurney further emphasizes the need for military-civilian partnerships to ensure medical providers maintain their skills. If your unit has an effective partnership in place for pre-hospital providers, please let us know about it at dustoffmedicpodcast.com.

Max mentions literature describing the effects of hypothermia on traumatic brain injury. More information: Jeremitsky, E., Omert, L., Dunham, C. M., Protetch, J., & Rodriguez, A. (2003). Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion. Journal of Trauma and Acute Care Surgery, 54(2), 312-319.

This episode relates to TC 8-800, Table I, III, and VII.

Dr. Andy Fisher joins us to discuss the SMOG Hemorrhage guideline.

Dr. Fisher mentions a case involving manual compression of a patient's aorta:
Lewis, C., Nilan, M., Srivilasa, C., Knight, R. M., Shevchik, J., Bowen, B., ... & Kreishman, P. (2020). Fresh Whole Blood Collection and Transfusion at Point of Injury, Prolonged Permissive Hypotension, and Intermittent REBOA: Extreme Measures Led to Survival in a Severely Injured Soldier-A Case Report. Journal of special operations medicine: a peer reviewed journal for SOF medical professionals, 20(2), 123-126.

This episode relates to TC 8-800, Table I

Welcome to the podcast. Listen to the introductory episode at https://feeds.buzzsprout.com/1316548.rss