7
No routine IVs and fluid bolus
Minimize interference with combatants who can continue to participate in the
engagement
Conserve limited IV fluid supplies
Attend to casualties with more severe wounds
Avoid delaying tactical movement - there are times when waiting 5 minutes might
get five of your team members killed
Fluid resuscitatioin only for casualties with controlled hemorrhage and shock
Saline Locks vs IVs
Ranger Saline Lock Setup
Field recognition of shock
Aggressive RX of Tension Pneumothorax
Needle decompression vs chest tube
Tension pneumothorax
Don't try to rely on usual clinical S/S of decreased breath sounds, tracheal shift, and
hyperresonance to percussion on the battlefield
May be very difficult to appreciate in that environment
GSW chest and increasing dyspnea = needle thoracostomy
Chest tube not required for field Rx
Israeli Chest Tube Study
16 patients
Chest tubes placed by physicians in the field
One iatrogenic pneumothorax
Three patients received chest tubes that were "clearly unnecessary"
Four patients with chest tubes inserted subcutaneously
Rosenblatt et al
J Trauma 1985
Preventable Death with Tension Pneumothorax
No CPR on the Battlefield
