PCC Crush Syndrome

Starting in a building of opportunity in a far forward location, participants receive handoff for a casualty 2 hours out from vehicle entrapment with crush injury. During the evaluation, the casualty develops compartment syndrome that requires fasciotomy, and rhabdomyolysis with hyperkalemia. The learner should identify hyperkalemia and give appropriate medications including IV calcium, insulin, dextrose, and albuterol. The learner should provide aggressive fluid hydration, monitor urine output with goal 100-200 ml/hr, check UA for myoglobinuria, provide appropriate antibiotics, provide analgesia, perform early teleconsultation, provide nursing measures, give DVT prophylaxis, assess nutrition, give GI prophylaxis, and request for urgent evacuation.

Learning Objectives

1. Demonstrate ability to provide patient care for extended periods of time when evacuation or mission requirements surpass available capabilities and/or capacity to provide that care.

2. Understand the use of the MARC2H3-PAWS-L algorithm in prolonged casualty care.
a. Evaluate for massive hemorrhage, and appropriately manage resources during a massive casualty situation.
b. Evaluate airway patency and perform interventions if indicated.
c. Evaluate respirations and perform any indicated interventions.
d. Evaluate circulation, and if required give IV fluids or blood products to improve circulation. Consider conversion of
tourniquets placed in the field.
e. Communicate appropriately with the casualty, team members, tactical leadership, evacuation platform, logistics
support, and perform teleconsultation.
f. Prevent hypothermia, and manage hyperthermia.
g. Evaluate for head Injury and if identified perform serial neurologic checks and appropriate treatments to mitigate the
effects of increased intracranial pressure from traumatic brain injury.
h. Provide appropriate pain control.
i. Give antibiotics as indicated.
j. Evaluate for wounds or burns and place appropriate dressings. Provide appropriate nursing care to keep wound dressings clean.
k. Provide appropriate splinting if indicated.

3. Understand the essential PCC capabilities – monitor, resuscitate, ventilate/oxygenate, airway control, sedation/analgesia, physical exam, diagnostics, nursing and hygiene, surgical interventions, telemedical consult, and package and prepare for flight.

4. Recognize sepsis and septic shock and manage appropriately by changing wound dressings, debriding non-viable tissue in an infected wound, starting broad-spectrum antibiotics, considering vasopressors, and performing teleconsult.

5. Recognize compartment syndrome and perform fasciotomy per teleconsult direction.

6. Identify rhabdomyolysis given the appropriate clinical history and manage appropriately with aggressive IV fluids and medical treatment of hyperkalemia.