BATTLEFIELD ANESTHESIA PATRICIA WEOTT DNAP CRNA MAJ USAR I have no - - PDF document

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BATTLEFIELD ANESTHESIA

PATRICIA WEOTT DNAP CRNA MAJ USAR

I have no disclosures

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OBJECTIVES

• Describe the goals of anesthesia in a

combat zone

• List the components of a Forward Surgical

Team

• Describe available assets to perform

anesthesia in a battle zone

• Discuss the hardships of living in an

austere environment

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Irony of War

• Civil/ WWI : Anatomy books
• WW II: Mobile units referred to as the “Trinity”

comprised of neurosurgeons, plastic surgeons and ophthalmic surgeons. First experience with psychosomatic/conversion disorders R/T Battlefield Trauma (PTSD).

• Korea: First Air Ambulance
• Vietnam: Huey Helicopters for evacuation, medical

corpsmen: surgical airways, needle decompressions and shock resuscitation; which led to our modern system of prehospital emergency care via EMTs and

• paramedics. MASH Units, ‘Golden Hour of Care’.

Persian Gulf Wars: Mobile Intensive Care Units, Blood Transfusion 1:1:1.

Signature Injuries

• Vietnam: PTSD/ Agent Orange
• Iraq: Amputations
• Afghanistan: Closed Head Injuries and

Concussions

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PREVENTABLE CAUSES OF COMBAT DEATH

• 60% Hemorrhage from extremity wounds
• 33% Tension pneumothorax
• 6% Airway obstruction e.g., maxillofacial

trauma

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Signature Injury: Blast/CHI

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Primary Blast Injury

• An explosion generates a blast

wave traveling faster than sound and creating a surge of high pressure immediately followed by a vacuum. The blast wave shoots through armor and soldiers' skulls and brains. While the exact mechanisms by which it damages the brain's cells and circuits are still being studied, the blast wave's pressure has been show to compress the torso, impacting blood vessels, which then send damaging energy pulses into the brain. The pressure can also be transferred partially through the skull, interacting with the brain.

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Airway

• According to TCCC guidelines, surgical

cricothyroidotomy is the preferred method for establishing a definitive airway during tactical field care or the tactical evacuation phase. This assumes care‐ providers in the field lack the necessary equipment, pharmaceutical agents, or training to perform rapid‐sequence

• rotracheal intubation.

CPGs

• Clinical Practice Guidelines
• Evidence‐based
• Improves care by reducing variation in

practice and systematizing “best practices”.

• Serve to reduce errors and provide

consistent quality of care.

• Guidelines also are cornerstones for

accountability and facilitate learning and the conduct of research.

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FORWARD SURGICAL TEAM

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SPECIAL FORCES aka ODA/ODB

• 18A Team Leader
• 18Z Team Sergeant
• 18A Warrant Officer
• 18B Weapons
• 18C Engineer
• 18D (Delta) Medic
• 18E Communications
• 18F Intel

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Lethal Triad

• Hypothermia
• Coagulopathy
• Acidosis

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Care Under Fire (cont.)

• Return fire as directed or required
• If able, the casualty(s) should also return

fire

• Try to keep from being shot
• Try to keep the casualty from sustaining

additional wounds

• Airway management is best deferred until

the Tactical Field Care phase

• Stop any life threatening hemorrhage with

a commercially available tourniquet (CAT)

• Reassure the casualty

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Challenges of Deployments

• Absolute Isolation
• Personnel with deployment stress and

loaded weapons

• Supplies
• Weather
• “Groundhog Day”
• Embedded with Afghans/Iraqis
• Flashbacks

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