This document discusses principles of combat casualty care, including:
1. The goals of Tactical Combat Casualty Care (TCCC) are to save preventable deaths, prevent additional casualties, and complete the mission.
2. About 60% of combat deaths are from hemorrhage from extremity wounds, 33% from tension pneumothorax, and 6% from airway obstruction - all of which can potentially be prevented with the right interventions.
3. There are three categories of casualties on the battlefield - those who will live regardless, those who will die regardless, and those who could be saved from preventable deaths with proper medical intervention. The goal is to target interventions to the correct mechanisms
A mass casualty incident is defined as an event which generates more patients at one time than locally available resources can manage using routine procedures. It requires exceptional emergency arrangements and additional or extraordinary assistance.
Approach to a trauma patient - Advanced Trauma Life SupportParthasarathi Ghosh
Approach to a trauma patient from a Critical Care Medicine perspective with basics of Advanced Trauma Life Support.
References - ATLS Manual 10th Edition
A mass casualty incident is defined as an event which generates more patients at one time than locally available resources can manage using routine procedures. It requires exceptional emergency arrangements and additional or extraordinary assistance.
Approach to a trauma patient - Advanced Trauma Life SupportParthasarathi Ghosh
Approach to a trauma patient from a Critical Care Medicine perspective with basics of Advanced Trauma Life Support.
References - ATLS Manual 10th Edition
Disaster and Mass Casualty Incidents (updated 7th July 2020)Chew Keng Sheng
A new updated slide on an overview of disaster management in Malaysia, including the formation of NADMA as the dedicated agency to coordinate disaster management in Malaysia.
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
Disaster and Mass Casualty Incidents (updated 7th July 2020)Chew Keng Sheng
A new updated slide on an overview of disaster management in Malaysia, including the formation of NADMA as the dedicated agency to coordinate disaster management in Malaysia.
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
This is lecture 1 of a 10 week Lecture series for Level 6 students Introducing them to Complex Trauma. This module is based on Courtis & Ford (2013) Treatment of Complex Trauma : A sequenced relationship based approach.London. Guildford Press.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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1. Why?
●A short history of military medicine
–Changing battlefields
–EBM, Better data sets
–Save before you can fix
–Resource constraints
●Drive to more efficient care
●Reduce Longterm dependancy
2. Goal
To perform the correct intervention at the correct
time in the continuum of Care to improve survival
and reduce morbidity.
In other words, a medically correct intervention
performed at the wrong time in the military
continuum of care may lead to further casualties or
worse outcomes
3. Factors influencing combat casualty
care
●Enemy Fire
●Medical Equipment Limitations
●Widely Variable Evacuation Time
●Tyranny of numbers
4. Principles of TCCC
• The three goals of Tactical Combat
Casualty Care (TCCC) are:
–1. Save preventable deaths
–2. Prevent additional casualties
–3. Complete the mission
31. OEF Total Trauma Admissions
Battle vs. Non-Battle Injury
385
572
725 743 722
627 589
477
348 348 302
448
126
93
120 117 111
87
83
110
126 130
114
150
0
100
200
300
400
500
600
700
800
900
1000
Apr-
10
May-
10
Jun-
10
Jul-10 Aug-
10
Sep-
10
Oct-
10
Nov-
10
Dec-
10
Jan-
11
Feb-
11
Mar-
11
Battle vs. Non-Battle Injury – 1 Year
Non-Battle (25%) Battle (75%)
8/17/2014 12 Right Patient, Right Care, Right
Place, Right Time
32.
33. How - Cause of Injury
Mar 2011
148
10
23
6
249
7
17
2
14
63
9
44
Bullet/GSW/Firearm
Burn
Fall
Hand Grenade
IED
Knife/Other Sharp Object
Machinery/Equipment
Mine/Landmine
Mortar/Rocket/Artillery Shell
MVC
RPG
Other
8/17/2014 36 Right Patient, Right Care, Right
Place, Right Time
ncludes both battle and non-battle injury
34.
35.
36. Trauma and The Lethal Triad
Acidosis Hypothermia
Coagulopathy
Death
Brohi, K, et al. J Trauma, 2003.
37. Combat Deaths
•KIA: 31% Penetrating head trauma
•KIA: 25% Surgically uncorrectable torso trauma
•KIA: 10% Potentially surgically correctable trauma
•KIA: 9% Hemorrhage from extremity wounds
•KIA: 7% Mutilating blast trauma
•KIA: 5% Tension pneumothorax
•KIA: 1% Airway problems
•12% Mostly from infections and complications of
shock
38. PREVENTABLE CAUSES OF
COMBAT DEATH
•60% Hemorrhage from extremity wounds
•33% Tension pneumothorax
•6% Airway obstruction e.g., maxillofacial trauma
•* Data is extrapolated from Vietnam to present
day Iraq and Afghanistan
39. Survival
80% survive
70% survive at 1
hour
60% survive to 24
hours
50% survive to 72
hours
20% die immediately
10% die over the first
hour – Hg/Airway
Further 10% die by 6
hours – lethal triad
10% die over the
next 48 hours –
lethal triad and late
complications
40. Summary
• There are three categories of
casualties on the battlefield:
1. Operators who will live regardless
2. Operators who will die regardless
3. Operators who will die from preventable
deaths unless there is intervention
• Target the intervention to the mechanism
and time window
44. OEF Shock on Admission (BD > 5)
0
20
40
60
80
100
120
140
OEF
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
13.3% of total OEF admissions
8/17/2014
18
Right Patient, Right Care, Right
Place, Right Time
1-Year’s Data: Apr 10– Mar 11
45.
46. OEF Hypothermia
Breakdown
7
2
27
0
5
10
15
20
25
30
35
40
US Military Coalition All Others
Admission Temperature < 96 F or < 35.5 C
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
1% of all US
admissions
.3% of all
Coalition
admissions
8/17/2014 17 Right Patient, Right Care, Right
Place, Right Time
4.5% of all
Others
admissions
49. Massive Transfusion
Component Therapy
0
5
10
15
20
25
30
18.2 18.7
3.2 3.1
21
Mar 2011 MT Patients (N= 49)
Mean # units
transfused
Mean RBC Age
Platelets:
1 unit = 6 pk plts
8/17/2014 25 Right Patient, Right Care, Right
Place, Right Time
Total Units FWB: 0
Doses of Factor VII: 1
(Level III Only)
50. OEF Level III
Massive Transfusion
Survival
70%
75%
80%
85%
90%
95%
100%
0
20
40
60
80
100
120
140
2nd Qtr 10 3nd Qtr 10 4th Qtr 10 1st Qtr 11
%Survival
#MassiveTransfusions
# Massive Transfusions % Survival
8/17/2014 23Right Patient, Right Care, Right
Place, Right Time
51. OEF Massive Transfusion Survival
Long Term US Military Only
70%
75%
80%
85%
90%
95%
100%
0
10
20
30
40
50
60
70
2nd Qtr 10 3rd Qtr 10 4th Qtr 10 1st Qtr 11
%Survival
#MassiveTransfusions
# Massive Transfusions % Survival
8/17/2014 18 Right Patient, Right Care, Right
Place, Right Time
52. OEF Massive Transfusion Survival
Long Term Coalition Only
70%
75%
80%
85%
90%
95%
100%
0
10
20
30
40
50
60
70
2nd Qtr 10 3rd Qtr 10 4th Qtr 10 1st Qtr 11
%Survival
#MassiveTransfusions
# Massive Transfusions % Survival
8/17/2014 24 Right Patient, Right Care, Right
Place, Right Time
53.
54.
55. More Complicated Than Anticipated –
Acute Coagulopathy of Trauma Shock
25% of trauma patients present coagulopathic