Crisis Medicine LLC

Is this the best small portable ventilator? The Ventway Sparrow ventilator, used by US SOF may be the best, small, portable ventilator. It is 1.3 kilos, can work with or without supplemental oxygen, can handle adult and pediatric patients down to 5 kilos, can do both non-invasive ventilation, like CPAP, as well as traditional mechanical ventilation. It has a 4 hour battery run time, and apparently a 12V adaptor to enable it to run off of a car battery. So far, it looks like its only downside is it uses a proprietary airway ventilation circuit. I’m told the manufacturer is working with other companies to make the tubing more available. Dislcaimer: This post is not sponsored or endorsed by any equipment manufacturer. Crisis Medicine does not accept funding from industry and has no disclosures. (Though if anyone knows someone at Inovytec, we’d absolutely accept one as a sample for testing!) #TECC #TCCC #firstresponder #lawenforcement #immediateresponder #swatmedic #combatmedic #paramedic #swat #fire #firefighter #ems #emergencymedicine #18D #crisismedtraining

The Combat Medical Conference (CMC) in Paris finished today. For take-home messages and summaries of some of the top teaching points, please see our posts on IG, @crisismedtraining

EMMA Capnography: Enhancing EtCO2 Monitoring in Respiratory Care - new article at the site: The January 2024 TCCC update requires end-tidal CO2 monitoring after the establishment of a surgical airway & for periodic reassessment. Pulse oximetry tells you about a casualty's oxygenation. End-tidal CO2 provides information on their ventilation. To understand a casualty's respiratory status, you need to monitor both. The chart shows the EMMA device's end-tidal CO2 readings correlate well with larger, less portable capnographs used in hospitals. Disclaimer: This post is not sponsored or endorsed by Masimo or any other equipment manufacturer. Crisis Medicine does not accept funding from industry and has no disclosures. #TECC #TCCC #PFC #prolongedfieldcare #AEC #firstresponder #lawenforcement #immediateresponder #swatmedic #combatmedic #paramedic #swat #fire #firefighter #ems #emergencymedicine #18D #crisismedtraining

Dr Mirzayanov, a Russian dissent who worked 26 years in the State Scientific Research Institute for Organic Chemistry and Technology in Russia, the lab responsible for creation of Novichok or “A” series nerve agents says in general those agents are more toxic than traditional ‘G” and ‘V” series nerve agents. Specifically, he states A-230 is 5 to 8X more toxic than VX nerve agent and A-232 10X more toxic than Soman (GD). However, there is conflicting data from other published research showing the “A” series might be less toxic than traditional agents. Unfortunately, this just demonstrates how little we currently know about these “newcomer” nerve agents. The chart in the illustration compares the toxicity of VX nerve agent and various “A” series Novichok agents per kg body weight. An LD50 is the dose that will kill 50% of those exposed to it. Data on the toxicity of VX is fairly consistent, but two different researchers have found that “A” series agent A-230 could be ten times more toxic than VX, while another showed it was tenfold less toxic. What do we currently know about Novichoks? The state of the art. Noga M, Jurowski K. Arch Toxicol. 2023 Mar;97(3):651-661. #TECC #TCCC #18D #hazmat #CBRN #CBRNE #TCBRN #HazardousMaterialUnit #masscasualty #MCI #tacticalmedic #NFPA #firehazmat #handsonhazmat #hazmat #hazmatteam #hazmattech #hazmatspecialist #FireFighter #Rescue #crisismedtraining

Crisis Medicine T-CBRN Journal Watch: On time, on target. If you find the JTS/Co-TCCC Journal Watch and literature update helpful, we have started a Journal Watch on articles relevant to the management of a casualty in a CBRN environment and 2024 Q3 is available now. Download in PDF or in e-Books. Link in bio. #TECC #TCCC #18D #hazmat #CBRN #CBRNE #TCBRN #HazardousMaterialUnit #masscasualty #MCI #tacticalmedic #NFPA #firehazmat #handsonhazmat #hazmat #hazmatteam #hazmattech #hazmatspecialist #FireFighter #Rescue #crisismedtraining

…Extreme cold can kill your casualty as quickly as a bleeding wound… With the end of the Global War on terror, there is recognition that what worked for casualty management in Iraq and Afghanistan, may not be as successful in Artic and extreme cold environments. Noting an increased mortality rate in traumatic casualties with body temperature less than 36.2 degrees Celsius, MhARCH has been proposed to greater emphasize the importance of hypothermia prevention in casualties. Specifically, in conditions where environmental exposure is as dangerous to the casualty as enemy fire, some have recommended no significant TCCC interventions be performed if it requires the casualty to be exposed to the elements. TCCC interventions would be deferred until there is a thermally protective environment for the casualty. In an Arctic or extreme cold weather situation the casualty is essentially in a care under fire phase until shielded from the elements and provided a heat source. Casualty evacuation in arctic and extreme cold environments: A paradigm shift for traumatic hypothermia management in tactical combat casualty care. Rund TJ. Int J Circumpolar Health. 2023 Dec;82(1):2196047. #ArcticTCCC #ArcticWarfare #TECC #TCCC #firstresponder #lawenforcement #immediateresponder #swatmedic #combatmedic #paramedic #swat #fire #firefighter #ems #emergencymedicine #18D #crisismedtraining

The FDA just approved an intranasal (IN) Epi pen. Does it work? The drug was studied in 175 healthy people, or those with mild allergic reactions, not anaphylaxis. They measured the amount of epinephrine in their blood stream after intranasal injection compared to an epi pen injection and it was similar. This was taken as proof the drug could treat anaphylaxis, a life threatening allergic reaction. The 2 mg IN injector comes with two doses. You put one in one nostril and if that doesn’t fix the anaphylaxis, they you put the other dose in the other nostril. Apparently, epinephrine isn’t absorbed well through the nasal mucosa, which is why it has taken so long to come up with this delivery system. This IN version of epinephrine is in some kind of sulfite, so if the pt is allergic to sulfa, they may also react to this too per the manufacturer. Until better literature is published, I would consider this totally unproven regarding effectiveness and wouldn’t recommend intranasal epi quite yet. https://lnkd.in/gXCURdKT

BY THE NUMBERS: Of 66 patients with unstable pelvic ring fractures evaluated at a level 1 trauma center from 2014 to 2018, 38 did not have a prehospital pelvic binder placed. Of the 28 pelvic binders applied prehospital, only 14 were felt to be at the correct location, defined as within 3 cm of the vertical midpoint of the greater trochanters or within 3 cm of the horizontal midpoint between each hip. There was no statistically significant difference in survival, hospital length of stay, or transfusions between those who had a pelvic binder placed correctly, incorrectly, or not at all. Does a prehospital applied pelvic binder improve patient survival? Reiter A, Strahl A. Injury. 2024 Apr;55(4):111392. #TECC #TCCC #firstresponder #lawenforcement #immediateresponder #swatmedic #combatmedic #paramedic #swat #fire #firefighter #ems #emergencymedicine #18D #crisismedtraining

Although a 2021 systematic review and meta-analysis comparing hypertonic saline and mannitol for severe TBI showed no statistically significant survival or favorable neurological outcome between either drug, there was a trend toward improved survival with hypertonic saline; it just didn’t reach a statistically significant number. A forest plot shows the result and confidence interval with one equalling no benefit. All but one study cited had a result favoring hypertonic saline. However, the result isn't considered significant since the confidence intervals touch or cross one. This still implies a trend toward hypertonic saline being better than mannitol. Read the full article at the site, link in bio. #TECC #TCCC #prolongedcasualtycare #prolongedfieldcare #swatmedic #combatmedic #paramedic #swat #fire #firefighter #ems #emergencymedicine #18D #crisismedtraining

Moderate to severe TBI patients, particularly with pupil dilation have a high fatality rate and poor neurological outcome even if they survive. These patients need emergent brain imaging and neurosurgical consultation. If ICP-lowering medications are used, hypertonic saline seems a better choice over mannitol, with its trend to higher overall survival, longer duration of effect, beneficial effects on hemodynamics, ability to lower increased ICP after mannitol failed to do so, and 9% higher ICU survival when administered prehospital. Read the full article at the site, link in bio. #TECC #TCCC #prolongedcasualtycare #prolongedfieldcare #swatmedic #combatmedic #paramedic #swat #fire #firefighter #ems #emergencymedicine #18D #crisismedtraining