[rakkasan187]

Airway:
1.Manually open airway maintaining C-spine immobilization if tactical situation permits and clinical condition warrants.
2. Clear airway of blood, secretions, teeth or other potential FBAO if present.
3. Position Pt to allow drainage of blood or secretions (recovery position) if tactical/clinical conditions allow.
4. Airway intervention to include NPA/ETT if Pt unable to protect airway or if you suspect that Pts condition may deteriorate and unable to protect airway.
5. If unable to secure airway by less invasive means due to facial trauma, swelling or FBAO perform needle or preferably surgical cric.

Breathing:
1. Be prepared to provide rescue breathing/ventilations to apneic Pt or Pt with inadequate spontaneous respirations.
2. Perform chest needle decompression to affected side if Pt presents with decreased BS, dyspnea, tachycardia, decreased BP (hemodynamic instability), cyanosis, JVD, tracheal shift secondary to penetrating trauma to thorax, abd, proximal upper extremeities or pelvis. Also indicated for blunt trauma to thorax abd etc if suspected tension pneumothorax.
3. Apply occlusive dressing (vaseline gauze wrapper, plastic wrap, Asherman, pediatric defib pad) to entrance/exit wounds. Be prepared to burp or relieve pressure from dressing if S/Sx in #2 present.

Circulation:
1. Control arterial/venous bleeding with direct pressure, elevation, pressure pts and/or tourniquet. Tourniquets reserved for extremity wounds that cannot be controlled by earlier mentioned means or that need immediate attenuation due to severity/tactical situation.
2. Place and or trans Pt in Trendelenburg if possible.
3. Gain IV access early prior to vascular collapse if possible. Resuscitate with crystalloid fluids titrating to mentation.
4. Gain second IV access site with saline/hep lock.
5. Needle decompression could be considered a circulation intervention due to clinical features of obstructive shock.


Getting the evil eye from the old lady...gotto go to the grocery store....will expound later...

rak