Austere Anaesthesia by Aebhric OKelly MA, FAWM, Critical Care Paramedic

Austere Anaesthesia  by Aebhric OKelly MA, FAWM, Critical Care Paramedic

Austere Anaesthesia  by Aebhric OKelly MA, FAWM, Critical Care Paramedic

Pain Management with OTC meds. There are a few options out there for pain meds for the non physician. Obviously the best option out there is to have a physician prescribe some heavy hitters. Unfortunately, this is not always an option for Austere Medics.

Ibuprofen has two doses: 400mg will have an analgesic effect and 600-800mg will have an anti-inflammation effect. Ibuprofen is an analgesic and an anti inflammatory. This will benefit any outdoor professional who is in pain from blisters, sprained ankles, or sore muscles. Taking the 800mg dose will address the pain and the inflammation of these injuries.

Paracetamol or Tylenol: 1gm up to 4gm per day. Even the military include this for battlefield casualties. It is also has the highest ratio of success of any analgesic. This means that more people can successfully take Paracetamol without dangerous side effects. Definitely a safe option for the Austere Settings.

Mixing Ibuprofen & Paracetamol: Recent studies have shown that taking 400mg of Ibuprofen and 1gm of Paracetamol/Tylenol together will be have a analgesic effect similar to 2mg of morphine.

Other OTC sedation drugs 

Chlorphenamine (CPM): is used as an anti-histamine. It is great for a runny nose. It can be used for a general analgesic. For Austere Medics who need to debride an infected wound it would help with calming and partially sedating the casualty. Anti-histamines are also quite effective for motion sickness and the prevention of the same. CPM also has an anti nausea effect and can be useful for someone who is suffering from motion sickness or other forms of nausea.

Diphenhydramine (DPH): is used primarily in North America and has the same uses and effect as CPM.

Our Tropical, Travel and Expedition Medicine (TTEMS) graduates get tuition in over-the-counter medications as well as the paramedic formulary. This has been quite useful for their careers as Austere Medics. One of our graduates got a job as the medic for a Mount Kilimanjaro trip for a not-for-profit organisation. As you can imagine they never thought about getting paramedic drugs for the medic. Our graduate quickly grabbed as many drugs as he could from the local chemist before flying to Africa. He had to deal with an ankle fracture with the Paracetamol/ Ibuprofen combination. It worked reasonable well and the casualty was grateful to have pain relief.

Prescription Only Drugs. According to the Pain Ladder, the use of Prescription Only Medications is warranted for moderate to severe pain. IV Paracetamol and Fentanyl are great options. For severe pain there is a need for ketamine with midazolam or possibly higher doses of fentanyl.

Reusing kit. A lot of anaesthetic kit can be reused after sterilisation. For the Austere Medic there are few options available. Having a pressure cooker in the team house is great for sterilising your medical kit. Make sure that your scrub the kit first to remove all of the bits first.

This is blog is for information purposes only. It is imperative that you are a physician or working under the orders of a licensed and registered doctor when using austere anaesthetic skills.

KETAMINE battlefield analgesic

3 reasons to use ketamine for prehospital analgesia

Entonox 50%/50%/ gas medicinal, comprimido Óxido nitroso N2O / Oxígeno O2

 are

Tranexamic Acid for trauma-related hemorrhage TXA

TRANEXAMIC ACID / ACIDO TRANEXAMICO

Leer tema relacionado 

Tema para ver con detenimiento y revisa, no creo sea concluyente, pero me llama la atención bastante 

Prehospital Tranexamic Acid for Severe Trauma. June 2023 

Conclusions: Among adults with major trauma and suspected trauma-induced coagulopathy who were being treated in advanced trauma systems, prehospital administration of tranexamic acid followed by an infusion over 8 hours did not result in a greater number of patients surviving with a favorable functional outcome at 6 months than placebo. (Funded by the Australian National Health and Medical Research Council and others; PATCH-Trauma ClinicalTrials.gov number, NCT02187120.).

Copyright © 2023 Massachusetts Medical Society.

https://pubmed.ncbi.nlm.nih.gov/37314244/

Abstracts

Adv Emerg Nurs J. 2014 Apr;36(2):123-31

Tranexamic Acid for trauma-related hemorrhage.Bailey AM, Baker SN, Weant KA

Abstract:

Trauma-related deaths represent a leading cause of mortality among persons younger than 45 years. A significant percentage of these are secondary to hemorrhage. In trauma, massive and rapid loss of blood creates an imbalance in hemostasis. Mainstays of resuscitation include surgical interventions, restoring intravascular volume, and pharmacologic interventions. Providers continue to search for improved pharmacologic options for achieving hemostasis. Tranexamic acid is an antifibrinolytic and inhibits fibrinolysis by blocking the lysine-binding sites on plasminogen. Tranexamic acid works to stabilize and inhibit the degradation of existing clots. Tranexamic acid has been prospectively proven to reduce mortality in trauma-related hemorrhage. Its use will likely expand into such areas as resuscitation and massive transfusion protocols and the prehospital setting. Therefore, it is critical for emergency medicine providers to be familiar with appropriate use of tranexamic acid in order to maximize efficacy and decrease the potential adverse events. 

Tranexamic Acid for trauma-related hemorrhage

AirLink VitaLink able to administer Tranexamic Acid to trauma patients with severe bleeding while en route to the New Hanover Medical Center

By EMS1 Staff

WILMINGTON, N.C. – The AirLink VitaLink critical care transport program has been authorized to administer Tranexamic Acid (TXA) to trauma patients with severe bleeding.

Dr. Heston Lamar, the service's medical director, told WECT that "the body can lose its ability to clot blood after a major traumatic injury. TXA works to restore that process and improve a patient's outcome of survival when used within three hours of the incident."

Since Dec. 1, TXA, prominently known for its use to treat wounded soldiers with severe bleeding, can be administered to patients in transport to the New Hanover Regional Medical Center. 

WECT talked to a spokesman for AirLink VitaLink Critical Care Transport team who explained, "Being able to take this drug [TXA] to the bedside and administer it there on scene to get the trauma center and ICU level care started earlier, the better off the patient outcomes are."

TXA has been administered inside the trauma centers for years. Recently, research on using TXA outside of the hospital was conducted.

Lamar said that tests showed TXA was highly effective in stabilizing patients before they arrived at the hospital. In addition to stocking TXA on the critical care helicopters and ambulances, the New Hanover Regional Medical Center is working on approval to stock county EMS ambulances with TXA. 

From EMS1

Related: Español 

Ácido Tranexámico mejora la mortalidad en el Trauma con Shock Hemorragico

By Dr. Ramon REYES, MD

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