Breathing in TACEVAC Consider tension pneumothorax in casualties with penetrating chest Watch for tension pneumothorax as injuries and progressive respiratory distress. Decompress with a casualties with a chest wound ascend to the needle thoracostomy. lower pressure at altitude. Pulse ox readings will become lower as Although chest tubes may be considered by trained personnel in long casualty ascends unless supplemental oxygen or delayed evacuations, they are considerably more difficult and is added. invasive procedures, and there is no evidence that they are more Chest tube placement may be considered if a effective than needle decompression for relieving tension casualty with suspected tension pneumo fails pneumothorax. to respond to needle decompression Supplemental Oxygen in Tactical Evacuation Care Most casualties do not need supplemental oxygen, but have oxygen available and use it Oxygen should be pre-positioned on evacuation assets. for: Casualties in shock Oxygen generators or concentrators are preferred over compressed – Low oxygen sat on pulse ox gas cylinders because of the reduced explosive hazard. – Unconscious casualties – Casualties with TBI – (maintain oxygen saturation > 90%) Chest wound casualties – 5. Tranexamic Acid (TXA) If a casualty is anticipated to need significant blood transfusion (for example: presents with hemorrhagic shock, one or more major If the casualty meets the criteria for treatment with TXA, and it has amputations, penetrating torso trauma, or not already been given, then give the first dose in Tactical Evacuation evidence of severe bleeding) Care. Note that TXA should not be initiated if more than three Administer 1 gram of tranexamic acid hours have passed since the casualty was injured. (TXA) in 100 cc Normal Saline or Lactated Ringer’s as soon as possible but NOT later than 3 hours after injury. Begin second infusion of 1 gm TXA after Hextend or other fluid treatment.
Breathing in TACEVAC Watch for tension pneumothorax as casualties with a chest wound ascend to the lower pressure at altitude. Pulse ox readings will become lower as casualty ascends unless supplemental oxygen is added. Chest tube placement may be considered if a casualty with suspected tension pneumo fails to respond to needle decompression Consider tension pneumothorax in casualties with penetrating chest injuries and progressive respiratory distress. Decompress with a needle thoracostomy. Although chest tubes may be considered by trained personnel in long or delayed evacuations, they are considerably more difficult and invasive procedures, and there is no evidence that they are more effective than needle decompression for relieving tension pneumothorax. Supplemental Oxygen in Tactical Evacuation Care Most casualties do not need supplemental oxygen, but have oxygen available and use it for: – Casualties in shock – Low oxygen sat on pulse ox – Unconscious casualties – Casualties with TBI (maintain oxygen saturation > 90%) – Chest wound casualties Oxygen should be pre-positioned on evacuation assets. Oxygen generators or concentrators are preferred over compressed gas cylinders because of the reduced explosive hazard. 5. Tranexamic Acid (TXA) If a casualty is anticipated to need significant blood transfusion (for example: presents with hemorrhagic shock, one or more major amputations, penetrating torso trauma, or evidence of severe bleeding) Administer 1 gram of tranexamic acid (TXA) in 100 cc Normal Saline or Lactated Ringer’s as soon as possible but NOT later than 3 hours after injury. Begin second infusion of 1 gm TXA after Hextend or other fluid treatment. If the casualty meets the criteria for treatment with TXA, and it has not already been given, then give the first dose in Tactical Evacuation Care. Note that TXA should not be initiated if more than three hours have passed since the casualty was injured.
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