Ortho Hand Exam

Hand injuries are the most common type of injury treated in an emergency department, and make up more than 12% of all trauma cases in the US (Maroukis et al). Having a good understanding of the anatomy and key landmarks is paramount for a medic, or any other medical provider, responsible for providing emergency care.

Despite the need to accurately describe hand injuries, many practitioners struggle in this skill. However, with a good understanding of some key terms, any medic could easily describe an injury to a medical provider over the phone or radio. In fact, a good grasp of this topic is so rare that I believe this video would also be good for a medical resident. I can count many times that even an Emergency Room physician described the wrong terms or landmarks for a hand injury to me over the phone (when I worked for an orthopedic trauma service). To be fair, I struggled also prior to working in orthopedics- this topic is just not taught much in medical programs. But this stuff isn’t that hard once you familiarize yourself with the topic. I tried to keep it informal and short in my 5 minute video below. Future videos may involve some teaching on some procedures that medics can learn and perform themselves in the field- stay tuned.

EXTRA RESOURCES FOR HAND TRAUMA

Check out the Orthobullets.com Hand Trauma dashboard for links to all sorts of hand injury information, if you are interested in learning more. This site was created by ortho residents- its a great resource. Check it out here.

ADTMC- MUSCULOSKELETAL

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This is a broad topic, but a very common complaint from Soldiers – orthopedic complaints. The 68W Combat Medic should have a basic understanding of how to recognize and diagnose, as well as treat injuries. The medic can further expand skillsets to be able to handle smaller things at their own level, when necessary. The medic can be very useful to his/her Soldiers if able to reliably recognize and treat these common issues.

The topic of orthopedics is very expansive. Therefore, I will do my best to cover a lot of topics here. I have done several posts previously on orthopedic topics, and so they will also be referenced below. I will probably continue to add to this list as time progresses. Also, I’ve highlighted the “OTTAWA RULES” video for “when to get an x-ray” because I believe this topic is so important for a medic.

Anytime we see a patient, we have to take a good medical history. In orthopedics, especially, this guides everything. “Mechanism of Injury” is the essential piece in a musculoskeletal exam in order to have suspicions and to know where to look. If one is aware of the specific mechanisms of injury for certain injuries, then the diagnosis becomes easier. For instance, the ACL tear of the knee has a typical mechanism of injury.

The next videos aren’t perfect (I wouldn’t make a perfect video either), but it does present the way that a medic ought to think when approaching a patient with a musculoskeletal injury- he does a good job. I also like how he expands his thinking to include the possibility of other injuries as well.

In a clinical setting instead of a pre-hospital setting, this will be more complicated. We aren’t just determining if the patient needs to go to the ER or not. We are determining how to treat and how to disposition the patient. Therefore, if the medic wants to be able to play an effective role in diagnosising and potentially returning Soldiers to duty quicker, he/she must become more familiar with common injuries.

I would recommend that each medic reviews the multiple ADTMC protocols (NOV 2019 edition) for the various musculoskeletal areas of the body. Essentially, the ADTMC discusses ruling out red flag issues and then referring. Or, the ADTMC will point to a “home exercise plan.” This may not be all that helpful since a “home exercise plan” is vague. I do have some posts (links at top of page) above that detail some rehab programs promoted by previous US ARMY Physical Therapists.

Splinting

Most of the splinting videos on YouTube are inadequate, in my opinion. In the future, I may make videos to detail splinting techniques and ways to avoid pitfalls. However, most responders will be placing a splint that is temporary. Therefore, there is less necessity to get the perfect splint. Often a SAM splint is used on the way to the hospital. However, there are some principles that may be reviewed later. A splint is not effective if it does not immobilize. An example would be a forearm fracture splinted with a splint that does not control for rotation. Or, an ankle dislocation+fracture that does not stabilize the joint and does not prevent the ankle from returning to a compromising position. Of course, these “permanent splint” ideas become more important during Prolonged Field Care. I will make a post and video about this later. For now, I recommend reviewing this link to learn the different types of splints for various parts of the body.

Check on Learning Quiz

The quiz will be performed live. If you are an instructor and would like a copy of my very basic quiz, please send me an email. Instructors can design their own quizzes also.

Contact me by Email: admin@nextlevelmedic.com

All content is intended to be educational only. Medics should operate under the supervision of a medical provider and abide by all local laws while stateside. Medics should only practice at the level credentialed, and only at the level allowed. This content is not intended to treat or give a substitution for any credentialed provider. Content is intended to aid in a deployed prolonged care setting. Take guidance from your leaders. Utilize these posts as preparation and as a supplement to your provider’s direction and teaching.

If You Enjoy This Content, Please Consider Sharing with Others to Help Them Learn Also

ADTMC- Allergic Reactions

Allergic reactions can be complex and range on a scale of severity. The 68W Medic must know how to sort out life threatening emergencies from less severe reactions. The ADTMC protocol can help with this. A screenshot of the ADTMC protocol is at the bottom of the post.

The goals of this post will be to solidify the definition and warning signs of anaphylaxis, to educate some on the physiology behind allergic reactions, and to help the medic have a clearer understanding of how to help a his/her supervising medical provider when treating from a remote location.

Make sure to master the first section: “What is Anaphylaxis?” Then, to become an even better medic, tackle the second section next. Studying “Allergic Reactions Further Explained in Greater Detail” will take some more time and may require additional reading or investigation.

What is Anaphylaxis?

A few different definitions exist. However, I will cite from Uptodate.com the definition proposed by the Second National Institute of Allergy and Infectious Disease /Food Allergy and Anaphylaxis Network symposium from 20061. It should be noted that there is no universal agreement on the criteria for diagnosis.

Anaphylaxis is highly likely when any 1 of the following 3 criteria are fulfilled:
  1. Acute onset of an illness (minutes to hours) with involvement of the skin, mucosal tissue, or both. Must also include either respiratory compromise (example wheezing, stridor, etc) or reduced blood pressure/syncope or collapse.
  2. Two or more of the following that occur minutes to hours after a likely allergen for the specific patient:
    1. Generalized skin involvement or swollen lips/tongue/uvula
    2. Respiratory compromise (example wheezing, stridor, etc)
    3. Reduced BP or associated symptoms such as collapse/syncope
    4. Persistent GI symptoms (abdominal pain, vomiting, cramps, etc)
  3. Drop in blood pressure after exposure to a known allergen for that specific patient that occurs in minutes to hours

Anaphylaxis Explained

Allergic Reactions Further Explained in Greater Detail

ADTMC Protocol for Allergic Reactions

Click Here to Take the Quiz to Check Learning

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All content is intended to be educational only. Medics should operate under the supervision of a medical provider and abide by all local laws while stateside. Medics should only practice at the level credentialed, and only at the level allowed. This content is not intended to treat or give a substitution for any credentialed provider. Content is intended to aid in a deployed prolonged care setting. Take guidance from your leaders. Utilize these posts as preparation and as a supplement to your provider’s direction and teaching.

This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.

REFERENCES

1 Sampson HA, Muñoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report–Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117(2):391‐397. doi:10.1016/j.jaci.2005.12.1303

ADTMC – Dermatology

Dermatology concepts are difficult for everyone. It takes a lot of exposure and experience to be able to differentiate. However, this post will attempt to provide a place to return when review is necessary. This lesson will likely take at least 60 minutes to complete, but it may be split up and accomplished over time to make things easier. The post will start with general concepts and then move to easier topics that medics can often manage. The ADTMC protocol for an unknown rash is at the bottom, and there is a video about cellulitis as well. Don’t forget the quiz at the bottom to check learning.

GENERAL CONCEPTS AND DEFINITIONS

After watching these intro videos to the types of lesions, this website from Stanford Medicine is a good thorough review. The website includes pictures and descriptions in greater academic detail, as well as some videos to discuss a good physical exam.

CONTACT DERMATITIS

Contact dermatitis is a reaction to a substance. When Soldiers are in the field, this is often from a plant such as poison ivy. My treatment protocol depends on the severity of the reaction. There are reports that talk about washing the oils off of the body with soap and water within 30 minutes from exposure- this can help prevent a lot of the reaction. However, once the rash appears, I typically prescribe a few medications.

For minimal local reaction that is not widespread, I typically give a topical steroid cream. My treatment of choice tends to be Triamcinolone 0.1% cream twice daily for 14 days. There are other creams and gels in this range of potency. Lots of literature suggests even stronger potency, but I find that triamcinolone tends to work fine. It is widely available in DOD pharmacies.

For more widespread lesions (not just one limb) or for more intense spread, I will often add prednisone oral pills. I often do a 9 day taper with the triamcinolone. My cocktail has often been 60 mg for 3 days, 40 mg for 3 days, and 20 mg for 3 days. However, I change this up depending on severity or concern. I may also give a Decadron 4-8 mg IM injection on the first day and then follow it up with my 9 day taper, all while using the triamcinolone cream.

Treatment Regimen for Contact Dermatitis
  • Mild: Triamcinolone 0.1% cream used twice daily to affected area for 14 days
  • Moderate: Oral Prednisone 60 mg for 3 days, 40 mg for 3 days, and 20 mg for 3 days, and the Triamcinolone 0.1% cream twice daily
  • More than Moderate: Decadron 8 mg IM injection on day one, Triamcinolone 0.1% cream twice daily x 14 days, and oral Prednisone tapering cocktail above started the day after the injection.

These regimens have worked for me in the past. However, I give this only as an example and not as what medics should do without guidance. I am not recommending that this necessarily be done for patients in all circumstances, and I am aware that many other providers would disagree with this approach or recommend other approaches to contact dermatitis treatment. Some will use calamine lotion or other lotions, but these really only help with some of the itching and does not resolve the reaction.

HEAT RASH

My approach to treating heat rash has been to give a low dose hydrocortisone 0.1% cream (over the counter strength) to be used twice daily. I also encourage staying out of the heat as best as possible and changing clothes more often to keep the moisture from staying against the skin. Soldiers often wear gear that causes the moisture to be compressed up against the skin, so I typically recommend that they stay in PT uniforms (shorts and t-shirt) when I can in order to reverse the process. Sometimes I use other creams instead or other approaches, but the Soldier really needs to prevent the rash from continuing by removing the offending behavior for a few days.

PSEUDOFOLLICULITIS BARBAE

Psuedofolliculitis Barbae is essentially razor bumps after shaving. This is also treated with hydrocortisone 0.1% twice daily and allow the Soldier to have a shaving profile. Allowing the hair to grow (not shaving) for a little bit typically resolves this. Most people know what this looks like. However, the short video below does have a few pictures.

TINEA PEDIS

COMMON PRESCRIPTIONS:
  • Terbinafine cream applied twice daily for 2 weeks
  • Clotrimazole cream applied twice daily for 4 weeks
  • Tolnaftate powder applied to the feet twice daily

CELLULITIS

Cellulitis is a serious condition that should be seen by a provider. There are many causes for rashes, and many are difficult to tease out. The ones above are typically straightforward and can often be managed by medics. However, this protocol below is a helpful protocol from the new ADTMC that details when to refer to a provider.

ADTMC PROTOCOL FOR SKIN COMPLAINT

QUIZ LINK – CHECK LEARNING HERE

All content is intended to be educational only. Medics should operate under the supervision of a medical provider and abide by all local laws while stateside. Medics should only practice at the level credentialed, and only at the level allowed. This content is not intended to treat or give a substitution for any credentialed provider. Content is intended to aid in a deployed prolonged care setting. Take guidance from your leaders. Utilize these posts as preparation and as a supplement to your provider’s direction and teaching.

If You Enjoy This Content, Please Consider Sharing with Others to Help Them Learn Also

This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.

ADTMC- Upper Respiratory Infections

When conducting sick call using Algorithm Directed Troop Medical Care (ADTMC), it is important to have an understanding of upper respiratory infections (URIs). These are very common complaints for day-to-day sick call. Additionally, URI knowledge is an essential task in the ADTMC competency checklist. This lesson will be more lengthy due to the complicated nature of the topic. I recommend breaking it up and completing the review in stages. Additionally, I recommend returning to this topic often for review because there is so much info.

Start Here – Files to Download And Review

Videos to Break it all Down

The videos above describe the URI types and sources. Most often these illnesses are caused by viruses. However, in military populations who sleep close to each other in open bays for prolonged times, we can often see a higher prevalence of atypical pathogens (mycoplasma) that require antibiotics (Z-pack often helps). Therefore, in my experience, it is probably more appropriate to be more liberal with prescribing antibiotics in military training populations.

Click here to review Acute Otitis Media.

TAKE THE QUIZ – CLICK HERE

Extra Credit- Complications seen in URIs

Peritonsillar abscesses can be seen in military age patients. Several of these present each year within basic trainees. The drainage of such abscesses is typically performed by either an ER physician or a ENT physician. Medics should not attempt to drain these, especially without training for a multitude of reasons (including the carotid artery in the area). Retropharyngeal abscesses (second video) are less likely in occurrence. There are more complications than just these two, but I felt these are two worth reviewing.

If You Enjoy This Content, Please Consider Sharing with Others to Help Them Learn Also

All content is intended to be educational only. Medics should operate under the supervision of a medical provider and abide by all local laws while stateside. Medics should only practice at the level credentialed, and only at the level allowed. This content is not intended to treat or give a substitution for any credentialed provider. Content is intended to aid in a deployed prolonged care setting. Take guidance from your leaders. Utilize these posts as preparation and as a supplement to your provider’s direction and teaching.

This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.

Contact me by Email: admin@nextlevelmedic.com

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From Military Apps, LLC. A Veteran Owned Business.

MRE APP is an app designed to help service members (or whoever is eating MREs) to choose the best MRE. See the contents of every MRE, search by desired item, search by category of snacks/desserts/beverages. See calorie content! Download now on Apple App Store or the Google Play Store.

ADTMC Clinical Topics

Otitis Media

Competency validation is now a well described crucial piece of Algorithm Directed Troop Medical Care (ADTMC). Medics must be validated by their medical officer before using ADTMC in daily sick call. The appendix G of the 2019 release of MEDCOM Pam 40-7-21 has both a clinical skills and knowledge requirement for medics prior to beginning the triage and treatment process. Click here to go to the ADTMC page for skills review.

Check on Learning

These videos help to quickly explain acute otitis media. In these videos, you should have learned about how the infection occurs, how to perform an exam, what it looks like on exam, how to treat it, and the complications that can rarely occur. Take this quick quiz to “Check on Learning.”

For more information, check out these links below to read more on the topic:

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This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.

Contact me by Email: admin@nextlevelmedic.com

ADTMC Skills Part 5

Algorithm Directed Troop Medical Care (ADTMC) has been updated as of 2019, and there’s a lot of improvements. The ADTMC has been the traditional manual for allowing 68W medics to run sick call under the “supervision” of a provider for a long time. However, the line units have been the only ones still doing this…and not consistently.

This post is not in reference to NMERT certification. ADTMC is a protocol for sick-call within units. Providers must validate that their medics have the proper skillset and knowledge base prior to permitting Medics to conduct sick call semi-independently.

We need to get back to it. We need to get back to teaching medics. We need to get back to allowing medics to do more. We have to. In a “Near Peer” fight we will be relying on them much more than the last 15 years. And global pandemics like the COVID-19 issue also shows us that we need to be able to have a ready force of 68Ws.

The new ADTMC allows Medics to perform at a higher level, but only after validation. This post is the skills portion of the ADTMC validation. Providers and senior medics should use these videos to enhance their training and save time.

See One, Do One, Teach One

This post is shorter and focuses on suturing and skin closures. Watch a few of the videos and then take the short quiz to check yourself to ensure you understood key concepts.

Check your Learning!

Take the Quiz Here

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From Military Apps, LLC. A Veteran Owned Business.

MRE APP is an app designed to help service members (or whoever is eating MREs) to choose the best MRE. See the contents of every MRE, search by desired item, search by category of snacks/desserts/beverages. See calorie content! Download now on Apple App Store or the Google Play Store.

This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.

Latest Posts

Contact me by Email: admin@nextlevelmedic.com

ADTMC Skills Validation Part 4

Algorithm Directed Troop Medical Care (ADTMC) has been updated as of 2019, and there’s a lot of improvements. The ADTMC has been the traditional manual for allowing 68W medics to run sick call under the “supervision” of a provider for a long time. However, the line units have been the only ones still doing this…and not consistently.

This post is not in reference to NMERT certification. ADTMC is a protocol for sick-call within units. Providers must validate that their medics have the proper skillset and knowledge base prior to permitting Medics to conduct sick call semi-independently.

We need to get back to it. We need to get back to teaching medics. We need to get back to allowing medics to do more. We have to. In a “Near Peer” fight we will be relying on them much more than the last 15 years. And global pandemics like the COVID-19 issue also shows us that we need to be able to have a ready force of 68Ws.

The new ADTMC allows Medics to perform at a higher level, but only after validation. This post is the skills portion of the ADTMC validation. Providers and senior medics should use these videos to enhance their training and save time.

See One, Do One, Teach One

This post is about a lot of blood and a lot of pus. Be prepared. But, these are skills that Medics can do with a little supervision. These are skills we expect them to be able to do.

Check Yourself! Take the Quiz Here!

If You Enjoy This Content, Please Consider Sharing with Others to Help Them Learn Also

This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.

CHECK OUT THE NEW MRE APP

From Military Apps, LLC. A Veteran Owned Business.

MRE APP is an app designed to help service members (or whoever is eating MREs) to choose the best MRE. See the contents of every MRE, search by desired item, search by category of snacks/desserts/beverages. See calorie content! Download now on Apple App Store or the Google Play Store.

Latest Posts:

ADTMC Skills Validation Part 3

Algorithm Directed Troop Medical Care (ADTMC) has been updated as of 2019, and there’s a lot of improvements. The ADTMC has been the traditional manual for allowing 68W medics to run sick call under the “supervision” of a provider for a long time. However, the line units have been the only ones still doing this…and not consistently.

This post is not in reference to NMERT certification. ADTMC is a protocol for sick-call within units. Providers must validate that their medics have the proper skillset and knowledge base prior to permitting Medics to conduct sick call semi-independently.

We need to get back to it. We need to get back to teaching medics. We need to get back to allowing medics to do more. We have to. In a “Near Peer” fight we will be relying on them much more than the last 15 years. And global pandemics like the COVID-19 issue also shows us that we need to be able to have a ready force of 68Ws.

The new ADTMC allows Medics to perform at a higher level, but only after validation. This post is the skills portion of the ADTMC validation. Providers and senior medics should use these videos to enhance their training and save time.

See One, Do One, Teach One

Medics, senior medics, and providers can use these videos to at least accomplish the “See One” portion of medical skills teaching. This is the Part 3 of the ADTMC validation series.

Hartmann’s Fluid = Lactated Ringers

Check Yourself on What You’ve Learned by Taking the Quiz Here

If You Enjoy This Content, Please Consider Sharing with Others to Help Them Learn Also

CHECK OUT THE NEW MRE APP

From Military Apps, LLC. A Veteran Owned Business.

MRE APP is an app designed to help service members (or whoever is eating MREs) to choose the best MRE. See the contents of every MRE, search by desired item, search by category of snacks/desserts/beverages. See calorie content! Download now on Apple App Store or the Google Play Store.

This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.

All content is intended to be educational only. Medics should operate under the supervision of a medical provider and abide by all local laws while stateside. Medics should only practice at the level credentialed, and only at the level allowed. This content is not intended to treat or give a substitution for any credentialed provider. Content is intended to aid in a deployed prolonged care setting. Take guidance from your leaders. Utilize these posts as preparation and as a supplement to your provider’s direction and teaching.

ADTMC Skills Validation Part 2

Algorithm Directed Troop Medical Care (ADTMC) has been updated as of 2019, and there’s a lot of improvements. The ADTMC has been the traditional manual for allowing 68W medics to run sick call under the “supervision” of a provider for a long time. However, the line units have been the only ones still doing this…and not consistently.

This post is not in reference to NMERT certification. ADTMC is a protocol for sick-call within units. Providers must validate that their medics have the proper skillset and knowledge base prior to permitting Medics to conduct sick call semi-independently.

We need to get back to it. We need to get back to teaching medics. We need to get back to allowing medics to do more. We have to. In a “Near Peer” fight we will be relying on them much more than the last 15 years. And global pandemics like the COVID-19 issue also shows us that we need to be able to have a ready force of 68Ws.

The new ADTMC allows Medics to perform at a higher level, but only after validation. This post is the skills portion of the ADTMC validation. Providers and senior medics should use these videos to enhance their training and save time.

See One, Do One, Teach One

Medics, senior medics, and providers can use these videos to at least accomplish the “See One” portion of medical skills teaching. This is PART 2 of the Skills Validation which will focus on the Eye.


Now, Check Yourself!

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CHECK OUT THE NEW MRE APP

From Military Apps, LLC. A Veteran Owned Business.

MRE APP is an app designed to help service members (or whoever is eating MREs) to choose the best MRE. See the contents of every MRE, search by desired item, search by category of snacks/desserts/beverages. See calorie content! Download now on Apple App Store or the Google Play Store.

This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.

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