My knee exam will be focused based on the history obtained, but I also tend to always perform most of the tests posted below every time. I develop a suspicion of the injury based on the history and mechanism of injury. Future posts will likely include more on this.
First observe the knee. Notice any clues like deformities or discoloration, and ask about severity of pain and/or any numbness. If these are present then the patient needs to be seen by a higher level of care for sure. Or, if the patient does not have full ROM then they need to be seen by a higher level of care. Do not miss a quad tendon tear or similar. Ensure the patient can fully extend the knee.
No, my intent is to help with the minor injuries in which no infection suspected, the pain is gradual, there has been no trauma, and the pain is not significant.
Below is a quick video on the basic anatomy of the knee.
Knee Anatomy Basics
Before we get into the academics of the knee, I think it is important to familiarize yourself on how to perform an adequate exam. Try to get a Doc, PA, Physical Therapist, PTA, or Athletic trainer to show you these also and allow you to practice. They can also go over the mechanisms of injury with you. In the meantime, you can obtain mental reps and save time by watching these videos.
Videos on the Special Tests for the Knee
Anterior Drawer Test to assess the ACL
Posterior Drawer for PCL Tear
Lackhman Test for ACL and PCL Tear
McMurray’s Test for Meniscus Tear
Looking for Patellofemoral dysfunction
Assessing the IT Band
Future posts will have more info. I am recruiting Physical Therapists and Athletic Trainers to assist me in this as well. Stay tuned.
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 is very common, and I believe that Medics can both diagnose and treat it. When Soldiers walk miles for Land Navigation in the dark on uneven terrain, ruck march 9-12 miles, and conduct patrols- they can definitely get some knee pain. This is one common reason why knee pain is seen so much in Ranger School, Pre-Ranger programs, and other exercise-intense courses. I think it is also why there is so much research into “exoskeleton” knee braces – a study is underway soon at Fort Benning.
Patellofemoral syndrome, of course, can only be diagnosed with a good knee exam. It is not a result of trauma, but usually a gradual onset. Therefore, a good history and a good knee exam is important before making this diagnosis. Future posts will detail more on knee history and exams.
A Quick 3 Minute Video from bellinhealth on Patellofemoral Syndrome
Patellofemoral Syndrome is one of the most common knee pain diagnoses that I see. I often treat it acutely with Ice packs (compressed with Ace wrap), NSAIDs, and an open patella knee brace to aid with patella tracking. And, if there is time, I send them to physical therapy to strengthen their quads.
Typically, physical therapists, physical therapy assistants, or athletic trainers will focus on quad stretching and isometric or other strengthening exercises. Some recommend foam rolling the quad also. In orthopedics, we would often prescribe short arc knee extension exercises, with little to no weight and with higher reps, if physical therapy was unaffordable. In short arc knee extension exercises, the knee only bends to approximately 30 degrees and then is extended fully on the knee extension machine. Or, alternatively, one can perform isometric quad strengthening exercises.
Below are a few videos describing some of these exercises. Again, this is posted to really get you the first few days of therapy until you followup. Or, if you are deployed to a remote location and have no other option. The last video is from Tom Brady’s body coaches detailing a good resistance band workout.
I think it is reasonable to eventually advance to functional exercises. I believe that this exercise below by TB12 is one that could build the endurance needed to sustain prolonged load bearing during increased and/or consecutive mileage. Ideally, Soldiers would complete these exercises in order to prevent injuries.
Once able to advance, Consider these exercises to improve quad function and/or prevent Patellofemoral Syndrome
I have future plans to enlist the help of some physical therapists and athletic trainers to help on these issues. Look for that info to come over the next few weeks.
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.
This post wasn’t an expected one for me. However, there have been a few hypothermia cases recently that motivated me to dig into this topic. This post will be a little more wordy, unfortunately. I admit that I completely nerded out on the reading and podcasts. But, I needed to find the most up-to-date info and answers. And I’ve posted it here for others to benefit as well
DEFINITIONS OF HYPOTHERMIA
Cold Stressed: 95-98.6 degrees (35-37 Celsius)
Mild hypothermia: 90-95 degrees F (32-35 Celsius)
Moderate hypothermia: 82-90 degrees F (28-32 Celsius)
Severe hypothermia: below 82 degrees F (28 Celsius)
(Some Sources) Profound Hypothermia: below 75 degrees F (24 Celsius)
Other sources will classify hypothermia in the Swiss system as Hypothermia (HT) 1, HT2, HT3, HT4, and HT5. Either way, hypothermia is usually described based on core temperature. However, this method may not be relevant or practical in assessment.
The American Heart Association defines hypothermia differently with different temperatures. However, the takeaway is that the AHA does not believe that defibrillation is likely to succeed until the patient is warmed above 30 degrees Celsius.
This podcast (A podcast taught by Emergency Department Physicians) suggests describing the diagnosis in more of a symptoms-based approach instead. This is in agreement with the overall direction and attitude of most of the recent articles that I reviewed. This podcast is great because they break everything down in 20 minutes, and they describe a lot of the symptoms. This is a MUST LISTEN TO podcast, in my opinion. You can read the show notes of the podcast also which are very helpful.
The degree of sluggishness and impairment is likely varied amongst individuals, so it is very difficult to diagnose. However, a proper diagnosis does have practical implications because there are different recommendations based on severity of hypothermia.
Rectal temperatures are unreliable for the core temperature in hypothermia patients, and exposing the patient to the cold may worsen the problem. Instead, we should probably focus more on symptoms and clinical picture more than the absolute measured temperature.
Current Recommendations and Protocols
The US Army has a Standard Medical Operating Guideline on Hypothermia for Flight paramedics. Mostly helpful. A good starting point. Posted below:
(ABOVE) REBEL EM PODCAST ON ACCIDENTAL HYPOTHERMIA
The SMOG is pretty good, except that medics on the ground don’t usually have the ability to perform an EKG. And being an algorithm, it is not full of details. Still, it’s a good starting point.
I also recommend this “COLD CARD” from the Wilderness Medicine Society. It is excellent and practical. Useful for assessment and treatment. THIS IS A MUST HAVE. Download it for free here.
CONTROVERSIES REGARDING HYPOTHERMIA
There is some disagreement regarding the diagnosis of mild vs. moderate hypothermia, and how to approach this patient. The controversy surrounds the idea of “Afterdrop.”
Afterdrop, the continued fall of deep body temperatures during rewarming after hypothermia, is thought to endanger the heart by further cooling from cold blood presumed to be returning from the periphery.
Webb, P. (1986). Afterdrop of body temperature during rewarming: an alternative explanation. Journal of Applied Physiology, 60(2), 385–390. doi: 10.1152/jappl.1986.60.2.385
The controversy is centered around the question: Is it safe to walk a mildly hypothermic patient? The Clinical Practice Guidelines by the Wilderness Medicine Society suggest that a patient should rest in a sitting or prone position for 30 minutes while warming in order to minimize afterdrop. However, some dispute this idea because it may be more important to move out of a dangerous situation and out of the elements. Also, the effects of “Afterdrop” may be overstated. Still, the 2019 update to the Clinical Practice Guidelines by the Wilderness Medicine Society left this recommendation in place.
After reading, it appears that it may be wise to not move the extremities or walk the patient in mild hypothermia, if possible. If necessary to move due to danger to the patient, or further harm to the rescuers remaining in the elements, then the risk should be assumed. Unfortunately, the studies are very limited and the data is lacking support. It is obviously unethical to perform studies by inducing hypothermia (harm) in controlled studies.
MANAGEMENT OF HYPOTHERMIA
THEY’RE NOT DEAD UNTIL THEY’RE WARM AND DEAD”
COLD STRESSED
Passive or active warming. Remove wet clothing. Provide a high-calorie food or drink. Move around and exercise to warm up.
MILD HYPOTHERMIA
Have patient lie down or sit for 30 minutes. Actively warm to head and trunk/chest. Use a vapor barrier, if possible. Can give warm PO high calorie fluids or food due to possible hypoglycemia. Evacuate if no improvement.
If the patient is already walking, or if the scene is unsafe, proceed with movement out of the harsh elements to safety.
MODERATE HYPOTHERMIA
Be careful with movements of the patient. Keep the patient horizontal. No drink or food. Parenteral glucose in I/O or IV. Heat the trunk/head/chest. Use the vapor barrier. Give warmed IV fluids at 40-42 degrees Celsius (around 104 F). Must be evacuated.
SEVERE HYPOTHERMIA
Treat the same as moderate hypothermia, except that CPR may be needed. If there are no obvious signs of breathing or pulse, then begin CPR. An AED may be used to assist. The rhythm may not convert in less than 30 degrees Celsius (86 F), until warmed. Evacuate immediately. Be wary of complications and arrhythmias, most common is V-Fib.
Maintain compressions for 5 minutes before moving, and then ensuring that the compressions resume within 5 minutes. Severe hypothermic may be able to tolerate interruptions due to lower metabolic requirements. However, this buffer will fade as the patient warms.
The above guidelines are a collaboration of the sources previously described or are cited below. My main source, and the one article that everyone should read, is the Clinical Practice Guidelines from the Wilderness Medical Society. As always, I would recommend reading through all of the sources in entirety. And keep in mind that the patient could have other reasons for collapse, V-Fib, or asystole besides hypothermia.
Who Needs to Be Evacuated?
Well, this is the big question. And it depends on who you ask/read. According to Dow et al:
” A shivering patient with impaired consciousness should be treated for moderate, not mild, hypothermia.”
Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update Dow, Jennifer et al. Wilderness & Environmental Medicine, Volume 30, Issue 4, S47 – S69
This is a bit murky because we already established that there are different levels of impaired consciousness, and that individuals respond differently. Additionally, the same article describes mild hypothermia as “still shivering” in most cases. Therefore, I believe that it is prudent to err on the side of caution and refer a patient who has become sluggish and impaired/slowed to the Emergency Room for further evaluation and workup.
What Actions Should Be Taken Now?
I am definitely going to conduct some more training with my medics by asking them to read this information, the articles, and to listen to the podcast. We will also try to develop some hands-on training scenarios with a mannequin in a severe hypothermia situation.
I may also redesign some cold weather training for the non medical guys/cadre. I would recommend others do the same since the scenario, if encountered, may be complex.
We will ensure that we stock all of our vehicles with active external warming equipment. I’ll be looking to purchase more HYPOTHERMIA PREVENTION AND MANAGEMENT KITS (HPMK) from North American Rescue since it is most easily transportable. It provides 10 hours of active warming once activated by oxygen (Anyone can buy from the NAR website or from Amazon.com). And, I’m going to look at this low profile alternative to the thermal angels. It’s basically IV tubing warmed with coils from what appears to be a slimmer-profile battery (sold by North American Rescue).
JOURNAL REFERENCES
Durrer, B., Brugger, H., Syme, D., and International Commission for Mountain Emergency Medicine. The medical on-site treatment of hypothermia: ICAR-MEDCOM recommendation. High Alt Med Biol. 2003;4: 99–103
Soar, J., Perkins, G.D., Abbas, G., Alfonzo, A., Barelli, A., Bierens, J.J. et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation. 2010; 81: 1400–1433
Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update. Dow, Jennifer et al.Wilderness & Environmental Medicine, Volume 30, Issue 4, S47 – S69
Hypothermia Evidence, Afterdrop, and Practical Experience. Brown, Douglas et al. Wilderness & Environmental Medicine, Volume 26, Issue 3, 437 – 439
Hypothermia Evidence, Afterdrop, and Guidelines. Zafren, Ken et al. Wilderness & Environmental Medicine, Volume 26, Issue 3, 439 – 441
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 post will momentarily take a different direction. It doesn’t have anything to do with improving your medical skills. But, it has everything to do with ensuring your Soldiers successfully get through medical in-processing and into Ranger School. That will make them happy, it will make your boss happy, and it will help you earn that Soldier’s trust.
Most Ranger Physicals are Not Performed Properly
It may seem like this post is not needed. I assure you that it is. My team screens more than 1000 Ranger physicals each year. Typically, 85-95 percent have a deficiency. It’s the same at Ranger School. And the result is that a lot of Soldiers get a game-day decision on their packet as to whether or not they can begin training. Don’t leave it up to chance. Soldiers get turned around and sent home all the time.
So, I recommend that you use this matrix to check the physical of the prospective Ranger Student in your unit before he/she goes. Or, give it to him/her to check on their own. The link for download is directly below. Ensure all of the labs are completed, and also that they are within limits.
Next, ensure that the Soldier doesn’t have any disqualifying conditions. If the Soldier has never had any medical problems, has never taken any chronic medications, has no limitations, and has never had a hot or cold weather injury–> then they’re probably “good to go” and can stop here. Otherwise, you will want to reference a couple of regulations.
AR 40-501 details the requirements in Chapter 5 regarding Ranger Physicals. When chapter 5 references “accession standards,” it is referring to the DoDI 6303.03. This is the initial entry standards for all services. If they have any of these conditions, then you must submit for a waiver. See the two references below. These are also listed in the “Policies and Regulations” page of the site.
Soldiers are not allowed to take any chronic medications at Ranger School (Only medicines prescribed at the Aid Stations while already in Ranger School are allowed). Daily medications are not allowed, or the condition has to be such that the Soldier can go without the medications during Ranger School (they probably require a waiver for that condition also).
Hot or Cold Weather Injury History
If the Soldier has had a hot or cold weather injury, then they cannot attend during the hot (April – October) or cold (October – April) months, respectively. The Ranger School website defines this on their page, for reference. They are very strict about this. This also often includes heat related rhabdomyolysis.
Find out information about how to submit for a waiver on their website.
Please share this page with your friends so we can help others, too. Too many physicals are wrong, and I’m looking to correct this.
Want to learn something I haven’t covered? Send me an email! I want to teach what you want to learn.
Email me at: admin@nextlevelmedic.com
Contact me by Email: admin@nextlevelmedic.com
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.
This will be my last post on this important topic until the next annual MCOE Heat Forum.
I get concerned about training each summer and the absence of knowledge and unit preparedness with regard to heat casualty prevention. Kids die each year on active duty training posts, but what about National Guard units that conduct training in un-manned areas? We read about these tragic stories all the time. Preparation is paramount.
The biggest challenges, in my opinion are:
Ignorance on the issue
Read these posts on Heat Injuries and share them with other medics. Volunteer to conduct a hot weather training class for the unit prior to the summer.
Start trying to change the culture. This idea of “drink enough water to prevent heat injuries” is dying. Adequate and appropriate hydration is important, but the focus should be more about heat load and heat dumping. Over-hydration is killing Soldiers, too.
Look at Drip Drop Packets for electrolyte supplementation during prolonged or consecutive hot training days. There are others, but this one is my favorite because it is nearly equal to an IV with regard to Sodium concentration, and it tastes really good. It’s also Class 8 now. You can even order DripDrop on Amazon, let your Soldiers try it, and then get your supply sergeant to buy it- that’s what I did. My unit used Drip Drop at JRTC and my BN Commander told me that he was convinced it prevented heat casualties (Who really knows?). Whether or not that is true, I do believe it is helpful for preventing hyponatremia and dehydration. Our Best Ranger Competitors use it during their training. Bottom line: Soldiers actually use it because it tastes good. There are several different brands to choose from to replace electrolytes, but Drip Drop is one of two approved by DOD and it tastes far superior to the other. See below for a graph on projected salt loss from the US Army Research Institute of Environmental Medicine.
Get your “guys” to spend time outdoors as it starts getting closer to the training event. Acclimatization is key. Gradually increase exercise in the heat also.
Spread around the cadre heat algorithm (added it below again). Ask your unit PA to review it and consider adding it to the OPORD for distribution. Make sure lowest level Soldiers know what to do. And send the 68W heat algorithm via text to all the medics so that they have it on their phone (they will forget it otherwise).
Lack of Resources
If you cannot prepare or pre-stage Ice Sheets in FLAs and/or Aid Stations, then find another solution.
Ice Water Lavage- EMS on Ft. Benning now uses this as a primary option. They use sports bottles (like those that can be stored on a bicycle) to spray two bottles of water at a time on exposed skin to cool the patient. They typically carry a cooler of 16 bottles or so. If you don’t have a small cooler, then throw a couple ice water bottles in a few ruck sacks. Get creative.
Dump canteens on a heat casualty if nothing else is available. I personally have been in a situation where we ran out of ice sheets and I had everyone line up to take turns dumping canteens of water on the patient. It is better than nothing.
Make prior coordination with local EMS – I always talk to the local guys to let them know what we are going to be doing so they don’t redirect resources unknowingly. I’ve even called the local civilian Air Medevac twice in the last year because I was worried enough about response times.
These are my thoughts and suggestions. Ultimately, just make sure you are prepared and have a plan. I think it is worthwhile to follow algorithms (posted below) decided upon by a large group of medical professionals at the training post that sees the most heat injuries. However, your unit may elect a different or more cautionary approach. I’m just trying to provide more of a resource than what is currently available. Whatever you choose, recognize that this is becoming a more frequent problem and that it deserves your attention.
Algorithm for all Soldiers other than 68W or Medical Providers as proposed by the Maneuver Center of Excellence at Fort Benning, GAAlgorithm for 68Ws as proposed by the Maneuver Center of Excellence at Fort Benning, GA
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.
As promised, this post will include several additional sources of information. One presentation is from Dr. Max Bursey from a previous Heat Conference. Use these slides to reference the latest proposed definitions and solutions. This one may be helpful to use for your hot weather training as it was originally designed for a large audience and it is fairly comprehensive.
I also have a hip pocket training PowerPoint below that I made awhile back. I’ve presented it several times to medics for hot weather training and it seems to work well. It’s a mix of slides from a lot of different sources. I admit that I have not yet taken the time to improve it visually. I’m trying to push out info on this site hastily while working around my actual job. Once I get more content on this site, I will go back and revise the PowerPoint for you guys. I chose to include this one also, though, because I think it will be helpful to explain some of the concepts. I include it below with a narrated version from me, as well as the raw version if you wish to use those slides to jazz it up a bit.
One of the biggest culture change issues that the docs at Fort Benning are trying to drive: “Drinking adequate water doesn’t necessarily prevent heat injuries.” That’s a tough point to sell. But we have to convince the masses that hyponatremia is also a threat. Appropriate hydration is good. Heat mitigation by way of proper preparation and heat dumping strategies should also be a part of the conversation. Informed medics can be excellent advisors to their leaders.
DRIP DROP (link goes to Amazon) can also be a useful way to prevent hyponatremia as well as dehydration. It is discussed more in the next post.
Feel free to reach out to me if these presentations don’t convince you. I’m willing to engage in a dialogue with you or even present more information 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.
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.
We have to agree on the definition before we can discuss treatment. Many different definitions and opinions exist out there. Fort Benning has taken the lead on research and committees to help shape these opinions.
Photo from MASCAL Exercise in 2015
It happens all the time. You go to the field and a dude passes out. No one knows what to do. You preach hydration. But will that really help? What do you do now?
As I said, Fort Benning has been leading the way by holding annual heat conferences and bringing in speakers from all over the US and Britain, and by bringing in the Army research teams. The U.S. Army Ranger School has been testing prevention and treatment methods, and they’ve conducted a few studies themselves. As you probably know, Ranger school sees a lot of heat casualties. The stats below were collected from the Emergency Room at Fort Benning.
Heat Casualties for Fort Benning in 2019
Heat Strokes: 74
Heat Injuries: 23
Exercise Associated Hyponatremia: 8
There have been several cases over the last decade of heat injuries and hyponatremia that resulted in death at Fort Benning, GA. These deaths highlight the importance of prompt recognition and treatment of heat related injuries.
I’m always amazed when I meet a leader who has never heard of ice sheets; it still happens from time to time. But did you know that there are other options. Did you know other things are being done?
One of the big issues is that various training centers and military installations have differing definitions of a “heat stroke” or a “heat injury.” We can’t even agree on apples to apples to know how extensive the problem is and if there is a trend. And we can’t decide on a standard treatment either. Below is a table of heat illnesses at different installations. But remember, they don’t all define it the same way!
Definitions As Proposed by Fort Benning
Exercise-Induced Muscle Cramps (Heat Cramps)
Brief, recurrent, agonizing skeletal muscle cramping of the limbs and trunk
May be due to electrolyte loss and/or fatigue
Not believed to pre-dispose to serious heat related illness
Consider adding electrolytes and/or rest
Heat Edema:
Dependent extremity edema (hands and feet) owing to venous and interstitial fluid pooling
Loosen clothes, elevate legs
Self limited
Often confusing and difficult to be certain of diagnosis as other more serious conditions can result in single limb edema. However, in the setting of heat exposure in a young individual without other medical problems, it may be easier to diagnose
Heat rash
Red papules, or sometimes vesicles, found in areas where sweat is often trapped.
This heat obstructed rash cannot fully participate in sweating and evaporative cooling. The patient may be pre-disposed to heat injury until clears, due to inability to effectively dump heat
Often responds to cooling, removing tight or occlusive clothing, limiting sweating, and sometimes use of Hydrocortisone cream (1% typically used)
Sunburn
Pre-disposes to heat injury for same reasons as heat rash- ineffective heat dumping
Treat pain with Tylenol/NSAIDs. Avoid sunlight. May also use zinc cream or ointment, aloe, or cool compresses
Heat Exhaustion
Symptoms include fatigue, dizziness, headache, nausea, tachycardia, hyperventilation, headaches.
No Altered mental status!
Treatment would usually consist of cessation of activity, cooling, removal from the heat, and expeditious cooling to prevent progression to more severe heat illness
Exertional Heat Injury
A Heat illness of Heat Exhaustion or heat stroke that results in any end- organ damage.
Liver enzymes may be elevated, cardiac enzymes may be elevated, creatinine may be elevated, etc. Often damages the brain, heart, gut, liver, kidneys, and skeletal muscles
Exertional Heat Stroke
Similar symptoms to heat exhaustion, but with altered mental status
combativeness, delirium, obtundation, or coma
Must treat with rapid cooling and cessation of heat stress.
Rectal temperature is often greater than 104 degrees F.
Photo from MASCAL Exercise in 2015
These definitions were proposed last year at the Heat Forum at Fort Benning, by Dr. Max Bursey, DO. I have borrowed that information from the author in order to present it here, with permission. I will post the full slides on my next post.
The presenters often advised that Heat related illnesses are not well defined in the literature. They also emphasized that heat related illnesses should be thought of as a spectrum and not strict defined definitions; there is bleed over. We cannot devise too strict of definitions. Not until this is better understood with analyzed data.
The committee did develop protocols and algorithms, however. And these algorithms have been used for a few years now at Fort Benning. I believe that they are very helpful and practical. I have used them at my own FTXs. I teach this to all my medics. They seem to work well.
I cannot usurp your provider or designated medical supervision, but I do believe that this protocol should be presented to your leadership for adoption. It was developed as a committee amongst several physicians, medics, nurses, and mid-level providers. It is now the Maneuver Center of Excellence heat policy. I have some screenshots of the algorithms below, and the entire policy is in the link below for download (pdf).
Does hydration really help? Is this the main issue? The Benning docs would argue it is not. Adequate proper hydration is important. However, over-hydration is also a problem, too. The next post will focus on more of this topic, as well as a PowerPoint that you can use to conduct your own internal hot weather/heat injury training for your unit.
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.
This post is all about foot and ankle injuries. What is an Emergency? What needs to be evacuated now? What can you take care of yourself? How can you prevent further harm? What steps can be taken for open fractures to improve outcomes?
Until I find a better way to present material, its gonna have to be powerpoint. Just about all medical lectures are powerpoint- a fact of life. It’s part of higher learning. This video is only 8 minutes long. That means I’ll probably have to make more videos if Medics wanna dive a little deeper or get more specific. This is not comprehensive. Shoot me an email and let me know.
This educational video contains:
What is an Emergency?
How to think about injuries
When to Xray
Initial Management of Open Fractures to prevent infection
A few Splinting and Casting Principles
Plantar Fasciitis
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.
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.
It’s boring stuff. I know. But it is important. It is important to know how to properly document issues for your guys. It’s important to know how to write a medical note properly on a SF600 in order to help your team.
This video is a quick 6 minute powerpoint (I know!) presentation that teaches you how to think. It teaches you how to approach the note. It teaches you how to write better notes that don’t waste your team’s time. It helps you be a contributor. And it helps your battle buddy have a good note that will document his or her injury for their medical records.
Writing good SOAP notes means that you know how to begin a proper assessment. It means that you are a good “doc” because it demonstrates that you know how to think independently when a patient comes to you.
TAKE THE TIME. Hunker down for just 6 minutes.
I also recommend you watch the next video about “How to take a good History” as this is crucial to getting to the proper diagnosis.
How to Take a Good History
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.
FROM ANOTHER PERSPECTIVE
Want to learn something I haven’t covered? Send me an email! I want to teach what you want to learn.
Over the next few weeks to months, I intend to post regularly. As I develop hip pocket training for the medics under my supervision, I will post it here so that others can benefit.
My intent is to deliver content that is relevant, helpful, and pithy. I know that medics all over the world sit in trucks and aid stations waiting for something to happen. This blog and my short videos can come with you. Utilize your time wisely. Increase your knowledge. Prepare.
It is my opinion that if we should find ourselves in a Near Peer fight, that the medic will become isolated. Already we are spreading our resources thin. Right now it is happening, and it is intentional. It could become more widespread in a Near Pear fight.
My aim is to make the medic or corpsman better. I want to deliver training that can assist a 68W, a navy corpsman, an 18D, or a flight medic to be able to take care of their “guys” without pulling them out of the fight. Trauma is not the only reason that Soldiers leave the battlefield. Being able to handle smaller situations could be extremely beneficial to prevent or delay evacuation.
I believe that I can teach medics to be eyes and ears for a provider. I can teach them to take a history and perform a relevant exam. If possible, they can relay this information back to a provider who can assist with the diagnosis and treatment plan for the medic to execute. This would be a win to keep the Soldier in the fight.
Again, my goal will be to deliver a myriad of content that is aimed at the medic level in order to improve care in austere environments. Please do provide me feedback on my content and send me suggestions for topics at admin@nextlevelmedic.com.
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.
Want to learn something I haven’t covered? Send me an email! I want to teach what you want to learn.
Email me at: admin@nextlevelmedic.com
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.
