Ranger Medic Handbook

• Editorial: Skyhorse
• Año: 2016
• ISBN:
  9781634509596
• Categoría: Médecine
• Categoría: Premiers soins et sécurité

Historically in warfare, the majority of all combat deaths have occurred prior to a casualty ever receiving advanced trauma management. The execution of the Ranger mission profile in the Global War on Terrorism and our legacy tasks undoubtedly will increase the number of lethal wounds. Ranger leaders can significantly reduce the number of Rangers who die of wounds sustained in combat by simply targeting optimal medical capability in close proximity to the point of wounding. Directing casualty response management and evacuation is a Ranger leader task; ensuring technical medical competence is a Ranger Medic task. A solid foundation has been built for Ranger leaders and medics to be successful in managing casualties in a combat environment. The true success of the Ranger Medical Team will be defined by its ability to complete the mission and greatly reduce preventable combat death. Rangers value honor and reputation more than their lives, and as such will attempt to lay down their own lives in defense of their comrades. The Ranger Medic will do no less.

SECTION THREE

RMED PHARMACOLOGY

SECTION I

“PROFICIENT AND ALWAYS CARRIED”

PHARMACOLOGY SECTION I: “PROFICIENT AND ALWAYS CARRIED”

1.	ACETAMINOPHEN (TYLENOL)	325-650 mg PO q4-6h prn (max: 4 g/d)
2.	DEXAMETHASONE	0.25–4 mg PO bid-qid; 8–16 mg IM/IV q1–3wks
3.	DIAZEPAM (VALIUM)	2-10 mg PO tid-qid; 5-10 mg slow IV push
4.	DIPHENHYDRAMINE (BENADRYL)	25-50 mg IV/IM/PO q4-6h
5.	EPINEPHRINE	0.1–0.5 mL SC/IM q10–15min (1:1000 soln = 1mg/1ml)
6.	ERTAPENEM (INVANZ)	1g IV/IM q24h
7.	FENTANYL ORAL LOZENGES (ACTIQ)	400-800 mcg (max: 1600 mcg/d)
8.	GATIFLOXACIN (TEQUIN)	400 mg IV/PO daily
9.	HETASTARCH (HEXTEND)	500–1000 mL IV
10.	IBUPROFEN (MOTRIN, ADVIL)	400–800 mg PO tid-qid (max: 3200 mg/d)
11.	KETOROLAC (TORADOL)	15-30 mg IV/IM q6h
12.	LIDOCAINE (XYLOCAINE)	Infiltration 0.5%–2% injection
13.	MELOXICAM (MOBIC)	7.5–15 mg PO daily
14.	MORPHINE SULFATE (MSO4)	5–15mg slow IV push, titrate to pain
15.	MOXIFLOXACIN (AVELOX)	400 mg PO/IV daily
16.	NALOXONE (NARCAN)	0.4–2.0 mg IV, repeat q2–3min up to 10 mg prn
17.	PROMETHAZINE (PHENERGAN)	12.5-25 mg PO/IM/IV q4-6h prn
18.	SODIUM CHLORIDE, 0.9% (NS)	500–1000 mL IV; 5-50 mL IV for med dilution or flush

1. ACETAMINOPHEN (TYLENOL)

Class: CNS agent – non-narcotic, analgesic, antipyretic

Action: Analgesia action possibly through peripheral nervous system; fever reduction through direct action on hypothalamus heat-regulating center resulting in peripheral vasodilation, sweating, and dissipation of heat; has minimal effect on platelet aggregation, bleeding time, and gastric bleeding

Dose: 325–650 mg PO q4–6h (max: 4 g/d)

Indications: For mild to moderate pain management, headache, fever reduction

Contraindications: Acetaminophen hypersensitivity; use with alcohol; pregnancy category B

Adverse Effects: Negligible with recommended dose; rash; acute poisoning: anorexia, nausea, vomiting, dizziness, lethargy, diaphoresis, chills, epigastric or abdominal pain, diarrhea; hepatotoxicity: elevation of liver function tests; hypoglycemia, hepatic coma, acute renal failure; chronic ingestion: neutropenia, pancytopenia, leukopenia, thrombocytopenic purpura, renal damage

Interactions: Cholestyramine may decrease absorption; barbiturates, carbamazepine, phenytoin, rifampin, and excessive alcohol use may increase potential for hepatotoxicity

2. DEXAMETHASONE

Class: Hormones and synthetic substitutes – steroid; adrenocorticoid; glucocorticoid

Action: Long-acting synthetic adrenocorticoid with intense glucocorticoid activity and minimal mineralocorticoid activity; Antiinflammatory and immunosuppression properties; prevents accumulation of inflammatory cells at sites of infection; inhibits phagocytosis, lysosomal enzyme release, and synthesis of selected chemical mediators of inflammation; reduces capillary dilation and permeability

Dose: 0.25–4 mg PO bid-qid; 8–16 mg IM/IV q1–3wks

Indications: For inflammatory conditions, allergic states, and cerebral edema

Contraindications: Systemic fungal infection, acute infections, tuberculosis, vaccinia, varicella, live virus vaccines (to patient, family members), amebiasis; pregnancy category C

Adverse Effects: Euphoria, insomnia, convulsions, increased ICP, vertigo, headache, psychic disturbances; CHF, hypertension, edema; hyperglycemia; cushingoid state; hirsutism; cataracts, increased IOP, glaucoma, exophthalmos; peptic ulcer or perforation, abdominal distension, nausea, increased appetite, heartburn, dyspepsia, pancreatitis, bowel perforation, oral candidiasis; muscle weakness, loss of muscle mass, vertebral compression fracture, pathologic fracture of long bones, tendon rupture; acne, impaired wound healing, petechiae, ecchymoses, diaphoresis, dermatitis, hypo- or hyperpigmentation, skin atrophy

Interactions: May inhibit antibody response to vaccines and toxoids

3. DIAZEPAM (VALIUM) - CONTROLLED SUBSTANCE: SCHEDULE IV

Class: CNS agent – benzodiazepine; anticonvulsant; anxiolytic

Action: Anticonvulsant and antianxiety psychotherapeutic drug with action at both limbic and subcortical levels of CNS; increases total sleep time, but shortens REM and stage 4 sleep

Dose: 2-10 mg po tid-qid; 5-10 mg slow IV push, repeat in 3-4h

Indications: For anxiety, seizures, skeletal muscle spasm relief; also used as an amnesic, for treatment of restless leg syndrome, acute alcohol withdrawal, and is the drug of choice for status epilepticus Contraindications: Shock, coma, alcohol intoxication, depressed vital signs; acute narrow-angle glaucoma, untreated open-angle glaucoma; MAOIs; pregnancy category D

Adverse Effects: Throat and chest pain; drowsiness, fatigue, ataxia, confusion, paradoxic rage, dizziness, vertigo, amnesia, vivid dreams, headache, slurred speech, tremor; EEG changes, tardive dyskinesia; hypotension, tachycardia, edema, cardiovascular collapse; blurred vision, diplopia, nystagmus; xerostomia, nausea, constipation, hepatic dysfunction; incontinence, urinary retention, gynecomastia (prolonged use); hiccups, coughing, laryngospasm; venous thrombosis, phlebitis

Interactions: Alcohol, CNS depressants, anticonvulsants, and herbals (kava kava, valerian) potentiate CNS depression; cimetidine increases levels and toxicity; may decrease effects of levodopa; may increase phenytoin levels; smoking decreases sedative and antianxiety effects

4. DIPHENHYDRAMINE (BENADRYL)

Class: ENT agent – H1-blocker; antihistamine

Action: H1-receptor antagonist and antihistamine as it competes for H1-receptor sites on effector cells; significant central anticholinergic activity as it prolongs action of dopamine by inhibiting its reuptake and storage, thus decreasing parkinsonism and drug-induced extrapyramidal symptoms

Dose: 25-50 mg IV/IM/PO q4-6h

Indications: For allergic conditions, treatment or prevention of motion sickness, vertigo, blood or plasma reactions, treatment of Parkinsonism and drug-induced extrapyramidal reactions; also used with epinephrine for anaphylaxis, as a cough suppressant, a sedative-hypnotic, and for intractable insomnia Contraindications: Antihistamine hypersensitivity; lower respiratory tract symptoms, asthma; n...