d. Oxygen is usually not available in this phase. Cylinders of compressed gas
and the associated equipment for supplying the oxygen are too heavy to make their
use in the field feasible.
(1) Traumatic chest wall defects should be closed with an occlusive
dressing without regard to venting one side of the dressing, as this is difficult to do in a
combat setting. You may use an Asherman chest seal (lesson 3) if one is available.
(2) If you are taping a field dressing envelope or other airtight material over
an open chest wound, tape all four sides of the material to the chest as long as the care
provider has the ability to needle decompress a possible tension pneumothorax. If the
ability to needle decompress the chest is not available, the occlusive dressing should
only be taped on three sides to allow a flutter valve effect in the dressing.
Tension pneumothorax is the second leading cause of preventable battlefield
(1) The soldier medic should now address any significant bleeding sites not
previously controlled. He should only remove the absolute minimum of clothing
required to expose and treat injuries, both because of time constraints and the need to
protect the patient from environmental extremes.
(2) Significant bleeding should be stopped as quickly as possible using a
tourniquet as described previously. Once the tactical situation permits, consideration
should be given to loosening the tourniquet and using direct pressure, a pressure
dressing, a chitosan hemostatic dressing, or a hemostatic powder (QuikClot) to control
any additional hemorrhage. Do not completely remove the tourniquet, just loosen it and
leave in place. If hemorrhage continues, the tourniquet should be retightened and left
g. Intravenous access.
Intravenous infusion procedures are discussed in MD0553, Intravenous
Infusions and Related Tasks.
(1) Intravenous access should be gained next. Although advanced trauma
life support (ATLS) recommends starting two large-bore (14- or 16- gauge) intravenous
infusions (IVs), the use of a single 18-gauge catheter is preferred in the field setting
because of the ease of starting the infusions and because it also serves to ration