Grumpē PĂ-dcast

It won't be long before you deploy somewhere, whether a training center, rotational mission, or to a combat theater. When you do, everybody is going to make it sound like everything you need is waiting for you there. They're lying. A lot. Better take a listen for some pointers from medicines and equipment to training and medical records.

In this episode we take some time to discuss better living through pharmaceuticals with our anesthesiologist friend Tyler. He schools us up on dosing, risks, and drugs you want in your aid bag. We also mention an essay about ketamine in the show, here’s the link to it: https://justinlascek.com/ketamine-essay/ Just so you have the JTS CPG one more time: https://learning-media.allogy.com/api/v1/pdf/0ea4945b-d7f0-495a-9c92-d505c442ff74/contents From our friends ar prolongedfieldcare.org: https://prolongedfieldcare.org/wp-content/uploads/2017/03/3rd-sfg-cc-medbox-cheatsheet.pptx

In this episode we explore who you work for, then give you some background on how and why you can tell everybody else to kick rocks when they start gettin' chippy. Put that in your DMHRSi and smoke it...

In this episode we explore the TTPs of successfully implementing, teaching, an certifying the Combat Life Saver Program and its intertwined/parallel first responder training efforts. Here's the link to the CLS centralized repository:       https://deployedmedicine.com/market/193  Now get out there, find and tour your local TSC and MSTC, and get to executing this critical training!

In this episode we chat with PA Dave and explore all the recent and planned changes in the 65D DSc programs as they are re-characterized as GPE, particularly ADSO & bonus rules that are now more favorable to you. We'll also focus on where those specialty trained people best fit in the conventional force today and tomorrow. BLUF - you really need to look at going into these programs!

Alright - you're certified, you've been doing some sick call and trying to figure out TCCC & Table VIII, time for a report card! Here's some juicy tidbits to guide you through your OERs! In this episode, we mention a DVIDS promotion board video. This is the link: https://www.dvidshub.net/video/506455/officer-mock-board-video?fb_comment_id=1148261778604378_1150461595051063. While it's a little dated, I haven't seen a newer version. It's 47 minutes, but only the first 30 or so apply to newer PAs, before they start yammering about MAJ/LTC stuff you probably don't care about...yet. 

In this episode, we get bloody. We talk FWB, ROLO, LTOWB, and Autologous FWB transfusion training. When you're done, go find all the colloids in your aid station and put them in the trash where they belong. Wait, maybe don't be that aggressive, but the window for colloids on the battlefield is a narrow one, and its probably razor thin below the Role 2/3. Here is the article from Next Gen Combat Medic that we talked about in the show: https://nextgencombatmedic.com/2017/09/03/whole-blood-toolkit/  Here are the case reports mentioned in the PAdcast - think about you or your medics in these situations and whether you're ready: 2009 Case Report - FWB transfusion in Afghanistan Role 1 BAS: Cordova CB, Cap AP, Spinella PC. Fresh Whole Blood Transfusion for a Combat Casualty in Austere Combat EnvironmentJournal of Special Operations Medicine. 14(1):9-12.  2019 Case Report - SWB & FWB transfusion at PoI by a medic: Lewis CL, Nilan M, Srivilasa C, Knight R, Shevchik J, Bowen B, Able T, Kreishman P. Fresh Whole Blood Collection and Transfusion at Point of Injury, Prolonged Permissive Hypotension, and Intermittent REBOA. Journal of Special Operations Medicine. 20(2):123-126.  Here is the 2013 Norwegian SOF study on physical capacity after blood donation: Strandenes G, Skogrand H, Spinella PC, Hervig T, Rein EB. Donor performance of combat readiness skills of special forces soldiers are maintained immediately after whole blood donation: a study to support the development of a prehospital fresh whole blood transfusion program. Transfusion. 53(3):526-30. Also: GrumPA mentioned a memorandum from the ISR to TCMC in Aug 2019 about changes coming to the JTS CPG. As of April 2021, the old recommendations persist in the DCR CPG dated July 2019. However, the TCCC CPG dated Nov 2020 is updated IAW with this memo for a single dose of 2g IV/IO TXA and Calcium dosing up front and every 4th unit. If you need/want a copy of the memo, an example Deliberate Risk Assessment Worksheet for Autologous FWB transfusion training, or any of the articles above (and you can't find them through your local medical library), just email [email protected] and he'll shoot it to you. Please include your work/global email address so I know I'm emailing a colleague. Notes on meds from above: -TXA is now 2gm IV ASAP but at least within 3 hours of wounding, instead of the old guidance of 1gm slow IV over 10 minutes followed by another 1gm in the first 8 hours. - Calcium is recommended as soon as you identify the need for blood transfusion, probably after TXA is on board if you have to choose one up front. Dose is 1g, then an additional 1g every 4 units of blood. Calcium Gluconate is 30cc of 10% CaGlu, Calcium Chloride is 10cc of 10% CaCl, best through a central line because it scleroses peripheral vessels/causes injection site pain/risks tissue damage if it infiltrates.

In this episode we explore the origins of TCCC in an ophthalmologist's office in the 1990s, then explore how to E&E the clinic so you can train your medics.  Consider a little learning about the "Walker dip" and how TCCC / CoTCCC are fighting the good fight in our current Walker Dip  - JTS Guidelines: https://jts.amedd.army.mil/index.cfm/pi_cpgs/cpgs - Walker Dip Article: https://jrnms.com/JournalArticle.ashx?ID=12576 (Walker AJ, The ‘Walker dip’, J R Nav Med Serv, 2018;104(3):173–176 - Tactical Combat Casualty Care in Operation Iraqi Freedom, 2005, CPT Michael J. Tarpey: http://www.specialoperationsmedicine.org/documents/TCCC_2016/06%20TCCC%20Reference%20Documents/Tarpey%20TCCC%20AMEDDJ%202005-2.pdf - Challenges of Implementing TCCC Article: https://academic.oup.com/milmed/article/179/5/477/4160781 (Mabry RL, DeLorenzo R, Challenges to Improving Combat Casualty Survival on the Battlefield, Military Medicine, May 2014;179(5):477–482, https://doi.org/10.7205/MILMED-D-13-00417)

In this episode we try to let you know that while you feel so very alone, you aren't. We've all been right where you are, felt just like you feel. A few pointers on key things to do right out of the gate when you get out of PA school and people start calling you Doc. In this episode, I mention a DVIDS promotion board video. This is the link:  https://www.dvidshub.net/video/506455/officer-mock-board-video?fb_comment_id=1148261778604378_1150461595051063.  While it's a little dated, I haven't seen a newer version. It's 47 minutes, but only the first 30 or so apply to newer PAs, before they start yammering about MAJ/LTC stuff you probably don't care about. It's worth it to watch now, because it will help you understand so much when we revisit promotions in a future episode. 

Welcome to the Grumpē PĂ-dcast, the only podcast dedicated to the personal & professional development of junior army Physician Assistants. In this trailer we discuss how your hosts GrumpePĂ and PAndemic PĂul met and why we decided to host a podcast. If you have feedback on the this or any episode, or would like to hear an episode on a specific topic, shoot us an email at [email protected]