『Prolonged Field Care Podcast』のカバーアート

Prolonged Field Care Podcast

Prolonged Field Care Podcast

著者： Dennis
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Become a Paid Subscriber: https://creators.spotify.com/pod/show/dennis3211/subscribe This podcast and website is dedicated to the healthcare professional who needs to provide high quality care in a very austere location. For more content: www.prolongedfieldcare.org Consider supporting us on: patreon.com/ProlongedFieldCareCollectiveDennis
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  • PFC Podcast: TXA - 2g Slam and other myths busted

    PFC Podcast: TXA - 2g Slam and other myths busted
    2026/06/18
    In this deep-dive episode of the Prolonged Field Care Podcast, Dennis sits down with trauma and critical care surgeon Dr. John McClellan ( University of North Carolina) to cut through the noise on tranexamic acid (TXA) in trauma.They cover the mechanism, who actually needs it, why the dosing shifted from 1g + drip to 2g upfront, pre-hospital decision-making when bleeding is controlled, redosing in ongoing hemorrhage, IM/IO options, seizure and hypotension concerns, the critical 3-hour window, and practical advice for the medic who is truly alone and afraid.Whether you’re a combat medic, flight medic, or trauma provider, this conversation delivers actionable clarity on one of the most studied — and sometimes misunderstood — tools in hemorrhagic shock resuscitation.Key Takeaways:TXA is a lysine analog that reversibly (and at higher doses irreversibly) binds plasminogen, preventing its conversion to plasmin and stabilizing clots. It is one of the most evidence-backed hemorrhage adjuncts available.The ideal candidate is any patient you suspect will trigger (or has triggered) a massive transfusion protocol — not just obvious amputations. Err on the side of giving it early in pre-hospital/austere settings to avoid missing occult bleeding.Modern trauma practice favors 2g IV push upfront over the older CRASH-2 regimen of 1g bolus + 8-hour drip because traumatic bleeding is an acute event that needs rapid high plasma levels. The 8-hour drip was designed for elective surgical cases with ongoing bleeding over hours.Overall safety is excellent. Large meta-analyses have not shown a clear increase in thrombotic events attributable to TXA. The bigger practical risks are seizures with doses significantly above 2g and accidental double-dosing due to poor handoff between pre-hospital and hospital teams.Transient hypotension can occur with rapid push, but causality is murky — it is often impossible to separate from the patient’s underlying shock state.Redosing is reasonable (another 1–2g) if significant re-bleeding causes hemodynamic instability. Roughly 25% of active TXA can be lost in major hemorrhage/transfusion models.Give TXA within 3 hours of injury for maximum benefit. After 3 hours efficacy drops sharply and some data suggest potential increased bleeding risk.For the solo medic: Preload if your protocol allows. Make TXA automatic once you have access (alongside calcium and blood products). Prioritize rapid transport. TCCC supports IM if no IV/IO is possible, though delivering the full 2g volume can be challenging.Documentation and clear handoff are non-negotiable when pre-hospital TXA is given.Chapters:00:00 – Welcome & Podcast Disclaimer00:25 – Guest Introduction: Dr. John McClellan, Trauma Surgeon01:52 – What is TXA and How Does It Actually Work?03:28 – Who Should Get TXA? The Massive Transfusion Patient04:16 – Pre-Hospital TXA: Bleed Control First or TXA First?07:06 – Safety Concerns: Thrombosis, Seizures & Double Dosing Risks09:54 – Dosing Evolution: CRASH-2, 1g + Drip vs 2g Push in Trauma13:33 – Does TXA Cause Hypotension? Unpacking the Evidence19:12 – IO & IM TXA: Practical Routes When IV Access Is Tough21:46 – Redosing TXA in Ongoing Bleeding or Transport29:37 – Advice for the Medic Who Is Truly “Alone and Afraid”32:21 – The 3-Hour Rule: Why Timing Matters and What Happens After34:14 – Final Thoughts & Practical Takeaways from Dr. McClellanFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠
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    35 分
  • PFC Podcast 283: Underground Manufacturing - Ukraine’s Shadow Factories Saving Lives

    PFC Podcast 283: Underground Manufacturing - Ukraine’s Shadow Factories Saving Lives
    2026/06/15
    In this episode of the PFC Podcast, Dennis sits down with David Plaster — former U.S. Army combat nurse, medic, and 68 Delta who has lived and worked in Ukraine since 2012, long before the full-scale invasion. David pulls back the curtain on one of the most remarkable stories in modern tactical medicine: how Ukraine built resilient, dispersed, underground manufacturing networks for hemostatic gauze and tourniquets when conventional supply chains collapsed or became targets.From the very first improvised IFACs in 2014 (duct-tape chest seals and all) to scaling production of Krovin Goss / Hemostat gauze at roughly $1 per meter and developing a functional “cat-style” tourniquet that Ukrainian and U.S. SOF tested and trusted, David shares the real mechanics of wartime medical logistics. He explains pre-planned basement factories, compartmentalized production across multiple hidden sites, the shift from volunteers to paid war widows and veterans’ families, rigorous quality control, and the constant fight against opportunists, “carpet baggers,” and adversarial intelligence collection.This is far more than a war story — it’s a masterclass in austere medical manufacturing, supply-chain resilience, and why training and knowledge will always outperform gear alone.Key Takeaways:Pre-war planning and deep personal networks (built years earlier) are the real force multipliers when supply chains get bombed or corrupted.Highly motivated local workforces — especially people with direct skin in the game (war widows, veterans’ families) — can deliver exceptional quality and output even in dispersed, low-tech underground conditions.Dramatic cost advantages ($1/m hemostatic gauze vs. $10+ imported) free up resources to buy more of everything else and keep production sustainable.Dispersed, multi-site manufacturing with compartmentalized components dramatically increases survivability and operational security.Functional analogs that are properly tested (double-blind SOF trials included) can serve as effective bridges when premium Western gear is unavailable or too expensive.The biggest failure point in tactical medicine is almost never the gear — it’s implementation and mastery of the basics by everyone, not just medics. Tourniquet application, conversion/repositioning, and preventive medicine thinking belong at the squad-leader level.Medics must operate as advisors and educators. Command emphasis on these skills across the force (not just in the aid bag) is what actually moves the needle on survival.Chapters:00:00 – Introduction & David Plaster’s Background (U.S. Army combat nurse in Ukraine since 2012)02:30 – Early Days: 2014 Improvisation, First IFACs, and the Complete Absence of Western TCCC06:00 – The Krovin Goss / Hemostat Gauze Story: Chemistry, Corruption, and the Pivot Underground11:30 – Going Underground: Pre-Planned Basements, Plan B/C/D, and Dispersed Manufacturing Strategy16:00 – Why the Tourniquet Project Started: Fake Chinese Gear, Expensive CATs, and Local Demand23:30 – The Manufacturing Model: Volunteers to Paid Staff, War-Affected Workers, and Quality Control27:00 – Security Realities: Protecting Sites from “Carpet Baggers,” Visitors, and Adversarial Interest30:00 – Bigger Lessons: Training Failures, ASM/Tourniquet Conversion Changes, and Why Knowledge > Gear36:00 – Preventive Medicine Mindset, Medics as Advisors, and Building Systems That Actually WorkFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠
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    52 分
  • PFC Podcast: Velocity Kills - Wound Ballistics, Shotguns & Unpredictable Trauma in Prolonged Field Care

    PFC Podcast: Velocity Kills - Wound Ballistics, Shotguns & Unpredictable Trauma in Prolonged Field Care
    2026/06/11
    In this episode of the Prolonged Field Care Podcast, Dennis sits down with trauma surgeon Mark Shapiro for a no-BS masterclass on wound ballistics. They break down why understanding the physics of penetrating and blast trauma matters in austere and combat environments — even when experience makes you cynical. From high-velocity rifle rounds and their massive temporary cavities to the infectious nightmare of shotgun wounds and the four phases of blast injury, Mark shares hard-won lessons from civilian Level I trauma centers and years training special operations medics and ground surgical teams.They tackle the myths around entry/exit wounds, when (and when not) to explore right upper quadrant gunshot wounds downrange, why you should almost never pack the abdomen or chest from the outside, how to assess neurovascular status in blast-injured extremities, and why bizarre bullet paths and “stable” patients with signs of life can still surprise you.Key Takeaways:Kinetic energy (½mv²) means velocity is king — high-velocity rifle rounds create devastating temporary cavities and fragmentation that can turn one projectile into many.Jacketed rounds still fragment at rifle speeds; never assume a clean through-and-through. Bone fragments act like secondary missiles and can create wounds up to 3x the size of the fragment.For stable patients with right upper quadrant GSWs in resource-limited settings, expectant management can be reasonable — but you must have a plan, know your limits, and be ready to move if things change.Never pack the abdomen or chest from the outside in most cases. It risks pushing debris deeper and worsening injuries. Cover exposed organs if needed, but don’t shove gauze into body cavities.Shotgun wounds (especially buckshot/birdshot) are “mobile IEDs” — massive tissue destruction, heavy debris inoculation, and extremely high risk of infection, fistula, and devascularized tissue requiring serial debridement.In extremity blast trauma, assess vascular status (pulses, Doppler signals, color, warmth, capillary refill) and neurologic function. The ~6-hour window to revascularization is critical, but the decision point comes earlier.Training + common sense + adaptability beat rigid protocols when resources are limited. Sometimes the best move is observation.Chapters04:15 – Why Wound Ballistics Knowledge Still Matters (even when you’re cynical)08:30 – High-Energy Rifle Wounds: Muzzle Velocity, Kinetic Energy & Spitzer Bullets13:45 – Fragmentation, Tumbling & Secondary Missiles (bone shards & unpredictable paths)18:20 – Clinical Reality: Multiple Injuries & Why “Small Entrance, Big Exit” Is a Myth22:50 – Entry vs. Exit Wounds: When Trajectory Actually Matters (and when it doesn’t)26:40 – Right Upper Quadrant GSWs: Explore, Observe, or Expectant Management Downrange?31:10 – The Dangers of Packing Abdominal & Chest Wounds from the Outside34:55 – Low-Energy Pistol Wounds: How They Differ (or Don’t) from Rifles37:20 – Shotgun Wounds: Close-Range Carnage, Debris & Infectious Nightmares42:40 – IEDs & Modern Explosives: Blast Physics, Ukraine Patterns & Hard-Ground Effects48:15 – Primary, Secondary, Tertiary & Quaternary Blast Injuries Explained52:30 – Neurovascular Assessment in Blast-Injured Extremities (Conscious & Unconscious Patients)56:45 – Lessons from the Trauma Bay: Common Sense, Training & Knowing When to Deviate from ProtocolFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠
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    58 分
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