UNITED STATES MARINE CORPS
Field Medical Training Battalion
Camp Lejeune
BLOCK
2 MEDICATION APPENDIX
Medications
Used During
Tactical Combat Casualty Care (TCCC)
Pain Relief
The
Committee on Tactical Combat Casualty Care (CoTCCC) recommends the following
medications be used in providing pain relief to casualties. The choice of which
medications to use is based on the patients ability to remain in the fight.
Mobic (meloxicam) is a Non Steroidal Anti-Inflammatory
Drug (NSAID) given for pain relief. This drug is usually given as soon as
possible following injury to casualties who are still able to fight. The CoTCCC
recommends this drug be supplied to individual operators as part of a Combat
Pill Pack. This drug was chosen because it has no documented platelet
dysfunction, meaning that unlike other NSAID’s such as Motrin, it does not
interfere with the bodies natural blood clotting abilities. Although it takes
up to five hours to reach its maximum level of effectiveness, it has a long
duration time and is stable even at high temperatures.
Tylenol (acetaminophen) 8-Hour Bi-layer Caplets
is an
analgesic and antipyretic (fever lowering) medication intended to be given with
at the same time Mobic is given. The outer layer of the caplet is designed to
dissolve quickly to provide quick relief. The CoTCCC recommends this medication
because it acts quickly and helps to bridge the gap until the Mobic takes
effect. It also should be issued to operators as part of the Combat Pill Pack
and should be given to casualties who need pain relief for their injuries but
are still able to participate in combat operations.
Morphine is an Opiod (narcotic) and is considered the
“gold standard” of analgesia. It should be only be administered to a casualty
out of the fight who already has IV access established. Dosage should be 5mg
given every 10 minutes until pain relief is achieved. Because patients who
receive narcotics often suffer from nausea and vomiting, Phenergan
(promethazine) should also be administered. Narcan (naloxone) should also be
on hand whenever narcotics are used in the event the patient suffers from
respiratory depression.
Oral Transmucosal Fentanyl Citrate (OTFC) is an Opiod
(narcotic) that provides a means of delivering effective, rapid onset pain
relief without starting an IV. This medication is produced in a lozenge
form. It should be given only to patients who can no longer participate in
combat operations. It should be administered by taping the “lozenge-on-a-stick”
to the patient’s finger and placing the lozenge in the patient’s mouth. Once
analgesia is achieved the patient may pass out and the lozenge will fall out of
his or her mouth. Similar to morphine, promethazine may be needed to reduce
nausea and Narcan should be on hand.
Phenergan (promethazine)
is given to reduce nausea. It is administered IV, IO, or IM in dosages of 25 mg
or 50 mg.
Narcan
(naloxone) is an Opiod reversal agent. It is designed
to prevent or reverse the effects of narcotics such as morphine or OTFC. It
should be administered in an initial dose of 0.2 mg IV, IO, or IM (up to 10 mg
total).
Antibiotics
Infection is a late cause of
morbidity (sickness) and mortality (death) in battlefield wounds. For this
reason the CoTCCC has recommended casualties receive antibiotic treatment as
soon as possible. The biggest challenge for you is the logistical requirements
that prevents you from carrying a wide variety of items. The CoTCCC identified
the antibiotics that provided the most “bang for the buck”. The following
medications were chosen for their, broad coverage, minimal side effects,
resistance to heat or cold, simple dosage requirements, and minimal storage
requirements.
Avelox (moxifloxacin)
is the oral antibiotic of choice. The dosage is one 400 mg tablet by mouth,
once a day. This should be administered to all casualties who can tolerate oral
medications as soon after injury as possible.
Cefotan (cefotetan) is the parenteral (injectable)
antibiotic drug of choice. The dosage is either 2 grams IV/IO delivered over
the span of 3 to 5 minutes or 2 grams IM. This should be given to casualties
who can not take oral medications. This includes casualties who are unconscious
or those who have significant facial wounds. Patients in hypovolemic shock
should not be given antibiotics orally because reduced blood flow to the stomach
impairs the body’s ability to process oral medications.
Invanz (ertapenum)
is the recommended alternative to cefotetan in the event it is not available (as
has been the case). The dosage is 1 gram administered IV, IO, or IM. This
should be given to casualties who can not take oral medications. This includes
casualties who are unconscious or those who have significant facial wounds.
Patients in hypovolemic shock should not be given antibiotics orally because
reduced blood flow to the stomach impairs the body’s ability to process oral
medications.
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