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Use all advanced monitoring capabilities for the "best" level of care. Severe trauma with altered mental status (in the absence of brain injury) and/or weak or absent radial pulse.Ĭontinue to monitor vital signs and tactically relevant indicators of shock to include:Īltered Mental Status and Absent Radial Pulse.Penetrating or blunt force injuries with suspected truncal hemorrhage.Proximal, Bi-lateral, or multiple amputations.Above the knee amputation (especially with pelvic fracture).Injury pattern consistent with massive hemorrhage: *Do not delay initiating DCR if hemorrhagic shock is clinically suspected: Begin treating immediately once hemorrhagic shock is suspected. Brings in advanced monitoring capabilities and focuses on clinical signs: Similar to the 75th hemorrhagic decision matrix for Tactical Damage Control Resuscitation. Rapid transport to forward surgical capability.ĬPG presents information in a “Minimum, Better, Best” format for planning and progressive strategy of treatment in a Role 1 PFC environment.Prevention of acidosis and hypothermia.Replacing Calcium in patients at risk of hypocalcemia.Early use of TXA is not new but continues to be recommended for NCTH and massive blood loss.Limited use of crystalloids now accepted in DCR to prevent dilution coagulopathy. The purpose of this CPG is to improve DCR in the Role 1 facility.įWB resuscitation by military surgical teams drove the changes and accepted strategy for Damage Control Resuscitation in the forward deployed environment. The information in this CPG is the standard for a combat medic. Below are some of the highlights from the DCR in PFC Clinical Practice Guidelines.