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The M.A.R.C.H. algorithm

I cannot stress enough the importance of the trauma medicine training. To be able to protect yourself or the ones around you, is not resuming only to the fire weapons and edge weapons training. You must have at least the basic knowledge to mantain the victims alive until the professional medical care are arriving.

The MARCH algorithm is a medical acronym that stands for Massive Hemorrhage, Airway, Respiration, Circulation, and Hypothermia. It is a tool used in the management of severely injured patients, particularly those who have sustained massive blood loss. The algorithm is designed to guide healthcare professionals in the timely and effective management of these patients, with the ultimate goal of reducing morbidity and mortality. In this article, we will discuss the MARCH algorithm in detail, including its components, application, and effectiveness.

Massive Hemorrhage:

The first component of the MARCH algorithm is Massive Hemorrhage.

This can be done using a variety of items, including tourniquets, pressure dressings, and hemostatic agents. It is important to have multiple items for treating massive bleeding in case one is not effective or cannot be used for a particular injury.



Some items that can be included in a wilderness survival trauma medicine kit for treating massive bleeding include:

  • Tourniquets: Tourniquets are used to stop bleeding by restricting blood flow to the affected area. They are used for injuries to the arms and legs.



  • Pressure dressings: Pressure dressings are used to apply pressure to the affected area to stop bleeding. They are typically used for injuries to the torso or head.



  • Hemostatic agents: Hemostatic agents are substances that help stop bleeding by promoting clotting. They can be applied directly to the wound and can be particularly useful for injuries in areas where tourniquets or pressure dressings cannot be used.



Airway:

The second component of the MARCH algorithm is Airway.

The airway is one of the most critical elements of the MARCH algorithm. When someone suffers a traumatic injury, they may experience difficulty breathing due to blockage or damage to their airway. If the airway is not managed immediately, it can quickly lead to suffocation and death.

The first step in managing the airway is to assess the situation. Is the person conscious? Are they able to speak or make any sounds? If the person is conscious, they may be able to manage their airway themselves. However, if they are unconscious or unable to speak, you will need to take action immediately.

One of the most common tools used to manage the airway is the nasopharyngeal airway (NPA). An NPA is a soft, flexible tube that is inserted through the nose and into the back of the throat. This tube helps keep the airway open and allows the person to breathe more easily.



To insert an NPA, you will need to measure the distance from the person's nostril to their earlobe. Once you have this measurement, lubricate the NPA and gently insert it through the nostril until it reaches the back of the throat. Be sure to secure the NPA in place using tape or another type of fastener.

Another tool used to manage the airway is the oropharyngeal airway (OPA). An OPA is a hard plastic tube that is inserted through the mouth and into the back of the throat. This tube helps keep the airway open and allows the person to breathe more easily.

To insert an OPA, you will need to open the person's mouth and insert the tube upside down. Once the tube is in place, rotate it 180 degrees so that it is right-side up. Be sure to secure the OPA in place using tape or another type of fastener.

A bag valve mask (BVM) can also be used to manage the airway. A BVM is a device that is used to provide artificial ventilation to a person who is unable to breathe on their own. It consists of a bag that is attached to a face mask and a one-way valve that allows air to flow into the person's lungs.

To use a BVM, place the face mask over the person's mouth and nose and ensure that it forms a tight seal. Squeeze the bag to provide a breath of air to the person. Release the bag and allow the person to exhale. Continue to provide breaths using the BVM.



Respiration is a vital process that occurs in the human body to provide the necessary oxygen to the body's tissues and remove carbon dioxide. The respiratory system consists of various structures such as the nose, pharynx, larynx, trachea, bronchi, and lungs, which work together to ensure proper breathing. However, in certain situations, such as trauma, the respiratory system may be compromised, leading to respiratory distress. Two conditions that can affect the respiratory system are open pneumothorax and tension pneumothorax. These conditions require prompt intervention to prevent respiratory failure and death. Chest seals and needle decompression kits are two essential tools used to manage these conditions.



Respiration:

The third component of the MARCH algorithm is Respiration.

The process of respiration involves the exchange of oxygen and carbon dioxide between the body and the environment. Oxygen is essential for the body's metabolic processes, and carbon dioxide is a waste product that needs to be removed from the body. The respiratory system works by moving air in and out of the lungs, where gas exchange occurs. The nose, pharynx, and larynx form the upper respiratory tract, while the trachea, bronchi, and lungs form the lower respiratory tract.

During inspiration, air is drawn into the lungs, and oxygen diffuses into the bloodstream through the alveoli. During expiration, carbon dioxide is removed from the body as air is exhaled from the lungs. The respiratory system is regulated by the nervous system, which controls the rate and depth of breathing.

Open Pneumothorax.

An open pneumothorax is a condition in which there is a hole in the chest wall that allows air to enter the pleural space. The pleural space is the area between the lungs and the chest wall, which normally contains a small amount of fluid that allows the lungs to move smoothly during breathing. When air enters the pleural space, it causes the lung to collapse, leading to respiratory distress.

Common causes of open pneumothorax include trauma, such as a gunshot wound or a stab wound to the chest. The clinical signs of an open pneumothorax include shortness of breath, chest pain, and decreased breath sounds on the affected side. In severe cases, the patient may develop respiratory failure and require mechanical ventilation.



The management of open pneumothorax involves sealing the hole in the chest wall to prevent air from entering the pleural space. Chest seals are an effective tool for managing open pneumothorax. A chest seal is a sterile occlusive dressing that is placed over the wound, creating an airtight seal. This prevents air from entering the pleural space and allows the lung to re-expand. Chest seals can be applied in the field and are easy to use, making them an essential tool in managing open pneumothorax.



An open pneumothorax is a medical emergency that requires immediate intervention to prevent further complications such as tension pneumothorax or respiratory distress. A needle decompression kit is a crucial tool used to manage this condition.

To perform a needle decompression, the following steps should be taken:

  • Identify the site of injury: The second intercostal space in the mid-clavicular line is the standard site for needle decompression in an open pneumothorax.

  • Prepare the site: Clean the area with an antiseptic solution and ensure that it is dry.

  • Prepare the needle: Remove the needle from the packaging and attach it to the syringe.

  • Insert the needle: Hold the needle with the non-dominant hand and use the dominant hand to make a small incision at the insertion site. Then, insert the needle into the pleural space, perpendicular to the chest wall, with a firm, rapid movement.

  • Verify correct placement: Once the needle is inserted, attach the syringe to the needle and aspirate. If air is present, it indicates that the needle is in the correct position.

  • Secure the needle: Once the needle is in place, secure it with an occlusive dressing to prevent it from dislodging.

  • Monitor the patient: Observe the patient for any signs of improvement or deterioration, and be prepared to provide further interventions as needed.


In summary, using the needle decompression kit for an open pneumothorax is a critical intervention that can be life-saving. By following the MARCH algorithm and the proper steps for needle decompression, emergency responders can effectively manage this condition and provide the best possible outcome for their patients.

Circulation

The fourth component of the MARCH algorithm is Circulation. This refers to the maintenance of the patient's blood pressure and perfusion. Injured patients may be in shock due to blood loss or other causes, and healthcare professionals must ensure that the patient's blood pressure is adequate to maintain organ perfusion. This may involve the administration of intravenous fluids or blood products, and the use of vasopressor agents if necessary.

Circulation refers to the need to assess and maintain blood flow to vital organs and tissues. Here's some information on what must be done in this stage:

When assessing circulation, it's important to first check for any signs of bleeding. If there is active bleeding, it should be controlled as quickly as possible using direct pressure or a tourniquet. If the bleeding is severe or uncontrollable, emergency medical services should be contacted immediately.

If bleeding is not present or has been controlled, the next step is to assess the person's pulse and blood pressure. A weak or absent pulse may indicate a serious problem with blood flow, such as shock. In this case, the person should be placed in a supine position (lying flat on their back) with their legs elevated above the level of their heart. This helps to improve blood flow to vital organs.

If the person is conscious and able to swallow, giving them fluids can also help to improve circulation. Water or isotonic drinks can be given orally, or intravenous fluids may be administered by trained medical personnel.

In some cases, medications may be needed to improve circulation. For example, if the person is experiencing chest pain or a heart attack, medications such as nitroglycerin or aspirin may be given to improve blood flow to the heart.

Overall, the goal of the circulation stage is to assess and maintain blood flow to vital organs and tissues. This is crucial in ensuring that the person's body has the oxygen and nutrients it needs to function properly, and can help to prevent further complications or deterioration of their condition.

Hypothermia

Hypothermia is a condition in which the body's core temperature drops below normal. It can be caused by prolonged exposure to cold temperatures, immersion in cold water, or inadequate clothing. Symptoms of hypothermia include shivering, confusion, drowsiness, and loss of coordination.

The MARCH algorithm recommends that hypothermia be addressed after all life-threatening injuries have been treated. The first step in treating hypothermia is to remove the patient from the cold environment and cover them with warm blankets. The patient's temperature should be monitored, and warm fluids should be given if the patient is able to tolerate them. Active rewarming techniques, such as warming blankets or warm water immersion, can also be used in severe cases of hypothermia.


Head Injury

Head injuries can range from mild concussions to severe traumatic brain injuries. Symptoms of a head injury can include headache, dizziness, confusion, and loss of consciousness. In severe cases, a head injury can lead to brain swelling or bleeding, which can be life-threatening.

The MARCH algorithm recommends that head injuries be addressed after all life-threatening injuries have been treated. The first step in treating a head injury is to assess the patient's level of consciousness and neurological function. The patient's airway and breathing should also be monitored. If there is any suspicion of a severe head injury, the patient should be transported to a hospital immediately.

In cases of mild to moderate head injuries, the patient may be able to be treated in the field. Treatment may include pain management, monitoring for signs of increased intracranial pressure, and observation for any changes in the patient's level of consciousness. If the patient's condition worsens, they should be transported to a hospital for further evaluation and treatment.

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