M.A.R.C.H. - Circulation
The MARCH algorithm is laid out differently from Advanced Trauma Life Support (ATLS) which uses Airway, Breathing, and Circulation (ABC’s) as the order of treatment to instead use Massive Hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head Injury for prioritizing lifesaving treatments.
There are some treatments mentioned in this portion of the MARCH algorithm that are more advanced than most of the the people visiting this site will be able to perform. Some are left in for awareness of what can be done to treat trauma patients. There are also topics discussed that can be performed by most people visiting this site and they will be discussed in future posts.
The “C” portion of the MARCH acronym refers to the broad topic of Circulation. In the context of MARCH, circulation covers a wide gamut of responsibilities, from assessing for hemorrhagic shock to administering blood transfusions to non-blood-based fluid replacements like Tranexamic Acid (TXA). However, the "C" phase is also an opportunity to “SEE”, i.e. Not just LOOK at our patient, but to really SEE our patient.
In TCCC, we use the “C” phase to expose and reassess the need and effectiveness of our previous efforts and "SEE" the overall view of our patient's status. In the “C” (or "See") portion, we use a discriminate eye to determine and answer the following:
Does the method of injury indicate that we should stabilize the pelvis?
If we used a tourniquet, did the injury need it?
How is our tourniquet placement? If you performed a hasty tourniquet application in a care under fire circumstance, can we apply a new device now two to three inches above the wound directly on the skin?
Can we safely perform a tourniquet conversion to a pressure dressing if the situation warrants it?
Have we marked times of application on the tourniquet(s) we applied or converted?
Do we see signs of hemorrhagic shock such as altered mental status in the absence of brain injury?
The circulation phase is where these deeper dive questions get answered, and we must use the "C" phase to "See" the answers.