68W Pre-Test

Which of the following diagnostic/treatment strategies should be implemented as soon as possible for a casualty with a suspected head injury? A) Apply a pressure dressing over any brain tissue protruding from the skull B) Evaluate for acute hearing loss as soon as possible C) Provide supplemental oxygen if available and monitor with pulse oximetry D) Obtain basic diagnostic imaging to establish a baseline before the casualty is evacuated

Not D

Casualty care documentation that is not completed in real-time at the point of injury should be documented retrospectively utilizing the _____________________. a. DD Form 1380 b. TCCC After Action Report c. Patient's medical record at the Role 3 facility d. After Action Review debriefing method

Not a

Regarding airway management, what should you do if the casualty is unconscious, but has no signs of airway obstruction? a. Proceed to assessing their respiratory status b. Insert a nasopharyngeal airway (NPA) and place the casualty into the recovery position c. Go back to the beginning of the MARCH sequence and reassess for bleeding d. Perform an emergent cricothyroidotomy

b. Insert a nasopharyngeal airway (NPA) and place the casualty into the recovery position

Basic care of an eye injury includes: a. Placing a rigid eye shield over both eyes b. Placing a rigid eye shield only over the injured eye c. Covering the injured eye with a pressure dressing d. Removing a penetrating object in order to place the eye shield

b. Placing a rigid eye shield only over the injured eye

Communicating with your casualty may: a. Help maintain a secure perimeter b. Reassure the casualty and help you assess mental status c. Give you information about the impact of the mission d. Help you facilitate evacuation

b. Reassure the casualty and help you assess mental status

On inspection of the back, a trauma casualty has a hematoma and localized lower back pain that radiates down the legs. You suspect this casualty has a _________________. a. Femur fracture b. Spinal fracture c. Pelvic fracture d. Compound fracture

b. Spinal fracture

When assessing a casualty, you notice one tourniquet is not controlling the bleeding. You should: a. Remove the first tourniquet and apply another high and tight tourniquet b. Tighten the original tourniquet to eliminate the distal pulse c. Apply direct pressure only for a minimum of 5 minutes d. Pack the wound with a hemostatic dressing and a pressure bandage

b. Tighten the original tourniquet to eliminate the distal pulse

A tourniquet was applied to a casualty's arm for a severely bleeding wound about 15 minutes ago while under fire. You have now reached a safe location. Which of the following statements is correct? a. You can now safely remove the tourniquet b. You can now reassess the casualty's wound c. You can perform a tourniquet conversion d. You can continue to tighten the tourniquet even if there is no further bleeding

b. You can now reassess the casualty's wound

If a casualty is not in shock and can swallow oral medications, they should be given a __________ tablet of moxifloxacin from their own Combat Wound Medication Pack (CWMP). a. 100 mg b. 200 mg c. 400 mg d. 800 mg

c. 400 mg

In what phase of care do you initiate documentation on the DD Form 1380 TCCC Card found in the Joint First Aid Kit? a. Care Under Fire b. Tactical Field Care c. Tactical Evacuation Care d. Post-Evacuation Care

Not C

The Combat Wound Medication Pack (CWMP) contains an antibiotic to facilitate early self-administration. Which antibiotic is found in the CWMP? a. Meloxicam b. Moxifloxacin c. Ertapenem d. Penicillin

Not C

Tactical Combat Casualty Care (TCCC) Guidelines recommend that combat trauma casualties without a pulse or respirations should have ____________________ performed during Tactical Field Care (TFC) due to the potential benefit and clear absence of additional harm. a. Active hypothermia measures b. Tourniquet application c. Bilateral needle decompression of the chest d. Cardiopulmonary Resuscitation

Not D

What is the evacuation category for a casualty who could deteriorate over the next 4 hours? a. Priority b. Urgent c. Routine d. Convenience

A. Priority

Who is responsible for documenting the casualty's injuries and care provided on the DD Form 1380? a. Whoever is providing care at the point of injury b. The Combat Medic/Corpsman c. The highest-ranking medical officer at the point of wounding d. The evacuation team

Not B

______________________ is described as having reduced concentrations of antibody titers, has been prescreened for transmissible diseases, and is leukocyte reduced. It is also the preferred blood product for the treatment of hemorrhagic shock. a. Plasma b. Fresh whole blood c. Group AB blood d. Low-titer group O whole blood

Not B

During the assessment of a casualty with a suspected pelvic fracture, the medic should not check for pelvic instability by applying bilateral downward pressure on the pelvis because _________________________. a. it would cause excess pain to the casualty b. it is not an effective method to evaluate for pelvic instability c. it should only be performed on unconscious casualties d. it causes further damage if a pelvic fracture is present

Not C

We have established that Hypovolemia is usually the primary cause for altered mental status on the battlefield out of the various principal causes. You should also expect to see ________________ if present, exacerbate a casualties mental status combined with the Hypovolemia a. Hypothermia b. Traumatic brain injury c. Hypoxia d. Hypovolemic shock

Some pain medications can alter a casualty's mental status, and this should be considered when assessing the casualty. Through determining the mechanism of injury and attempting to communicate with the casualty while assessing their verbal and nonverbal responses, you can determine if a casualty is not responding appropriately and exhibiting signs and symptoms of an altered mental status. The mechanism of injury is often your first clue that a casualty has received injuries that might lead to an altered mental status. Specifically, exposure to blasts and significant impacts can lead to head injuries that are not always accompanied by obvious external signs. Of course, the presence of injuries that cause massive hemorrhage or altered respiratory status increase the likelihood of hypovolemia and/or hypoxia and should increase your suspicion that the casualty will have an altered mental status.

What are the top priorities during Care Under Fire (CUF), Tactical Field Care (TFC), and Tactical Evacuation Care (TACEVAC) respectively? a. CUF - establish scene safety and stop life-threatening external hemorrhage if tactically feasible, TFC - establish a secure perimeter and triage casualties, TACEVAC - establish evacuation point security and stage casualties for evacuation b. CUF - fire superiority and MARCH PAWS interventions, TFC - tactical trauma assessment and evacuation requests, TACEVAC - tourniquet reassessment and casualty preparation c. CUF - MARCH interventions and immediate casualty extraction, TFC - fire superiority and remaining MARCH PAWS interventions, TACEVAC - medical resupply and establishment of a secure perimeter d. CUF - fire superiority and evacuation request initiation, TFC - MARCH interventions and casualty preparation, TACEVAC - remaining MARCH PAWS interventions

a. CUF - establish scene safety and stop life-threatening external hemorrhage if tactically feasible, TFC - establish a secure perimeter and triage casualties, TACEVAC - establish evacuation point security and stage casualties for evacuation

Which of these statements are applicable to the Care Under Fire (CUF) phase? a. CUF includes massive hemorrhage control b. CUF includes airway management c. CUF includes burn treatment d. CUF includes treatment for hypothermia

a. CUF includes massive hemorrhage control

The potential for head injury is greatest if the casualty was within __________ of the blast. a. 50 meters b. 75 meters c. 100 meters d. 125 meters

a. 50 meters

When managing hypothermia in a trauma casualty, which of the following provides external heating of the casualty? a. Active hypothermia management b. Passive hypothermia management c. Lifting the casualty off the ground d. Covering casualty with a blanket

a. Active hypothermia management

Casualties with altered mental status should be ________________. a. Immediately disarmed b. Allowed to keep communications equipment c. Physically restrained at all times d. Permitted to hold on to mission-sensitive items

a. Immediately disarmed

If a penetrating eye injury is suspected, you should perform a _______________________. a. Rapid field test of visual acuity b. Neurological exam c. Traumatic brain injury evaluation questionnaire d. Gait and balance assessment

a. Rapid field test of visual acuity

You are assessing a casualty's carotid pulse and he begins to complain of lightheadedness. What is the first action you should take to help resolve his lightheadedness? a. Remove your fingers from the carotid to relieve excessive pressure b. Give a fluid bolus to treat hypotension c. Administer Narcan to counteract any opioids that have been given d. Transfuse one unit of cold-stored low-titer type O whole blood

a. Remove your fingers from the carotid to relieve excessive pressure

Which of the following is a sign of early hypovolemic shock? a. Tachypnea b. Hypertension c. Decreased respiratory rate d. Bradycardia

a. Tachypnea

Before assessing and treating a casualty with 10% thermal burns, which of the following apply? a. You should stop the source of the burning b. You should remove/pull all clothing away from the burned area, even if it is adhering to skin c. Immediately drag or carry the casualty to safety d. Immediately cover the casualty with a vapor barrier shell to prevent hypothermia

a. You should stop the source of the burning

The vented chest seal used to cover an open chest wound must extend at least how many inches beyond the edges of a penetrating wound? a. 1 inch b. 2 inches c. 3 inches d. 4 inches

b. 2 inches

What lifesaving actions should be performed during the Care Under Fire (CUF) phase? a. Establish an airway for a casualty who is not breathing b. Apply a tourniquet to control bleeding c. Perform a needle chest decompression to a life-threatening chest injury d. None of these interventions can be performed during CUF

b. Apply a tourniquet to control bleeding

Which of the following are found within the Joint First Aid Kit (JFAK)? a. Ibuprofen, chest seal, chest tube b. Nasopharyngeal airway (NPA), chest seal, endotracheal tube c. Chest seal, NPA, tourniquet d. Chest seal, Ibuprofen, bag valve mask

c. Chest seal, NPA, tourniquet

Who is responsible for the transition of care from Tactical Field Care to the receiving evacuation team as the casualty enters the Tactical Evacuation Care phase? a. Combat Lifesaver b. Logistics officer c. Combat Medic/Corpsman d. Evacuation personnel

c. Combat Medic/Corpsman

A casualty has a tourniquet placed correctly and needs to be treated for hypothermia. Which choice represents the correct application of the vapor barrier in active hypothermia management? a. Cover the tourniquet b. Cover the face and the tourniquet c. Cover the casualty completely, except the face d. Cover the face; do not cover the tourniquet

c. Cover the casualty completely, except the face

A life-threatening hemorrhage does not include: a. Bright-red blood pooling on the ground b. Pulsatile, steady bleeding c. Dark-red, slow-trickling bleeding d. Bandages or clothes soaked with blood

c. Dark-red, slow-trickling bleeding

Which analgesic medication is indicated for casualties who are in mild to moderate pain, are not able to fight, and are not in shock or respiratory distress (or at high risk of either condition)? a. Meloxicam tablet b. Ketamine intravenous infusion c. Fentanyl citrate lozenge d. Morphine intramuscular administration

c. Fentanyl citrate lozenge

______________________ is used to treat nausea and vomiting associated with the administration of opiates in trauma casualties. a. Fentanyl b. Naloxone c. Ondansetron d. Acetaminophen

c. Ondansetron

What is a valid reason to conduct casualty evacuation team rehearsals both at the unit's home station and down-range? a. Usually there is significant downtime down-range that allows for extra training and preparation b. It is enough to talk through the casualty evacuation process whether at home or down-range and understand it in theory c. Without appropriate rehearsals, the evacuation process may be delayed leading to adverse clinical outcomes d. If the Combat Medic/Corpsman is well versed in the evacuation procedures, he/she can guide the other team members through the process in real time.

c. Without appropriate rehearsals, the evacuation process may be delayed leading to adverse clinical outcomes

What is the best method to control bleeding from an amputation? a. Apply direct pressure at the stump b. Pack the stump with a hemostatic dressing c. Apply a pressure dressing over the stump d. Apply a tourniquet above the amputation

d. Apply a tourniquet above the amputation

What is a likely cause of altered mental status in a trauma casualty on the battlefield? a. Use of recreational drugs b. Sleep deprivation c. Poor nutrition d. Blood loss

d. Blood loss

Tactical situation permitting, in which of the following casualties with no signs of life would you consider initiating Cardiopulmonary Resuscitation (CPR) during Tactical Field Care? a. Casualty with a gunshot wound to the chest b. Casualty that was thrown 30 feet due to a building explosion c. Casualty with a lower extremity amputation after an IED attack d. Casualty with severe hypothermia after a near-drowning

d. Casualty with severe hypothermia after a near-drowning

What is the best method to prevent hemorrhagic shock in a trauma casualty? a. Oral rehydration b. Administration of tranexamic acid c. Transfusion of blood products d. Control all sources of bleeding

d. Control all sources of bleeding

Trends in vital signs (VS) provide insight into the casualty's clinical course that help the responder identify the need for interventions or assessments earlier than would happen with a single set of VS, but when caring for multiple casualties, it is very difficult to remember the VS of each casualty and the changes that occur over time. Which of the following would help the CMC accurately monitor VS trends for multiple casualties? a. Monitor VS in the same sequence each time to facilitate remembering b. Focus on the most severely injured casualty since they are most likely to have changes in VS c. Enlist the help of other CMCs to help trend VS on multiple casualties d. Document VS on the DD Form 1380 TCCC Casualty Card after each assessment

d. Document VS on the DD Form 1380 TCCC Casualty Card after each assessment

What is the most common cause of preventable combat death? a. Tension pneumothorax b. Airway problems c. Shock d. Hemorrhage

d. Hemorrhage

Altered mental status in a trauma casualty in the absence of a head injury may be indicative of ____________________. a. Intracranial hypertension b. Recreational drug overdose c. CO2 narcosis d. Hypovolemic shock

d. Hypovolemic shock

A casualty hit the steering wheel during a high-impact vehicle collision and is in respiratory distress. You are having difficulty getting under the body armor to visually inspect the chest. What would make you suspect a life-threatening chest injury? a. Presence of polytrauma b. Diaphoresis and pain c. Need for a nasopharyngeal airway d. Mechanism of injury and presentation

d. Mechanism of injury and presentation

Which of the following medications is found in the Combat Wound Medication Pack (CWMP) and is used for analgesia? a. Moxifloxacin b. Ibuprofen c. Ketamine d. Meloxicam

d. Meloxicam

A casualty has a lower limb amputation after a blast injury. Based on this injury pattern, you suspect the casualty might also have a ________________. a. Humeral fracture b. Orbital fracture c. Cranial fracture d. Pelvic fracture

d. Pelvic fracture

Assuming that all are available, which of the following should be transfused first in the management of hemorrhagic shock? a. Plasma or red blood cells (RBCs) alone b. Cold-stored low-titer O whole blood c. Pre-screened low-titer O fresh whole blood d. Plasma, RBCs and platelets in a 1:1:1 ratio

d. Plasma, RBCs and platelets in a 1:1:1 ratio Initial hemorrhagic shock resuscitation begins with the administration of IV fluids, followed by transfusion of blood products at a 1:1:1 ratio. The initial IV fluids should be a 2 L bolus of 0.9% normal saline or two 20 mL/kg boluses by patient weight. The patient is then determined to be either a responder, transient responder, or nonresponder to IV fluids based on their improvement. Typically, patients in Class 1 or 2 can be treated initially with a trial bolus of crystalloids, but patients in Class 3 or 4 should be getting blood products immediately with the first bolus of crystalloids. The amount of blood transfused depends on a variety of factors, but is specifically centered around the concept of "permissive hypotension". Permissive hypotension is the idea that a patient in active hemorrhagic shock should be transfused just enough blood products to retain a systolic blood pressure above 70 mmHg. Then, after hemorrhage is controlled, the patient can be transfused to retain a systolic blood pressure above 90 mmHg. As a rule of thumb, one can expect roughly a loss of 1 L blood with a femur fracture, and at least 1 L blood loss with a pelvic fracture. Other long bone fractures such as the humerus, tibia, or fibula can also account for as much as 500 ccs each of blood loss. As such, a patient with bilateral femur fractures or a pelvic fracture can already be assumed to be approaching stage 3 or IV of hemorrhagic shock. As the saying goes in accounting for blood loss in hemorrhagic shock, "blood on the floor, plus four more". This phrase meaning basically that a life-threatening amount of blood can be lost as active hemorrhage outside the body, in the thigh compartments of bilateral femur fractures, the pelvis, abdomen, or chest. It should also be noted that no

The Joint First Aid Kit (JFAK) includes the following equipment: a. Tourniquet, hemostatic dressing, intravenous access equipment b. Tourniquet, pressure bandage, junctional tourniquet c. Nasopharyngeal airway, chest seal, blood transfusion tubing d. Tourniquet, hemostatic dressing, nasopharyngeal airway, chest seal

d. Tourniquet, hemostatic dressing, nasopharyngeal airway, chest seal

How should you open the airway of a casualty with a suspected neck or spinal injury? a. Open the airway using the head-tilt/chin-lift airway maneuver b. Insert a nasopharyngeal airway c. Perform an emergent cricothyroidotomy d. Use the jaw-thrust maneuver to open the airway

d. Use the jaw-thrust maneuver to open the airway