FC 2 Study Guide
How many liters of blood can come from the femur?
1-2 L
How many thoracic vertebrae are there?
12
How many phalanges are in each hand?
14
What percentage of stab wounds require surgical intervention?
15%
What is the proper rate of ventilations for head trauma casualties?
20 bpm on adults
How much blood can a pregnant casualty lose before showing signs of hypovolemia?
30-35% of total blood volume
What is the ideal urine output when you titrate fluids in a burn casualty?
30-50 mL/hr
How many sacral vertebrae are there?
4
How many coccyx vertebrae are there?
4 fused
How many lumbar vertebrae are there?
5
How many metacarpals are in each hand?
5
How much water does the colon absorb per day?
5-7 L
Penetrating trauma in the gluteal area is associated with significant intraabdominal trauma in what percentage of cases?
50%
How many cervical vertebrae are there?
7
How many bones are in the wrist? What are they called?
8 carpal bones
What percentage of GSWs require surgical intervention?
85%
What is the desired SpO2 for your casualty?
90 or above
What is a second degree burn?
A burn that results in damage through the epidermis into a variable depth of the dermis, commonly presents with blisters and will heal in 2-4 weeks
What is a third degree burn?
A burn that results in damage to all layers of the epidermis and the dermis that appear charred
What is a fourth degree burn?
A burn that results in damage to the epidermis, dermis, subcutaneous layer, and bones or internal organs
What is a first degree burn?
A burn that results in minor tissue damage that red dents the epidermis only and heals in 3-6 days
What difference in size in regards to pupils is considered abnormal?
A difference of great her than 1 mm in pupil size
When do the most devastating effects of radiation poisoning appear?
A few hours after exposure
What is cerebrospinal fluid?
A nutrient fluid that bathes and protects the brain/spinal cord
What is the skull?
A structure of fused bones that encase and protect the brain tissue
Hypotension caused by a head injury is usually what type of event?
A terminal event
What is the most important step in evaluating ocular problems?
A visual acuity test
What does the small intestine do?
Absorption of carbohydrates, ions, water, proteins, and fat
What does the large intestine (colon) do?
Absorption of water and electrolytes, and storage of fecal matter until it can be expelled
What are linear skull fractures?
Account for 80% of skull fractures, breaks that go all the way through the skull
How much of a casualty's circulating volume could be lost in the abdominal cavity?
All of it
What is the subcutaneous layer?
An adipose layer that aids in insulation of the body
How do you treat an evisceration?
Apply a moist sterile dressing without trying to replace segment
What if distal pulses are absent when splinting?
Apply gentle traction in an attempt to regain pulse
How long should you irrigate the eye?
As long as needed
What is some MOI for TBIs?
Blasts, projectiles, falls, direct impacts, or MVAs
What can injury of the solid and vascular organs cause?
Bleeding into the abdominal cavity
What is likely if both pupils are dilated and don't react to light?
Brain stem injury
How do you treat dryer chemical burns?
Brush the chemicals away
What would cause you to suspect A basilar skull fracture?
CSF drainage from the ears, mouth, or nose, raccoon eyes, and Battle's sign
What is the severe TBI like?
Can be closed or open injury, confused state lasts more than 24 hours, LOC for more than 24 hours, and memory loss lasting more than 7 days
What are the indications of a mid-facial fracture?
Casualty's face may appear asymmetrical or flattened, inability to close mouth, crepitus may be present
What are the brain hemispheres?
Cerebrum, cerebellum, and the brain stem
What is the fluid of choice for burn patients in shock?
Colloids (hextend or TXA/whole blood/TXA)
What is the moderate TBI like?
Confused or disoriented state lasts more than 24 hours, LOC for more than 30 minutes but less than 24 hours, and memory loss lasts more than 24 hours but less than 7 days
What is the mild like TBI?
Confused or disoriented state that lasts less than 24 hours, LOC for up to 30 minutes, and memory loss lasting less than 24 hours
How can you identify possible life-threatening abdominal injuries?
Considering the MOI and maintaining a high index of suspicion
What does COBBLES stand for?
Contact lenses, objects penetrating, bloodshot, bleeding in or around, lacerations, extrusion, and swelling
What is the retina?
Contains rods and cones of the eye
What happens when the hollow organs rupture?
Contents spill into the peritoneal and retroperitoneal space
How should you treat genitourinary injuries?
Control hemorrhage w/ direct pressure or pressure dressings and manage amputated genital body parts like any other amputated body part
What is the treatment for orbital fracture, corneal abrasions, and eyelid lacerations?
Cover the affected eye with a fox shield and administer the combat pill pack if possible
What is crush syndrome?
Damaged muscle tissue releases potassium and myoglobin
What can cause shearing injuries?
Deceleration injuries and restraining devices (seat belts)
When would a donut be used?
Depressed skull fractures
What is the primary factor in assessing abdominal trauma?
Determining that the abdominal injury exists
What are the indications of a nasal fracture?
Epistaxis, edema, ecchymosis, nasal deformity, and crepitus upon palpation
What do the kidneys do?
Excrete most of the end products of bodily metabolism via filtration of blood and formation of urine, and regulates water, electrolyte, and acid-base contents of the blood
What is decerebrate posturing?
Extension of arms and legs straight out with head tilted backward and toes pointed downward
Indications of inhalation burns
Facial burns, singed eyebrows, soot around the mouth, and carbonaceous sputum
What is decorticate posturing?
Flexion of the arm and legs pulled toward the core of the body from ICP
How do you treat liquid chemical burns?
Flush with as much water as possible
What are basilar skull fractures?
Fractures of the floor of the cranium
What are depressed skull fractures?
Fractures where fragments of bone are driven toward or into the underlying brain tissue
If the skin is burned, and you cannot establish IV access, how should you gain vascular access?
IO
What bones are in the pelvis?
Ilium, ischium, and pubis
What is Cushing's triad?
Increased BP, decreased heart rate, and irregular breathing
What effect does morphine have on patients w/ suspected brain injuries?
Increases CO2 retention and produces side effects that make it difficult to do a neurologic assessment, including checking the pupils
What us peritonitis?
Inflammation of the peritoneum or lining of the abdominal cavity?
What burn casualties are evacuated as urgent surgical?
Inhalation injury, second degree burns greater than 20% TBSA, third or fourth degree burns, burns of the face, hands, feet, genitalia, perineum, or major joints, electrical burns, chemical burns, and burn casualties with preexisting conditions that could complicate management, casualty with burns and trauma, burns to a child, and circumferential chest burns
What are the hollow organs of the abdominal cavity?
Intestine, gallbladder, and urinary bladder
What can electrical burns cause?
Irregular heartbeat (dysrhythmia) that can lead to loss of pulse
What do you do for superficial foreign bodies?
Irrigate and cover with a fox eye shield
What are the three categories of musculoskeletal injuries?
Isolated non life-threatening, non-life threatening, and definite life-threatening
Why shouldn't you hyperventilate a casualty with ICP?
It creates ischemia in the brain as less oxygen is able to be utilized
What are the characteristics of the spleen?
It is an organ of the lymphatic system, and it is highly vascular making it prone to hemorrhage
What are some signs and symptoms of a TBI?
LOC, memory problems, nausea, vomiting, sensory problems, mood changes, depressed, drowsiness, sleep problems, slurred speech, weakness, numbness, loss of coordination, loss of bowel/bladder, headache, convulsions, dilation of eyes, CSF drainage from nose and ears
What is the fluid of choice for burn patients?
Lactated ringers
What are the solid and vascular abdominal organs?
Liver, spleen, aorta, and vena cava
What are the lacrimal glands?
Located in the upper-outer aspect of each upper eyelid, it prevents infection, moistens the eye, and drains via ducts behind the eyelids
How long should a splint be?
Long enough to immobilize the joint above and below the injury
What does MACE stand for?
Military Acute Concussion Evaluation
With extremity circumferential burns, what should you monitor in the patient? Why?
Monitor extremity pulses because circumferential burns can prevent distal circulation
What is the preferred antibiotic for ocular injuries?
Moxifloxacin (avelox)
What is the conjunctiva?
Mucus membrane that lines the eyelid and extends from the eyelid to the front of the eyeball, it covers the anterior part of the sclera
When compartment syndrome sets in, what is the most vulnerable and the first to become injured?
Nerves
How far should you elevate the head?
No more than 30 degrees
What are key indicators of abdominal injuries?
Obvious signs of trauma, signs of hypovolemic shock w/o obvious cause, degree of shock greater than would be expected from present injuries, presence of peritoneal signs, and MOI
How should you transport a pregnant casualty?
On the left side with the right leg elevated to relieve supine hypotension
What is the epidermis?
Outermost layer of the skin, made up of epithelial cells, serves as a barrier between our body and the environment
What are the five P's of compartment syndrome?
Pain, paresthesia, pulselessness, pallor, and paralysis
What fracture can cause severe hemorrhage and can be fatal?
Pelvic fracture
What does the pancreas do?
Produces insulin and glucagon, and produces/secrets digestive juices into the duodenum
What is the function of the meninges?
Protects the cranial nerves and spinal cord
What are the functions of the skin?
Regulates body temp, the site of many nerve endings, temporarily stores fat, glucose, water, and salts, and absorbs certain drugs/substances
What are additional injuries associated with electrical injuries?
Ruptured tympanic membranes, and fractures from muscle contraction
How do you treat injuries from white phosphorus?
Seal out all oxygen (wet mud, saline, wet cloth, water)
What do you do for embedded/penetrating foreign bodies?
Stabilize the object and cover with a fox eye shield
What is the first step of treating a burn casualty in tactical field care?
Stop the burning process
What does the liver do?
Stores about 10% of total blood volume, forms bile, forms clotting factors, detoxifies/excretes and metabolizes many drugs
What does the gallbladder do?
Stores bile formed by the liver
What does the stomach do?
Stores large quantities of food until it can be converted into chyme and emptied into the duodenum
How do you control bleeding for casualties with head trauma?
Sufficient pressure on the edges of the wound
How would you treat inhalation burns?
Surgical cricothyroidotomy
What is an escharotomy?
Surgical incision made through burnt tissue to allow expansion of the deeper tissue and decompression
If the patient is able to swallow and is suffering from ocular injuries, what should they do?
Take their combat pill pack
What are shearing injuries?
Tearing forces exerted against supporting ligaments of solid organs and vessels
Why shouldn't you cover both eyes in the battlefield?
The casualty may feel anxious because they are defenseless
What are the indications of a mandible fracture?
The casualty's teeth "don't fit" together, crepitus may be present
What is the arachnoid?
The center layer of the meninges that absorbs CSF
How does a circumferential chest burn affect a casualty?
The chest wall can become constricted to such a degree that the casualty suffocates from the inability to take a deep breath
What is the first step in treating a casualty suffering from ocular burns?
The eyes must be flushed to stop the burning process
What is the scalp?
The highly vascular, outermost portion of the head that covers the skull and bleeds profusely when lacerated
What is the leading cause of death in fires?
The inhalation of toxic smoke
What is the cerebrum?
The largest part of the brain that houses sensory functions, motor functions, intelligence, and memory functions
What happens when a casualty with crush syndrome is extricated?
The new blood will sweep the toxins from the damaged muscle into the rest of the body
What is the dura mater?
The outermost of the meninges, it is the most resilient
What is the cerebellum?
The part of the brain that controls primitive functions, coordination, and balance
What is the brain stem?
The part of the brain that controls vital bodily functions such as cardio-respiratory functions
What must you always consider with eye injuries?
The possibility of an underlying head injury
What is the foremen magnum?
The primary opening located at the base of the skull, pressure can be released here and the spinal cord passes through here
What is the dermis?
The thick collagen connective tissue below the epidermis, contains nerves, hair follicles, sweat glands, and oil glands
What is the pia mater?
The thin, innermost membrane
What is the sclera?
The tough layer that protects the inner structure of the eye and helps to maintain the shape of the eye, it is connected to six muscles
What is the cornea?
The tough, transparent, and colorless cover over the pupils and iris
What are the three elements of smoke inhalation?
Thermal injury, asphyxiation, and toxin-induced lung injury
Why are contact lenses not authorized during BCTm FTXs, gas chambers, deployments, or combat?
They will worsen chemical exposures to the eye and corneal injuries
What are the meninges?
Three membranes that cover the brain
What is the halo test used for?
To determine the presence of CSF in blood
What is the purpose of MACE?
To evaluate a casualty in whom a concussion is suspected
What are compression injuries?
Trauma that occurs when organs are crushed between solid objects
What is your priority when it comes to head injuries?
Treat any life-threatening bleeding
What should you never do with an ocular extrusion?
Try to force the eye back into its pocket
What category of precedence do you use for TBIs?
Urgent surgical
What precedence are abdominal trauma casualties?
Urgent surgical
What precedence is a casualty with circumferential chest burns?
Urgent surgical
What is the gross visual acuity?
Used to test visual acuity in the field, starts with near sight card, then guessing held fingers, then hand motions, then light perception
When should you assume an inhalation injury?
When a fire takes place in an enclosed space
When should fluid resuscitation be considered for burn casualties?
When burns cover over 20% of TBSA
When would you administer antibiotics to a burn patient?
When penetrating trauma is present
Where is CSF produced?
Within the ventricles of the brain
What are the red flags of TBI?
Witnessed LOC, 2 or more blast exposures in 72 hours, unusual behavior/combative, unequal pupils, seizures, repeated vomiting, double vision, loss of vision, worsening headache, weakness of body on one side, confusion, and abnormal speech
Why should you avoid cleaning scalp lacerations?
You may cause more bleeding
What is a traumatic brain injury?
brain damage due to impact of external forces
What does the spleen do?
stores RBCs and platelets, removes RBC and platelets that are worn out or defective, and carries out immune functions
What does TBSA stand for?
total body surface area