68W FC1
Whole blood type O; Plasma, RBC and platelets 1:1:1 ratio; plasma and RBC in 1:1 ratio, any blood product alone; hextend
1st choice of fluid resuscitation in order
800ml
A 500 ml bag of hextend administered results in how much of intravascular fluid expansion?
Tracheal bronchial tree injury.
A rupture or tear in the windpipe or bronchial tubes, the major airways leading to the lungs. A tear can also occur in the tissue lining the windpipe.
1 Liter
A typical adult can bleed up to how much into 1 thigh?
1500 ml
A typical adult casualty can bleed up to how much in each side of the chest?
10 Liters of blood and IV fluid
A typical adult casualty can hemorrhage up to how much into the abdomen?
Rotary and fixed winged aircraft
Aeromedical evacuation is accomplished by both what?
Hypovolemic shock
Also called hemorrhagic shock is a life threatening condition when you lose 20% of your bodies blood or fluid supply.
IV Morphine 5 mg IV/IO
Alternative to OTFC if IV access has been obtained.
Vented Occlusive dressing
Apply what to a penetrating torso trauma injury?
M113
Armored personnel carrier, casualty capacity is 4 litters or 10 ambulatory casualties or a combination of the two.
He must notify the tactical leader
As soon as the combat medic identifies a need for medical evacuation what must he do?
Enclosed area
Blast overpressure is more effective in this type of area.
A
Brevity code for Ambulatory in Line 5
B
Brevity code for Biological in Line 9 (wartime)
C
Brevity code for Chemical in Line 9 (Wartime)
E
Brevity code for Convenience in Line 3
E
Brevity code for Enemy prisoner of War in Line 8
X
Brevity code for Enemy troops in area escort required in line 6 (wartime)
E
Brevity code for Enemy troops in the area in Line 6 (wartime)
C
Brevity code for Extraction Equipment in Line 4
B
Brevity code for Hoist in Line 4
L
Brevity code for Litter in Line 5
D
Brevity code for Non-U.S. Civilian in Line 8
C
Brevity code for Non-U.S. Military in Line 8
A
Brevity code for None in Line 4
N
Brevity code for Nuclear in Line 9 (wartime)
P
Brevity code for Possible enemy troops in the area in Line 6 (wartime)
C
Brevity code for Priority in Line 3
B
Brevity code for Pyrotechnic signal in Line 7
D
Brevity code for Routine in Line 3
C
Brevity code for Smoke signal in line 7
B
Brevity code for U.S. Civilian in Line 8
A
Brevity code for U.S. Military in Line 8
B
Brevity code for Urgent Surgical Line 3
A
Brevity code for Urgent in Line 3
A
Brevity code for VS17 panels in Line 7
D
Brevity code for Ventilator in Line 4
N
Brevity code for no enemy troops in the area in Line 6 (Wartime)
D
Brevity code for none in Line 7
E
Brevity code for other in line 7
Extrinsic causes
Cardiac tamponade, tension pneumothorax are examples of what type of damage to the heart?
M1133 Stryker Light Armored Vehicle or MEV
Carrying capacity 4 litters or 6 ambulatory casualties, or a combination of the two. Classified as a standard evacuation vehicle.
Loaded head first
Casualties are loaded in this position because they are less likely to experience motion sickness or nausea, less noise from doors opening and closing, less danger of further injury in the event of a rear collision.
500 ml bolus of LR by IV
Casualties suffering any cause of shock other than hypovolemia administer what?
Shock management and urgent surgical evacuation and surgery
Casualties with non-compressible hemorrhage need appropriate what?
MaxPro MRAP
Casualty capacity of 2 litters or 3 ambulatory casualties Cat 1.
HAGA MRAP
Casualty capacity of 3 litters or 6 ambulatory casualties Cat 2.
Urgent Surgical
Casualty requires evacuation with surgical intervention within a maximum of 1 hour
Urgent
Casualty requires evacuation within a maximum of 1 hour
Pack strap carry
Casualty's weight rests high on your back. This makes it easier to carry the casualty a moderate distance (50 to 300 meters)
2 mg IV (slow piush over 3-5 minutes or IM every 12 hours)
Cefotetan (If unable to take PO)
Body temp below 93 degrees
Clotting factors affected at what body temperature.
Medical Evacuation (MEDEVAC)
Collecting the wounded, sorting (Triage) and prioritizing for evacuation, providing an evacuation mode (transportation) and perform emergency medical interventions and care in route are all encompassed in what?
Casualty's IFAK
Combat medics should use what before using their own supplies in their aid bag?
Role 3
Combat support hospital
WW1 through today
Combat wounds have been consistent since when?
Tactical Combat Casualty Care Goals
Complete the mission, prevent additional casualties and treat the casualty are what?
6% Hetastarch in lactated eloectrolyte solution (Hextend)
Current prehospital fluid of choice for combat trauma casualties in the absence of blood and blood components. M9 aid bag comes stocked with two 500ml bags of hextend.
Sam junctional tourniquet (SJT)
Designed to control bleeding where traditional tourniquets would not be effective
Armored Medical Evacuation Vehicle (AMEV)
Designed to replace the shortcomings of M113, casualty capacity is 4 litters and 8 ambulatory
ResQGARD
Device makes it harder to inhale and increases the negative pressure in the chest. Can help increase BP
Tactical field care phase
During this phase the combat medic provides updates of evacuation category and changes in casualty status. Assesses for and treats preventable causes of death and disability. Non-life threatening injuries may be treated if time and resources permit.
Omit line 9
During wartime, how should you communicate there is no danger of CBRN?
1 gm IV/IM once a day
Ertapenem (If unable to take PO)
Pocho, Tarp, blanket, drag litter or SKED
Examples of mediums reducing friction between casualty and the ground.
Enemy fire, medical equipment limitations, widely variable evacuation time.
Factors influencing care on the battlefield.
Hypothermia; Acidosis; Hemodilution; Medications; Blood Pressure
Factors that contribute to coagulopathy (difficulty clotting)
Median cubital vein
First choice vein for vascular access.
Role 1
First medical care a soldier receives
Extracellular fluid
Fluid outside of the cells.
Intracellular fluids
Fluids found within the cells
Monitor airway, breathing and circulation
For casualties given opioids or ketamine ensure to do this.
Gain vascular access with a saline lock
For combat casualties with a significant injury assess mental status and radial pulse and also _______
Intrinsic causes
Heart muscle damage, dysrhythmia, valvular disruption are examples of what type of damage to the heart?
8 hours
How long will colloids maintain intravascular space?
90 degree angle from the front of the helicopter
How should litter bearers approach a UH-60 Blackhawk?
Anaphylactic shock
Hypersensitive reaction to the antigen causes severe bronchospasms and vasodilation.
Initiate Sternal intraosseous IO Line
If casualty needs fluid resuscitation after two failed attempts at initiating a saline lock what do you do?
Change method of hemorrhage control
If evacuation is delayed 2 or more hours you can reduce tissue damage by doing what?
Hypothermia, near drowning, electrocution
In a combat environment CPR should be considered for the following non-traumatic disorders.
Use call sign and frequency from SOI, keep transmission to a minimum of 25 seconds, provide the opening statement "I have a MEDEVAC request, over"
In sending a transmission a sender must
Psychogenic shock
Increase stimulation of the vagus nerve causes vasodilation and hypotension.
Confined spaces
Inhalation burns occur with greater frequency in fires in these areas.
Significant injury, AMS, Absent radial pulse
Initiate IV fluid resuscitation if the combat casualty meets the following criteria.
MEDEVAC
Is performed by dedicated medical vehicles and aircraft staffed with medical personnel who provide in route medical care.
Antibiotics
Kills or inhibits the growth of bacteria, recommended for all penetrating combat wounds.
Location of the pickup site
Line 1 of the medevac
Radio Frequency, call sign and suffix
Line 2 of the medevac
Number of casualty's by precedence
Line 3 of the medevac
Special Equipment
Line 4 of the medevac
Number of casualties by type
Line 5 of the medevac
Security of Pickup Site
Line 6 (Wartime) medevac
Number and type of wound, injury or illness
Line 6 peacetime
Blood type
Line 6 peacetime, if serious bleeding is reported what else should be given?
Method of marking pickup site
Line 7 of the medevac
Casualty nationality and status
Line 8 of the medevac
NBC Contamination
Line 9 Wartime
Terrain
Line 9 medevac (Peacetime)
Role 4
Medical care that is found in CONUS based hospitals and other safe havens.
Traumatic asphyxia
Medical emergency caused by intense compression of the thoracic cavity, causing venous backflow.
Brain, heart, lungs, kidney
Most important organs in shunting.
Penetrating trauma and hemorrhage
Most soldiers who die in combat do so within minutes due to what?
Tactical indications for spinal immobilization
Motor vehicle crashes, falls from greater than 15 feet, IED Blast involving MRAP Vehicle
400 mg PO once a day (in the pill pack)
Moxifloxacin (If able to take PO)
Deliberate tourniquet
Newly discovered life threatening hemorrhage on the upper or lower extremities should be treated with what?
Burns greater than 20% of body surface area
Non hemorrhagic causes of hypovolemic shock.
7.35 - 7.45
Normal pH required for clotting
Uphill or upstairs
Normally the casualty should be carried on the litter feet first, except when going where?
M997
Normally used within the operating base, casualty capacity is 4 Litters or 8 ambulatory casualties or 2 litters and 4 ambulatory casualties
Intravenous fluids
Not every injured casualty will require what?
Normal Saline solution
Not indicated for restoring the loss of body fluids
Signal operating instruction (SOI), automated net contral device (ANCD) or Radio and telephone operator (RTO)
Obtain radio frequency, call sign and suffix from one of the following sources.
Simple Rescue
Open fields, vehicles or structures, there are no hindrances to removing casualties.
Pill Pack self administered
Option 1 for mild to moderate pain, casualty is still able to fight - Medications on the battlefield.
Oral Transmuccal Fentanyl Citrate (OTFC) 800 ug
Option 2 for moderate to severe pain, casualty is not in shock or respiratory distress. Casualty is not at significant risk of developing either condition.
Ketamine 50 mg IM/IN or Ketamine 20mg slow IV or IO
Option 3 for moderate to severe pain, casualty is in hemorrhagic shock or respiratory distress or is at risk of developing either condition.
80 mmHg
Perfusion of vital organs can be maintained with a systolic BP of at least what?
Eergency surgical cricothyroidotomy
Preferred advanced airway in the combat environment
Role 2
Provides packed red blood cells (liquid), Forward surgical teams (FST) are found in this role of care.
Cardiogenic shock
Shock referred to as Pump failure
Routine
Sick and wounded in this category should be evacuated within 24 hours
Abdominal rigidity and tenderness, bloody vomiting.
Signs and symptoms of non-compressible hemorrhage include what?
Enemy Fire
Single most significant obstacle to the Combat medics ability to provide care.
Lactaded ringers
Solution of choice for burn casualties
Complex rescue
Structure ingress and egress, vehicle extrication, tactical search and rescue.
Neurogenic shock
Sympathetic control of the smooth muscle within the vascular walls is lost allowing vasodilation. Bradycardic, warm dry skin, alert and oriented, lucid when in the supine position.
Complete the mission, prevent additional casualties, treat casualties
TCC has three main goals what are they?
Tactical Evacuation Care phase
Tactical commander may direct use of vehicles of opportunity as needed for combat "load and go's"
Peel, Push, Pile, Pressure
The 4 P's of wound packing
The Tactical Leader
The decision to use CASEVAC rather than MEDEVAC for casualty transport is made by who?
1 gm in 100 cc of IV solution (NS or LR)
The dose and route given for TXA, must be given within first 3 hours from injury.
Hemorrhage 90.9%b
The majority of these potentially survivable deaths were due to?
NPAs
These are better tolerated and should be considered before OPAs in a combat environment, they are less likely to dislodge during transport.
Colloids
These expand and maintain the intravascular volume more than crystalloids.
Improvised tourniquets
These should be used as a last resort if manufactured tourniquets are not available.
King LT
This airway device can cause Esophageal rupture and dysphagia.
UH-60A Blackhawk
This assets normal evacuation configuration is 4 litter casualties and one ambulatory casualty, maximum evacuation is 6 litter casualties and one ambulatory or seven ambulatory casualties. This asset is also capable of loading from both side simultaneously.
Warrior Aid and Litter Kit (WALK)
This contains a folding talon litter and a robust amount of first aid supplies suitable for hemorrhage control and treatment for shock.
Ketamine
This drug is a useful adjunct to reduce the amount of opioids required to provide effective pain relief. It is safe to give to a casualty who had previously received morphine or OTFC. Should be given over 1 minute if IV.
Zofran, (Ondansetron) 4-8mg IV/IM/IO
This drug is given every 6 hours as needed for nausea and vomiting.
Naloxone (Narcan) 0.4 mg IV or IM
This drug should be available when using opioid analgesics (OTFC and Morphine)
Primary blast injury
This injury is caused by the blast overpressure (or wave) from an explosive.
Disarm the casualty
This intervention may be needed after administering OTFC, Ketamine or Morphine
Tranexamic Acid (TXA)
This is an intravenous medication that helps the body prevent breakdown of clots indicated in casualties with hemorrhagic shock, amputations, torso trauma or evidence of severe bleeding.
Cover and concealment
This is often overlooked and is a highly effective tool.
Septic shock
This type of shock shows signs that the body is fighting an infection, fever, rigors and petechiae.
Stokes basket, Jungel penetrator, SKED litter
Three most common devices used by the hoist to extract casualties are
6.0 mm
Tube diameter should be a minimum of what for a cricothyroidotomy?
Two man fore and aft carry
Two man carry for transporting the casualty over a long distance (Over 300 meters), useful for placing casualty on litter.
Hasty tourniquet
Used during care under fire, placed over the clothing, placed as high on extremity as possible.
SKED litter
Used to evacuate a casualty from confined spaces, rough and difficult terrain, water rescues with attached flotation devices, and is the primary litter used by the Army in helicopter hoist missions
Priority
Used when the individual should be evacuated within 4 hours.
Tourniquets
What are the first tactical choice for life threatening hemorrhage of an extremity in combat?
Care under fire, Tactical field care and Tactical evacuation phase
What are the three phases of tactical combat casualty care?
Platelets
What become activated and red blood cells stick to the fibrin net forming a clot.
Expiration date, color, particles and consistency
What do you look for when inspecting the IV bag before administering?
Microemboli released, acidotic blood, metabolic waste and toxins from non-perfused tissue back into circulation.
What happens if you loosen a tourniquet after 6 hours?
CPR
What is not appropriate to perform on a patient who has sustained blast or penetrating trauma and has no signs of life?
Infiltration
What is occurring when the infusion site is pale, swollen, cool and hard to the touch?
Phlebitis
What is occurring when you assess redness and warmth at the site and along the vein?
Air embolism
What is occurring when you find an abrupt drop in blood pressure, weak rapid pulse, cyanosis and chest pain?
Enemy Fire
What is suppressed before casualty care is rendered.
Chest tube
What is the definitive treatment for a pneumothorax?
18 gauge 1.25 inch
What is the gauge and length of recommended needle for intravascular access?
10 or 14 gauge needle and catheter 3.25 inches in length
What is the gauge and length of the Needle chest decompression?
Upper right, lower right, upper left, lower left.
What is the loading sequence for four litter casualties?
Extremity hemmorhage control
What is the medical priority for the combat medic?
Fourth intercostal space or lower
What penetrating thoracic wound location should be considered both abdominal and thoracic?
24%
What percent of combat fatalities are survivable by early intervention with Combat Medic Tasks and rapid evacuation to a surgical facility?
Hemostatic agents
What should be strongly considered with wounds of the neck, axillary area and inguinal area, especially in the presence of life threatening bleeding?
60 mmHg
What systolic BP does a carotid pulse indicate?
70 mmHg
What systolic BP does a femoral pulse indicate?
80 mmHg
What systolic BP does a radial pulse indicate?
93 mmHg
What systolic blood pressure is high enough to dislodge any blood clots?
Medical personnel recieve injured or ill soldiers and continue as far rearwards as the casualties medical condition warrants or military situation requires.
When does the MEDEVAC begin and end?
Alveoli
Where 02 and CO2 exchange occurs
Ketamine and OTFC
Which drugs have the potential to worsen severe TBI?
Lines 1-5
Which lines must be transmitted first to allow evacuation to begin without delay
6 + 9
Which two lines of the 9 line change in wartime as compared to peacetime operations.
Most Imjured
Who are loaded last so that they will be the first to be offloaded?
Tactical Leader
Who is always in command and will decide if casualties will be evacuated?
Aeromedical evacuation personnel
Who supervises the loading of loading casualties on a fixed or rotary wing?
Extremities 60%
Wound Data - Remember these areas are not protected by body armor.
Longer than 6 hours
You can not loosen tourniquet if it has been in place for how long or death may occur.
Impending death
falling blood pressure is a sign of what?
1500 ml or more
when does decompensated shock begin regarding fluid loss volume?