Field Craft 1
Your PA has ordered an IV infusion of 150 ml of Normal Saline over 1 hour. The Administration set being used delivers 20 gtts/ml. calculate the drops / minuet to be administered
50 gtts/ min
Where is the acceptable alternate primary NCD sited located?
5th intercostal space, anterior axillary line, directly over the 6th rib on the injured side
extremities combat fatalities %
60%
Wound Data
60% extremities 25% head and neck region 9%torso
King LT airway
A single-lumen airway that is blindly inserted into the esophagus; when properly placed in the esophagus, one cuff seals the esophagus, and the other seals the oropharynx.
Which of these is NOT a first choice tool to control massive external bleeding?
Abdominal dressings
What is the criteria for administering an intraosseous infusion to a combat casualty?
After two failed IV attempts
Where is the cricothyroid membrane located?
Between the thyroid and cricoid cartilage
When the body attempts to compensate for shock, to which structures are blood shunted?
Brain, heart, lungs and kidneys
What are the extrinsic causes of cardiogenic shock?
Cardiac Tamponade and Tension pneumothorax
What is the definitive treatment for a pneumothorax?
Chest Tube
What is the tactical priority in Care Under Fire?
Gaining fire superiority
You have made an unsuccessful IV attempt on the right forearm where should your second attempt be made?
Left forearm
How do you avoid hypoxemia when suctioning?
Limit suctioning to 15 seconds
During what phase of care is the airway first managed?
Tactical Field Care
Who is responsible for requesting medical evacuation?
Tactical Leader
Mild to moderate pain (meds) (casualty still able to fight)
combat wound medication pack: Tylenol-650mg bilayer caplet, 2 PO every 8hrs Meloxicam-15mg PO once a day
Who signs the TCCC card?
Medic providing care
size of cric tube?
6mm internal diameter allows for spontaneous breathing
% of deaths occurring prehospital
87.3% combat deaths 75.7% classified as non-survivable 24.3% died from potentially survivable deaths
% of deaths attributed to hemorrhage
90% 13.5% due to extremity hemorrhage 19.2% junctional wounds 67.3% truncal hemorrhage
You suspect your patient has internal bleeding. What are some signs and symptoms that may confirm your suspicions?
Abdominal rigidity and tenderness
Which of the following is the definition of IV infiltration?
Accumulation of fluid in the tissue surrounding an IV catheter insertion site
True of False. Once you begin medical care for a casualty, you will remain with that casualty until he or she reaches a medical officer (MO).
false
parietal pleural membrane
membrane attached to the surface of the chest wall
visceral pleura membrane
membrane covering the lungs
What is one of the four types of distributive shock?
Anaphylactic shock
How is blood pressure assessed in combat?
Checking for palpable pulses to estimate the systolic blood pressure
what does surface tension created by the pleural fluid lead to?
the unification of the chest wall and lung surface
tactical indications for spinal mobilization:
1) motor vehicle crashes 2) falls from greater than 15ft 3) IED blast involving a MRAP vehicle
_____ of combat fatalities are survivable by early intervention with combat medic tasks
24%
How much time do you have to have to transmit the 9 line MEDEVAC request?
25seconds
Which of the following statements about tourniquets is incorrect and could cause harm to a casualty?
You should loosen a tourniquet that has been on for more than six hours Loosening a tourniquet that has been in place for more than 6 hours can release micro-emboli into the body, resulting in a pulmonary embolism or stroke.
King LT indications
casualties: near drowning electrocution drug overdose medical cardiac arrest
tertiary blast injury
casualty is blown into a solid object such as wall or vehicle and suffers blunt trauma
What is the preferred advanced airway in the combat environment?
Emergency Surgical Cricothyroidotomy
What is the medical priority in Care Under Fire?
Extremity hemorrhage control
Which types of cardiogenic shock can be treated by in the combat environment?
Extrinsic causes
True or False? During wartime, you must include line 9 when there is no danger of CBRN.
False - omit line 9 during wartime when there is no danger or no CBRN present
You are conducting your assessment on a casualty with bilateral amputations that is in shock. Which pain medication should you give this patient?
Ketamine, 20mg IV
What are the four P's of packing?
Peel, Push, Pile, Pressure
What is the first intervention that should be completed on a casualty suffering from hemorrhagic shock?
Stop massive hemorrhage
After two failed attempts to start an IV in a casualty that requires immediate fluid resuscitation to start preparing to gain intraosseous access. Where is the site for IO administration?
The Manubrium
What will happen to a casualty's respiratory rate when his CO2 blood level increases?
The casualty's respiratory rate will increase.
What is the difference between a hasty and deliberate tourniquet?
The deliberate is placed 2 to 3 inches above the wound directly on the skin, while the hasty is placed as high as possible and over the clothing
How is the IV you started written on the casualty's documentation?
The type of administration set used along with the location and size of the catheter and they type and amount of fluid, if any was given
Your casualty has a thoracic entrance and exit wound. In what order should the wounds be treated?
The wounds should be treated in the breathing portion of my assessment in the order they are found
How is hemorrhage controlled in Tactical Field Care (TFC) phase?
Tourniquets Pressure dressing Hemostatic agents
True or False? The goal of battlefield documentation is to provide written record assessment findings and treatments given.
True
What are the Medical Evacuation Precedences?
Urgent, Urgent Surgical, Priority, Routine, Convenience
#1 obstacle for care on battlefield
enemy fire
When to do CPR in Combat environment
hypothermia, near-drowning, electrocution
King LT contraindications
inhalation burns
Positioning the Unconscious Patient
open airway recovery position or suction if necessary and NPA
moderate to severe pain (meds) (casualty IS NOT in shock or resp distress AND casualty is not at risk for those)
oral transmucosal fentanyl citrate (OTFC) 800ug -place lozenge between the cheek and the gum -to not bite or chew lozenge
what takes precedence over medical care?
the mission
True or False: Can an emergency cricothyroidotomy be performed on a conscious casualty with inhalation burns / edema?
true
Which of the following is an intrinsic causes of cardiogenic shock?
Direct damage to the heart
The IV Solution, IV tubing and IV catheter are replaced in accordance with local SOP or commonly every
IV Solution- 24 hours, IV tubing- 48 Hours, IV catheter- 72 hours
In what part of the assessment should you (the medic) assess for and treat thoracic injuries?
In Tactical Field Care, after you have assessed and treated Hemorrhage and Airway
What can you do if the casualty begins to develop progressive respiratory distress even after the wound has been dressed with an occlusive dressing and a NCD has already been placed?
Insert a second needle directly alongside (laterally) the first NCD Flush the previously placed catheter with 1-2 mL of sterile IV solution
Your casualty has experienced significant blood loss from an arterial bleed, he has an altered mental status and absent radial pulse. You are preparing an IV to administer 500 ml (1unit) of whole blood, when selecting a vein from the antecubital space for starting the IV. The first choice because it is well supported and less apt to roll should be the
Median cubital vein
Which antibiotic is given to patients that are able to swallow and is found in the Combat Wound Medication Pack/ Combat Pill Pack?
Moxifloxacin 400mg
Line 5
Number of casualties by type L: litter A: ambulatory
Line 3
Number of patients by precedence
Option 2: Moderate to severe pain (NOT in shock or respiratory distress or at risk of developing shock or respiratory distress) Which analgesics do you administer? How much and how often can you administer?
Oral transmucosal fentanyl citrate (OTFC) 800ug (micrograms)
You have a casualty with injuries, present radial pulses and normal mental status, what type of vascular access do you need?
Saline Lock
How should you administer Ketamine I.V. or IO while working on a combat casualty?
Slow push, over 1 minute
How are thoracic injuries dealt with during Care Under Fire?
Thoracic injuries should be addressed by directing the casualty to perform self-aid by placing their hand over the wound
Why do we convert tourniquets?
To save as much of the limb tissue as possible
A soldier walks over to you with a deep laceration on their arm. They start to describe their pain and inform you that they can still carry their weapon. Which pain medication(s) should you give this soldier?
Tylenol or Meloxicam
indications for NPA
Unconscious casualty with no respiratory distress or airway obstruction with intact gag reflex
By sticking to the 15 second rule, we can avoid stimulating the _____ nerve which can lead to profound bradycardia and hypotension.
Vagus
What is the first choice of occlusive dressing/ chest seal for treating open and/or sucking chest wounds to the thorax?
Vented
You have an unconscious casualty during the Care Under Fire phase of care. How should you manage their airway during this phase of care.
Wait until the Tactical Field Care phase
what is part of a soldiers official and permanent medical record?
battlefield documentation
inhalation burns occur with greater frequency in?
fires in confined spaces
acute cric complications occur?
in 10% of cases
moderate to severe pain (meds) (casualty IS in hemorrhagic shock or resp distress OR sig risk of those conditions)
ketamine 50mg IM or IN OR 20mg slow IV push -repeat doses q30min prn for IM or IN -repeat doses q20min prn for IV or IO -End points: control the pain or development of nystagmus -the combat medic may administer morphine 5mg IV/IO as an alternate to OTFC -repeat dose every 10 mins as necessary to control severe pain -monitor for resp. depression -zofran to counteract nausea from narcotics
Why are NPAs preferred
less likely to dislodge during transport most patients take it
positioning conscious casualties
let them move to their position of comfort
Which lines must be submitted to get the MEDEVAC request started?
lines 1-5
Which two lines of the 9 Line changes in wartime as compared to peacetime operations?
lines 6 + 9
How many liters of blood and IV solution can a typical adult casualty hemorrhage into the abdomen?
up to 10
can cric be performed on conscious patient?
yes, under local anesthesia
when to use emergency surgical cricothyroidotomy?
-significant airway obstruction -severe maxillofacial trauma -inhalation burns -unconscious casualty unable to maintain their own airway
What is the length and gauge of needle catheter required to perform a Needle Chest Decompression?
14 gauge, 3.25 inch needle catheter
About how much blood can be lost before the casualty's blood pressure will drop?
1500 mL - 2000 mL
TXA Dose
1gm ASAP but not later than 3hrs after injury administered over 10mins by IV infusion should not be given with hextend
What causes a pneumothorax?
A pneumothorax is caused by an accumulation of air within the potential space between the visceral and parietal pleura
While treating a casualty with hemorrhagic shock, why do we not want to improve the casualty's blood pressure back to it's normal level?
A systolic blood pressure of 80 mmHG will perfuse all vital organs As the blood pressure decreases, the body may be able to establish and maintain clots at the site of the injury A systolic blood pressure above 93 mmHG is high enough to dislodge any blood clots
After the administration of an IV your patient begins to complain of chest pain, you have a difficult time attaining a radial pulse. What should you immediately consider the problem to be and the corrective action?
Air embolism and notify the Medical Officer immediately
Your casualty has an amputated foot with little to no bleeding. How should you treat this injury?
Apply a tourniquet
secondary blast injury
Caused by debris or shrapnel from the explosion
primary blast injury
Caused by the blast overpressure or wave from an explosion. Damage to hollow organs(rupturing them)
What does "X" refer to?
"X" refers to place where casualty when down or was wounded in battle
option 1: mild to moderate pain
- CASUALTY IS STILL ABLE TO FIGHT TCCC COMBAT PILL PACK - TYLENOL- 650 MG BILAYER CAPLET, 2 PO Q8HRS - MELOXICAM -15 MG PO ONCE A DAY
narcan/naloxone
0.4mg IV or IM
MEDICAL EVACUATION (MEDEVAC) encompasses?
1) Collecting the wounded 2) Sorting (triage) and prioritizing for evac 3) Providing an evacuation mode (transportation) 4) Perform emergency medical interventions and care
Ertapenem 1gm IV/IM once a day
1gm IV/IM once a day give this to them if they are unconscious
9 line delivered in_____?
25secs or less
Moxifloxacin
400mg PO xday
With a tubing set of 10 gtts/ml the casualty is ordered to receive 500 ml (1 unit) of packed red blood cells over 1 hour. Calculate the required drip rate
83 gtts/min
APEL
Authorized protective eyewear list
Line 8
Casualty nationality and status A: US Military B: US Civilian C: Non-US Military D: Non-US Civilian E: Enemy Prisoner of War (EPW)
What does Tranexamic Acid (TXA) do for the body?
It prevents or slows the further breakdown of clots
Line 1
Location of pickup site
Line 7
Method of marking pickup site
Line 9 (wartime)
N- Nuclear B- Biological C- Chemical
Line 6 (Peacetime)
Number and type of wound, injury, or illness
Line 2
Radio frequency, call sign, and suffix
Line 4
Special Equipment A-none B-hoist C-extraction equipment D-ventilator
Line 9 (peacetime)
Terrain description
True or False? Once the Combat Medic completes his primary assessment (HABC), he can provide lines 3, 4, and 5 of the 9-line MEDEVAC.
True
when may casualties need to be disarmed?
after being given OTFC, or ketamine or morphine
blast overpressure is more effective in?
an enclosed area
give ______ to all penetrating combat wounds
antibiotics
no _______ to casualties with just burns
antibiotics
not every ______ requires intravenous fluids
casualty
tactical combat casualty care goals
complete the mission prevent addition casualties treat the casualty
role 3
damage control surgery combat support hospital
majority of combat wounds?
due to penetrating trauma
_______ is the single most significant obstacle to the combat medic
enemy fire
Role 2
evacuate from BAS to forward surgical team provides packed red blood cells (liquid)
inhalation burns in a blast injury
greatest concern is airway edema resulting in inadequate airway
If a casualty is dehydrated but alert, able to swallow, has a present radial pulse, and not experiencing nausea how should he be treated?
have the patient drink water
Tranexamic acid (TXA)
helps reduce blood loss from internal hemorrhage sites
majority of combat deaths?
hemorrhage 90%
TXA indications
hemorrhagic shock one or more major amputations penetrating torso trauma evidence of severe bleeding
reasons for trauma CPR
hypothermia near drowning electrocution
it is safe to give ______ to a casualty who has previously received morphine of OTFC
ketamine
Option 3: Moderate to severe pain (Casualty IS in respiratory distress or shock or WILL develop these conditions!) Which analgesics do you administer? How much and how often can you administer?
ketamine 50mg IM/IN or ketamine 20mg slow IV or IO endpoints: Nystagmus
Which analgesics have potential to worsen TBI?
ketamine and OTFC
role 4
medical care in CONUS based hospitals
alternative to OTFC?
morphine 5mg IV/IO may be diluted in 5cc's of sterile solution reassess every 5 mins repeat does every 10mins
tactical indications for spinal immobilization?
motor vehicle crashes falls from greater than 15ft IED blast involving a MRAP vehicle
medical equipment limitations?
only have whats in aid bag or IFAK widely variable evacuation time
tactical considerations takes precidence over?
patient care
most soldiers who dies in combat die within mins due to?
penetrating trauma and hemorrhage
overall goal of medical documentations on battlefield?
provide a written record of assessment findings and treatments given
Line 6 (wartime)
security at pickup site N-no enemy troops in area P-Caution: enemy contact unlikely E-Caution: Enemy contact possible X-Danger: Enemy in area
DD form 1380 VS sharpie on tape
standard VS nonstandard
Role 1
starts with: self aid/buddy aid ends with: battalion aid station (BAS)
decision to CASEVAC rather than MEDEVAC who?
tactical leader
who decides if casualties will be evacuated?
tactical leader
overclassification
tendency to classify a wound as more severe than it actually is
precedence of casualty (Line #3)
urgent: 1hr urgent surgical: 1hr priority: 4hrs routine: 24hrs convenience: whenever
WALK
warrior aid and litter kit robust amount of first aid supplies placed on several different vehicles in case of IED