EFMB 2022

The ear, specifically the _____________, is the most sensitive organ to primary blast injury. Page 2

tympanic membrane

T/F: Vestibular trauma to the inner ear may manifest in vertigo. Page 4

True

All trauma patients arriving at a Role ___ will receive proper and expeditious radiologic screening of injuries. Page 7

3

What are the responsibilities of a regional medical director? Page 12

1. In conjunction with medical planners advise the Combatant/Theater Commander on medical common operating picture and allocation of resources for intra-theater transport. 2. Ensure requirements of documentation of intra-theater transport care are done. 3. Assist medical directors operating in theater and ensure that they have the knowledge and skills to perform the job. 4. Provide technical supervision to medical directors in theater. 5. Ensure relevant out of hospital research is supported and accomplished. 6. Ensure information from intra-theater transportation is supplied to the DoD Trauma Registry.

Optimal but not necessarily definitive patient stabilization before transport is critical and encompasses four connected elements. What are these elements? Page 4 & 5

1. Injuries must be controlled 2. Resuscitation must be optimized but may be ongoing 3.Treatments besides resuscitative measures should be at steady-state, not requiring dynamic, complex, or life-preserving adjustments en route. 4. Deterioration requiring en route intervention must be anticipated and prevented with risk mitigation procedures prior to departure

Which inner ear abnormalities may cause vertigo? Page 3

1. otic capsule violating temporal bone fractures 2.secondary infections of the inner ear or vestibular nerves 3.trauma induced endolymphatic hydrops 4. activation of subclinical superior semicircular canal dehiscence.

Red Blood Cells are stored for up to 6 days at 1 - 6 °C before being frozen in a cryoprotectant (40% w/v glycerol), and stored in the frozen state at minus 65 °C or colder for up to ______. [CPG ID:26 Page 2]

10 years

A patient has suffered burn injuries to the entire anterior torso (chest and abdomen), the anterior and posterior of both arms, and the anterior of his face and neck. Calculate the patient's initial burn size using the Rule of Nines. Pages 4 and 19

18%(Anterior torso)+18%(Both arms)+4.5%(Face and neck) =40.5%

Burn casualties with injuries greater than ___ Total Body Surface Area (TBSA) are at high risk of hypothermia. Page 4

20%

Patients with TTS greater than ______ losses in three consecutive frequencies should be considered candidates for high dose oral and/or transtympanic steroid injections when not otherwise contraindicated. Page 4

25dB

For children suffering burn injuries, ___ x Total Body Surface Area (TBSA) x body weight in kg gives the volume for the first 24 hrs of fluid resuscitation. Page 5

3

How long does it take to thaw frozen red blood cells in a plasma thawer? Page 3

35 min

A patient has suffered burn injuries to the anterior and posterior legs and the perineum. Calculate the patient's initial burn size using the Rule of Nines. Pages 4 and 19

36%(Both legs)+1%(Perineum)=37%

A patient has suffered burn injuries to the anterior of her face, neck, and torso (chest and abdomen). Calculate the patient's initial burn size using the Rule of Nines. Pages 4 and 19

4.5%(anterior Face and neck)+18%(torso)=22.5%

How long does it take to thaw frozen red blood cells in a 42°C water bath? Page 3

45 min

Deglycerolized Red Blood Cells are derived from _____ ml of whole blood collected in Citrate/Phosphate/Dextrose or Citrate/Phosphate/Dextrose/Adenine collection bags. [CPG ID:26 Page 2]

450-500mL

Distance is also protective from radiation exposure. If feasible based on the patient's condition, any personnel without lead shielding should move a short distance away from the x-ray unit. The recommended minimal distance is _____. Page 3

6ft

Hearing loss that persists ___ hours after acoustic trauma warrants a hearing test or audiogram. Page 4

72

The majority of tympanic membrane perforations that close spontaneously do so within the first ___________ after injury. Page 2

8 weeks

FAST in combat trauma has a sensitivity of only 56% and specificity of ___. Page 3 & 4

98%

1. An 18g ______________ IV is typically desired for Computed Tomography IV access. Page 5

Antecubital

The Richmond Agitation Sedation Scale (RASS) is used to assess ________. Page 5

Anxiety

At 8-12 hours post-burn, if the hourly IV fluid rate exceeds 1500 mL/hr or if the projected 24 hr total fluid volume approaches 250 mL/kg, initiate 5% ___________ infusion for an adult burn patient. Page 5

Albumin

The DoD/VA Pain Rating Scale requires patients to select their pain level on a scale of 0-10, with 10 being ___________. Page 18

As bad as it could be nothing else matters

Battlefield Acupuncture (BFA) is a non-pharmacological pain therapy for mild to moderate pain or an adjunct to opioid medications. BFA is accomplished by applying needles to which body part? Page 21

Both ears

The goal for patients with delirium is to achieve a delirium free state as measured by the __________. Page 5

CAM

__________ is the most common infectious complication with pediatric burn patients and usually presents within 5 days of injury. Page 15

Cellulitis

____________ transport is required when "the patient has a critical illness or injury that acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient's condition during transport." Page 5

Critical care

Continuous infusions should be stopped _______ to obtain a reliable physical examination, including neurologic assessment, and to perform a spontaneous breathing trial in ventilated patients. Page 4

Daily

If is it not feasible to incorporate the acute pain service (APS) team into trauma rounds, then the APS is responsible for _________ pain rounds, pain management consults, and reports to the trauma team leader. Page 4

Daily

What are standardized and validated scoring systems for the assessment of pain, anxiety, and delirium? Page 5

DoD/VA Pain Rating Scale-Pain Richmond Agitation Sedation Scale (RASS) -Anxiety Confusion Assessment Method (CAM)-Delirium

What are examples of specific medical materials designated as patient movement items (PMI)?

Examples of PMI include ventilators, patient monitors, pulse oximeters, suction machines, IV pumps, oversized litters, negative pressure wound vacuums, pneumatic compression stockings/devices and more.

The ABCDE's should be incorporated into treatment care plans as efforts to prevent delirium in critically injured patients. The "E" stands for ________________. Page 6

Exercise (Mobility)

While the FAST scan has been validated only in hemodynamically unstable blunt trauma patients, it has become a standard tool in the trauma bay and Emergency Department (ED) in most trauma patients. FAST stands for____________________. Page 3

FOCUSED ABDOMINAL SONOGRAPHIC ASSESSMENT FOR TRAUMA

T/F: When providing point of injury care to a burn patient, you must immediately debride blisters and cover burns with loose, moist gauze wraps or a wet clean sheet. Page 4

False (Do not debride blisters until the patient has reached a facility with surgical capability. Cover burns with loose, dry gauze wraps or a clean sheet.)

T/F: Continuous dosing of analgesics and anxiolytics, as opposed to intermittent dosing, has been shown to reduce the duration of mechanical ventilation and continuous dosing of analgesics and anxiolytics should be instituted prior to intermittent dosing. Page 11

False (Intermittent dosing)

T/F: A hypotonic solution is the preferred resuscitation fluid for a burn patient. Page 5

False (Isotonic)

T/F: The Acute pain service (APS) should be established and be an integral part of casualty care starting at the Role I.

False (It's Role 3)

T/F: Sedation should be optimized as a priority over pain control. Page 3

False (Pain control should be optimized as a priority over sedation)

T/F: When performing Computed Tomography scan on a Military Working Dog, utilize a scanning protocol based on the adult settings to include the doses of and rates of contrast administration. Page 6

False (Pediatric)

T/F: Magnetic Resonance Imaging is widely used in theater, as its utility in the acute management of combat trauma was extensively establishment during Operation Enduring Freedom. Page 7

False (While MRI has been deployed to theater in the past, its utility in the acute management of combat trauma has not been established.)

T/F: Patients exposed to hazardous noise are only at risk for aural trauma. Page 2

False (at high risk for acoustic trauma and subsequent Hearing Loss (HL))

T/F: Computed Tomography scanning has been largely replaced by cervical spine radiographic evaluation (CSRE) and should only be performed when CSRE is unavailable. Page 2

False(Cervical spine radiographic evaluation has been largely replaced by CT and should only be performed when a CT is unavailable)

T/F: The FAST exam remains the most sensitive test for hollow viscus injury and mesenteric injury. Page 4

False(DPL remains the most sensitive test for hollow viscus injury and mesenteric injury)

T/F: While the patient is delivered to the receiving medical treatment facility, the patient care record should be maintained with the evacuation unit. Page 13

False(The PCR should be completed and delivered to the receiving MTF along with the patient.)

T/F: Medical direction at the regional level (Patient Evacuation Control Center) is centered on online medical direction activities. Page 11

False(offline)

T/F: For significant facial pareses/paralyses, early administration of steroids must always be provided regardless of contraindications. Page 3

False, (For significant facial pareses/paralyses, early administration of steroids should be provided if not contraindicated)

Which classification of burns are moist and sensate, blister, and blanch? Page 4

Partial thickness burns (2nd degree)

The standard FAST examination is focused on evaluating for the presence of ______________ in certain areas of the body. Page 4

Free intraperitoneal fluid

Which classification of burns appear leathery, dry, non-blanching, are insensate, and often contain thrombosed vessels? Page 4

Full thickness burns (3rd degree

Acute management of intratemporal facial nerve injury is to provide objective documentation of facial movement using the _____________ scale. Page 3

House-brackmann grading

______________, in parenteral doses of 0.15-0.3 mg/kg, has been shown to reduce pain scores, total narcotic use, and need for rescue medication when used with morphine for acute pain control.

Ketamine

Members of the trauma team should have _____ aprons and thyroid shields available near the trauma bay for radiation safety. Page 3

Lead

When performing a FAST examination on a patient, you inspect the right upper quadrant. You are inspecting between which two organs? Page 4

Liver and Kidney

The MIST report was recently incorporated into the 9-line medical evacuation request. MIST stands for: Page 9

M - Mechanism of injury I - Type of Injury S - Signs (vital signs) T - Treatment given

What is not a narcotic agent of choice approved for repeated Patient Controlled Analgesia (PCA) pump? Page 8

Meperidine (Demerol)

Calculate a burn patient's initial burn size using the Rule of _____. Page 4

Nine

______________ medical direction includes protocol development and review, continuing education of prehospital providers, and quality improvement activities. Page 10

Offline

______________ is a safe antiemetic in the adult population and is increasingly the therapy of choice for acute undifferentiated and trauma-related nausea. Page 12

Ondansetron

The commander of the unit assigned to perform medical evacuation should appoint the unit's ________________ as the medical director. Page 10

Physician

The gold standard for unstable patient transport is movement with critical care capability led by a ____________ who is qualified, experienced, and proficient at critical care transport. Page 5 & 6

Physician

The initial radiographic evaluation of a trauma patient begins with supine AnteriorPosterior (AP) chest and pelvis radiographs taken in the trauma bay usually with a(n) _________________. Page 2

Portable X ray machine

What are medications used to treat anxiety and agitation? Page 10 & 11

Propofol, Dexmedetomidine, clonidine

What is the lowest level of care equipped with a portable x-ray machine? Page 3

Role 2

What is the lowest level of care equipped with a Computed Tomography scanner?

Role 3

What is the Rule of 10s burn fluid resuscitation equation? Ensure you can apply it. Page 5

Rule of Tens: 10 x % TBSA > 40 kg and < 80 kg; if > 80 kg, add 100 ml/hr for every 10 kg > 80 kg

Which type of burn is NOT included in the estimation of Total Body Surface Area (TBSA) used for fluid resuscitation? Page 4

Superficial burns (1st degree

Which classification of burns appear red, do not blister, and blanch readily? Page 4

Superficial burns (1st degree)

Which approved Joint Trauma System patient care record (PCR) is primarily used for Critical Care Air Transport Team movements? Page 13

The AF IMT 3899 is primarily used for Aeromedical Evacuation, with supplements A through K as indicated for CCATT movements.

Which approved Joint Trauma System patient care record (PCR) is required whenever a search or rescue is attempted or accomplished that involves Navy personnel or assets? Page 13

The Medical Rescue Report SAR Form 3- 50.1A is required whenever a search or rescue is attempted or accomplished that involves Navy personnel or assets. (NTTP 3-50.1)

Which approved Joint Trauma System patient care record (PCR) is primarily used for rotary wing transports from point of injury or inter-facility transfer? Page 13

The Tactical Evacuation Patient Care Record is primarily used for rotary wing transports

Who assumes risk of reduced capability when a medical evacuation organization is not capable of providing the required intratheater en route care capability? Page 6

Theater commander

T/F: Adequate early pain control has been shown to reduce post-traumatic stress disorder and ongoing pain control is an obligatory part of trauma care. Page 7

True

T/F: All patients evacuated through casualty evacuation should have images sent electronically ahead of time as well as have a CD created to send with the patient as a backup. Page 7

True

T/F: At the Role 3, properly trained providers including radiologists, surgeons, and emergency physicians, can perform and interpret FAST scans in the emergency department on a hand held portable device. Page 4

True

T/F: Both under- and over- fluid resuscitation of burn patients can result in serious morbidity and even mortality; patients who receive over 250 mL/kg in the first 24 hours are at increased risk for severe complications including acute respiratory distress syndrome and both abdominal and extremity compartment syndromes. Page 5

True

T/F: Each unit of deglycerolized red blood cells (DRBCs) should be considered equivalent to a fresh unit of RBCs since they are frozen within 6 days of collection and have a 14-day shelf-life upon deglycerolization. [CPG ID:26 Page 2]

True

T/F: Early ambulation and physical therapy, is critical to the long-term functional outcome in burn patients. Once post-operative dressings are removed, perform range of motion of all affected joints. Page 14

True

T/F: Intermediate en route care should be initiated for a patient that does not require critical care but is in need of a dedicated medical attendant with at least the knowledge and skills equivalent to a paramedic as defined by the National Emergency Medical Services (EMS) Scope of Practice Model. Page 6

True

T/F: Low molecular weight heparin (LMWH) use in patients undergoing epidural anesthesia increases the risk of spinal or epidural hematoma, which may cause long term or permanent paralysis. Page 9

True

T/F: Medical capability is the quality or state of being able to provide the expected and required medical services and support to the casualty. Page 5

True

T/F: Seriously injured patients who are not intubated should be assessed every 1-4 hours for the presence of pain. Page 6

True

T/F: The Interfacility Transport of Patients Between Theater Medical Treatment Facilities Clinical Practice Guideline defines medical direction as the direct technical authority to determine capability, promulgate medical policy, and the authority to enforce the standard of care through quality assurance with local privileging actions of individual en route care providers. Page 9 & 10

True

T/F: The goal of Computed Tomography contrast injection is to provide concurrent solid organ enhancement, arterial enhancement, and pulmonary arterial. Page 6

True

T/F: The senior military person (or designated on-ground mission commander) present in coordination with the senior medical person determines when to request medical evacuation and the precedence assigned to the patient for evacuation. Page 8

True

T/F: Well trained teams improve outcomes so en route care teams who train together prior to operational assignment may optimize patient outcomes. Page 7

True

A FAST examination is performed with a portable hand-held machine most commonly using a standard 3-7 MHz curved array _______________ probe. Page 4

US

Definitive care for US service members suffering from burn injuries is provided at _____________. Page 12

USAISR Burn center in San Antonio Texas

Adjuncts can greatly increase patient safety and the effectiveness of narcotics to treat pain while reducing side effects. What are examples of adjuncts? Page 4

acetaminophen, ketamine, non-steroidal anti-inflammatory drugs (NSAIDs), continuous peripheral nerve infusions, and continuous epidural infusions

What are the clinical indications for use of each unit of deglycerolized red blood cells (DRBCs)? [CPG ID:26 Page 2]

as a supplement to liquid RBCs during surge periods of increased transfusion requirements in order to decrease casualty hemorrhagic morbidity and mortality

What are indications for endotracheal intubation during your initial burn survey? Page 4

comatose patient, symptomatic inhalation injury, deep facial burns, and burns over 40% Total Body Surface Area (TBSA).

What is the best course of action if you find debris in the external auditory canal or in the middle ear? Page 3

fluoroquinolone and steroid containing topical antibiotic (e.g., four (4) drops of ciprofloxacin/dexamethasone or ofloxacin in the affected ear three (3) times a day for seven (7) days)

All patients with subjective hearing loss and tinnitus following blast exposure should: Page 4

have the exposure documented, and should be evaluated by hearing testing as soon as possible

The symptoms of acoustic trauma are: Page 2

hearing loss, tinnitus (ringing in the ear), aural fullness, recruitment (ear pain with loud noise), difficulty localizing sounds, difficulty hearing in a noisy background, and vertigo.

What are clinical signs of inhalation injury? Page 7

progressive voice changes, soot about the mouth and nares, hypoxia, and shortness of breath

All Service Members that develop symptoms consistent with noise trauma (acute tinnitus, muffled hearing, fullness in the ear) should: Page 3

should be educated and directed to self-report for evaluation and possible treatment as soon as practicable.

When performing a FAST examination on a patient, you inspect the left upper quadrant. You are inspecting between which two organs? Page 4

spleen and kidney

1. Acoustic trauma may result in sensorineural hearing loss (SNHL) that is either _____________or _____________. Page 2

temporary or permanent

T/F: The smaller the size of the tympanic membrane perforation, the greater the likelihood is of spontaneous closure. Page 2

true

What are the approved Joint Trauma System patient care records (PCR) for interfacility patient transports? Page 13

▪ DD Form 1380 Tactical Combat Casualty Care (TCCC) Care ▪ DA 4700 overprint Tactical Evacuation Patient Care Record (JTS approved 20141119) ▪ AF IMT 3899 Patient Movement Record (20060819, V1) ▪ Medical Rescue Report SAR Form 3-50.1A