Field Craft 2

Cushing's triade

increases BP, decreased PR, RR to increase or decrease depending

Dura mater

outermost membrane and most resilient

When would you not perform a visual acuity and physical assessment first for a patient with an eye injury?

chemical burns to the eyes

Cerebrum

largest part of the brain; houses sensory functions, motor functions, and higher intellectual functions such as intelligence and memory

MACE Exam

method for evaluation of acute TBI in military operational settings. NOT performed in CUF/TFC phase, but at BN station or higher.

arachnoid

middle layer of the meninges covers the brain and spinal cord

first degree burn

minor tissue damage that reddens the epidermis only -heals 3-6 days

What could the presence of non life-threatening musculoskeletal injuries indicate ?

more serious problems that may have been caused by the same mechanism of injury.

goals of burn wound care

prevent shock, infection, and minimize disfiguration

What is the most successful thing to do for Eye injuries?

Prevention

Mandible Fracture

MOI: direct blow S/S: deformity; loss of normal occlusion of the teeth "teeth no longer fit together"; crepitus or step off may be noted Tx: temporary immobilization; airway management as tongue may occlude airway

Why are soft tissue injuries not a good indication for intraabdominal bleeding?

May not present for hours later

What antibiotic, that is located in the combat pill pack, is one of the few antibiotics that can affect the eye?

Moxifloxacin

Should you ever try to remove a foreign body from the eye with your fingers

NO, it can cause further damage to the eye

Is a loss of consciousness required to make a possible diagnosis of a concussion?

No

Should you hyperventilate a casualty with a head injury?

No

When should pain management be considered for musculoskeletal injuries?

Once the injury is splinted

danger signs of enclosed fire injuries

ALWAYS assume inhalation injury -facial burns, singed eyebrows, carbonaceous sputum=signs

How long should you irrigate the eye for a chemical burn?

ATLEAST 20mins

How long should chemical burns to the eyes be irrigated?

Irrigation should be maintained as long as supplies will allow or until the casualty reaches the medical treatment facility

What are the different types of scalp injuries?

Lacerations, abrasions, avulsions and de-gloving

brain stem

controls vital body functions such as cardio-respiratory functions

Urgent Surgical evacuation for Burns

-inhalation injury -2nd degree burns greater that 20% -3rd or 4th degree burns -burns to face, hands, feet, genitalia, perineum or major joints -electrical burns -chemical burns -burn casualty w/preexisting med disorders -any children burns -circumferential chest burns -casualty w/burns + trauma injury

When should a neurological assessment (CMS - Circulatory, motor and sensory) be completed

Before & after

What is the most common cause for compartment syndrome in combat casualties?

When arterial blood flow continues into the extremity, but venous flow is restricted from returning

cerebellum

controls primitive functions, coordination and balance

4th degree burn

extends below the subcutaneous tissue to reach muscle or bone -happens with casualties struck by lightening

function of skin

protecting underlying tissues from dehydration and injury regulates temperature absorption temporary storage sensory nerves insulation

TBI (traumatic brain injury)

an injury to the brain resulting from an external force and/or acceleration/deceleration mechanism from an event.

What is the first step taken when treating a casualty with chemical burns?

flush the eyes

Vascular/IO access

for casualties w/burns covering greater than 20% TBSA, establish IV access -avoid placement trough burned tissue if possible -If IV access is not possible, an IO catheter should be placed -immediately begin fluid resuscitation based on "rule of tens"

scattered burns

the casualties palm surface of the hand represents 1% of their TBSA

pia mater

thin, innermost membrane of the meninges

Meninges

three membranes that cover the brain function: protects the cranial nerves and spinal cord

When assessing a casualty with an ocular injury what other type of injury should you asses for?

underlying head trauma

Determination of TBSA

use Rule of Nines to determine percentage of body surface area burned

Hypotension caused by head injury..?

usually a terminal event.

Several off duty Soldiers were injured when a suicide bomber detonated in the outdoor market near the Combat Support Hospital in Baghdad's Green Zone. Two of the Soldiers were not wearing their ballistic eye protection and have eye injuries. What is the most important step in evaluating ocular problems?

visual acuity

Where and when should the MACE assessment be performed?

Battalion Aid Station or higher

circumferential chest burn

-can constrict chest wall to degree that casualty suffers from inability to inhale a deep breath. -evacuate all circumferential chest burns as Urgent Surgical w/O2 supplementation to maintain O2 @ 92% or higher

SFC Romero went to the beach and fell asleep on the sand. When he awoke, his posterior trunk, posterior arms and posterior legs are red and blistered. He is brought to the BAS for care. What type of burn does this Soldier have?

2nd degree burns.

SFC Romero went to the beach and fell asleep on the sand. When he awoke, his posterior trunk, posterior arms and posterior legs are red and blistered. He is brought to the BAS for care. Using the Rule of Nines, calculate the percentage of BSA burned.

45%

In Bosnia, you are called to a small vehicle fire. Your patient (an 80kg. male) has second-degree thermal burns of his anterior trunk, anterior arms, anterior legs and groin. Using the Rule of Nines, calculate the percentage of BSA burned.

46%

What percentage of penetrating trauma in the gluteal area is associated with significant intraabdominal trauma?

50%

In Bosnia, you are called to a small vehicle fire. Your patient (an 80kg. male) has second-degree thermal burns of his anterior trunk, anterior arms, anterior legs and groin. Calculate the casualty's fluid resuscitation needs using the Rule of Tens.

600ml/hr

3rd degree burn

All three layers have been effected -surgical repair with grafting and rehabilitation is necessary -pain due to surrounding 2nd degree burns -"reseed" the area with new skin tissue

For which casualties should a MACE assessment be performed?

Any Service Member in a vehicle associated with a blast event, collision or rollover. Any Service Member within 50 meters of a blast (inside or outside). Anyone who sustains a direct blow to the head or repeated exposures resulting in a TBI.

When treating a musculoskeletal injury to an extremity. You find the distal pulse is absent. What should the next step be?

Apply gentle traction

If there is an increase in intracranial pressure what will happen to the blood pressure, pulse rate, and respiratory rate?

BP will increase, pulse rate will decrease and respiratory rate will increase, decrease and/or become irregular.

If CSF is draining from the ear or nose what should you suspect?

Basilar skull Fracture

How do circumferential burns complicate casualty care?

It can cause a tourniquet effect to the burned area

For mild TBI what pain control can be administered?

Ketamine and Fentanyl If casualty is aware and able to vocalize pain, then the TBI is likely not severe enough tp prevent these pain meds

Several civilians from the village outside your FOB were burned from an IED explosion that used white phosphorus ammunition rounds. What is the initial treatment for white phosphorus burns?

Cover with water, saline, a wet cloth, or wet mud, anything that seals the white phosphorus from the air

Red flags for head injury

LOC 2 or more blast explosions w/in 72 hours unusual behavior unequal pupils seizures repeated vomiting double vision weakness on one side of body abnormal speech

Based on your pervious training what would be some signs or symptoms that casualty is suffering from inhalation burns?

Facial burns Carbonaceous sputum Singed eyebrows

cerebrospinal fluid

Fluid in the space between the meninges that acts as a shock absorber that protects the central nervous system. Obstruction of CSF will create an accumulation of the spinal fluid within the brain which causes an increase in ICP

How is a gross visual acuity test completed?

In order, ask to read near card, count fingers at a distance, asses ability to detect hand motion, turn off all light and test eyes for light perception

You are concerned that the burned Soldier from question one may have inhaled super-heated air and are preparing to do an emergency cricothyroidotomy. What is the leading cause of death in fires?

Inhalation of toxic smoke causing thermal injury, asphyxiation, or toxin-induced lung injury.

What are the 3 categories musculoskeletal injuries can be placed in?

Isolated non life-threatening, non life-threatening, definite musculoskeletal life-threatening

After a mortar attack on your FOB, a civilian worker is discovered with both legs crushed under some rubble from a collapsed wall. You know it is important to gain IV access prior to extrication. Why is normal saline the solution of choice for crush injuries instead of lactated ringers?

Lactated ringers contains potassium which is also released from the damaged muscle tissue and can cause cardiac arrthymias

How should an obviously pregnant female be transported?

Left side, elevate right leg

What type of physical exam should be completed on a combat casualty with an abdominal injury?

Light palpation for TRDP

What are the types of skull fractures?

Linear, Depressed and Basilar skull Fractures

What is the correct length and consistency of a splint?

Long enough to immobilize the joint above and below the injury and rigid enough to keep the bone from moving

What information is necessary to assume the casualty is suffering from an abdominal injury due to blunt trauma?

MOI and pain

What are the 5 P's of compartment syndrome?

Pain, paresthesia, pulselessness, pallor paralysis

What are the different considerations of an injured hollow organ versus an injured solid organ?

Solid organs are very vascular and hollow organs release digestive acids into the peritoneal cavity

How should you transport a casualty with a head injury?

Supine Position

You have extracted a casualty from the inside of a burning guntruck. If the casualty's mental status becomes altered and shows sign of increased difficulty breathing what do you do?

Surgical chicothyroidotomy.

You were called to treat a civilian contract worker that was electrocuted while taking a shower because improper wiring was used in the hot water heater. He has what looks like small superficial entrance and exit wounds. Why are electrical burns usually more serious that they appear on the skin surface?

The current has burned deep tissue along an unpredictable path or caused heart beat problems.

You suspect abdominal trauma on a casualty that was thrown fifteen feet when a building he was about to enter exploded. He is pale, has a rapid pulse, and has abdominal redness with no obvious external bleeding. What is the primary factor in assessing abdominal trauma?

The determination that an abdominal injury does exist

leading cause of death in fires

The inhalation of toxic smoke

What is the most reliable indicator of intraabdominal bleeding?

The presence of hypovolemic shock from an unexplained cause

Your unit is conducting medical treatment for members of the local village outside your COB in Afghanistan. A pregnant civilian is brought to you for evaluation of abdominal pain and vaginal bleeding after a fall. You determine that she is about 16 weeks pregnant. During pregnancy, how long is the uterus protected by the pelvis?

Until about the 12th week

Your patient has a traumatic amputation of his left leg below the knee from an IED explosion. He has significant blood loss and is showing signs of shock. What is his evacuation category?

Urgent surgical

Danger signs of extremity circumferential burns

distal circulation compromise due to swelling and edema in these types of burns

special considerations for TBI treatment

early detection and treatment is key to preventing long term effects.

2nd degree burn

epidermis and part of dermis (blistered) -appears mottled (blotchy), red with weeping blisters (oozing) -heals in 2-4 weeks -very painful

1st step in treatment of burn injuries

stop the burning process (remove the burn source)