Field Craft one

M997

4 litter or 8 ambulatory, 2 litter and 4 ambulatory

UH - 60A Blackhawk

4 litters and 1 ambulatory 6 litters and 1 ambulatory

Armored medical evacuation vehicle

4 litters and 8 ambulatory

M113

4 litters or 10 ambulatory or combo of both

Stryker Light Armored Vehicle M1133

4 litters or 6 ambulatory or a combo of both

IV Morphine

5 mg IV/IO Reassess and repeat every 10 min of necessary Monitor respiratory depression

What are the main ABO blood types

A - only antigen A B - only antigen B AB - both antigen A & B O - contains neither A or B

Septic shock

A systemic infection (hypotension, low urine output, altered mental status, fever, rigors, petechiae)

When do you use a saline lock

Bilateral radial pulses are present casualty has normal mental status

What is non-compressible hemorrhage

Bleeding can't be compressed with direct pressure, wound packing, pressure dressing Chest, abdomen, pelvis

What is the hemorrhagic causes of hypovolemia

Blood loss is most common cause in combat trauma casualties. (internally or externally)

What is compensated shock

Blood lost the heart is stimulated to increase cardiac output. shunting blood to vital organs. aerobic to aerobic. lactic acid build up.

When the body attempts to compensate for shock, to which structures are blood shunted

Brain, heart, lungs, kidneys

Suring compensated shock where does the blood shunt to

Brian, heart, lungs, kidneys

MEDEVAC

Collect the wounded, triage, provide evacuation, perform emergency medical interventions

A typical adult casualty can bleed up to ____________L into one thigh

1 L

A typical adult can bleed ________ ml into each side of the chest A typical adult casualty can hemorrhage up to __________L of blood and IV fluids into abdomen

1500ml 10L

How much blood can be lost before the casualties blood pressure will drop

1500ml - 2000ml

How much TXA do you infuse and for how long

2 grams over 1-2 minute slow push

Max Pro MRAP ambulance

2 litters or 3 ambulatory

How much blood does a casualty need to lose to be in hypovolemic shock

20% (1/5)

How long do you have to call a MEDEVAC

25 seconds

HAGA MRAP ambulance

3 liters or 6 ambulatory

Packed RBCs

Whole blood removing 250ml of plasma Improve oxygen delivery to tissue Can be refrigerated up to 42 days

What is compressible hemorrhage

can be compressed with direct pressure, TQ, wound packing, pressure dressing Ex: arms, legs, axilla, groin, neck, superficial injures to head and torso

What are the extrinsic cause of cariogenic shock

cardiac tamponade and tension pneumothorax

What is the estimated blood pressure for carotid, femoral, and radial pulse

carotid: 60mmHg Femoral: 70mmHg Radial: 80mmHg

When shouldn't TQs be converted

casualty will arrive at a surgical facility within 2 hours TQ has been in place for 6hrs or longer Casualty has an amputation Casualty in profound shock

How is blood pressure assessed in combat

check for palpable radial pulse to estimate the systolic blood pressure

What are the stages of shock

compensated shock and decompensated shock

Examples of concealment and cover

concealment: smoke cover: buildings cover/concealment: armored tactical vehicle

What are non-hemorrhagic cause of hypovolemic shock

Dehydration, burns, tachycardia

What antibiotics are given to a casualty who can't take it by mouth

Ertapenem 1g IV/IM one a day

Fresh Frozen Plasma (FFP)

Frozen and thawed on demand, stored for 5 days Can be stored with anticoagulants for 26 days administer to increase level of clotting factors

What do you do with a casualty with normal status and present radial pulse

Gain vascular access

What do you do with AMS and weak or absent radial pulse

Gain vascular access and push hextend with saline

What kind of TQ do you put on during CUF

Hasty

What is intrinsic causes

Heart muscle damage, dysrhythmia, valvular disruption

Anaphylactic shock

Hypersensitive reaction in which an antigen (wheezing, tachycardia, abdominal cramping)

Factors effecting the clotting process

Hypothermia acidosis hemodilution medications blood pressure

What is the lethal triad

Hypothermia - body loses oxygen and glucose to produce, leads to acidosis Acidosis: buildup of lactic acid from anaerobic metabolism causing coagulopathy Coagulopathy: inability to clot properly

When do you convert TQs

If evacuation to a definitive facility delayed (at least 2 hrs), you can reduce tissue damage Wound has been exposed and assessed Tactical situation allows Enough time before evacuations

Psychogenic shock

Increase stimulation of vagus nerve causes vasodilation and hypotension and leads to a dramatic fall in cardiac output. (syncope)

What are the two types of extracellular fluid

Interstitial fluid: surround tissue cells, includes cerebrospinal and synovial fluid Intravascular fluid: found in vessels, plasma of the blood

Do you use crystalloid in combat environment

It is no the fluid of choice for combat trauma casualties that require intravascular volume expansion due to hemorrhage

How does the ResQGARD work

It makes it a little harder to inhale and increase the negative pressure in the check. This pulls more blood back into the heart that results in increase filling of the heart will enhance cardiac output on subsequent cardiac contractions.

Moderate to sever pain, casualty is in hemorrhagic shock or respiratory distress

Ketamine 50mg IV/IM (30 min) or 30mg slow IV/IO (20 min) Stop giving when nystagmus develops Narcan 0.4mg iv/im if needed Zofran 4-8mg iv/im every 8 hrs as needed

What. two analgesics can worsen a severe TBI

Ketamine and OTFC

What antibiotics are given to a casualty who can take it by mouth

Moxifloxacin 400mg one a day PO

Anchor wounds for neck, axillary, inguinal wounds

Neck: under axilla opposite of wound Axillary: opposite shoulder against neck Inguinal: casualty's thigh, buttocks, or belt

Line 3

Number of patients by precedence: A - Urgent B - Urgent Surgical C - Priority D - Routine E - Convenience

Moderate to severe pain NOT in shock or respiratory distress. What do you give them

OTFC 800ug tape lozenge on casualty's finger to reduce risk of overdoes

Indications for ResQGARD

Orthostatic intolerance (fainting) Hypovolemia Dialysis Blood donation

Who is the commander of a litter team

Person located at the casualty's right shoulder

What does the resQGARD do

Provides a safe, simple, and convenient way to treat state of low blood pressure in spontaneously breathing casualty

What is the main cause of cariogenic shock

Pump failure

Line 2

Radio frequency, call sign, and suffix

Combat medic's responsibilities for ground ambulances are

Responsible for the ambulance at all times Driver maintenance of the vehicle and equipment, reporting of major deficiencies

Rh-identifies individuals as being either negative or positive

Rh+: have the Rh antigen on their RBCs (can receive Rh+ or Rh- blood) Rh-: lack the Rh antigen (can administer Rh+ once)

What documents do you put time blood pack was received

SF518 ( have 2 people verify and match info on blood pack)

Casualty has significant injuries, absent radial pulse, altered mental status, what do you do

Saline lock followed by TXA 2g (IV push slowly over 1-2 min

Secondary and tertiary blast injury

Secondary: shrapnel and debris Tertiary: casualty is blown into a solid object

Freeze Dried Plasma (FDP)

Shelf life 2yrs produced from 5-10 donors Universal donor Ph buffer

line 4

Special Equipment

Neurogenic shock

Spinal cord injury interrupts the sympathetic nervous pathway. (bradycardia, alert, oriented and lucid in supine)

When do you don gloves

Tactical field care

Who is in charge of determining if casualties will be evacuated

Tactical leader

During CUF what are two priorities

Tactical priority: gaining fire superiority Medical priority: extremity hemorrhage control

Which type of cardiogenic shock can be treated by in the combat environment

Tension Pneumothorax (Extrinsic course)

Who's IFAK contents should medics use first

The casualty's

Aeromedical ambulances loading

The loading is supervised by aeromedical evacuation personnel

Total body fluid, intracellular fluid, extracellular fluid

Total body: 60% Intracellular: 45% Extracellular: 15%

Mild to moderate pain, casualty is able to fight. What do you give them

Tylenol 500mg 2 tablets every 8 hours Meloxican (Mobil) 15 mg once daily

How do you load casualties

Upper right, lower right, upper left, lower left Seriously injured loaded last load head first

What is distributive shock

Vascular container enlarges without a proportional increase in fluid volume. (less fluid and cardiac output decreases)

Fresh Whole Blood (FWB)

Walking blood bank room temp for 24hrs refrigerated with 8hrs of collection full hemostatic function prescreened donors but no TTD test

What is WALK, where can you find it, what is included

Warrior aid and litter kit carried on each ground vehicle folding talon litter first aid supplies for hemorrhage and shock

What is an intrinsic cause of cariogenic shock

direct damage to the heart

What is the single most significant obstacle to combat medics

enemy fire

Wound Data for extremities, head and neck region, torso

extremities: 60% Head and Neck: 25% Torso: 9%

What is lethal triad

hypothermia, acidosis, coagulopathy

What is TXA

injectable hemostatic agent Tranexamic acid (Cyklokapron) helps prevent break down of clots given within 3hrs from injury 2g given slow ivp over 1-2 minutes

What are the 4P's of wound packing

peel, push, pile, pressure

What sticks to fibrin net forming a clot

platelets

What are the 4 types of distributive shock

septic, neurogenic, anaphylactic, psychogenic

Themes of rescue

simple: no obstacles complex: obstacles

Three most common devices used by the hoist

stokes basket jungle penetrator SKED litter

What is the 1st intervention that should be completed on a casualty suffering from hemorrhagic shock

stop massive bleeding

Inhalation burns

this injury occurs when burning takes place in enclosed spaces without ventilation. Airway edema can result in inadequate airway. Prepare to perform surgical cricothyroidotomy

What is hypotensive resuscitation

Casualty is provided intravascular fluids to maintain a low perfusing bp. a low 80mmHg will perfuse to all vital organs

primary blast injury

Caused by wave from explosion lung, colon, stomach, middle ear

TC3 phases of care

Care under fire Tactical field care Tactical evacuation care

CASEVAC

Casualty Evacuation in Non Medical Vehicle or Aircraft

What is decompensated shock

Compensatory mechanisms can no longer account for the loss of blood volume. Doesn't occur until 1500ml or more of blood is lost. Falling BP is signs of impending death

TC3 3 main goals

Complete mission, prevent additional casualties, treat casualty

TC3 Goals

Complete the mission, prevent additional casualties, treat the casualty

How does Extend fluid shift

Large particles remain in vessels I=for 8hrs or longer Osmotic pressure pulls additional water form interstitial and intracellular spaces into the vessels Benefit from 500ml hextend = 800ml of blood volume expansion

What lines do you need to need to get the MEDEVAC going

Lines 1-5

Line 1

Location of pickup site

What is MARCH

Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia