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