TCCC

Match each of the phases of a blast injury with the appropriate description A. Injuries resulting from the blast wave or overpressure which causes direct tissue damage B. Injuries from ballistic wounds produced by fragments from exploding weapons C. Injuries caused by propulsion of casualties into the ground or into solid objects D. Injuries from burns and toxicities in the blast environment E. Injuries caused by radiation, chemicals or biological agents 1. Primary injuries 2. Secondary injuries 3. Tertiary injuries 4. Quaternary injuries 5. Quinary injuries

1. A 2. B 3. C 4. D 5. E

Match the type/classification of shock to its corresponding definition: A. Related to abnormality in vascular tone arising from several different causes B. Related to the loss of circulating blood volume C. Related to interference with the pump action of the heart 1. Hypovolemic 2. Distributive 3. Cardiogenic

1. B 2. A 3. C

What are the 3 criteria for safe conversion of tourniquets to hemostatic or pressure dressings?

1. Casualty is not in shock 2. It is possible to monitor the wound closely for bleeding 3. The tourniquet is not being used to control bleeding from an amputated extremity.

For each of the following casualty descriptions, identify the correct triage category. A. Delayed B. Minimal C. Immediate D. Expectant 1. A casualty in coma with open head injury and brain matter exposed/A casualty with third degree burns over 90% of TBSA who is also in respiratory distress. 2. A casualty with a gunshot wound to the chest in respiratory distress/A casualty with severe, uncontrolled hemorrhage from a traumatic amputation of his right foot. 3. An ambulatory casualty with a 3 cm laceration to the left thigh with slow venous bleeding controlled after applying direct pressure/A casualty with a first degree burn to approximately 2% TBSA on his abdomen. 4. A casualty with an open fracture of the left lower leg/A casualty with traumatic amputation of his left foot; bleeding controlled by C.A.T tourniquet.

1. D 2. C 3. B 4. A

Casualties who have cervical spine injuries also have a ___% chance of having another spinal fracture. Therefore, the entire spine must be immobolized in casualties who have indications for cervical spine immobilization.

10

Your blood pressure is 150/90. What is your mean arterial pressure (MAP)?

110

Consideration of kinematics is important in every trauma casualty. Overall, only about ___% of casualties with stab wounds to the abdomen will require surgical intervention, whereas about ___% of casualties with gunshot wounds will need surgery for definitive management of their abdominal injuries.

15, 85

You are a medical officer riding in a convoy that was just struck by an IED. There are several severely injured soldiers, and you need to call for evacuation. What information will you need to request evacuation? (select all that apply) A. Patient nationality and status B. Past medical history for all casualties C. Number of patients by precedence D. Security at the pick-up site

A, C, D

Who is the best person to perform initial triage in a mass casualty situation? A. An Air Force emergency medicine physician (residency trained, board-certified). B. Navy "0000" corpsman (quad zero -- a corpsman who is very junior, has completed "A" school and hasn't gone on for specialized training yet). Since he doesn't know much yet, he won't be able to help with casualty treatment, so he should stay out in the triage area. This will leave the better-trained people free to provide direct patient care. C. A Navy medical service corps officer (admin officer, typically Master's-level education, who is intimately familiar with the administrative aspects of the evacuation process but has no experience with direct patient care). D. An Army operating room nurse

A. An Air Force emergency medicine physician (residency trained, board-certified).

A soldier is brought into your aid station after a training accident during which he fell from a guard tower. He arrives with a bayonet impaled in his abdomen. After completing your primary survey you find he is stable with HR=102, RR=17, POx = 98% RA, BP=127/68. In managing and assessing this patient, which should you do next? A. Arrange for surgical care; no further abdominal examination is necessary B. Remove the bayonet and apply a standard abdominal field dressing C. Asucultate and perform deep palpation of the abdomen to determine if there is intraabdominal bleeding D. Remove the bayonet and apply a hemostatic dressing E. Inflate a PASG in anticipation of shock as a result of pelvic fracture and resultant pelvic bleeding

A. Arrange for surgical care; no further abdominal examination is necessary

During your secondary survey in a casualty with abdominal trauma, you determine that he has peritonitis. Which of the following findings is NOT a physical sign of peritonitis? A. Bowel sounds heard over the thorax B. Involuntary guarding C. Significant abdominal tenderness on palpation D. Rebound tenderness

A. Bowel sounds heard over the thorax

An 82 y.o male presents to your clinic with his wife because she fears he has had a stroke. She tells you that he has been complaining of weakness and burning in his hands; on exam he is slow to move and has bilateral weakness of his grips and flexion/extension at the elbow. The rest of his physical exam is unremarkable except for a slow and deliberate, but otherwise normal gait. In discussion with his wife, you find he had a fall 10 days ago and hit his head. She says he did not lose consciousness and was "OK" after the fall. Of the following, which is the MOST likely diagnosis? A. Central Cord Syndrome B. Posterior Cord syndrome C. Brown-Sequard Syndrome D. Anterior Cord Syndrome

A. Central Cord Syndrome

Which of the following is recommended as the first-line treatment for life-threatening hemorrhage that is not amenable to tourniquet placement A. Combat Gauze B. Occlusive pressure dressing C. HemCon D. QuikClot E. Direct digital pressure on the proximal artery and vein

A. Combat Gauze

According to the Trauma Coma Data Bank, the presence of which of the following types of intracranial hemorrhage DOUBLES the incidence of death in Traumatic Brain Injury patients? A. Epidural hemorrhage B. Subdural hemorrhage C. Intracerebral hemorrhage D. Subarachnoid hemorrhage

A. Epidural hemorrhage

During the primary survey, you attempt to manage your casualty's airway. Which of the following considerations is true? A. Every trauma casualty with a significant mechanism of blunt injury is suspected of spinal injury B. Because you must maintain cervical spine stabilization, you cannot perform advanced airway interventions C. You should immobilize the casualty's spine with in line stablization and a spine board before attempting to open the airway D. You must protect the cervical spine from excessive motion only if there is evidence of neurological damage

A. Every trauma casualty with a significant mechanism of blunt injury is suspected of spinal injury

An airman in your squadron is severely burned in a deployed setting. Once he reaches a level III facility for care, what is the most likely course of action? A. He will be evacuated as expeditiously as possible to a CONUS facility for definitive treatment B. He will stay in theater for as long as possible, allowing time for his wounds to stabilize before transport C. He will likely be declared "expectant" and given comfort care until he dies D. A surgical team will be flown into theater to provide any necessary operations. The patient can expect to return to duty within 1-2 weeks

A. He will be evacuated as expeditiously as possible to a CONUS facility for definitive treatment

Which of the following factors have contributed to the Combat Application Tourniquet being selected as the preferred tourniquet for use in combat? (Check all that apply) A. It can be applied rapidly with one hand B. It must be maintained carefully before use in order to be effective C. It is small enough to be carried easily D. It abolished radial and femoral arterial blood flow in approximately 75% of uses on healthy adult male test subjects

A. It can be applied rapidly with one hand C. It is small enough to be carried easily

The leading cause of traumatic brain injury (TBI) in those under 65 years old is _____; in the elderly, the leading cause is _____. A. MVC; Falls B. MVC; MVC C. Gunshot wounds; Gunshot wounds D. Falls; MVC E. Falls; Falls

A. MVC; Falls

You are managing a patient with a severe pelvic fracture and who has lost a significant amount of blood; he appears to have no other injury. His GCS is 14, airway and breathing are intact but he has diffuse abdominal pain. His current systolic blood pressure is 85. how much crystalloid fluid should be administered in order to obtain an acceptable pressure in this hemorrhaging patient? A. None, this is an acceptable pressure for the prehospital environment B. 500 ml boluses every twenty minutes until his systolic pressure is greater than 100mmHg C. 2L as fast as it will go in order to prevent other complications D. 3L as fast as it will go then consider giving blood if no response

A. None, this is an acceptable pressure for the prehospital environment

You are a medical officer assigned to a special operations unit preparing for a high-intensity operation in a large, densely populated Middle Eastern city. You are considering possible casualties. Which of the following is true? A. You should anticipate higher casualty rates than a conventional operation B. You should anticipate lower casualty rates than a conventional operation C. Casualty rates are not affected by urban versus conventional combat environments

A. You should anticipate higher casualty rates than a conventional operation

Which of the following are absolute or relative contraindications to placement of a peripheral IV at that location/extremity (check all that apply): A. Extremities with large area of burns B. Insertion of IV through site of cellulitis C. Extremities with massive edema D. Veins that are flattened and collapsed because of systemic hypovolemia or dehydration E. Extremities with shunts or fistulas F. Extremities on the side of radical mastectomies G. Veins actively affected by phlebitis or thrombosis H. Veins that drain from an area of neck trauma or an affected traumatic extremity

All of the above

Which of the following are considered environmental stressors for casualties undergoing aeromedical evacuation? (check all that apply) A. Hypoxia B. Vibration C. Decreased atmospheric pressure D. Elevated ambient noise levels E. Thermal stress F. Dehydration

All of the above

Which of the following can produce an altered level of consciousness in trauma casualties? [check all that apply] A. Hypoxia B. Shock with impaired cerebral perfusion C. Metabolic processes such as diabetes, seizures, and eclampsia D. Traumatic brain injury E. Intoxication with alcohol or drugs

All of the above

While direct pressure can be an effective method for the medic/corpsman to control accessible hemorrhage, which of the following conditions of tactical casualty care are likely to prevent adequate maintenance of pressure? (check all that apply) A. Inability to stay with patient during transportation B. Multiple injury sites C. Multiple patients D. Enemy fire

All of the above

You are setting-up a Casualty Collection Point (CCP) for an operation. Which of the following is appropriate? (check all that apply) A. The CCP should be reasonably close to the fight B. The CCP should be close to paths across terrain that are likely to be used when going from one place to another C. The CCP should have access to evacuation routes D. The CCP should avoid natural or enemy chokepoints

All of the above

What percentage of significant falls (from a height of >15 feet) have an associated lumbar spine fracture? A. 10% B. 20% C. 30% D. 40% E. 50% F. 60%

B. 20%

During full expiration, what is the maximum upward excursion of the diaphragm anteriorly? This is important because a penetrating thoracic wound at or below this line may have traversed both the thoracic and abdominal cavities. A. 2nd intercostal space B. 4th intercostal space C. 6th intercostal space D. 8th intercostal space E. 10th intercostal space

B. 4th intercostal space

Shock is defined as: A. Systolic Blood Pressure less than 90 mmHg, and diastolic blood pressure less than 60 mmHg B. A state of generalized cellular hypoperfusion with inadequate oxygen delivery to meet metabolic needs C. Hypotension and Tachycardia D. A person who is very anxious/startled after witnessing a tragic event

B. A state of generalized cellular hypoperfusion with inadequate oxygen delivery to meet metabolic needs

You are a GMO physician caring for a 22 year-old soldier injured by an IED blast. The helicopters are en route to transfer the patient from your Battalion Aid Station to a level III facility in theater. You suspect severe traumatic brain injury. He begins having changes to his physical exam. Which of the following physical findings are associated with herniation (check all that apply): A. Decorticate posturing B. A unilateral enlarged pupil C. Increased verbalizations D. Consistently rapid, deep breaths E. Cheyne-Stokes ventilation F. Greatly increased blood pressure with bradycardia

B. A unilateral enlarged pupil

Which of the following causes of cardiogenic shock are considered to be extrinsic causes? A. Myocardial infarction B. Cardiac tamponade C. Dysrhythmia D. Tension pneumothorax E. Mitral valve rupture

B. Cardiac tamponade D. Tension pneumothorax

A patient has suffered a closed fracture of the ulna and radius, and a splint was applied. The next step is to: A. Make a sling for the patient B. Check the neurovascular status of the limb C. Avoid elevating the limb D. Check for mobility of the fracture fragments

B. Check the neurovascular status of the limb

What clinical situation will most likely require an escharotomy? A. Chemical burn of the left hand B. Circumferential thermal burn of the lower extremity C. Electrical burn of the hand D. Full-thickness burns of the trunk, abdomen and face

B. Circumferential thermal bone of the lower extremity

During your secondary survey on a casualty with abdominal trauma, you auscultate and hear bowel sounds in the left lower lung fields. What does this most likely indicate? A. Peritonitis B. Diaphragmatic rupture C. Pneumothorax D. Retroperitoneal bleeding E. Small bowel obstruction

B. Diaphragmatic rupture

You are on the scene of a motor vehicle collision where a colleague intubates a critically ill patient. She asks about confirming endotracheal tube placement. Which of the following is the most appropriate advice? A. When the provider is pretty sure she saw the ET tube pass through the vocal cords, no further confirmation is necessary B. ET tube placement should always be confirmed with multiple assessments immediately after placement C. For unstable patients, it is okay to wait to confirm ET tube placement until the patient has been transferred to a higher level of care D. No confirmation of placement is required for patients less than 50 years old with no known cardiac disease

B. ET tube placement should always be confirmed with multiple assessments immediately after placement

Regarding the epidemiology of injured patients after a blast, which of the following would you most likely expect to see A. Small numbers of minimally wounded and dead patients with a large number of critically ill patients (50%) who may be saved B. Large numbers of dead and minimally wounded patients with a small number of critically injured patients (10-15%) who may be saved C. Large numbers of dead, large numbers of critically injured patients (50%) who may be saved, and a small number of minimally wounded patients D. An equal distribution of dead, critically injured patients who may be saved, and minimally injured patients

B. Large numbers of dead and minimally wounded patients with a small number of critically injured patients (10-15%) who may be saved

In the START triage system decision points are based on: A. Medical resources available B. Respiratory rate, perfusion, and mental status C. Anticipated survival times of casualties D. Type of injury discovered in the casualty

B. Respiratory rate, perfusion, and mental status

All of the following burns necessitate burn unit care EXCEPT? A. Burns sustained from lightning B. Superficial partial-thickness burns involving 5% BSA C. Full-thickness burns in an otherwise healthy 25 year-old man D. Burns involving bilateral hands

B. Superficial partial-thickness burns involving 5% BSA

Warning signs of possible increased intracranial pressure and herniation include: (check all that apply) A. Precipitous drop in blood sugar level B. Fever C. Cushing's phenomenon D. Development of hemiplegia or hemiparesis E. Development of a sluggish or nonreactive pupil F. Decline in GCS score by two points or more

C, D, E, F

You are assessing a trauma casualty and observe that, when you palpate his left arm, he opens his eyes and grabs his left arm, but otherwise his eyes remain closed. He is muttering incomprehensibly, but says "banana oil" and grabs his left arm when you ask him if he's ok. He will not answer or respond to any direct questions. His Glasgow Coma Scale (GCS) is: A. 12 B. 8 C. 9 D. 6 E. 5

C. 9

Who is statistically more likely to successfully perform an orotracheal intubation? A. An MS-1 USU student who has completed the Combat Medical Skills course and has intubated 5 mannequins. B. A paramedic who has been appropriately trained for orotracheal intubation, has been practicing for 10 years, and has performed 40 intubations on casualties. C. A paramedic who has been appropriately trained for orotracheal intubation, has been practicing for 5 years, and has performed 60 intubations on casualties.

C. A paramedic who has been appropriately trained for orotracheal intubation, has been practicing for 5 years, and has performed 60 intubations on casualties.

Traumatic cardiopulmonary arrest has a dismal prognosis. Performing CPR on a trauma victim puts prehospital providers at risk of exposure to blood and bodily fluids, and it also diverts resources away from other casualties who may be viable. Which of the following is NOT a reason to withhold CPR? A. A penetrating trauma patient has no signs of life (no pupillary reflexes, no spontaneous movement, no organized cardiac rhythm on ECG >40 bpm). B. A patient has suffered an obviously fatal injury (eg, decapitation), or evidence exists of dependent lividity, rigor mortis, and decomposition. C. Casualties of drowning, lightning strike, and hypothermia. D. A blunt trauma patient is pulseless and apneic on arrival of prehospital care providers.

C. Casualties of drowning, lightning strike, and hypothermia.

You have inserted an IV in a casualty and have been administering fluids and medications through the IV for the last 24 hours while awaiting evacuation. Your patient complains of pain and tenderness in the IV. Upon examination you observe redness and palpate a cord around the IV site. What should you do? A. Flush the IV with antibiotics every 8-12 hours B. Apply triple-antibiotic ointment to the skin surrounding the IV site C. Discontinue the IV at that location and start an IV in the opposite arm D. Remove the IV catheter and insert a new one cephalad to that IV site E. Apply an ice pack and continue administering normal saline; monitor the site for signs of infection

C. Discontinue the IV at that location and start an IV in the opposite arm

In comparing the effectiveness of peripheral IV and central venous access, which of the following is true? A. Less than 50% of peripheral IV fluid reaches central circulation when wearing a PASG (pneumatic anti-shock garment) B. Central venous access is the procedure of choice for IV access during CPR C. During CPR, medications reach central circulation faster with central venous access than with peripheral venous access D. In a normally perfusing patient, delivery times for injections are significantly faster with central compared to peripheral venous access

C. During CPR, medications reach central circulation faster with central venous access than with peripheral venous access

While rounding on the Trauma Service as a fourth year medical student, the surgery resident attempts to throw you off by stating "this patient has a craniofacial dysjunction injury". Being a superior USUHS student, you astutely inform him the eponym is a _____? A. Lis-Franc fracture B. Jeffersonian fracture C. LeFort III fracture D. Salter-Harris III fracture

C. LeFort III fracture

A fracture that is associated with a break in the skin is called a(n): A. Displaced fracture B. Grade III fracture C. Open fracture D. Spiral fracture E. Comminuted fracture

C. Open fracture

Pulse oximetry devices are inexpensive, small, and (generally) very accurate, and they are increasingly being used on the battlefield. Regarding pulse oximetry, which of the following statements is false? A. Carboxyhemoglobin (as may occur with significant smoke inhalation and carbon monoxide poisoning) may lead to falsely normal or high saturation readings. B. Methemoglobin (as may occur in casualties who have previously been treated with dapsone, primaquine, or other related antimalarials) may lead to falsely low saturation readings -- typically about 85%. C. Pulse oximetry is a valuable adjunct in assessing the viability of an injured extremity, and in determining the presence or absence of a vascular injury. D. Even in normal (healthy, uninjured) volunteers, pulse oximetry values decrease with altitude. This may be important during aircraft evacuations, as well as when operating in mountainous regions. Normal levels at the following altitudes are: Sea level: 97.5% 5,000 ft: 96.2% 8,000 ft: 93.7% 12,000 ft: 86.1% E. Although pulse oximetry can be a useful adjunct in care of casualties in the tactical setting, pulse oximetry should NOT be considered a portable "all-in-one" monitor of oxygenation, pulse rate, rhythm regularity, and overall cardiopulmonary well-being. Overreliance on pulse oximetry may lead to delays in therapy or inappropriate decision making in the field.

C. Pulse oximetry is a valuable adjunct in assessing the viability of an injured extremity, and in determining the presence or absence of a vascular injury.

A TBI casualty has a decreased level of consciousness and left-sided hemiplegia. The right pupil is 6 mm, and the left is 2 mm. What side of the skull/brain (right or left) is most likely to have an intracranial hematoma? A. Left B. Neither right nor left -- this is most likely a brainstem lesion C. Right

C. Right

All of the following are primary blast injuries EXCEPT? A. Blast lung B. Tympanic membrane rupture C. Ruptured globe (eye) from a flying piece of glass D. Traumatic brain injury

C. Ruptured globe (eye)

Rapid and accurate patient assessment is important for the pre-hospital provider for which of the following reasons (select one)? A. The "golden period" is the first 2 hours post injury, and is the critical period during which the casualty must receive definitive care B. The "golden hour" means that most casualties will survive if they receive definitive care within the 1st hour post-injury C. The "golden period" means that many casualties have less than an hour to receive definitive care, and that the earlier the casualty can be transported to a facility to receive definitive care, the higher his chances of survival are D. The rapid application of critical lifesaving interventions during the "golden period" at the point of injury is not as important as early transport to definitive care E. Delays in transport will extend the "golden period" allowing the pre-hospital provider to provide definitive emergency treatment at the point of injury

C. The "golden period" means that many casualties have less than an hour to receive definitive care, and that the earlier the casualty can be transported to a facility to receive definitive care, the higher his chances of survival are

When considering a location for peripheral IV cannulation, which of the following is true: A. The veins of the hand are drained by the metacarpal and dorsal veins; they are excellent sites for a large bore (14-16 gauge) IV catheter in trauma scenarios. B. The lower extremity is an ideal site for IV access due to the low likelihood of trauma, and low incidence of thrombosis. C. The antecubital veins are often the best location for a large bore (14-16 gauge) peripheral IV due to their large size, but have the disadvantage of causing discomfort and restriction of mobility for the patient. D. The cephalic vein ("intern vein") can usually be successfully cannulated, but due to the small size of the vein, the largest catheter it can typically accommodate is a 22-gauge. E. Veins that are firm and cordlike are good choices for large-bore IVs, since they do not tend to collapse when punctured by the IV catheter.

C. The antecubital veins are often the best location for a large bore (14-16 gauge) peripheral IV due to their large size, but have the disadvantage of causing discomfort and restriction of mobility for the patient.

Which of the following is a contraindication to placement of an oropharyngeal airway? A. The patient already has an endotracheal airway B. Significant facial trauma C. The patient is semi-conscious D. Significant blood in oropharynx preventing direct visualization

C. The patient is semi-conscious

Which of the following options best describes where a tourniquet should be applied? A. as proximal on the affected extremity as possible B. directly on the bleeding site C. At the distal margin of the bleeding wound D. 2 to 3 inches proximal to the bleeding site

D. 2 to 3 inches proximal to the bleeding site

The most correct location to insert a needle (or catheter over needle) to relieve a tension pneumothorax is: A. 4th intercostal space, mid-clavicular line B. 2nd intercostal space, anterior axillary line C. 5th intercostal space, anterior axillary line D. 2nd intercostal space, mid-clavicular line E. 5th intercostal space, mid-clavicular line

D. 2nd intercostal space, mid-clavicular line

When performing triage, which of the following best correlates with survival and the need for life-saving interventions: A. Pulse rate B. Respiratory rate C. Pulse oximetry reading D. Glasgow coma scale (GCS)

D. Glasgow coma scale (GCS)

You are working at a Battalion Aid Station when a Marine arrives in shock. He was on guard duty on a watchtower when he was shot through the thigh and fell about 15 feet to a cement surface below. He has evidence of a femur fracture with enormous swelling, and bruising at his thigh. His lower extremities are paralyzed and he complains of severe back pain. His heart rate is 125. What is the most accurate statement and initial treatment for his condition? A. This patient is most likely in cardiogenic shock and should be treated accordingly B. He is in neurogenic shock and requires treatment to counteract dilation of peripheral arteries. He will not require treatment for blood loss C. He should be treated with antiobiotics immediately for a possible septic shock D. He likely has components of both hemorrhagic shock and neurogenic shock, and should be treated immediately for presumed blood loss

D. He likely has components of both hemorrhagic shock and neurogenic shock, and should be treated immediately for presumed blood loss

Which is true regarding the "sniffing position" to facilitate endotracheal intubation? A. It improves anatomic alignment, and should be used for all rapid sequence intubations B. It has been repeatedly shown to be ineffective for non-trauma patients C. It is used exclusively for awake nasotracheal intubations D. It hyperextends the neck at C1-C2, and hyperflexes it at C5-C6 (both common fracture sites) and should not be used for trauma patients

D. It hyperextends the neck at C1-C2, and hyperflexes it at C5-C6 (both common fracture sites) and should not be used for trauma patients

A patient with chest trauma is hypotensive on presentation and c/o shortness of breath (SOB) in a pre-hospital setting. Exam reveals jugular venous distension (JVD), tracheal deviation, and decreased breath sounds associated with hyperresonance to percussion on one side of his chest. Other than providing O2, starting IVs, and placing the patient on a cardiac monitor, what is the most appropriate initial therapy for this patient? A. Intubation B. Pericardiocentesis C. Tube thoracostomy D. Needle thoracostomy

D. Needle thoracostomy

Which of the following would be MOST likely to cause erroneous SpO2 measurements when using a pulse oximeter? A. Vasoconstriction from a hyperthermic patient B. Elevated PaCO2 levels C. Sensor placement on an extremity D. Poor casualty perfusion

D. Poor casualty perfusion

What are the critical steps and sequence in performing Rapid Sequence Intubation in an adult? A. Pre-oxygenate with 100% O2, administer an analgesic, administer atropine, Insert ET tube, confirm ET tube placement B. Pre-oxygenate with 100% O2, administer a sedative, administer a paralytic agent, Insert ET tube C. Pre-oxygenate with 100% O2, administer a paralytic agent, Insert ET tube, confirm ET tube placement, administer a sedative agent D. Pre-oxygenate with 100% O2, administer a sedative, administer a paralytic agent, Insert ET tube, confirm ET tube placement

D. Pre-oxygenate with 100% O2, administer a sedative, administer a paralytic agent, Insert ET tube, confirm ET tube placement

You are a flight surgeon evaluating a patient for aeromedical evacuation (AE). The treating physicians think the patient needs to arrive in Germany within the next 2-3 days. Which evacuation category should you indicate on his patient movement request (PMR)? A. Standard B. Routine C. Urgent D. Priority

D. Priority

The components of Beck's Triad include all of the following except? A. Jugular Venous Distension (JVD) B. Hypotension C. Muffled heart tones D. Pulsus paradoxus

D. Pulsus paradoxus

Crush syndrome carried a mortality of 90% in World War II, which was subsequently reduced to approximately 50% by the Vietnam era. Which of the following is an important complication of crush syndrome? A. Limb ischemia B. Nerve injury C. Hypovolemic shock D. Renal failure

D. Renal failure

In a pre-hospital setting, effective ventilation of a patient is BEST monitored by: A. Venous CO2 levels B. Pulse Oximetry C. Arterial oxygen levels D. Respiratory (or end tidal CO2) Capnography

D. Respiratory (or end tidal CO2) Capnography

You are treating the 2 year-old daughter of an Enemy Prisoner of War. The vehicle her father was driving ignited when captured by US forces. She has extensive full and partial thickness burns. Which of the following is true regarding her IV fluid management? A. She should receive Lactated Ringer's at 1-2 ml/kg/%TBSA B. Assuming the patient weighs 10 kilograms, her standard maintenance fluid rate would be 30 ml/hour C. The USAISR "Rule of Ten" is designed to simplify burn fluid calculations, and can be used for all age groups D. She should receive 5% dextrose containing IV fluids at a standard maintenance rate in addition to burn resuscitation fluids

D. She should receive 5% dextrose containing IV fluids at a standard maintenance rate in addition to burn resuscitation fluids

You have just prepared a 9-line MEDEVAC request for transmission and have written down "E" for line 8. What does this indicate to the MEDEVAC mission planner? A. The evacuation site will be marked with VS-17 panels B. He needs to ensure the aircraft is equipped with a jungle penetrator C. There are enemy troops in the area D. They will be picking up enemy prisoner of war casualties E. They need to respond within 4 hours

D. They will be picking up enemy prisoner of war casualties

A significant amount of research has focused on fluid resuscitation strategies for trauma patients. Which of the following is currently recommended for civilian trauma patients in class I or II shock with uncontrolled hemorrhage? A. Infuse crystalloid fluids through two large-bore peripheral IVs at the maximum possible rate B. Maintain patent IVs at a maintenance rate C. Titrate blood pressure to a SBP 100-120 mmHG (MAP of 70-80 mmHg) D. Titrate blood pressure to a SBP 80-90 mmHG (MAP of 60-65 mmHg)

D. Titrate blood pressure to a SBP 80-90 mmHG (MAP of 60-65 mmHg)

A small U-Haul moving van is packed with explosives (explosive capacity approximately equivalent to 10,000 pounds of TNT). What is the safe evacuation distance in feet for building evacuation distance and outdoor evacuation distance? A. building: 70 ft outdoor: 850 ft B. building: 150 ft outdoor: 1,850 ft C. building: 650 ft outdoor: 2,750 ft D. building: 860 ft outdoor: 3,750 ft E. building: 1,240 ft outdoor: 6,500 ft F. building: 1,570 ft outdoor: 7,000 ft

D. building: 860 ft outdoor: 3,750 ft

The "Tactical Field Care" phase of TCCC is defined as: A. The care rendered once the casualty has been picked up by an aircraft, vehicle, or boat for transportation to a higher echelon of care B. Used interchangeably between all levels of care performed within a tactical environment C. This stage of care only pertains to casualties who sustain injuries while training D. the phase when medical personnel and their casualties are no longer under effective hostile fire, and more extensive care can be provided

D. the phase when medical personnel and their casualties are no longer under effective hostile fire, and more extensive care can be provided

You are the first responder to the scene of an Improvised Explosive Device (IED) attack. The area is now secure, and your next patient has multiple small lacerations over his face and torso, none of which are serious. After checking ABC's you are sweeping his extremities with your hands, looking for painful injuries, and, upon moving his left arm it begins to gush with arterial bleeding from a deep wound over the medial upper arm. Your first action is to: A. Tape a small 2x2 gauze dressing over the wound B. Reposition the casualty's arm in an attempt to stop the bleeding C. Apply digital pressure to the left radius region in an attempt to stop the venous return D. Elevate the arm E. Apply a C.A.T. tourniquet to the arm proximal to the wound

E. Apply a C.A.T. tourniquet to the arm proximal to the wound

T/F?: In a civilian urban environment, endotracheal intubation has been the preferred method for achieving maximum control of the airway in trauma casualties who are either apneic or require assisted ventilations. Critically injured trauma casualties have a better outcome with endotracheal intubation by prehospital providers, when compared to those who are transported with only BVM (bag-valve-mask) and OPA (oropharyngeal airway).

False

T/F?: Splinting and immobilization of bone fractures reduces pain and promotes healing. While immobilization of long-bone fractures (ie, femur, tibia, humerus) are relatively straightforward, immobilization of rib fractures is difficult. A tight ACE-wrap around the chest or firm tight taping is the best treatment of rib fractures.

False

T/F?: Steroids should routinely be administered to all patients with presumptive spinal cord injury. They should be administered as early as possible (preferably by medics in the field)

False

T/F?: There are no appropriate supraglottic devices for children

False

T/F?: Tourniquets should only be used as a last resort method for hemorrhage control, after attempting control via elevation and pressure points

False

T/F?: You are planning medical support for urban warfare operations. A fellow medical officer tells you that accidental, blunt trauma (such as vehicle accidents and falls) are very rare events and do not require any particular planning.

False

T/F?: Articles 12 and 13 of the First Geneva Convention dictates that the wounded should be cared for in the order of severity of their wounds without regard to their status of friendly or hostile.

True

T/F?: During cardiopulmonary resuscitation (CPR), medications have been shown to reach the central circulation faster with central access than with peripheral venous access. However, peripheral IV cannulation is still the procedure of choice even during CPR, because of the usual speed, ease, and safety with which it can be accomplished.

True

T/F?: For critically injured trauma patients, transportation should never be delayed while IV lines are placed and fluid infused

True

T/F?: Management of the airway in civilian trauma casualties takes precedence over all other procedures because without an adequate airway, a positive outcome cannot be achieved. Advanced airway interventions such as intubation or cricothyrotomy may not always be immediately required or necessary, though -- in most casualties, basic-level procedures may be sufficient initially [i.e. manual clearing of foreign bodies from the airway, jaw thrust, chin lift, suctioning, oropharyngeal or nasopharyngeal airways].

True

T/F?: Neurogenic shock refers to an injury to the spinal cord that results in a temporary loss of sensory and motor function; the spinal cord has been damaged ("shocked") and is not working properly.

True

T/F?: Pain out of proportion to visible injury is the most characteristic sign of compartment syndrome

True

T/F?: Regarding casualty position during transport: In casualties who are in shock, the Trendelenburg position (casualty placed on an incline with the feet higher than the head) or "shock" position (head and torso supine with legs elevated) result in significant autotransfusion of blood to vital organs from the lower extremities.

True

T/F?: Regarding the "care under fire" phase of TCCC: If the casualty has suffered only penetrating trauma (not blunt), there is no requirement to immobilize the spine with a C-collar before moving a casualty out of a firefight.

True

A patient's blood pressure is 150/90. Their intracranial pressure is elevated at 30 mmHg. Their cerebral perfusion pressure (CPP) is

80

Possible interventions that may help acutely control/manage increased intracranial pressure include the following: (check all that apply) A. sedation B. osmotherapy (such as mannitol) C. chemical paralysis D. application of PASG/MAST trousers E. controlled hyperventilation F. controlled hypoglycemia

A, B, C, E

You are dispatched to a motor vehicle crash. On arrival, you observe that an SUV truck has struck a tree on the driver's side, which has sustained substantial damage. The driver of the SUV, a 30 y/o male, is unresponsive (GCS=4) and has periorbital ecchymosis. You observe bleeding from both nares and the right ear. Frequent suctioning is required to maintain a patent airway, and no gag reflex is noted. Ventilations are irregular, and snoring sounds are audible. The patient's skin is pale, and cyanosis is present around the lips. What indicators for endotracheal intubation are evident in this patient? [check all that apply] A. perioral cyanosis B. sonorous and irregular ventilations C. requirement for frequent suctioning D. physical exam findings that suggest a basilar skull fracture E. unresponsive (GCS of 4)

A, B, C, E

A 22 y.o male is found down outside his apartment building and 911 called. On arrival, you find that he is having a generalized (grand mal) seizure. You suspect traumatic brain injury as the cause, but generate a quick differential of other reversible causes of seizure. Which of the following would you include as the MOST likely, reversible, cause of his seizure? A. Acute Alcohol Intoxication B. Tachycardia C. Hypoglycemia D. Hyperglycemia

A. Acute Alcohol Intoxication

Burns are extremely painful, debilitating injuries. Which of the following types of burns will not require any analgesia? A. All burn patients will likely require pain control B. Partial-thickness burns C. Full-thickness burns D. Superficial burns E. Fourth-degree burns

A. All burn patients will likely require pain control

You are treating a casualty with a fragment wound to the right upper arm. You are in the tactical warm zone with good cover and this is your only patient. You initially applied a field dressing and now, ten minutes later, it is soaked with blood. Your next course of action is to: A. Apply a pressure dressing B. Remove the initial dressing and pack the wound with gauze C. Apply a splint D. Apply a tourniquet

A. Apply a pressure dressing

When compared with other hemostatic agents, which of the following has the LEAST hemostatic efficacy? A. HemCon B. Combat Gauze C. Woundstat D. Celox

A. HemCon

A patient with decreased minute-volume during respiration will initially develop? A. Hypercarbia B. Hypoxia C. Hypocarbia D. Anoxia

A. Hypercarbia

Which of the following statements regarding cardiac tamponade is inaccurate? A. It is most commonly caused by blunt chest trauma B. It can manifest as PEA (Pulseless Electrical Activity) C. Initial therapy is with IV fluids and pericardiocentesis D. Clinical findings include hypotension, jugular venous distension (JVD), pulsus paradoxis, and muffled heart tones

A. It is most commonly caused by blunt chest trauma

Which of the following are TRUE regarding CASEVAC by air? (mark all that apply) A. Interventions such as intubation, electronic monitoring, and fluid resuscitation may be impractical or even impossible during CASEVAC operations. B. In some cases it is faster and safer to move casualties by ground than by air C. Not all casualties require urgent evacuation D. Environmental conditions (such as darkness, bad weather, or lack of a sutiable landing zone) may prevent evacuation by air E. The tactical situation may preclude evacuation by air (e.g. heavy enemy fire)

All of the above

Which of the following are considered analgesics (pain medications) rather than anxiolytics (anxiety medications)? (check all that apply) A. Diazepam B. Fentanyl C. Midazolam D. Alprazolam E. Ketorolac F. Morphine G. Lorazepam

B, E, F

In an average adult during resting ventilation, what is the average tidal volume? A. 7000 ml B. 500 ml C. 150 ml D. 1000 ml

B. 500 ml

All of the following are contraindications to placement of a supraglottic airway EXCEPT: A. Intact gag reflex B. Recent ingestion of caustic substances C. Hypoxia D. Known esophageal disease

C. Hypoxia

T/F?: A Navy Explosive Ordnance Disposal Diver is brought to your emergency department after a weapon inadvertently exploded underwater. The patient has blast injuries. Given that he was underwater when the blast occurred, he will have milder injuries than if he were subjected to an equivalent blast on land.

False

You are called to the scene of a multi-car accident. You find one of the victims walking around at the accident scene. Although he was involved in the MVC, he got out of his car to check on other injured people. T/F?: Since he is already walking around, you do not need to apply a cervical spine collar to this patient.

False

Which of the following are signs of a compartment syndrome? (Check all that apply) A. Paresthesias B. Paralysis C. Protuberence D. Pallor E. Puffiness F. Pain out of proportion to the injury G. Pulselessness

A, B, D, F, G

T/F?: In the military prehospital setting, if there is an anticipated difficult airway (such as massive midface trauma), surgical cricothyrotomy should be the initial airway control method.

True

What is the first choice for resuscitation fluids for a patient in hemorrhagic shock?

Whole blood

What are the administration protocols for tranexamic acid?

1 gm in 100 ml normal saline or lactated Ringer's no later than 3 hours after injury, administered over 10 min by IV infusion. Infuse another 1 gm after fluid resuscitation is completed.

What percentage of deaths on the battlefield are potentially preventable?

25%

Hemostatic dressings should be applied with at least ___ minutes of direct pressure.

3

You receive a 9-line MEDEVAC request. Line 3 is reported as "2 Alpha, 1 Bravo, 3 Charlie." What should you expect? A. Two casualties with Airway issues, one casualty with Breathing issues, and three casualties with Circulation issues. B. Two urgent casualties, one urgent surgical casualty, and three priority casualties. C. Two US military casualties, one US civilian casualty, and three non-US military casualties. D. Landing zone marked with two colored panels (VS-17 panels), one pyrotechnic signal, and three smoke signals.

B. Two urgent casualties, one urgent surgical casualty, and three priority casualties.

What is the primary cause of potentially preventable deaths on the battlefield?

Hemorrhage (90%)

Trauma patients are in ___________________ shock until proven otherwise.

Hemorrhagic

What is the major benefit of using ketamine vs OTFC or morphine?

It can be safely given to patients who are in shock or respiratory distress

What is the difference between MEDEVAC and CASEVAC?

MEDEVAC uses special dedicated, non-combatant medical assets marked with a red cross. CASEVAC may also carry a quick-reaction force and provide close air support.

What are the 3 medications included in the TCCC Combat Pill Pack?

Moxifloxacin, acetaminophen, and meloxicam

How do you determine fluid resuscitation needs for a burn patient?

Using the Rule of Ten: Estimate burn size to nearest 10% and multiply by 10 to determine initial fluid rate in ml/hr (for adults 40-80kg).