3. BUMEDINST 6224.8D; EMERGENCY WAR SURGERY; OPNAVINST 5100.19E; OPNAVINST 6100.3A Flashcards
Which instruction provides policy and guidance for controlling tuberculosis (TB) among Department of the Navy (DON) military personnel and Military Sealift Command (MSC) civilian mariners (CIVMAR)?
BUMEDINST 6224.8B, Tuberculosis Control Program
What form is the Initial Tuberculosis Exposure Risk Assessment?
NAVMED 6224/7
What form is the Interim Tuberculosis Exposure Risk Assessment?
NAVMED 6224/8
What form is the Monthly Evaluation for Patients receiving Treatment for Latent Tuberculosis Infection?
NAVMED 6224/9
What form is the Adult Immunizations Record?
NAVMED 6230/4
What form is the Child Immunizations Record?
NAVMED 6230/5
Records created as a result of BUMEDINST 6224.8B, Tuberculosis Control Program, regardless of media and format shall be managed per what instruction?
SEVNAV-M 5210.1
What needs to occur to significantly reduce the spread of Tuberculosis (TB)?
Early detection and respiratory isolation of persons infected with TB
What is the strategy to control tuberculosis?
a. To promptly detect, treat and report persons who have contracted clinically active TB
b. To protect persons in close contact with patients with active TB
c. To prevent TB in DON MSC and CIVMAR through early detection and treatment of latent TBd. Assessment of DON contract workers and contract healthcare workers
Pertaining to TB the navy is only required to adhere to federal regulations , but not state and local law if they conflict with federal law. T or F?
TRUE
The skin and blood test required for entry into Naval service, identifies individuals asymptomatically infected whith what complex bacteria known to cause Tuberculosis (TB)?
Mycobacterium Tuberculosis
Appropriate TB testing, identifies Individuals that are at increased risk for developing active TB, but are not infectious. What are they diagnoised with?
Latent Tuberculosis Infection (LTBI)
All Navy and Marine Corps accessions, and all individuals beginning employment as Civilian Mariners (CIVMARs) for the Military Sealift Command (MSC) must be screened for what?
Latent Tuberculosis Infection (LTBI) unless previously documented of TB Infection
What must all personnel be screened for during their operational suitability screening?
Latent Tuberculosis Infection (LTBI)
Documented screening or testing for LTBI within what time frame of reporting aboard a commissioned vessel is acceptable?
6 months
Which form should be used to screen all Active duty and Reserve personnel during the PHA to determine their TB exposure history and risk of acquiring TB?
NAVMED 6224/8, Interim Tuberculosis Exposure Risk Assessment
CIVMARs will be screened or tested _______ or during their periodic physical examination at the direction of MSC Fleet Surgeon based on their different risk profile in comparison to uniformed service members
Annually
TB screening must be performed on all personnel prior to or within how many months of arrival on a commissioned vessel?
6 months
It is no longer required that all personnel must have Latent Tuberculosis Infection (LTBI) test results documented within the 6 months prior to separation or retirement. T or F?
TRUE
What is the approved tuberculin routine skin test?
Mantoux test
Tuberculosis Skin Test (TST) test results can be entered into AHLTA, MRRS, or which other authorized electronic medical information system?
Shipboard Non-Tactical ADP Program (SNAP) Automated Medical System (SAMS)
What information is included when documenting a Tuberculosis Skin Test (TST)?
NAME?
Within how many hours after Purified Protein Derivative (PPD) administration must the TST reaction be read?
48-72 hours
If person, returns more than 72 hours after the Tuberculosis Skin Test (TST) placement, what is the next process?
Record results as “Not Read” and thenapply a TST on the opposite forearm
Measurement of the TST reaction is to the nearest whole millimeter (mm). How would a no induration be documented?
“0 mm” or “zero mm”
When should additional LTBI screening and subsequent testing be done?
- date
- type
- strength of tuberculin
- manufacturer
- lot number
- route
What is the normal rate of newly-identified LTBI converters to personnel tested per year in most Navy and Marine Corps settings based on historical TST results associated with routine (non-targeted) screening?
1-2 percent
If the rate of newly identified converters is two times greater than the expected baseline conversion rate of the command among any group tested, who needs to be contacted for specific guidance?
the cognizant Navy Environmental Preventative Medicine Unit (NAVENPVNTMEDU)
A TST may be placed on the same day parenteral live-attenuated virus vaccines are given or at least how many weeks later?
4 weeks
Are TST considered safe for pregnant women?
They are both safe and reliable and should be performed if needed
If they are undergoing further evaluation, what should the service members with positive TST do?
They should not deploy until the evaluations are complete. (i.e. Chest X-rays & mycobacterium cultures)
All individuals with a TST induration that is greater than or equal to how many mm must be evaluated to determine if their test is positive base on risk factors?
5 mm
An increase in reaction size of how many mm or more, within a three-year period is also considered a skin test conversion or positive test indicative of a recent infection with TB?
10 mm
Service members and individuals assigned to operational military forces, including shipboard personnel, without risk factors for acquiring TB are in what risk group? What is their TST induration?
Low Risk
Greater than or equal to 15 mm
Recent immigrants (within the last 5 years) from high TB prevalence countries, Myobacteriology laboratory personnel, and persons with clinical conditions that place them at increased risk are designated what risk group?
Medium Risk
Greater than or equal to 10 mm
Recent close contacts of active TB disease patients, persons with fibrotic or other changed on chest radiograph consistent with prior TB, and patients suspected of having active TB diseas are designated as what risk group?
High Risk
Greater than or equal to 5 mm
To determine if all persons have active TB disease, ensure all persons newly identified as having a positive TST are evaluated by who?
MO, Nurse Practitioner, PA, or IDC
Chest x-rays should be examined for _______ changes consistent with old TB infectionand for any signs of active TB.
Fibrotic
_______ women also should have active TB ruled out with chest x-ray using appropriate shielding.
Pregnant
A person with suspected active TB disease should immediately be what?
Masked, Isolated, and reffered to an appropriate MTF provider
What is the preferred isoniazed (INH) treatment regimen?
INH 5 mg/kg (300 mg max) daily for 9 months
What is the alternate isoniazed (INH) treatment regimen?
INH 15mg/kg (900 mg max) bi-weekly for 9 months with directly observed theraphy (DOT)
How often must follow ups be conducted for individuals receiving therapy for LTBI until treatment is completed?
Monthly
What is the recommended mechanism to assure LTBI treatment compliance whenever feasible?
directly observed theraphy (DOT)
Which form should be used to document patient education and counseling?
SF 600, Medical Record Chronological Record of Medical Treatment
Persons on treatment for LTBI often miss doses. The 9-month daily Isoniazid (INH) regimen should not be restarted if at least how many doses of INH can be administered within a 12-month period?
270 doses
Patients must be examined to exclude active TB disease, if the treatment has been interrupted for more than how many months ?
2 months
What is the ICD 9 code that you should use when evaluating a patient in AHLTA for TB?
ICD9M code v74.1
“Screening exam for pulmonary TB”
What should you do if you suspect a patient has a strain of Tb that is resistant to INH?
Consult Navy Environmental Preventive Medicine Unit (NAVENPVNTMEDU) for treatment plan
Do you need to do baseline lab testing for someone starting INH therapy?
No you do not need to routinely do base line labs prior to treatment
Only do a LFT for those at risk of liver disease
Which form must be used to document the need for continued LTBI treatment for all naval service beneficiaries who transfer from the treating health care facility or leave the military service before completing a course of treatment for LTBI?
NAVMED 6224/9, Monthly Evaluation of Patients Receiving Theraphy for Latent Tuberculosis Infection (LTBI)
Where can members members leaving active service eligible for continued TB treatment and follow up care?
Veteran’s Administration (VA)
Upon discoveray of suspected or confirmed case of active tuberculosis (TB) in a service member assigned to Navy or Marine Corps operating forces, the CO ir OIC must notify who?
Cognizant Navy Enviromental Preventative Medicine Unit (NAVENPVTMEDU) and local health department
Upon completion of the cognizant NAVENPVTMEDU TB contact investigation, assited by command medical personnel, the NAVENPVTMEDU will provide an investigation report to the Command, cognizant Fleet.Type Commander Surgeon, and who?
Navy and Marine Corps Public Health Center (NMCPHC)
Who will conduct the TB contact investigation on persons not assigned to naval operational forces?The MTF will notify the cognizant NAVENPVTMEDU upon initiating a contact investigation and will submit the completed investigation report to who?
Servicing MTFNavy Medicine Region and Navy and Marine Corps Public Health Center (NMCPHC)
Which reference contains the guidance that should be employed when conducting TB contact investigations with suspected transmission within aircraft cabins?
WHO/HTM/TB/2008.399
Within what time frame must a Medical Event Report be submitted for all new cases of active TB or suspected new cases of active TB by the ship or station?
24 hours
What is the minimum particulate respirator size that medical department personnel must wear when working in rooms or spaces containing a person with known or suspected active TB?
N95 mask
Which type of event overwhelms immediately available medical capabilities to include personnel, supplies, and/or equipment?
Mass Casualty
Which principle is effective mass casualty response founded on?
Triage
Which system sorts and prioritizes casualties based on the tactical situation, mission, and available resources?
Triage
The ultimate goal of combat medicine are the return of the greatest possible number of warfighters to combat and the preservation of what?
Life, Limb, and Eyesight
How many different categories of triage are there?
4; Immediate, delayed, minimal, and expectant
Groups of injured people who require attention within minutes to 2 hours on arrival to avoid death or major disability to life, limb, or eyesight fall under which triage category?
Immediate
Which triage category would a patient be placed into who presents with a head injury requiring emergent decompression?
Immediate
Which triage group includes those wounded who are in need of surgery, but whose general condition permits delay in treatment without unduly endangering life, limb, or eyesight?
Delayed
Which triage category would a patient be placed into who arrives with fractures or soft-tissue injuries without significant bleeding?
Delayed
Which triage group has relatively minor injuries and can effectively care for themselves or with minimal medical care?
Minimal
Which triage group has injuries that overwhelm current medical resources at the expense of treating salvageable patients and should not be abandoned, but separated from the view of other casualties?
Expectant
Prior to entering the treatment facility, Wounded contaminated in a biological and/or a chemical battlefield environment must be?
Decontaminated
Heavy stress patients should be sent to a combat stress control restoration center for up to how many days reconstitution?
3
Which mnemonic should be used where resources/tactical situations allow for combat stress patients?
BICEPS:
Brief - Keep interventions to 3 days or less of rest, food, and conditioning
Immediate - Treat symptoms at recognition (do not delay)
Central - Keep in one area for mutual support and identity as soldiers
Expectant - Reaffirm return to duty after brief rest
Proximal - Keep as close as possible to their unit
Simple - Do not engage in psychotherapy and only address present stress response and situation
What are the external factors of Triage resource constraints?
- Tactical situation and the mission
- Resupply
- Time
What are the internal factors of Triage resource constraints?
- Medical supplies
- Space/capability
- Personnel
- Stress
What has transfusion medicine in the theater of war historically relied on and will probably continue to rely on in the future
Walking blood bank
What information is of critical importance when reaching a decision in triage?
- Initial vital signs
- Pattern of injury
- Response to initial intervention
The majority of combat wounded will suffer nonfatal extremity injuries. How will these be triaged in general?
Non-emergent
All casualties should flow through a single triage area and undergo rapid evaluation by whom?
Initial triage officer
What are the qualities of an ideal initial triage area?
- Proximity
- One-way flow
- Well-lit, covered, climate-controlled
- Casualty recorders
- Litter bearers
Who is responsible for overarching clinical management of the mass casualty response at role 2-4 facilities?
Chief of Trauma
Who must each individual on the resuscitation treatment team coordinate the movement of their patients with?
Chief Surgical Triage Officer
Numerous authors have stated that, after the first 24 hours of a mass casualty ordeal, the activities of the care providers must be decreased by what percentage to allow for participant recovery and rest?
50%
What is defined as the movement of a casualty from the point of injury to medical treatment by nonmedical personnel? (typically involves a helicopter returning from the battlefield)
Casualty Evacuation (CASEVAC)
What is defined as the timely, efficient movement and en route care provided by medical personnel to the wounded being evacuated from the battlefield to MTFs using medically equipped vehicles or aircraft? (e.g., civilian aeromedical helicopter services and Army air ambulances)
Medical Evacuation (MEDEVAC)
Which type of evacuation generally utilizes United States Air Force (USAF) fixed-wing aircraft to move sick or injured personnel within the theater of operations (intratheater) or between two theaters (intertheater)? (e.g., Afghanistan to Germany)
Aeromedical Evacuation (AE)
Which type of care is the maintenance of treatment initiated prior to evacuation and sustainment of the patient’s medical condition during evacuation?
En route care
How many litter straps are used to secure patients to the litter for patients entering the medical evacuation system?
3
Due to differences in the type of evacuation assets used and their effect on the patient’s medical condition (e.g., flying in the pressurized cabin of an aircraft), requests to transport patients via USAF Aeromedical Evacuation (AE) system must be validated by who?
theater validating flight surgeon
Who determines the evacuation precedence for all patients requiring evacuation from Role 2 MTFs or Forward Surgical Teams (FSTs)?
Brigade Surgeon
What should be contacted at the earliest possible time when a patient is readied for evacuation from the Forward Surgical Team (FST) by United States Air Force (USAF) assets?
Patient Movement Requirements Center (PMRC)
What must be bivalve just in case it is over a surgical wound site and mist have a “window” to allow for tissue expansion and emergency access?
Cast
The volume of a gas bubble in liquid doubles at how many feet above sea level?
18,000 ft
Cabin pressures in most military aircraft are maintained at altitudes between 8,000 and how many feet?
10,000 ft
What should be considered when transporting patients by air who are presenting with severe pulmonary disease?
Cabin Altitude Restriction (CAR)
What amount of oxygen saturation does a healthy patient have at a cabin altitude of 8,000 feet?
90%
How many personnel typically make up the Aeromedical Evacuation Liaison Team (AELT)?
4-6 personnel
For evacuation precedence, what movement classification is immediate aeromedical evacuation (AE) to save life, limb, or eyesight? Within how many hours?
Urgent
MEDEVAC (Navy, Army, Marines) = Within 1 hour
AE (Air Force) = ASAP
For evacuation precedence, what movement classification is prompt medical care not available locally and medical condition could deteriorate, meaning the patient cannot wait for routine AE? Within how many hours?
Priority
MEDEVAC (Navy, Army, Marines) = Within 4 hours
AE (Air Force) = Within 24 hours
For evacuation precedence, what movement classification is conditions not expected to deteriorate significantly while awaiting flight? Within how many hours?
Routine
MEDEVAC (Navy, Army, Marines) = Within 24 hours
AE (Air Force) = Within 72 hours or next available mission
