3.1.2. MMPL-CMS Hemorrhage Control and Patient Assessment Flashcards
What are two major differences between combat casualty care and civilian care?
- Care under fire; working in the dark; multiple casualties and limited equipment
- Prolonged evacuation times as well as the need for tactical maneuver
How is tourniquet use different between the military and civilian world?
Liberal use encouraged with the military (BIG difference b/w civilian and combat casualty care)
When was the first splint used and what was it?
Thomas Splint in WWI
What is MASH based on?
Mobile Surgical Hospitals
What is TCCC
Tactical Combat Casualty Care
Who issed TCCC and when?
1993 by Naval Special Warfare Command.
Later continued by the US Special Operations Command USSOCOM
What was develped out of the proposal for TCCC?
Developed a set of tactically appropriate battlefield trauma care guidelines that were published as a supplement to Military Medicine in 1996
What does TCCC give combat medics and corpsmen?
The TCCC guidelines provide battlefield medics and corpsmen with trauma management strategies that combine good medicine with good small-unit tactics
3 goals of TCCC
Treat the casualty
Prevent additional casualties
Complete the mission
Trauma care measures proposed in the original TCCC guidelines include what?
A 3-phase approach to tactical trauma care; tourniquets; battlefield antibiotics; tactically appropriate fluid resuscitation; improved battlefield analgesia; etc
What are the different combat medic personnel in the branches of the military referred to as?
Medics in the Army; corpsmen in the Navy and Marine Corps; medics and “PJs” in the Air Force
What are the three phases (not goals) of TCCC?
Care under Fire
Tactical Field Care
Tactical Evacuation Care
What steps do you need to take before you begin the ABCs of tactical care?
- Remove the weapon and look for life threatening injuries
2. Check for major hemorrhaging and address it
What are the ABCs of tactical field medical care?
Airway Breathing Circulation Disability Exposure/Environment
Describe what you are doing/looking for during the Airway portion of tactical medical care
If the airway is compromised, it will have to be opened, initially using manual methods (trauma chin lift or trauma jaw thrust), and cleared of blood, body substances, and foreign bodies, if necessary
Airway management can advance to mechanical means (oral airway, nasal airway, supraglottic airway, or endotracheal intubation) or to transtracheal methods (percutaneous transtracheal ventilation)
C-Spine stabilization is important during this phase!
Steps of the breathing phase of tactical field care
- Remove body armor and do quick inspection
- Auscultate
- Palpate for small fragment wounds and small fractures
- Consider rescue breaths
- Check ventilation rate
What does the inspired oxygen concentration need to be at the least?
85%
What are the five categories of ventilation rate and what do we do for them?
Apneic (not breathing)
Slow (below 12 breaths/min) - Give assisted or total ventilation
Normal (12-20)
Too fast (20-30) - Give administration of oxygen
Abnormally fast (>30) - Give assisted ventilation
What do you do during circulation for the ABCs of tactical field care?
- Blood sweep from head to toe
2. Perfusion check
What are some no-nos of doing the blood sweep?
Don’t forget arms
Don’t hop over patient
don’t drag hands (make sure to pull hands out so that you can better identify the source of the bleeding)
What are you checking for during perfusion?
Pulse, Skin (color, temperature, and moisture)
Capillary Refill
What are you doing during the Disability portion of tactical field care?
Determine level of consciousness (LOC) and ascertain for the potential of hypoxia
- GCS scale (normal is 15) and check pupils
- PERLA: Pupils are Equal and responsive to Light; Accommodation
What are you doing during the E phase of the ABCs of tactical field care?
Exposure/Environment
Remove necessary clothes and prevent hypothermia: warm blankets
What is the lethal triad?
combination of acidosis, coagulopathy and hypothermia that usually leads to death in a patient experiencing trauma
What are the major causes of injury? What do they lead to?
Explosions are major cause of large tissue injuries. Force of explosions cause concussive wounds, bone fractures, major trauma
