5 - Military Medicine Flashcards
Levels of care in military medicine?
Role I: self/buddy aid - BTN aid station
Role II: brigade/division level
Role III: corps level - combat support hospital
Role IV: definitive care
Role V: hospital in US
Capability of Role II?
Role II: brigade/division level
- medical support company
- forward surgical team (FST)
- blood, x-ray, lab, pt hold
Capability of role III?
Role III: corps level - combat support hospital
- in theater mil tx facility
- full surgical care
- hold
- lab
- radiology (include CT)
- stabilizing care for evac
Capability of role IV?
Role IV: definitive care
- out of theater
- full rehab care
- tertiary care capability
Capability of Role V?
Hospital in US (if role IV is not in US)
9 line medivac request
1: location
2: call sign/freq
3: # pts by PRECEDENCE
4: special equipment
5: # pts by TYPE
6:
- security (wartime)
- # and type of wounded (peacetime)
7: method of marking DZ
8: Pt nationality and status
9:
- NBC (wartime)
- landmarks (peacetime)
First 5: Low flying pilots eat tacos
- will get the bird off the ground
What is TCCC designed for?
Address preventable causes of death
- extremity hemorrhage
- hemo/pneumothorax
- hypothermia/coagulopathy
Phases of TCCC?
Phase 1: care under fire
Phase 2: tactical field care
Phase 3: casualty evacuation
What is phase 1 (TCCC)
Care under fire
- during active enemy engagement
- 1st priority is to return fire/secure site
- very limited medical care
What is the only medical care performed under phase 1?
Hemorrhage control
- tourniquets
- field and pressure dressings
Phase 2 (TCCC)
Tactical field care
- no longer under effective hostile fire
- longest phase of care
- perform primary survey
- limited medical care
What medical tx are performed in phase 2?
C-B-A/MARCH:
Hemorrhage control
- hemotstatic agents: combat gauze/hemcon
- tourniquets, pressure dressing, field dressing
Airway
- Needle D, Chest tuber, occlusive dressing, crichothyrodomy
Circulation
- IV/IO access - permissive HOTN
Hypothermia/head injury
- keep them warm
- inform air crew about head inj
- keep SBP 90-95 (brain perfusion)
Secondary survey
Pain control
Phase 3?
Casualty evacuation
prepare for MEDEVAC
- secure and wrap pt
MEDEVAC
- proper handoff w flight medic
- prep meds etc
What are considered special situations for TCCC?
Burns
Mass casualty
CPR
Joint/international ops
Burns - special situation
- stop the burning
- treat life threats
- protect airway
- keep pt warm
- acute fluid resuscitaiton (LR Preferred)
- monitor urine output
How is acute fluid resuscitaiton conducted with burns?
Rule of 10’s
Adults = 80kg: 10ml/hr x % TBSA
- adults >/= 80kg: add 100ml/hr for every 10kg over 80kg
Kids - 3x TBSA x body weight (kg) = amount of fluid given in 1st 24hrs
- 1/2 in first 8 hrs
Urine output for burn therapy?
Maintain
- adults: 30-50ml/hr
- kids: 0.5-1ml/kg/hr
Triage categories for Mass casualty event?
ID ME or DIME
I - immediate - “now” to avoid death D - delayed - surg intervention but can delay M - minimal - self/buddy aid E - expectant - will die no matter what (dont wast time/resources)
Triage methods?
Simple and SALT
Slides 21, 22
CPR in combat?
If req CPR = expectant
- don’t provide CPR at the expense of other casualties
NO CPR UNDER FIRE
Goal of fluid rescuscitation in TCCC?
Enhance body’s ability to clot wile minimizing edema, dilution etc (iatrogenic resuscitaiton injury)
- keep vital organs perfused
- optimize oxygen carrying capacity
Fluid resuscitation methods?
PO (preferred) Crystalloids: MC - watch dilution Colloids: not widely used Whole blood: if youve got it PRBC and platelets: difficult to store/transport
Pain control in TCCC?
Crucial comfort for transport
Combat pill pack
Fentinyl lollipop
Ketamine 50mg IM, IV, IO, Intranasal
Nausea (from pain meds): ondasetron PO
TCCC antibiotics?
Combat pill pack includes them
- moxifloxacin 400mg po
- cefotetan 2gm or ertapenem 1gm IV
Whats wrong with velcro?
Its a total rip off
