Combat Casualty material

Question 1

What factors affect coagulation?

Answer 1

Top 3

1. Hypothermia - Treat for shock
2. Lactic Acidosis (Poor perfusion) - Treat for shock
3. Hemodilution - Give fluids judiciously
   - —
4. Increased BP - (Breaks clots) - Give fluids judiciously
5. Rx - meds interfering with clotting process

Question 2

Two most important things to do in the field to prevent coagulation problems?

Answer 2

1. Treat for shock

2. Give fluids judiciously

Question 3

When should fluids be given?

Answer 3

Lost of radial pulse or AMS

Question 4

What sites on the body are noncompressible and what is the best way to treat?

Answer 4

Torso (Chest/Abd) and TXA

Question 5

How should TXA be given in the field?

Answer 5

2 grams TXA with 100ml Saline followed by 500 ml Hextend.

Question 6

What is the pharma-physiology of TXA?

Answer 6

Prevents fibrin degradation aka prevents clots from breaking down

Question 7

Criteria to place a D-TQ?

Answer 7

W/in 2hrs to surgery per tactical situation
Wound exposed and assessed
H-TQ on <6hrs or on amputation
Or in profound shock

Question 8

TC3 card is also known as?

Answer 8

DD Form 1380

Question 9

Is a TQ ever removed in the field?

Answer 9

NO - only loosened

Question 10

TXA administration indications?

Answer 10

Significant bleeds
Penetrating torso trauma
Severe ABD trauma (+/-)
Profound hemorrhagic shock

Question 11

At what point should TXA not be given?

Answer 11

3H post injury

Question 12

In addition to a TQ what should be placed for an above/below the knee amputation AKA/BKA?

Answer 12

Pelvic Binder

Question 13

What is does the MIST report stand for?

Answer 13

MOI
Injuries/Interventions
S/S
Treatments provided

Question 14

What is Lactated Ringer used for generally?

Answer 14

Burns or Dehydration

Question 15

What is the target blood pressure in fluid resuscitation and how can it be checked in the field

Answer 15

Target BP = 80-90 Systolic
and if a pulse is located at
1. Radial indicates >80
2. Femoral indicates >70
3. Carotid indicates > 60

Question 16

What is the minimum blood pressure to maintain perfusion?

Answer 16

80 systolic

Question 17

Preferred fluid resuscitation guideline list?

Answer 17

Whole blood type O
1:1:1 - RBCs/Plasma/Platelets
1:1 - RBCs/Plasma
RBCs alone, Thawed FFP alone, Reconstituted plasma
Hextend
LR or Plasma-Lyte A

Question 18

After initiating a saline lock or IO access what is the next thing to do?

Answer 18

Flush with Saline

Question 19

Criteria to switch to the IO intervention?

Answer 19

If in combat

• AMS and NO radial pulse
• Will req fluids
• Missed at least two IVs

Question 20

How much blood can be lost before blood pressure drops?

Answer 20

1500-2000mL (1.5-2L)

Question 21

Two ways to open airway w/out adjuncts (Least invasive?

Answer 21

Head Tilt/Chin Lift

Jaw Thrust

Question 22

At what point can you let go of C-Spine stabilization?

Answer 22

After fully secured on spine board with blocks

Question 23

What happens if a patient gags while inserting an airway adjunct?

Answer 23

Back out the adjunct

Question 24

NPA is contraindicated if?

Answer 24

Clear fluid running from nose or ears

Maxilla-facial trauma

Question 25

What is a definitive airway adjunct?

Answer 25

ET tube. however in the field = cric

Question 26

NPA indications

Answer 26

• Unconscious pt w/ sponontaneous respirations w/ no respiratory distress
• Unconscious pt w/out airway obstruction (Securing)
• AMS w/ intact gag refex

Question 27

Blind intubation definition?

Answer 27

Does not visualize vocal cords

Question 28

Indications of improper lower airway adjuncts?

Answer 28

Unilateral breath sounds/rise

Question 29

If no BVM is available how else could you give air?

Answer 29

Mouth to tube