EMERGENCY WAR SURGERY (REVISION-4), EMERGENCY WAR SURGERY FOURTH UNITED STATES REVISION; Chapter 3 ,4 ,7 , 9, 10, 33, & 36 Flashcards
1
Q
Which type of event overwhelms immediately available medical capabilities to include personnel, supplies, and/or equipment?
A
Mass Casualty
2
Q
Which principle is effective mass casualty response founded on?
A
Triage
3
Q
Which system sorts and prioritizes casualties based on the tactical situation, mission, and available resources?
A
Triage
4
Q
The ultimate goal of combat medicine are the return of the greatest possible number of warfighters to combat and the preservation of what?
A
Life, Limb, and Eyesight
5
Q
How many different categories of triage are there?
A
4; Immediate, delayed, minimal, and expectant
6
Q
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?
A
Immediate
7
Q
Which triage category would a patient be placed into who presents with a head injury requiring emergent decompression?
A
Immediate
8
Q
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?
A
Delayed
9
Q
Which triage category would a patient be placed into who arrives with fractures or soft-tissue injuries without significant bleeding?
A
Delayed
10
Q
Which triage group has relatively minor injuries and can effectively care for themselves or with minimal medical care?
A
Minimal
11
Q
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?
A
Expectant
12
Q
Prior to entering the treatment facility, Wounded contaminated in a biological and/or a chemical battlefield environment must be?
A
Decontaminated
13
Q
Heavy stress patients should be sent to a combat stress control restoration center for up to how many days reconstitution?
A
3
14
Q
Which mnemonic should be used where resources/tactical situations allow for combat stress patients?
A
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
15
Q
What are the external factors of Triage resource constraints?
A
- Tactical situation and the mission
- Resupply
- Time
16
Q
What are the internal factors of Triage resource constraints?
A
- Medical supplies
- Space/capability
- Personnel
- Stress
17
Q
What has transfusion medicine in the theater of war historically relied on and will probably continue to rely on in the future
A
Walking blood bank
18
Q
What information is of critical importance when reaching a decision in triage?
A
- Initial vital signs
- Pattern of injury
- Response to initial intervention
19
Q
The majority of combat wounded will suffer nonfatal extremity injuries. How will these be triaged in general?
A
Non-emergent
20
Q
All casualties should flow through a single triage area and undergo rapid evaluation by whom?
A
Initial triage officer
21
Q
What are the qualities of an ideal initial triage area?
A
- Proximity
- One-way flow
- Well-lit, covered, climate-controlled
- Casualty recorders
- Litter bearers
22
Q
Who is responsible for overarching clinical management of the mass casualty response at role 2-4 facilities?
A
Chief of Trauma
23
Q
Who must each individual on the resuscitation treatment team coordinate the movement of their patients with?
A
Chief Surgical Triage Officer
24
Q
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?
A
50%
25
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)
26
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)
27
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)
28
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
29
How many litter straps are used to secure patients to the litter for patients entering the medical evacuation system?
3
30
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
31
Who determines the evacuation precedence for all patients requiring evacuation from Role 2 MTFs or Forward Surgical Teams (FSTs)?
Brigade Surgeon
32
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)
33
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
34
The volume of a gas bubble in liquid doubles at how many feet above sea level?
18,000 ft
35
Cabin pressures in most military aircraft are maintained at altitudes between 8,000 and how many feet?
10,000 ft
36
What should be considered when transporting patients by air who are presenting with severe pulmonary disease?
Cabin Altitude Restriction (CAR)
37
What amount of oxygen saturation does a healthy patient have at a cabin altitude of 8,000 feet?
90%
38
How many personnel typically make up the Aeromedical Evacuation Liaison Team (AELT)?
4-6 personnel
39
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
40
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
41
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
42
Which facilities manage the administrative processing and staging, providing limited medical care of casualties entering or transiting the Aeromedical Evacuation (AE) system?
Aeromedical Staging Facilities (ASFs)
43
How many hours are patients typically held at Aeromedical Staging Facilities (ASFs) prior to evacuation?
2-6 hours
44
Patients should have at least how many hours worth of supplies and medications for intratheater transfer?
24 hours
45
Patients should have at least how many hours worth of supplies and medications for intertheater transfer?
48 hours
46
Who at the originating MTFs submits requests for movement, timing, destination, suggested support therapies, etc.?
Physicians
47
Which type of event is an Aeromedical Evacuation (AE) clearance?
Medical care
48
Which type of event is an Aeromedical Evacuation (AE) validation?
Logistical
49
What is a decision the referring physician and the local flight surgeon in regards to USAF Aeromedical Evacuation (AE)?
Clearance
50
Which type of transport is available for patients in need of intensive nursing care, constant hemodynamic monitoring, mechanical ventilation, frequent therapeutic interventions, or other medical or surgical interventions vital to sustain life, limb, and eyesight during movement of the patient through the aeromedical environment?
Critical Care Air Transport Team (CCATT)
51
How many or more months can the process take for arranging routine humanitarian evacuations out of theater?
6 months
52
What medical treatment has the goal to maintain adequate perfusion?
Resuscitation
53
Which clinical condition is marked by inadequate organ perfusion and tissue oxygenation, manifested by poor skin turgor, pallor, cool extremities, capillary refill greater than 2 seconds, anxiety/confusion/obtundation, tachycardia, weak or thready pulse, and hypotension?
Shock
54
What is the most common type of shock seen in combat casualties that is results in poor perfusion due to diminished volume from hemorrhage, diarrhea, dehydration, and burns?
Hypovolemic
55
Hypotension is a late finding in shock, occurring after what percentage of blood volume loss?
30%-40%
56
Which type of shock is defined as pump failure from intrinsic cardiac failure or obstructive cardiac dysfunction from a tension pneumothorax or cardiac tamponade?
Cardiogenic
57
Which type of shock is defined is defined as poor perfusion due to loss of vascular tone?
Distributive
58
What are the two types of distributive shock?
Neurogenic and Septic
59
Which type of shock is seen with spinal cord injury T6 and above due to loss of sympathetic tone and unopposed parasympathetic stimulation with resultant vasodilation?
Neurogenic
60
Which type of shock has fever, hypotension, tachycardia, and warm extremities from massive vasodilation related to infection?
Septic
61
What are the three fluid resuscitation groups of casualties?
Responders, Transient, Non-Responders
62
Which types of casualties have a sustained response to fluids, may have had significant blood loss but have stopped bleeding?
Responders
63
What have no role in the initial treatment of hemorrhagic shock?
Vasopressors
64
Blood product transfusions should be considered early in the resuscitation, particularly in patients who have lost what percentage or more of their blood volume?
30%
65
What is a critical early step in the management of trauma?
Vascular access
66
The first attempt for a vascular access is the peripheral. If unsuccessful what is the next intervention?
Intraosseous (IO)
67
Which position should the casualty be placed for subclavian vein access or internal jugular venipuncture?
Trendelenburg (15° head down)
68
What technique is used during subclavian vein or internal jugular vein catheter insertion?
Seldinger Technique
69
Where must humeral or tibial IO devices not be used?
Sternum
70
What should be given for all penetrating wounds as soon as possible?
Antibiotics
71
How many soft-tissue examination may be performed on the initial presentation of a sterile field dressing?
One-look
72
Within how many hours, preferably, of being wounded should wound debridement take place?
6 hours
73
Which type of wound incisions allow for proximal and distal extension for more thorough visualization and debridement?
Longitudinal
74
Which type of wound incisions should be avoided because they do not facilitate subsequent extension if needed?
Transverse
75
Tissue-sparing debridement is acceptable if follow-on wound surgery will occur within how many hours?
24 hours
76
What 4 assessments should be used in determining the extent of muscle damage?
Color, Contraction, Consistency, and Circulation
77
Irrigation volume between 6 and how many L is often utilized for significantly contaminated, large open wound?
12
78
Which type of irrigation is preferred for acute wounds?
Low-pressure
79
What may be helpful in extending the period of bacterial growth after initial debridement?
Antibiotic beads
80
What is normally made using 1g of Vancomycin/ 1.2g of Tobramycin per 40g of poly (methyl methacrylate) (PMMA) cement?
Antibiotic beads
81
Wounds undergo a planned second debridement and irrigation in how many hours?
24-48 hours
82
How many hours may the time interval between debridements be extended if Negative Pressure Wound Therapy (NPWT) devices are utilized providing all nonviable tissue has been removed?
48-72 hours
83
Which syndrome is characterized by ischemia and muscle damage or death (rhabdomyolysis) due to compression of extremities, buttocks, or trunks for a prolonged time?
Crush
84
Reperfusion injuries can cause up to how many L of third-space fluid loss per limb that can precipitate hypovolemic shock?
10
85
Combat extremity injuries are at an elevated risk of developing a compartment syndrome within how many hours post injury?
48-72 hours
86
What are all wounds incurred on the battlefield grossly contaminated with?
Bacteria
87
What are the 4 things that you are looking for to determine wound infection?
Pain and tenderness, redness, warmth, and swelling (The four "-or's: dolor, rubor, calor, and tumor)
88
Pseudomonoas, Enterobacter, Acinetobacter, along with what else are common nosocomial pathogens usually expected among casualties who have been hospitalized for an extended period, not those fresh off the battlefield?
Serratia
89
Salmonella, Shigella, along with what else should be suspected in cases of bacterial dysentery?
Vibrio
90
Which fungal species should be suspected in casualties hospitalized for prolonged periods, those malnourished or immunosuppressed, or those who have received broad spectrum antibiotics, adrenocortical steroids, or parenteral nutrition?
Candida
91
Gram-positive cocci and mouth anaerobes in the orofacial and neck region are generally responsive to surgery along with what else?
Clindamycin
92
What is often responsible for a potentially severe diarrheal colitis (intra-abdominal) that occurs following the administration of even one dose of antibiotic?
Clostridium difficile
93
Which syndrome is caused by a bloodborne or severe regional infection resulting in a global inflammatory response (fever, leukocytosis, tachycardia, tachypnea, and possibly hypotension)?
Systemic sepsis
94
Surgical and antibiotic treatment should begin as early as possible for war wound infections, ideally within how many hours after injury?
3 hours
95
Optimally, surgical debridement should be achieved within how many hours of injury?
6 hours
96
Which role of care would self aid, buddy aid, combat lifesaver, Corpsman/Medic aid, BAS, STP, and no patient holding capacity fall under?
Role 1
97
Which role of care would medical company or expeditionary medical support, holding capacity for blood transfusion, radiology, laboratory, and Field Surgical Team support fall under?
Role 2
98
Which role of care would a US Army combat support hospital, Air Force theater hospital, or casualty receiving ships; all with full inpatient capacity with ICUs and operating rooms fall under?
Role 3
99
Which role of care would a regional hospital or US Naval hospital ships, typically outside of the combat zone; general and specialized inpatient medical and surgical care fall under?
Role 4
100
Which role of care would care facilities within the United States, typically tertiary care medical centers fall under?
Role 5
101
Antibiotics should be started as soon as possible after wounding, then continued for how many hours, depending on the size, extent of destruction, and degree of contamination of the wound?
24 hours
102
Empiric cultures should be performed for empiric treatment of SEPSIS and then antibiotic treatment should be initiated within how many hours?
4 hours
103
Empiric broad-spectrum antibiotic therapy is initiated against likely pathogens and continued for how many days?
7-10 days
104
What are battle wounds prone to due to high levels of contamination with Clostridium tetani?
Tetanus
105
What is manifested by localized skin erythema, heat, tenderness, and swelling or induration?
Cellulitis
106
What are the most dreaded infections resulting from battlefield wounding?
Necrotizing soft-tissue
107
About what percentage of all trauma casualties requiring evacuation do not require any blood product transfusion?
75%
108
What is the leading cause of preventable deaths during war?
Exsanguinating hemorrhage
109
What percentage of evacuated casualties will lose large volumes of blood during initial care and require “massive transfusion” (10 or more units of red blood cells (RBCs) in 24 hours)?
5%-8%
110
What should be immediately applied to extremities with potential for life-threatening blood loss?
Tourniquets
111
Which group of blood products are the predominant type fielded with forward surgical units?
O-stored RBCs and AB plasma
112
Fresh frozen plasma (FFP) is thawed and stored at what degree Celsius for up to 5 days as thawed plasma?
1-6 degree Celsius
113
Which type of RBCs are safe for emergency transfusion until the ABO type of the casualty is known?
Type O
114
What is the only type of plasma considered safe for emergency transfusion?
AB
115
Only what percentage of the population has AB blood?
4%
116
Massive transfusion is typically defined as needing how many or more units of blood in 24 hours?
10 Units
117
Blood products should be transfused with a goal ratio of what?
6 RBCs: 6 FFPs: 1 aPLT
118
If plasma and platelets are unavailable, what should be collected/transfused?
Type-specific fresh whole blood
119
What develops in trauma patients from conductive, convective, evaporative, and radiative losses due to environmental and surgical exposure?
Hypothermia
120
What is caused due to hypoperfusion, but can be exacerbated by crystalloids and stored RBCs?
Acidosis
121
What is a common complication due to extracellular potassium that increases over time in stored RBCs?
Hyperkalemia
122
What occurs in massive transfusions that is cause by the citrate (anticoagulant) in plasma and platelet products?
Hypocalcemia
123
What is Emergency Collection of Fresh Whole Blood in the field known as?
Walking Blood Bank
124
What should be reserved for when standard blood products are exhausted or unavailable?
Emergency Collection of Fresh Whole Blood (Walking Blood Bank)
125
How many minutes at best does emergency fresh whole blood collection take from the request to its bedside availability?
30-40 minutes
126
Approximately what percentage of all transfusions are accompanied by a temperature elevation?
1%
127
What is manifested by rapid onset of "noncardiogenic" pulmonary edema with dyspnea, hypoxemia, and pulmonary infiltrates within 6 hours after transfusion?
Transfusion-related acute lung injury (TRALI)
128
What is the estimated mortality rate for recognized Transfusion Related Acute Lung Injury (TRALI)?
5%-8%
129
What is the only transfusion reaction in which the blood product can be continued?
Urticaria (hives/itching)
130
The order to activate the walking blood bank must come from who?
medical providers
131
Which modified form will be used by laboratory personnel to record donor temperature, heart rate, and blood pressure to ensure adequacy for donation?
DD Form 572
132
How many blood collection tubes are collected for screening blood donors?
6 tubes (3 red/marble top tubes and 3 lavender top tunes)
133
How are the blood collection tubes labelled?
Full Name, SSN, and date/time of collection
134
How many hours after the date and time of blood tube collection will it expire?
24 hours
135
What are being tested when performing a rapid test?
ABO/Rh, HIV, HCV, HBV, Malaria, and RPR for Syphilis
136
How many hours may fresh whole blood be kept stored at room temperature?
8 hours
