EMERGENCY WAR SURGERY (REVISION-4), EMERGENCY WAR SURGERY FOURTH UNITED STATES REVISION; Chapter 3 ,4 ,7 , 9, 10, 33, & 36 Flashcards
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
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)
How many hours are patients typically held at Aeromedical Staging Facilities (ASFs) prior to evacuation?
2-6 hours
Patients should have at least how many hours worth of supplies and medications for intratheater transfer?
24 hours
Patients should have at least how many hours worth of supplies and medications for intertheater transfer?
48 hours
Who at the originating MTFs submits requests for movement, timing, destination, suggested support therapies, etc.?
Physicians
Which type of event is an Aeromedical Evacuation (AE) clearance?
Medical care
Which type of event is an Aeromedical Evacuation (AE) validation?
Logistical
What is a decision the referring physician and the local flight surgeon in regards to USAF Aeromedical Evacuation (AE)?
Clearance
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)
How many or more months can the process take for arranging routine humanitarian evacuations out of theater?
6 months
What medical treatment has the goal to maintain adequate perfusion?
Resuscitation
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
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