HMC Severson Review Flashcards
What is a french word to sort?
Triage
What is the process of prioritizing treatment during a mass casualty event based on their need for or likely benefit from medical attention
Triage
The number of patients and the severities of their injuries DO NOT exceed the resources and capabilities
Multiple casualties
The number of patients and the severities of their injuries DO exceed the resources and capabilities.
Mass Casualties
Five Principles of Triage
(1)Degree of life threat posed by the injuries sustained
(2)Injury severity
(3)Salvageability
(4)Resources
(5)Time, distance, and environment
Triage tags consist of four colors
(a)Black (Deceased/Expectant)
(b)Green (Minimal)
(c)Red (Immediate)
(d)Yellow (Delayed)
What is BICEP in regards to Combat Stress
a)Brief
b)Immediate
c)Central
d)Expectant
e)Proximal
f)Simple
g) Refer
Phases of TCCC
(1)Care under fire
(2)Tactical field care
(3)Tactical evacuation
Quickly choose a casualty collection point based on:
(a)Proximity to patients
(b)Proximity to vehicular access.
(c)Proximity to HLZ
(d)Geography, safety “geographic triage.”
Level (role/echelon) 1
First medical care military personnel receive. Includes immediate life saving measures, disease and non-battle injury prevention and care, combat and operational stress control (COSC), patient location and acquisition
Examples include:
1)Battalion Aid Station
2)Cruisers, Destroyers
Level (role/echelon) 2
Initial resuscitative care is the primary objective of care at this level. Saving life, limb, and when necessary stabilization for evacuation to level 3.
Ex
LHD: Largest medical capability
LHA
CVN
Medical battalion (MEDBN)
Shock trauma platoon (STP):
Forward resuscitative surgical suite (FRSS)
Level (role/echelon) 3
The highest level of care available within a combat zone. Advanced resuscitative care is the primary objective of care
Examples included:
1)Fleet hospitals
2)Hospital ships (USNS Comfort/USNS Mercy)
Level (role/echelon) 4
Definitive medical care is the primary objective at this level
(a)OCONUS Hospital Examples:
1)NH Yokosuka
2)Landstuhl Regional Medical Center
Level (role/echelon) 5
Restorative and rehabilitative care is the primary objective of care at this level
Example:
(a)CONUS hospital examples:
1)NMC SD
2)Walter Reed National Medical Center
MEDEVAC/CASEVAC Priorities
- Urgent: Casualty must be evacuated within 2 hours in order to save life, limb or eyesight
- Priority: Casualty must be evacuated within 4 hours or condition could worsen.
- Routine: Casualty must be evacuated within 24 hours for further care.
Line 1 of 9 Line
(1)Location of pick up site (Grid coordinates).
Line 2 of 9 Line
(2)Frequency/Call sign of pick up site.
Line 3 of 9 Line
Number of patients by precedence:
(a)A- Urgent
(b)C- Priority
(c)D- Routine
Line 4 of 9 Line
Special equipment needed:
(a)A- None
(b)B- Hoist
(c)C- Extraction equipment
(d)D- Ventilator
Line 5 of 9 Line
Number of patients by type
(a)L - # of litter
(b)A- # of ambulatory
Line 6 of 9 Line
Security of pickup site:
(a)N - No enemy
(b)P - Possible enemy
(c)E - Enemy in area
(d)X - Armed escort required
Line 7 of 9 Line
Method of marking pickup site:
(a)A - Panels
(b)B - Pyrotechnics
(c)C - Smoke
(d)D - None
(e)E – Other
Line 8 of 9 Line
Patient nationality and status:
(a)A - US Military
(b)B - US Civilian
(c)C - Non US Military
(d)D - Non U
(e)S Civilian
(f)E – EPW
Line 9 of 9 Line
NBC Contamination:
(a)N- Nuclear
(b)B- Biological
(c)C- Chemical
Mist Report consists of the four following categories
(a)Mechanism of Injury
(b)Injuries Sustained
(c)Signs/Symptoms
(d)Treatment
Energy Levels of Projectiles
(1)Low: Knives, needles, ice picks (hand-driven weapons)
(2)Medium: Firearms with muzzle velocity of less than 1,500 feet second. (.357 magnum, 9 mm, .45auto)
(3)High: Firearms with muzzle velocity of more than 1500 feet per second. (.44 magnum, .50AE)
Blast injuries are subdivided into four categories
- Primary - Effects of Overpressure and Under pressure from a blast wave
- Secondary - Flying Debris/fragments
- Tertiary - Body Displacement
- Quaternary - Burns
TCCC Approved Tourniquets
(a)Combat Application Tourniquet (C.A.T.)
(b)Special Operations Forces Tourniquet-Tactical (SOFT-T)
(c)Emergency and Military Tourniquet (EMT)
TCCC approved Hemostatic Agent
(a)Combat Gauze
(b)Celox Gauze or Chito Gauze
XStat (Best for deep narrow tract Junctional wounds)
Which TCCC hemostatic agent is FDA-cleared for life threatening junctional bleeds
X Stat
CoTCCC Junctional Tourniquets
(1) Combat Ready Clamp
(2) Junctional Emergency Treatment Tool
(3) SAM Junctional Tourniquet
Tourniquet placement
(a)Apply tourniquet 2 to 3 inches above bleeding site
(b)If unable to identify the site, apply “high and tight.”
(c)If bleeding is still uncontrolled, apply a 2nd tourniquet directly above the first
Insufficient oxygenation; that is decreased partial pressure of oxygen in blood.
Hypoxemia
Indications for Oxygen Therapy.
(1) All trauma causalities should receive appropriate ventilator support with supplemental oxygen to ensure that hypoxia is corrected or averted entirely.
(2) In deciding which method or equipment to use, prehospital care providers should consider the following devices in their respective oxygen concentrations.
(3) If the oxygen saturation is 94% or lower, the patient is hypoxic and needs to be treated quickly.
The following requires what kind of oxygen delivery
(a)Decompression illness (the “bends”)
(b)Carbon monoxide poisoning
(c)Radiation necrosis
(d)Reconstructive surgery
(e)Some infection, wounds
Hyperbaric Oxygen
Manual airway manuevers
- Head Tilt/Chin Lift.
- Jaw Thrust Maneuver
- Sellick’s Maneuver.
- BURP Maneuver.
Which manual air way maneuver?
In casualties with suspected head, neck, or facial trauma, the cervical spine is maintained in a neutral inline position
Jaw Thrust Maneuver.
Which manual air way maneuver?
- Prevention of gastric aspiration is one of the key components in airway maintenance
- particularly during BVM ventilation, aids in preventing aspiration.
Sellick’s Maneuver
Which manual air way maneuver?
The maneuver improves the visualization of the larynx structures and eases the intubation.
BURP Maneuver
What is the most frequently used artificial airway device
Oropharyngeal Airway (OPA).
Contraindications for Oropharyngeal Airway (OPA).
Casualty who is conscious or semiconscious
Complications of OPA
1)Due to gag reflex stimulation,
2)Use of the OPA may lead to gagging, vomiting, and laryngospasmin casualties who are conscious.
Disadvantage of NPA
The risk of nasal bleeding during insertion
Contraindication for NPA
Suspected basilar skull fracture.
preferred supraglottic airway because it makes it simpler to use and avoids the need for cuff inflation and monitoring
I-gel
preferred definitive airway is tracheal intubation through the mouth using direct laryngoscopy
Endotracheal Intubation.
Contraindications for Endotracheal Intubation.
- Lack of training in technique.
- Lack of proper indications.
What airway should be used for trapped patients?
Combitube
What are the 2 basic types of cricothyroidotomy
(a)Needle Cricothyrotomy
(b)Surgical Cricothyrotomy
Indications for Cricothyroidotomy
(1) Massive midface trauma precluding the use of BVM device.
(2) Inability to control the airway using less invasive maneuvers.
(3) Ongoing tracheobronchial hemorrhage.
Contraindications for cricothyroidotomy
(1) Any casualty who can be safely intubated, either orally or nasally.
(2) Casualties with laryngotracheal injuries
(3) Children under 10 years of age.
(4) Casualties with acute laryngeal disease of traumatic or infectious origin.
(5) Insufficient training
Needle decompression should be performed when the following three criteria are met:
(a)Evidence of worsening respiratory distress or difficulty with BVM device.
(b)Decrease or absent breath sounds
(c)Decompensated shock (SBP <90mm Hg)
Assessment: Casualty may appear in distress with the following signs andsymptoms:
(a)Anxiety / Restlessness
(b)Chest Pain
(c)Tachypnea
(d)Signs of Shock (pallor, confusion, hypotension)
(e)Frothy, Blood Sputum
(f)Diminished Breath Sounds on Affected Side
(g)Tachycardia
(h)Flat Neck Veins
Hemothorax