Military medicine

Question 1

Role I

Answer 1

Self/buddy aid and battalion aid station

Question 2

Role II

Answer 2

Brigade/division level

• brigade support batt
• area medical support co
• forward surgical teams
• 1st level of blood products
• limited lab/rad
• pt hold capability

Question 3

Role III

Answer 3

Corps level (cache)

• combat support hospital
• in-theater mil facilities
• full surgical care
• hold, lab, rad (CT)
• stabilizing care for evac

Question 4

Role IV

Answer 4

Definitive care,
out of theater
Full rehab care
tertiary care

Question 5

Role V

Answer 5

USA hospital

Question 6

9 line responsibility

Answer 6

Not medics responsibility to fill out/call

Question 7

TCCC is

Answer 7

Highly developed, standardized, prehospital guidelines designed to address PVT causes of death

Question 8

3 phases of TCCC

Answer 8

1. Care under fire
2. Tatical field care
3. Casualty evac

Question 9

Phase 1 TCCC - care under fire

Answer 9

Active engagement w/ hostiles
1st priority- return fire/secure site to TXT pt
Medical care
-Tourniquets 
-field/pressure dressing

Question 10

Phase 2 TCCC - tactical field care

Answer 10

No more hostile fire
Longest phase
Maintain situational awareness 
Perform primary survey
Use TCCC principles
Perform secondary survey
Pain control

Question 11

Phase 3 TCCC - casualty evac

Answer 11

Preparation for MEDEVAC
-secure lines/tubes
-wrap pt correctly 
-ensure 9-line sent
MEDEVAC
-speak to flight medic
-inform injury status/inflight issues 
-have necessary meds
already measured/prepared

Question 12

PVT causes of death addressed w/ TCCC

Answer 12

Extremity hemorrhage
Hemo/pneumothorax
Hypothermia/coagulopathy

Question 13

TCCC principle to guide care

Answer 13

C-A-B
circulation, AW, breathing
MARCH
-Massive hemorrhage 
-AW
-Resp
-Circulation
-hypothermia/head injury

Question 14

Phase 2 TCCC - tactical field care addressing - breathing

Answer 14

Needle decompression
Occlusive chest wall dressing
Chest tubes

Question 15

Phase 2 TCCC - tactical field care addressing - Circulation

Answer 15

IV access - permissive HOTN/low-volume resus
IO (IV alternative)
Resus fluids (severe hypovolemic shock)

Question 16

Low-volume resus/permissive HOTN purpose

Answer 16

Wounds unable to control (abd - cant place tourniquet) - pvts blowing clot w/ too much fluids

Question 17

Resus fluids in order of preference

Answer 17

Fresh whole blood
1:1:1 ratio pRBCs,FFP, Plt
1:1 ratio pRBCs:FFP
plasma (FFP or freeze-dried)
Hextend
LR or plasmalyte

Question 18

PO fluids preferred when?

Answer 18

No massive hemorrhage or ABD injury or AMS

Question 19

MC fluid resus

Answer 19

Crystalloids

Question 20

Crystalloid precaution?

Answer 20

Do not over dilute clotting factors

Question 21

Whole blood best use when?

Answer 21

Severe hypovolemic shock and massive hemorrhage

Question 22

pRBCs and Plts are not ideal in field why?

Answer 22

Difficult storage/poor shelf life

Question 23

Phase 2 TCCC - tactical field care addressing - Hypothermia/head injury

Answer 23

Layered coverings
-Ensure secure during a MEDEVAC
-O2 if head injury
Maintain SBP 90-95 to perfuse brain

Question 24

Phase 2 TCCC - tactical field care addressing - pain control

Answer 24

Combat pill pack - lesser injuries (meloxicam/APAP)
Fentanyl - os 15m
Ketamine (IM,IV,IO,IN) 50mg Q30m
Ondansetron (PO) Q6hrs PRN for nausea due to pain meds

Question 25

Phase 2 TCCC - tactical field care addressing - ABX

Answer 25

Early ABX Moxifloxacin 400mg PO Cefotetan 2gm IV Ertapenem 1gm IV

Question 26

TCCC - tactical field care addressing - Special situation

Answer 26

Burns Mass casualties CPR Joint/international ops

Question 27

TCCC - tactical field care addressing - Burns

Answer 27

``` 1st - stop burning process TXT - other life threats Protect AW Keep pt warm Evac ASAP Be aware of tourniquet effect items/tapes ```

Question 28

Ensure to protect AW if pt has?

Answer 28

AMS Inhalation injury Facial burns TBSA >40%

Question 29

Acute fluid resuscitation of burns points for adults

Answer 29

Rule of 10s (adults) <80kg: 10mL/h x TSBA% >80kg: add 100mL/hr fir every 10kg over 80kg

Question 30

Acute fluid resuscitation of burns points for PEDs

Answer 30

3 x TSBA x wgt(kg) = amount given 1st 24hrs | 1/2 of that volume given 1st 8hrs

Question 31

Fluids used for acute fluids resus w/ Burn pts?

Answer 31

LR or PlasmaLyte A - use NS cautiously

Question 32

Monitoring urine output for burn pts?

Answer 32

Adults - 30-50mL/hr | PEDs - 0.5-1.0mL/kg/hr

Question 33

Triage categories

Answer 33

``` ID ME I- immediate D- delayed M- minimal E- expectant ```

Question 34

Immediate - triage category

Answer 34

Req medical intervention now to avoid death/disability

Question 35

Delayed - triage category

Answer 35

Req surgical intervention but may be delayed w.out endangering life, limb, eye site.

Question 36

Minimal - triage category

Answer 36

Minor injuries in which self/buddy aid will suffice

Question 37

Expectant - triage category

Answer 37

Injuries exceed resources/time or if TXT’d pt would still be expected to die

Question 38

Triage method: SALT

Answer 38

S- sort A- assess L- lifesaving interventions T- treatment/transport

Question 39

Triage method: simple - addressing AW

Answer 39

``` Moving air? Y- assess breathing N- open AW > moving air? Y- assess breathing N- EXPECTANT ```

Question 40

Triage method: simple - addressing - breathing

Answer 40

RR >30 breaths/min? Y- IMMEDIATE, address cause N- assess circulation

Question 41

Triage method: simple - addressing - circulation

Answer 41

Radial pulses weak/absent OR HR >140b/min? Y- IMMEDIATE, address cause N- assess AMS

Question 42

Triage method: simple - addressing - address AMS

Answer 42

Responds to commands? Y- not immediate N- IMMEDIATE, address cause

Question 43

CPR notes -

Answer 43

Situational dependent CPR need prehospital = expectant technically Dont perform CPR at expense of other pts No CPR under fire