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Emed 4 > Military medicine > Flashcards

Military medicine Flashcards

1
Q

Role I

A

Self/buddy aid and battalion aid station

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2
Q

Role II

A

Brigade/division level

  • brigade support batt
  • area medical support co
  • forward surgical teams
  • 1st level of blood products
  • limited lab/rad
  • pt hold capability
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3
Q

Role III

A

Corps level (cache)

  • combat support hospital
  • in-theater mil facilities
  • full surgical care
  • hold, lab, rad (CT)
  • stabilizing care for evac
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4
Q

Role IV

A

Definitive care,
out of theater
Full rehab care
tertiary care

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5
Q

Role V

A

USA hospital

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6
Q

9 line responsibility

A

Not medics responsibility to fill out/call

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7
Q

TCCC is

A

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

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8
Q

3 phases of TCCC

A
  1. Care under fire
  2. Tatical field care
  3. Casualty evac
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9
Q

Phase 1 TCCC - care under fire

A 
Active engagement w/ hostiles
1st priority- return fire/secure site to TXT pt
Medical care
-Tourniquets 
-field/pressure dressing
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10
Q

Phase 2 TCCC - tactical field care

A 
No more hostile fire
Longest phase
Maintain situational awareness 
Perform primary survey
Use TCCC principles
Perform secondary survey
Pain control
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11
Q

Phase 3 TCCC - casualty evac

A 
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
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12
Q

PVT causes of death addressed w/ TCCC

A

Extremity hemorrhage
Hemo/pneumothorax
Hypothermia/coagulopathy

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13
Q

TCCC principle to guide care

A 
C-A-B
circulation, AW, breathing
MARCH
-Massive hemorrhage 
-AW
-Resp
-Circulation
-hypothermia/head injury
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14
Q

Phase 2 TCCC - tactical field care addressing - breathing

A

Needle decompression
Occlusive chest wall dressing
Chest tubes

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15
Q

Phase 2 TCCC - tactical field care addressing - Circulation

A

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

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16
Q

Low-volume resus/permissive HOTN purpose

A

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

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17
Q

Resus fluids in order of preference

A 
Fresh whole blood
1:1:1 ratio pRBCs,FFP, Plt
1:1 ratio pRBCs:FFP
plasma (FFP or freeze-dried)
Hextend
LR or plasmalyte
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18
Q

PO fluids preferred when?

A

No massive hemorrhage or ABD injury or AMS

19
Q

MC fluid resus

A

Crystalloids

20
Q

Crystalloid precaution?

A

Do not over dilute clotting factors

21
Q

Whole blood best use when?

A

Severe hypovolemic shock and massive hemorrhage

22
Q

pRBCs and Plts are not ideal in field why?

A

Difficult storage/poor shelf life

23
Q

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

A

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

24
Q

Phase 2 TCCC - tactical field care addressing - pain control

A

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

25
Q

Phase 2 TCCC - tactical field care addressing - ABX

A

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

26
Q

TCCC - tactical field care addressing - Special situation

A

Burns
Mass casualties
CPR
Joint/international ops

27
Q

TCCC - tactical field care addressing - Burns

A 
1st - stop burning process
TXT - other life threats
Protect AW
Keep pt warm
Evac ASAP
Be aware of tourniquet effect items/tapes
28
Q

Ensure to protect AW if pt has?

A

AMS
Inhalation injury
Facial burns
TBSA >40%

29
Q

Acute fluid resuscitation of burns points for adults

A

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

30
Q

Acute fluid resuscitation of burns points for PEDs

A

3 x TSBA x wgt(kg) = amount given 1st 24hrs

1/2 of that volume given 1st 8hrs

31
Q

Fluids used for acute fluids resus w/ Burn pts?

A

LR or PlasmaLyte A - use NS cautiously

32
Q

Monitoring urine output for burn pts?

A

Adults - 30-50mL/hr

PEDs - 0.5-1.0mL/kg/hr

33
Q

Triage categories

A 
ID ME
I- immediate
D- delayed
M- minimal
E- expectant
34
Q

Immediate - triage category

A

Req medical intervention now to avoid death/disability

35
Q

Delayed - triage category

A

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

36
Q

Minimal - triage category

A

Minor injuries in which self/buddy aid will suffice

37
Q

Expectant - triage category

A

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

38
Q

Triage method: SALT

A

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

39
Q

Triage method: simple - addressing AW

A 
Moving air?
Y- assess breathing
N- open AW > moving air?
Y- assess breathing
N- EXPECTANT
40
Q

Triage method: simple - addressing - breathing

A

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

41
Q

Triage method: simple - addressing - circulation

A

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

42
Q

Triage method: simple - addressing - address AMS

A

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

43
Q

CPR notes -

A

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

Emed 4 (10 decks)

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