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Trauma > Organization of Trauma Care > Flashcards

Organization of Trauma Care Flashcards

1
Q

The process of prioritizing patient treatment during mass casualty events based on their need for or likely benefit from immediate medical attention

A

Triage

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2
Q

Triage categories are based upon:

A

Number of injured

Available resources

Nature and extent of injuries

Change in patient’s condition

Hostile threats in the area

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3
Q

The number of patients and the severities of their injuries DO NOT exceed the resources and capabilities

A

Multiple casualties

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4
Q

The number of patients and the severities of their injuries DO exceed the resources and capabilities

A

Mass casualty

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5
Q

Five principles of triage

A

Degree of life threat posed by the injuries sustained

Injury severity

Salvageability

Resources

Time, distance, and environment

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6
Q

Categories of military triage

A

Immediate

Delayed

Minimal

Expectant

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7
Q

Needs lifesaving interventions within minutes up to 2 hours on arrival to avoid death or major disability

A

Immediate

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8
Q

1) Massive Hemorrhage
2) Airway obstructions or potential compromise, including potential complications from facial burns or anaphylaxis
3) Tension pneumothorax
4) Penetrating chest wound WITH respiratory distress
5) Torso, neck, or pelvis injuries WITH shock
6) Head injuries requiring emergent decompression
7) Threatened loss of limb
8) Retrobulbar hematoma (threat to loss of sight)
9) Multiple extremity amputations

A

Immediate

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9
Q

Requires medical attention but CAN wait

A

Delayed

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10
Q

Examples include those who show NO signs of shock with the following injuries:

1) Soft tissue injuries without significant bleeding.
2) Fractures
3) Compartment syndrome
4) Intra-abdominal and/or thoracic wounds
5) Moderate to severe burns with less than 20% of total body surface area
6) Blunt or penetrating torso injuries without the signs of shock
7) Facial fractures without airway compromise
8) Globe injuries

A

Delayed

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11
Q

Can be treated with self aid, buddy aid, and corpsman aid

A

Minimal

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12
Q

Often referred to as “walking wounded”

A

Minimal

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13
Q

1) Minor burns, lacerations, contusions, sprains and strains.
2) Simple, closed fractures without neurovascular compromise.
3) Combat stress reaction.

A

Minimal

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14
Q

Require complicated treatments that may not improve life expectancy

A

Expectant

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15
Q

1) Massive head injuries with signs of impending death or in coma.
2) Cardiopulmonary failure.
3) Clearly dead casualty with no signs of life or vital signs regardless of mechanism of injury.
4) Second and third degree burns in excess of 85% total body surface area.
5) Open pelvic injuries with uncontrolled bleeding and class IV shock.
6) High spinal cord injuries

A

Expectant

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16
Q

Fourth stripe on the triage tag, casualties are dead or non-salvageable and entails no care is needed

A

Black (deceased/expectant)

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17
Q

Third stripe on the triage tag, casualties have minor injuries and will need minimal care

A

Green (minimal)

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18
Q

Second stripe on the triage tag, casualties are in the most need of care and or transport to a higher echelon of care

They should receive care before all other casualties

A

Red (immediate)

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19
Q

First stipe on the tag, casualties will need care, but in no hurry

They will be transported only after the more critically injured have been stabilized and transported

A

Yellow (delayed)

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20
Q

Simply and quickly categorizing patients; identifying and stop life threats. Breaks down patients down into more manageable groups.

A

Primary Triage

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21
Q

Allows for adjustment on patient response, to direct more in-depth treatment and prepare for a nine-line medical evacuation request

A

Secondary triage

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22
Q

Stage of triage that includes immediate life sustaining care

A

Primary triage

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23
Q

Stage of triage that includes documenting, reassessing, and sorting patients by their treatment needs

A

Secondary triage

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24
Q

Stage of triage where you begin the MEDEVAC/CASEVAC considerations and request the medical evacuation if not already done

A

Secondary triage

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25
Q

Continued management of patients where more complicated procedures should be weighed against the situation

A

Tertiary triage

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26
Q

(a) Reassess condition of patients relevant to resources, transportation capabilities and medical facilities available to receive casualties.
(b) Determine the priority for disposition of patients from incident site.
(c) CPR should only be considered for non-traumatic disorders such as hypothermia, near drowning, or electrocution

A

Tertiary triage

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27
Q

Early trauma deaths are due to disruptions in one, or all, of three bodily systems:

A

Respiratory system

Vascular system

Nervous system

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28
Q

Category of stress

Immediate return to duty or return to unit or unit’s noncombat support element with duty limitations or rest

A

Light stress

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29
Q

Category of stress

Send to combat stress control restoration center for up to 3 days reconstitution

A

Heavy stress

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30
Q

Mnemonic used for combat stress

A

BICEP SO

Brief: Keep interventions to 3 days or less of rest, food, and reconditioning

Immediate: Treat as soon as symptoms are recognized

Central: Keep in one area for mutual support and identity of SVM

Expectant: Reaffirm that we expect them to return to duty

Proximal: Keep them as close as possible to the unit

Simple: Do not engage in psychotherapy. Address the present stress response and situation only, using rest, limited catharsis and brief support

Or refer: Must be referred to a facility that is better equipped or staffed for care

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31
Q

TCCC

Get the patients who are not clearly dead to cover if possible

Continue with the mission/fight. Gain fire superiority.

A

Care under fire

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32
Q

TCCC

Perform an initial rapid assessment of the casualty for triage purposes. This should take no more than 1 minute per patient

Perform immediate lifesaving interventions as indicated. Move rapidly

A

Tactical Field Care

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33
Q

Talk to the casualty when checking radial pulse. If the patient obeys commands and has strong radial pulse, they have a >___% chance of living

Should be categorized as minimal or delayed

A

> 95%

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34
Q

If patient obeys commands, but has weak and absent pulse, he/she is at increased risk of dying and may benefit from a lifesaving intervention

This patient should be categorized as ________

A

Immediate

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35
Q

If the casualty does not obey commands and has a weak or absent radial pulse, the casualty has markedly increased risk of dying of >__%

Patient needs lifesaving intervention and should be categorized as immediate or possibly expectant

A

> 92%

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36
Q

Quickly choose a casualty collection point based on:

A

Proximity to patients

Proximity to vehicular access

Proximity to HLZ

Geography, safety “geographic triage”

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37
Q

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

Treatment provided by self aid, buddy aid, combat life saver

A

Level (role/echelon) 1

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38
Q

Levels of care

1) Battalion Aid Station
2) Cruisers, Destroyers

A

Level (role/echelon) 1

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39
Q

Initial resuscitative care is the primary objective of care at this level

Saving life, limb, and when necessary stabilization for evacuation

A

Level 2

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40
Q

Examples of Level 2

A

LHD

LHA

CVN

MEDBN

STP

FRSS

R2LM

R2E

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41
Q

Provides surgical care for the Marine Expeditionary Forces. Provides stabilizing surgical procedures capable of holding patients for 72 hours

A

Medical Battalion (MEDBN)

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42
Q

A small forward unit with one physician supporting the MEF, specializing in patient stabilization and casualty evacuation, but does not have surgical capabilities. ATLS intensive consisting of a stabilization section and collecting/evacuation.

A

Shock trauma platoon (STP)

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43
Q

Forward deployed surgical suite developed due to the medical battalion being too large

A

Forward resuscitative surgical suite (FRSS)

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44
Q

Light, highly mobile medical units designed to support lane maneuver formations. Conducts advanced resuscitation procedures up to damage control surgery. Casualties will leave this level and be transported to either role 3 or R2E.

A

Role 2 light maneuver (R2LM)

45
Q

Provides basic secondary healthcare built around primary surgery, intensive care unit, and ward beds. Able to stabilize patients for evacuation to role 4 without having to route them through a role 3.

A

Role 2 enhanced

46
Q

The highest level of care available within a combat zone

Advanced resuscitative care is the primary objective of care

A

Level 3

47
Q

Examples of Level 3

A

Fleet hospitals

Hospital ships

48
Q

Definitive medical care is the primary objective at this level

A

Level 4

49
Q

Examples of Level 4

A

NH Yokosuka

Landstuhl regional medical center

50
Q

Restorative and rehabilitative care is the primary objective of care at this level

A

Level 5

  • NMCSD
  • Walter Reed National Medical Center
51
Q

Timely, efficient movement and en route care provided by medical personnel to the wounded being evacuated from the battlefield to the military treatment facility (MTF) using medically equipped vehicles or aircraft. This includes transportation from one MTF to another by medical personnel, such as ship to shore.

A

MEDEVAC

52
Q

The movement of casualties from the point of injury to medical treatment by non-medical personnel. Casualties transported under these circumstances may not receive en route medical care. Usually a lift of opportunity

A

CASEVAC

53
Q

Generally, utilizes USAF fixed-winged aircraft to move sick or injured personnel within the theater or operations (Intra-theater) or between two theaters (Inter-theater). This is a regulated system in which care is provided by AE crewmembers. The crew may be augmented with Critical Care Air Transport Teams (CCATTs) to provide intensive care unit level of care.

A

Aeromedical Evacuation (AE)

54
Q

The maintenance of treatment imitated prior to evacuation and sustainment of the patient’s medical condition during evacuation

A

En route care

55
Q

Prefabricated and may have accessories to be used with them.

(a) Standard collapsible litter most widely used in theater.
(b) Litter can be decontaminated.

A

Standard litter

56
Q

Most commonly used litter onboard ships.

(a) Composed of steel or aluminum with a tubular frame with a wooden slat to support patients back.
(b) It has ropes, cables or steel rings that can be attached to the litter for vertical recoveries.

A

Stokes

57
Q

Compact and lightweight transport system used to evacuate a patient over land. Can also be used to rescue a patient in water.

A

SKED litter

58
Q

Made from various materials normally available in a forward area.

(a) Great for manual carries or may have an injury that may be aggravated by manual transport.
(b) Must be well constructed to avoid dropping patient or furthering injury.

A

Improvised litter

59
Q

In moving a patient, the litter bearers must make every movement deliberately and gently as possible. The command “_______” should be used in order to prevent undue haste.

A

Steady

60
Q

Patients must be carried on the litter feet first, except when:

A

Going uphill/upstairs

61
Q

Consider cabin altitude (CAR) for the following:

A

Penetrating eye injuries with intraocular air

Free air in any body cavity

Severe pulmonary disease

Decompression sickness and Arterial gas embolism

62
Q

MEDEVAC/CASEVAC Priorities

Casualty must be evacuated within 2 hours in order to save life, limb or eye sight

A

Urgent

63
Q

MEDEVAC/CASEVAC Priorities

Casualty must be evacuated within 4 hours or condition could worsen

A

Priority

64
Q

MEDEVAC/CASEVAC Priorities

Casualty must be evacuated within 24 hours for further care

A

Routine

65
Q

First five lines of the MEDEVAC Request (9 line)

A

Location

Frequency

Number of patients by precedence

Special equipment needed

Number of patients by type

66
Q

Last 4 lines of MEDEVAC request (9-line)

A

Security of pickup site

Method of marking pickup site

Patient nationality and status

NBC Contamination

67
Q

Instituted as a standard part of the MEDEVAC request during OEF in Afghanistan. Although not a requirement per NATO guidelines it has become a norm in combat theaters.

A

MIST reporting

68
Q

MIST stands for:

A

Mechanism of Injury

Injuries Sustained

Signs/symptoms

Treatment

69
Q

The branch of mechanics that studies the motion of a body or a system of bodies without consideration given to its mass or the forces acting on it, its essence revolves around motion. All injury, except thermal and radiation, are related to the interaction of the host and a moving object.

A

Kinematics

70
Q

Every object will remain at rest or in uniform motion unless compelled to change its state by the action of an external force. We know it more commonly as Inertia.

A

Newton’s first law

71
Q

Defines a force (F) as equal to the product of the mass (m) and acceleration (a). F=ma.

A

Newton’s second law

72
Q

Mass x acceleration/deceleration

A

Force

73
Q

The forms energy can take are:

A

Mechanical

Thermal

Electrical

Chemical

74
Q

Theodore Kocher first proposed that the kinetic energy possessed by the bullet was dissipated in what ways:

A

Heat

Energy used to move tissue radically outward

Energy used to form a primary path by direct crush of the tissue

75
Q

When a solid object strikes the human body or when the body is in motion and strikes a stationary object, the tissue particles are knocked out of their normal position creating a hole or cavity. This process is known as __________

A

Cavitation

76
Q

The characteristics of damage created along the track of a bullet are divided into two components

A

Temporary and permanent cavities

77
Q

Bullets can be constructed to alter their performance and increase the permanent cavity after they strike their target. This can be enhanced in four ways that all work by increasing the surface area of the projectile- tissue interface which facilitates the transfer of kinetic energy to the target. These include the following

A

Yaw

Tumbling

Deformation

Fragmentation

78
Q

The deviation of the projectile in its longitudinal axis from the straight line of flight

A

Yaw

79
Q

The forward rotation around the center of mass

A

Tumbling

80
Q

Mushrooming of the projectile that increases the diameter of the projectile, usually by a factor of 2, increases the surface area, and, hence, the tissue contact area by four times; hollow point, soft nose, and dum-dum bullets

A

Deformation

81
Q

In which multiple projectiles can weaken the tissue in multiple places and enhance the damage rendered by cavitation. This usually occurs in high-velocity missiles.

A

Fragmentation

82
Q

Penetrating trauma depends on:

A

Speed of entry

Type of body tissue penetrated

83
Q

Energy Levels of Projectiles

Knives, needles, ice picks (hand-driven weapons)

1) Tissue damage by crushing is minimal
2) Throat, thoracic, abdominal, and back stabbing

A

Low

84
Q

Energy Levels of Projectiles

Firearms with muzzle velocity of less than 1,500 feet second. (.357 magnum, 9 mm, .45 auto)

A

Medium

85
Q

Energy Levels of Projectiles

Firearms with muzzle velocity of more than 1500 feet per second. (.44 magnum, .50 AE)

Injury track of high-powered weapons are at least 2-3 times the diameter of the projectile

A

High

86
Q

Tissue crush is limited by the:

A

Physical size or profile of the projectile

87
Q

Missiles that flatten upon impact

A

Deformation

88
Q

Tolerate damage better than non-elastic organs (heart, liver, kidney and brain.)

A

Elastic tissue (bowel and lung)

89
Q

____ velocity produces more energy and more cavitation

A

High

90
Q

_____ velocity produces localized injury and little force

A

Low

91
Q

Range

The most devastation

A

Direct contact

92
Q

Close range =

A

7 yards or less

93
Q

High power =

A

More damage with muzzle velocities

94
Q

The two signs, which remain absolute indications for laparotomy following penetrating or blunt abdominal trauma are:

A

Peritonitis

Hemodynamic instability

95
Q

Penetrating injuries to the head, particularly gunshot wounds to the head can carry as high as __% mortality

A

90%

96
Q

Neck

The majority of penetrating trauma is a result of:

A

Stabbings and gunshots

97
Q

High velocity injuries, (>2,500 feet/second), such as high-powered rifles, often generate a missile velocity which has ____ times more energy generated than handguns that are associated with substantially lower missile velocities

A

60

98
Q

Thoracic injuries are common following both penetrating and blunt trauma and it has been estimated that chest injuries are responsible for ___% of all trauma deaths.

A

20 to 25%

99
Q

The approach to thoracic injuries typically depends upon the:

A

Mechanism

Severity

Location of injury

100
Q

Stab wounds to the back result in significant injuries requiring surgical repair in only about ___% of patients.

A

15%

101
Q

The mere presence of a gunshot wound to the abdomen with potential violation of the peritoneum equals a:

A

Laparotomy

102
Q

The great majority of vascular injuries are due to _______ trauma

A

Penetrating

103
Q

As an IDC, your focus should be on:

A

Early identification and location of penetrating trauma

Stabilization of the patient and MEDEVAC/CASEVAC to a higher echelon of care as soon as the patient(s) can tolerate the transfer.

104
Q

Blast injuries are subdivided into four categories:

A

Primary

Secondary

Tertiary

Quaternary

105
Q

Blast injury

Effects of Overpressure and Underpressure from a blast wave-is distinctly uncommon in surviving casualties except in the form of perforated tympanic membranes.

A

Primary

106
Q

Blast injury

Flying Debris/fragments, missiles in conjunction with the “blast wind” (i.e., the mass of air displaced by the explosion) are responsible for the gross mutilation that is characteristic of such injuries

A

Secondary

107
Q

Blast injury

Body displacement

A

Tertiary

108
Q

Blast injury

Burns

A

Quaternary

Trauma (12 decks)

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