Phase 3 Mod 1 Deck 1 Flashcards
________ is the movement of casualties via non-specialized vehicles (air or ground) with or without a trained medical attendant.
CASEVAC is the movement of casualties via non-specialized vehicles (air or ground) with or without a trained medical attendant.
In what condition does stress inoculation occur best at?
Stress inoculation occurs best at Condition Red.
What is the minimum weight for the use of the Rule of Tens for a burn patient?
The minimum weight for the use of the Rule of Tens for a burn patient is 40 kg (88 lbs).
According to the Rule of Tens, how much additional fluid per hour is added for a patient who weighs in between 110-119 kg (242 - 263 lbs)?
300 mL
Formula: TBSA (rounded to nearest 10) x 10 + 300 =
What is the battle field analgesia option for a patient experiencing moderate to severe pain, who is unable to stay in the fight and is not in shock or respiratory distress (and not at significant risk of developing shock or respiratory distress)?
The battle field analgesia option for a patient experiencing moderate to severe pain, who is unable to stay in the fight and is not in shock or respiratory distress (and not at significant risk of developing shock or respiratory distress) is:
1 - Oral Transmucosal Fentanyl Citrate (OTFC) 800 mg
Fear and performance are based on levels of physiological stimulation during battle, which are categorized with five conditions. What are those five conditions?
Fear and performance are based on levels of physiological stimulation during battle, which are categorized with five conditions. Those five conditions are:
1 - Condition White 2 - Condition Yellow 3 - Condition Red 4 - Condition Black 5 - Condition Grey
Narcan is indicated for patients experiencing:
Narcan is indicated for patients experiencing respiratory depression due to narcotic analgesics.
What are the two field antibiotics recommend for use per TC3 guidelines?
The two field antibiotics recommend for use per TC3 guidelines are:
1 - Moxifloxacin (avelox): 400 mg PO/IV qd
2 - Ertapenem (Invanz): 1 g IV/IM q 24 hr
What injury is contraindicated for the use of antibiotics?
Burn injuries are contraindicated for the use of antibiotics.
using antibiotics on a burn patient can set the stage for severe infections later on
What is line 5 of the 9-Line MEDEVAC?
Line 5 of the 9-Line MEDEVAC is the number of casualties by type.
L - Number of litter patients
A - Number of ambulatory patients
E - Number of escorts
What is the maximum time window for the administration of TXA?
The maximum time window for the administration of TXA (tranexamic acid) is 3 hours.
What is an effective way to bring the sympathetic nervous system under control when experiencing threat stress?
Breathing control is an effective way to bring the sympathetic nervous system under control when experiencing threat stress.
Controlled breathing stimulates the parasympathetic nervous system to counteract the sympathetic stimulation.
What is the standard dose of Zofran (ondansetron)?
The standard dose of Zofran (ondansetron) is 4 mg; Dose may be repeated after 20 minutes if symptoms persist.
Max dose of 8 mg in 8 hours
________ is anything that stimulates the sympathetic nervous system (fight or flight).
Threat stress is anything that stimulates the sympathetic nervous system (fight or flight).
Ex. Being under fire during combat
According to the Rule of Tens, how much additional fluid per hour is added for a patient who weighs in between 100-109 kg (220 - 241 lbs)?
200 mL
Formula: TBSA (rounded to nearest 10) x 10 + 200 =
Pupil dilation, tremors, tachycardia, vasoconstriction, bronchodilation, blood shunting and enhanced neuro stimulation are effects of which nervous system sub-division?
Pupil dilation, tremors, tachycardia, vasoconstriction, bronchodilation, blood shunting and enhanced neuro stimulation are effects of the Sympathetic Nervous System (fight or flight).
What is line 7 of the 9-Line MEDEVAC?
Line 7 of the 9-Line MEDEVAC is the LZ marking.
A - Panels B - Pyrotechnics C - Smoke D - None E - Other (specify)
Using the Rule of Nines:
What is the TBSA of the head, burned circumferentially?
The Total Burned Surface Area of the head, burned circumferentially, is 9%
(4.5% for front and 4.5% for the back of the head)
Why is it important that antibiotics be administered as soon as possible after injury?
It is important that antibiotics be administered as soon as possible after injury to maximize their ability to prevent wound infections.
What is line 6 of the 9-Line MEDEVAC?
Line 6 of the 9-Line MEDEVAC is the security at the LZ.
N - No enemy
P - Possible enemy
E - Enemy in area
X - Armed escort required
What is line 3 of the 9-Line MEDEVAC?
Line 3 of the 9-Line MEDEVAC is the number AND precedence of casualties.
A - Urgent
B - Priority
C - Routine
What is the battle field analgesia option for a patient experiencing mild to moderate pain and still able to fight?
The battle field analgesia option for a patient experiencing mild to moderate pain and still able to fight is:
1 - Tylenol 650 mg (APAP) x2, every 8 hours
2 - Meloxicam (mobic) 15 mg x1 daily.
What areas need to be thoroughly examined during the blood sweep (M of MARCH)?
The areas that need to be thoroughly examined during the blood sweep (M of MARCH) are the extremities, neck, axillary and inguinal areas.
The physiological effects seen from threat stress are under the influence of the (1)___________, which is a sub-system of the (2)_____________.
The physiological effects seen from threat stress are under the influence of the Autonomic Nervous System, which is a sub-system of the Peripheral Nervous System.
What is the standard dose of promethazine (Phenergan)?
The standard dose of promethazine (Phenergan) is 12.5 - 25 mg IV
promethazine (Phenergan) has a black box warning due to risk of serious tissue injury if administered incorrectly
What treatment and/or interventions are performed during the TFC phase of TCCC?
Assessment and treatment of preventable causes of death (MARCH algorithm) are performed to include all interventions within the scope of practice are performed during the Tactical Field Care of Tactical Combat Casualty Care.
According to the Rule of Tens, how much additional fluid per hour is added for a patient who weighs in between 90-99 kg (198 - 219 lbs)?
100 mL
Formula: TBSA (rounded to nearest 10) x 10 + 100 =
Using the Rule of Nines:
What is the TBSA of the torso, burned circumferentially?
The Total Burned Surface Area of the torso, burned circumferentially, is 36%
(18% for the front and 18% for the back of the torso)
What is stress inoculation?
Stress inoculation is the process of building a person’s resistance to the effects of threat stress.
(similar to inoculating a person to a disease and building resistance to it)
When is the 9-Line MEDEVAC called?
The 9-Line medevac is called during the Tactical Field Care phase of Tactical Field Care of Tactical Combat Casualty Care.
Is morphine sulfate acceptable for use on a patient experiencing altered mental status?
No, morphine sulfate is NOT acceptable for use on a patient experiencing altered mental status.
For burn patients, what is the maximum allowable volume of Hextend the patient can receive?
The maximum allowable volume of Hextend a burn patient can receive is 1000 milliliters.
What is the condition and beats per minute (BPM) associated with deteriorating fine motor skills?
Condition Yellow is associated with deteriorating fine motor skills at 115 bpm.
Prior to the medic going onto the “X”, what should the medic do while in CUF?
Prior to the medic going onto the “X”, the medic should shout:
1 - Instruct the casualty to return fire
2 - Instruct the casualty to apply self-aid
3 - Instruct the casualty to move to cover
Only if unable should the medic approach the casualty
What is the battle field analgesia option for a patient experiencing moderate to severe pain, who is unable to stay in the fight and is in shock or respiratory distress (or at a significant risk of developing shock or respiratory distress)?
The battle field analgesia option for a patient experiencing moderate to severe pain, who is unable to stay in the fight and is in shock or respiratory distress (or at a significant risk of developing shock or respiratory distress) is:
1 - Ketamine 50 mg IM/IN (repeat doses q 30 mins prn)
OR
2 - Ketamine 20 mg slow IV/IO (repeat doses q 20 mins prn)
What is the Rule of Tens formula?
(TBSA [rounded to nearest 10] x 10) + weight differential (90+ kg only)
Using the Rule of Nines:
What is the TBSA of the posterior torso?
The Total Burned Surface Area of the posterior torso is 18%
What are some indications to administer TXA?
Some indications to administer TXA (tranexamic acid) are:
1 - suspected hemorrhagic shock
2 - one or more major amputations
3 - penetrating torso trauma
4 - evidence of severe bleeding
When should antibiotics be administered in the field?
Antibiotics should be administered in the field as soon as possible.
Which condition is categorized by a pulse rate in excess of 175, irrational “fight or flight”, submissive behavior, loss of bowel and/or bladder control and maximum gross motor skill level?
Failure Mode is categorized by a pulse rate in excess of 175, irrational “fight or flight”, submissive behavior, loss of bowel and/or bladder control and maximum gross motor skill level.
Using the Rule of Nines:
What is the TBSA of the upper extremity, burned circumferentially?
The Total Burned Surface Area of the upper extremity, burned circumferentially, is 9%
What are the initial dosages of morphine sulfate?
The initial dosage of morphine sulfate (adult) is 4-10 mg IV/IO; 8-15 mg IM
(5 mg IV every 10 mins until pain is controlled [max of 20 mg])
What is the TBSA of the entire lower extremity, burned circumferentially?
The TBSA of the entire lower extremity, burned circumferentially, is 18%
(The leg is divided into four 4.5% sections; upper and lower, anterior and posterior)
_________ burns involve pain, blistering and reddening.
Second-degree (partial thickness) burns involve pain, blistering and reddening.
Which condition is categorized by having normal pulse rate, respiratory rate, fine motor skills and normal cognitive abilities?
Condition White is categorized by having normal pulse rate, respiratory rate, fine motor skills and normal cognitive abilities.
Ex. Deployed Soldier in his/her billet or recreation area.
What is the medication (and dose) for a patient presenting with signs and symptoms of suspected hemorrhagic shock, one or more major amputations, penetrating torso trauma, and/or evidence of severe bleeding?
The medication (and dose) for a patient presenting with signs and symptoms of suspected hemorrhagic shock, one or more major amputations, penetrating torso trauma, and/or evidence of severe bleeding is TXA (tranexamic acid).
The dose is 1 gm of TXA in 100 mL of NS or LR over 10 minutes.
Why is lactated ringers preferred over normal saline when treating burn patients?
lactated ringers preferred over normal saline (NS) when treating burn patients because burn patients typically require large volumes of IV fluid. Receiving large amounts of NS cause cause patients to develop a condition known as hyperchloremic acidosis due to the large quantity of chloride in the NS.
What are the current medications provided to reduce pain (analgesics)?
The current medications provided to reduce pain (analgesics) are:
1 - Aspirin (ASA) 2 - Acetaminophen (APAP) -- Tylenol 3 - Ibuprofen (Motrin, Advil) 4 - Naproxen (Aleve, Naprosyn) 5 - Fentanyl 6 - Morphine 7 - Ketamine
According to recent data from Iraq and Afghanistan (2013), what resulted in the greatest number (percentage wise) of combat fatalities?
According to recent data from Iraq and Afghanistan (2013), non-compressible hemorrhage resulted in the greatest number (69%) of combat fatalities.
Which nervous system sub-division stimulates digestion, slowing of the heart rate and respirations?
The parasympathetic nervous system stimulates digestion, slowing of the heart rate and respirations (feed and breed).
Which condition is a special level within Condition Black?
Condition Grey a special level within Condition Black.
For patients suffering 20% or greater TBSA, what should the medic consider doing for the patient?
For patients suffering 20% or greater TBSA, the medic should consider utilizing a heat-reflective shell blanket
(treat for hypothermia)
What are the three phases of TCCC?
The three phases of Tactical Combat Casualty Care are:
1 - Care Under Fire (CUF)
2 - Tactical Field Care (TFC)
3 - Tactical Evacuation Care (TACEVAC)
Which condition is categorized by experiencing limited (mild) stimulation, presenting with a pulse rate of 80 - 115 bpm, heightened awareness, relatively normal respiration rate, slightly elevated blood pressure and minor tremors?
Condition Yellow is categorized by experiencing limited (mild) stimulation, presenting with a pulse rate of 80 - 115 bpm, heightened awareness, relatively normal respiration rate, slightly elevated blood pressure and minor tremors.
Ex. Locking and loading while rolling out the wire
Fine motor skills deteriorate at 115 bpm
What is line 4 of the 9-Line MEDEVAC?
Line 4 of the 9-Line MEDEVAC is special equipment required.
A - none B - Hoist C - Extraction D - Ventilator E - Other (specify)
_________ burns involve superficial burns of the epidermis only; characterized as being red and painful.
First-degree burns involve superficial burns of the epidermis only; characterized as being red and painful.
What is a potential special consideration when administering ketamine and OTFC (fentanyl)
Ketamine and OTFC (fentanyl) have the potential to worsen severe traumatic brain injury (TBI)
What is the purpose for applying Silvalon dressings?
Silvalon dressings are impregnated with a silver compound which helps prevent infection.
What is line 2 of the 9-Line MEDEVAC?
Line 2 of the 9-Line MEDEVAC is the requesters call sign and frequency.
For burn patients, what is the target urine output (UOP) subsequent to fluid resuscitation?
he target urine output (UOP) subsequent to fluid resuscitation is 30 - 35 mL/Hr for burn patients.
________ is the movement of large numbers of casualties.
STRATEVAC is the movement of large numbers of casualties.
What medication is incompatible with the administration of TXA?
Hextend (IV fluid medication) is incompatible with the administration of TXA (tranexamic acid).
What level of care is administered when the causality and/or medic are still under effective enemy engagement?
Care Under Fire (CUF) is administered when the causality and/or medic are still under effective enemy engagement.
(1) What is an effective method of controlled breathing? (2) What is it used for?
(1) An effective method of controlled breathing is slow, deep inhalation lasting 4 seconds, holding it for 4 seconds, and a slow, full exhalation lasting 4 seconds.
(2) Controlled breathing stimulates the parasympathetic nervous system to counteract the sympathetic stimulation.
What is the standard dose of Narcan (naloxone)?
The standard dose of Narcan (naloxone) is 0.2 - 4.0 mg
What is the classification of ketamine?
The classification of ketamine is a dissociative anesthetic
How often is ketamine administered via IM/IN repeated?
ketamine administered via IM/IN (50 mg) is repeated every 30 mins as needed until symptoms subside or development of nystagmus.
____________ is the process of building a person’s resistance to the effects of threat stress.
Stress inoculation is the process of building a person’s resistance to the effects of threat stress.
(similar to inoculating a person to a disease and building resistance to it)
Using the Rule of Nines:
What is the TBSA of the anterior torso?
The Total Burned Surface Area of the anterior torso is 18%
_________ burns involve all levels of skin to include underlying fat, muscles, bones, and internal organs.
Forth-degree burns involve all levels of skin to include underlying fat, muscles, bones, and internal organs.
What are the contraindications for the OTFC?
Contraindications for the use of the Oral Transmucosal Fentanyl Citrate (800 mcg) is suspected head trauma and maxillofacial injury
What does the MARCH acronym stand for?
The MARCH acronym stands for:
M - Massive hemorrhage A - Airway R - Respirations C - Circulation H - Hypothermia/ Head Injury
What is the drug classification of Zofran (ondansetron)?
The drug classification of Zofran (ondansetron) is an anti-emetic, used to relieve nausea.
What are the two main divisions of the nervous system?
The two main divisions of the nervous system are:
1 - Central Nervous System (CNS)
2- Peripheral Nervous System (PNS)
Medications:
What is the OTFC?
The OTFC is the Oral Transmucosal Fentanyl Citrate
What are the three goals of TCCC?
The three goals of Tactical Combat Casualty Care are:
1 - Complete the mission
2 - Prevent additional casualties
3 - Save preventable deaths
What are the two sub-divisions of the Autonomic Nervous System?
The two sub-divisions of the Autonomic Nervous System are:
1 - Sympathetic Nervous System
2- Parasympathetic Nervous System
Which condition is categorized by experiencing maximum stimulation, resulting in a pulse rate of 145 - 175, decrease in cognitive abilities, loss of depth perception, peripheral vision, near vision as well as auditory exclusion (decreased hearing)?
Condition Black is categorized by experiencing maximum stimulation, resulting in a pulse rate of 145 - 175, decrease in cognitive abilities, loss of depth perception, peripheral vision, near vision as well as auditory exclusion (decreased hearing).
Which condition is categorized by experiencing significant stimulation, resulting in a pulse rate of approximately 115 - 145, increased respirations and utilization of complex motor skills only with cognitive and visual reaction time at its peak?
Condition Red is categorized by experiencing significant stimulation, resulting in a pulse rate of approximately 115 - 145, increased respirations and utilization of complex motor skills only with cognitive and visual reaction time at its peak.
Ex. Middle of fire fight/Combat
_________ burns involve painless, charred skin, eschar with pain associated from surrounding tissue.
Third-degree (full thickness) burns involve painless, charred skin, eschar with pain associated from surrounding tissue.
What are the two sud-divisions of the Peripheral Nervous System (PNS)?
The two sud-divisions of the Peripheral Nervous System (PNS) are:
1 - Somatic Nervous System
2 - Autonomic nervous system
How often is ketamine administered via slow IV/IO repeated?
ketamine administered via slow IV/IO (20 mg) is repeated every 20 mins as needed until symptoms subside or development of nystagmus.
What is the process of scrutinization when used as a stressor?
Scrutinization, when used as a stressor, involves getting the student to “second guess” themselves.
Ex. “Do you really want to do that right now?”
What interventions are performed during the CUF phase of TCCC?
The only intervention performed during the Care Under Fire phase of Tactical Combat Casualty Care is tourniquet application.
Hasty tourniquets, high n’ tight
When evacuation of burn patients is delayed 24+ hours, what medical should the medic consider?
When evacuation of burn patients is delayed 24+ hours, the medic should consider applying Silvalon dressings.
The __________ controls the sensory nerves and the efferent, motor nerves (intentional movement and sensation).
The Somatic Nervous System controls the sensory nerves and the efferent, motor nerves (intentional movement and sensation).
According to new TCCC guidelines, how long should the NCD needle remain within the catheter after insertion?
According to new Tactical Combat Casualty Care guidelines, the Needle Chest Decompression needle should remain within the catheter for 5 - 10 seconds after insertion.
What is a MIST report?
A mist report is:
M- Mechanism of Injury
I - Injury type / Injury sustained
S - Signs and symptoms
T - Treatment
What is the TCCC card form number?
The TCCC (TC3) card form number is DD Form 1380
What are the two most common antibiotics stocked in the BAS SKO?
The two most common antibiotics stocked in the BAS SKO are:
1 - Ancef (cefazolin) 1-2 g IV/IM every 8 hrs
2 - Rocephin (cerftriaxone) 1-2 g IV/IM every 8 hrs
________ is evacuation on a dedicated medical vehicle (air or ground) with a trained medical attendant on board.
MEDEVAC is evacuation on a dedicated medical vehicle (air or ground) with a trained medical attendant on board.
According to the Rule of Tens, how much additional fluid per hour is added for a patient who weighs in between 80-89 kg (179 - 197 lbs)?
0 mL
Formula: TBSA (rounded to nearest 10) x 10 + 0=
The __________ controls automatic (involuntary) body functions (unconscious body functions).
The Autonomic Nervous System controls automatic (involuntary) body functions (unconscious body functions).
What is the preferred dosage (adult) for ketamine?
The preferred dosage (adult) for ketamine is 20 mg slow IV/IO push over 1 minute; Repeated every 20 minutes as needed.
What is the formula to calculate a drip rate?
(desired dose) x (gtt) / (60)
What level of care is administered when the causality and the medic are behind cover?
Tactical Field Care (TFC) is administered when the causality and the medic are behind cover.
Narcotics are indicated for _________ casualties with normal mental status, experiencing moderate to severe pain.
Narcotics are indicated for conscious casualties with normal mental status, experiencing moderate to severe pain.
no need to sedate an unconscious patient
What is the greatest concern for inhalation burns?
The greatest concern for inhalation burns is airway edema resulting in an inadequate airway.
What is line 1 of the 9-Line MEDEVAC?
Line 1 of the 9-Line MEDEVAC is location (grid coordinates) of unit/casualty
8 or 10 digit grid coordinates
Which condition is categorized by the performance of simple motor functions by very well trained Soldiers?
Condition Grey is categorized by the performance of simple motor functions by very well trained Soldiers.
Condition Grey is a special level within Condition Black
