PRINCIPLES OF PROLONGED CARE

Question 1

definition of what?
beyond TCCC and exceeds doctrinal planning guidelines. “Begins when evac doesn’t”

Answer 1

Prolonged Field Care (PFC)

Question 2

Reasons for PFC

Answer 2

(a) Long evac times
(b) Indigenous capabilities
(c) Requires different skills
(d) Different environments

Question 3

What is the Operational planning and logistics RTHP mean?

Answer 3

Ruck
Truck
House
Plane

Question 4

what part of the RTHP
gear carried to furthest point usually by medical personnel

Answer 4

RUCK

Question 5

what part of the RTHP
additional gear carried in vehicles

Answer 5

TRUCK

Question 6

what part of the RTHP
gear available to IDC/Medical personnel however, can only realistically be maintained at house/tent/FOB or support site. “highest level of care unit has”

Answer 6

HOUSE

Question 7

what part of the RTHP
planning stage to consider how casualties will be moved

Answer 7

PLANE

Question 8

Three Phases of PFC

Answer 8

(1) Evaluation phase
(2) Resuscitation Phase
(3) Transport Phase

Question 9

What phase of PFC
(a) Prevent hypothermia,
(b) Secure patient and litter,
(c) Splinting,
(d) Monitors and cuffs,
(e) Emergency meds,
(f) Sedation pain,
(g) Secure tubing
(h) Documentation of patient condition, response to therapy and treatment rendered

Answer 9

Transport Phase

Question 10

What phase of PFC
(a)During this time procedures and steps taken to normalize vitals and reverse physiological effects based on skill set available
(b)Shock –
-1)Crystalloid for burns
-2)Bleeding TXA, FWB or blood products,
-3)Distributive crystalloid +/- pressor,
-4)Obstructive chest tube and pleurovac
(c) Lethal triad addressed – hypothermia, acidosis, coagulopathy + sepsis
(d) Re-evaluate for life, limb, eyesight conditions and re-evaluate resuscitation efforts
(e) Nursing care – hydration, tubes, meds, padding
(f) Telemedicine

Answer 10

Resuscitation Phase

Question 11

What phase of PFC
Systematic approach priority to treat life threats in order of severity
1) Resuscitation and lifesaving procedures
2) Treat shock
3) Completion or MARCH and
4) Upgrading stopgaps (intubating, cricothyrotomy, chest tubes, etc.)
5) Initiate evacuation plan

Answer 11

Evaluation phase

Question 12

What is the lethal triad?
What phase of PFC is it in?

Answer 12

hypothermia, acidosis, coagulopathy + sepsis
Resuscitation phase

Question 13

There are no documents cases of permanent tissue damage, nerve damage or vascular injury from properly applied TQ in place for less than how long?

Answer 13

2 hours

Question 14

_________ is a deliberate process where the clinician downgrades to hemostatic agents and or pressure dressing. This should be attempted as soon as tactically appropriate.

Answer 14

TQ conversion

Question 15

TQ conversion Should not be attempted for TQ’s in place longer than how long?

Answer 15

6 hours
- unless it occurs at definitive care facility.

Answer 16

1. Add 1 loose TQ to each extremity
2. Loosen first TQ if no bleeding leave TQs dress wound
3. If bleeding is noted, apply a hemostatic agent and hold pressure for 3-5 minutes. If no further bleeding, leave TQs in place and dress wound.
   4) If hemostatic agents fail to control the bleeding, tighten the original TQ in as distal a position as possible to control the bleeding. Leave the “Plus 1” TQ loose and proximal to the tightened TQ.

Question 17

TQ conversion Timing:
a) ___ hours is considered safe (attempt conversion)
b)____ hours is likely safe (attempt conversion)
c) ____ hours require caution (conversion not advised in PFC)

Answer 17

a) <2 hours is considered safe (attempt conversion)
b) 2-6 hours is likely safe (attempt conversion)
c) >6 hours require caution (conversion not advised in PFC)

Question 18

________ is the fluid of choice for patients in hemorrhagic shock as well the capability to provide a transfusion should be a basic capability of any clinician providing PFC

Answer 18

Fresh Whole Blood (FWB)

Question 19

Fresh whole blood (FWB) is the fluid of choice for patients in hemorrhagic shock. To mitigate risks in PFC recommendations are…..

Answer 19

a) MAP of 65mmhg
b) Adequate UOP (at least 0.5cc/kg/hr)
c) Adequate mentation

Question 20

The selection of maintenance or resuscitation (bolus) fluid should be guidedby the patient’s clinical condition:
a) If UNSTABLE _______________________
b) If STABLE ___________________________

Answer 20

a) If UNSTABLE resuscitate with bolus fluid
b) If STABLE use maintenance fluid. achieve a urine output of at least 0.5mL/kg/hour

Question 21

Ketamine
3 Dose ranges
Low dose =
Mid-range =
High dose =

Answer 21

a) Low dose pain 10-20mg IV
b) Mid-range – AVOID – 0.3-1mg/kg IV
c) High dose dissociative – 2.0 mg/kg IV

Question 22

What range of Ketamine should be avoided

Answer 22

Mid-range – 0.3-1mg/kg IV

Question 23

Ketamine High dose should be included with what and why?

Answer 23

Versed to avoid vivid dreams which can lead to lifelong dreams and PTSD

Question 24

Morphine and Fentanyl
1. Stable patients can get _____.
2. Hemodynamically unstable patients should get _______.

Answer 24

1. Morphine
2. Fentanyl