TCCC Final Flashcards
1
Q
Pain and tenderness around the IV site
A
Start IV in opposite arm
2
Q
Injury most commonly associated with pelvic fracture
A
TBI
3
Q
Bayonet impaled in abdomen and stable
A
Arrange for surgical care
4
Q
Increased risk for secondary brain injury
A
Hypotension, hematoma, hypoxia
5
Q
Secondary survey neurological exam
A
GCS, PERRLA and sensorimotor function
6
Q
SBP greater than ____ is desirable for neurologically injured casualties
A
90
7
Q
Defect in chest wall that allows air to enter/exit pleural space from outside w/o ventilatory effort
A
Open pneumothorax
8
Q
Air entering pleural space has no avenue for egress, resulting in increasing pressure
A
Tension pneumothorax
9
Q
Presence of air within pleural space. As air in pleural space increases, lung on that side collapses
A
Simple pneumothorax
10
Q
blood pressure is 150/90. What is MAP?
A
(DP + (1/3)PP) = (90 - 20) = 110
11
Q
Neck contusion, loss of the prominence of the thyroid cartilage, subcutaneous emphysema in neck. Best way to protect his airway?
A
Cricothyroidotomy
12
Q
____% of casualties with stab wounds to the abdomen will require surgical intervention, ____% of casualties with gunshot wounds will need surgery
A
15%, 85%
13
Q
Pelvic ring fracture with the highest associated mortality
A
Vertical shear fracture
14
Q
Blast injury phase: Radiation, chemicals, biological agents
A
Quinary
15
Q
Blast injury phase: Propulsion of casualties into the ground
A
Tertiary
16
Q
Blast injury phase: Blast wave or overpressure
A
Primary
17
Q
Blast injury phase: Ballistic wounds produced by fragments from exploding weapons
A
Secondary
18
Q
Blast injury phase: Burns and toxicities in the blast environment
A
Quaternary
19
Q
Pelvic fracture may occur when a person is pinned between vehicle and wall. Also known as “open book” pelvic fractures, symphysis is separated and volume of pelvis is greatly increased. May have significant hemorrhage.
A
Anterior-posterior compression fractures
20
Q
Patient fell 15 feet, best way to transport.
A
Cervical hard collar and spine board
21
Q
Pelvic fracture may occur with a fall from a height, landing on one leg first. Account for the smallest proportion of pelvic ring fractures, but tend to cause the highest mortality from severe hemorrhage
A
Vertical shear fracture
22
Q
Leading cause of occupational injury/death for EMS workers
A
Ambulance collisions during the response phase
23
Q
All of the following cardiac injuries are associated with blunt force to the anterior chest EXCEPT?
A. blunt cardiac rupture
B. All of the following are associated with blunt injury to the anterior chest
C. commotio cordis
D. cardiac contusion
E. valvular rupture
A
All of the following are associated with blunt trauma to the anterior chest
24
Q
Predominant cause of combat injury and death
A
Explosives
25
Which is true in transportation of trauma victims to definitive medical care?
A. Initiating transport is the single most important aspect of definitive care in the field
B. Transportation should only be considered once detailed field assessments are completed
C. Scene time should not exceed 10 minutes
D. Trauma patients have better outcomes when an extra 3-5 minutes spent "fixing patients" on scene
E. Transporting patients to definitive medical care within the "golden period" is crucial for survival
A, C and E
26
Individuals who fall forcibly on their perineum ("straddle" injury)
Rami fractures
27
Most likely explain his reason for being in shock after falling from helicopter: GCS 14, HR 133, BP 60/30, RR 23, O2 Sat 96%.
Spleen rupture
28
Can contribute to secondary brain injury
Hematoma, hypoxia, hypotension, hypoglycemia, cerebral edema
29
Air bubbles coming from chest wound when patient exhales
Construct an occlusive dressing and observe for signs of a tension pneumothorax
30
In a pre-hospital setting, effective ventilation of a patient is BEST monitored by
Respiratory capnography
31
Tibia fracture and absent pedal pulses, on site intervention?
Cover the bone ends with sterile dressing and attempt to restore normal anatomic position before splinting
32
Most common cause of spinal cord injury
Motor vehicle accidents
33
Setting up a triage scene when HAZMAT is present
Hot zone: HAZMAT located downwind of cold zone
34
"B" for line 4 of MEDEVAC request
Need aircraft with an operational hoist
35
Casualties who have cervical spine injuries also have a ____% chance of having another spinal fracture
10%
36
Mandates that you do NOT apply any pressure to the globe
Scleral defect with expulsion of a small amount of intraocular contents
37
Routes for morphine delivery
IM, IV and SQ
38
Casualty cannot follow commands, and has a weak or absent radial pulse, what is the risk of mortality
92%
39
Not a complication of PEEP
Decrease in ability to provide adequate oxygenation
40
Leading cause of traumatic brain injury (TBI) in those under 65 years old is _____; in the elderly, the leading cause is _____.
Motor vehicle accidents, falls
41
Which of the following statements is false about pulse oximetry?
A. Methemoglobin may lead to false low readings.
B. Overreliance on pulse oximetry may lead to delays in therapy or inappropriate decisions.
C. Carboxyhemoglobin may lead to false normal or high saturation readings.
D.Pulse oximetry is a valuable adjunct in determining presence of vascular injury.
E. Pulse oximetry values decrease with altitude.
D
42
"Full IV set-up" cost
$5-$10
43
Penetrating abdominal wound and anticipated prolonged transport period. Oral fluids?
Yes, to conserve supplies
44
Why the Combat Action Tourniquet was chosen
Small, can be applied w/one hand
45
Child had diarrhea, vomiting for three days post viral infection. What type of shock
Hypovolemic
46
Shock type: Man in motor crash. diffuse bruising, positive FAST scan
Hemorrhagic
47
Shock type: Drunk teen dives head-first into pool. Cannot move limbs
Neurogenic
48
Shock type: From nearby nursing home. Coughing/wheezing, fever
Septic
49
Shock type: 12 y.o. with lip swelling, hives, wheezing. Ate peanut butter.
Anaphylactic
50
Evacuation from forward line of conflict
CASEVAC
51
Evacuation of a casualty from one point of care to another point of care within the tactical theater
MEDEVAC
52
Movement of a casualty from a point of care within the theater to a more rearward location
Aeromedical Evacuation
53
A new term introduced to encompass en route care from point of wounding to care facility
TACEVAC
54
Most likely course of action once a burn patient reaches a level III facility
Evacuated as expeditiously as possible to a CONUS facility for definitive treatment
55
Abdominal exam in TBI patient
Unreliable
56
BP is 150/90. ICP is 30 mmHg. Cerebral perfusion pressure (CPP) is ____.
CCP = MAP - ICP = (90 + 20) - 30 = 80
57
Situation that will most likely require an escharotomy
Circumferential thermal bone of the lower extremity
58
The LEAST hemostatic efficacy
HemCon
59
Best correlates with mortality or the need for life-saving interventions during triage
GCS and SBP
60
What options are available for fluid resuscitation in a combat setting (select all that apply)?
A. Oral rehydration
B. Limited (hypotensive) fluid resuscitation
C. Hetastarch solutions
D. Hypertonic Saline/Dextran (HSD)
A, B, C
61
Your casualty is breathing spontaneously with a ventilatory rate of 25. What is the most appropriate immediate intervention?
Supplemental O2
62
A single episode of a SBP less than ________ mmHg significantly increases likelihood of a poor outcome in a TBI patient.
90
63
2 y.o. girl has extensive full and partial thickness burns. IV fluid management?
5% dextrose containing IV fluids at standard rate w/ burn resuscitation fluids
64
Correct method to use Combat Gauze
Apply to bleeding site with three minutes of sustained, direct pressure
65
Beck's Triad
Muffled heart sounds, JVD and hypotension
66
Delivers highest O2 content to patient
A non-rebreather with reservoir and a bagmask with reservoir deliver about the same oxygen concentration
67
82 y.o. male fears he had a stroke. Worsening headache, blurred vision; lethargic ; weakness on right side. He had a fall 10 days ago and hit his head. Did not lose consciousness, was “OK” after the fall.
Subdural hemorrhage
68
"Gold standard" for determining ET tube placement
CO2 capnography
69
First-line treatment for life-threatening hemorrhage that is not amenable to tourniquet placement
Combat gauze
70
Shock type: A Marine was shot and fell 15 ft off a watchtower. Evidence of femur fracture, enormous swelling, bruising. Lower extremities paralyzed. Severe back pain. HR 125.
Hemorrhagic and neurogenic
71
Pleural space can accommodate how much volume
3000 mL
72
Patient unresponsive (GCS=4). Periorbital ecchymosis, bleeding from nares/ear. Frequent suctioning to maintain patent airway. Irregular ventilation, cyanosis around lips. What indicators for ET intubation are evident?
Perioral cyanosis, unresponsive, sonorous and frequent suctioning
73
Maximum upward excursion of the diaphragm anteriorly
4th intercostal space
74
PEEP greater than ________ can cause a dangerous raise in intracranial pressure
15
75
Intracranial hemorrhage DOUBLES the incidence of death in TBI patients
Subarachnoid
76
Most common complaint of patient's with a mandibular fracture
Malocclusion of the teeth
77
Outpatient Clinic
BAS
78
Major trauma center with teaching and research
US-based military hospital
79
Regional trauma center, limited capacity, 30-day ICU holding capacity
Theater hospital
80
Aggressive IV fluid replacement is the contraindicated therapy for
Pulmonary contusions
81
Patient’s RR 35/min, very deep. Drops to 6/min, very shallow. This continues in a repeating cycle
Cheyne-Stokes Respiration
82
Most useful clinical signs for combat medical personnel to identify shock in the battlefield
Radial pulse and mentation
83
```
Which of the following are signs of a compartment syndrome?
A. Paresthesias
B. Pulselessness
C. Paralysis
D. Puffiness
E. Protuberence
F. Pain out of proportion to the injury
G. Pallor
```
A, B, C, F, G
84
100% Effective tourniquets
CAT, EMT and SF
85
Analgesia for severe pain without risk of histamine-mediated hypotension
Fentanyl
86
Rapid Sequence Intubation
Pre-oxygenate, administer sedative/paralytic agent, insert ET tube, confirm ET tube placement
87
A patient has been intubated. What is their maximum Glascow Coma Score
10T
88
Success rate for U/S guided IV placement
87 to 91%
89
Decontaminating casualties at a mass casualty scene
Have casualties self-decontaminate
90
```
Possible interventions that may help acutely control/manage increased intracranial pressure include the following: (check all that apply)
A. chemical paralysis
B. sedation
C. controlled hyperventilation
D. controlled hypoglycemia
E. application of PASG/MAST trousers
F. osmotherapy (such as mannitol)
```
A, B, C, F
91
```
Which of the following is NOT a contraindication to using a femur traction splint (e.g. HARE splint)?
A. Suspected fracture adjacent to knee
B. Suspected femoral neck fracture
C. Amputation of foot
D. Suspected pelvic fracture
E. Loss of pedal pulse on fractured leg
```
E
92
```
Which of the following are considered analgesics (pain medications) rather than anxiolytics (anxiety medications)? (check all that apply)
A. Midazolam
B. Lorazepam
C. Diazepam
D. Fentanyl
E. Alprazolam
F. Morphine
G. Ketorolac
```
D, F, G
93
HALLMARK finding for the diagnosis of concussion
Post-traumatic amnesia
94
A patient has suffered a closed fracture of the ulna and radius, and a splint was applied. The next step is to
Check neurovascular status of limb
95
You initially applied a field dressing and now, ten minutes later, it is soaked with blood. Your next course of action is to
Apply a pressure dressing
96
Important complication of crush syndrome
Renal failure
97
Trauma casualties with a weak radial pulse were ____ times more likely to die than those with a normal pulse
15
98
9-line MEDEVAC request for transmission and have written down "E" for line 8. What does this indicate
They will be picking up enemy casualties
99
Trauma victim has RR 22, O2 SAT 98%, HR 120, and narrowed pulse pressure. Somewhat anxious, but able to give event details. Complains of pain in right leg which has an obvious deformity. Significant blood loss from open femur fracture. He is in which Class of Hemorrhagic Shock?
II
100
Which is true regarding c-spine immobilization (select all that apply)?
A. The unique primary purpose of a c-collar is to protect the c-spine from compression
B. Rigid collar provides definitive immobilization of c-spine. No additional methods needed
C. Cervical collars are designed as "one size fits all"
D. Blankets, towels can be used as alternative methods
E. A soft cervical collar is of no use as an adjunct
A, D, E
101
In considering advanced airway management, all other factors being equal, a GCS score at or below ___ prompts properly trained prehospital personnel to strongly consider intubation
8
102
Patient with diffuse full and partial thickness burns (35% TBSA). Singed nasal hairs, eyebrows and mustache burned off. Strong radial pulses. What is most concerning immediate life-threat?
Airway compromise from inhalation injury secondary to being trapped in a vehicle.
103
There are four primary reasons for an individual to exhibit a decreased level of consciousness or aberrant behavior. Which is NOT one of these primary reasons?
Conversion disorder
104
Percentage of significant falls (from a height of >15 feet) have an associated lumbar spine fracture
20%
105
A casualty has a significant wound to his leg. The casualty is coherent and has a palpable radial pulse. The wound has been dressed and the bleeding is controlled. What should you do next?
A. Nothing, unless the casualty loses consciousness
B. Wrap in blankets to prevent hypothermia
C. Initiate a saline lock
D. Initiate a saline lock and begin administering intravenous fluids
C
106
9-line MEDEVAC request for transmission and have written down "B" for line 7. What does this indicate?
Pyrotechnic signals
107
A 90 kg man sustains a 25% TBSA burn. According to the Parkland formula, what should the rate of fluid administration be for the first 8 hours
Vol = 4 * Weight (kg) * TBSA = 4 * 90 * 25 = 9000mL. Administer 4500mL over 1st 8 hours, then the rest over the next 16 hours. 1st 8 hours rate is 563mL/hr
108
Preferred way of decontaminating eyes after a chemical exposure
Copious irrigation w/Morgan lens
109
Primary concern when evaluating a casualty with abdominal trauma in the field
Massive blood loss in the abdomen
110
```
Female who is 36 weeks pregnant involved in MVC. Severe abdominal/back pain. On primary survey, airway and breathing are intact; pulse is fast and regular. On secondary survey, abdomen is tense with diffuse tenderness. Of the following, which would be your GREATEST concern?
A. Ruptured intestine
B. Abruptio placenta
C. Placenta previa
D. Acute Appendicitis
```
B
111
Patient needs to arrive in Germany within the next 2-3 days. Which aeromedical evacuation category should you indicate on his patient movement request (PMR)?
Priority
112
All of the following are contraindications to placement of a supraglottic airway EXCEPT:
A. Recent ingestion of caustic substances
B. Known esophageal disease
C. Intact gag reflex
D. Hypoxia
D
113
“This patient has a craniofacial dysjunction injury”. You inform him the eponym is a _____?
LeFort III fracture
114
```
Among the many complications of shock is acute renal failure. Which of the following combinations of metabolic derangements is most likely from renal failure?
A. Metabolic alkalosis and hyperkalemia
B. Metabolic alkalosis and hypokalemia
C. Metabolic acidosis and hyperkalemia
D. Metabolic acidosis and hypokalemia
```
C
115
22 y.o. soldier has bilateral amputations of lower extremities, hemoptysis, ruptured tympanic membranes and evidence of TBI. Based on injury pattern, what explosive was most likely used?
TNT
116
A CCATT team is en route to pick up your patient for transfer. All of the following are true EXCEPT?
A. CCATT teams transport ONLY stable patients
B. CCATT equipment is self-contained and self-carried
C. A CCATT team is composed of intensivist-trained physician, critical care nurse, respiratory therapist
D. CCATT teams augment standard aeromedical evacuation (AE) team
A
117
Cord syndrome: elderly male fell forward hyperextending neck. Normal leg strength, bilateral arm weakness
Central
118
Cord syndrome: 18 y/o football player struck in upper abdomen; loss of motor, pain/temp, light touch below T8
Anterior
119
Cord syndrome: Man stabbed in back; complete loss of vibration on right side T10 down, loss of pain/temp on left side
Brown-Sequard
120
```
Small U-Haul moving van packed with explosives (equal to 10,000 pounds of TNT). What is the safe evacuation distance in feet for building evacuation distance and outdoor evacuation distance?
A. building: 70 ft, outdoor: 850 ft
B. building: 150 ft, outdoor: 1850 ft
C. building: 650 ft, outdoor: 2750 ft
D. building: 860 ft, outdoor: 3750 ft
E. building: 1240 ft, outdoor: 6500 ft
F. building: 1570 ft, outdoor: 7000 ft
```
D
121
This type of pelvic fracture may occur when a pedestrian is truck by a car. Account for the majority of pelvic ring fractures. The volume of the pelvis is decreased in these fractures.
Lateral compression fractures
122
22 y.o. male is found having a generalized (grand mal) seizure. You generate a differential of reversible causes. Which would you include as the MOST likely cause of his seizure?
Hypoglycemia
123
9-line MEDEVAC request. Line 3 is reported "2 Alpha, 1 Bravo, 3 Charlie."
2 Urgent, 1 Urgent surgical and 3 Priority casualties
124
Most likely have renal failure due to myoglobinuria?
A. 56 year old man fell asleep while smoking and sustained 15% TBSA full and partial thickness burns to his upper extremities
B. 45 year-old janitor splashes a toilet cleaner solution into his face and eyes
C. 38 year-old hiker is struck by lightning on a mountain ridge and sustains 5% TBSA burns
D. 2 year-old pulls pot of boiling water off stove, full and partial thickness scald injuries 15% TBSA
C
125
Ecchymosis around the umbilicus
Cullen's sign
126
Increased arterial blood pressure and bradycardia
Cushing's phenomenon
127
A 24 year-old man falls playing football. He has a right shoulder dislocation. On neurovascular exam, he cannot move his right thumb normally. Which nerve do you suspect is injured?
Radial
128
Which of the following findings would be considered to be ABNORMAL in a woman who is 36 weeks pregnant?
A. Systolic Blood Pressure of 95 mmHg
B. Supine hypotension when lying flat on her back, which is relieved by lying on her left side
C. Decrease in cardiac output
D. Heart rate of 105 at rest
C
129
Loss of function on the affected side with loss of pain/temp on opposite side
Brown-Sequard syndrome
130
Which of the following are TRUE regarding a suitable helicopter landing zone (HLZ)? (Mark all that apply)
A. If possible, have wind indicator just outside HLZ
B. The HLZ should be a minimum of 300 feet in diameter, largerfor CH-47 or MH-53
C. Keep the HLZ as inconspicuous as possible
D. Mark the zone as per protocol (VS-17 panels, smoke, etc)
E. HLZ should be as flat as possible, even terrain
A, C, D, E
131
Best correlates with survival and the need for life-saving interventions
GCS
132
Loss of motor, pain/temp, light touch below level of injury. Vibration, position sense spared
Anterior cord syndrome
133
A supply convoy is ambushed en route to a FOB. Two casualties are loaded into nearby supply trucks (without medical supplies or equipment) and driven by fellow soldiers to a Battalion Aid Station at the FOB. Which term best describes this type of evacuation?
CASEVAC
134
Primary survey begins with
Global overview of patient's respiratory, circulatory and neurological symptoms
135
Regarding epidemiology of injured patients after a blast, what would you most likely expect to see?
Many dead and minimally wounded, 10-15% critically injured patients who may be saved
136
In comparing the effectiveness of peripheral IV and central venous access, which of the following are true? (check all that apply)
A. During CPR, medications reach central circulation faster with central venous access
B. Less than 50% of peripheral IV fluid reaches central circulation when wearing a PASG
C. Central venous access is choice during CPR
D. In a normally perfusing patient, delivery times are significantly faster with central venous access
A, D
137
Sniffing position for ET tube
It hyperextends the neck at C1-C2, and hyperflexes it at C5-C6, should not be used for trauma patients
138
For a pre-hospital provider who does not have adequate advanced airway skills, what is the preferred airway management methodology for a casualty that requires advanced airway management?
Bag-valve mask
139
Extended suctioning in a patient with significant secretions can lead to which complication?
Bradycardia
140
Pediatric patients have unique anatomic and physiologic considerations compared to adult burn patients. Select all true statements below.
A. Pediatric patients have proportionally larger heads than adults
B. Children require relatively smaller amounts of IV fluids than adults
C. Lund-Browder chart has age-related changes in children, can be helpful for pediatric TBSA
D. Pediatric burns less likely to be intentional
A, C
141
You infused 1 L of normal saline through a patient's IV. You want to obtain a basic chemistry panel. Can you draw blood from this IV site?
A. Yes, shut off infusion for 2 min, waste 5 mL blood
B. You must perform phlebotomy at a distant site to get accurate results
C. Yes, you can stop the fluid infusion temporarily and immediately draw blood for lab analysis
D. Yes, shut off infusion for 2 min, waste 5 mL blood, but Na and Cl will be inaccurate
A
142
Medications considered for young children, but not adults, during rapid-sequence intubation?
Atropine
143
Consistently rapid, deep breaths
Central neurogenic hyperventilation
144
Erratic ventilatory efforts that lack any pattern
Ataxic breathing
145
Which of the following statements regarding cardiac tamponade is inaccurate?
A. Most commonly caused by blunt chest trauma
B. It can manifest as PEA (Pulseless Electrical Activity)
C. Initial therapy is with IV fluids and pericardiocentesis
D. Clinical findings include hypotension, jugular venous distension (JVD), pulsus paradoxis, and muffled heart tones
A
146
Order of the standard 9-line MEDEVAC request
```
Location of casualty/HLZ
Radio frequency and call sign
Evacuation precedence
Special equipment requests
Numbers of litter and ambulatory patients
Evacuation site security
Marking of evacuation site
Casualty nationalities and combat status
Nuclear/Biologic/Chemical threats
```
147
Which of the following fluid resuscitation strategies is currently recommended for trauma patients in class I or II shock with uncontrolled hemorrhage?
A. Titrate blood pressure to a SBP 100-120 mmHG
B. Infuse crystalloid fluids through two large bore peripheral IVs at the maximum possible rate
C. Titrate blood pressure to a SBP 80-90 mmHG
D. Maintain patent IVs at a KVO (keep vein open) rate
D
148
Which of the following injury mechanisms is most likely to result in a traumatic aortic disruption?
A. A single stab wound to the right, upper chest
B. A motor vehicle collision, in which the patient's vehicle was struck by another vehicle perpendicularly on the passenger's door (T-bone)
C. A high-speed MVC in which the patient's vehicle hits a bus in a head-on collision
D. A stab wound to the left upper back
C
149
Toxic gas and antidote combination.
Cyanide and hydroxycobalamin
150
In an average adult during resting ventilation, what is the average tidal volume
500mL
