TCCC Final Review - CMS Quiz 5 Flashcards by Krista Moore

Analgesic and sedative medications are sometimes used together with a synergistic effect for
patients in severe pain. Benzodiazepines are an important class of anxiolytic medications.
Which of the following are benzodiazepines (check all that apply)?
A. Fentanyl
B. Morphine
C. Meperidine
D. Diazepam
E. Ketorolac
F. Lorazepam
G. Alprazolam
H. Midazolam

D. Diazepam 
F. Lorazepam 
G. Alprazolam 
H. Midazolam
Pg 347

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Consideration of kinematics is important in every trauma casualty. Overall, only about
____% of casualties with stab wounds to the abdomen will require surgical intervention,
whereas about ____% of casualties with gunshot wounds will need surgery for definitive
management of their abdominal injuries.

15%; 85%

Pg 321-22

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While a rare complication, which of the following is the greatest concern when using
narcotics for control of acute pain?
A. Developing drug dependency 
B. Nausea and vomiting 
C. Vasodilation 
D. Masking signs and symptoms of other
injuries
E. Respiratory depression

E. Respiratory depression

Pg 347

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What is the primary concern when evaluating a casualty with abdominal trauma in the field?
A. Metabolic derangements as a result of
trauma to the spleen, liver, or pancreas
B. Massive blood loss in the abdomen as a
result of blunt or penetrating trauma
C. Overwhelming sepsis leading to death as
a result of large or small bowel disruption
D. Respiratory distress as a result of
diaphragm rupture

B. Massive blood loss in the abdomen as a
result of blunt or penetrating trauma
Pg 318

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While on a field exercise, a young airman is involved in a role-over crash of his HMMWV
(Humvee) and is pinned beneath the vehicle. After extrication, he complains of shortness of
breath, abdominal pain and that he cannot move his feet. His vital signs are HR 144, BP
100/77, RR 30, O2 Sat 87%. He has loss of breath sounds on one side, bruising of his upper chest and neck, and a small piece of bowel and omentum protruding through his abdominal wall. Which of the following is the next BEST course of action?
A. Cover intestine with clean dry dressing,
begin IV, place in C-Collar and on rigid back
board and transport to nearest trauma center.
B. Cover intestine with clean dry dressing,
perform needle decompression of
pneumothorax, place in C-Collar and on rigid
back board, begin IV and bolus 2L crystalloid
solution, and transport to nearest medical
facility.
C. Perform immediate needle decompression
of his pneumothorax, cover intestine with
clean moist dressing, place in C-Collar and
on rigid back board, and begin IV while
transporting to nearest trauma center.
D. Perform immediate needle decompression
of pneumothorax, push intestine back into
abdominal cavity, place in C-Collar and on
rigid back board, and transport to nearest
trauma center.

C. Perform immediate needle decompression
of his pneumothorax, cover intestine with
clean moist dressing, place in C-Collar and
on rigid back board, and begin IV while
transporting to nearest trauma center.
Pg 326-7

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You are transporting a trauma victim to the closest trauma center in rural Kansas; you expect to arrive within 25 minutes. He has a knife protruding from his abdomen in the left upper quadrant. He has become hypotensive (systolic blood pressure ~60) and tachycardic (heart rat 140’s). How should you manage the patient en-route to the trauma center?
A. Remove the knife to prevent the sharp
blade from further lacerating internal organs,
apply a standard abdominal dressing (normal
gauze), then administer IV fluids until the
systolic blood pressure is >80 mmHg.
B. Leave the knife in place and administer IV
fluids until the systolic blood pressure is 80-
90 mmHg.
C. Remove the knife to prevent further
internal injury from the sharp blade, apply
Quickclot Combat Gauze to stop the
bleeding, then administer IV fluids until the
systolic blood pressure is >100 mmHg.
D. Leave the knife in place and administer IV
fluids until the blood pressure is 120/80
mmHg.

B. Leave the knife in place and administer IV
fluids until the systolic blood pressure is 80-
90 mmHg.
Pg 326-7

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Which of the following statements is true regarding abdominal trauma?
A. The pregnant patient with abdominal
trauma will usually have signs of hypovolemic
shock with less blood loss than the nonpregnant patient
B. Significant intra-abdominal bleeding will
cause immediate peritoneal signs
C. The abdominal exam is unreliable in a
Traumatic Brain Injury (TBI) victim
D. Pelvic fractures with significant bleeding
will always have pain on abdominal and
pelvic palpation

C. The abdominal exam is unreliable in a
Traumatic Brain Injury (TBI) victim
Pg 319, 323-4, 326, 328-29

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Which of the following historical questions are pertinent for motor vehicle collisions (MVC’s)
and penetrating injury? (Check all that apply.)
A. Amount of blood at the scene
B. Type of weapon (handgun or rifle, caliber,
lenght of knife)
C. Number of times the casualty was stabbed
or shot
D. Position of casualty in the vehicle
E. Extent of vehicle damage (compromise of
passenger compartment, steering wheel
deformity, requirement for prolonged
extrication)
F. Use of safety devices (seat belt,
deployment of airbags, presence of child
safety seats)
G. Type of collision

A, B, C, D, E, F, G

Pg 321-23

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Which of the following is NOT a contraindication to using a femur traction splint (e.g. HARE splint)?
A. Loss of pedal pulse on fractured leg 
B. Amputation of foot 
C. Suspected fracture adjacent to knee 
D. Suspected femoral neck fracture 
E. Suspected pelvic fracture

A. Loss of pedal pulse on fractured leg

Pg 344

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You are serving as a unit Flight Surgeon and are on the flight line preparing for your crew
duties for the day when a call comes in that there has been a fueling accident. On arrival to
the ramp, you observe a flaming fuel truck and diffusely scattered debris. The first casualty
you come across is having difficulty breathing and you discover a metal fragment impaled in
his right lateral chest wall in the 4th intercostal space; aside from this, the rest of his exam
does not show obvious signs of external trauma. Which of the following is least likely in this
patient?
A. Splenic Laceration
B. Liver Laceration
C. Hypovolemic Shock
D. Cardiac Tamponade
E. Tension Penumothorax

A. Splenic Laceration

Pg 319-21

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Crush syndrome caried a mortality of 90% in World War II, which was subsequently reduced
to approximately 50% by the Vietnam era. Which of the following is an important
complication of crush syndrome?
A. Hypovolemic shock
B. Compartment syndrome
C. Limb ischemia
D. Renal failure

D. Renal failure

Pg 350-51

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Match the description of the pelvic fracture with it’s type:
1. Rami fractures
2. Acetabular fractures
3. Lateral compression fractures
4. Anterior-posterior compression fractures
5. Vertical shear fractures
A. May occur when a person is pinned
between a vehcile and a wall. Also known as
“open book” pelvic fractures, because usually
the symphysis is separated and the volume of
the pelvis is greatly increased. May have
significant hemorrhage.
B. 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.
C. Individuals who fall forcibly on their
perineum (“straddle” injury)
D. The head of the femur is driven into the
acetabulum of the pelvis; may be associated
with significant hemorrhage.
E. 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.

1 C
2 D
3 E
4 A
5 B
Pg 344

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Which type of pelvic ring fracture has the highest associated mortality?
A. Vertical shear fracture
B. Open-book fracture
C. Lateral compression fracture
D. Anterior-posterior compression fracture

A. Vertical shear fracture

Pg 344

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You are treating one of your unit members on the drop zone at Ft. Bragg after a bad
Parachute Landing Fall (PLF). On exam you find an open tibia fracture and absent pedal
pulses. Which of the following is the most correct intervention you should make on the drop zone?
A. Cover the bone ends with sterile dressing
and attempt to restore normal anatomic
position before splinting
B. Administer IV antibiotics immediately
C. Attempt to return the exposed ends of the
bone to the soft tissue; then splint in place
D. Splint in place and evacuate

A. Cover the bone ends with sterile dressing
and attempt to restore normal anatomic
position before splinting
Pg 340-342

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Match the sign/physical exam finding to the appropriate description:
1. Grey-Turner's sign
2. Cullen's sign 
3. Seatbelt sign
A. Linear ecchymosis or abrasion across the
abdomen
B. Ecchymosis around the umbilicus
C. Ecchymosis involving the flanks

1 C
2 B
3 A

Pg 323-4

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During your secondary survey in a casualty with abdominal trauma, you determine that he
has peritonitis. Which of the following findings is NOT a physical sign of peritonitis?
A. Involuntary guarding
B. Significant abdominal tenderness on
palpation
C. Bowel sounds heard over the thorax
D. Rebound tenderness

C. Bowel sounds heard over the thorax

Pg 323-4

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Assessing abdominal injuries can be difficult in trauma patients. Which of the following
increase your concern that a given patient has a serious internal abdominal injury? (Check all
that apply)
A. Degree of shock greater than can be
explained by other injuries (e.g. fractures,
external hemorrhage)
B. Presence of peritoneal signs during
physical exam
C. Positive FAST exam
D. Obvious signs of trauma (e.g. soft tissue
injuries, gunshot wounds)
E. Signs of hypovolemic shock without an
obvious cause
F. Concerning mechanism of injury (e.g. bent
steering wheel)

A,B,C,D,E,F

Pg 321-326

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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. Morphine
E. Ketorolac
F. Alprazolam 
G. Fentanyl

D. Morphine
E. Ketorolac
G. Fentanyl
Pg 347

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Which of the following complications of fracture is primarily associated with open fracture?
A. Compartment syndrome
B. Hypovolemic shock 
C. Loss of distal pulses
D. Malunion 
E. Osteomyelitis

E. Osteomyelitis

Pg 340

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Because the pelvis is a strong bone and difficult to fracture, casualties with pelvic fractures
frequently have associated injuries. Match the associated injury with it's incidence in patients
with pelvic fractures:
1. Traumatic brain injury 
2. Long-bone fractures 
3. Thoracic injuries 
4. Urethral disruption in men 
5. Splenic trauma 
6. Liver trauma 
A. 15%
B. 7%
C. 51%
D. 48%
E. 20%
F. 10%

1 C
2 D
3 E
4 A
5 F
6 B
Pg 344

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Which is the injury most commonly associated with pelvic fracture?
A. Thoracic injury
B. Rectal laceration or disruption
C. Traumatic Brain Injury (TBI)
D. Injury to internal organs (spleen, liver,
kidney)
E. Urethral disruption

C. Traumatic Brain Injury (TBI)

Pg 344

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Some pelvic ring fractures are associated with an increase in the pelvic volume. Because
the volume is increased, there is less tissue surrounding the pelvis to tamponade bleeding.
Several companies manufacture “pelvic binders,” which have been shown to decrease the need for blood transfusions and decrease overall mortality.
True
False

False

Pg 345 Figure 13-13

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A 22 year-old woman is brought into the Emergency Department via EMS after a motor vehicle collision. Inspection reveals the following physical exam finding (see image - abrasion/bruising diagonally across the chest). What can you conclude from the image, and what particular injuries are you concerned about?
A. The patient was likely injured by flying
glass, and has a strong likelihood of
perforating injury to her bowel
B. The patient was likely struck with an
airbag, and has about a 50% chance of
having a splenic laceration
C. The patient was likely not wearing her
seatbelt, and most likely has an injury to the
renal parynchema
D. The patient was likely wearing her
seatbelt, and has a significant risk of a bowel
or mesentery injury

D. The patient was likely wearing her
seatbelt, and has a significant risk of a bowel
or mesentery injury
Pg 323-4

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You are evaluating a pregnant active duty woman at 34 weeks estimated gestational age.
Her husband struck her repeatedly in the abdomen with a baseball bat. She arrives in
extremis. Which of the following is true regarding her potential injuries and treatment?
A. At this gestational age, the uterus sits
inside the bony pelvis and pregnancy related
injuries are unlikely
B. The fetus is unlikely to survive if the
mother dies
C. The patient should be placed in a right
lateral decubitus position to relieve
compression on her Inferior Vena Cava and
increase blood return to her heart
D. Uterine rupture and placental abruption
(abruptio placentae) are first trimester
complications and would not be expected at
this stage of pregnancy

B. The fetus is unlikely to survive if the
mother dies
Pg 327-9

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Which of the following findings would be considered to be ABNORMAL in a woman who is 36 weeks pregnant? A. Decrease in cardiac output B. Supine hypotension when lying flat on her back, which is relieved by lying on her left side C. Systolic Blood Pressure of 95 mmHg D. Heart rate of 105 at rest

A. Decrease in cardiac output | Pg 327-9

``` A fracture that is associated with a break in the skin is called a(n): A. Grade III fracture B. Comminuted fracture C. Spiral fracture D. Displaced fracture E. Open fracture ```

E. Open fracture | Pg 340

A soldier is brought into your aid station after a training accident during which he fell from a guard tower. He arrives with a bayonet impaled in his abdomen. After completing your primary survey you find he is stable with HR=102, RR=17, POx = 98% RA, BP=127/68. In managing and assessing this patient, which should you do next? A. Asucultate and perform deep palpation of the abdomen to determine if there is intraabdominal bleeding B. Arrange for surgical care; no further abdominal examination is necessary C. Remove the bayonet and apply a hemostatic dressing D. Inflate a PASG in anticipation of shock as a result of pelvic fracture and resultant pelvic bleeding E. Remove the bayonet and apply a standard abdominal field dressing

B. Arrange for surgical care; no further abdominal examination is necessary Pg 326-7

``` Which of the following musculoskeletal injuries is potentially life threatening? A. Rib fracture B. Femur fracture C. Pelvic fracture D. All of the above E. None of the above ```

D. All of the above | Pg 336

A 31 y.o female who is 36 weeks pregnant presents to the Emergency Department after a Motor Vehicle Collision. She is complaining of severe abdominal pain and back pain. On primary survey her airway and breathing are intact; her pulse is fast and regular. On secondary survey her abdomen is tense with diffuse tenderness on exam. Of the following, which would be your GREATEST concern in this patient? A. Abruptio placenta B. Acute Appendicitis C. Placenta previa D. Ruptured intestine

A. Abruptio placenta | Pg 327-9

When managing a casualty with an isolated fracture, you should: A. Avoid pain medications since patients can quickly become addicted/dependent on narcotics B. Avoid pain medications since it will make the orthopedic surgeon's exam difficult C. Avoid pain medications since they can compromise respiration and turn an orthopedic routine injury into a life-threatening emergency D. Use pain medications liberally as needed to control pain as tolerated by the patient E. Avoid pain medications since you should be able to control the pain through restoration of anatomic position and splinting

D. Use pain medications liberally as needed to control pain as tolerated by the patient Pg 346-7

What is the approximate internal blood loss associated with the following fractures? 1. Rib 2. Radius or ulna 3. Humerus 4. Tibia or fibula 5. Femur 6. Pelvis ``` A. 1000-massive B. 125 mL C. 250-500 mL D. 500-1000 mL E. 1000-2000 mL F. 500-750 mL ```

``` 1 B 2 C 3 F 4 D 5 E 6 A ``` Pg 340

Dislocations should always be reduced before transport True False

False | Pg 346

``` Which of the following are signs of a compartment syndrome? (Check all that apply) A. Pulselessness B. Protuberence C. Paralysis D. Paresthesias E. Pain out of proportion to the injury F. Pallor G. Puffiness ```

``` A. Pulselessness C. Paralysis D. Paresthesias E. Pain out of proportion to the injury F. Pallor Pg 349-50 ```

``` What is the definitive treatment for compartment syndrome? A. Pain control B. Skin grafting C. Antibiotics D. Splinting E. Fasciotomy ```

E. Fasciotomy | Pg 350

The following image is of a right upper quadrant (RUQ) FAST (Focused Assessment with Sonography in Trauma) exam. Does the image demonstrate a positive (free intraperitoneal fluid/blood is present) or negative (no free fluid/blood) FAST exam? A. Positive FAST exam (free intraperitoneal fluid/blood is present) B. Negative FAST exam (no free intraperitoneal fluid/blood)

A. Positive FAST exam (free intraperitoneal fluid/blood is present) Pg 325

``` 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? A. Radial B. Median C. Ulnar D. Musculocutaneous E. Axillary ```

A. Radial | Pg 338 Figure 13-5

``` Which of the following anatomical structures is NOT found in the retroperitoneal space? A. Spleen B. Duodenum C. Aorta D. Rectum E. Pancreas ```

A. Spleen | Pg 318

``` Which of the following routes can Morphine be delivered through for pain control? (check all that apply) A. Per Rectum (PR) B. Sublingual (SL) C. Subcutaneous (SQ) D. Intravenous (IV) E. Intramuscular (IM) ```

C. Subcutaneous (SQ) D. Intravenous (IV) E. Intramuscular (IM) Pg 347

You have responded to a casualty who was involved in an aircraft mishap. On assessment he is stable after initial fluid resuscitation. His vital signs are HR 110, BP 110/75, RR 12-15. His Glasgow Coma Scale (GCS) is 14. He has been splinted for upper and lower extremity fractures and several lacerations have been dressed. He has a significant abdominal wound with eviscerated bowel. You should: A. Administer pain medications, leave the bowel uncovered, and ask the patient if he has any last words he would like you to convey to family members B. Leave the bowel on the surface of the abdomen and protect with moist sterile dressings, provide pain medications and help him remain calm C. Immediately extend the incision (puncture wound) in the abdomen to allow the bowels to be replaced easily inside the abdomen D. Clean the bowel with sterile water and gently replace into abdominal cavity

``` B. Leave the bowel on the surface of the abdomen and protect with moist sterile dressings, provide pain medications and help him remain calm Pg 327 ```

``` Which of the following is NOT one of the four acoustic windows (views) that are imaged as part of the FAST exam? A. Perihepatic B. Pelvic C. Perisplenic D. Pericardial E. Periumbilical ```

E. Periumbilical | Pg 325

During your secondary survey on a casualty with abdominal trauma, you auscultate and hear bowel sounds in the left lower lung fields. What does this most likely indicate? A. Pneumothorax B. Small bowel obstruction C. Retroperitoneal bleeding D. Peritonitis E. Diaphragmatic rupture

E. Diaphragmatic rupture | Pg 324

A patient has suffered a closed fracture of the ulna and radius, and a splint was applied. The next step is to: A. Check the neurovascular status of the limb B. Check for other injuries C. Make a sling for the patient D. Avoid elevating the limb

A. Check the neurovascular status of the limb | Pg 342

Which of the following medications is most likely to offer potent analgesia for severe pain without risk of histamine-mediated hypotension? A. Diazepam B. Morphine C. Fentanyl D. Ibuprofen

C. Fentanyl | Pg 347

You are examining a Marine who fell out of a helicopter during an assault. Your primary survey was unremarkable, as was your secondary survey, but his vital signs reveal a GCS of 14, HR 133, BP 60/30, RR 23, O2 Sat 96%. Which of the following would MOST likely explain his reason for being in shock? A. Tension pneumothorax B. Spleen rupture C. Occult traumatic brain injury D. Spinal cord injury

B. Spleen rupture | Pg 321-23

You are managing a patient with a severe pelvic fracture and who has lost a significant amount of blood; he appears to have no other injury. His GCS is 14, airway and breathing are intact but he has diffuse abdominal pain. His current systolic blood pressure is 85. how much crystalloid fluid should be administered in order to obtain an acceptable pressure in this hemorrhaging patient? A. None, this is an acceptable pressure B. 500 ml boluses every twenty minutes until his systolic pressure is greater than 100mmHg C. 2L as fast as it will go in order to prevent other complications D. 3L as fast as it will go then consider giving blood if no response

A. None, this is an acceptable pressure | Pg 326

A 22 year-old Marine is pulled by fellow Marines from a burning vehicle. He has diffuse full and partial thickness burns (35% TBSA). He has singed nasal hairs, and his eyebrows, and mustache are burned off. He has strong radial pulses. Which of the following is the most concerning immediate life-threat? A. Death from overwhelming infection secondary to immune compromise from skin disruption B. Rapid airway compromise from inhalational injury secondary to being trapped in a super-heated vehicle C. Cardiac arrest from hypovolemia secondary to fluid shifts and losses D. Elevated potassium causing lifethreatening cardiac dysrythmia

B. Rapid airway compromise from inhalational injury secondary to being trapped in a super-heated vehicle Pg 360

``` Burns are extremely painful, debilitating injuries. Which of the following types of burns will not require any analgesia? A. Partial-thickness burns B. Superficial burns C. All burn patients will likely require pain control D. Full-thickness burns E. Fourth-degree burns ```

C. All burn patients will likely require pain control Pg 358-59

Prevention of burn injuries is important. The military is currently developing burn-resistant uniforms and gloves, but has so far been unable to successfully make or field any of these uniforms. True False

False | Pg 716-17

Which of the following is NOT appropriate in burn management A. Removing all clothing and jewelry B. Terminating the burning by irrigating with copious volumes of ice-water C. IV fluid therapy with Lactated Ringer's solution D. High-concentration anti-microbial dressings

B. Terminating the burning by irrigating with copious volumes of ice-water Pg 363-4

What is the preferred way of decontaminating eyes after a chemical exposure? A. With copious irrigation via a Morgan lens B. With copious irrigation done by the patient splashing water in her eyes C. Irrigation is generally not necessary as eyes are particularly resilient to chemical exposure D. Treatment with a neutralizing agent is preferred to irrigation

A. With copious irrigation via a Morgan lens | Pg 371

A firefighter is rescued from a burning warehouse that manufactures plastics. He was not wearing a respirator. He is obtunded. The base-station physician is worried he may have a toxic inhalational injury. Select the most likely toxic gas and antidote combination. A. carbon monoxide, amyl nitrate B. carbon dioxide, high-flow oxygen C. cyanide, hyperbaric oxygen D. cyanide, hydroxycobalamin

D. cyanide, hydroxycobalamin | Pg 367-8

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. The Lund-Browder chart takes into account the age-related changes in children and can be helpful when estimating pediatric TBSA D. Pediatric burns are less likely to be intentional (abuse) than adult burns

A. Pediatric patients have proportionally larger heads than adults C. The Lund-Browder chart takes into account the age-related changes in children and can be helpful when estimating pediatric TBSA Pg 361-362, 365, 368-369

You are the physician at a Battalion Aid Station when a soldier is carried in by medics with severe burns covering about 50% TBSA. Both arms and legs are burned as well as his chest, neck and groin. The medics did not start an extremity IV because they were taught never to start an IV through burned skin. What should you tell them? A. They are partially correct. It is okay to start an IV through superficial burns and partial thickness burns, but not through full thickness burns B. Ideally IVs should not be placed through or adjacent to burned tissue; however, placement through the burn is appropriate if no alternative sites are available C. It is okay to delay IV starts until the patient is transferred to a higher echelon of care where he can have IVs started by an interventional radiologist D. They are correct, never start an IV through burned skin

B. Ideally IVs should not be placed through or adjacent to burned tissue; however, placement through the burn is appropriate if no alternative sites are available Pg 360-1, 364-5

Pediatric burns are frequently the result of child abuse True False

True | Pg 368-9

``` Match the following terms used to describe burn depth/severity appropriately 1. First-degree burn 2. Second-degree burn 3. Third-degree burn A. Superficial burn B. Full-thickness burn C. Partial-thickness burn ```

1 A 2 C 3 B Pg 358-9

You are treating the 2 year-old daughter of an Enemy Prisoner of War. The vehicle her father was driving ignited when captured by US forces. She has extensive full and partial thickness burns. Which of the following is true regarding her IV fluid management? A. The USAISR "Rule of Ten" is designed to simplify burn fluid calculations, and can be used for all age groups B. She should receive 5% dextrose containing IV fluids at a standard maintenance rate in addition to burn resuscitation fluids C. Assuming the patient weighs 10 kilograms, her standard maintenance fluid rate would be 30 ml/hour D. She should receive Lactated Ringer's at 1- 2 ml/kg/%TBSA

``` B. She should receive 5% dextrose containing IV fluids at a standard maintenance rate in addition to burn resuscitation fluids Pg 714 ```

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? A. 400 ml/hour B. 563 ml/hour C. 500 ml/hour D. 463 ml/hour

B. 563 ml/hour | Pg 366

What clinical situation will most likely require an escharotomy? A. Chemical burn of the left hand B. Circumferential thermal burn of the lower extremity C. Electrical burn of the hand D. Full-thickness burns of the trunk, abdomen and face

B. Circumferential thermal bone of the lower extremity Pg 366

An airmen in your squadron is severely burned in a deployed setting. Once he reaches a level III facility for care, what is the most likely course of action? A. He will be evacuated as expeditiously as possible to a CONUS facility for definitive treatment B. He will stay in theater for as long as possible, allowing time for his wounds to stabilize before transport C. He will likely be declared "expectant" and given comfort care until he dies D. A surgical team will be flown into theater to provide any necessary operations. The patient can expect to return to duty within 1-2 weeks

A. He will be evacuated as expeditiously as possible to a CONUS facility for definitive treatment Pg 714-15

``` All of the following burns necessitate burn unit care EXCEPT? A. Superficial partial-thickness burns involving 5% BSA B. Full-thickness burns in an otherwise healthy 25 year-old man C. Burns involving bilateral hands D. Burns sustained from lightning ```

A. Superficial partial-thickness burns involving 5% BSA Pg 363

Covering a partial-thickness burn with a dressing will reduce a burn patient's pain? True False

True | Pg 364 Figure 14-14

Which of the following patients would most likely have renal failure due to myoglobinuria? A. A 38 year-old hiker is struck by lightning on a mountain ridge and sustains 5% TBSA burns B. A 56 year old man fell asleep while smoking and sustained 15% TBSA full and partial thickness burns to his upper extremities C. A 2 year-old boy pulls a put of boiling water off a stove and sustains full and partial thickness scald injuries to 15% TBSA D. A 45 year-old janitor splashes a toilet cleaner solution into his face and eyes

A. A 38 year-old hiker is struck by lightning on a mountain ridge and sustains 5% TBSA burns Pg 366

Which of the following are TRUE regarding CASEVAC by air? (mark all that apply) A. The tactical situation may preclude evacuation by air (e.g. heavy enemy fire) B. Interventions such as intubation, electronic monitoring, and fluid resuscitation may be impractical or even impossible during CASEVAC operations. C. In some cases it is faster and safer to move casualties by ground than by air D. Not all casualties require urgent evacuation E. Environmental conditions (such as darkness, bad weather, or lack of a sutiable landing zone) may prevent evacuation by air

A,B,C,D,E | Pg 655-656 (Figure 28-3)

You are preparing to transport a Marine with a blast lung injury. You are concerned about altitude effects on your patient. At altitude, there is: A. no change in either percentage or partial pressure of oxygen B. a decrease in the partial pressure of oxygen in the atmosphere C. an increase in the percentage of oxygen in the atmosphere D. a decrease in the percentage of oxygen in the atmosphere E. an increase in the partial pressure of oxygen in the atmosphere

B. a decrease in the partial pressure of oxygen in the atmosphere Pg 660

``` Which of the following would be considered an absolute contraindication to aeromedical evacuation (AE)? (Check all that apply) A. spinal trauma B. traumatic extremity amputation C. untreated pneumothorax D. blunt abdominal trauma ```

C. untreated pneumothorax | Pg 659

Match the standard nine-line MEDEVAC request to its appropriate description: 1. Line 1 2. Line 2 3. Line 3 4. Line 4 5. Line 5 6. Line 6 7. Line 7 8. Line 8 9. Line 9 ``` A. Location of casualty/HLZ (Helicopter Landing Zone) B. Numbers of litter and ambulatory patients C. Radio frequency and call sign D. Nuclear/Biologic/Chemical threats and terrain specifics E. Evacuation precedence F. Marking of evacuation site G. Casualty nationalities and combat status H. Special equipment requests I. Evacuation site security ```

Line 1 - A. Location of casualty/HLZ (Helicopter Landing Zone) Line 2 - C. Radio frequency and call sign Line 3 - E. Evacuation precedence Line 4 - H. Special equipment requests Line 5 - B. Numbers of litter and ambulatory patients Line 6 - I. Evacuation site security Line 7 - F. Marking of evacuation site Line 8 - G. Casualty nationalities and combat status Line 9 - D. Nuclear/Biologic/Chemical threats and terrain specifics Pg 657 Figure 28-4

``` Which of the following are considered environmental stressors for casualties undergoing aeromedical evacuation? (check all that apply) A. Dehydration B. Hypoxia C. Decreased atmospheric pressure D. Thermal stress E. Elevated ambietn noise levels F. Vibration ```

A,B,C,D,E,F | Pg 659-660

You are a flight surgeon evaluating a patient for aeromedical evacuation (AE). The treating physicians think the patient needs to arrive in Germany within the next 2-3 days. Which evacuation category should you indicate on his patient movement request (PMR)? A. Priority B. Routine C. Standard D. Urgent

A. Priority | Pg 661

The introduction of a helicpoter evacuation system during the Korean War is usually credited as the most important component in the improved survival rate among combat casualties seen in that conflict. This system was further developed during the Vetnam War. The success of this evacuation system led to its widespread adaptation by civilian programs in the US. True False

True | Pg 654

The term "CASEVAC" refers only to rotary-wing aircraft (NOT ground vehicles or watercraft). True False

False | Pg 655

You have just prepared a 9-line MEDEVAC request for transmission and have written down "B" for line 7. What does this indicate to the MEDEVAC mission planner? A. They need to respond within 2 hours and fly the casualty to a surgical facility B. He needs to ensure the flight medic grabs an IMPAC 754 ventilator on his way to the aircraft C. There are biological threats in the operational area D. The evacuation site will be marked with pyrotechnic signals E. He needs to send an aircraft with an operational hoist

D. The evacuation site will be marked with pyrotechnic signals Pg 657

Match the following terms to their appropriate description: 1. CASEVAC 2. MEDEVAC 3. Aeromedical evacuation 4. TACEVAC A. A new term introduced to encompass en route care from the point of wounding to the definitive care facility. B. Movement of a casualty ("patient") from a point of care within the theater to a more rearward location, such as regional hospital or CONUS. Traditionally, this phase of movement has employed fixed-wing aircraft such as the C-17, or C-130. C. Evacuation of a casualty ("patient") from one point of care to another point of care within the tactical theater. This movement usually occurs with a rotary-wing aircraft or tactical fixed-wing aircraft such as the C-130. D. Evacuation of a casualty from the forward line of conflict; may expose the crew and aircraft to hostile fire and involves aircraft that are designed for (but not necessarily dedicated to) casualty movement.

1. CASEVAC - C 2. MEDEVAC - D 3. Aeromedical evacuation - B 4. TACEVAC - A Pg 654

You are a general surgeon caring for a patient with multiple traumatic injuries sustained in an IED blast. You have stabilized him and want to transfer him via aeromedical evacuation to Germany. You have thoroughly assessed the patient. At this point he needs to be cleared by a flight surgeon. True False

True | Pg 661

You are caring for a critically ill soldier at a theater hospital in Afghanistan. A CCATT team is en route to pick him up for transfer. All of the following are true regarding CCATT transport EXCEPT? A. CCATT equipment is self-contained and self-carried B. A CCATT team is composed of an intensivist-trained physician, a critical care nurse, and a respiratory therapist C. CCATT teams functions to augment a standard aeromedical evacuation (AE) team D. CCATT teams transport ONLY stable patients

D. CCATT teams transport ONLY stable patients Pg 658-9

You receive a 9-line MEDEVAC request. Line 3 is reported as "2 Alpha, 1 Bravo, 3 Charlie." What should you expect? A. Two casualties with Airway issues, one casualty with Breathing issues, and three casualties with Circulation issues. B. Two urgent casualties, one urgent surgical casualty, and three priority casualties. C. Two US military casualties, one US civilian casualty, and three non-US military casualties. D. Landing zone marked with two colored panels (VS-17 panels), one pyrotechnic signal, and three smoke signals.

B. Two urgent casualties, one urgent surgical casualty, and three priority casualties. Pg 657 Figure 28-4

You have just prepared a 9-line MEDEVAC request for transmission and have written down "E" for line 8. What does this indicate to the MEDEVAC mission planner? A. He needs to ensure the aircraft is equipped with a jungle penetrator B. The evacuation site will be marked with VS -17 panels C. They need to respond within 4 hours D. There are enemy troops in the area E. They will be picking up enemy casualties

E. They will be picking up enemy casualties | Pg 657

Generally in aeromedical evacuation, a wounded soldier is considered a PATIENT until he or she reaches the first point of definitive medical care. Once entered into the medical care system, the patient is considered a "casualty". True False

False | Pg 654

If possible, medical procedures such as starting IV lines, applying splints or dressings, and airway procedures (e.g. endotracheal intubation) should be done BEFORE aeromedical evacuation flights. If a particular problem (e.g. unstable airway) is a concern, it is prudent to address this issue aggressively BEFORE transport, rather than midway thorugh a flight at altitude and in the dark. True False

True | Pg 659

You have just prepared a 9-line MEDEVAC request for transmission and have written down "B" for line 4. What does this indicate to the MEDEVAC mission planner? A. The evacuation site will be marked with pyrotechnic signals B. They need to respond within 2 hours and fly the casualty to a surgical facility C. There are biological threats in the operational area D. He needs to ensure the flight medic grabs an IMPAC 754 ventilator on his way to the aircraft E. He needs to send an aircraft with an operational hoist

E. He needs to send an aircraft with an operational hoist Pg 657

Which of the following are TRUE regarding a suitable helicopter landing zone (HLZ)? (Mark all that apply) A. Mark (or prepare to mark) the zone as per protocol (VS-17 panels, smoke, chem lights, strobe lights, vehicle lights). B. If possible, have a wind indicator (wind sock, ribbon on stick) just outside the HLZ, easily visible to the pilot. C. In a tactical situation, keep the HLZ as inconspicuous as possible to prevent the enemy from zeroing in on it. D. The HLZ should be a minimum of 300 feet in diameter, larger if a CH-47 or MH-53 will be landing. E. The HLZ should be as flat as possible, with even terrain and no surrounding large trees, wires, or tall structures.

``` A,B,C,E Pg 656 (Figure 28-3) ```