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TCCC HM Flashcards

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1
Q

Name 3 Criteria for converting limb and junctional tourniquets to hemostatic or pressure dressings

A
  1. Casualty is not in shock
  2. It is possible to monitor the wound closely for bleeding
  3. Tourniquet is not being used to control bleeding from an amputated extremity.
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2
Q

Describe the needle/catheter needed for decompressing a TENSION PNEUMOTHORAX

A

14 Gauge

3.25” long

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3
Q

List the FIVE Locations for I/O

A
  1. Sternum
  2. Proximal Humerus
  3. Proximal Tibia (just under kneecap)
  4. Distal Tibia
  5. Tibia
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4
Q

What drug helps to reduce blood loss from INTERNAL hemorrhage sites that can’t be addressed by tourniquets + hemostatic dressings?

A

Tranexamic Acid (TXA)

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5
Q

Name the Battlefield Objectives of TCCC

A
  1. Treat the Casualty
  2. Prevent Additional Casualties
  3. Complete the Mission
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6
Q

Why do we need to learn about TCCC?

A
  1. Military units trained in TCCC have documented the lowest incidence of preventable deaths among their casualties in the history of modern warfare.
  2. TCCC is now used by all services of the U.S. Military and many allied nations for combat wounded care.
  3. TCCC-based pre-hospital trauma training is now becoming widespread in the civilian sector as well.
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7
Q

What two types of medical training was battlefield trauma modeled after prior to 9/11?

A
  1. Emergency Medical Technician [EMT]

2. Advanced Trauma Life Support [ATLS]

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8
Q

Eight differences of Prehospital Trauma Care in Military vs Civilian

A
  1. Hostile fire
  2. Darkness
  3. Environmental extremes
  4. Different wounding epidemiology
  5. Limited equipment
  6. Need for tactical maneuver
  7. Long delays to hospital care
  8. Different medic training and experience
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9
Q

Two leading causes of preventable deaths on the battlefield

A
  1. Hemorrhage

2. Tension pneumothorax

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10
Q

Facts about the Committee on TCCC (CoTCCC)

A
  1. 42 members from all services in the DoD + civilian sector
  2. Trauma Surgeons; Emergency Medicine; Critical Care Physicians; Combatant Unit Physicians; Medical Educators; Combat Medics; Corpsmen; and PJs (Para-Jumpers - AF Special Tactics)
  3. 100% Deployed Experience as of 2017
  4. Meet and update TCCC as needed
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11
Q

Characteristics of Battlefield Trauma Care Today

A
  1. Phased care in TCCC
  2. Aggressive use of Tourniquets in CUF
  3. Combat Gauze as hemostatic agent
  4. Aggressive needle thoracostomy*
  5. Sit up & lean forward airway positioning
  6. Surgical airways for maxillofacial trauma
  7. Hypotensive resuscitation
  8. IVs only when needed; IO access if required
  9. PO meds, OTFC**, ketamine as “Triple Option” for battlefield analgesia
  10. Hypothermia prevention; avoid NSAIDs
  11. Battlefield antibiotics
  12. Tranexamic Acid (TXA)
  • Incision into the chest wall, with maintenance of the opening for drainage.
  • *Oral Transmucosal Fentanyl Citrate
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12
Q

Characteristics of Battlefield Trauma Care Today

A
  1. Phased care in TCCC
  2. Aggressive use of Tourniquets in CUF
  3. Combat Gauze as hemostatic agent
  4. Aggressive needle thoracostomy*
  5. Sit up + lean forward airway positioning
  6. Surgical airways for maxillofacial trauma
  7. Hypotensive resuscitation
  8. IVs only when needed; IO access if required
  9. PO meds, OTFC**, ketamine as “Triple Option” for battlefield analgesia
  10. Hypothermia prevention; avoid NSAIDs
  11. Battlefield antibiotics
  12. Tranexamic Acid (TXA)
  • Incision into the chest wall, with maintenance of the opening for drainage.
  • *Oral Transmucosal Fentanyl Citrate
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13
Q

How many combat deaths today are potentially preventable?

A

Up to 24%

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14
Q

What is the best medicine on the battlefield?

A

Fire superiority

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15
Q

What type of injuries do not require C-Spine stabilization?

A

Head and neck injuries

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16
Q

What kind of injuries require c-spine stabilization in the field?

A
  1. Falls
  2. Fast-roping injuries
  3. Motor vehicle accidents
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17
Q

What is the #1 priority in CUF?

A

Early control of severe hemorrhage

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18
Q

What are signs of life threatening bleeding?

A
  1. Pulsing or steady bleeding
  2. Blood pooling
  3. Clothes soaked in blood
  4. Bandages are ineffective
  5. Traumatic amputation
  6. Prior bleeding leading to shock
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19
Q

What should all personnel on combat missions have on them at all times?

A

CoTCCC-recommended limb tourniquets

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20
Q

In what phase is Airway Management implemented?

A

Tactical Field Care

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21
Q

List considerations of Casualty Movement Rescue Plan

A
  1. LOCATION of nearest cover
  2. HOW best to move him to cover
  3. RISK to the rescuers
  4. WEIGHT of casualty and rescuer
  5. DISTANCE to be covered
  6. Using SUPPRESSION FIRE & SMOKE to best advantage
  7. Recover casualty’s WEAPONS if possible
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22
Q

List considerations of Casualty Movement Rescue Plan

A
  1. LOCATION of nearest cover
  2. HOW best to move him to cover
  3. RISK to the rescuers
  4. WEIGHT of casualty and rescuer
  5. DISTANCE to be covered
  6. Using SUPPRESSION FIRE + SMOKE to best advantage
  7. Recover casualty’s WEAPONS if possible
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23
Q

Guidelines of CUF

A
  1. Return fire and take cover
  2. Direct or expect casualty to remain engaged as a combatant if appropriate
  3. Direct casualty to move to cover and apply self-aid if able
  4. Try to keep the casualty from sustaining additional wounds
  5. Casualties should be extricated from burning vehicles or buildings and moved to a relative safety. Do what is necessary to stop the burning process.
  6. Stop life-threatening external hemorrhage if tactically feasible
  7. Defer Airway Management to TFC phase
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24
Q

Guidelines of CUF

A
  1. Return fire + take cover
  2. Direct or expect casualty to remain engaged as a combatant if appropriate
  3. Direct casualty to move to cover and apply self-aid if able
  4. Try to keep the casualty from sustaining additional wounds
  5. Casualties should be extricated from burning vehicles or buildings + moved to a relative safety. Do what is necessary to stop the burning process.
  6. Stop life-threatening external hemorrhage if tactically feasible
  7. Defer Airway Management to TFC phase
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25
How many deaths occurred in Vietnam secondary to hemorrhage from external wounds?
Over 2500
26
Injury to a major vessel can quickly lead to what two things?
1. Shock | 2. Death
27
Where should the tourniquet be placed on a soldier's battle gear?
A standard location
28
Signs of life-threatening bleeding
1. Pulsing or steady bleeding 2. Blood is pooling 3. Clothes are soaked in blood 4. Bandages are ineffective & steadily becoming soaked with blood. 5. Traumatic amputations 6. Patient is in shock because of prior bleeding (e.g. unconscious, confused, pale)
29
Signs of life-threatening bleeding
1. Pulsing or steady bleeding 2. Blood is pooling 3. Clothes are soaked in blood 4. Bandages are ineffective + steadily becoming soaked with blood. 5. Traumatic amputations 6. Patient is in shock because of prior bleeding (e.g. unconscious, confused, pale)
30
Guidelines for applying a tourniquet
1. Not too narrow. 2" thick 2. High + Tight 3. Go directly to a tourniquet; forget about direct pressure, pressure dressings, or anything else. 4. Do not put a tourniquet directly over the knee or elbow 5. Do not put the tourniquet directly over a holster or cargo pocket that contains bulky items 6. Do not apply a tourniquet for minimal bleeding 7. Reassess regularly; monitor casualty closely
31
What should you do if a tourniquet fails to control the bleeding?
Apply a second tourniquet just above (proximal to) the first.
32
Places not to use a tourniquet
1. Neck 2. Axilla (armpit) 3. Groin
33
For how long do you hold direct pressure on a wound?
Three minutes
34
Is it possible to apply a hemostatic agent such as Combat Gauze during CUF?
Not tactically feasible because you must hold direct pressure for 3 minutes.
35
What does MARCH stand for?
1. Massive Hemorrhage (Control life threatening bleeding) 2. Airway (Establish a patent airway) 3. Respiration (Decompress suspected tension pneumothorax, seal open chest wounds, & support ventilation/oxygenation) 4. Circulation (Establish IV/IO access & administer fluids to treat shock) 5. Head injury/ Hypothermia (prevent/treat hypotension & hypoxia to prevent worsening of traumatic brain injury & prevent/ treat hypothermia
36
You approach a casualty with an altered mental status. What should be your first action?
Request you hold their weapon + communication equipment while you treat them.
37
What does Tranexamic Acid (TXA) do?
Helps to reduce blood loss from INTERNAL hemorrhage sites that can’t be addressed by tourniquets and hemostatic dressings
38
For how long is XSTAT12 good?
4 hours
39
How many mini sponges are in XSTAT12?
Approximately 38
40
List the hemostatic dressings
1. Combat Gauze 2. Chito Gauze 3. Celox Gauze
41
What form is used to record the use of XSTAT12
DD 1380 (TCCC Casualty Card)
42
What is the ID# for the TCCC Casualty Card?
DD 1380
43
After opening the airway for an unconscious casualty what is the next step?
Place them in the Recovery Position
44
If a person is unconscious, in what position do you place them?
Any position that best maintains and protects the airway
45
List the signs of Tension Pneumothorax
1. Apnea 2. Unequal rise and fall of chest 3. Tracheal Deviation (late sign)
46
What can tension pneumothorax eventually cause?
1. Respiratory Distress | 2. Shock
47
Normal pulse oxymetry
96-100% at Sea Level | 86% at 12,000 Feet
48
List pelvic binders
1. Pelvic Binder 2. T-POD 3. SAM Pelvic Sling II
49
Secondary pelvic binders
1. SAM Junctional Tourniquet (SJT) | 2. Junctional Emergency Treatment Tool (JETT)
50
What are the primary goals of triple option analgesia?
1. Preserve the fighting force 2. Achieve rapid and maximal relief of pain from combat wounds 3. Minimize likelihood of adverse effects on the casualty from the analgesic medication used
51
When do you repeat doses of IM or IN Ketamine?
Every 30 min
52
How often do you repeat IV Morphine?
Every 10 min
53
9-LINE MEDEVAC Request - Line 6
Security at pick-up site: N - No enemy troops in area P - Possible enemy troops in area (approach with caution) E - Enemy troops in area (approach with caution) X - Enemy troops in area (armed escort required)
54
What is the last resort if TXA and HEXTEND do not work?
Lactated Ringers
55
What is used to treat nausea and vomiting?
4 mg of Ondansetron
56
OTFC (Oral Transmucosal Fentanyl Citrate) works almost as fast as what?
IV Morphine
57
9-LINE MEDEVAC Request - Line 2
Radio frequency, call sign, and suffix
58
Oxygen Saturation of casualties with TBI?
>90%
59
Traumatic Brain Injury (TBI): Administer ___ of ____
Administer 250cc of 3% or 5% hypertonic saline bolus
60
Define bolus
1. A single, relatively large quantity of a substance, such as a dose of a drug, intended for therapeutic use and taken orally. 2. A concentrated mass of a substance administered intravenously for diagnostic or therapeutic purposes.
61
TBI: To what degree do you elevate the head?
30°
62
MEDEVAC
Evacuation using SPECIAL DEDICATED MEDICAL ASSETS MARKED WITH A RED CROSS. *Non-Combatant Assets
63
CASEVAC
Evacuation using NON-MEDICAL PLATFORMS. *May carry a Quick-Reaction force and provide close air support as well.
64
TACEVAC
Term encompasses both MEDEVAC and CASEVAC
65
During Transition of Care in TACEVAC, what is the minimum information required to be communicated?
1. Stable or unstable 2. Injuries identified 3. Treatments Rendered
66
During Transition of Care in TACEVAC, what is the minimum information required to be communicated?
1. Stable or unstable 2. Injuries identified 3. Treatments Rendered "SIT"
67
9-LINE MEDEVAC Request - Line 1
9-LINE MEDEVAC Request - Line 1: | PICKUP LOCATION
68
9-LINE MEDEVAC Request - Line 3
``` 9-LINE MEDEVAC Request - Line 3: NUMBER OF PATIENTS BY PRECEDENCE (EVACUATION CATEGORY) A: Urgent B: Urgent-Surgical C: Priority D: Routine E: Convenience ```
69
9-LINE MEDEVAC Request - Line 4
``` 9-LINE MEDEVAC Request - Line 4: SPECIAL EQUIPMENT REQUIRED A: None B: Extraction Equipment C: Ventilator ```
70
9-LINE MEDEVAC Request - Line 5
9-LINE MEDEVAC Request - Line 5: NUMBER OF CASUALTIES BY TYPE L: Number of Litter Patients A: Number of Ambulatory Patients
71
9-LINE MEDEVAC Request - Line 7
9-LINE MEDEVAC Request - Line 7: A: Panels B: Smoke Signal C: None
72
Four objectives of Prehospital Fluid Resuscitation for casualties in hemorrhagic shock
1. Enhance the body's ability to form clots at sites of active bleeding 2. Minimize adverse effects (edema and dilution of clotting factors) resulting from iatrogenic resuscitation injury. 3 Restore adequate intravascular volume and organ perfusion prior to definitive surgical control of hemorrhage. 4. Optimize oxygen carrying capacity.
73
Order of precedence for fluid resuscitation of casualties in hemorrhagic shock:
1. Whole blood 2. 1:1:1 Plasma:RBCs: Platelets 3. 1:1 Plasma:RBCs 4. Either plasma (liquid, thawed, or dried) or RBCs alone 5. Hextend 6. Either Lactated Ringer's or Plasma-Lyte A
74
Goals of Fluid Resuscitation Therapy
1. Improved state of consciousness (if no TBI) 2. Palpable radial pulse corresponds roughly to systolic blood pressure of 80mmHg 3. Avoid over-resuscitation of shock from torso wounds. * **4. Too much fluid volum may make internal hemorrhage worse by "Popping the Clot."***
75
How much Hextend should be administered during Fluid Resuscitation Strategy
Hextend 500ml bolus initially. | If mental status and radial pulse improve, maintain saline lock - do not give additional Hextend.
76
Analgesia Option 1
Mild to Moderate Pain - Casualty is still able to fight. TCCC Combat Wound Medication Pack (CWMP) Tylenol 650mg bilayer caplet, 2 PO every 8 hrs. Meloxicam - 15mg PO once a day
77
Analgesia Option 2
* Moderate to Severe Pain * Casualty IS NOT in shock or respiratory distress * Casualty IS NOT at significant risk of developing either condition * Oral transmucosal fentanyl citrate (OTFC) 800ug * Place lozenge between the cheek and the gum * Do not chew the lozenge
78
What is the only drug measured in MICROGRAMS?
Oral Transmucosal Fentanyl Citrate (OTFC) which is administered as an analgesia Option 2 in 800ug.
79
Analgesia Option 3
* Moderate to Severe Pain * Casualty IS in shock or respiratory distress OR * Casualty IS at significant risk of developing either condition * Ketamine 50mg IM or IN/ or Ketamine 20mg slow IV or IO - -Repeat doses q30min prn for IM or IN - -Repeat doses q20min prn for IV or IO - -End points: Control of pain or development of nystagmus (rhythmic back-and-forth movement of the eyes)
80
What is an alternative to OTFC if IV access has been obtained?
IV Morphine 5mg IV/IO * Reassess in 10 minutes * Repeat dose every 10 minutes as necessary to control severe pain * Monitor for respiratory depression
81
Morphine and Fentanyl Contraindications
1. Hypovolemic shock 2. Respiratory Distress 3. Unconsciousness 4. Severe head injury
82
9-LINE MEDEVAC Request - Line 8
``` 9-LINE MEDEVAC Request - Line 8: CASUALTY'S NATIONALITY AND STATUS A: US Military B: US Civilian C: Enemy Prisoner of War ```
83
9-LINE MEDEVAC Request - Line 8
``` 9-LINE MEDEVAC Request - Line 8: CASUALTY'S NATIONALITY AND STATUS A: US Military B: US Civilian C: Enemy Prisoner of War ```
84
9-LINE MEDEVAC Request - Line 9 (WARTIME)
``` 9-LINE MEDEVAC Request - Line 9 (WARTIME) CBRN CONTAMINATION C: Chemical B: Biological R: Radiological N: Nuclear ```
85
9-LINE MEDEVAC Request - Line 9 (PEACETIME)
9-LINE MEDEVAC Request - Line 9 (PEACETIME) | TERRAIN DESCRIPTION
86
A casualty has torso trauma or polytrauma, with no pulse or respirations. There is no immediate threat of fire. What can you do for the patient?
Bilateral needle decompression (NeedleD)
87
A casualty on the battlefield needs CPR. How many breaths per minute do you give?
Zero. The cost of giving CPR on the battlefield: 1. CPR performers may get killed 2. Mission gets delayed 3. Casualty stays dead * Wait until TECEVAC phase
88
What are the benefits of a MIST report? List 4.
1. Conveys additional evac info that may be required by theater commanders. 2. A MIST report is supplemental to a MEDEVAC request, and should be sent as soon as possible. 3. MEDEVAC missions should NOT be delayed while waiting for MIST info. 4. MIST info helps the receiving MTF better prepare for the specific casualties inbound.
89
What info is on the front of the TCC card?
Name & Allergies (already filled in)
90
What info is on the back of the TCC card?
1. Type of EVAC 2. Treatments 3. Meds 4. First responder name - Last 4
91
Three categories for CASEVAC
A: Urgent (denotes a Critical, Life-Threatening Injury) B: Priority (Serious injury) C: Routine (Mild to Moderate Injury
92
``` Mental Status: Alert Radial Pulse: Full Heart Rate: 100+ SBP: Normal lying down RR: Normal What's the blood loss? ```
1000 ml Blood Loss
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