Tactical Field Care – Circulation, Bleeding, Shock & Resuscitation

Forty vocabulary flashcards highlighting key Tactical Field Care concepts: pelvic fracture management, tourniquet use and conversion, shock recognition, TXA, vascular access, and fluid resuscitation priorities.

Pelvic Fracture

Break in the pelvic ring; occurs in 26 % of OEF/OIF fatalities and may cause massive hemorrhage with up to 40 % mortality when unstable.

Pelvic Binder

External compression device applied at the greater trochanters to stabilize a suspected pelvic fracture and reduce bleeding.

Indications for Pelvic Binder

Severe blunt/blast injury with pelvic pain, major lower-limb amputation, exam findings of fracture, unconsciousness, or shock.

Open Book Pelvic Injury

Life-threatening pelvic fracture where the front of the pelvis “opens like a book,” tearing pelvic ligaments.

Vertical Shear Pelvic Injury

Pelvic fracture in which one half of the pelvis is forcefully shifted upward.

Lateral Crush/Compression Injury

Pelvic fracture produced when half of the pelvis is crushed inward or outward.

Greater Trochanters

Prominent femoral landmarks where pelvic binders must be centered—NOT on the iliac wings.

Junctional Tourniquet

Device that occludes bleeding at groin or axilla and can double as a pelvic binder (e.g., SAM Junctional, JETT).

Tourniquet Repositioning

Replacing a high-and-tight tourniquet with one 2-3 in above the wound to restore proximal limb perfusion.

High-and-Tight Tourniquet

Initial field tourniquet placed as proximal as possible over clothing to rapidly control hemorrhage.

Tourniquet Conversion

Transitioning from a limb/junctional tourniquet to hemostatic or pressure dressing when conditions allow (<2 h ideally).

Combat Gauze

Kaolin-impregnated hemostatic dressing used with pressure to control bleeding during tourniquet conversion.

Hemostatic Dressing

Bleeding control gauze (e.g., Combat Gauze) that promotes clotting when applied with direct pressure.

Criteria to Convert Tourniquet

Casualty not in shock, wound can be closely monitored, and tourniquet is NOT controlling an amputation bleed.

Commercial Pelvic Binder Devices

Pelvic Binder, T-POD, and SAM Pelvic Sling II—any may be used to stabilize fractures.

When NOT to Convert Tourniquet

Casualty in shock, cannot monitor wound, tourniquet >6 h, controlling amputation, arrival to MTF <2 h, or tactical/medical reasons.

Documentation of Tourniquet

Mark placement time, re-application, conversion, and removal times on both the tourniquet and the TCCC Casualty Card.

Shock (General Definition)

State of inadequate tissue perfusion and oxygen delivery that leads to cellular dysfunction and death if uncorrected.

Hemorrhagic Shock

Shock caused by severe blood loss; leading preventable cause of battlefield death.

Tactical Indicators of Shock

Decreased consciousness (without TBI) and weak/absent radial pulse.

Tranexamic Acid (TXA)

Antifibrinolytic drug that preserves existing clots; given early to reduce mortality from internal hemorrhage.

TXA Dose & Timing

1 g IV/IO slow push ASAP (not later than 3 h post-injury), followed by second gram in 100 mL NS over 10 min.

TXA Contraindication

Do NOT administer if >3 h have elapsed since injury—late use increases mortality.

TXA Side Effects

Possible nausea, vomiting, diarrhea, visual changes, hypotension if pushed too fast, and ↑ risk of post-injury clots.

Intravenous (IV) Access

Preferred 18-gauge catheter with saline lock for resuscitation/meds when casualty is in or at risk of shock.

Saline Lock

Short IV catheter capped and flushed with 5 mL NS every 1–2 h to keep access patent without continuous fluids.

Intraosseous (IO) Access

Needle placed in bone marrow when IV access fails and fluids/meds are urgently needed.

FAST1® IO Device

Sternal IO system; contraindicated in <50 kg, chest fractures, tissue damage, osteoporosis, or prior sternotomy.

EZ-IO

Battery-powered IO drill system with site-specific needles; training on simulators only—risk of osteomyelitis.

Indications for IV/IO

Hemorrhagic shock or high risk (e.g., torso GSW), need for medications when oral route impossible.

Fluid Resuscitation Strategy

Assess for shock, control bleeding, then give preferred blood products in order: whole blood → 1:1:1 → 1:1 → single components → Hextend → crystalloid.

Whole Blood (Low-Titer O)

Most preferred resuscitation fluid—cold-stored or prescreened fresh whole blood identical to lost blood.

1:1:1 Ratio

Balanced transfusion of plasma, red blood cells, and platelets mimicking whole blood composition.

Resuscitation Endpoints

Return of palpable radial pulse, improved mental status, or SBP ≈100 mmHg; stop fluids when reached.

Over-Resuscitation Risk

Excess fluids may raise BP, dilute clotting factors, and disrupt developing clots (“popping the clot”).

Calcium Administration

Give 1 g calcium (30 mL 10 % calcium gluconate or 10 mL 10 % calcium chloride) after first blood product transfused.

Low-Titer O Whole Blood

Type O whole blood screened for low anti-A/anti-B titers, allowing universal use far forward.

Hypothermia Prevention

Initiate warming measures during transfusion/resuscitation to prevent coagulopathy and worsen shock.

Refractory Shock & Tension Pneumothorax

Persistent shock despite fluids may indicate untreated tension PTX; treat with needle or finger thoracostomy.

Objectives of Prehospital Fluid Resuscitation

Enhance clotting, minimize resuscitation injury, restore perfusion before surgery, and optimize O₂-carrying capacity.