68W COMBAT MEDIC FIELDCRAFT MODULES I-III

What are the tactical indications for spinal immobilization

Motor vehicle accident, Fall greater than 15 ft, IED blast involving a MRAP

primary blast

Overpressure wave (internal damage to hollow organs)

Shrapnel and debris penetrating wounds

Secondary Blast

Casualty is thrown into a solid object

Tertiary Blast

What is the leading cause of preventable death on the battlefield

Extremity Hemorrhage

Why is extremity hemorrhaging the leading cause of death on the battlefield

Not protected by body armor

When should CPR be considered in the combat environment?

Hypothermia, Electrocution, near drowning

Factors that influence care on the battlefield?

Enemy fire, medical equipment, variable evacuation time, tactical considerations, casualty transportation

What is a WALK kit?

Warrior Aid and Litter Kit

Where can a WALK kit be found?

several ground vehicles

What medication is found in the combat pill pack?

Acetaminophen, Meloxicam, Moxiflaxicin

Which combat casualties will receive ABX?

All will eventually, ABX should not be given at the point of injury unless evac. is delayed greater than 3 hours

What does MEDEVAC encompass?

Collecting the wounded, triage, provide a mode of transportation, provide care en route

level 1

First responder- BAS, Medical PLT, Combat Medic

role 2

Forward Resuscitative Care Capability; Forward Surgical Team (FST)- 20 person mobile unit

role 3

Theater Hospitalization Capability; Combat Support Hospital

role 4

Definitive Care Capability Outside of the Combat Zone; CONUS and OCONUS (Germany)

role 5

CONUS DOD Hospitals; DOD Hospital, VA Hospital

What are the authorized methods of documenting care on the battlefield?

TC3 Card dd 1380, Sharpie on tape

What is the timeframe for a Urgent/Urgent Surgical casualty

1 hour

What is the timeframe for a Priority casualty?

4 hours

What is over classification and what is the impact on the mission?

Classifying casualties worse than they are; pulls medical assets that could be used else where

What is a Simple rescue?

Open field, no hindrances to removing casualty

What makes up a complex rescue?

Vertical casualty movement, vehicle extrication, tactical search and rescue

What is the load capacity of a M997

4 litter or 8 ambulatory or 2 litter and 4 ambulatory

What is the load capacity of a M113

4 litter or 10 ambulatory or a combination

What is the load capacity of a Haga rg33

3 litter or 6 ambulatory

What are the 3 most common devices used in hoist operations?

Sked, Jungle penetrator, stokes basket

What is the leading cause of preventable death on the battlefield?

Extremity hemorrhage

Plasma

provides a fluid environment for the other components and warmth for the body

Erythrocytes (RBCs)

Carry oxygen to the tissue

Leukocytes (WBCs)

Fight infection and consume dead tissue

Thrombocytes

Specialized cells that form clots

What are the 5 factors that affect blood clotting?

Hypothermia, Acidosis, Hemodilution, High BP, Medication

What is the difference between Compressible hemorrhage and non-compressible hemorrhage

Direct pressure can control the hemorrhage

What are some S/S of Non-compressible hemorrhage

Bruising, hemoptysis, rectal bleeding, hematemesis

How many liters of fluid can the average adult hold in the abdomen?

10 liters

How many liters of fluid can the average adult hold in 1 thigh?

1 liter

How much fluid can be held on one side of the chest?

1500 mL

How fast can the intercostals muscles bleed?

100 mL per minute

What is the only medical treatment done in the Care under fire phase?

Hasty Tourniquets

Describe a delibrate tourniquet?

Directly to the skin; 2-3 inches above the wound; not over a joint; tightened till bleeding stopped or distal pulse absent

What are the 4 P's of packing?

Peel, Push, Pile, Pressure

When should you not loosen a tourniquet?

If casualty will arrive at surgical facility less than 2 hours; TQ has been place for longer than 6 hours; Amputations; Casualties in profound shock

What is the 1st step in the assessment for circulation?

Treat significant non-pulsating hemorrhage with packing and pressure

What is the respiratory response to increased CO2 production

As CO2 increases; respiratory rate increases

What is the normal respiratory rate for an adult

12-20

What is the normal respiratory rate for a child

15-30

What is the normal respiratory rate for an infant

25-50

What are the complications of suctioning

Will cause hypoxemia, cardiac dysrhythmia, vagus nerve stimulation

What are the essential Airway skills

Positioning, manual maneuvers, suctioning, NPA

What is the "Gold Standard" in Advanced airway management?

Endotracheal intubation

What is the perferred advanced airway in the combat environment?

Emergency Cricothryoidotomy

What are the landmarks for an emergency cric?

Thyroid Cartilage; Cricothyroid membrane, cricoid cartilage

What are the indications for a Cric?

Severe maxillofacial trauma, airway obstruction, structural deformities, inhalation burns, unconscious and unable to secure own airway

Define diagphram?

A musculofibrous partition separating the thoracic abdominal cavities

what is the difference between visceral and parietal pleura

Visceral attached to lung, parietal attached to chest wall

Describe inhalation

diaphragm and intercostal muscles contract; lungs expand, intrathoracic pressure decreases

Describe exhalation

diaphragm and intercostal muscles relax; intrathoracic pressure increases

What type of wound is considered both an ABD and a thoracic injury

Penetrating wound below the 4th intercostals space

Describe a pneumothorax

Air within the pleural space

Describe a tension pneumothorax

Air builds up pressure and prevents the heart from filling/ pumping and compresses the other lung

What are the S/S of respiratory distress?

Tachypnea, bradypnea, labored breathing, retractions, hemoptysis, one or two word sentences, agitation or air hunger

Describe a sucking chest wound?

An open wound that is 2/3 the size of the trachea

Describe the placement of a Needle Chest decompression

2nd ICS, mid-clavicular line, over the 3rd rib

What are the troubleshooting procedures for a NCD

Place 2nd needle lateral to the 1st, flush catheter with 1-2 ml of iv solution, burp the wound

What are the 4 types of distributive shock?

Spetic, Neurogenic, anaphylactic, psychogenic

What are the intrinsic causes of Cardiogenic shock

Heart muscle damage, dysrhythmia, vavular disruption

Extrinsic causes of Cardiogenic shock

Cardiac Tampnade, pneumothorax

Describe decompensated shock?

When the body can no longer compensate and casualty's BP drops

How much blood must be lost to see a decrease in BP

1500ml

Systolic of at least 80

Radial

Systolic of at least 70

Femoral

Systolic of at least 60

Carotid

Fluid of choice for burns, dehydration

Lactated Ringer

used in conjunction with blood transfusion, restoring the loss of body fluid

Normal Saline

Calorie replacement, hypoglycemia

D5W

What are the types of Colloid Solutions?

Blood and Blood components, Hextend

What is the vein order of precedence for vascular access

Median cubital, cephalic, basilic

What are the indication for an intraosseuous infusion

Small children, trauma to the extremities, two unsuccessful IV attempts and casualty is in shock

Fluid accumulation in the tissue surrounding IV site, flow rate slower, infusion site cool hard to touch, pale, swollen, pt complains of tenderness, pain burning

Infiltration

Inflammation of the vein wall, sluggish flow rate, swelling, pt c/o pain and tenderness, redness and warmth of the site

Phlebitis

Obstruction of a blood vessel caused by air in the bloodstream, abrupt drop in BP, weak and rapid pulse, cyanosis, chest pain

Air Embolism

Increase in vascular volume resulting in too much IV fluid pushed too fast; elevated BP, JVD, rapid breathing, SOB, tachcycardia, rhonchi or rales, fluid intake greater than urinary output

Circulatory overload

Redness, swelling of site, pt c/o fever, chills malaise, sudden rise in temp., purulent drainage

Infection

Use only eye and motor scales and add a "T" to score

If the casualty is intubated,

(ETT, Combitube, King LT)

how is the GCS scored?

Increased blood pressure (hypertension).

Decrease in pulse rate (bradycardia).

Respiratory rate to increase, decrease and/or become irregular.

What is Cushing's Triad

brainstem injury is probable if both pupils are dilated and do not react to light

What if both pupils are dilated and do not react to light

hyperextension of the legs and flexion at the arms and elbows with the hands oming in toward the cnter of the body. Injury to the upper midbrain

Decorticate

Teeth clenched arms and legs extended wrist flexed usually caused by secere injury to the midbrain

Decerebrate

To determine if there is a change in the casualty

Why is it important to take serial GCS assessments

Being dazed, confused, "saw stars" or lost consciousness, even momentarily as a result of an explosion/blast, fall, motor vehicle crash.

Who should the MACE assessment be administered on

Unequal pupils, Deteriorating examination

Decreasing or loss of consciousness

What are the RED FLAGS of a head injury

An injury to the brain resulting from an external force and/or acceleration/deceleration mechanism from an event

Traumatic Brain injury

Brain trauma can cause a broad range of physical, cognitive emotional and social problems.

Significance of TBI

AMS, headache, nausea, vomiting, dizziness/balance problems, fatigue, insomnia, sleep disturbances, drowsiness, sensitivity to light and noise, blurred vision, difficulty remembering and/or difficulty concentrating.

What are the signs and symptoms of a TBI

Decreased memory and attention/concentration, slower thinking, irritability, depression, impaired vision, mood swings, balance problems, headaches, and nausea.

Post concussion symptoms

Mild-GCS 14-15 80% of head injuries Usually full

recovery within weeks. Moderate-GCS = 9 to13

10% of head injuries most are admitted/observed

due to potential for deterioration. Severe- GCS = < 9 10% of head injuries Mortality approx. 40% long term

Levels of TBI

massive systemic infection that includes hypotension, decreased urine output and altered mental status

Sepsis

inflammation of the peritoneum or lining of the abdominal cavity

Peritonitis