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Medicine
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Nov 24, 2024
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TCCC Final Exam
TCCC is used by who?
-
CORRECT ANS army, navy, airforce, Marine corps,
and coast guard
TCCC approach
-
CORRECT ANS Identify causes of preventable death on
battle field
Address them aggressively
Combine good medicine with good tactics
How long can you bleed out from a hemorrhage?
-
CORRECT ANS 3
minutes
Can can CONSIDER what while under fire?
-
CORRECT ANS C spine
What are the 3 objectives of TCCC
-
CORRECT ANS Treat casualty
prevent additional casualties
complete the mission
How are changes in TCCC made?
-
CORRECT ANS The committee of
tactical combat casualty care
What does Tranexamic Acid (TXA) do?
-
CORRECT ANS helps internal
hemorrhaging
What are the phases of care in TCCC
-
CORRECT ANS Care under fire
Tactical field care
Tactical evacuation care
Equipment while in the field is what?
-
CORRECT ANS Limited
What is PMARCHP used for?
-
CORRECT ANS to effectively treat battlefield
casualties to prevent missing vital medical interventions
What does PMARCHP stand for?
-
CORRECT ANS Patient safety
mass hemorrhage
airway
respirations
circulation
head trauma/hypothermia
Pain management
What treatment is the only treatment you do on the X? -
CORRECT ANS Stop
massive bleeding
When is the first time you assess the patients level of consciousness (LOC)? -
CORRECT ANS Airway
When do you do your secondary blood sweep? -
CORRECT ANS Circulation
When do you do DCAPBTLS? -
CORRECT ANS Circulation
What does bilateral radial pulses tell you? -
CORRECT ANS if patient is going
into shock and needs IV fluids
What is the main contraindication to pain management? -
CORRECT ANS If
patient is unconscious
What medication do you NOT use during shock? -
CORRECT ANS Morphine
and Fentanyl (Opiods)
What medications can slow the respiratory system and is not meant to be used
during shock? -
CORRECT ANS Morphine/ Fentanyl
What do you do first during care under fire? -
CORRECT ANS return fire and
take cover
Stop life threatening external hemorrhage only if... -
CORRECT ANS feasible
How do you do burn prevention CUF -
CORRECT ANS remove casualty from
fire and move to cover
How do you stop burning during CUF -
CORRECT ANS any non flammable
fluids, smothering or rolling on ground
What is the normal one medical priority in CUF? -
CORRECT ANS Early
control of severe hemorrhage
Apply the tourniquet without removing what? -
CORRECT ANS clothes
Military vs. Civilian Trauma care -
CORRECT ANS Hostile fire
darkness
Enviroment
limited equipment
Combat medical training historically was modeled on what civilian courses? -
CORRECT ANS Emergency medical technician
advanced trauma life support
What is the number 1 worry for patients when it comes to tourniquets? -
CORRECT ANS amputations
Apply a C Spine ONLY if the danger of hostile fire does not constitute
....
-
CORRECT ANS a greater threat
How do you check the airway on an unconscious patient? -
CORRECT ANS
chin lift or jaw thrust
What are the 3 symptoms to a possible tension pneumothorax? -
CORRECT
ANS hypoxia, respiratory distress or hypotension
How do you treat a suspected tension pneumothorax? -
CORRECT ANS treat
by burping, removing dressing or needle D
Where can you put a needle D? -
CORRECT ANS 2nd intercostal space
midclavicular line or 4th or 5th intercostal space at anterior axillary line
What establishes the airway? -
CORRECT ANS head tilt chin lift or jaw thrust
What secures the airway? -
CORRECT ANS nasopharyngeal or circ
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When do you treat a sucking chest wound with a vented occlusive dressing
completely over the defect? -
CORRECT ANS during expiration
How do you apply combat gauze? -
CORRECT ANS Expose wound, pack
wound, apply direct pressure, bandage over combat guaze, and transport
How many times can you use combat guaze? -
CORRECT ANS Once
What can you use to add direct pressure over combat guaze? -
CORRECT
ANS ETD (emergency trauma dressing)
What are the three TCCC recommended junctional tourniquets? -
CORRECT
ANS CRoC, JETT, SJT
(Combat Ready Clamp, Junctional Emergency Treatment Tool, SAM junctional
Tourniquet)
All casualties don't need what? -
CORRECT ANS IV's
When do you give fluid resuscitation for shock or risk of shock? -
CORRECT
ANS When patient cannot take medications PO
If you are unable to start an IV what do you do? -
CORRECT ANS Instead an
I/O line into the sternum
How do you insert an I/O? -
CORRECT ANS 60 pounds of pressure
What does TXA do? -
CORRECT ANS lengthen clotting process
How many grams of TXA do you administer in 100 cc of normal saline or
Lactated ringers? -
CORRECT ANS 1
How many hours after injury can you NOT give TXA? -
CORRECT ANS 3
hours
TXA helps with ___________ while tourniquets and combat guaze do not? -
CORRECT ANS internal bleeding
TXA prevents what from being broken down in the body? -
CORRECT ANS
clots
You cannot infuse what into the same line at the same time? -
CORRECT ANS
Hextend and TXA
500cc Blood Loss -
CORRECT ANS alert
radial pulse full
normal heart rate
normal SBP
Normal RR
Casualty will not die
Normal amount of blood in adult? -
CORRECT ANS 5 liters
1000cc Blood Loss -
CORRECT ANS Alert
radial pulse full
HR 100 +
Normal laying down SBP
RR may be normal
casualty will not die
1500cc Blood Loss -
CORRECT ANS Alert but anxious
Pulse may be weak
HR 100+
may be decreased SBP
RR 30
casualty will most likely not die
2000cc Blood Loss -
CORRECT ANS Confused/lethargic
Weak pulse
HR 120+
Decreased SBP
RR >35
Casualty might die
2500cc Blood Loss -
CORRECT ANS unconscious
Absent pulse
HR 140+
markedly decreased SBP
RR over 35
patient will probably die
What are the best TACTICAL indicators of shock? -
CORRECT ANS
decreased state of consciousness
abnormal character or radial pulse
Goal for fluid resuscitation? -
CORRECT ANS Optimize oxygen carrying
capacity (NOT INCREASE)
What is the most ideal fluid resuscitation to give? -
CORRECT ANS Whole
blood
What is the least ideal fluid resuscitation to give? -
CORRECT ANS Crystalloid
Continue resuscitation until what? -
CORRECT ANS palpable radial pulse,
improved mental status, or SBP of 80-90 mmHg is present
If Hextend is unavailable resuscitate with what? -
CORRECT ANS lactated
ringers
Reassess the casualty _________ to check for recurrence of shock -
CORRECT ANS frequently
Do not administer IV fluid if what? -
CORRECT ANS patient is NOT in shock
Too much fluid volume may make internal
hemorrhage worse by... -
CORRECT ANS popping the clot
As you infuse fluid, BP does what? -
CORRECT ANS goes up
Do not try to restore a ________blood pressure -
CORRECT ANS normal
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Do not start your fluid resuscitation by giving two liters of LR or NS wide open
before what? -
CORRECT ANS re-assessing your casualty
1000ml of lactated ringers weighs what? -
CORRECT ANS 2.4 pounds
LR's yield an expansion of the circulating blood volume of only about ________
ml one hour after fluid given -
CORRECT ANS 200
500ml of Hextend weighs? -
CORRECT ANS 1.3lbs
For every 500ml of hextend , intravascular volume expands _________ml -
CORRECT ANS 600-800ml
Intravascular expansion is still present with Hextend for how long? -
CORRECT
ANS 8 hours
Hextend or LR, which is more preferred? -
CORRECT ANS Hextend
Hextend is... -
CORRECT ANS less weight for equal effect
stays where it's supposed to be
less likely to cause undesirable side effects
If signs of shock are present control what first? -
CORRECT ANS bleeding
If a casualty with an altered mental status due to suspected TBI has a weak or
absent peripheral pulse, treat for what first? -
CORRECT ANS shock
If penetrating eye injury occurs, do what? -
CORRECT ANS visual acuity test
cover eye with rigid eye shield
400mg of moxifloxican tablet in combat pill
pack or iv/im antibiotics are given
Do not cover the _______ eye in combat -
CORRECT ANS good
Good Oxygen saturation is important for what? -
CORRECT ANS Unconscious
penetrating chest trauma
chest contusion
severe blast trauma
Oxygen Saturation values may be inaccurate in... -
CORRECT ANS very high
ambient light levels
The simplified triple option approach to battlefield analgesia has three primary
goals: -
CORRECT ANS to preserve fighting force
to achieve rapid and mac relief of pain
to minimize likelihood of adverse effects
For mild to moderate pain you take what? -
CORRECT ANS tylenol 650 mg
meloxicam 15mg
for moderate to severe pain NOT IN SHOCK you take what? -
CORRECT ANS
Fentanyl 800ug (micrograms)
for moderate to severe pain IN SHOCK you take what? -
CORRECT ANS
Ketamine
How much ketamine for IM? -
CORRECT ANS 50ml every 30 min
How much ketamine for IV? -
CORRECT ANS 20ml for every 20min
Monitor what after taking fentanyl? -
CORRECT ANS for respiratory
depression
What is the dose of IV Morphine if IV access has been obtained? -
CORRECT
ANS 5mg IV/IO
What two analgesia can potentially worse severe TBI? -
CORRECT ANS
Ketamine and OTFC (fentanyl)
If respiration's are noted to be reduced after using opioids or ketamine use what?
-
CORRECT ANS ventilator support using the BVM
You take zofran when? -
CORRECT ANS every 8 hours as needed for nausea
or vomitting
Fentanyl lozenges... -
CORRECT ANS do not require IV or IO
can be administered quickly
fast acting
DO NOT CHEW, LET DISSOLVE
At low levels ketamine can do what? -
CORRECT ANS potent analgesia and
mild sedation
At high levels ketamine can do what? -
CORRECT ANS dissociative
anesthesia and moderate to deep seduction
If IV ketamine is administered too rapidly what can happen? -
CORRECT ANS
respiratory depression and apnea
Mobic and Tylenol do not interfere with what? -
CORRECT ANS platelet
function
Morphine and Fentanyl contraindications are? -
CORRECT ANS hypovolemic
shock
unconsciousness
severe head injury
Ketamine can be safely given after what? -
CORRECT ANS fentanyl lozenge
Antibiotics for all open combat wounds are? -
CORRECT ANS Moxifloxacin
and Ertapenem
What is the dosage of moxifloxacin? -
CORRECT ANS 400mg by mouth once
a day
What is the dosage for Ertapenem? -
CORRECT ANS 1g IV/IM once a day
What antibiotic is preferred by TCCC? -
CORRECT ANS Ertapenem
Ertapenem IV infusion time is what? -
CORRECT ANS 30 min
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Ertapenem should be diluted with what? -
CORRECT ANS 3.2cc Lisdocaine
Facial burns can be associated with what? -
CORRECT ANS inhalation injury
(aggressively monitor airway)
If burns are greater than 20% if total body surface area what should be initiated?
-
CORRECT ANS fluid resuscitation
Resuscitation for hemorrhagic shock takes precedence over what? -
CORRECT
ANS resuscitation for burn shock
All TCCC interventions can be performed on or through ______skin -
CORRECT ANS burned
CPR on the battlefield can cause what? -
CORRECT ANS get killed
delayed mission
dead casualty
CPR in tactical setting only in the case of cardiac arrests from what? -
CORRECT ANS hypothermia
near drowning
electrocution
What is the DD form 1380 -
CORRECT ANS TCCC casualty card
Pulse OX readings will become lower as casualty ascends unless what? -
CORRECT ANS supplemental oxygen is added
If needle decompression fails what can be considered? -
CORRECT ANS
Chest tube placement
Casualties with moderate/severe TBI should be monitored for what? -
CORRECT ANS decrease in LOC
Pupillary dilation
SBP> 90mmHg
O2 Sat >90
Hypothermia
PCO2
To decrease intracranial pressure do what? -
CORRECT ANS administer
250cc of 3% or 5% hypertonic saline bolus
elevate head 30 degrees
hyperventilate the casualty
To hyperventilate... -
CORRECT ANS 1 breath every 3 seconds
Do NOT hyperventilate unless signs of what are present? -
CORRECT ANS
impending herniation
Blood products should only be transfused by who? -
CORRECT ANS
providers unless orders given to HM
During what can CPR be attempted? -
CORRECT ANS Tactical evacuation
care
CPR should NOT be given at the expense of what? -
CORRECT ANS
compromising the mission or denying lifesaving care to others
Urgent, Priority, Routine -
CORRECT ANS Immediate
delayed
minimal or expectant
Urgent means what? -
CORRECT ANS PT is in danger of loosing life, limb or
eyesight
The rule of thumb helps indicate what true urgencies? -
CORRECT ANS
interferes with mission
high risk for team
high risk for TACEVAC platform
Enemy casualties are hostile until when? -
CORRECT ANS indicate surrender
drop all weapons
proven no longer a threat
No medical care during care under fire is given to who? -
CORRECT ANS
wounded hostile combatants
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