Hemorrhage Control
How do you apply a deliberate tourniquet?
Directly on the skin, 2-3 inches above the wound
Name two potential interventions to maintain open airway for an unconscious casualty with no airway obstruction
1. Head tilt chin lift
2. NPA
3. Extraglottic airway
4. Recovery position
Where are the two possible locations to insert an NCD?
1. 5th intercostal space in the anterior axillary line
2. 2nd intercostal space in the mid-clavicular line
Name one sign your casualty may be in shock
1. Decreased consciousness without TBI
2. Weak or absent radial pulse
If available, what is the most preferred fluid for fluid resuscitation?
Whole blood
If bleeding is not controlled with the first deliberate tourniquet, what do you do?
Apply a second tourniquet side-by-side to the first
A conscious casualty should be allowed to ________ if it is helpful to their airway
Assume any position that allows them to breathe better
Name at least 2 indications of a tension pneumothorax
1. Severe or Progressive respiratory distress
2. Severe or Progressive tachypnea (rapid breathing)
3. Decreased/absent breath sounds on one side
4. Cardiac arrest without obvious fatal wounds
5. <90% pulse ox reading|
6. Shock
True or false: not all casualties need IVs
True. Do not start an IV on casualties who are unlikely to need fluid resuscitation or IV medications. It wastes time, supplies, and can take your attention away from more serious issues.
How many milliliters of Hextend do you give?
500 ml
Name one reason you should NOT convert a tourniquet to a hemostatic dressing
1. Casualty is in shock
2. The tourniquet has been on more than 6 hours
3. There is an amputation distal to the tourniquet
4. Casualty will arrive at medical center within 2 hours of placement
Why is the recovery position helpful in maintaining an open airway?
Protects against vomiting and aspiration
What size needles can be used for an NCD?
14 gauge or 10 gauge, and 3 1/4 inches in length
The adult body contains 5 liters of blood. Someone will be in hemorrhagic shock after losing how many liters?
2 liters or 2,000 ml
You may readminister Hextend if needed, but not to exceed __________ ml.
1000 ml
When should a pelvic binder be applied?
Severe blunt force or blast injury with one or more of the following: pelvic pain, major lower limb amputation, physical signs of pelvic fracture, unconsciousness, shock
When would you need to perform a cric?
1. Casualty has face/mouth trauma
2. Facial burns w/suspicion of inhalation burns
Explain what happens to the lung during a tension pneumothorax
Injured lung tissue creates a one-way valve that traps air between lung and chest wall. Pressure builds up and compresses the lung and the heart.
What is the purpose of TXA?
It helps reduce blood loss from internal hemorrhagic sites that cannot be addressed with tourniquets or combat gauze.
What medications are found in a combat pill pack?
1000 mg Tylenol (Acetaminophen)
15 mg Mobic (NSAID)
400 mg Moxifloxacin (Antibiotic)
Name the 3 CoTCCC approved junctional tourniquets
1. Combat Ready Clamp (CRoC)
2. SAM Junctional Tourniquet
3. Junctional Emergency Treatment Tool (JETT)
According to CoTCCC, what is the preferred extraglottic airway?
i-gel
If a second NCD is required, where do you insert the second needle?
At whichever site was not previously used
Name one indication you should administer TXA
Casualty is expected to need significant blood transfusion. Signs include: hemorrhagic shock, major amputation(s), penetrating torso trauma, or evidence of severe bleeding.
What is the appropriate initial dose and administration of TXA?
1 gram in 100ml of normal saline or LRs over 10 min. NOT administered through the same line as blood products/Hextend. NOT later than 3 hours after injury.