MASSIVE HEMORRHAGE
What is the proper distance a deliberate tourniquet should be placed from the bleeding site in TFC? What else makes it deliberate?
A deliberate tourniquet placed in TFC should be 2-3 inches above (proximal) to the site of bleeding. It should be on the skin, on viable tissue.
What is the best position for a conscious casualty that is breathing on their own?
Allow the conscious casualty that is breathing on their own to assume whatever position allows them to breathe most comfortably.
How should you treat an open chest wound?
Treat open chest wounds by applying a vented chest seal completely over the wound during expiration.
What is the definition of shock?
Progressive cellular and tissue hypoxia leading to organ damage and, if not treated, death.
True or False? Hypothermia is not an issue in hot operational environments?
False. Even in a hot environment, a trauma or burn casualty can become hypothermic due to hemorrhage and shock. Hypothermia prevention and management is a consideration for all trauma casualties.
How long should direct pressure be applied onto packed hemostatic dressings?
3 minutes
What are the signs of an airway obstruction?
In cases of partial or complete airway obstruction, the casualty may experience agitation, cyanosis, confusion or even unconsciousness, difficulty breathing (dyspnea), or high-pitched breathing noises such as stridor, wheezing, snoring, or gurgling sounds.
What should you do if you suspect a casualty has a tension pneumothorax?
If a chest seal is in place, burp the seal. If there is no improvement after burping the seal perform a needle decompression of the chest.
What signs or symptoms are suspicious for pelvic instability?
Pelvic pain, Any major lower limb amputation or near amputation, Physical exam findings suggestive of a pelvic fracture, Unconsciousness, and Shock.
Why is it important to prevent/manage hypothermia in a trauma casualty?
Even a small decrease in body temperature can interfere with blood clotting and increase the risk of bleeding to death. Casualties in shock are unable to generate body heat effectively. Avoid the “lethal triad”.
Why is it important to check the pulse after applying a pressure bandage?
A pressure bandage should not be a tourniquet. It is important to check to ensure a pulse is still present distally after bleeding has been controlled by application of a pressure bandage. If no pulse is present the pressure bandage should be loosened and reapplied
Name three common errors when performing a cricothyroidotomy?
The most common error is making the initial incision too small, thereby limiting the ability to clearly visualize the cricothyroid membrane; identifying the landmarks properly is difficult and commonly leads to incorrect placement; “stabbing” when incising; not inserting a finger, once the membrane has been incised, to manually feel for the lumen and tracheal rings.
What is tension pneumothorax?
As a tension pneumothorax develops, air enters the chest cavity through the wound with every inspiration, but doesn’t leave with expiration and is trapped, so every breath adds more air to the air space inside the rib cage and outside the lung, and the pressure inside the chest builds up and causes the lung to collapse. Injured lung tissue acts as a one-way valve, trapping more and more air between the lung and the chest wall. Pressure builds up and compresses both lungs and the heart.
What are the most reliable indicators of shock in a TFC setting?
The two most reliable indicators of shock in a TFC setting are an altered mental status in the absence of head injury and an absent or weak radial pulse.
What is the difference between active and passive hypothermia management?
Active hypothermia treatment uses an external heating source to warm the casualty. Passive hypothermia management strategies will keep the casualty from losing more heat, but will not warm the casualty or reverse the hypothermic process.
What is a junctional hemorrhage and what are the four junctional areas we identify for our blood sweep?
Bleeding from the large vessels at the junction where the extremities join the body. The areas include the neck, axillary (armpit), inguinal (groin), and limbs themselves.
What condition warrants oxygenation in TFC according to the TCCC Guidelines?
Traumatic brain injury; maintain an oxygen saturation >90%
What are late signs of a tension pneumothorax?
Jugular vein distention, tracheal deviation, subcutaneous emphysema, and mediastinal shift.
What are contraindications to converting a tourniquet to wound packing and a pressure bandage?
Shock, Inability to closely monitor for rebleeding, or Amputation.
What is the goal of management for casualties with suspected head injuries/TBI in TFC?
Prevention of secondary brain injury from hypotension and hypoxia.
How do we treat junctional hemorrhages?
If available a CoTCCC-recommended junctional tourniquet should be applied. If not available, the wound should be packed with hemostatic gauze and direct pressure applied to the wound. Application of an improvised pressure delivery device may be needed to apply additional, targeted, and sustained pressure to control hemorrhage.
Name the contraindications of a NPA?
Clear fluid coming from the nose or ears, signs of inhalation burns, or moderate to severe trauma to the nose.
What are the two sites for placing an NCD?
The second intercostal space, mid clavicular line, and the fifth intercostal space anterior axillary line.
What is the proper protocol for administering tranexamic acid?
2 grams of tranexamic acid should be administered via slow IV or IO push as soon as possible but NOT later than 3 hours after injury.
What external forces can cause a head injury?
MOI of a vehicle blast event, collision, or rollover, within 50 METERS of a blast (inside or outside), direct blow to the head or a fall, Gunshot or shrapnel wound to the head, open skull fracture, or witnessed loss of consciousness, and Exposure to more than one blast event (the Service member’s commander will direct a medical evaluation).