War Wounds: Debridement
and Irrigation
and Irrigation
The current recommendation of irrigation volume for moderate wounds is?
4-8 liters
Propelled explosive devices impaled in a casualty usually consist of?
A propulsion system, a trigger mechanism, and a main explosive charge
The result from the i-STAT are generally available in ______ minutes or less.
10 minutes
A provider of prolonged field care must first and foremost be an expert in ____.
TCCC
A patient is experiencing a superficial skin injury; pain on re-warming, numbness, hyperemia, occasional blue mottling, swelling and superficial desquamation.
Classify the degree of cold injury the patient is suffering from.
Fist degree
During debridement, extremity wounds should be extended ________?
longitudinal
True or False. All retained ordnance impaled in a patient should be considered "armed" or activated to a degree that final triggering of the fuse would cause the ordnance to explode.
True
Prior to using a i-STAT cartridges, it must be removed from refrigerated storage and kept at a room temperature in its protective pouch for a least __ minutes?
5 minutes
_______ is the main indicator of resuscitation adequacy in burn shock.
Urine output (UO)
What must be established prior to making the diagnosis of cold injury?
normothermia
Due to their heavy contamination and the diminished healing capacity, how long should the closure of blast wounds be avoided after the injury occurs?
2 days or more until a final wound closure strategy is defined.
As the common impaled ordnance types have a number variants, the ______ ______ can provide advice on specific concerns to prevent arming and detonating the device.
EOD Specialist
What is the ideal method to update an i-STAT device without internet connectivity?
Use a second i-STAT with current software
______ and exercise are included in the "best, "better", and "minimum" care recommendations when treating a patient with an extremity burn.
Elevate
_______ is a syndrome related to prolonged exposure to moisture causing water logging of the feet.
Trench Foot
A(n) ________________ events refer to an iatrogenic event in which a sponge or surgical instrument is deliberately or unintentionally left behind while the wound proceeds to definitive management.
retained foreign object (RFO)
Which imaging device is considered safe with respect to potential inadvertent triggering of a UXO?
Plain radiographs
If the i-STAT analyzer and simulator have been stored separately in areas where the ambient temperature differs by more than _____, allow the stimulator and analyzer to stand in the same place for 30 minutes before inserting the stimulator into the analyzer.
3 Celsius or 5F
Monitoring _______ is an important capability for all intubated patients. A rising _______ could indicate clogging of endotracheal tube or poor ventilation from another cause.
end-tidal CO2
end tidal CO2
After rewarming a patient with cold injuries/frostbite, what measures should you take during the course of treatment?
Patients should be prohibited from using any tobacco and nicotine- containing products as well as any medications inducing vasoconstriction. The limb should be elevated to reduce swelling.
What are risk factors of invasive fungal infections assessed for during the first wound debridement?
Dismounted blast injury; above knee immediate amputation; Extensive perineal/genitourinary/rectal injury; massive transfusion of > 20 units in the first 24 hours (or anticipation of 20 units; Progression from below-knee to through knee to above knee amputation; recurrent necrosis following at least two consecutive debridement.
Personnel participating in surgery on a patient with an impaled UXO should wear what protective equipment?
Gown and gloves over ballistic protective equipment including safety glasses, helmet, and body armor with ballistic plates.
An alternative approach is to perform UXO surgery while wearing an EOD bomb disposal helmet suit.
Liquid controls used in a cartridge that measures oxygen concentration must stand at room temperature for a minimum of __ hours before use; controls for other analytes only need to equilibrate at room temperature for __ minutes.
4 hours
30 minutes
What is the MINIMUM recommendation regarding airway management when providing prolonged field care for a burn patient?
Cricothyroidotomy, ketamine, ambu bag with positive end-expiratory pressure (PEEP) valve
If you are concerned that infection is present for a patient with immersion foot, which bacteria should treatment target?
Streptococcal, staphylococcal, and P aeruginosa based on local antibiogram while awaiting any available culture.