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Deployed Trauma Imaging Modalities
and Protocols
Section 1 - Radiology: Imaging Trauma Patients in a Deployed Setting - ANSWERS-- The initial radiographic evaluation of a trauma patient begins with supine Anterior-Posterior (AP) chest and pelvis radiographs taken in the trauma bay usually with a(n) __________. - ANSWERS- portable x-ray machine T/F: Computed Tomography scanning has been largely replaced by Cervical Spine Radiographic Evaluation (CSRE) and should only be performed when CSRE is unavailable. - ANSWERS-FALSE. Cervical Spine Radiographic Evaluation (CSRE) has been largely replaced by Computed Tomography (CT) and should only be performed when a CT is unavailable. What is the lowest level of care equipped with a Computed Tomography (CT) Scanner? - ANSWERS-Role 3 What is the lowest level of care equipped with a portable x-ray machine? - ANSWERS-Role 2 Members of the trauma team should have __________ aprons and thyroid shields available near the trauma bay for radiation safety.
Distance is also protective from radiation exposure. If feasible based on the patient's condition, any personnel without lead shielding should move a short distance away from the x-ray unit. The recommended minimal distance is __________ feet. - ANSWERS-Six (6) While the FAST scan has been validated only in hemodynamically unstable blunt trauma patients, it has become a standard tool in the trauma bay and Emergency Department (ED) in most trauma patients. FAST stands for __________. - ANSWERS-Focused Abdominal Sonographic Assessment for Trauma FAST in combat trauma has a sensitivity of only 56% and and specificity of __________. - ANSWERS-98% T/F: The FAST exam remains the most sensitive test for hollow viscus injury and mesenteric injury. - ANSWERS-FALSE. Diagnostic Peritoneal Lavage (DPL) remains the most sensitive test for hollow viscus injury and mesenteric injury. T/F: At the Role 3, properly trained providers including radiologists, surgeons, and emergency physicians, can perform and interpret FAST scans in the emergency department on a hand held portable US device. - ANSWERS-TRUE
based on the pediatric settings to include the doses of and rates of contrast administration. T/F: All patients evacuated through casualty evacuation should have images sent electronically ahead of time as well as have a CD created to send with the patient as a backup. - ANSWERS- TRUE T/F: Magnetic Resonance Imaging (MRI) is widely used in theater, as its utility in the acute management of combat trauma was extensively established during Operation Enduring Freedom. - ANSWERS-FALSE. While Magnetic Resonance Imaging (MRI) has been deployed to theater in the past, its utility in the acute management of combat trauma has not been established. All trauma patients arriving at a Role __________ hospital will receive proper and expeditious radiologic screening of injuries. - ANSWERS- Section 2: Aural Blast Injury Acoustic Trauma & Hearing Loss - ANSWERS-- T/F: Patients exposed to hazardous noise are only at risk for aural trauma. - ANSWERS-FALSE. Service Members exposed to hazardous noise is impact noise or noise greater than 140 dB are at high risk for acoustic trauma and subsequent hearing loss. Patients exposed to blasts are at risk for both aural and acoustic trauma.
The symptoms of acoustic trauma are: - ANSWERS-1. Hearing Loss
- Tinnitus (Ringing in the Ear)
- Aural Fullness
- Recruitment (Ear Pain with Loud Noise)
- Difficulty Localizing Sounds
- Difficulty Hearing in a Noisy Background
- Vertigo "H-TARDD-V" Acoustic trauma may result in sensorineural hearing loss (SNHL) that is either __________ or __________. - ANSWERS-temporary (temporary threshold shift, TTS) or permanent (permanent threshold shift, PTS) The ear, specifically the __________, is the most sensitive organ to primary blast injury (PBI). - ANSWERS-tympanic membrane (TM) T/F: the smaller the size of the tympanic membrane perforation, the greater the likelihood is of spontaneous closure. - ANSWERS- TRUE
What is the best course of action if you find debris in the External Auditory Canal (EAC) or in the middle ear (as seen through a TM perforation)? - ANSWERS-Treat the patient with a fluoroquinolone and steroid containing topical antibiotic (e.g., four (4) drops of ciprofloxacin/dexamethasone or ofloxacin in the affected ear three (3) times a day for seven (7) days. Do not irrigate the ear as it may provoke pain and vertigo. Hearing loss that persists __________ hours after acoustic trauma warrants a hearing test or audiogram. - ANSWERS-72 hours T/F: Vestibular trauma to the inner ear may manifest in vertigo. - ANSWERS-TRUE All patients with subjective hearing loss and tinnitus following blast exposure should... - ANSWERS-...have the exposure documented, and should be evaluated by hearing testing as soon as possible Patients with temporary threshold shift (TTS) greater than __________ losses in three (3) consecutive frequencies should be considered candidates for high dose oral and/or transtympanic steroid injections when not otherwise contraindicated. - ANSWERS-25 dB Section 3: Burn Care - ANSWERS--
What are indications for endotracheal intubation during your initial burn survey? - ANSWERS-1. A Comatose Patient
- Symptomatic Inhalation Injury
- Deep Facial Burns
- Burns Over 40% Total Body Surface Area (TBSA) "CSDB" Burn casualties with injuries greater than __________ Total Body Surface Area (TBSA) are at high risk of hypothermia. - ANSWERS- 20% T/F: When providing point of injury care to a burn patient, you must immediately debride blisters and cover burns with loose, moist gauze wraps or a wet clean sheet. - ANSWERS-FALSE. In the field, Interrupt the Burning Process and address any life threatening bleeding, airway compromise, or tension pneumothorax as directed by Tactical Combat Casualty Care guidelines. Do not debride blisters until the patient has reached a facility with surgical capability. Cover burns with loose, DRY gauze wraps or a clean sheet. Calculate a burn patient's initial burn size using the Rule of __________. - ANSWERS-Nines
For children suffering burn injuries, __________ x Total Body Surface Area (TBSA) x Body Weight (kg) gives the volume for the first 24 hours of fluid resuscitation. - ANSWERS- T/F: A hypotonic solution is the preferred resuscitation fluid for a burn patient. - ANSWERS-FALSE. Lactated Ringer's (LR), Plasmalyte (Baxter International, Deerfield, II) or other isotonic solution is the preferred T/F: Both under- and over- fluid resuscitation of burn patients can result in serious morbidity and even mortality; patients who receive over 250 mL/kg in the first 24 hours are at increased risk for severe complications including acute respiratory distress syndrome and both abdominal and extremity compartment syndromes. - ANSWERS-TRUE At 8-12 hours post-burn, if the hourly IV fluid rate exceeds 1500mL/hr, or if the projected 24 hour total fluid volume approaches 250 mL/kg, initiate 5% __________ infusion for an adult burn patient. - ANSWERS-albumin What are the clinical signs of inhalation injury? - ANSWERS-1. Progressive Voice Changes
- Soot About the Mouth and Nares
- Hypoxia
- Shortness of Breath
"PSHS"
Definitive care for U.S. Service Members suffering from burn injuries is provided at __________ - ANSWERS-USAISR Burn Center in San Antonio, Texas T/F: Early ambulation and physical therapy is critical to the long- term functional outcome in burn patients. Once post-operative dressings are removed, perform range of motion of all affected joints. - ANSWERS-TRUE __________ is the most common infectious complication with pediatric burn patients and usually presents within five (5) days of injury. - ANSWERS-Cellulitis A patient has suffered burn injuries to the entire anterior torso (chest and abdomen), the anterior and posterior of both arms, and the anterior of his face and neck. Calculate the patient's initial burn size using the Rule of Nines. - ANSWERS-Anterior Torso
- 18% Anterior & Posterior of Both Arms - 4.5% x 4 = 18% Anterior of Face & Neck - 4.5% Total of 40.5%
The __________ is the best person to control the Military Working Dog; they have the most accurate information about past medical problems and the current situation, and they have first aid training and can assist in care. - ANSWERS-dog handler __________ is the normal temperature (rectal) range for a Military Working Dog at rest. - ANSWERS-101 - 103 Degrees F __________ is the heart/pulse rate range for a Military Working Dog at rest. - ANSWERS-60 - 80 bpm T/F: The normal blood pressure for a Military Working Dog at rest is systolic 120 mmHg / diastolic 80 mmHg. - ANSWERS-TRUE. Systolic 120 mmHg, Diastolic 80 mmHg Use the __________ vein for long-term fluid therapy, large volume fluid delivery, and repeated blood sampling on Military Working Dogs. - ANSWERS-external jugular vein T/F: When introducing a catheter into a Military Working Dog, it is acceptable to create a small nick over the intended catheter insertion site to facilitate penetration of the dog's thick skin. - ANSWERS-TRUE. This nick can be made with the tip of a # scalpel blade or the bevel of an 18-gauge needle The arterial pulse of a Military Working Dog is best palpated at the __________ artery on the medial aspect of the proximal thigh in the
inguinal area, or at the dorsal metatarsal artery on the dorsal aspect of the proximal hind paw. - ANSWERS-femoral Pulse oximetry probes used for people (typically finger probes) are best placed on the __________ for optimal reliability in unconscious, sedated, or anesthetized dogs. - ANSWERS-tongue What are the three (3) characteristic breathing patterns typically displayed in Military Working Dogs in respiratory distress? - ANSWERS-1. Parenchymal
- Restrictive
- Obstructive "PRO" When performing a tracheostomy on a Military Working Dog, make a transverse incision completely through the __________ ligament. - ANSWERS-annular While placing an endotracheal tube in a Military Working Dog, you palpate the dog's neck and feel two (2) tubes. This indicates that the endotracheal tube is in the dog's __________. - ANSWERS- esophagus When performing cardiopulmonary resuscitation on a Military Working Dog, begin sustained, forceful chest compressions with the MWD in lateral recumbency (on either side) at a rate of
Hypothermia in Military Working Dogs caused by low body temperature due to trauma, toxicity, underlying illness, or anesthesia and surgery is classified as __________ hypothermia. - ANSWERS-secondary Calculate the estimated percent of Total Body Surface Area (TBSA) burned on a Military Working Dog suffering from burns to the head, neck, chest, and abdomen. - ANSWERS-Head & Neck - 9% Chest - 18% Abdomen - 18% Each Forelimb - 9% Each Hindlimb - 9% 9% + 18% + 18% = 45% For PO supplementary analgesia for an injured Military Working Dog, administer __________ 5-10ml/kg PO q8-12h for up to five (5) days. - ANSWERS-Tramadol Section 5: Whole Blood Transfusion - ANSWERS-- How long can whole blood collected in the anticoagulant CPD be stored? - ANSWERS-21 Days at 1-6°C
How long can whole blood collected in the anticoagulant CPDA- be stored? - ANSWERS-35 Days at 1-6°C If stored at room temperature, fresh whole blood must be destroyed if not used within what time period? - ANSWERS- Hours of Collection T/F: The most important safety consideration in transfusing whole blood is that donor red blood cells be compatible with the recipient to avoid acute hemolytic transfusion reactions (a.k.a., major mismatch) - ANSWERS-TRUE How often SHOULD titer and transfusion transmitted disease retesting be conducted? - ANSWERS-Every 90 Days In order to mitigate the risk of transfusion-associated acute lung injury (TRALI), the Armed Services Blood Program collects whole blood from everyone EXCEPT: - ANSWERS-1. Pregnant Females
- Females Testing Positive for Anti-HLA Antibodies __________ is the preferred resuscitation product for the pre- hospital treatment of patients in hemorrhagic shock. - ANSWERS- Whole blood, and in particular, Low Tier O-Whole Blood (LTOWB) Storage lesion describes the degradation of the red blood cells (RBC) involving the loss of what? - ANSWERS-membrane plasticity, diphosphoglycerate, adenosine triphosphate, nitric
from a single donor. - ANSWERS-FALSE. No more than two (2) units may be taken from a single donor. Is there a known contraindication to using whole blood in pediatric casualties? - ANSWERS-No A massive transfusion in children is defined as __________ mL/kg - ANSWERS-40 mL/kg Section 6: Infection Prevention in Combat-Related Injuries - ANSWERS-- T/F: Infection Prevention in Combat-Related Injuries standard precautions apply to all patients, regardless of suspected or confirmed infectious status. - ANSWERS-TRUE The World Health Organization's "five moments of hand hygiene" include... - ANSWERS-1. Use of Soap & Water or Alcohol-Based Sanitizer Before Patient Contact;
- Before Aseptic Tasks;
- After Body Fluid Exposure Risk;
- After Patient Contact; and
- After Contact with Patient Surroundings, Even if Gloves were Worn
What are Infection Prevention in Combat-related injuries standard precautions? - ANSWERS-1. Handwashing
- Gloves
- Gowns
- Masks
- Goggles or Face Shields
- Hand Hygiene
- Cohorting
- Transmission-Based Isolation
- To prevent spread from other hospitalized patients and to decrease antibiotic pressure selecting for resistant organisms * T/F: When implementing infection prevention measures in a combat zone, Cohorting is the process of clustering host nation patients (who are not eligible to evacuate from theater) and U.S. and coalition patients (who are eligible for evacuation from theater) and separate when possible to reduce the risk of cross- contamination with multi-drug resistant organisms. - ANSWERS- TRUE __________ and __________ should be worn with all patients suspected or known to have multi-drug resistant organism colonization or infection with C. difficile-infection (CDI). - ANSWERS-Gloves, gowns
