EFMB Written Test (2024) - Radiology, Aural Blast Injury, Burn Care, Exams of Nursing

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EFMB Written Test (2024) (400 Questions

And Answers).

Section 1 - Radiology: Imaging Trauma Patients

in a Deployed Setting - -

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) __________. - Correct Answer 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. - Correct Answer 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? - Correct Answer Role 3 What is the lowest level of care equipped with a portable x-ray machine? - Correct Answer Role 2 Members of the trauma team should have __________ aprons and thyroid shields available near the trauma bay for radiation safety. - Correct Answer lead 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. - Correct Answer 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

__________. - Correct Answer Focused Abdominal Sonographic Assessment for Trauma FAST in combat trauma has a sensitivity of only 56% and and specificity of __________. - Correct Answer 98% T/F: The FAST exam remains the most sensitive test for hollow viscus injury and mesenteric injury. - Correct Answer 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. - Correct Answer TRUE A FAST examination is performed with a portable hand-held machine most commonly using a standard 3-7 MHz curved array __________ probe. - Correct Answer Ultra Sound (US) The standard FAST examination is focused on evaluating for the presence of __________ in certain areas of the body. - Correct Answer Free Intraperitoneal Fluid When performing a FAST examination on a patient, you inspect the right upper quadrant. You are inspecting between which two (2) organs? - Correct Answer Liver & Kidney When performing a FAST examination on a patient, you inspect the left upper quadrant. You are inspecting between which two (2) organs? - Correct Answer Spleen & Kidney An 18g __________ IV is typically desired for Computed Tomography IV access. - Correct Answer antecubital T/F: The goal of Computed Tomography (CT) contrast injection is to provide concurrent solid organ enhancement, arterial enhancement, and pulmonary arterial. - Correct Answer TRUE

T/F: When performing Computed Tomography (CT) scan on a Military Working Dog, utilize a scanning protocol based on the adult settings to include the doses of and rates of contrast administration. - Correct Answer FALSE. Utilize a scanning protocol 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. - Correct Answer 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. - Correct Answer 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. - Correct Answer 3 Section 2: Aural Blast Injury Acoustic Trauma & Hearing Loss - Correct Answer - T/F: Patients exposed to hazardous noise are only at risk for aural trauma.

• Correct Answer 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: - Correct Answer 1. Hearing Loss

2. Tinnitus (Ringing in the Ear)
3. Aural Fullness
4. Recruitment (Ear Pain with Loud Noise)
5. Difficulty Localizing Sounds
6. Difficulty Hearing in a Noisy Background
7. Vertigo "H-TARDD-V"

Acoustic trauma may result in sensorineural hearing loss (SNHL) that is either __________ or __________. - Correct Answer 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). - Correct Answer tympanic membrane (TM) T/F: the smaller the size of the tympanic membrane perforation, the greater the likelihood is of spontaneous closure. - Correct Answer TRUE The majority of tympanic membrane perforations that close spontaneously do so within the first __________ after injury. - Correct Answer 8 weeks Acute management of intratemporal facial nerve injury is to provide objective documentation of facial movement using the __________ grading scale. - Correct Answer House-Brackmann T/F: For significant facial pareses/paralyses, early administration of steroids must always be provided regardless of contraindications. - Correct Answer FALSE. Early administration of steroids should be provided if not contraindicated, and referral for management by an otolaryngologist is indicated. Which inner ear abnormalities may cause vertigo? - Correct Answer 1. Otic Capsule Violating Temporal Bone Fractures

2. Secondary Infections of the Inner Ear or Vestibular Nerves
3. Trauma Induced Endolymphatic Hydrops
4. Activation of Subclinical Super Semicircular Canal Dehiscence "OSTA" All Service Members that develop symptoms consistent with noise trauma (acute tinnitus, muffled hearing, fullness in the ear) should... - Correct Answer ...be educated and directed to self-report for evaluation and possible treatment as soon as practicable. 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)? - Correct Answer 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. - Correct Answer 72 hours T/F: Vestibular trauma to the inner ear may manifest in vertigo. - Correct Answer TRUE All patients with subjective hearing loss and tinnitus following blast exposure should... - Correct Answer ...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. - Correct Answer 25 dB Section 3: Burn Care - Correct Answer - What are indications for endotracheal intubation during your initial burn survey? - Correct Answer 1. A Comatose Patient

2. Symptomatic Inhalation Injury
3. Deep Facial Burns
4. 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. - Correct Answer 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. - Correct Answer 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 __________. - Correct Answer Nines Which type of burn is NOT included in the estimation of Total Body Surface Area (TBSA) used for fluid resuscitation? - Correct Answer Superficial Burns (1st Degree) Which classification of burns appear red, do not blister, and blanch readily?

• Correct Answer Superficial Burns (1st Degree) Which classification of burns are moist and sensate, blister, and blanch? - Correct Answer Partial Thickness Burns (2nd Degree) Which classification of burns appear leathery, dry, non-blanching, are insensate, and often contain thrombosed vessels? - Correct Answer Full Thickness Burns (3rd Degree) What is the Rule of 10s burn fluid resuscitation equation? (Ensure You Can Apply It) - Correct Answer Use the Rule of Tens to Determine Fluid Requirements for the First 24 Hours Post-Burn. 10 mL/hr x %TBSA > 40kg and < 80kg. If > 80kg, Add 100 mL/hr to IV fluid rate for Every 10 kg > 80kg For Children, 3 x TBSA x Body Weight (kg) gives the Volume for the First 24 Hours 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. - Correct Answer 3 T/F: A hypotonic solution is the preferred resuscitation fluid for a burn patient. - Correct Answer 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. - Correct Answer 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. - Correct Answer albumin What are the clinical signs of inhalation injury? - Correct Answer 1. Progressive Voice Changes

2. Soot About the Mouth and Nares
3. Hypoxia
4. Shortness of Breath "PSHS" Definitive care for U.S. Service Members suffering from burn injuries is provided at __________ - Correct Answer 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. - Correct Answer TRUE __________ is the most common infectious complication with pediatric burn patients and usually presents within five (5) days of injury. - Correct Answer 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. - Correct Answer Anterior Torso - 18% Anterior & Posterior of Both Arms - 4.5% x 4 = 18% Anterior of Face & Neck - 4.5% Total of 40.5%

A patient has suffered burn injuries to anterior and posterior legs and the perineum. Calculate the patient's initial burn size using the Rule of Nines. - Correct Answer Anterior Legs - 9% x 2 = 18% Posterior Legs 9% x 2 = 18% Perineum = 1% Total of 37% A patient has suffered burn injuries to the anterior of her face, neck, and torso (chest and abdomen). Calculate the patient's initial burn size using the Rule of Nines. - Correct Answer Anterior Face & Neck - 4.5% Anterior Torso - 18% Total of 22.5% Section 4: Military Working Dogs - Correct Answer - T/F: In addition to providing immediate care to preserve life, limb, or eye sight when veterinary personnel are not available, human healthcare providers are also responsible for providing routine medical, dental, or surgical care to Military Working Dogs in combat or austere areas of operation. - Correct Answer FALSE. Routine medical, dental, or surgical care is NOT to be provided by Human Healthcare Providers (HCPs). 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.

• Correct Answer dog handler __________ is the normal temperature (rectal) range for a Military Working Dog at rest. - Correct Answer 101 - 103 Degrees F __________ is the heart/pulse rate range for a Military Working Dog at rest.
• Correct Answer 60 - 80 bpm T/F: The normal blood pressure for a Military Working Dog at rest is systolic 120 mmHg / diastolic 80 mmHg. - Correct Answer 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. - Correct Answer 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. - Correct Answer TRUE. This nick can be made with the tip of a #11 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. - Correct Answer femoral Pulse oximetry probes used for people (typically finger probes) are best placed on the __________ for optimal reliability in unconscious, sedated, or anesthetized dogs. - Correct Answer tongue What are the three (3) characteristic breathing patterns typically displayed in Military Working Dogs in respiratory distress? - Correct Answer 1. Parenchymal

2. Restrictive
3. Obstructive "PRO" When performing a tracheostomy on a Military Working Dog, make a transverse incision completely through the __________ ligament. - Correct Answer 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 __________. - Correct Answer 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 __________ compressions per minute. Sustain compression for at least 2-3 minutes per cycle. - Correct Answer 100

T/F: If single-person cardiopulmonary resuscitation is performed on a Military Working Dog, the responder should only perform ventilation, as this optimizes circulation. - Correct Answer FALSE. The responder should only perform chest compressions, as this optimizes circulation. T/F: Conventional human tourniquets applied to the limb of a Military Working Dog are an unreliable intervention to effectively control hemorrhage. - Correct Answer TRUE. Tourniquets are unreliable on the limbs of dogs due to the anatomic shape of the leg. Calculate the approximate safe but effective crystalloid bolus volume for a 55 pound Military Working Dog experiencing signs and symptoms of shock.

• Correct Answer ADD a ZERO (0) to the Dog's Body Weight (in Pounds) to Approximate a Safe but Effective Bolus Volume. Approximate Safe Bolus Volume = 550 mL T/F: Gastric Dilation-Volvulus Syndrome (GDV) in Military Working Dogs occurs when the stomach rapidly dilates with fluid, food, and air, and then rotates along the long axis (volvulus). When volvulus develops, the esophagus and duodenum become twisted, preventing the passage of stomach contents. - Correct Answer TRUE Hypothermia in Military Working Dogs caused by low body temperature due to trauma, toxicity, underlying illness, or anesthesia and surgery is classified as __________ hypothermia. - Correct Answer 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. - Correct Answer 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. - Correct Answer Tramadol Section 5: Whole Blood Transfusion - Correct Answer - How long can whole blood collected in the anticoagulant CPD be stored? - Correct Answer 21 Days at 1-6°C How long can whole blood collected in the anticoagulant CPDA-1 be stored? - Correct Answer 35 Days at 1-6°C If stored at room temperature, fresh whole blood must be destroyed if not used within what time period? - Correct Answer 24 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) - Correct Answer TRUE How often SHOULD titer and transfusion transmitted disease retesting be conducted? - Correct Answer 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: - Correct Answer 1. Pregnant Females

2. Females Testing Positive for Anti-HLA Antibodies __________ is the preferred resuscitation product for the pre-hospital treatment of patients in hemorrhagic shock. - Correct Answer 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? - Correct Answer membrane plasticity, diphosphoglycerate, adenosine triphosphate, nitric oxide, and other factors leading to potentially reduced delivery of oxygen T/F: Fresh whole blood (FWB) is FDA-approved and is intended or indicated for routine use. - Correct Answer FALSE. FWB is NOT FDA- approved and is NOT intended or indicated for routine use.

Fresh whole blood is to be used only when... - Correct Answer 1. Other blood products cannot be delivered at an acceptable rate to sustain the resuscitation of an actively bleeding patient

2. When specific stored products are not available (Stored Whole Blood, Red Blood Cells, Fresh Frozen Plasma, Platelets, Cryo)
3. When stored components are not adequately resuscitating a patient with an immediately life-threatening injury. T/F: Fresh whole blood should routinely be collected from pre-screened donors as a way to maintain a routine inventory of Walking Blood Bank - Stored Whole Blood products. - Correct Answer FALSE. Fresh whole blood should not routinely be collected from pre-screened donors. Use of Walking Blood Bank for collection of FWB is for emergency use only. In general, whole blood units should not be collected from donors more frequently than every __________ weeks. - Correct Answer 8 T/F: In situations where there are a limited number of donors and a dire need for blood, no more than three (3) units may be taken from a single donor. - Correct Answer 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? - Correct Answer No A massive transfusion in children is defined as __________ mL/kg - Correct Answer 40 mL/kg Section 6: Infection Prevention in Combat-Related Injuries - Correct Answer - T/F: Infection Prevention in Combat-Related Injuries standard precautions apply to all patients, regardless of suspected or confirmed infectious status.

• Correct Answer TRUE The World Health Organization's "five moments of hand hygiene" include...
• Correct Answer 1. Use of Soap & Water or Alcohol-Based Sanitizer Before Patient Contact;

2. Before Aseptic Tasks;

3. After Body Fluid Exposure Risk;
4. After Patient Contact; and
5. After Contact with Patient Surroundings, Even if Gloves were Worn What are Infection Prevention in Combat-related injuries standard precautions? - Correct Answer 1. Handwashing
6. Gloves
7. Gowns
8. Masks
9. Goggles or Face Shields
10. Hand Hygiene
11. Cohorting
12. 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. - Correct Answer 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). - Correct Answer Gloves, gowns Daily __________ of ICU patients has shown a reduction of infections with vancomycin-resistant enterococci (VRE) and methicillin-resistant staphylococcus aureus (MRSA). - Correct Answer bathing T/F: Antimicrobial drug usage has no impact on the development of multidrug-resistant organisms. - Correct Answer FALSE. Antimicrobial drug usage CONTRIBUTES to the development of multi-drug resistant organisms.

• Use of overly broad antibiotics for combat trauma prophylaxis has resulted in an increased risk of MDRO infection without improvement in long-term clinical outcomes * T/F: All facilities should avoid unnecessary empiric use of broad spectrum antibiotics. - Correct Answer TRUE T/F: Prolonged duration of prophylaxis has been shown to decrease long term rates of infections in patients with combat-related open fractures. - Correct Answer FALSE. Prolonged duration of prophylaxis has NOT been shown to decrease long term rates of infections. Blast injuries, especially those related to __________, present a unique bloodborne pathogen risk if an impaled body part is introduced into the trauma patient. - Correct Answer suicide bomber attacks T/F: The risk of transmission for human immunodeficiency virus is considered very high after blast injury and generally warrants immediate action regardless of the region of operation. - Correct Answer FALSE. The risk of HIV is considered VERY LOW after blast injury and generally warrants NO ACTION. For a patient that sustained injuries from a suicide bomber, testing for Hepatitis B virus (HBV) and Human Immunodeficiency Virus (HIV) should be obtained __________ and up to six (6) months post-exposure. - Correct Answer at the time of exposure Which role of care should have a designated Infection Prevention and Control Officer? - Correct Answer Roles 2 & 3 All facilities responsible for trauma care should monitor adherence to __________ as listed in the Joint Trauma System (JTS) guidelines for infection prevention after combat-related injuries and present rates to providers regularly. - Correct Answer antimicrobial prophylaxis regimens Section 7: Inhalation Injury & Toxic Industrial Chemical Exposure - Correct Answer - What substance is NOT a highly water soluble irritant? - Correct Answer Oxides of Nitrogen & Phosgene

Treatment for chlorine inhalation includes... - Correct Answer 1. Skin Decontamination

2. Supplemental Oxygen as Necessary
3. Beta Agonists
4. Acute Respiratory Distress Syndrome (ARDS) Ventilatory Techniques Which chemical irritant has a sweet, pleasant smell of mown hay? - Correct Answer Phosgene Which chemical irritant may produce a severe cough with laryngospasm when exposed to high concentrations? - Correct Answer Phosgene Which chemical irritant smells like rotten eggs? - Correct Answer Hydrogen Sulfide Which chemical irritant produces a "knockdown" effect, a sudden loss of consciousness, when exposed to high concentrations? - Correct Answer Hydrogen Sulfide Which chemical irritant forms a strong base which can cause mucosal irritation, severe upper airway irritation, and alkali skin burns when reacting with water? - Correct Answer Ammonia The triad of severe cyanide toxicity consists of... - Correct Answer 1. Hypotension
5. Altered Mental Status
6. Lactic Acidosis (Commonly > 8 mmol/L) "HAL" Which of the following is the most commonly available antidote for cyanide poisoning? - Correct Answer Hydroxocobalamin (Sold as Cyanokit) T/F: High index of suspicion must be present when treating patients exposed to carbon monoxide as elevated CO may be present despite normal PaO2 and SpO2 readings. - Correct Answer TRUE Section 8: Frozen & Deglycerolized Red Blood Cells - Correct Answer -

Deglycerolized Red Blood Cells are derived from __________ mL of whole blood collected in Citrate/Phosphate/Dextrose or Citrate/Phosphate/Dextrose/Adenine collection bags. - Correct Answer 450- Red Blood Cells are stored for up to six (6) days at 1-6 °C before being frozen in a cryoprotectant (40% w/v glycerol), and stored in the frozen state at minus 65 °C or colder for up to __________. - Correct Answer 10 years T/F: Each unit of deglycerolized red blood cells (DRBCs) should be considered equivalent to a fresh unit of RBCs since they are frozen within six (6) days of collection and have a 14-day shelf-life upon deglycerolization. - Correct Answer TRUE What are the clinical indications for use of each unit of deglycerolized red blood cells (DRBCs)? - Correct Answer Primary Indication - As a supplement to liquid RBCs during surge periods of increased transfusion requirements in order to decrease casualty hemorrhagic morbidity and mortality. Each Unit of DRBCs:

1. Should be considered equivalent to a fresh unit of RBCs since they are frozen within 6 days of collection and have a 14-day shelf life upon deglycerolization.
2. Contains more than 80% of the RBCs present in the original unit of blood
3. Provides the same physiologic benefits as liquid RBCs.
4. Carries the same expectation for post-transfusion survival as liquid stored RBCs.
5. Contains significantly lower concentrations of proteins associated with non-hemolytic transfusion reactions. How long does it take to thaw frozen red blood cells in a plasma thawer? - Correct Answer About 35 Minutes How long does it take to thaw frozen red blood cells in a 42 °C water bath?

• Correct Answer About 45 Minutes Section 9: Interfacility Transport of Patients Between Theater Medical Treatment Facilities - Correct Answer -

Optimal, but not necessarily definitive patient stabilization before transport is critical and encompasses four (4) connected elements. What are these elements? - Correct Answer 1. Injuries - Actual & Potential (e.g., Spinal Instability) Must Be Controlled

2. Resuscitation Must be Optimized but May be Ongoing
3. Other Treatments Besides Resuscitative Measures Should be at Steady- State, Not Requiring Dynamic, Complex, or Life-Preserving Adjustment En Route
4. Deterioration Requiring En Route Intervention Must be Anticipated and Prevented with Risk Mitigation Procedures Prior to Departure T/F: Medical capability is the quality or state of being able to provide the expected and required medical services and support to the casualty. - Correct Answer TRUE __________ transport is required when "the patient has a critical illness or injury that acutely impairs one (1) or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient's condition during transport - Correct Answer Critical Care The gold standard for unstable patient transport is movement with critical care capability led by a __________ who is qualified, experienced, and proficient at critical care transport. - Correct Answer Physician T/F: Intermediate en route care should be initiated for a patient that does not require critical care, but is in need of a dedicated medical attendant with at least the knowledge and skills equivalent to a paramedic as defined by the National Emergency Medical Services (EMS) Scope of Practice Model.

• Correct Answer TRUE Who assumes risk of reduced capability when a medical evacuation organization is not capable of providing the required intratheater en route care capability? - Correct Answer Theater Commander T/F: Well trained teams improve outcomes so en route care teams who train together prior to operational assignment may optimize patient outcomes. - Correct Answer TRUE What are examples of specific medical materials designated as patient movement items (PMI)? - Correct Answer 1. Ventilators

2. Patient Monitors
3. Pulse Oximeters
4. Suction Machines
5. IV Pumps
6. Oversized Litters
7. Negative Pressure Wound Vacuums
8. Pneumatic Compression Stockings/Devices T/F: The Senior military person (or designated on-ground mission Commander) present in coordination with the Senior medical person determines when to request medical evacuation and the precedence assigned to the patient for evacuation. - Correct Answer TRUE The MIST report was recently incorporated into the 9-line medical evacuation request. MIST stands for: - Correct Answer M - Mechanism of Injury I - Type of Injury S- Signs (Vital Signs) T - Treatment Given T/F: The Interfacility Transport of Patients Between Theater Medical Treatment Facilities Clinical Practice Guideline defines medical direction as the direct technical authority to determine capability, promulgate medical policy, and the authority to enforce the standard of care through quality assurance with local privileging actions of individual en route care providers. - Correct Answer TRUE __________ medical direction includes protocol development and review, continuing education of prehospital providers, and quality improvement activities. - Correct Answer Offline The Commander of the unit assigned to perform medical evacuation should appoint the unit's __________ as the medical director. - Correct Answer Physician T/F: Medical direction at the regional level (Patient Evacuation Control Center) is centered on online medical direction activities. - Correct Answer FALSE. It is centered on OFFLINE medical direction activities.

What are the responsibilities of a regional medical director? - Correct Answer 1. In conjunction with medical planners, advise the Combatant/Theater Commander on medical common operating picture and allocation of resources for intra-theater transport. 2. Ensure requirements of documentation of intra-theater transport care are done.

3. Assist medical directors operating in theater and ensure that they have the knowledge and skills to perform the job.
4. Provide technical supervision to medical directors in theater.
5. Ensure relevant out of hospital research is supported and accomplished.
6. Ensure information from intra-theater transportation is supplied to the DoD Trauma Registry. What are the approved Joint Trauma System patient care records (PCR) for inter-facility patient transports? - Correct Answer 1. DD Form 1380 - Tactical Combat Casualty Care (TCCC) Card
7. DA 4700 Overprint Tactical Evacuation Patient Care Record (JTS Approved 20141119)
8. AF IMT 3899 - Patient Movement Record (20060819, V1)
9. Medical Rescue Report SAR Form 3-50.1A Which approved Joint Trauma System patient care record (PCR) is primarily used for rotary wing transports from point of injury or inter-facility transfer? - Correct Answer Tactical Evacuation Patient Care Record Which approved Joint Trauma System patient care record (PCR) is primarily used for Critical Care Air Transport Team movements? - Correct Answer AF IMT 3899, with Supplements A-K Which approved Joint Trauma System patient care record (PCR) is required whenever a search or rescue is attempted or accomplished that involves Navy personnel or assets? - Correct Answer Medical Rescue Report SAR Form 3-50.1A T/F: While the patient is delivered to the receiving medical treatment facility, the patient care record should be maintained with the evacuation unit. - Correct Answer FALSE. The PCR should be completed and delivered to the receiving MTF along with the patient. Section 10: Pain, Anxiety, and Delirium - Correct Answer -

T/F: The Acute Pain Service (APS) should be established and be an integral part of casualty care starting at the Role 1. - Correct Answer FALSE. Starting at the theater hospital (Role 3) T/F: Sedation should be optimized as a priority over Pain Control. - Correct Answer FALSE. Pain Control should be optimized over Sedation Adjuncts can greatly increase patient safety and the effectiveness of narcotics to treat pain while reducing side effects. What are examples of adjuncts? - Correct Answer 1. Acetaminophen

2. Ketamine
3. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs),
4. Continuous Peripheral Nerve Infusions
5. Continuous Epidural Infusions If it is not feasible to incorporate the Acute Pain Service (APS) team into trauma rounds, then the APS is responsible for __________ pain rounds, pain management consults, and reports to the trauma team leader. - Correct Answer daily What are the standardized and validated scoring systems for the assessment of pain, anxiety, and delirium? - Correct Answer 1. DoD/VA Pain Rating Scale
6. Richmond Agitation Sedation Scale (RASS)
7. Confusion Assessment Method (CAM) The Richmond Agitation Sedation Scale (RASS) is used to assess __________. - Correct Answer anxiety The goal for patients with delirium is to achieve a delirium free state as measured by the __________. - Correct Answer Confusion Assessment Method (CAM) The ABCDE's should be incorporated into treatment care plans as efforts to prevent delirium in critically injured patients. The "E" stands for? - Correct Answer ABC - Awakening & Breathing Coordination D - Non-Pharmacologic Delirium E - Early Exercise

T/F: Seriously injured patients who are not intubated should be assessed every 1-4 hours for the presence of pain. - Correct Answer TRUE T/F: Adequate early pain control has been shown to reduce post-traumatic stress disorder and ongoing pain control is an obligatory part of trauma care. - Correct Answer TRUE __________, in parenteral doses of 0.15-0.3 mg/kg, has been shown to reduce pain scores, total narcotic use, and need for rescue medication when used with morphine for acute pain control. - Correct Answer Ketamine What is not a narcotic agent of choice approved for repeated Patient Controlled Analgesia (PCA) pump? - Correct Answer Meperidine (Demerol) T/F: Low molecular weight heparin (LMWH) use in patients undergoing epidural anesthesia increases the risk of spinal or epidural hematoma, which may cause long term or permanent paralysis. - Correct Answer TRUE What are medications used to treat anxiety and agitation? - Correct Answer 1. Propofol

2. Dexmedetomidine
3. Clonidine T/F: Continuous dosing of analgesics and anxiolytics, as opposed to intermittent dosing, has been shown to reduce the duration of mechanical ventilation and continuous dosing of analgesics and anxiolytics should be instituted prior to intermittent dosing. - Correct Answer FALSE. Intermittent dosing, as opposed to continuous dosing AND Intermittent dosing should be instituted prior to Continuous dosing. Continuous infusions should be stopped __________ to obtain a reliable physical examination, including neurologic assessment, and to perform a spontaneous breathing trial in ventilated patients. - Correct Answer daily __________ is a safe antiemetic in the adult populations and is increasingly the therapy of choice for acute undifferentiated and trauma- related nausea. - Correct Answer Ondansetron

The DoD/VA Pain Rating Scale requires patients to select their pain level on a scale of 0-10 with 10 being __________. - Correct Answer "as bad as it could be, nothing else matters" Battlefield Acupuncture (BFA) is a non-pharmacological pain therapy for mild to moderate pain or an adjunct to opioid medications. BFA is accomplished by applying needles to which body part? - Correct Answer The Ear Section 11 - War Wounds: Debridement & Irrigation - Correct Answer - During debridement, extremity wounds should be extended __________. - Correct Answer in a longitudinal manner (parallel with the bone) During debridement, truncal wounds should be extended __________. - Correct Answer along Langer's lines Due to their heavy contamination and the diminished healing capacity, how long should the closure of blast wounds be avoided after the injury occurs?

• Correct Answer After the First Washout or Within the First 48 Hours Assurance of __________ and removal of all nonviable skin, fat, fascia, muscle, and bone are essential to reduce the load of contamination and necrotic tissue prior to dressing application. - Correct Answer hemostasis All methods of wound irrigation are adjuncts and not substitutes to what? - Correct Answer sharp surgical debridement The current recommendation of irrigation volume for small wounds is... - Correct Answer 1-3 Liters The current recommendation of irrigation volume for moderate wounds is...
• Correct Answer 4-8 Liters The current recommendation of irrigation volume for large wounds or wounds with evidence of heavy contamination is... - Correct Answer 9 or More Liters

T/F: Normal saline, sterile water, and potable tap water all have comparable efficacy and safety as irrigation solutions. - Correct Answer TRUE T/F: The inclusion of irrigation fluid additives such as iodine, bacitracin, or antibiotics has proven benefits. - Correct Answer FALSE. They are without proven benefit. What risk factors of invasive fungal infections are assessed during the first wound debridement? - Correct Answer 1. Dismounted Blast Injury

2. Above Knee Immediate Amputation
3. Extensive Perineal/Genitourinary/Rectal Injury
4. Massive Transfusion of > 20 Units in the First 24 Hours (or Anticipation of 20 Units) T/F: All wounds must be closed prior to arrival at a definitive care location to prevent further bacterial and fungal introduction. - Correct Answer FALSE. Most wounds should NOT be closed prior to arrival at a definitive care location. T/F: Placement of antibiotic impregnated polymethacrylate (PMMA) can be used as an adjunct to debridement and irrigation of a wound to deliver increased local antibiotic concentrations while minimizing the associated side effects of high systemic loads of these antibiotics. - Correct Answer TRUE A(n) __________ event refers to an iatrogenic event in which a sponge or surgical instrument is deliberately or unintentionally left behind while the wound proceeds to definitive management. - Correct Answer Retained Foreign Object (RFO) Explosive munitions injure through how many major mechanisms? - Correct Answer Four (4)
5. Primary
6. Secondary
7. Tertiary
8. Quaternary

Section 12: Unexploded Ordnance (UXO) Management - Correct Answer

Propelled explosive devices impaled in a casualty usually consist of... - Correct Answer 1. Mortars

2. Rocket Propelled Grenades (RPG)
3. 40mm Projectiles (Rifle-Launched Grenades) OR
4. Propulsion System
5. Trigger Mechanism
6. Main Explosive Charge T/F: 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. - Correct Answer TRUE T/F: Only enemy patients require an initial inspection in order to find and remove all weapons and ammunition prior to entry into a transport vehicle or treatment facility. Friendly patients should not have their treatment delayed. - Correct Answer FALSE. All patients, regardless of whether they are friendly or enemy, require an initial inspection Safe removal of impaled UXO's require significant coordination with... - Correct Answer 1. Local Security
7. Base Command Element
8. EOD Personnel As the common impaled ordnance types have a number of variants, the __________ can provide advice on specific concerns to prevent arming and detonating the device. - Correct Answer EOD Specialist T/F: Standard metal detector wands are NOT recommended for use to assist with locating loose or impaled UXOs due to the increased risk of arming or detonating the device. - Correct Answer FALSE. Standard metal detector wands CAN be used with little risk of causing loose or impaled UXO to arm or detonate.

T/F: When conducting treatment on a patient with an impaled UXO, it is ideal to use a confined space such as a bunker to limit the potential trauma from a blast to those not directly involved in treatment. - Correct Answer FALSE. Avoid conducting this type of surgery in a confined space such as a contained bunker since the overpressure from a blast will only exacerbate the trauma from an explosion. Which imaging device is considered safe with respect to potential inadvertent triggering of a UXO? - Correct Answer Plain Radiographs What piece of equipment is recommended for use during surgery on a patient with an impaled UXO? - Correct Answer Non-Powered Manual Saws Who should the final selection of the surgeon(s) to conduct operations on patients with an impaled UXO be left up to? - Correct Answer Lead Surgeon Personnel participating in surgery on a patient with an impaled UXO should wear what protective equipment? - Correct Answer Gown & Glove Over Ballistic Protective Equipment Includes...

1. Safety Glasses
2. Helmet
3. Body Armor with Ballistic Plates Amputation of a limb with an impaled UXO may occur when? - Correct Answer If it is Deemed the Quickest Way to Safely Remove the Ordnance Section 13: The i-STAT Portable Blood Analyzer in Austere Locations - Correct Answer - What device is best described as a portable blood analyzer? - Correct Answer i-STAT __________ is defined as a pathology or laboratory test that is performed at the site of clinical interaction, in a non-laboratory setting, allowing immediate decision regarding treatment. - Correct Answer Point of Care (POC) Testing