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Fieldcraft 1 2 3 (68W) exam 160 + questions with verified answers A+ rated 2024, Exams of Nursing

Scalp - Answer- Bleeds profusely; vascular Foramen magnum - Answer- opening through which pressure can be released; spinal cord passes through Meninges - Answer- membranes that cover brain (pia, arachnoid, dura) Dura mater - Answer- Outermost layer, most resilient Brain Hemispheres - Answer- cerebrum, cerebellum, brain stem Cerebrum - Answer- largest

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Download Fieldcraft 1 2 3 (68W) exam 160 + questions with verified answers A+ rated 2024 and more Exams Nursing in PDF only on Docsity! Fieldcraft 1 2 3 (68W) exam 160 + questions with verified answers A+ rated 2024 Scalp - Answer- Bleeds profusely; vascular Foramen magnum - Answer- opening through which pressure can be released; spinal cord passes through Meninges - Answer- membranes that cover brain (pia, arachnoid, dura) Dura mater - Answer- Outermost layer, most resilient Brain Hemispheres - Answer- cerebrum, cerebellum, brain stem Cerebrum - Answer- largest part of brain, controls higher functions Cerebellum - Answer- controls primitive functions (coordination & balance) Brain stem - Answer- controls vital functions (cardio-resp) CSF created where? Absorbed by what? - Answer- Ventricles of brain, reabsorbed by arachnoid membrane MACE stands for? - Answer- Military Acute Concussion Evaluation GCS highest/lowest/significant score - Answer- High-15 Low-3 Significant-deterioration of 2+ Baseline Assessment for mental status - Answer- AVPU Decorticate - Answer- hyper extension in legs, flexion at arms and elbows, hands towards center/core. UPPER MID BRAIN Decerebrate - Answer- Teeth clenched, arms and legs extended. CENTRAL MID BRAIN GCS deteriorating patients at risk for? - Answer- Ongoing pathological process How to determine if CSF is present in blood - Answer- Halo/Target sign Halo test - Answer- drop of blood on gauze- csf will form halo ring around blood Difference of 1+mm pupil size is considered - Answer- abnormal both pupils dilated but not reacting to light - Answer- brainstem injury pupils dilated but they react to light - Answer- injury is reversible dilated pupils that do/dont react to light for other reasons besides head trauma include... - Answer- hypothermia, anoxia, lightning, optic nerve injury, direct eye trauma, drugs If the pateint has a normal LOC, dilated pupils are not due to... - Answer- head injury. Look for other reasons Suspect c-spine injuries for... - Answer- all non-penetrating head/face/neck wounds Cushing's Triad - Answer- response to increse in ICP. Increase BP, Decrease HR, irregular respirations Low BP due to head injury usually indicates - Answer- terminal event ventilatory rates - Answer- adult-10 child-20 infant-25 hypoxia and hypotension combined = mortality rate of... - Answer- 75% Medication NOT reccommended for TBI - Answer- mornphine, increases ICP and pupillary response Elevating injured head decreases ICP but... - Answer- jeopardizes cerebral perfusion when elevated more than 30 degrees Passive protection of eyes - Answer- take cover, wear eye pro What to do with foreign bodies in eyes (superficial) - Answer- irrigate, cover What to do with penetrating bodies in eyes - Answer- stabilize, cover, pills Main symptom of orbital fracture - Answer- double vision RUQ - Answer- liver, gallbladder, head of pancreas, right kidney LUQ - Answer- stomach, spleen, tail of pancreas, left kidney LLQ - Answer- part of colon and small intestine, part of bladder, left fallopian tube and ovary RLQ - Answer- appendix, part of bladder, right fallopian tube and ovary pancreas - Answer- secretes digestive juice, insulin, glucagon spleen - Answer- largest amount of lymphatic tissue, stores RBCs and platelets Liver - Answer- 10% total blood volume, metabolizes protein carb and fat Kidney - Answer- regulates water,electrolytes, ph of blood Sepsis - Answer- systemic infection: hypotension, decreased urine output, AMS Significant intraabdominal trauma (50% of cases) due to - Answer- penetrating trauma in gluteal area Blunt trauma - Answer- greater threat to life than penetrating Most frequent cause of penetration injuries in combat - Answer- fragmentation wounds Most reliable indicator of intraabdominal bleeding - Answer- presence of hypovolemic shock from unexplained source Peritoneal cavity can hold -- blood before showing signs of distension - Answer- 1.5L Uterus is protected by pelvis until... - Answer- 12th week Mom's blood volume increases by about 50% by - Answer- end of 36th week Pregnant casualty can lose up to -- blood before showing signs of hypovolemia - Answer- 30- 35% Things to consider regarding circumferential chest burns - Answer- Urgent status, 02 saturation to 92% Burns covering 20% or more - Answer- IV access, LR, fluid resuscitation with rule of 10s Leading cause of death in fires - Answer- inhalation burns Monitor pulse in burn patients because - Answer- increased chance of compromise to distal circulation due to swelling 3 elements of smoke inhalation - Answer- thermal injury, asphyxiation, toxin-induced lung injury (delayed) 1st degree burn - Answer- Epidermis reddened 2nd degree - Answer- epidermis and dermis, mottled, weeping blisters 3rd degree - Answer- all layers of epidermis and dermis, charred/transluscent, surgery needed 4th degree - Answer- all layers and subcutaneous layers of muscle, tissue, bone, organs Scattered burns- use what form of measurement - Answer- casualty's palm (1%) Urgent Surgical burns- symptoms - Answer- inhalation injury 2nd degree burns 20% TBSA Electrical/chemical face hands feet genitalia child with blunt/penet trauma Goal of burn wound care - Answer- prevent shock, infection, minimize disfiguration Always used when administering morphine - Answer- Narcan 0.4 mg IV/IM Medication given for soldiers with nausea or vomiting - Answer- Zofran (Ondansetron) 4-8 mg IV/IM/IO What should be done prior to administering opioids or ketamine? - Answer- Document mental status What can Ketamine and OTFC potentially due to severe TBI? - Answer- Worsen the injury What are antibiotics recommended for? - Answer- All penetrating wounds Antibiotic given to patient if ABLE to take PO - Answer- Moxifloxacin (400 mg once daily) Antibiotic given to patient if UNABLE to take PO - Answer- Ertapenum (1 g IV/IM once daily) What is the most important contraindication to antibiotics? - Answer- Burn casualties The three Tactical Combat Casualty Care phases of care - Answer- Care under fire, tactical field care, tactical evacuation care The three goals of Tactical Combat Casualty Care - Answer- Complete the mission, prevent additional casualties, treat the casualties Role 1 - Answer- The first medical care a soldier receives Role 2 - Answer- Operations operated by the area support squad, medical treatment platoon, or medical companies Role 3 - Answer- Casualty treated at MTF Role 4 - Answer- Medical care found in CONUS-based hospitals Urgent classification evacuation time - Answer- 1 hour Urgent-Surgical classification evacuation time - Answer- 1 hour Priority classification evacuation time - Answer- 4 hours Routine classification evacuation time - Answer- 24 hours Convenience classification evacuation time - Answer- Whenever convenient Lines needed to get a helicopter in the air for a Nine Line MEDEVAC request - Answer- Lines 1-5 Maximum time for a Nine Line MEDEVAC request - Answer- 25 seconds Who's callsign is to be given in line 2 of the Nine Line MEDEVAC - Answer- The callsign of the individual at the pickup site Standard Battlefield documentation - Answer- DD 1380 card Nonstandard Battlefield documentation - Answer- Sharpie Marker on tape Documentation used by aeromedical personnel? - Answer- SF 600 How does "fight or flight" reactions affect your ability to do your job and complete the mission? - Answer- Fine motor skills will diminish Optimal distance to be away from the casualty to gain leverage - Answer- 2-3 feet Name of the litter primarily used by the US Army - Answer- Talon II M997 casualty load capacity - Answer- 4 litters or 8 ambulatory or 2 litter and 4 ambulatory M113 APC casualty load capacity - Answer- 4 litter or 10 ambulatory or a combination of the two Armored Medical Evacuation Vehicle casualty load capacity - Answer- 4 Litters or 8 ambulatory casualties M1133 Stryker Medical Evacuation Vehicle casualty load capacity - Answer- 4 Litters or 6 ambulatory casualties or a combination of the two MaxPro MRAP ambulance casualty load capacity - Answer- 2 litter or 3 ambulatory HAGA MRAP ambulance casualty load capacity - Answer- 3 litter or 6 ambulatory What way are casualties loaded into vehicles? - Answer- head first In what way are the most seriously wounded loaded? - Answer- Loaded last UH-60 maximum casualty loading capacity - Answer- 6 litter and 1 ambulatory or 7 ambulatory How should casualties be oriented when in a helicopter? - Answer- Head will be forward in the cabin Signs of neurogenic shock - Answer- Lack of pale, cool, or clammy skin Result of direct damage to the heart itself - Answer- Intrinsic causes Result of problems outside of the heart - Answer- Extrinsic causes Amount of fluid loss to indicate hypovolemic shock - Answer- 20 percent or more Signs of compensated shock - Answer- Increased heart rate and blood pressure Signs of decompensated shock - Answer- falling blood pressure Non-hemorrhagic causes of hypovolemic shock - Answer- Dehydration, dehydration secondary to vomiting and diarrhea, burns greater than 20% of body surface area How much blood can be lost before the casualty's blood pressure will begin to drop? - Answer- 1500-2000 ml or 30-40% Percentage of the total amount of water in the body fluids - Answer- 70 percent Current prehospital choice for combat trauma casualties suffering from hemorrhagic shock in the absence of blood components - Answer- Hextend How long the effects of hextend last - Answer- 8 hours Solution of choice for burn casualties - Answer- Lactated Ringer's Solution of choice for dehydration if not able to swallow - Answer- Lactated Ringer's The ONLY solution to be used in conjunction with a blood transfusion - Answer- Saline solution Minimum blood pressure to perfuse all organs - Answer- 80 mmHg systolic Blood pressure high enough to dislodge any blood clots - Answer- 93 mmHg systolic Gauge catheter used for IVs - Answer- 18 gauge Condition that involves inflammation of the wall of the vein - Answer- Phlebitits How often is it recommended to change the tubing of an IV? - Answer- Every 48 hours How often is it recommended to change the solutions and dressings of an IV? - Answer- Every 24 hours How often is it recommended to change the site of an IV? - Answer- Every 72 hours Key sign for indicating circulatory overload - Answer- Shortness of breath Math equation for IVs - Answer- (volume to be infused X Drops/ml of infusion set) / Total infusion time in minutes T of F Scalp wounds are extremely vascular - Answer- True What kind of skull fractures increase the risk of intracranial hematoma? - Answer- Closed depressed skull fracture What is the casualty more exposed to if they have an open depressed skull fracture? - Answer- Bacteria Your casualty has CSF drainage from the ears, raccoon eyes and/or battle signs what is your suspected diagnosis? - Answer- Basilar skull fracture Your casualty states their "teeth are not fitting together correctly" What do you suspect? - Answer- Mandible fracture T or F The casualty's face may appear asymmetrical or flattened when they have mid- face fracture - Answer- True What is a major sign/symptom mid-face fracture? - Answer- They wont be able to close their mouth What are the MOI for C-spine? - Answer- Motor vehicle accidents, Falls greater that 15ft, IED blast involving an MRAP When do you not give an NPA? - Answer- if there is visual trauma to the head or face What medication do you not give to a casualty with a TBI? - Answer- Morphine What is the pupil dilation that indicates an abnormality showing a TBI? - Answer- 1mm pupil dilation in eyes is abnormality that shows TBI. Signs and symptoms of a TBI - Answer- Headache, Nausea, vomiting A casualty has an eye injury what else might the medic be worried about? - Answer- TBI and facial trauma You recognize your casualty has an eye injury, what is the first step to treating them? - Answer- Flush the eye for 20 min T or F a pelvis break will cause a fatal amount of blood loss - Answer- True Amputations might not bleed right away because of what? - Answer- vascular spasms 5 P's of compartment syndrome - Answer- pain, pallor, pulselessness, paralysis, paresthesia Damaged muscle tissue releases what? - Answer- myoglobin and potassium Myoglobin can damage what organ? - Answer- kidneys What is a obvious sign of kidney damage due to myoglobin - Answer- tea/cola colored urine Why do you not give lactated ringers for crush injuries? - Answer- lactated ringers contains potassium, give normal saline. What precedence is a mangled extremity? - Answer- URGENT SURGICAL What can elevated potassium levels cause? - Answer- Arrhythmias When do you check PMS when splinting? - Answer- Before and after splinting When splinting how many ties do you use? where are they placed? - Answer- 4, 2 above the injury and 2 below. you give analgesics with what kind of injuries? - Answer- Isolated joint and limb injuries When should you not give analgesics? - Answer- Casualties with serious multisystem trauma Casualty with head trauma is struggling to remember things and lacks their usual intelligence, what part of the brain might be affected? - Answer- Cerebrum Casualty with head trauma is stumbling and seems to be struggling to control their coordination and balance, what part of the pain might be affected? - Answer- Cerebellum The brain stem controls which functions? - Answer- Vital body functions ( cardio-respiratory) Where is CSF produced? - Answer- in the ventricles of the brain Casualty has multiple small breaks to the bones of their skull but seems to have no bone displacement. what kind of skull fracture do they likely have? - Answer- linear skull fracture Casualty has multiple fragments of bone driven into or toward underlying brain tissue that you can now see what kind of skull fracture do you suspect and what is that casualty now at greater risk of? - Answer- Open depressed skull fracture, increased risk of intracranial hematoma? Casualty has Epistaxis, Eccitymosis and crepitus to nasal area, what is the predicted diagnosis? - Answer- Nasal fracture Casualty complains of "teeth not fitting together" What do you suspect is the reasoning for that? - Answer- Mandible fracture A mid- facial fracture may appear as what with a complaint of what? - Answer- Face may appear asymmetrical or flattened, casualty may not be able to open/close mouth. What analgesic effects pupil response? - Answer- Morphine Ketamine and fentanyl may worsen a TBI but if the patient is complaining of pain can you give it to them? - Answer- Yes, if a casualty can coherently complain about pain their TBI is not too severe to give pain meds. What is a major pupil abnormality a medic may look for? - Answer- A pupil difference greater than 1mm What are some other reasons besides a TBI that might effect pupil response? - Answer- hypothermia, anoxia, lightening strike, optic nerve injury, trauma to the eye and drugs What degree do you not want to elevate the casualty with a TBI's head? - Answer- Greater than 30 degrees, because it could limit the blood flow to the brain What causes cushing's triad? - Answer- Increased Intracranial pressure signs and symptoms of cushing's triad? - Answer- hypertensive, bradycardic, and irregular respiration T or F you should not hyperventilate casualty with TBI? - Answer- True At what rate should you vetilate the casualty with a TBI? - Answer- 20 breaths per min What position do you transport a casualty with a TBI in? - Answer- supine Define TBI (Traumatic Brain Injury) - Answer- An injury to the brain resulting from an external force and/or acceleration/deceleration mechanism from an event Signs and symptoms of a TBI - Answer- Nausea/vomiting, dizziness/balance problems, fatigue, insomnia, drowsiness, sensitivity to light/noise, blurred vision, difficulty remembering/concentrating MACE (Military Acute Concussion Evaluation) - Answer- Preformed in an aid station, 5 alternative lists, Base line is 25-30 Mild TBI - Answer- Confused/disorientated: less than 24hrs solid organs - Answer- Liver, Spleen, Pancreas, Kidneys, aorta, vena cava Why do we only palpate lightly on a casualty with potential internal bleeding? - Answer- Deep palpation can dislodge clots What are the 3 bones fused together in the pelvis? - Answer- Ilium, Ischium, pubis skin layers - Answer- epidermis, dermis, subcutaneous What is the medical priority for a casualty with burns ? - Answer- Airway patentcy How do you treat white phosphorus burns? - Answer- Smothering the area Casualty has redness and is warm to touch burn, what degree is it and how long is recovery? - Answer- 1 degree and 3-6 days Casualty grabbed a pot directly from the stove and now has multiple blisters around their hands. What degree and how long is recovery? - Answer- 2 degree and 2-4 weeks Burns appeared charred and will likely require skin grafting. What degree burn is this? - Answer- 3 degree Casualty's leg is burned to the bone, what degree burn is this? - Answer- 4 degree What is the first part of the small intestine? - Answer- duodenum Types of joints - Answer- ball-and-socket, condyloid, gliding, hinge, pivot, saddle What test do you use when checking for CSF fluid? - Answer- Halo test Your casualty is complaining of double vision, what do you suspect? - Answer- Orbital fracture What part of the eye has rods and cones - Answer- Retina What are tear glands? - Answer- lacrimal glands Tactical Combat Casualty Care (TCCC) Card - Answer- DD Form 1380 Under what conditions would you consider spinal precautions possibly necessary? - Answer- Motor vehicle crashes, Falls from greater than 15ft, IED blast involving an MRAP vehicle The leading cause of preventable battlefield death is? - Answer- Hemorrhage Where on the body are the majority of combat wounds suffered? - Answer- Extremities What is the single biggest obstacle you will face when providing battlefield care? - Answer- Enemy fire Who decides if casualties will be evacuated? - Answer- The tactical commander/leader. What treatments will you provide during Care Under Fire (CUF) phase? - Answer- The only treatment you will provide is a hasty tourniquet. The distance a casualty can be transported by manual carry depends upon what? - Answer- 1. Strength and endurance of the bearers 2. Weight of the casualty 3. Nature of the injuries 4. Obstacles encountered durning transport What is line four of a nine line medevac? - Answer- Special equipment. What are the brevity codes for line four special equipment? - Answer- A= none B= Hoist C= Extraction equipment D= Ventilator What is line three of the nine line Medevac? - Answer- Number of patients by precedence. What are the brevity codes for line three number of patients by precedence? - Answer- A= Urgent B= Urgent Surgical C= Priority D= Routine E = Convenience Loading sequence for 4 litter casualties - Answer- Upper right, lower right, upper left, lower left The _________ are loaded last so that they can be the first to be off loaded - Answer- The most seriously injured The three most common devices used by the hoist to extract casualties are? - Answer- The stokes basket, the jungle penetrator, the SKED litter How many casualties can a HAGA MRAP evacuate? - Answer- 3 litter and 6 ambulatory How many casualties can a STRYKER evacuate? - Answer- 4 little and 6 ambulatory. How many casualties can an M997 evacuate? - Answer- 4 litter or 8 ambulatory of 2 litter and 4 ambulatory All tourniquets placed during Care Under Fire must be - Answer- Hasty Tourniquets What are the 4 "P's" of wound packing? - Answer- Peel, push, pile, pressure Pile the gauze above the love of the skin _____ inches - Answer- 1-2 inches Capillaries - Answer- Where O2 and CO2 exchange occurs. Bleeding oozes. What are the extrinsic causes of cariogenic shock - Answer- Cardiac tamponade and tension pneumothorax How much blood can be lost before the casualty's blood pressure will drop. - Answer- 1500- 2000 ml How much blood can be lost before the casualty's blood pressure will drop. - Answer- 1500- 2000 ml Lactated ringers is the solution of choice for - Answer- Burn casualties Colloids - Answer- Expand and maintain the intravascular volume. Antibiotics - Answer- Recommended for all penetrating combat wounds Zofran, also known as Ondansetorn dose - Answer- 4-8 mg IV/IM/IO every 6 hours as need for nausea or vomiting Analgesics - Answer- Painkillers Line four of a nine line - Answer- Special equipment Brevity codes for ventilator - Answer- D Brevity code for Hoist - Answer- B Brevity code for extraction equipment - Answer- C Three straps positions on a litter - Answer- Nametape, navel, knees Casualty movements - Answer- Pack-strap carry, the two man fore and aft carry, the two man supporting carry What are the main goals of TCCC - Answer- Complete the mission, prevent additional casualties, treat casualties Tactical priority - Answer- Gaining fire superiority Medical priority - Answer- Extremity hemorrhage control types of distributive shock - Answer- Septic, neurogenic, anaphylactic, psychogenic What solution is used for burn casualties? - Answer- Lactated Ringers Colloids - Answer- Contains high molecular weight / larger sized such as proteins or starches. They stay in the vascular space A typical casualty can bleed up to ____ ml into each side of the chest - Answer- 1500 A typical adult casualty can bleed up to ____ into one thigh - Answer- 1 liter When do you give TXA? - Answer- Given to those would will need a blood transfusion. Such as causal ties with hemorrhagic shock, amputations, torso trauma, or evidence of serve bleeding. TXA does - Answer- 1 hmmm in 100 cc of IV solution Neck anchor point - Answer- Under the axilla opposite of the wound Axillary anchor point - Answer- Over the opposite should against the neck Inguinal anchor point - Answer- The belt When young men who are still growing are forced to enter military service and thus loose all hope of returning safe to their beloved homeland, they become sad, taciturn, listless, solitary, musing... Nostalgia Physiological signs, increased heart rate, chest pain, panic, a sense of doom Soldier's heart Concussive or vacuum effects of exploding artillery shells and trench warfare Shell shock How is COSR treated? Sleep, downtime, good food. Everything that happens on deployment has effects on the _______ and _______. Body and mind TAIL T ell people you are concerned A ll are impacted by deployment I insist on getting help L ook for ways to help What are the 3 things a medic does for a soldier for CMRT? Identify person needs help Talk to the soldier and normalize behavior Empower, encourage to help Who can diagnose PTSD? MO Treatment for PTSD? Talk therapy, medication What is the purpose of ACT model? self awareness and resilience IDME What months people tend to commit suicide in? Jan, April, Sep, Oct What is IHL? the body of rules which in wartime protects people who are not or no longer participating in the hostiles. What is the purpose of red cross? Protects victims of war 5 S's Search Segregate Silence Speed Safeguard Who is the only person that can escort a wounded enemy? Secretary of defense What are the in processing items that a detainee will have done? Physical exam, a chest x-ray(tb) dental screen, mental health screening, height and weight. With a deceased casualty what do you do with their gear and personal effects? IBA and personal effect will be ion a separate bag but kept with them. Clothing and anything on their person will stay on them in the body bag. Anthropoid Animals, insects and crustaceans Vector a carrier Venom toxin produced Envenomation The act of injecting venom. Passive mechanical transmission Anthropoid carries pathogen from one host to another. Flies and roaches Fith flies Carrie bacteria and disease infected with feces "taxi service" Active transmission Fecal contamination, crushing, regurgitation, inoculation What do mosquito carry? malaria, yellow fever Malaria A disease caused by mosquitoes implanting parasites in the blood. febrile illness How long can it take for symptoms of malaria to appear? 7-30 days What is the treatment for malaria? chemoprophylaxis Dengue fever, Yellow fever Aedes mosquito encephalitis Aedes and culex mosquito What can be spread through flies and roaches? Cholera, dysentery, typhoid, and food borne gastroenteritis What can you get from an infected bite from a sand flie Leishmaniasis What can you get from bio warfare agents? Plague and typhus, tularemia What is the most efficient anthropoid and why? Ticks because females can pass pathogen onto offspring Main symptom of Lyme disease? Stiff neck and bullseye What do mites give you? Scabies What are the three types lice? head lice, body lice, crab lice What are the three types of heat injuries? heat cramps, heat exhaustion, heat stroke What % of people will die from heat exhaustion if not treated? 80% When should you start hydrating? 72hrs prior How do you physically handle someone with hypothermia and why? Gently because you can send them into v-vib What are the non freezing injuries? hypothermia, chilblain, immersion syndrome, snow blindness How do you deal with frostbite? below 32 degrees, feels like a piece of wood, warm sl;owly rewarming will be painful How long will it take for frostbite to be evident? 24-48 hrs How much increase of temp does an IBA have? 10 degrees what is the max amount of water intake daily 12 quarts COLD C keep clothing Clean O avoid Overheating L Loose and Layers D Keep clothing Dry how long does it take to acclimated to an environment? 2 weeks What is the elevation in which an injury MAY occur? 6500 1. Blast wave, 2. shrapnel , 3. thrown into wall/hard surface What is the most significant obstacle to a combat medics ability to provide care? Enemy fire What take precedence over providing medical care? The mission What type of wound gets antibiotics? Penetrating wounds What type of wound DOES NOT get antibiotics? Burns Standard Documentation TCCC Card, DD Form 1380 Nonstandard documentation Writing on PT's skin or tape What is PT's battle roster? First letter of first name, first letter of last name, last 4 of Social or DOD MEDEVAC A medical platform, with medical personnel and equipment CASEVAC A non medical platform (civilian vehicle) without medical personnel or equipment What two lines of the 9 line medevac have a wartime and peacetime? 6, 9 How long do you have to complete the first 5 lines of the 9 line medevac? 25 seconds What are the options for the special equipment? A-None, B- hoist, C-extraction, D-ventilator What line in the 9 line medevac do you add blood type? line 6 peacetime When does medical EVAC start? As soon as medic arrives at casualty Who determines when an evacuation will occur? The tactical leader Urgent/Urgent surgical 1hr priority 4hr Routine 24hr convenience whenever What qualifies Urgent? Burns to the hands, feet,and genitalia AND uncontrollable hemorrhaging M997 4L 8A M113 4L 10A AEV 4L 8A STRYKER 4L 6A MRAP 2L 3A HAGA 3L 6A UH-60 Blackhawk M: 6L 1A OR 7A R:4L 1A Who is in charge of getting PT to PU site? Tactical Commander What are the 3 Hoist equipment options? Stokes basket, jungle penetrater, SKED What is the distance a medic should have from the casualty when using a drag? 2-3ft What is the purpose of the medical evacuation system? The purpose of the medical evacuation system is to ensure sick and injured are moved quickly into and through the health service support system In what amount of time should a bird be headed home after picking up a casualty? within 72 HRs Points of Injury? Role 1: BAS, Role 2: Limited x-ray, dental, and labs, Role 3: surgical abilities, Role 4: full capability hospital, Role 5: BAMC True or False you will accompany the casualty through the evacuation system? False What temp is recognized hypothermia? 95 degrees and below What body temp hinders clotting? 93 degrees and below How much blood can each side of the chest hold? 1500 ml How much blow can 1 thigh hold? 1L TXA 1g mixed with 100ml of normal saline, over 10 min IV Tells the brain to not stop clotting When would you use SJT? When bleeding is in an area a TQ can not be used. TXA needs to be in the body within how many hours? Reverse N, UR, LR, UL, LL What antibiotic is given in the pill pack? Moxifloxcian 400mg Treatment in care under fire? Hasty TQ, supplies only out of IFac When does medevac start? as soon as you arrive at casualty. How do you approach the blackhawk? 90 Degree angle and from the rear. How do you load the balckhawk ? Head first, head going direction of travel. What ground ambulance is typically the one to be outside of the wire? HAGA MRAP What systolic BP will dislodge a clot? Under 93 Acidosis build up of lactic acid and co2. Metabolism switches from aerobic to anaerobic.lowers ph level. Medications that affect clotting? Aspirin(AHA), blood thinners, ibuprofen, naproxen What is the difference between a pnuemothorax and a tension pneumothorax? A tension pneumothorax is a complete lung clasped. How long is a NCD effective? 4 hours. What is the cavity between the heart and the great vessels? Mediastinum Casualty has two open chest wounds, that you sealed with occlusive dressings when you notice the casualty has stopped breathing and has no pulse. what do you do? Double NCD Signs and symptoms of pneumothorax? Trauma and respiratory distress NCD Needle gauge and length 10 or 14 gauge needle, 3.25 length Which intercostal space divides the thoracic cavity and the abdomen? 4th intercostal space definitive treatment for pneumothorax Chest tube What is the 4th leading cause of death? Hypothermia What is the drops equation? Total volume X drop set (gtts)/ time in min Explain Disruptive shock Vascular container enlarges with proportional increase in fluid volume What causes anaphylatic shock? Bronchospasm and vasodilation What are the most important tissues? Brain, heart, lungs, and kidney When does decompensated shock occur? After 1500ml of blood lost Failing BP impending death What are the pressures of , femoral, and radial c-60, f-70, r-80 What pressure does the radial pulse need to be to perfuse all vital organs? 80 What is the 1st choice for IO site? Manubrium What is the gauge and size of the IV needle? 18 gauge, 1.25" How often do you change IV tubing? Every 48 hrs (local SOP) How often do you change solutions and dressings? 24 hrs (local SOP) How often do you change the IV site? 72 hrs (local SOP) How much air causes an air embolism ? 5ml, the length of an IV tube What is the first action of phlebitis? Remove IV immediately Corrective action of air embolism? Place casualty on left side and elevate feet to allow pulmonary artery to absorb small air bubbles. administer O2 Signs/symptoms of air embolism? Abrupt drop in BP, Weak rapid pulse, cyanosis, chest pain T OR F Crystaloids are NOT the fluid of choice in combat? True What is the civilian fluid of choice for trauma? LR lactated ringers What is the military 1st choice colloid ? Hextand What is the fluid given for burns and dehydration in the military? LR lactated ringers Within what time limit does TXA need to be given? within 3 hours of injury Define Bolus Wide open, fast IV push T or F Every medication that can be given IV can be given IO anxiety begins to decrease as you adjust to being at home but will not necessarily return to how it was before deployment (post-traumatic growth) During deployment all Warriors experience change? Yes, everyone is impacted including families at home How does deployment physically effect the body? 1. sleep deprivation during sustained operations 2. being on guard almost all of the time 3. physical threats 4. maintaining emotional control 5. extreme physical stress and exhaustion 6. carrying heavy loads, wear and tear on muscles and joints 7. injuries, including concussions/mTBIs and combat trauma What is Post-traumatic stress (PTS)? aka combat stress typical expected reactions to deployment stressors; everyone who deploys will experience at least a mild form of one or more of the signs at some point or points during their transition home the sooner warriors seek help, the better the outcome Will dialing-down combat physiology take time? Yes time, work, effort Do all service members experience PTS? Yes What is the goal of resilience training? to provide soldiers with adaptive skills to deal with any challenge to not just survive but thrive in the face of adversity Risk-taking Behavior (red flags) the start or increase in frequency of behaviors that may endanger health and the health and safety of those around them signs and symptoms are seen as "triggers" Anger Problems (red flags) returning warriors can be easily angered or have uncontrolled anger; anger has been found to be a prominent symptom of traumatic exposure Sleep Problems (red flags) returning warriors may have difficulty falling asleep or staying asleep, some may wake early and not be able to get back to sleep and have frequent nightmares (getting 7-8 hours of continuous uninterrupted sleep is extremely important) Alcohol (or other substance abuse) Problems (red flags) half of all PTSD diagnosed warriors have associated alcohol problems, many of whom have not previously been "problem" drinkers Relationship Problem (red flags) 25% of warriors report stress reactions that may interfere with their ability to trust and be emotionally close to others What is the key to preventing psychological trauma from further developing into a physical disorder? recommend talking to experts (BH/chaplain) What physical disorder must be ruled out with a warrior demonstrating behavioral change? everyone experiences PTS but not everyone experiences PTSD Signs and Symptoms/Triggers of behavioral health problems 1. behaviors/reactions that impair performance or jeopardize training 2. persistent problems with sleep 3. reckless or dangerous behaviors 4. drinking too much alcohol, misusing substances 5. severe guilt or hopelessness 6. withdrawals from buddies, friends or family 7. rage, threatening statements 8. talking/joking about not wanting to be alive Goal of Successful Transition to minimize "collateral damage" such as damage to relationships or careers, and general self- destructive behavior; they must learn how to transition from deployed mindset back to the "home front" and it will take time, work and effort Broken Tail Light when a warrior does not realize that he or she has a problem; TAIL can be used to help friends with transition problems TAIL T: tell them you're concerned A: all are impacted by deployment I: insist that they talk with someone L: look for ways to help What are the 3 things Medics are expected to do? 1. identify those warriors in your platoon/unit who are at-risk 2. talk to your soldiers and normalize their behavior 3. empower warriors to seek help because the sooner they get help the better the outcome *always recommend that warriors talk to the experts, whichever is more comfortable for them; your role is to help them get the help they need Important Points about PTSD 1. can be caused by exposure to a traumatic event 2. significantly impacts functioning (victims can no longer consistently perform duties of daily tasks) 3. is a diagnosis that requires a group of symptoms to be present for an extended period of time 4. must be diagnosed by a medical professional What percent of soldiers are actually diagnosed with PTSD? only around 3-5% are diagnosed with PTSD most soldiers DO NOT develop PTSD as a result of their deployment experiences Which soldiers are at a higher risk of having serious stress-related problems? 1. genetic predisposition 2. early-life trauma 3. no strong social support system 4. regularly engaged in frequent or intense combat 5. witnessed injury or death 6. involved in a serious event where they felt they had no control, esp if they felt there was a mistake, poor leadership or negligence Why are concussions hard to diagnose? mild TBIs can sometimes go undetected from the start and can be difficult to distinguish from moderate or severe brain injuries make sure warrior takes a break (take a knee) even if they insist they are feeling fine When to get a medical evaluation for concussions emotions are feelings and reactions are behaviors Leveraging the Healthcare System when a conversation starts feeling like therapy, it is time to send the soldier to the experts, it is best to encourage self-referral so that the individual takes responsibility and is more likely to get the needed help sometimes command referrals are necessary, although it may be difficult for you to want to get the command involved What are the Triage Principles (3)? 1. the medical sorting of casualties according to type and severity of injury, likelihood of survival and establishment of priorities of tx and evacuation 2. ensures that medical resources are used to provide care for the greatest benefit to the largest number of casualties 3. affords the greatest number of casualties the greatest chance of survival What is MASCAL? a situation that occurs when the number of casualties exceeds the available medical capability to rapidly treat and evacuate them; can occur at multiple locations with varying resources technically a MASCAL can occur if soldier medic has more than one seriously injured soldier to manage at one time Medic Responsibilities for Triaging triage establishes the order of tx based on life signs of casualty, NOT WHETHER TX IS GIVEN responsibilities are based on the tactical and environmental situation: - at a BAS or MTF, you may be a member of a tx or evac team - on a COP, mission or convoy as the only medic, you may be the primary decision maker and have to do all the roles How to triage survey and classify casualties for the most efficient use of available resources (medical personnel, supply capabilities, and evac assets) 1. number and location of the injured 2. severity of injuries (time constrains may not allow time intensive procedures like CPR) 3. assistance available (self-aid/buddy-aid, CLS, medical personnel) 4. determine the number of injuries by type (litter vs ambulatory) 5. identify availability of evacuation resources with regard to time, distance and terrain (ground vs air assets) 6. resupply capabilities and requirements (time and available class VIII) 7. assure tx is directed first towards casualties that have the best likelihood of survival by assigning appropriate triage category 8. locate troops with minor wounds and return them to duty (goal is to return greatest number of soldiers to combat asap) NOTE: likely outcome of individual casualty must be factored into decision process prior to committing limited medical resources What are the 4 triage categories? 1. immediate 2. delayed 3. minimal 4. expectant IDME What is immediate category? HIGHEST PRIORITY - casualties whose condition demands immediate resuscitative tx to save life (severe life- threatening wounds) and have a high likelihood of survival - after being stabilized, no further tx (non-life/limb-threatening) will be given until other "immediate" casualties have been treated salvage of life takes priority over salvage of limb Examples of immediate category 1. airway obstruction 2. open pneumothorax WITH resp distress 3. tension pneumothorax 4. unstable abdominal wounds WITH shock 5. massive external bleeding (ex: amputation) 6. open fx of long bones 7. hypovolemic (hemorrhagic) shock 8. any burns to face, neck, hands, feet or perineum/genitalia cardiorespiratory arrest may not be considered immediate on battlefield, would most likely be classified as expectant, contingent upon mission, battlefield situation, number of casualties, support, etc What is delayed category? casualties who have less risk of losing life or limb by tx being delayed and can tolerate delay prior to intervention without unduly compromising the likelihood of a successful outcome Examples of delayed category 1. open chest wound WITHOUT resp distress 2. abdominal wounds WITHOUT shock 3. eye and central nervous (CNS) injuries 4. soft tissue wounds requiring debridement (all combat wounds will require some form of debridement) 5. other fx open or closed 6. second or third degree burns 20% or more TBSA (not involving face, hands, feet, genitalia, perineum) 7. maxillofacial wounds WITHOUT airway compromise 8. genitourinary tract disruption What is minimal (ambulatory/walking wounded) category? wounds that are so superficial, they require no more than cleansing, minimal debridement under local anesthesia , administration of tetanus toxoid, and first-aid dressings can be managed by self-aid or buddy-aid and usually not evacuated to MTF Examples of minimal category 1. minor lacerations, abrasions 2. contusions 3. sprains and strains 4. minor combat stress problems 5. burns, first or second degree under 20% TBSA and not involving critical areas such as hands, feet, face, genitalia, perineum 6. upper extremity fx WITHOUT neurovascular compromise 7. behavioral disorders or other psychiatric disturbances 8. suspicion of blast injuries (ruptured TMs) 9. symptomatic but unquantified radiation exposure What is expectant category? so critically injured that only complicated and prolonged tx offers any hope of improving life expectancy; wounds so extensive that even if they were the sole casualty and had the benefit of optimal medical resources application, their survival would be very unlikely should be separated from view of other casualties but not abandoned 75% of complete suicides were triggered by relationship problems 50% occurred while soldiers were pending UCMJ action 42% were experiencing financial problems 34% were having drug and alcohol problems Immediate Danger Signals Related to Suicide 1. talking about their death or hinting at suicide 2. giving away important possession; making a will in connection with the disposal of personal property 3. obsession with death; sad music, or sad poetry (themes of death in letters or artwork) 4. uncharacteristic behavior, withdrawal from social activities 5. significant change in performance 6. has specific plans to commit suicide and access to lethal means 7. buying a gun in connection with any of the above if the person demonstrates imminent behavior AND has experienced some life stress events associated with suicide, appears to be depressed, and/or has history known to cause an increased risk of suicide, the chances of suicide increase even more WHAT TO DO when confronted with suicidal individual 1. remove potential means of self-harm 2. ask directly 3. convey concerns 4. get help WHAT NOT TO DO when confronted with suicidal individual 1. keep the individual safe 2. don't assume the person is not the suicidal "type" 3. don't make moral judgments, act shocked, or make light of the situation 4. don't keep deadly secrets What is ACE? suicide prevention training programs What are ARTHROPODS? animals, including ticks, spiders, mites and other insects as well as crustaceans such as shrimp, lobster and crabs What is a VECTOR? a carrier (an arthropod that transports a disease causing organism or pathogen from one host to another) What is VENOM? toxin produced by some animals, such as scorpions, spiders, and snakes What is ENVENOMATION? the injection of poisonous materials by bites or stings of arthropods or snakes What is PASSIVE TRANSMISSION? (aka mechanical transmission) the arthropod carries the pathogen from one host to another; the pathogen does nothing during the transfer except 'go along for the ride' What is ACTIVE TRANSMISSION? (aka biological transmission) the disease causing agent undergoes some change in the body of the arthropod, the pathogen may multiply or simply develop into an infectious form there are 4 ways a pathogen can be passed to humans via active transmission: 1. Inoculation 2. Regurgitation 3. Fecal Contamination 4. Crushing the vector MNEUMONIC: I Really Fcking Care (if mosquitoes bite me) What is INOCULATION? a vector injects the pathogen into host with its saliva while it feeds on the host ex: mosquitoes transmit malaria by inoculation What is REGURGITATION? the vector vomits the pathogen into the host while it feeds on the host ex: fleas transmit bubonic plague by regurgitation What is FECAL CONTAMINATION? the vector defecates into a wound on the host as the wound itches, scratching and rubbing by the host causes the pathogen to enter the host's body ex: Chagas' disease, aka North American Sleeping Sickness, is transmitted in this way by the kissing bug What is CRUSHING THE VECTOR? the vector is smashed onto the skin of the host; when the host wipes off the dead bug, the pathogen is rubbed into the skin ex: the bacteria that cause epidemic typhus live and multiply in the body of the body louse, the body louse transmits epidemic typhus in this manner Mosquitoes are the most important arthropod to the military, found everywhere, in high numbers, capable of transmitting a large number of diseases, some of which have been war stoppers Mosquito Habitat mosquito larvae inhabit areas with standing water such as ponds, puddles and ditches Mosquito Bite Prevention the most effective means of malaria control is AVOIDING mosquito bites 1. insect bar (bed nets) - mosquitoes are night-biters and soldier can use aerosol on inside of net to kill any mosquitoes that may be under the net 2. long-sleeved, loose fitting clothing - mosquitoes can only bite through clothing when it is worn tightly against skin 3. chemical repellants - apply DEET on all exposed skin surfaces every 4-6 hours and apply PERMETHRIN on fabrics (permethrin should not be applied to inner clothing) 4. prevention - includes education on eliminating or destroying mosquito larval habitats What is malaria? one of the most important preventable diseases in man - humans get malaria from the bite of a malaria-infected female mosquito, it ingests microscopic malaria parasites found in the person's blood, then bites another person; the parasites go from the mosquito's mouth into the person's blood What is the standard antimalarial medication? CHLOROQUINE an acute, self-limiting viral disease transmitted through the bite of the sandfly - occurs in TROPICAL and subtropical areas - epidemics are seen in non-native persons such as US troops entering endemic areas Prevention and PPM for Sandfly Fever the proper wearing of the uniform and application of repellents will prevent most infections - PERMETHRIN to uniforms - DEET to skin - avoid domesticated animals What is Leishmaniasis? this disease is found in most 3rd world countries and transmitted by the bite of an infected sandfly Prevention and PPM for Leishmaniasis there is no vaccine for Leishmaniasis - PERMETHRIN to uniforms - DEET to skin - avoid domesticated animals Fleas 1. efficient vectors of plague, typhus and tularemia 2. become infected feeding on rodents and other mammals infected with the disease 3. transmit bacteria to humans when they feed (bite) plague and typhus have been identified as potential bio warfare agents Flea Habitat large populations of fleas can usually be found around animal beds, burrows, and nests outdoors; fleas are abundant during rainy summers and high humidity areas Prevention and PPM for Fleas 1. locating and removing the rodents is the key to eliminating the diseases they carry 2. sprays, fogs, powders and traps are useful tools but are only successful when used with pest elimination measures 3. isolate suspected cases of plague modern antibiotics are effective against plague; the plague vaccine is currently not in use Ticks the most efficient arthropod when it comes to disease transmission b/c the female tick can pass the pathogen to the egg so that when the larva hatches it is already able to pass on the disease upon eating its first meal Ticks Habitat 1. ticks and mites are generally found in areas of tall grass or underbrush in close proximity to mammal resting places and watering holes Lyme disease signs & symptoms 1. characterized by a distinctive skin lesion, systemic symptoms and neurologic, orthopedic and cardiac involvement that occur in combinations over a period of months to years 2. includes development of a red, slowly expanding "bulls-eye" rash with tiredness, fever, headache, stiff neck, muscle and joint aches 3. typically presents in summer and first symptom in about 90% of pts appears as a red macule or papule that expands slowly in a circular manner, sometimes with a central clearing (BULLS- EYE) = ERYTHEMA MIGRANS (EM) -> single or multiple 4. if untreated with antibiotics, pt may develop ARTHRITIS, NEUROLOGIC OR CARDIAC PROBLEMS Prevention and PPM for Lyme Disease PERMETHRIN to UNIFORM DEET to SKIN search total body area daily and remove ticks promptly - with gloves on, remove any attached ticks by using gentle, steady traction with forceps or tweezers applied close to skin to avoid leaving mouthparts in the skin - following removal, cleanse skin site with soap and water Lyme disease vaccine is currently not available Mites tiny arthropods, barely visible to naked eye generally found in areas of tall grass or underbrush in close proximity to mammal resting places and watering holes Scabies highly contagious infestation of humans caused by the ITCH MITE may occur in all populations and common in developing countries found in skin folds, such as finger and toe webs, axilla, or genital areas tx includes application of ointments and laundering of clothing prevention = personal cleanliness with frequent hand washing, bathing, avoidance with potentially infested persons Chiggers aka "redbugs, jiggers or harvest mites" are the immature stages of a tiny red mite and found in most areas of the world Chiggers Habitat areas of tall grass, associated with low wet spots such as ponds and forest underbrush they attach themselves to the clothing of people and then move to an area of the body to feed Symptoms of Chiggers itching and small welts appear over bite area bites may continue to itch up to 2-3 weeks after the chigger has dislodged Prevention of Chiggers PERMETHRIN to UNIFORMS DEET to SKIN Lice (3 species) 3 species of military importance: 1. body louse 2. head louse 3. crab louse anyone may become infected under suitable conditions of exposure: 1. lice are easily transmitted from person to person under direct contact 2. head lice infestations are frequently found in schools and institutions 3. crab lice area spread through sexual contact 5. progressive weakness to unconsciousness 6. anaphylaxis and anaphylactic shock Field Tx of Snakebites 1. initial assessment and management of ABC (look for allergic rxn or anaphylaxis) 2. apply oxygen, if available 3. start an IV in ALL snakebite victimes (in unaffected extremity) 4. remove watches and jewelry from affected extremity 5. keep casualty as calm and inactive as possible to slow down the absorption of the venom 6. gently clean around the snakebite to remove any venom from skin 7. consider immobilization and splinting affecting limb 8. evacuate casualty to the nearest tx facility; tetanus prophylaxis must be assessed What NOT to do for Snakebites 1. do not delay tx attempting to capture snake 2. do not suction or cut into bite site 3. do not place ice on the bite 4. if possible, dead snake should be brought to tx facility with pt for identification 5. do not touch head of snake; dead snakes may still contain venom 6. do not transfer live snake with casualty Risk Factors of Environment Injuries 1. Age - very young, very old are more susceptible 2. Poor general health and fitness makes you more susceptible 3. Fatigue makes individuals more lax in taking proper precautions 4. Predisposing medical conditions (atherosclerosis, hypovolemia, diabetes, alcohol, previous weather related injury) 5. Lack of acclimatization - need approx 2 weeks to become fully acclimated to heat; during periods of sudden temp change, treat all as non-acclimated Medication Effects on Environmental Injuries 1. peripheral vasodilator meds - cause vessels to dilate and the body to lose more heat 2. diuretics - cause more fluid to be excreted making dehydration more common 3. nicotine - causes peripheral vasoconstriction which decreases circulation to extremities 4. antihistamines - impair body's ability to sweat and dissipate heat Mechanisms of Heat Loss 1. Conduction - transfer of heat from one substance to another due to difference in temp 2. Convection - transfer of heat through gas or liquid by circulated heat particles 3. Evaporation - loss of heat at the surface from vaporization of liquid (ex: sweating) 4. Radiation - energy in the form of heat radiates in waves through the air or other mediums (water) 5. Respiration - heat leaves the body through each breath Environmental Factors 1. climate, season and weather are all factors that make you more susceptible to cold weather injuries 2. atmospheric (barometric) pressure - the pressure exerted by the weight of air (increase in altitude decreases pressure; the higher the elevation = the colder the climate) 3. terrain - more environmental exposures on mountains and ridges than in valleys or depressions Types of Heat Injuries (3) 1. heat cramps 2. heat exhaustion 3. heatstroke What are Heat Cramps? a muscle cramp or spasm of the voluntary muscles caused by depletion in the body of water and salt (dehydration) What is Heat Exhaustion? a systemic reaction to prolonged heat exposure and is due to excessive fluid (dehydration) loss and electrolyte (sodium) depletion DO NOT ELIMINATE HEAT EXHAUSTION AS A POSSIBILITY! heat cramps and heat exhaustion may coexist; heat cramps usually occur in individuals with heat exhaustion who are not acclimatized to a hot environment and heat cramps accompany heat exhaustion in up to 60% of cases What is Heatstroke? caused by failure of the temperature-regulating system in the brain; usually involves excessive exposure to strenuous physical activity under hot conditions however, elderly or chronically ill pts may develop heatstroke without strenuous physical activity key indicator of heatstroke = ALTERED MENTAL STATUS heatstroke is a medical emergency that will result in death if tx is delayed and has a 80% fatality rate if left untreated Signs and symptoms of heat injuries 1. painful spasms of skeletal muscles including muscles of extremities (arms and legs) and abdomen; muscles involved are generally the larger muscle groups; muscles feel tight and hard when palpated 2. dehydration - body loses too much fluid, salt, minerals; when individuals engage in any strenuous exercise or activities, an excessive amount of fluid and salt is lost through sweat 3. skin that is moist and pale to normal and cool temperature indicates a less serious condition (skin that is hot, red and dry moist indicates a serious condition) 4. core temperature (body's central temperature) is normal or elevated; in order to obtain accurate core temp, you must obtain rectal temp readings 5. headache; often with weakness and fatigue, thirst, dizziness, confusion (pt may feel better when lying down but become lightheaded when they attempt to stand or sit (orthostatic hypotension) 6. loss of appetite, nausea (with or without vomiting) 7. respirations and pulse rate may be rapid and the pulse may feel "thready" at the radial artery; systolic BP may be normal or slightly decreased 8. dark urine 9. altered mental status - a sign of heatstroke 10. seizure activity may be present *heatstroke is medical emergency that will result if tx is delayed; any casualty that is warm to the fluids orally b. if necessary and available, provide 500 to 1000ml bolus of D5W (if unavailable any crystalloid solution is satisfactory) warmed to 109 deg F; ensure solution does not freeze during administration 6. evacuate to nearest MTF ASAP, continue to monitor vital signs and LOC while en route unresponsive hypothermia casualties require airway protection; at minimum an OPA or NPA w/ BVM ventilation, intermediate airways (King LT) must be considered What is Chillblains? caused by repeated prolonged exposure of bare skin in damp nonfreezing temps; often precipitated by acute repeated exposure to cold, more common in cold damp climates Signs and symptoms of Chillblains 1. redness or cyanosis of affected areas 2. blue and red patches commonly on lower extremities, face, hands, feet 3. hot, tender, itching skin, subcutaneous nodules may be present 4. may have ulcerated or bleeding lesions with chronic repeated episodes Tx for Chillblains 1. warm and dry injured body part 2. place injured body part in contact with warm object, such as rescuer's hands or casualty's body; instruct casualty to cross arms and place hands under armpits 3. DO NOT RUB TISSUE; do not apply direct heat or ice 4. elevate affected body part 5. protect rewarmed injury from further cold exposure or trauma 6. evacuate to nearest MTF ASAP What is Immersion Syndrome (Immersion foot/Trench foot/Paddy foot)> injuries that result from prolonged exposure of feet to cool or cold water or mud; inactive feet in damp or wet socks and boots, or tightly laced boots that impair circulation are even more susceptible to injury Signs and symptoms of Immersion Syndrome 1. early stages/first phase (develops slowly over hours to days) include affected area is cold, pale, numb, tingling, with pulses that are diminished or absent 2. later stages/advanced stage, casualty will complain of the limbs feeling hot and burning with shooting pains; affected area is pale and there may be blisters, swelling, redness, and ulcerations 3. complications - anesthesia (numbness) may persist for weeks, along with hyperhydrosis (excessive sweating) and cold sensitivity; infection and gangrene occurs in very severe cases Tx for Immersion Syndrome tx is the same as tx for Chillblains prevention - keep feet warm and dry, change wet socks several times daily; ensure boots fit well, never sleep in wet socks and boots What is Snow Blindness? 1. burns to the eye from UV radiation 2. the damage is to the cornea and similar to welding flash burn to the eye 3. more likely to occur in hazy, cloudy weather than in sunny weather Signs and symptoms of Snow Blindness scratchy, watery, red feeling in eyes (as if sand or dirt are in your eyes) Tx for Snow Blindness visual acuity test cover and patch eyes with dark cloth (consider the tactical environment) and evacuate Dehydration (Cold Weather) in cold weather, it is extremely difficult to realize that this condition exists What is Frostbite? type of freezing injury is the freezing injury of tissue caused from exposure to cold, usually below 32 deg F depending on wind chill factor, duration of exposure and adequacy of protection body parts most easily frostbitten are cheeks, nose, ears, chin, forehead, wrists, hands and feet Signs and symptoms of Frostbite listed in order in which they would appear with increased exposure and time 1. loss of sensation or numb feeling in any part of the body 2. sudden whitening of the skin in affected area followed by momentary tingling feeling 3. redness of skin in light-skinned soldiers, grayish coloring in dark-skinned soldiers 4. blisters with clear fluid indicate a less severe injury; hemorrhagic blisters indicate a deeper more severe injury 5. swelling or tender areas 6. loss of previous feeling of pain in affected area 7. pale, yellowish, waxy-looking skin 8. frozen area feels solid or wooden to the touch note: usually takes 24-48 hours after warming to determine extent of injury Tx for Frostbite 1. warm area using firm, steady pressure of the hand, underarm, or abdomen (aid giver or buddy's) depending on area affected 2. for the face, ears, and nose, cover the area with the casualty's or a buddy's hands until sensation and color return; cover casualty with a blanket or other dry material 3. loosen or remove tight clothing and watches/jewelry 4. evacuate casualty 5. pain meds may be required; administer IAW TCCC guidelines and/or MO's SOP DO NOT attempt to thaw casualty's feet or seriously frozen areas if casualty will be required to walk or travel to receive further tx, thawing in the field increases the possibilities of infection, gangrene, or other injury; avoid freeze-thaw-refreeze WHAT NOT TO DO: 1. DO NOT soak the frostbitten part 2. DO NOT rub affected area with snow 3. DO NOT expose to any extreme heat source 4. DO NOT rub or move part in any way to increase circulation 5. DO NOT allow casualty to smoke or drink alcohol 6. DO NOT expose the frozen part to an open fire Prevention of Heat and Cold Injuries WET BULB GLOBE THERMOMETER (WGBT) - the WBGT index is used to determine the heat condition - use of MOPP or IBA gear increases WBGT by about 10 deg F - important that soldiers in MOPP get maintain adequate water consumptions, are frequently rotated to reduce occurrence of heat injuries and establish appropriate rest and work periods to ensure adequate manpower is available What is the maximum recommended daily intake of water? TWELVE QUARTS Who cannot enforce the Geneva Conventions? 1. the International Community of the Red Cross, which has the official role in protecting victims of war, does not have the power to enforce these rules 2. nations that have signed these conventions are required to enforce the rules themselves and publicize the most serious violations, known as breaches or war crimes Obligations to report violations of the Geneva Conventions - if you follow an order that violates the Law of War, you are responsible for and can be tried and punished for committing the crime - no one can force you to commit a crime, and you cannot be court-martialed or punished for refusing to obey an unlawful order - first and best option is to report through your chain of command - other reporting options include: 1. local office of Inspector General 2. office of the provost marshal (military police) 3. judge advocate (military lawyer) 4. chaplain who can help you report through official channels Who are considered "noncombatants"? 1. civilians 2. wounded and sick in the field and at sea 3. prisoners of war 4. medical personnel medical personnel are specifically identified in the 1st Geneva Convention What are the two forms of protection that medical personnel receive under the Geneva Conventions? 1. protection from attack: medical personnel who perform non-medical duties harmful to the enemy lose their protective status; they may not perform acts that are harmful to the enemy, as this will jeopardize their protected status; they can do various administrative type duties that do not harm the enemy 2. protection upon capture: if captured, medical personnel are considered "retained personnel", not POWs *retained personnel can only be required to perform medical duties and must receive at least all the benefits conferred on POWs, but must obey the POW camp rules; may be retained only as long as needed to tend to prisoners of war who are sick and wounded and must be returned when "retention not indispensable" In order to enhance OPSEC, can the emblem be camouflaged, e.g. use a dark brown cross with a light sand color background? The Geneva Conventions authorizes the use of the following distinctive emblems on a white background: 1. Red Cross (the emblem consists of a Red Cross on a white background) 2. symbol of the Red Cross on a white background is the reverse of a Swiss flag in honor of the origin of this initiative 3. not a "Christian" symbol 4. a "cross" is not a "cross" 5. Red Crescent 6. Red Crystal 7. Red Star of David emblem What is collateral damage? damage or loss caused incidentally during an attack undertaken despite all necessary precautions designed to prevent or minimize loss of civilian life, injury to civilians and damage to civilian objects Enemy Prisoner of War (EPW) one who, while engaged in combat under orders of his or her government, is captured by the armed forces of the enemy Civilian Internee (CI) interned during an international armed conflict for security reasons, for protection, or b/c they have committed an offense (insurgent, criminal) against the detaining power Retained Person (RP) enemy personnel who are medical, chaplains or are in voluntary aid societies (Red Cross etc) are eligible to be considered retained personnel Other Detainees (OD) a person in the custody of U.S. armed forces that have not yet been classified as an EPW, CI, or RP How to treat captured persons - Always initially treat a captured person as an EPW - process them according to the "Five S's": 1. Search - them immediately for weapons, ammo, equipment, documents with intelligence value; EPW/RP will be allowed to retain personal effects of sentimental or religious value 2. Segregate - them into groups of enlisted, noncommissioned officers and officers; individuals presumed to have intelligence value should be separated immediately from other EPWs 3. Silence - them; segregating should prevent prisoners from communicating with each other by voice or visual means 4. Safeguard - them; while they are your prisoner, you are responsible for their safety 5. Speed - them to the rear; the wounded EPW patient is evacuated to the rear as soon as their medical condition permits medical inspections for general health, nutrition and cleanliness will be held at least once a month by CAMP COMMANDERS Recovery of Human Remains and Portions 1. when casualty is dead at the scene: a. prepare DD Form 1380 TCCC card as deceased and attach to remains b. do not remove clothing or Organizational Clothing and Individual Equipment (OCIE) c. do not remove Personal Effects (PE) 2. when casualty died during First Aid: a. do not remove IVs, monitor patches, cut IV tube and leave catheter in place b. prepare DD Form 1380 TCCC card as deceased to remains; list all lifesaving procedures c. place IBA in a separate bag marked with name and date d. evacuate to nearest Mortuary Affairs Collection Point (MACP) 3. portions recovery: a. do not remove any PE from portions b. place each portion in individual plastic bag c. individually bagged portions may be placed in one Human Remains Pouch to facilitate transport d. evacuate to the nearest MACP 4. Recovery of Dissociated Personal Effects: a. personal effects not on the remains or portions b. items that were separated during the death event c. individually bag each item d. individually bagged disassociated effects may be placed in one plastic bag or Human Remains Pouch to facilitate transport e. evacuate to the nearest MACP