Trauma Care and Emergency Medicine Practices, Exams of Nursing

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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) - 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. - ANSWER F What is the lowest level of care equipped with a Computed Tomography scanner? - ANSWER Role 3 What is the lowest level of care equipped with a portable x-ray machine? - ANSWER Role 2 Members of the trauma team should have aprons and thyroid shields available near the trauma bay for radiation safety. - 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 - ANSWER 6 feet

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 - ANSWER Focused Abdominal Sonographic Assessment for Trauma FAST in combat trauma has a sensitivity of only 56% and specificity of - ANSWER 98% T/F: The FAST exam remains the most sensitive test for hollow viscus injury and mesenteric injury - ANSWER F 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 handheld portable device. - ANSWER T A FAST examination is performed with a portable hand-held machine most commonly using a standard 3 - 7 MHz curved array probe. - ANSWER US The standard FAST examination is focused on evaluating for the presence of in certain areas of the body. - ANSWER free intraperitoneal fluid When performing a FAST examination on a patient, you inspect the right upper quadrant. You are inspecting between which two organs? - ANSWER liver and kidney When performing a FAST examination on a patient, you inspect the left upper

quadrant. You are inspecting between which two organs? - ANSWER spleen and kidney An 18g IV is typically desired for Computed Tomography IV access. - ANSWER antecubital T/F: The goal of Computed Tomography contrast injection is to provide concurrent solid organ enhancement, arterial enhancement, and pulmonary arterial. - ANSWER T T/F: When performing Computed Tomography 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. - ANSWER F 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. - ANSWER T T/F: Magnetic Resonance Imaging is widely used in theater, as its utility in the acute management of combat trauma was extensively establishment during Operation Enduring Freedom. - ANSWER F All trauma patients arriving at a Role will receive proper and expeditious radiologic screening of injuries. - ANSWER role 3 T/F: Patients exposed to hazardous noise are only at risk for aural trauma. - ANSWER F

The symptoms of acoustic trauma are: - ANSWER hearing loss, tinnitus (ringing in the ear), aural fullness, recruitment (ear pain with loud noise), difficulty localizing sounds, difficulty hearing in a noisy background, and vertigo Acoustic trauma may result in sensorineural hearing loss (SNHL) that is either or. - 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). - ANSWER tympanic membrane (TM) T/F: The smaller the size of the tympanic membrane perforation, the greater the likelihood is of spontaneous closure. - ANSWER T The majority of tympanic membrane perforations that close spontaneously do so within the first after injury. - ANSWER 8 weeks Acute management of intratemporal facial nerve injury is to provide objective documentation of facial movement using the scale. - ANSWER House-Brackmann grading T/F: For significant facial pareses/paralyses, early administration of steroids must always be provided regardless of contraindications. - ANSWER F Which inner ear abnormalities may cause vertigo? - ANSWER otic capsule

violating temporal bone fractures, secondary infections of the inner ear or vestibular nerves, trauma induced endolymphatic hydrops, and activation of subclinical superior semicircular canal dehiscence All Service Members that develop symptoms consistent with noise trauma (acute tinnitus, muffled hearing, fullness in the ear) should: - 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 or in the middle ear? - 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). Hearing loss that persists hours after acoustic trauma warrants a hearing test or audiogram. - ANSWER 72 T/F: Vestibular trauma to the inner ear may manifest in vertigo. - ANSWER T All patients with subjective hearing loss and tinnitus following blast exposure should: - ANSWER have the exposure documented, and should be evaluated by hearing testing as soon as possible. Patients with TTS greater than losses in three consecutive frequencies should be considered candidates for high dose oral and/or transtympanic steroid injections when not otherwise contraindicated. - ANSWER 25 dB

What are indications for endotracheal intubation during your initial burn survey? - ANSWER comatose patient, symptomatic inhalation injury, deep facial burns, and burns over 40% Total Body Surface Area (TBSA) Burn casualties with injuries greater than Total Body Surface Area (TBSA) are at high risk of hypothermia. - 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. - ANSWER F Calculate a burn patient's initial burn size using the Rule of. - ANSWER nines Which type of burn is NOT included in the estimation of Total Body Surface Area (TBSA) used for fluid resuscitation? - ANSWER Superficial (1st degree) burn Which classification of burns are moist and sensate, blister, and blanch? - ANSWER Partial thickness burns (2nd degree) Which classification of burns appear red, do not blister, and blanch readily? - ANSWER Superficial burns (1st degree) Which classification of burns appear leathery, dry, non-blanching, are insensate, and often contain thrombosed vessels? - ANSWER Full thickness burns (3rd degree)

What is the Rule of 10s burn fluid resuscitation equation? Ensure you can apply it. - ANSWER 10 mL/hr x %TBSA, for >80kg add 100mL/hr for every 10kg>80kg For children suffering burn injuries, x Total Body Surface Area (TBSA) x body weight in kg gives the volume for the first 24 hrs of fluid resuscitation. - ANSWER 3 T/F: A hypotonic solution is the preferred resuscitation fluid for a burn patient. - ANSWER F 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. - ANSWER T At 8-12 hours post-burn, if the hourly IV fluid rate exceeds 1500 mL/hr or if the projected 24 hr total fluid volume approaches 250 mL/kg, initiate 5% infusion for an adult burn patient. - ANSWER albumin What are clinical signs of inhalation injury? - ANSWER progressive voice changes, soot about the mouth and nares, hypoxia, and shortness of breath Definitive care for US service members suffering from burn injuries is provided at. - 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. - ANSWER T is the most common infectious complication with pediatric burn patients and usually presents within 5 days of injury. - 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. - ANSWER 40% A patient has suffered burn injuries to the anterior and posterior legs and the perineum. Calculate the patient's initial burn size using the Rule of Nines. - ANSWER 33% 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. - ANSWER 22% 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. - ANSWER F 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. - ANSWER dog handler is the normal temperature (rectal) range for a Military Working Dog at rest. - ANSWER 101° to 103° F is the heart/pulse rate range for a Military Working Dog at rest.

• ANSWER 60 - 80 bpm T/F: The normal blood pressure for a Military Working Dog at rest is systolic 120 mmHg/diastolic 80 mmHg. - ANSWER T Use the vein for long-term fluid therapy, large volume fluid delivery, and repeated blood sampling on Military Working Dogs. - ANSWER cephalic or lateral saphenous veins T/F: When introducing a catheter into a Military Working Dog, it is acceptable to create a small skin nick over the intended catheter insertion site to facilitate penetration of the dog's thick skin. - ANSWER T 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. - 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. - ANSWER tongue What are the 3 characteristic breathing patterns typically displayed in Military Working Dogs in respiratory distress? - ANSWER Obstructive, Restrictive, Parenchymal When performing a tracheostomy on a Military Working Dog, make a transverse incision completely through the ligament. - ANSWER annular While placing an endotracheal tube in a Military Working Dog, you palpate the dog's neck and feel 2 tubes. This indicates that the endotracheal tube is in the dog's. - ANSWER esophagus When performing cardiopulmonary resuscitation on a Military Working Dog (MWD), 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. - 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. - ANSWER F T/F: Conventional human tourniquets applied to the limb of a Military Working Dog are an unreliable intervention to effectively control hemorrhage.

• ANSWER T

Calculate the approximate safe but effective crystalloid bolus volume for a 55 pound Military Working Dog experiencing signs and symptoms of shock. - ANSWER 550mL 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. - ANSWER T Hypothermia in Military Working Dogs caused by low body temperature due to trauma, toxicity, underlying illness, or anesthesia and surgery is classified as hypothermia. - ANSWER secondary Calculate the estimated percent of total body surface area burned on a Military Working Dog suffering from burns to the head, neck, chest, and abdomen. - ANSWER 45% For PO supplementary analgesia of an injured Military Working Dog, administer 5 - 10ml/kg PO q8-12h for up to 5 days. - ANSWER TRAMADOL How long can whole blood collected in the anticoagulant CPD be stored? - ANSWER 21 days How long can whole blood collected in the anticoagulant CPDA-1 be stored? - ANSWER 35 days

If stored at room temperature, fresh whole blood must be destroyed if not used within what time period? - ANSWER 24 hours 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. - ANSWER T How often SHOULD titer and transfusion transmitted disease retesting be conducted? - ANSWER 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: - ANSWER female donors testing positive for anti-HLA antibodies is the preferred resuscitation product for the pre-hospital treatment of patients in hemorrhagic shock. - ANSWER whole blood (WB) Storage lesion describes the degradation of the RBC involving the loss of what?

• ANSWER membrane plasticity, diphosphoglycerate, adenosine triphosphate, nitric oxide, and other factors leading to potentially reduced delivery of oxygen to tissues and contribution to a variety of pathophysiologic processes T/F: Fresh whole blood (FWB) is FDA-approved and is intended or indicated for routine use. - ANSWER F Fresh whole blood is to be used only when: - ANSWER other blood products

cannot be delivered at an acceptable rate to sustain the resuscitation of an actively bleeding patient, when specific stored products are not available (e.g., SWB, RBCs, FFP, PLTs, Cryo), or 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. - ANSWER F In general, whole blood units should not be collected from donors more frequently than every weeks. - ANSWER 8 T/F: In situations where there are a limited number of donors and a dire need for blood, no more than three units may be taken from a single donor. - ANSWER F Is there a known contraindication to using whole blood in pediatric casualties?

• ANSWER No A massive transfusion in children is defined as ml/kg. - ANSWER 40 T/F: Infection Prevention in Combat-related Injuries standard precautions apply to all patients, regardless of suspected or confirmed infectious status. - ANSWER T The World Health Organization's "five moments of hand hygiene" include: - ANSWER 1. use of soap and water or alcohol-based sanitizer before patient

contact;

2. before aseptic tasks; 3. after body fluid exposure risk;
3. after patient contact; and
4. after contact with patient surroundings, even if gloves were worn. What are Infection Prevention in Combat-related Injuries standard precautions? - ANSWER Handwashing, Gloves, Gowns, Mask, Goggles 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. - ANSWER T and should be worn with all patients suspected or known to have multi-drug resistant organism colonization or infection with C. difficile- infection (CDI). - ANSWER Gloves, gowns Daily of ICU patients has shown a reduction of infections with vancomycin-resistant enterococci (VRE) and methicillin-resistant staphylococcus aureus (MRSA). - ANSWER bathing T/F: Antimicrobial drug usage has no impact on the development of multidrug resistant organisms - ANSWER F T/F: All facilities should avoid unnecessary empiric use of broad spectrum antibiotics. - ANSWER T

T/F: Prolonged duration of prophylaxis has been shown to decrease long term rates of infections in patients with combat-related open fractures. - ANSWER F Blast injuries, especially those related to , present a unique bloodborne pathogen risk if an impaled body part is introduced into the trauma patient. - 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. - ANSWER F 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 months post-exposure. - ANSWER at time of exposure Which role of care should have a designated Infection Prevention and Control Officer? - ANSWER role 2 and role 3 All facilities responsible for trauma care should monitor adherence to as listed in the Joint Trauma System guidelines for infection prevention after combat-related injuries and present rates to providers regularly. - ANSWER antimicrobial prophylaxis regimens T/F: All facilities responsible for trauma care should monitor adherence to antimicrobial prophylaxis regimens as listed in the JTS guidelines for infection prevention after combat-related injuries and present rates to providers

regularly. - ANSWER T What substance is NOT a highly water soluble irritant? - ANSWER Oxides of Nitrogen & Phosgene Treatment for chlorine inhalation includes: - ANSWER Which chemical irritant has a sweet, pleasant smell of mown hay? - ANSWER Phosgene (Carbonyl Chloride COCl2) Which chemical irritant may produce a severe cough with laryngospasm when exposed to high concentrations? - ANSWER Phosgene (Carbonyl Chloride COCl2) Which chemical irritant smells like rotten eggs? - ANSWER Hydrogen Sulfide (H2S) Which chemical irritant produces a "knockdown" effect, a sudden loss of consciousness, when exposed to high concentrations? - ANSWER Hydrogen Sulfide (H2S) Which chemical irritant forms a strong base which can cause mucosal irritation, severe upper airway irritation, and alkali skin burns when reacting with water? - ANSWER Ammonia The triad of severe cyanide toxicity consists of: - ANSWER 1. Hypotension

2. Altered mental status
3. Lactic acidosis (commonly > 8mmol/L) Which of the following is the most commonly available antidote for cyanide poisoning? - 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. - ANSWER T Deglycerolized Red Blood Cells are derived from ml of whole blood collected in Citrate/Phosphate/Dextrose or Citrate/Phosphate/Dextrose/Adenine collection bags. - ANSWER 450 - 500 ml Red Blood Cells are stored for up to 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. - 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 6 days of collection and have a 14 - day shelf-life upon deglycerolization. - ANSWER T What are the clinical indications for use of each unit of deglycerolized red blood cells (DRBCs)? - ANSWER Each unit of DRBCs:
4. Should be considered equivalent to a fresh unit of RBCs since they are frozen w/in 6 days of collection and should have a 14-days shelf-life upon deglyceroliztion.

2. Contains more than 80% of the RBCs present in the original unit of blood.
3. Provides the same physiologic benefit 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.
6. The primary indication for use of frozen and deglycerolized RBCs is a supplement to liquid RBCs during the surge periods of increased transfusion requirements in order to decrease casualty hemorrhagic morbidity and mortality. How long does it take to thaw frozen red blood cells in a plasma thawer? - ANSWER 35 Minutes How long does it take to thaw frozen red blood cells in a 42°C water bath? - ANSWER 45 Minutes Optimal but not necessarily definitive patient stabilization before transport is critical and encompasses four connected elements. What are these elements? - ANSWER 1. Injuries - actual and potential - must be controlled
7. Resuscitation must be optimized but may be ongoing
8. Other treatments besides resuscitative measures should be at steady-state, not requiring dynamic, complex, or life-preserving adjustments enroute
9. Deterioration requiring enroute 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. - ANSWER T transport is required when "the patient has a critical illness or injury that acutely impairs one 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." - 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. - 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. - ANSWER T Who assumes risk of reduced capability when a medical evacuation organization is not capable of providing the required intratheater en route care capability? - ANSWER The 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. - ANSWER T What are examples of specific medical materials designated as patient movement items (PMI)? - ANSWER Examples:

1. Ventilators
2. Patient monitors
3. Pulse oximeters
4. Suction machines
5. IV Pumps
6. Oversized litters
7. Negative pressure wound vaccums
8. Pneumatic compression stockings/devices
9. && more 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. - ANSWER T The MIST report was recently incorporated into the 9-line medical evacuation request. MIST stands for: - 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. -

ANSWER T

. medical direction includes protocol development and review, continuing education of prehospital providers, and quality improvement activities. - ANSWER Offline medical directions The commander of the unit assigned to perform medical evacuation should appoint the unit's as the medical director. - ANSWER Physician T/F: Medical direction at the regional level (Patient Evacuation Control Center) is centered on online medical direction activities. - ANSWER F What are the responsibilities of a regional medical director? - ANSWER 1. 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 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 interfacility patient transports? - ANSWER 1. DD Form 1380 TCCC

2. DA 4700 overprint Tactical Evacuation Patient Care Record (JTS approved

3. AF IMT 3899 Patient Movement Record
4. 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? - ANSWER DA 4700 overprint Tactical Evacuation Patient Care Record (JTS Approved 20141119) Which approved Joint Trauma System patient care record (PCR) is primarily used for Critical Care Air Transport Team movements? - ANSWER AF IMT 3899 w/ supplements A through 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? - 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. - ANSWER F T/F: The Acute pain service (APS) should be established and be an integral part of casualty care starting at the Role I. - ANSWER F T/F: Sedation should be optimized as a priority over pain control. - ANSWER F

Adjuncts can greatly increase patient safety and the effectiveness of narcotics to treat pain while reducing side effects. What are examples of adjuncts? - ANSWER 1. Acetaminophen

2. Ketamine
3. Non-steroidal anti-inflammatory drugs (NSAIDs)
4. Continuous peripheral nerve infusions
5. Continuous epidural infusions If is it 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. - ANSWER daily What are standardized and validated scoring systems for the assessment of pain, anxiety, and delirium? - ANSWER DoD/VA pain rating scale The Richmond Agitation Sedation Scale (RASS) is used to assess. - ANSWER Anxiety The goal for patients with delirium is to achieve a delirium free state as measured by the. - ANSWER CAM - Confusion Assessment Method The ABCDE's should be incorporated into treatment care plans as efforts to prevent delirium in critically injured patients. The "E" stands for . - ANSWER Early exercise T/F: Seriously injured patients who are not intubated should be assessed

every 1 - 4 hours for the presence of pain. - ANSWER T 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. - ANSWER T , 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. - ANSWER Ketamine What is not a narcotic agent of choice approved for repeated Patient Controlled Analgesia (PCA) pump? - 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. - ANSWER T What are medications used to treat anxiety and agitation? - ANSWER 1. 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. - ANSWER F Continuous infusions should be stopped to obtain a reliable physical examination, including neurologic assessment, and to perform a spontaneous

breathing trial in ventilated patients. - ANSWER daily is a safe antiemetic in the adult population and is increasingly the therapy of choice for acute undifferentiated and trauma-related nausea. - ANSWER Ondansetron The DoD/VA Pain Rating Scale requires patients to select their pain level on a scale of 0 - 10, with 10 being. - ANSWER Severe - "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? - ANSWER the ear During debridement, extremity wounds should be extended. - ANSWER In a longitudinal manner (parallel with the bone) During debridement, truncal wounds should be extended. - 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? - ANSWER 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. - ANSWER Hemostasis