EFMB Official Study Guide 2022

EFMB Official Study Guide 2022 100% approved grade boosting solution 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) - 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. - F What is the lowest level of care equipped with a Computed Tomography scanner? - Role 3 What is the lowest level of care equipped with a portable x-ray machine? - Role 2 Members of the trauma team should have _____ aprons and thyroid shields available near the trauma bay for radiation safety. - 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 - 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 - Focused Abdominal Sonographic Assessment for Trauma FAST in combat trauma has a sensitivity of only 56% and specificity of - 98% T/F: The FAST exam remains the most sensitive test for hollow viscus injury and mesenteric injury - 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. - T A FAST examination is performed with a portable hand-held machine most commonly using a standard 3-7 MHz curved array _______________ probe. - US The standard FAST examination is focused on evaluating for the presence of ______________ in certain areas of the body. - free intraperitoneal fluid When performing a FAST examination on a patient, you inspect the right upper quadrant. You are inspecting between which two organs? - liver and kidney When performing a FAST examination on a patient, you inspect the left upper quadrant. You are inspecting between which two organs? - spleen and kidney An 18g ______________ IV is typically desired for Computed Tomography IV access. - antecubital T/F: The goal of Computed Tomography contrast injection is to provide concurrent solid organ enhancement, arterial enhancement, and pulmonary arterial. - 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. - 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. - 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. - F All trauma patients arriving at a Role ___ will receive proper and expeditious radiologic screening of injuries. - role 3 T/F: Patients exposed to hazardous noise are only at risk for aural trauma. - F The symptoms of acoustic trauma are: - 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 _____________. - 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). - tympanic membrane (TM) T/F: The smaller the size of the tympanic membrane perforation, the greater the likelihood is of spontaneous closure. - T The majority of tympanic membrane perforations that close spontaneously do so within the first ___________ after injury. - 8 weeks Acute management of intratemporal facial nerve injury is to provide objective documentation of facial movement using the _____________ scale. - House- Brackmann grading T/F: For significant facial pareses/paralyses, early administration of steroids must always be provided regardless of contraindications. - F Which inner ear abnormalities may cause vertigo? - 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: - 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? - 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. - 72 T/F: Vestibular trauma to the inner ear may manifest in vertigo. - T All patients with subjective hearing loss and tinnitus following blast exposure should: - 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. - 25 dB What are indications for endotracheal intubation during your initial burn survey? - 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. - 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. - F Calculate a burn patient's initial burn size using the Rule of _____. - nines Which type of burn is NOT included in the estimation of Total Body Surface Area (TBSA) used for fluid resuscitation? - Superficial (1st degree) burn Which classification of burns are moist and sensate, blister, and blanch? - Partial thickness burns (2nd degree) Which classification of burns appear red, do not blister, and blanch readily? - Superficial burns (1st degree) Which classification of burns appear leathery, dry, non-blanching, are insensate, and often contain thrombosed vessels? - Full thickness burns (3rd degree) What is the Rule of 10s burn fluid resuscitation equation? Ensure you can apply it. - 10 mL/hr x %TBSA, for 80kg add 100mL/hr for every 10kg80kg 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. - 3 T/F: A hypotonic solution is the preferred resuscitation fluid for a burn patient. - 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. - 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. - albumin What are clinical signs of inhalation injury? - 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 _____________. - 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. - T ____________ is the most common infectious complication with pediatric burn patients and usually presents within 5 days of injury. - 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. - 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. - 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. - 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. - 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. - dog handler ________________ is the normal temperature (rectal) range for a Military Working Dog at rest. - 101° to 103° F ________________ is the heart/pulse rate range for a Military Working Dog at rest. - 60 - 80 bpm T/F: The normal blood pressure for a Military Working Dog at rest is systolic 120 mmHg/diastolic 80 mmHg. - T Use the ______________ vein for long-term fluid therapy, large volume fluid delivery, and repeated blood sampling on Military Working Dogs. - 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. - 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. - femoral Pulse oximetry probes used for people (typically finger probes) are best placed on the ______________ for optimal reliability in unconscious, sedated, or anesthetized dogs. - tongue What are the 3 characteristic breathing patterns typically displayed in Military Working Dogs in respiratory distress? - Obstructive, Restrictive, Parenchymal When performing a tracheostomy on a Military Working Dog, make a transverse incision completely through the ______________ ligament. - 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 _____________. - 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. - 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. - F T/F: Conventional human tourniquets applied to the limb of a Military Working Dog are an unreliable intervention to effectively control hemorrhage. - T Calculate the approximate safe but effective crystalloid bolus volume for a 55 pound Military Working Dog experiencing signs and symptoms of shock. - 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. - 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. - 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. - 45% For PO supplementary analgesia of an injured Military Working Dog, administer _____________ 5-10ml/kg PO q8-12h for up to 5 days. - TRAMADOL How long can whole blood collected in the anticoagulant CPD be stored? - 21 days How long can whole blood collected in the anticoagulant CPDA-1 be stored? - 35 days If stored at room temperature, fresh whole blood must be destroyed if not used within what time period? - 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. - T How often SHOULD titer and transfusion transmitted disease retesting be conducted? - 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: - female donors testing positive for anti-HLA antibodies _____________ is the preferred resuscitation product for the pre-hospital treatment of patients in hemorrhagic shock. - whole blood (WB) Storage lesion describes the degradation of the RBC involving the loss of what? - 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. - F Fresh whole blood is to be used only when: - 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. - F In general, whole blood units should not be collected from donors more frequently than every ____ weeks. - 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. - F Is there a known contraindication to using whole blood in pediatric casualties? - No A massive transfusion in children is defined as ____ ml/kg. - 40 T/F: Infection Prevention in Combat-related Injuries standard precautions apply to all patients, regardless of suspected or confirmed infectious status. - T The World Health Organization's "five moments of hand hygiene" include: - 1. use of soap and water or alcohol-based sanitizer before patient contact; 2. before aseptic tasks; 3. after body fluid exposure risk; 4. after patient contact; and 5. after contact with patient surroundings, even if gloves were worn. What are Infection Prevention in Combat-related Injuries standard precautions? - 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. - 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). - Gloves, gowns Daily ______________of ICU patients has shown a reduction of infections with vancomycin-resistant enterococci (VRE) and methicillin-resistant staphylococcus aureus (MRSA). - bathing T/F: Antimicrobial drug usage has no impact on the development of multidrug resistant organisms - F T/F: All facilities should avoid unnecessary empiric use of broad spectrum antibiotics. - T T/F: Prolonged duration of prophylaxis has been shown to decrease long term rates of infections in patients with combat-related open fractures. - F Blast injuries, especially those related to_____________, present a unique bloodborne pathogen risk if an impaled body part is introduced into the trauma patient. - 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. - 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. - at time of exposure Which role of care should have a designated Infection Prevention and Control Officer? - 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. - 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. - T What substance is NOT a highly water soluble irritant? - Oxides of Nitrogen & Phosgene Treatment for chlorine inhalation includes: - Which chemical irritant has a sweet, pleasant smell of mown hay? - Phosgene (Carbonyl Chloride COCl2) Which chemical irritant may produce a severe cough with laryngospasm when exposed to high concentrations? - Phosgene (Carbonyl Chloride COCl2) Which chemical irritant smells like rotten eggs? - Hydrogen Sulfide (H2S) Which chemical irritant produces a "knockdown" effect, a sudden loss of consciousness, when exposed to high concentrations? - 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? - Ammonia The triad of severe cyanide toxicity consists of: - 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? - 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. - T Deglycerolized Red Blood Cells are derived from _____ ml of whole blood collected in Citrate/Phosphate/Dextrose or Citrate/Phosphate/Dextrose/Adenine collection bags. - 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 ______. - 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. - T What are the clinical indications for use of each unit of deglycerolized red blood cells (DRBCs)? - Each unit of DRBCs: 1. 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? - 35 Minutes How long does it take to thaw frozen red blood cells in a 42°C water bath? - 45 Minutes Optimal but not necessarily definitive patient stabilization before transport is critical and encompasses four connected elements. What are these elements? - 1. Injuries - actual and potential - must be controlled 2. Resuscitation must be optimized but may be ongoing 3. Other treatments besides resuscitative measures should be at steady-state, not requiring dynamic, complex, or life-preserving adjustments enroute 4. 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. - 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." - 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. - 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. - T Who assumes risk of reduced capability when a medical evacuation organization is not capable of providing the required intratheater en route care capability? - 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. - T What are examples of specific medical materials designated as patient movement items (PMI)? - 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. - T The MIST report was recently incorporated into the 9-line medical evacuation request. MIST stands for: - 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. - T . _______________ medical direction includes protocol development and review, continuing education of prehospital providers, and quality improvement activities. - Offline medical directions The commander of the unit assigned to perform medical evacuation should appoint the unit's ________________ as the medical director. - Physician T/F: Medical direction at the regional level (Patient Evacuation Control Center) is centered on online medical direction activities. - F What are the responsibilities of a regional medical director? - 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? - 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? - DA 4700 overprint Tactical Evacuation Patient Care Record (JTS Approved ) Which approved Joint Trauma System patient care record (PCR) is primarily used for Critical Care Air Transport Team movements? - 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? - 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. - F T/F: The Acute pain service (APS) should be established and be an integral part of casualty care starting at the Role I. - F T/F: Sedation should be optimized as a priority over pain control. - F Adjuncts can greatly increase patient safety and the effectiveness of narcotics to treat pain while reducing side effects. What are examples of adjuncts? - 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. - daily What are standardized and validated scoring systems for the assessment of pain, anxiety, and delirium? - DoD/VA pain rating scale The Richmond Agitation Sedation Scale (RASS) is used to assess ________. - Anxiety The goal for patients with delirium is to achieve a delirium free state as measured by the __________. - 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 ________________. - Early exercise T/F: Seriously injured patients who are not intubated should be assessed every 1-4 hours for the presence of pain. - 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. - 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. - Ketamine What is not a narcotic agent of choice approved for repeated Patient Controlled Analgesia (PCA) pump? - 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. - T What are medications used to treat anxiety and agitation? - 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. - 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. - daily ______________ is a safe antiemetic in the adult population and is increasingly the therapy of choice for acute undifferentiated and trauma-related nausea. - Ondansetron The DoD/VA Pain Rating Scale requires patients to select their pain level on a scale of 0-10, with 10 being ___________. - 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? - the ear During debridement, extremity wounds should be extended _________. - In a longitudinal manner (parallel with the bone) During debridement, truncal wounds should be extended _________. - 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? - 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. - Hemostasis All methods of wound irrigation are adjuncts and not substitutes to what? - Sharp surgical debridement The current recommendation of irrigation volume for small wounds is: - 1-3 liters The current recommendation of irrigation volume for moderate wounds is: - 4-8 liters The current recommendation of irrigation volume for large wounds or wounds with evidence of heavy contamination is: - 9 or more liters T/F: Normal saline, sterile water and potable tap water all have comparable efficacy and safety as irrigation solutions. - T T/F: The inclusion of irrigation fluid additives such as iodine, bacitracin or antibiotics has proven benefits. - F What are risk factors of invasive fungal infections assessed for during the first wound debridement? - 1. Dismounted blast injury 2. Above knee immediate amputation 3. Extensive perineal/genitourinary/rectal injury 4. Massive transfusion of 20 units in the first 24 hrs (or anticipation of 20 units) T/F: All wounds must be closed prior to arrival at a definitive care location to prevent further bacterial and fungal introduction. - F T/F: Placement of antibiotic impregnated polymethylmethacrylate (PMMA) can be used as an adjunct to debridement and irrigation of a wound to deliver increased local antibiotic concentrations while minimizing the associated side effects of high systemic loads of these antibiotics. - T A(n) _________ event refers to an iatrogenic event in which a sponge or surgical instrument is deliberately or unintentionally left behind while the wound proceeds to definitive management. - RFO - Retained Foreign Object" Explosive munitions injure through how many major mechanisms? - 4 ( Thermal Injuries, Blast injuries, Fragment injuries, Damage radii) Propelled explosive devices impaled in a casualty usually consist of: - 1. Propulsion system 2. A trigger mechanism 3. Main explosive charge T/F: All retained ordnance impaled in a patient should be considered "armed" or activated to a degree that final triggering of the fuse would cause the ordnance to explode. - T T/F: Only enemy patients require an initial inspection in order to find and remove all weapons and ammunition prior to entry into a transport vehicle or treatment facility. Friendly patients should not have their treatment delayed. - F Safe removal of impaled UXO's require significant coordination with: - 1. Local security 2. The base command element 3. EOD personnel As the common impaled ordnance types have a number of variants, the _________ can provide advice on specific concerns to prevent arming and detonating the device. - EOD Specialist T/F: Standard metal detector wands are NOT recommended for use to assist with locating loose or impaled UXOs due to the increased risk of arming or detonating the device. - F T/F: When conducting treatment on a patient with an impaled UXO, it is ideal to use a confined space such as a bunker to limit the potential trauma from a blast to those not directly involved in treatment. - F Which imaging device is considered safe with respect to potential inadvertent triggering of a UXO? - Plain radiographs are generally safe What piece of equipment is recommended for use during surgery on a patient with an impaled UXO? - Who should the final selection of the surgeon(s) to conduct operations on patients with an impaled UXO be left up to? - The lead surgeon Personnel participating in surgery on a patient with an impaled UXO should wear what protective equipment? - 1. Gown1. Gown 2. Gloves over ballistic PPE 3. Safety glasses 4. Helmet 5. Body armor w/ ballistic plates Amputation of a limb with an impaled UXO may occur when? - It is deemed the quickest way to safely remove the ordnance. What device is best described as a portable blood analyzer? - i-STAT __________________ is defined as a pathology or laboratory test that is performed at the site of clinical interaction in a non-laboratory setting, allowing immediate decision regarding treatment? - point of care T/F: While using an i-STAT device one of the most important environment factors that medics must always be cognizant of are extremes in ambient temperatures/exposure to extreme temperatures can render results inaccurate. - T What are lab values the i-STAT can measure? - 1. Cardiac Troponin I 2. Electrolytes 3. Blood gas 4. Urea 5. Creatinine 6. Glucose 7. Ionized calcium 8. International normalized ratio T/F: i-STAT cartridges are each loaded with a sample of the patient's urine and inserted into the bottom port of the analyzer for analysis. - F T/F: i-STAT cartridges must be frozen to maintain their integrity and reliability? - F T/F: Optimal operating temperature for the i-STAT is 16-30 degress Celcius (61-86 degree Fahrenheit). - T T/F: When executing a blood draw for the i-STAT device on a patient with IV fluids being administered you must draw blood proximal to an IV site. - F T/F: When drawing a blood sample for an i-STAT it is recommended to have the patient pump their fist multiple times to decrease the change of missing the vein. - F Prior to using an i-STAT cartridge it must be removed from refrigerated storage and kept at room temperature in its protective pouch for at least ________ minutes. - 5 minutes T/F: Liquid controls which are injected into i-STAT cartridges, verify the cartrdges are producing accurate results and should be used each time a new batch of cartridges is opened. - T i-STAT does not recommend the use of ____________ cartridges for patients receiving Propofol or thiopental sodium. - EC8+ When using an i-STAT device _____________ and creatine can increase creatinine measurements by 0.20-0.25 mg/dl. - Acetaminophen T/F: The i-STAT device will function for 15 days with expired software. - F What is the ideal method to update an i-STAT device without internet connectivity? - Desktop computer or updated i-STAT T/F: When running the i-STAT external simulator the electronic simulator will fail if high relative humidity interferes with the measurements. - T If the i-STAT analyzer and simulator have been stored separately in areas where the ambient temperature differs by more than _____ degrees Celsius ( ______ degrees Fahrenheit) allow the simulator and analyzer to stand in the same place for 30 minutes before inserting the simulator into the analyzer. - 3 degrees Celsius ( 5 degrees Fahrenheit) Liquid controls used in a cartridge that measures oxygen concentration must stand at room temperature for a minimum of _____ hours before use; controls for other analytes only need to equilibrate at room temperature for ______ minutes. - 4 hours; 30 minutes How frequently are CLEW software updates on the i-STAT device are mandated? - 2x a year The results from the i-STAT are generally available in ________ minutes or less? - 10 minutes A provider of prolonged field care must first and foremost be an expert in __________. - TCCC Burns covering greater than __________ percent of the total body surface area (TBSA), or those with smoke inhalation injury ( and airway or breathing problems), are life threatening. - 20% T/F: Hypothermia risk is high in burn patients. Anticipate that all burn casualties will become hypothermic and take immediate measures to prevent it by covering patient. Aggressively rewarm if temperature falls below 36 degrees Celsius (96.8 degree Fahrenheit). - T All patients with burn covering greater than __________ percentage total body surface area (TBSA) should be intubated because total-body swelling will tend to obstruct the airway. - 40% What is the MINIMUM recommendation regarding airway management when providing prolonged field care for a burn patient? - 1. Cricothyroidotomy 2. Ketamine 3. Ambu bag w/ positive end-expiratory pressure (PEEP) Monitoring _____________ is an important capability for all intubated patients. A rising ____________ could indicate clogging of endotracheal tube or poor ventilation from another cause (e.g., bronchospasm, tight eschar across chest) - End-tidal CO2 T/F: For large wounds, calculate the size of the wound by using the patient's hand size (including fingers) to represent a 1% TBSA. - F Sunburns are an example of ______________ degree burns. - 1st Degree Over the first 24-48 post burn, _______________ is lost into the burned and unburned tissues, causing hypovolemic shock ( when burn size is 20%) - Plasma T/F: Plain water is ineffective for shock resuscitation and can cause hyponatremia. - T _______________ is the main indicator of resuscitation adequacy in burn shock. - Urine output For prolonged care of burn patients, a(n) _______________ infusion may provide more consistent analgesia and help conserve supplies of analgesic medications. - Ketamine When providing wound care for a burn patient, you can use ____________ nylon dressing as an alternative to topical antimicrobial cream. - Silver nylon - "Silverlon" T/F: When performing an escharotomy incision on a burn patient, you must not carry the incision across any of the involved joints. - F _____________ and Exercise are included in the "best", "better", and "minimum" care recommendations when treating a patient with an extremity burn. - Elevate The ultimate mechanism of cold injury involves these combination of factors: - 1. Direct cold injury to the cells 2. Direct intracellular and intercellular ice formation 3. Ischemia from thrombosis of the vasculature 4. Reperfusion Injury T/F: Increased rates of frostbite occur at extreme high altitude secondary to ambient temperature increased and microcirculatory changes that occur at altitudes less than 17,000 ft. - F T/F: All patients with identified cold injury should be considered trauma patients first to identify other life threatening injuries. - T What must be established prior to making the diagnosis of cold injury? - Normothermia A patient is experiencing a superficial skin injury; pain on re-warming, numbness, hyperemia, occasional blue mottling, swelling and superficial desquamation. Classify the degree of cold injury the patient is suffering from. - 1st Degree A patient is experiencing a partial thickness skin injury; vesiculation of the skin surrounded by erythema and edema, swelling and superficial desquamation, numbness, and hyperemia. Classify the degree of cold injury the patient is suffering from. - 2nd Degree A patient is experiencing entire thickness of skin extending into the subcutaneous tissue; bluish to black and non-deformable skin, hemorrhagic blisters, vesicles not present, and ulcerations. Classify the degree of cold injury the patient is suffering from. - 3rd Degree A patient is experiencing full thickness damage to the skin and bone; area cold to touch and feels stiff. Classify the degree of cold injury the patient is suffering from. - 4th Degree T/F: For the sake of caution in the field, the recommendation is to treat all acute cold injuries presentations of cold injury as frostnip. - T ____________ is a syndrome related to prolonged exposure to moisture causing water logged of the feet. - Trench foot What is the BEST treatment when attempting to re-warm a patient with frostbite? - During the re-warming process for frostbite, which medication should be utilized liberally for pain management? - Ibuprofen/aspirin and/or ketamine After re-warming a patient with cold injuries/frostbite, what measures should you take during the course of treatment? - Patients should be prohibited from using any tobacco and nicotine-containing products as well as any medications inducing vasocontraction. What are some factors that will qualify a patient with cold injuries as candidate for Thrombolytic Therapy? - 1. W/in 24 hrs of start of injury 2. Evidence of injury with vascular compromise. For a patient that has severe frostbite on two extremities, what is maximum rate of Tissue Plasminogen Activator (tPA)? - 0.5 mg/h T/F: If a third degree frostbite forms an eschar, it should be immediately debrided, even if in an operational environment. - F For minor cold injuries, local wound care can be performed with the addition of what? - Topical antibiotic & aloe vera gel or sterile topical emollient every 6 hrs. T/F: Surgical debridement should be done at a definitive care site outside of theater. - T What is the process for rewarming the extremity of a patient diagnosed with immersion foot? - Air drying at room temp If you are concerned that infection is present for a patient with immersion foot, which bacteria should treatment target? - 1. Streptococcal 2. Staphylococcal 3. P aeruginosa A Glasgow Coma Scale (GCS) score of 13-15 indicates a traumatic brain injury (TBI) severity classification of: - Mild TBI A Glasgow Coma Scale (GCS) score of 9-12 indicates a traumatic brain injury (TBI) severity classification of: - Moderate TBI a Glasgow Coma Scale (GCS) score of 3-8 indicates a traumatic brain injury (TBI) severity classification of: - Severe TBI T/F: In no circumstance should a neurologic examination take priority over measurement of the optic nerve sheath diameter, and all results must be considered in the context of the neurologic examination and overall patient status. - F T/F: Visualizations of spontaneous venous pulsations with an ophthalmoscope can reassure the provider that intracranial pressure (ICP) is not critically elevated. - T What is the target systolic blood pressure in polytrauma patients with ongoing bleeding and a suspected traumatic brain injury (TBI)? - SBP 110 What is the target urine output for a polytrauma patient with a suspected traumatic brain injury (TBI)? - 30-50 mL/h T/F: Colloids and hetastarches are the preferred fluid for traumatic brain injury (TBI) patients. - T If the Glasgow Coma Scale (GCS) score is less than or equal to __________ or there is facial trauma with compromised airway, a definitive airway is most likely needed. - Less than or equal to 8 Every effort should be made to optimize airway placement for a traumatic brain injury (TBI) patient on the first attempt by doing: - 1. Preoxygenating with supplemental O2 2. Selecting the most experienced provider available 3. Using the technique most familiar to the provider T/F: Patients typically require less sedation after cricothyroidotomy than after endotracheal tube (ETT) placement. - T What are measures to reduce intracranial pressure? - 1. Elevate head of bed (HOB) 30 - 60 degrees 2. Maintain neck in midline position 3. Maintain arterial blood oxygen saturation (SpO2) 90% (or 95% if receiving ventilatory support) 4. Maintain EtCO2 between 35 mmHg and 40 mmHg 5. Maintain core temperature between 96 and 99.5 degrees Fahrenheit 6. Maintain SBP 100 mmHg, ideally at 110 mmHg 7. Prevent or rapidly manage seizure activity 8. If concerned for impending herniation, hyperventilate the patient for no more than 20 minutes to an EtCO2 target of 30 mmHg. Seek expert consultation immediately. What potentially adverse complications can mannitol cause in a traumatic brain injury patient? - Mannitol is a diuretics' & might lower blood pressure; can damage brain barrier & worsen intracranial pressure (ICP) When treating patient with traumatic brain injury, what are the "BEST" antibiotic options? - 1. Ceftriaxone 2 gm IV/IO every 24 hours or cefazolin 2g IV/IO every 8 hours for 5 days. 2. Add metronidazole 500 mg IV/IO every 8 hours for 5 days for wounds that are grossly contaminated with organic debris (e.g., dirt, debris, clothing) What are common signs of non-convulsive seizures in TBI patients? - 1. Coma 2. Delirium 3. Agitation 4. Aphasia 5. Blank staring Which medication is preferred to lower a traumatic brain injury patient's core body temperature? - Acetaminophen 650 mg every 4 hours orally & Cold saline IV In a traumatic brain injury (TBI) patient, target a blood glucose level of _____ mg/dL via handheld glucometer to avoid both hypoglycemia and hyperglycemia. - 180 mg/dL T/F: Hyperglycemia is more harmful to the brain than hypoglycemia. - F T/F: Neuromuscular blocking agents will mask seizures and clinical examination changes in traumatic brain injury (TBI) patients. - T Why should traumatic brain injury patients be loaded with their head toward the front of the aircraft during fixed wing transport? - To minimize G-Forces transmitted to the brain What are the steps of retrieving a drowning victim in body of water? - 1. Reach with an object from the safety of the shore of ship 2. Throw an object like a rope or flotation devices (this may help the victim stay afloat or the search and rescue team locate the victim) 3. Row (or paddle) a smaller craft to the victim if they are too far from shore to reach or have a floatation device thrown. The rescuer should ideally stay out the water 4. Tow them into shore or away from danger in the water (i.e. swift water rescue) 5. Go into the water (as a last resort) to rescue the victim (highest risk to rescuer) Once you get a downing victim on land, you call for additional help and ensure the victim's head and feet are at the same level. The victim is unconscious and not breathing. What is your next step? - Begin 5 rescue breaths (ABC); Continue 30:2 ( compressions : rescue baths) T/F: The Heimlich maneuver is no longer recommended for drowning. - T Consider ______________ as many drowning patients swallow water prior to inhaling and between 60-80% will vomit at some point during recovery or resuscitation. - Gastric decompression When do you terminate resuscitation efforts in the field for drowning victim? - 1. Resuscitation may be stopped after 30 minutes of CPR without return of spontaneous circulation if patient is not hypothermic. 2. After patient has been rewarmed to 30-33 degree Celsius/ 86-93 degree Fahrenheit (if hypothermic) and asystole has persisted for 20 minutes for a patient submerged in cold water. T/F: Downing victims with return of spontaneous circulation (ROSC) who remain comatose should NOT be actively rewarmed above 90-93 degree Fahrenheit/ 32-34 degree Celcius. - T Water in lungs washes out _____________ causing atelectasis (alveolar collapse), diminished gas transfer, ventilation perfusion mismatch, and hypoxia. - Surfactant A drowning victim that was rescued from ______________ waters may have increased chance of lung injury and require bronchoalveolar lavage to cleanse. - Contaminated What are the risk factors for swimming induced pulmonary edema (SIPE) - 1. Hypertension 2. Female 3. Swimming equal or greater than 1.2 miles, 4. Prior history of SIPE For patients who have been diagnosed with Swimming Induced Pulmonary Edema (SIPE) management of treatment will consist of: - 1. Dyspnea or cough 2. Hypoxemia 3. +/- Hemoptysis 4. CXR shows pulmonary edema or infiltrates that resolve w/in 48 hours 5. Absence of underlying pulmonary infection or aspiration of water The hallmark clinical presentation of _________ that leads to diagnosis is tissue hypoxia without cyanosis with the finding of metabolic acidosis. - cyanide T/F: When a victim has been exposed to cyanide in a gas form, clothing should be remove before evacuation from location. - F What should be done before decontaminating a patient who has been exposed to cyanide with irrigation solutions? - Treatment w/ antidote is first priority For a patient that has been exposed to cyanide, the mainstay of treatment is antidote therapy with _____________. - Hydroxocobalamin If the preferred cyanide antidote is not available, _____________ can be used. - Cyanide antidote kit Nerve agents consist of mainly two classes which are _________ and ________________. - V agents & G agents Rapid antidote treatment is extremely important since some nerve agents can irreversibly bind to ______________. - Acetylcholinesterase The speed of symptom onset depends on the route of exposure and dose of the agent. ______________ tends to result in faster onset of symptoms and can quickly cause death due to rapid systemic distribution. - Inhalation After removing the casualty from a nerve agent's vapor exposure area, what should be the next step? - Remove any article of clothing or piece of equipment w/ possible agent contamination. Diagnosis of nerve agent exposure is based on _________. - Rapid identification of the clinical symptoms & identification of the agent through detection methods. Nerve agent antidotes include which of the following? - 1. 2 PAM 2. Atropine 3. Benzodiazepines Which antidote will help dry secretions (bronchorrhea) and counter the effects of the bronchoconstriction caused by the nerve agent? - Atropine _____________ hold historical significance as the forerunners of modern chemical warfare and still hold relevance today as likely chemical culprits given their availability. - Pulmonary agents T/F: There are no readily available diagnostic tests to confirm or quantify pulmonary agent toxicity. - T Chlorine exposures may lead to copious secretions and laryngospasm shortly following exposure, therefore providers should be prepared for _____________ and possibly ________________. - Prepared for airway management & possibly emergent surgical airway. T/F: Sulfur mustard agents will cause chemical burns associated with blisters within a few hours of contact with the skin or mucous membranes. - T First responders should have ______________ during initial treatment of mustard casualties - Respiratory and skin protection Patients with ___________ can present with dry mouth and tachycardia leading the provider to believe dehydration is present when the patient is euvolemic. - Anticholinergic toxicity When performing nursing interventions during prolonged field care, personnel must flush saline locks with 10ml of normal saline at least every _______ hours. - 8 hours In order to prevent ischemic tissue injury and the formation of pressure sores on patients who cannot reposition themselves, nursing staff must reposition themselves, nursing staff must reposition the patient and check padding every _________ hours. - 2 hours T/F: Burned and injured extremities should be slightly elevated and rigidly straight to optimize venous return and maintain adequate peripheral pulses. - T T/F: Lip moisturizer is included in the "minimum" recommendation for oral care during prolonged field care. - T Patients who are conscious and able should brush their teeth a minimum of every ________ hours. For unconscious patients, performed oral care at least every __________ hours. - 12 hours, 4 hours During prolonged field care, perform Foley care ______________ or as needed for excessive damage. - Once a day T/F: When washing a patient during prolonged field care, you should always was the face first. - T T/F: If baby wipes or skin wipes are used to was the skin, the wipes should be thoroughly rinsed with water first, because most contain alcohol and residues that can irritate the skin. - T During prolonged field care, replace infusing bag of fluids and tubing with new equipment ____________ if possible - Every 72 hrs If available, check blood glucose level (BGL) every 8 hours or more frequently as dictated by patient status while performing prolonged field care. A low BGL must be treated immediately with oral sugar or juice or IV glucose. What is considered a low BGL? - 80 mg/dL If available, check blood glucose level (BGL) every 8 hours or more frequently as dictated by patient status while performing prolonged field care. A high BGL is less dangerous than low glucose, but may be treated if the capability is available. What is considered high BGL? - 200 mg/dL Which nursing intervention minimized the risk for patient to develop deep vein thrombosis (DVT) during prolonged field care? - unconscious=compression stockings, conscious=mobility exercises How often should nursing staff perform deep vein thrombosis prevention for unconscious patients during prolonged field care? - Every 2 hrs T/F: It is of the utmost importance for the nursing staff to perform range of motion exercise at least every 8 hours on all movable joints during prolonged field care, regardless of any injuries the patient may have. - F T/F: Prolonged Field Care (PFC) is intended for use prior to TCCC guidelines when evacuation to higher level of care is not immediately possible. - F Completion of the prolonged field care AAR will contribute greatly to performance improvement to develop training, tools, and techniques for improving the care of casualties in austere environments. AAR stands for _____________. - After Action Review What is the minimum recommendation for documentation during prolonged field care (PFC)? - TCCC Card DD 1380 What is the most useful tool to recognize important clinical changes in complex casualties such as decompensation, response to resuscitation, development of complications, effectiveness of medications, etc.? - Prolonged Field Care flow sheet When prehospital care transitions to prolonged field care, documentation should transition the ____________ to the ____________. - Transition the TCCC Card to the PFC flow sheet The prolonged field care flowsheet includes what information? - 1. Vital signs 2. Fluid input and output 3. Medication times, routes, dose 4. Physical exam findings 5. Problem list 6. Treatment plan 7. Telemedicine call script TCCC or prolonged field care AARs, along with any medical documentation not completed before patient handoff, should be completed within __________ of patient handoff and submitted to the Joint Trauma System (JTS). - 24 hrs T/F: Using the telemedicine report incorporated in the prolonged field care flowsheet is the best option to facilitate communication between prehospital providers and telemedicine consultants. - F T/F: The PFC providers job is not done until the receiving team understand the patient's condition and can begin to manage the patient appropriately. - T T/F: Hard copy documentation is the standard in hospitals and advanced field medical facilities. - F What are the major snakebite syndromes? - 1. Neurotoxic 2. Hemotoxic 3. Cytotoxic What are the major signs and symptoms of a neurotoxic snakebite? - 1. Bilateral ptosis 2. Descending paralysis 3. Dyspnea / ams What are the major signs and symptoms of a hemotoxic snakebite? - 1. Coagulopathy (VICC) 2. Local bleeding 3. Systemic bleeding What are the major signs and symptoms of a cytotoxic snakebite? - 1. Severe pain 2. Progressive edema 3. Tissue destruction T/F: When treating a snake bite patient, identifying the snake species will not change your patient care. - T T/F: Snake bite victims should be aggressively treated with antivenom regardless of if they have developed signs or symptoms. - T What is the preferred route for snake antivenom administration? - Via IV or IO injection or infusion T/F: Snake antivenom dosage is not weight-based and there is no difference in dosing between adults and children. - T T/F: Overdosing snake antivenom is not a concern during the active treatment phase, and the worst-case scenario is an allergic reaction. - T T/F: The evacuation of a patient with snakebite envenomation takes precedence over the administration of the appropriate antivenom. - F Observe and monitor the patient closely at the bedside for a minimum of _________ after each dose of antivenom has been given. - 1 hr T/F: Compartment syndrome is common in snakesbites. Patients should receive a fasciotomy in conjunction with antivenom in most cases. - F T/F: Routine administration of antibiotics should be given to patients with snakebites unless signs and symptoms of an infection are present. Direct infections are rare from most snakebites when prompt, appropriate treatment is given. - True Continuous clinical monitoring for the effectiveness of snake antivenom includes: - 1. Vital signs 2. Urine Output 3. Detailed assessment for new or worsening signs of neurotoxic, or cytotoxic envenomation Snakebite patients should be held for at least 24 hours after resolution of all signs and symptoms, and the following steps should be completed prior to discharge: - 1. Repeat blood tests before releasing the patient to ensure resolution of coagulopathy 2. Administer a booster dose of tetanus toxoid if needed 3. Patients should be instructed to return if any new worrying signs or symptoms develop. What is the only prophylactic treatment that has been shown to effectively reduce the incidence of early adverse reactions in snakebite patients? - Epinephrine T/F: Serum sickness associated with antivenom treatment may be uncomfortable but is not dangerous. - T What interventions are not appropriate when treating a snakebite? - 1. DO NOT cut, suck, electrocute, burn or use chemicals on the envenomation site 2. DO NOT apply constricting bandages, tourniquets or other circulation-reducing intervention! 3. DO NOT use venom extractors or other commercial snakebite first aid kits 4. DO NOT administer test doses of antivenom to check for hypersensitivity as these are ineffective and waste both time and antivenom. 5. DO NOT administer antihistamines or steroids as prophylactic pretreatment for prevention of anaphylaxis or other early adverse reactions (EARs) to antivenom as neither is effective as premedication. WHO category _________ venomous snakes are defined as "highly venomous snakes capable of causing morbidity, disability or death, for which exact epidemiological or clinical data may be lacking; and/or which are less frequently implicated) due to their activity cycles, behavior, habitat preferences or occurrence in areas remote to large human populations)." - WHO category 2 WHO category ________ venomous snakes are defined as "highly venomous snakes which are common or widespread and cause numerous snakebites, resulting in high levels of morbidity, disability or mortality." - WHO category 1 What are criteria used to predict the need for a massive transfusion using the assessment of blood consumption score? - Assessment of Blood Consumption score (ABC) of 2 or greater predicted the need for massive blood transfusion with 75% sensitivity and 86% specificity. T/F: Blood product usage can be optimized when hemorrhage control is undertaken simultaneously. - T T/F: Rapid transfusion of blood can cause sheering of red blood cells and should be avoided if possible. - T T/F: In low titer group O whole blood, the titer of Anti-A and Anti-B antibiodies is low enough to represent minimal risk of clinical consequences, and may be considered a universal donor. - T Blood products should be transfused in a plasma:platelet:RBC ratio of __________. - 1:1:1 If available, type ________ RBC's should be used preferentially for females of childbearing years. - Type O T/F: When administering blood products, potential future pregnancy complications takes precedence over resuscitation and prevention of exsanquination in female patients. - F "Never frozen" liquid plasma has a shelf life of _________ days. - 26 days Thawed plasma has a shelf life of __________. - 5 days Ensure that all blood products issues have a ______________ attached and activated for temperature monitoring. - Safe-T-VUE Before loading blood products for transportation, ensure that the blood product containers are ___________ and ____________. - Properly charged & maintained prior to loading blood products Thawed plasma needs to be refrigerated with a temperature between ____________ prior to attaching a Safe-T-VUE. - 1-6 degree Celcius Blood products carried outside of a medical treatment facility (MTF) and/or laboratory will be contained in an approved storage container for a maximum of __________ hours. - 48 hours What is the first step in treating a prehospital transfusion reaction? - Stop transfusion When should the administration of one gram of calcium (30 ml of 10% calcium gluconate or 10 ml or 10% calcium chloride) IV/IO be given in patients receiving blood products? - After the first unit of blood product T/F: Anaphylaxis from an arthropod envenomation is not an indication for antivenom. - T A patient has a chief compliant of abdominal muscle spasm. You notice a pair of small red spots that appear to be a bite. The patient states he did feel a pinprick at that same site about an hour ago. The patient also states the pain started at that site, but is more concern with his abdominal pain. More than likely the patient is suffering from what? - Temporary diaphoretic, grimaced, and contorted appearance of the face referred to as "facies latrodectismica" T/F: You have a patients with significant symptoms that meet indications for antivenom, but has a history of asthma. You can still give one 2.5 milliliters vial of sterile water intravenously. - T When patients do have significant symptoms meeting indications for antivenom you can administer ___________. - Expired antivenom may be used. Loxosceles reclusa is a venomous spider more commonly known as what? - Brown recluse, violin spider, or fiddleback spider Loxosceles venom is cytotoxic and consists of what two main constituents? - 1. Sphingomyelinase - D 2. Hyaluronidase You have a patient who was bitten by a brown recluse. What treatment should be done on this patient? - 1. Wound care 2. Tetanus prophylaxis 3. Analgesics 4. Antipruritic as necessary T/F: Tarantula bites are not dangerous to humans. - T What is the best way to remove tarantula's barbed hairs from the skin? - The use of adhesive tape Unlike other species of the spiders, funnel web spiders can bite tenaciously and may _________. - Have to be physically removed from the patient. Prehospital management for a funnel web spider's bite consists of what? - Pressure Immobilization using elastic crepe bandage applied tightly enough to limit lymphatic spread, but not to restrict blood flow. Scorpion venoms are complex and can include: - 1. Phospholipase 2. Acetylcholinesterase 3. Hyaluronidase 4. Serotonin 5. Neurotoxin The majority of scorpion envenomation can be adequately managed with ________. - 1. Pain medication (Ibuprofen, acetaminophen, opioids) 2. Wound management (Tetanus prophylaxis) For clinically significant envenomation, management is supportive and focused on the patient's symptoms. _______________ are the first line therapy for sympathomimetic toxicity. - Benzodiazepines For severe reactions, immediately stop the antivenom infusion and treat using a ____________. - Standard anaphylaxis protocol