EFMB FY24

EFMB FY24 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. - False; CSRE has been replaced by CT Scanning What is the lowest level of care equipped with a Computed Tomography scanner?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; Many of the portable units, especially at the Role 2, have limited ability to penetrate 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 _________. - (F)ocused (A)bdominal (S)onographic Assessment for (T)rauma 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. - False; DPL (Diagnostic Peritoneal Lavage) remains the most sensitive test T/F: At the Role 3, properly trained providers including radiologists, surgeons, and emergency physicians, can perform and interpret FAST scans in the emergency department on a hand held portable device. - True A FAST examination is performed with a portable hand-held machine most commonly using a standard 3-7 MHz curved array __________ probe. - US (Ultrasound) 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. - True 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. - False; Scanning protocol should be based on Pediatric Settings 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. - True 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. - False; its utility in the acute management of combat trauma has not been established. All trauma patients arriving at a Role _______ will receive proper and expeditious radiologic screening of injuries. - Three T/F: Patients exposed to hazardous noise are only at risk for aural trauma. - False; They are also at risk for Acoustic Trauma 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, Vertigo Acoustic trauma may result in sensorineural hearing loss (SNHL) that is either ______ or _______. - Temporary (temporary threshold shift, TTS), Permanent (permanent threshold shift, PTS The ear, specifically the _____, is the most sensitive organ to primary blast injury. - Tympanic Membrane (TM) T/F: The smaller the size of the tympanic membrane perforation, the greater the likelihood is of spontaneous closure. - True 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. - False; must be provided if there are no Contraindications Which inner ear abnormalities may cause vertigo? - Traumatic Brain Injury (TBI) following a blast injury, Otic capsule violating temporal bone fractures, Secondary fractures of the inner ear, Vestibular nerves, Trauma induced endolymphatic hydrops, 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. 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. - True 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. - False, DO NOT debride blisters until patient reaches treatment facility with surgical capabilities, cover loosely with dry gauze wraps or a clean sheet 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 burns (1st degree) 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 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. - False; Isotonic solutions are preferred T/F: Both under- and over- fluid resuscitation of burn patients can result in serious morbidity and even mortality; patients who receive over 250 mL/kg in the first 24 hours are at increased risk for severe complications including acute respiratory distress syndrome and both abdominal and extremity compartment syndromes. - True 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. - True _________ 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. - 40.5% 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. - 37% A patient has suffered burn injuries to the anterior of her face, neck, and torso (chest and abdomen). Calculate the patient's initial burn size using the Rule of Nines. - 22.5% 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. - False; HCPs should only perform medical or surgical procedures - within the scope of their training or experience - necessary to manage problems that immediately threaten life, limb, or eyesight, and to prepare the dog for evacuation to definitive veterinary care. 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. - True Use the ________ vein for long-term fluid therapy, large volume fluid delivery, and repeated blood sampling on Military Working Dogs. - external jugular 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. - True 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. - False; Responders should only perform chest compressions. T/F: Conventional human tourniquets applied to the limb of a Military Working Dog are an unreliable intervention to effectively control hemorrhage. - True; Some success is reported in use of improvised tourniquets, such as surgical rubber tubing or constrictive gauze bandage. If delay in definitive care of major extremity trauma is expected, use hemostatic agents, direct pressure, and compressive bandaging to assist with hemorrhage control. Calculate the approximate safe but effective crystalloid bolus volume for a 55 pound Military Working Dog experiencing signs and symptoms of shock. - 550 mL T/F: Gastric Dilation-Volvulus Syndrome (GDV) in Military Working Dogs occurs when the stomach rapidly dilates with fluid, food, and air and then rotates along the long axis (volvulus). When volvulus develops, the esophagus and duodenum become twisted, preventing the passage of stomach contents. - True Hypothermia in Military Working Dogs caused by low body temperature due to trauma, toxicity, underlying illness, or anesthesia and surgery is classified as _______ hypothermia. - Secondary Hypothermia 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? - it can be stored for 21 days at 1-6°C How long can whole blood collected in the anticoagulant CPDA-1 be stored? - it can be stored for 35 days at 1-6°C If stored at room temperature, fresh whole blood must be destroyed if not used within what time period? - it needs to be used within 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. - True How often SHOULD titer and transfusion transmitted disease retesting be conducted? - Every 90 Days In order to mitigate the risk of transfusion-associated acute lung injury (TRALI), the Armed Services Blood Program collects whole blood from everyone EXCEPT: -