TNCC Written Exam. Bank Questions. Revision Resource Guide.

TNCC Written Exam. Bank Questions. Revision Resource Guide. Document Content and Description Below algorithm for TCCC - MARCH - PAWS - 9 Line tasks in "M" - Gain fire superiority/return fire "Are you hurt? Can you fight? Can you treat yourself? Can you move? Tourniquet for massive he morrhage Move off X check tourniquet sweep all extremites for obvious active bleeds (big pipes/little pipes Steps in Care Under FIre - Gain fire superiority/return fire Are you hurt? Can you fight? Can you treat yourself? Can you move yourself? tourniquet for massive bleeds only move off X "M" - Care Under fire: -gain fire superiority/return fire Are you hurt? Can you fight? Can you treat yourself? Can you move yourself? Tourniquet for massive hemorrhage only (leave controlled bleeding for later Move off XRecheck tourniquets post movement sweep head/extremities for big pipes/little pipes "A" - head tilt/chin lift, jaw thrust look, listen, feel inspect airway for trauma/burns/obstruction/maxillofacial trauma Interventions: NPA, I-Gel, Cri-key best airway if expecting bird transport - I-Gel b/c won't expand with elevation due to gas laws best airway if facial burns/swelling - cri-key early "R" interventions - expose chest, search wounds w/ "tiger claw" or spreading skin **cover sites over nickel in size w/occlusive dressing pelvic stability back side tiger claw/skin spread spine check for stepoffs credit card swipe **cover sites w/occclusive dressing. vented if over a nickel size lay down on litter w/blanket recheck interventions since rolled look listen feel check for pneumo and dart if needed reassess post dart needle size for thoracentesis - 10 gague or 14 gague3 1/4 inch "C" - sweep all limbs again for trauma (DCAPBTLS) combat gauze/wound pack to small active bleeds bilateral pulse check - for shock start IV if shock ruggedized IV, EZ-IO, FAST 1 TXA, IVF when do you start an IV - in circulation after the all extremity blood sweep and pulse check identifying shock intervention post starting IV - TXA IVF - whole blood, blood products, hextand, LR TXA purpose - to preserve clots already formed TXA dose/rate - 1 gram in 100ml bag over 10 minutes IVF in trauma - whole blood other blood products Hextand LR important thing to remember about giving solutions through IV - TXA and Hextand aren't compatable crystallizeneed a good flush probably should start second IV "H" - Head/Hypothermia "H" interventions - DCAPTBLS CSF from nose/ears w/halo test PERRL (pupils equal, round, reactive to light) visual acuity LOBBS (lacerations, obstructions, broken teeth, bleeding, swelling battle signs/raccoon eyes "P" - Triple Option 1. Combat Pill Pack (consciuos/can swallow) *TYlenol 1300mg (2tab) Q8hr *Mobic 15mg po QID 2. Fentanyl Lollypop 80mcg 3. Ketamine IM/IN -50mg IM/IN Q30 minutes IV/IO- 20mg Q20 minutes pain options if conscious and can swallow - "Combat Pill Pack Tylenol 1300mg (2 650mg tabs) Q8hr MObic 15 mg QID contraindications for fentanyl lollypop - shock/high risk of shockrespiratory distress/high risk of respiratory distress unconscious severe TBI/head trauma allergic/narcoti intolerant Ketamine IM/IN - 50mg q30 minutes Ketamine IV/IO - 20mg q20 minutes "A" (PAWS) - Combat pill pack = Moxifloxacin 400mg po QID Ertapenem 1gram IV/IM QD "A" in PAWS if can tolerate po - combat pill pack = Moxifloxacin 400mg QID "A" in PAWS if cannot tolerate po - Ertapenem 1gram IV QD "W" - treat minor wounds "S" - splinting. PMS heck before and after final step of TCCC - 9 line -Urgent, Priority, Routine -special needs like blood/ventilator/OR capability/Neuro capability -Liter or ambulatory pt - Deployed Medicine App - Youtube TCCC MARCHPAWS F(nal TEst OUt - benefit of TCCC training - documented lower incidents IV cutdown - stopgap - eschelon - common injury from IED attack - junctional hemorrhage goals of TCCC - Treat the casualty Prevent additional casualties Complete the mission Joint Trauma System - best way to help a person who can't breathe but is conscious - let them sit up/lean forward assume any position that is comfortable what do medics often overlook - simple interventions like airway positioning -people have died b/c the medics would not let them assume the most comfortable position = die b/c drown in hemothroax USAISR Report - TCCC COmbat Eval 2005TCCC studies - what has made a big difference in battle survival between now and 2001 - in 2001, no one in the military carried a tourniquet important thing to remember about medical ethics in combat - good medicine can be bad tactics % of combat deaths that are potentially preventable - up to 24% of combat deaths are potentially preventable 3 phases of T CCC - care under fire Tactile Field Care TACEVAC care second stage of TCCC care - tactile field care third stage of TCCC care - TACEVAC care only authorized things to do in Care Under Fire - gain fire superiority tourniquet for massive bleeding "enemy isn't stupid. wait and detonate. lots of rounds on first responders" aka victim - casualty point of injury - on teh X on the X - point of injurybest way for a casualty to be moved off the X - have him move himself Entebbe - intervention if a firefight is actively going on - no treatment in care under fire best medicine on the battlefield - fire superiority ideal movement - casualty moves themself casualty can't move and is unresponsive - likely beyond help and moving while under fire might not be worth the risk not worth it to do a "medal of honor" run how to rescue a casualty if they can't move - plan in advance -# of rescuers -how to cover -how to move 0-where to cover -use suppression fire/smoke to best advance -recover casualty's weapon if possible what is not performed in care under fire - no airway or c-spine interventions if penetrating trauma -yes if blunt trauma like fall intervention if burn - stop burning process Nomex material - only intervention in Care Under Fire - stop life-threatening bleedintg w/tourniquet move off X time it takes to bleed out frtom a femoral artery bleed - 3 minutes placement of a tourniquet - tourniquet should be easily placed on top of pack so casualty can reach it for themself from either hand first choice for bleeding - tourniquet when should you not use a tourniquet - non=-life threatening bleeds -can use combat gauze/wound pack for other bleeds application of tourniquet and unform - apply over uniform in care under fire can cut away clothes later how to place a tourniquet in your pack - on top so you can reach it from either hand pulse and tourniquet - tourniquet should eliminate pulse how to tell if a tourniquet is working - should eliminate pulse stop bleeding completely CAT - combat application tourniquet intervention if a CAT tourniquet is too long - can't cut excess length b/c the ribbon goes through the entire length. if cut, it becomes as effective as a loose braceletCoTCCC - marking tourniquet time - directly on the tourniquet T on the pt's head on the documentation card important thing to remember during Tactical Field Care - prepare to reengage w/the enemy transport versus treatment - never delay transport for treatment need need eschelon of care more why is preventing hypothermia a priority - worsens TBI worsens coagulopathy assumptions you can make if they have an amputation - need tourniquet even if not bleeding badly prepare for shock/need for IV access TXA/blood products assume they will become hypothermic usually tapped to be the triage officer - Dentists intervention if pt has an altered mental status - take weapons and radio devices away causes of trauma altered mental status - TBI shock shypoxia pain medications "idiot brain" when they are on the fentanyl lollypoptourniquet conversion - convert tourniquet at 2 hours. if conversion fails, keep it on do not convert tourniquet -5 - shock traumatic amputation over 6hrs not able to monitor the site will be at the next eschelon of care in under the 2hr mark example of junction tourniquet - SAM purpose of the blue stripe on combat gauze - see on Xray letting up pressure on a wound - don't let up direct pressure to check the wound until you are prepared to control the bleeding w/tourniquet or junctional types of gauze to pack wound - Combat Gauze (1st choice) Chito gauze/Celox (doesn't cause a shellfish allery problem) how to pack a wound - hold pressure against bone towards heart -hold bleeder while youpack. ensure bleed doesn't let up pressure. -cover combat gauze w/pressure dressing how to identify the bleeding vessel when you pack a wound - feel for pulsatile vessel. put pressure on bone in direction of heart. then pack with a 1 to 1 swap *if can't identify the site of the bleed, cover potential site w/multiple fingers then let up one at a time to see where it is. then cover that site once you identifyform used to document casualty care - DD 1380 how to hold wrap when you are packing a wound - don't throw it over shoulder or let it traiil syringe w/sponges - Xstat -syringe w/tiny sponges. minisponges rapidly expand on contact w/blood causing a tamponade effect -all sponges have a xray stamp -20seconds contraindications for Xstat - Xstat = syringe w/tiny sponges to provide tamponade upon contact w/blood pleural, abd, ... things to remember about Xstat - Xstat = syringe w/tiny sponges to provide a tamponade effect upon contact w/blood not popular b/c combat gauze is more versatile significant ccavitation may need 3 syringes injury to expect w/IED blast - junctional hemorrhage bifurcate - types of junctional tourniquests - SAM, JETT where do you apply the JETT tourniqut - apply at teh level of the greater trocanterJETT tourniquet - SAM splint - how to pack a neck wound - pack wound, put gauze rap under armpit and over shoulder aka armpitq - Ax pocket how to pack an axilla pocket wound - make an "X" across the back b/c it will slip if you just wrap around arm. so wrap arm under first then wrap once around back. can put hand in pocket or bind to side for added pressure how to keep wound packing in place if it is at risk for slipping - make an "X" to keep high femoral.. neck arm from sliding down -only need to make one X where should you not do wound packing - no wound poacking into chest how to do a high femoral wound packing/wrap - warp = make an X across the side 1. loose wrap 2. tighter 3. make one X around to hold it all in place 4. go oppoiste direction how to do wound packing to an inguinal space - can use a belt/make a diaper suaped differences between the JETT and SAM junctional - JETT = moveable pucks SAM - BP cuff bulb to pump up the puckfeature of the JETT junctional - has moveable pucks feature of the SAM junctional - BP cuff bulb to pump up the pucks semper paratus - "the scene is safe" in TCCC - fire superiority hostile combatant is rendered incapacitated and safe by not us Q's to ask ptt - "where were you hit" "can you move" **This assesses airway, LOC, if chan moe/shoot, or get them to craw to your, tell them to put direct pressure first preference to move patient - crawl to me how to properly do a blood sweep - "grip it and rip it" -so fast. not "click" as a distance - where can blood hide on a patient - sweep inside body armor b/c it can hide therem overall goals of Care Under Fire - fire superiority tourniquet for massive bleeding get them off the Xfirst step after a patient is moved - check any tourniquets you may have applied why should you continue to assess "A" if the patient is conscious and talking - even if okay "A" and skip over interventiosn like NPA/i-gel/cri-key, if bleeding they may go into shock and loose airway later *trauma adrenaline so airway might start to craump later. if okay to start w/o airwy damage *consider NPA just int case but if talkative, nten not how does an NPA function - like a doorstop for tongue to rest on. why arent' OPA's used in TCCC - gag dislodge w/movement step prior to inserting NPA - 90 degree petroleum gelly is thick and gunky so not great. use water soluble or pt spit J. Spec Opermed - insertion of NPA - 90 degrees bevel to septum rotate if left nare straight back if right *dont' go along the floor b/c it goes straight back then curved. if straight up, then not towards head/brain how is an NPA designed - to go into right nostril. if left nostril, rotate and twist intervention not to skip even if pt is talking - still check mouth for patency. ask to open even if talking.. might have dip/seeds/gum.*tell them to spit it out onset of lidocaine for anesthesia - ability to correctly answer the question "Do y