Breathing

Question 1

What is the ‘R’ in the MARCH algorithm?

Answer 1

Respiration (Breathing).

Question 2

What is the goal of respiration assessment in TCCC?

Answer 2

Identify and treat life-threatening chest injuries that impair breathing.

Question 3

What are common life-threatening respiratory injuries in trauma?

Answer 3

Tension pneumothorax, open pneumothorax, flail chest.

Question 4

What should be done after establishing a patent airway?

Answer 4

Assess breathing and chest for injuries.

Question 5

What is a sign of tension pneumothorax?

Answer 5

Progressive respiratory distress, absent breath sounds, tracheal deviation (late sign).

Question 6

What is the TCCC treatment for suspected tension pneumothorax?

Answer 6

Needle decompression of the chest.

Question 7

Where is needle decompression performed?

Answer 7

2nd intercostal space, midclavicular line or 5th ICS, anterior axillary line.

Question 8

What size needle is recommended for decompression?

Answer 8

14-gauge, 3.25-inch needle.

Question 9

What is the most reliable site for needle decompression?

Answer 9

5th intercostal space, anterior axillary line.

Question 10

What should be done after needle decompression?

Answer 10

Reassess for improvement in respiratory status.

Question 11

What is an open pneumothorax?

Answer 11

A chest wound that allows air to enter the pleural space during breathing.

Question 12

How is an open pneumothorax treated in TCCC?

Answer 12

Vented chest seal application over the wound.

Question 13

Why are vented chest seals preferred?

Answer 13

They reduce the risk of tension pneumothorax while sealing the wound.

Question 14

What is a flail chest?

Answer 14

Segment of ribs fractured in multiple places causing paradoxical movement.

Question 15

How is flail chest managed in TCCC?

Answer 15

Pain control, supportive care, and possibly positive pressure ventilation.

Question 16

What is the risk of sealing a chest wound without a vent?

Answer 16

Development of tension pneumothorax.

Question 17

What is the next step if respiratory distress persists after needle decompression?

Answer 17

Repeat decompression or decompress the opposite side.

Question 18

What is the primary cause of preventable death from thoracic trauma?

Answer 18

Tension pneumothorax.

Question 19

What are signs of respiratory compromise?

Answer 19

Increased respiratory rate, dyspnea, cyanosis, decreased breath sounds.

Question 20

How often should breathing be reassessed?

Answer 20

Continuously or after any intervention or movement.

Question 21

What should be monitored in all chest trauma patients?

Answer 21

Breath sounds, chest rise, respiratory rate, SpO2 (if available).

Question 22

What should be avoided with chest injuries?

Answer 22

Aggressive positive pressure ventilation without need.

Question 23

What tool assists in identifying chest trauma in the field?

Answer 23

Physical exam; ultrasound if available.

Question 24

What is the benefit of pulse oximetry in TCCC?

Answer 24

Helps assess oxygenation and detect hypoxia.

Question 25

When is oxygen used in tactical medicine?

Answer 25

When available and practical, especially with chest injuries.

Question 26

What should be done if no improvement after chest interventions?

Answer 26

Consider other causes or reassess for missed injuries.

Question 27

What is an indication of successful decompression?

Answer 27

Improved breathing, oxygenation, and chest rise.

Question 28

What should be done if the chest seal fails to stick?

Answer 28

Use tape to secure or replace with another seal.

Question 29

What kind of chest seal is recommended by CoTCCC?

Answer 29

Vented chest seals.

Question 30

Can decompression be performed through clothing?

Answer 30

No, expose the site to avoid incorrect placement.

Question 31

What do absent breath sounds on one side suggest?

Answer 31

Pneumothorax or hemothorax.

Question 32

What are late signs of tension pneumothorax?

Answer 32

Tracheal deviation, hypotension, cyanosis, unconsciousness.

Question 33

What is a secondary effect of rib fractures?

Answer 33

Pain leading to inadequate ventilation.

Question 34

What is the preferred patient position for breathing problems?

Answer 34

Sitting upright if conscious and tactically feasible.

Question 35

What is a hemothorax?

Answer 35

Accumulation of blood in the pleural space impairing breathing.

Question 36

How is hemothorax managed in the field?

Answer 36

Supportive care, rapid evacuation; decompression won’t help.

Question 37

What must be ensured before applying a chest seal?

Answer 37

Clean and dry the area as much as possible.

Question 38

What is the maximum number of decompressions recommended?

Answer 38

As many as clinically indicated, reassess frequently.

Question 39

What is the most common error during needle decompression?

Answer 39

Incorrect site or inadequate needle length.

Question 40

How can breath sounds be assessed in noisy tactical settings?

Answer 40

Observe chest rise and assess oxygen saturation if available.

Question 41

What should be included in every IFAK (Individual First Aid Kit)?

Answer 41

Chest seal, decompression needle.

Question 42

When should the casualty be evacuated after decompression?

Answer 42

As soon as possible regardless of response.

Question 43

What is the role of positive pressure ventilation?

Answer 43

Used if patient is not breathing adequately and airway secured.

Question 44

How should multiple chest wounds be managed?

Answer 44

Seal all wounds, decompress if needed, reassess regularly.

Question 45

What should be done after sealing a chest wound?

Answer 45

Monitor for signs of developing tension pneumothorax.

Question 46

Why should both anterior and posterior chest be assessed?

Answer 46

To identify exit wounds or posterior injuries.

Question 47

What is the size range for vented chest seals?

Answer 47

Typically 6-inch diameter.

Question 48

How long does a decompression needle remain in place?

Answer 48

It is typically left in situ until higher care is available.

Question 49

What is the tactical significance of fast decompression?

Answer 49

Can prevent respiratory arrest and death in seconds to minutes.