Circulation

Question 1

What is the ‘C’ in the MARCH algorithm?

Answer 1

Circulation.

Question 2

What is the goal of circulation management in TCCC?

Answer 2

Detect and treat shock and ongoing internal hemorrhage.

Question 3

What are the key signs of shock in trauma patients?

Answer 3

Tachycardia, hypotension, pale skin, altered mental status.

Question 4

What is the most common cause of shock in trauma?

Answer 4

Hemorrhagic shock.

Question 5

What is the main focus of circulation management after hemorrhage control?

Answer 5

Restore perfusion and prevent/treat shock.

Question 6

What fluids are recommended in TCCC for shock due to hemorrhage?

Answer 6

Whole blood, followed by 1:1:1 plasma, RBCs, platelets; or alternatives like plasma or Hextend.

Question 7

What is the target systolic BP in TCCC for shock resuscitation?

Answer 7

SBP of 100 mmHg or palpable radial pulse.

Question 8

Why is over-resuscitation harmful in hemorrhagic shock?

Answer 8

It can dislodge clots and worsen bleeding.

Question 9

What is hypotensive resuscitation?

Answer 9

Permissive hypotension strategy to maintain minimal perfusion until bleeding is controlled.

Question 10

When is IV or IO access indicated in TCCC?

Answer 10

For fluid resuscitation or medication administration.

Question 11

What is the preferred site for IO access?

Answer 11

Proximal tibia or humeral head.

Question 12

What gauge and type of catheter is recommended for IV access?

Answer 12

18-gauge or larger, saline lock or extension tubing.

Question 13

What are signs that shock is improving?

Answer 13

Improved mental status and stronger radial pulse.

Question 14

What type of fluids should be avoided in large volumes in TCCC?

Answer 14

Normal saline and lactated Ringer’s.

Question 15

What is the first step in assessing circulation in TCCC?

Answer 15

Check for ongoing bleeding and signs of shock.

Question 16

What is the best indicator of adequate perfusion in a conscious casualty?

Answer 16

Normal mental status.

Question 17

Why are radial pulses assessed in TCCC?

Answer 17

To estimate systolic blood pressure and perfusion.

Question 18

When should blood products be given in the field?

Answer 18

If the casualty is in shock and products are available.

Question 19

What is the CoTCCC-preferred fluid for hemorrhagic shock?

Answer 19

Whole blood.

Question 20

What is the backup fluid if whole blood is unavailable?

Answer 20

Plasma, RBCs, platelets in 1:1:1 ratio; then plasma or Hextend.

Question 21

What is the indication for TXA in TCCC?

Answer 21

Significant hemorrhage or high risk of hemorrhage.

Question 22

What dose of TXA is recommended in TCCC?

Answer 22

1 gram IV/IO over 10 minutes, ideally within 1 hour of injury.

Question 23

What is the follow-up dose of TXA after the first one?

Answer 23

1 gram over 8 hours as maintenance infusion.

Question 24

Why is early TXA administration important?

Answer 24

Reduces mortality from hemorrhagic shock.

Question 25

When should TXA be given according to TCCC?

Answer 25

As soon as possible and within 3 hours of injury.

Question 26

What is the impact of hypothermia on circulation?

Answer 26

Worsens coagulopathy and increases bleeding risk.

Question 27

What should be done to prevent hypothermia in shock?

Answer 27

Use warming blankets, minimize exposure, and keep casualty dry.

Question 28

What is the function of the Pelvic Binder in TCCC?

Answer 28

To reduce pelvic bleeding by stabilizing pelvic fractures.

Question 29

When should a pelvic binder be applied?

Answer 29

Suspected pelvic fracture or unconscious casualty with blunt trauma.

Question 30

What is the danger of missed internal bleeding?

Answer 30

Delayed shock and death if not treated.

Question 31

What is the lethal triad in trauma?

Answer 31

Hypothermia, acidosis, and coagulopathy.

Question 32

What is the advantage of whole blood over crystalloids?

Answer 32

Provides volume, oxygen-carrying capacity, and clotting factors.

Question 33

What is a sign of compensated shock?

Answer 33

Normal blood pressure but signs of poor perfusion (e.g., tachycardia).

Question 34

What action should be taken for ongoing internal bleeding?

Answer 34

Rapid evacuation and supportive care.

Question 35

What does a weak or absent radial pulse suggest?

Answer 35

Poor perfusion or hypotension.

Question 36

What tools are used to assess circulation in tactical settings?

Answer 36

Pulse check, capillary refill, mental status.

Question 37

What should be done if shock signs worsen despite fluids?

Answer 37

Reevaluate for continued bleeding or missed injuries.

Question 38

Why is TXA important in tactical medicine?

Answer 38

Improves survival when used early in bleeding casualties.

Question 39

What can worsen shock during casualty handling?

Answer 39

Rough movement, cold exposure, or missed bleeding.

Question 40

What is the best method to reduce bleeding from limb fractures?

Answer 40

Proper splinting to reduce movement.

Question 41

When should blood pressure be taken in tactical settings?

Answer 41

Only when equipment and time allow; pulse and mental status are quicker.

Question 42

Why is speed critical in treating shock?

Answer 42

Early intervention improves survival and reduces complications.

Question 43

What is the role of resuscitative fluids?

Answer 43

To maintain perfusion until definitive control of bleeding.

Question 44

What must always accompany fluid resuscitation?

Answer 44

Ongoing reassessment for bleeding and perfusion.

Question 45

How can you monitor response to fluids in unconscious casualties?

Answer 45

Improved pulse quality and skin color.

Question 46

What is the tactical priority after hemorrhage is controlled?

Answer 46

Prevent and treat shock and maintain circulation.

Question 47

What are late signs of hemorrhagic shock?

Answer 47

Hypotension, bradycardia, unconsciousness.

Question 48

Why is field blood transfusion increasingly used?

Answer 48

Improves outcomes in hemorrhagic shock when given early.

Question 49

What factor increases clotting efficiency in trauma patients?

Answer 49

Normothermia and early use of TXA and blood products.

Question 50

Why is rapid evacuation critical in circulation compromise?

Answer 50

Definitive care is often needed to stop internal bleeding.