Hypothermia & Head Injury

Question 1

What does the ‘H’ in MARCH stand for?

Answer 1

Head injury and Hypothermia prevention.

Question 2

Why is hypothermia prevention critical in trauma?

Answer 2

Hypothermia worsens coagulopathy and increases mortality.

Question 3

What temperature should be maintained in trauma patients?

Answer 3

Above 36°C (96.8°F).

Question 4

What are signs of hypothermia in trauma?

Answer 4

Cold skin, shivering, slowed mental status, bradycardia.

Question 5

What is the first step in preventing hypothermia?

Answer 5

Minimize exposure and insulate the casualty from the ground.

Question 6

What should be used to prevent heat loss in casualties?

Answer 6

Hypothermia prevention kits, blankets, insulation, external heat sources.

Question 7

What is the ‘Ready-Heat’ blanket used for?

Answer 7

Active warming in trauma patients to prevent hypothermia.

Question 8

How does hypothermia affect clotting?

Answer 8

It impairs platelet function and the coagulation cascade.

Question 9

What is the lethal triad in trauma care?

Answer 9

Hypothermia, acidosis, coagulopathy.

Question 10

How can you minimize heat loss during transport?

Answer 10

Use heat-reflective blankets and minimize exposure.

Question 11

Why is the casualty’s back insulated in field care?

Answer 11

Significant heat loss occurs through contact with cold ground.

Question 12

When should hypothermia prevention begin?

Answer 12

Immediately after hemorrhage is controlled.

Question 13

What is the ideal ambient temperature for treating casualties?

Answer 13

Warm environment >20°C (68°F) if possible.

Question 14

How often should the casualty’s temperature be reassessed?

Answer 14

Routinely, especially if signs of hypothermia appear.

Question 15

What is the impact of shivering in trauma patients?

Answer 15

Increases metabolic demand and can worsen acidosis.

Question 16

Why should wet clothing be removed in trauma care?

Answer 16

Wet clothes accelerate heat loss and hypothermia.

Question 17

What should be done before wrapping a casualty in a blanket?

Answer 17

Ensure bleeding is controlled and dry insulation is used.

Question 18

What devices can provide active warming?

Answer 18

Heating pads, chemical heat blankets, thermal management systems.

Question 19

What is a risk of using excessive heat sources?

Answer 19

Burns or overheating, especially in unconscious patients.

Question 20

What is the target treatment for hypothermia?

Answer 20

Prevent progression and maintain core body temperature.

Question 21

What is a primary concern with head injuries in the field?

Answer 21

Preventing secondary brain injury.

Question 22

What are signs of traumatic brain injury (TBI)?

Answer 22

Altered consciousness, vomiting, seizures, unequal pupils, confusion.

Question 23

What is a red flag sign of increased intracranial pressure (ICP)?

Answer 23

Cushing’s triad: hypertension, bradycardia, irregular respirations.

Question 24

What is the best position for a conscious TBI patient?

Answer 24

Head elevated 30 degrees if not contraindicated.

Question 25

Why is hypoxia dangerous in TBI?

Answer 25

It exacerbates brain injury and worsens outcomes.

Question 26

Why is hypotension dangerous in TBI?

Answer 26

Decreased cerebral perfusion leads to worsened outcomes.

Question 27

What is the minimum SBP to maintain in TBI?

Answer 27

At least 90 mmHg.

Question 28

What should be done for vomiting in TBI patients?

Answer 28

Turn the head to the side to prevent aspiration.

Question 29

What medications are contraindicated in moderate to severe TBI?

Answer 29

Ketamine (cautiously) and opioids in excess (may worsen LOC).

Question 30

What is the best fluid for TBI with shock?

Answer 30

Whole blood, or blood products while maintaining SBP >90 mmHg.

Question 31

How should seizures be managed in TBI?

Answer 31

Use midazolam or diazepam if available.

Question 32

What should be avoided in suspected skull fractures?

Answer 32

NPA insertion through the nose.

Question 33

What is a sign of basilar skull fracture?

Answer 33

Raccoon eyes, Battle’s sign, CSF rhinorrhea or otorrhea.

Question 34

Why is repeated GCS assessment useful?

Answer 34

Tracks progression or improvement in TBI severity.

Question 35

What GCS score indicates severe TBI?

Answer 35

GCS 8 or less.

Question 36

What does a unilateral dilated pupil suggest?

Answer 36

Possible brain herniation.

Question 37

What is the role of oxygen in TBI patients?

Answer 37

Prevent hypoxia to reduce secondary brain injury.

Question 38

Why should carbon dioxide levels be monitored in ventilated TBI patients?

Answer 38

To avoid hypo- or hypercapnia, both harmful to the brain.

Question 39

What is the ideal SpO2 for TBI casualties?

Answer 39

Above 90%.

Question 40

What is the role of analgesia in TBI?

Answer 40

To manage pain while avoiding oversedation.

Question 41

What medication can be used for pain in TBI if needed?

Answer 41

Low-dose ketamine or fentanyl with close monitoring.

Question 42

Why is rapid evacuation important in TBI?

Answer 42

Neurosurgical intervention may be urgently required.

Question 43

What are common causes of secondary brain injury?

Answer 43

Hypoxia, hypotension, hypothermia, hypercarbia.

Question 44

What should be done if TBI casualty becomes unconscious?

Answer 44

Check airway and breathing; position to protect airway.

Question 45

What is an important consideration in transporting TBI patients?

Answer 45

Head elevation and cervical spine precautions.

Question 46

What environmental condition worsens TBI outcomes?

Answer 46

Cold exposure (hypothermia).

Question 47

What is a critical aspect of head injury care in tactical settings?

Answer 47

Preventing further injury and stabilizing vitals.

Question 48

What is a simple field test for TBI in conscious casualties?

Answer 48

AVPU or GCS assessment.

Question 49

What is the goal of TBI management in tactical care?

Answer 49

Prevent secondary injury and maintain perfusion and oxygenation.