PHEC - Initial Assessment and Cat Hem

Question 1

CUF Threats

Answer 1

Hostile forces and enemy fire
Equipment limitations – only what’s on webbing, tourniquet / ECB
Limited visibility – smoke, night, weather
Communication difficulty – loud environment
Time

Question 2

CUF Aims

Answer 2

CUF – occurs in Non-permissive environment
Win the fire fight
Casualties return fire/self care where possible
SAFE and <C>A</C>

Question 3

TFC – TRaPS

Answer 3

TRaPS in semi-permissive environment
The fire-fight has been won
When safe to do so: conduct Tactical Rapid Primary Survey:

<C>ABCDE
Additional injuries will be discovered during your assessment
Clinical assessment will be challenging in field conditions
Treat as you find
</C>

Question 4

Primary Survey

Answer 4

Occurs in a Permissive environment
More detailed <C>ABCDE approach – including RISE N FALL and TWELVE.</C>

Question 5

Primary Survey - A

Answer 5

Check/clear/maintain
Remove obstruction – postural drainage/suction etc
Manual airway opening manoeuvres
Airway adjuncts / surgical requirement recognised
Give O2 if available

Question 6

Primary Survey - <C></C>

Answer 6

<C> -Deal with any other <C> bleeds
Re-check catastrophic haemorrhages – tourniquets and cellox
</C></C>

Question 7

Primary Survey - B

Answer 7

Look, Listen, Feel
RISE N FALL
Injuries to consider for breathing
GSW/ frag to chest – entry and exit
Open pneumothorax – sucking chest wound
Tension pneumothorax
Massive haemothorax
Flail chest

Question 8

Primary Survey - C

Answer 8

Re-check catastrophic haemorrhage
Check appropriate pulses
‘Blood on the floor and four more’
Check the floor, chest, abdo, pelvis and long bones
Dress / realign / splint other injuries
IV/IO fluid resuscitation as required

Question 9

Primary Survey - D

Answer 9

AVPU
Alert
Voice
Painful Stimuli
Unresponsive
Pupil responsiveness – Pupils Equal And Reactive to Light & Accommodation (PEARLA)
Pain relief:
Physical / Pharmaceutical / Psychological (splinting / fentanyl / reassurance)

Question 10

Primary Survey - E

Answer 10

Environment
Consider shock
Hypovolemic,
Consider environment
Hypothermia
Appropriately package
Ensure all dressings secure and casualty ready for evacuation

Question 11

Compressible Haemorrhage

Answer 11

An external bleed
Direct pressure to wound
Indirect pressure points on brachial or femoral arteries
Use of CAT, CELOX, ECB
Elevation

Question 12

Non-Compressible Haemorrhage

Answer 12

Internal Bleed
How is it controlled?
Splint, Pelvic binder etc, Fluids
EVAC ASAP T1
Will require urgent evacuation, blood transfusion and surgical intervention.
What makes us suspect one?
Pulse >100, weak
Low BP
Bruising to area
Pain
Rigidness
MOI
Increase in breathing
Sluggish Capillary refill
Cyanosis

Question 13

State under what circumstances 2 CATs may need to be applied

Answer 13

If the first fails apply a second proximally only two finger space.
Above knee traumatic amputations will require 2x CATs

Question 14

Equipment to control bleeding

Answer 14

Tourniquets – CAT, Celox Rapid, ECB (First Field Dressing FFD), Blast bandage

Question 15

Preservation of Amputated Parts

Answer 15

Rinse the part free of debris with cool, sterile saline
Wrap the part loosely in saline moistened sterile gauze
Seal the part inside a plastic bag
Keep it cold but do not allow to freeze
Never warm an amputated part
Never place an amputated part in water
Never place an amputated part directly on ice

Question 16

CAT Technique

Answer 16

Tourniquet
Apply as close to the wound as possible. If this tournequet fails, second tournequetapplied approx 2 finger space proximally.
Re-visit in circulation trying other methods
Mark with a ‘T’ where visible and record time
May have to move to a single bone or above a joint.

Question 17

Celox Indications

Answer 17

Severe bleeding that cannot be controlled by field dressing(s) and pressure, +/- elevation if it is an injured limb
In addition to tourniquet(s) if these are required to control catastrophic limb bleeding
Bleeding from wounds in the groin, armpit or neck where a tourniquet cannot be used and/or pressure through a plain field dressing is not enough to stop the bleeding
If Celox and bandages are not working but direct pressure is aiding in stemming the bleed this pressure is to be maintained throughout treatment and evacuation.
Situations such as when the underlying bone is shattered preventing adequate pressure being applied.

Question 18

Celox Use

Answer 18

Ideally a two person technique. Hold pressure for 1 min after packing.
Shelf life decreases at temperatures 40C and above to approx 6 months.
We don’t use celox in chest and abdominal cavities or in an open head wound