TCCC

Question 1

How to apply hemostatic dressings?

Answer 1

-With at least 3min of direct pressure -If one doesn’t work, try another

Question 2

IT Clamp?

Answer 2

-Head and neck wounds easily approximated -Pack wound first -No extra external pressure needed -Continuously re-evaluate airway for hematoma *DONOT apply on or near eye (1cm within orbit)

Question 3

Airway for unconscious pt without airway obstruction?

Answer 3

-Recovery position -Chin lift/jaw thrust OR -NPA OR -Extraglottic airway

Question 4

What is combat gauze?

Answer 4

Gauze impregnated with kaolin *No shellfish, animal prots, low allergy potential *Has radiopaque strip down middle

Question 5

What is Kaolin?

Answer 5

Inorganic mineral Speeds up clotting by activating factor XII

Question 6

What are the CoTCCC recommended limb tourniquets?

Answer 6

-CAT Gen 6, Gen 7 -RMT-T (mil model) -SOFTT-W (new 1.5” nylon strap) -TMT -TX2, TX3

Question 7

First two things you do when transition to tactical field care?

Answer 7

1) Establish a perimeter 2) Triage *any pt w/ AMS needs their weapons and comms taken away immediately

Question 8

Where to place tourniquet in tactical field care?

Answer 8

-Directly to the skin - 2 to 3’’ above bleeding site

Question 9

Use of hemostatic dressings?

Answer 9

-For compressible hemorrhage you can’t tourniquet -dressing of choice = COMBAT GAUZE -alternatives = celox/chito/stat/it clamp

Question 10

Most recent update to TCCC?

Answer 10

01 Aug 2019

Question 11

What specific type of airway will you place in case of cricothyroidotomy?

Answer 11

Flanged and cuffed airway cannula <10mm outer diameter 6-7mm internal diameter 5-8cm of intra-tracheal length

Question 12

What are the preferred options for Cric’s?

Answer 12

Preferred option: Cric-Key technique Next: Bougie aided open surgical Last: Standard open surgical technique

Question 13

What is the preferred extraglottic airway?

Answer 13

I-gel *simpler b/c no need for cuff inflation/monitoring

Question 14

What is the recovery position?

Answer 14

Question 15

What type of needle for needle D?

Answer 15

10 gauge, 3.25 inch

Question 16

Last thing you do before giving up resuscitation?

Answer 16

Bilateral needle decompression

Question 17

Where to placed the needle D?

Answer 17

5th ICS in the AAL

OR

2nd ICS in the MCL

**DO NOT insert medial to nipple line

Question 18

How to place needle D?

Answer 18

Perpendicular to chest wall

Just over top of lower rib

Hub it, hold in place for 5-10sec

Question 19

If initial needle D fails to improve the signs/symptoms, what next?

Question 20

What should be initiated immediately during assessment of breathing?

Answer 20

pulse oximetry

Question 21

When to put on a pelvic binder?

Answer 21

Severe blunt force or blast injury PLUS

pelvic pain

OR

lower limb amputation or near so

OR

Unconsciousness OR shock OR PE suggestive

Question 22

What should you do every time you address Circulation during a triage?

Answer 22

Reassess prior tourniquet application

Question 23

First thing you do for suspected tension pneumothorax?

Answer 23

If pt has a chest seal, burp it or remove it

Question 24

Should you attempt to convert tourniquets to hemostatic/pressure dressings?

Answer 24

Yes, as soon as posible, but only if certain circumstances met

Question 25

What three criteria must be met before tourniquets can be converted?

Answer 25

1) Casualty is not in shock
2) Its possible to monitor the wound for bleeding
3) Tourniquet is not being used to control blding from an amputation

Question 26

How long can you go before converting a tourniquet?

Answer 26

Withing 2hrs (never 6hr or later)

Question 27

What is of utmost importance when utilizing tourniquets?

Answer 27

Documenting their time of application and conversion on the TCCC card

Question 28

Does every casualty get an IV?

Answer 28

NO

Only those with hemorrhagic shock OR at risk for it OR need IV fluids OR can’t take oral meds

Question 29

Who gets TXA?

Answer 29

Patients needing blood products (pts in shock)

Question 30

How much/how to give TXA?

Answer 30

1gm TXA in 100mL of NS or LR

push over 10min

Never after 3hrs

Question 31

When to give second dose of TXA?

Answer 31

After initial fluid resuscitation has been completed.

Question 32

What are measures of adequate resuscitation?

Answer 32

Papable radial pulse

Improved mental status

SBP 80-90

Question 33

When should you begin hypothermia prevention on a trauma patient?

Answer 33

When you initiate blood products (if not obvious before that)

Question 34

What to do for penetrating eye trauma?

Answer 34

Perform rapid field test of visual acuity and document