EFMB Medical Skills & Combat Medicine 3 — Questions and Answers
Question 1: Which IV fluid is the preferred resuscitation fluid for hypovolemic shock in TCCC?
- Hextend (6% hetastarch) (Correct answer)
- Normal saline (0.9% NaCl)
- 5% dextrose in water (D5W)
- Lactated Ringer's solution
Correct answer: Hextend (6% hetastarch)
Hextend is the preferred resuscitation fluid in TCCC for hypovolemic shock because 500 mL provides volume expansion equivalent to 2 liters of crystalloid.
Question 2: What is the maximum number of times a tourniquet site should be marked with the time of application?
- Once, on the tourniquet itself
- Twice, on the tourniquet and the casualty's forehead (Correct answer)
- Once, only on the casualty's skin
- Three times for redundancy
Correct answer: Twice, on the tourniquet and the casualty's forehead
TCCC protocol requires marking the time of tourniquet application on the tourniquet and also on the casualty's forehead with a marker to prevent loss of information during handoff.
Question 3: A casualty has burns to both arms and the front of both legs. Using the Rule of Nines, what percentage of total body surface area (TBSA) is burned?
- 36% (Correct answer)
- 27%
- 45%
- 18%
Correct answer: 36%
Each arm = 9%, each front leg = 9%; two arms (18%) + two front legs (18%) = 36% TBSA.
Question 4: Which medication is recommended in TCCC for pain management in a casualty who can still fight?
- Oral transmucosal fentanyl citrate (OTFC) (Correct answer)
- IV morphine sulfate
- Ketamine IM injection
- Acetaminophen only
Correct answer: Oral transmucosal fentanyl citrate (OTFC)
OTFC (fentanyl lollipop) is recommended for casualties who can still engage in the fight because it does not impair the ability to fire a weapon.
Question 5: What is the preferred route for IV/IO access when peripheral veins are inaccessible in a combat casualty?
- Intraosseous (IO) access (Correct answer)
- Central venous access
- Femoral vein access
- Sublingual medication only
Correct answer: Intraosseous (IO) access
IO access is preferred when peripheral IV access cannot be rapidly established, as it provides a reliable vascular access point even in hypovolemic casualties.
Question 6: What clinical finding best differentiates hemorrhagic shock from neurogenic shock in a combat casualty?
- Skin color and temperature (Correct answer)
- Respiratory rate
- Level of consciousness alone
- Pupillary response
Correct answer: Skin color and temperature
Hemorrhagic shock presents with cold, pale, clammy skin while neurogenic shock presents with warm, dry, flushed skin due to loss of sympathetic tone.
Question 7: In Tactical Field Care, at what systolic blood pressure should fluid resuscitation be targeted in a penetrating trauma casualty WITHOUT head injury?
- 80–90 mmHg (Correct answer)
- 110–120 mmHg
- 60–70 mmHg
- 120–140 mmHg
Correct answer: 80–90 mmHg
Permissive hypotension targets a systolic BP of 80–90 mmHg in penetrating trauma without TBI to maintain organ perfusion without worsening coagulopathy.
EFMB Medical Skills & Combat Medicine 3
Which IV fluid is the preferred resuscitation fluid for hypovolemic shock in TCCC?