EFMB Medical Skills & Combat Medicine 4 — Questions and Answers
Question 1: A casualty sustains a blast injury with suspected traumatic brain injury (TBI) AND hemorrhagic shock. What is the target systolic blood pressure for resuscitation?
- 110 mmHg or higher (Correct answer)
- 80–90 mmHg
- 60–70 mmHg
- Normal pressure is not a concern with TBI
Correct answer: 110 mmHg or higher
With suspected TBI, the target systolic BP is 110 mmHg or greater to maintain cerebral perfusion pressure and prevent secondary brain injury.
Question 2: What is the correct sequence for applying a junctional tourniquet (e.g., SAM JT) to control groin hemorrhage?
- Position over femoral triangle, tighten until bleeding stops, secure strap (Correct answer)
- Apply above the iliac crest, inflate cuff, reassess
- Pack the wound first, then apply junctional device
- Apply the device at the axilla, not the groin
Correct answer: Position over femoral triangle, tighten until bleeding stops, secure strap
A junctional tourniquet is positioned over the femoral triangle, tightened to occlude the femoral artery until bleeding ceases, then secured.
Question 3: Which of the following is NOT an indication for performing a surgical cricothyrotomy in TCCC?
- Casualty is responsive and speaking clearly (Correct answer)
- Airway obstruction from massive facial trauma
- Failed nasopharyngeal airway insertion
- Unconscious casualty with airway obstruction unrelieved by repositioning
Correct answer: Casualty is responsive and speaking clearly
A casualty who is speaking clearly has a patent airway and does not need surgical airway intervention.
Question 4: What is the primary purpose of administering tranexamic acid (TXA) in combat casualties?
- To inhibit fibrinolysis and preserve clot formation (Correct answer)
- To increase blood pressure directly
- To replace lost red blood cells
- To prevent infection at wound sites
Correct answer: To inhibit fibrinolysis and preserve clot formation
TXA inhibits fibrinolysis (the breakdown of clots), helping casualties who are at risk of traumatic coagulopathy retain their ability to form blood clots.
Question 5: Within what time window must TXA (tranexamic acid) be administered to be effective in a trauma casualty?
- Within 3 hours of injury (Correct answer)
- Within 6 hours of injury
- Within 1 hour of injury only
- At any time after injury
Correct answer: Within 3 hours of injury
TXA must be given within 3 hours of injury; administration after 3 hours has been shown to increase mortality rather than decrease it.
Question 6: How should a hypothermic combat casualty be managed in Tactical Evacuation Care (TACEVAC)?
- Remove wet clothing, apply heat packs to the axillae and groin, cover with a hypothermia wrap (Correct answer)
- Immerse in warm water if available
- Administer cold IV fluids slowly to stabilize core temperature
- Keep the casualty sitting upright and exposed to air
Correct answer: Remove wet clothing, apply heat packs to the axillae and groin, cover with a hypothermia wrap
Preventing and treating hypothermia involves removing wet clothing, applying chemical heat packs to high-blood-flow areas, and wrapping the casualty in an insulating layer.
Question 7: A casualty has an open eye injury with visible uveal tissue prolapse. What is the correct field management?
- Cover the eye with a rigid shield without pressure and do not remove any protruding tissue (Correct answer)
- Apply firm pressure with a bandage to control hemorrhage
- Irrigate the eye with saline and replace protruding tissue
- Apply a soft eye patch with gentle pressure
Correct answer: Cover the eye with a rigid shield without pressure and do not remove any protruding tissue
An open globe injury requires a rigid eye shield (not pressure) to protect the eye; applying pressure can force intraocular contents out and cause permanent blindness.
EFMB Medical Skills & Combat Medicine 4
A casualty sustains a blast injury with suspected traumatic brain injury (TBI) AND hemorrhagic shock.
What is the target systolic blood pressure for resuscitation?