EFMB Medical Skills & Combat Medicine 5 — Questions and Answers
Question 1: Which landmark is used to perform an emergency intraosseous (IO) insertion at the proximal tibia?
- 2 cm below the tibial tuberosity on the anteromedial surface (Correct answer)
- Directly over the tibial tuberosity
- 2 cm above the medial malleolus
- Lateral aspect of the tibial head
Correct answer: 2 cm below the tibial tuberosity on the anteromedial surface
The proximal tibial IO site is 2 cm below the tibial tuberosity on the flat anteromedial surface of the tibia, away from the growth plate.
Question 2: What is the first action when a combat casualty goes into cardiac arrest due to non-traumatic causes (e.g., heat stroke)?
- Begin CPR immediately (Correct answer)
- Apply tourniquet to all extremities
- Establish IO access before any other intervention
- Administer epinephrine without CPR
Correct answer: Begin CPR immediately
For non-traumatic cardiac arrest, standard CPR (chest compressions and ventilations) should begin immediately according to TCCC guidelines.
Question 3: What condition is indicated by absent breath sounds unilaterally, hypotension, and distended neck veins in a mechanically ventilated casualty?
- Tension pneumothorax (Correct answer)
- Hemothorax
- Pulmonary embolism
- Cardiac tamponade
Correct answer: Tension pneumothorax
The triad of absent unilateral breath sounds, hypotension, and JVD in a ventilated patient is the classic presentation of tension pneumothorax.
Question 4: A casualty presents with Beck's Triad (hypotension, muffled heart sounds, JVD) after a penetrating chest wound. What injury should you suspect?
- Cardiac tamponade (Correct answer)
- Tension pneumothorax
- Massive hemothorax
- Aortic transection
Correct answer: Cardiac tamponade
Beck's Triad — hypotension, muffled heart sounds, and jugular vein distension — is the classic presentation of cardiac tamponade caused by blood in the pericardial sac.
Question 5: When treating a combat casualty for hypothermia prevention, at what core body temperature does severe hypothermia (risk of cardiac arrhythmia) begin?
- Below 30°C (86°F) (Correct answer)
- Below 36°C (96.8°F)
- Below 32°C (89.6°F)
- Below 35°C (95°F)
Correct answer: Below 30°C (86°F)
Severe hypothermia is defined as a core temperature below 30°C (86°F), at which ventricular fibrillation and other life-threatening arrhythmias become likely.
Question 6: What is the recommended method for assessing a casualty's level of consciousness (LOC) rapidly in the field?
- AVPU scale (Alert, Voice, Pain, Unresponsive) (Correct answer)
- Glasgow Coma Scale (GCS)
- Revised Trauma Score
- Hunt and Hess Scale
Correct answer: AVPU scale (Alert, Voice, Pain, Unresponsive)
The AVPU scale is the rapid field assessment tool for LOC; the full GCS is used in more controlled settings and requires more time to complete.
Question 7: A casualty with a suspected spinal injury needs to be moved due to incoming fire. What is the correct TCCC approach?
- Move the casualty using a hasty drag while keeping the spine as straight as possible; tactical situation takes priority (Correct answer)
- Never move a spinal injury casualty under any circumstances
- Spend time applying a cervical collar before moving
- Wait for evacuation assets regardless of threat level
Correct answer: Move the casualty using a hasty drag while keeping the spine as straight as possible; tactical situation takes priority
TCCC prioritizes removing the casualty from danger; spinal precautions are maintained as feasibly as possible, but tactical necessity overrides rigid spinal immobilization protocols.
EFMB Medical Skills & Combat Medicine 5
Which landmark is used to perform an emergency intraosseous (IO) insertion at the proximal tibia?