ASM 014

Respiratory Management Essentials in TCCC – Tier 1 – You are in a SAFE and SECURE location – The primary learning objective is to describe, review, and practice the Respiratory phase of care in the M A R C H algorithm: inspecting the chest for wounds and for any evidence of a tension pneumothorax (dropped lung). Subsequent scenarios will allow you to practice evaluating patients for these injuries. The estimated time to complete this scenario is 8 minutes. This is your first time taking care of this casualty. The casualty was near a drone explosion that occurred 4 minutes ago. The massive hemorrhage and airway phases of care have been completed, and the patient has no massive bleeding and no airway obstruction. You already have personal protective equipment (gloves) on. No other interventions have been performed. This scenario occurs in the Tactical Field Care Phase and covers the MA[R]CH portion(s) of care. Equipment Available: Individualized First Aid Kit (IFAK) U.S Version (x2). Evacuation/Disposition is possible through the tablet. Selecting the patient’s disposition will end the exercise. (This is Scenario 014).

Dynamic Physiology Disclaimer:
To obtain the most accurate and effective training experience, we recommend completing each scenario in one uninterrupted session. The virtual patients used in this training are powered by highly realistic physiological models that continuously adjust vital signs and overall condition. The scenarios have been modified to give you time to review instructional materials, and you will not lose points for delays in scenarios with instructional content. However, it is still possible that, depending on your completion pace, the scenario may not progress in perfect alignment with the guided prompts, and for critically injured patients, even moderate delays may result in deterioration or death before the scenario concludes. This is not meant to indicate you did not perform well; rather, it is because of how the high-fidelity engine performs.

Ongoing Development Disclaimer: It is possible small updates or changes to the system are not reflected in the wording. All grading is set to the current standard described in this package.

Patient Communication

Patient: Hey, I am here to take care of you.
Response: Thank you. I’m really struggling to breathe
Location: Head
Patient: Can you tell me your name?
Response: Vanessa Price
Location: Head
Patient: What happened?
Response: There was an explosion... I was thrown to the ground. My chest really hurts.
Location: Head
Patient: Are you hurting anywhere?
Response: Yes, my chest hurts, and it’s really hard to breathe.
Location: Head
Patient: Does your throat hurt or feel tight?
Response: My throat doesn't feel tight, but I can’t seem to get enough air.
Location: Head
Patient: Are you having a hard time breathing?
Response: Yes, I feel like I can’t get a full breath.
Location: Head
Patient: Does your chest hurt?
Response: Yes, it’s sharp and really painful on the left side
Location: Head
Patient: Did you pass out (lose consciousness)?
Response: No. I didn't pass out.
Location: Head
Patient: Do you have any numbness or weakness?
Response: No, I don’t think so.
Location: Head
Patient: Does your head hurt?
Response: No, I don’t think so.
Location: Head
Patient: Does your neck hurt?
Response: No, I don’t think so.
Location: Head
Patient: Does your back hurt?
Response: No, I don’t think so.
Location: Head
Patient: Does your abdomen hurt?
Response: No, I don’t think so.
Location: Head
Patient: Do you have any allergies?
Response: I do not have any allergies.
Location: Head
Patient: Do you take any medications?
Response: I do not take any medications.
Location: Head
Patient: Do you have any medical problems?
Response: No. I am healthy.
Location: Head
Patient: Have you ever had any surgeries?
Response: I have never had a surgery.
Location: Head
Patient: When did you last eat or drink something?
Response: I drank some water about an hour ago
Location: Head
Patient: Do you smoke, drink, or use recreational drugs?
Response: I don't do any of those.
Location: Head
Patient: I am here to take care of you.
Response: Thank you. I appreciate it.
Location: Head
Patient: I’ll use the back of my hand to check under your breast
Response: I understand. Thank you for telling me.
Location: Head
Patient: I am going to remove your clothes to look for wounds.
Response: I understand. Thank you for telling me.
Location: Head

Audio Triggers

When performing this assessment, it is critical to avoid rocking the pelvis or putting any strain on the pelvis. The action you performed only checks for evidence of pelvic pain or gross instability. When in doubt, you can liberally place a pelvic binder.

Scoring Details

Exam: Assessment: Roll the patient over
Exam: Assessment: Remove the patient's shirt
Exam: Assessment: Remove the patient's underbra
Displace mammary tissue (left side)
Displace mammary tissue (right side)
Patient disposition: Medical Evacuation

Scenario Details

Scenario Package
TCCC Tier 1 Curriculum
Learner type
  • militaryMedic
Patient severity at start
Serious
Patient severity overall
Serious
Duration to complete
<5 minutes
Scenario difficulty
Standard
Environment
POI
Equipment
  • bandage
  • Duct Tape
  • Combat Application Tourniquet
  • Combat Application Tourniquet
  • Trauma Shears
  • FoilBlanket
  • Blanket
  • ChestSealPackage
  • AlcoholWipe
  • PackingGauze
  • Gloves box
  • Eye Guard
  • Marker
  • Non-Adherent Dressing
  • Decompression needle
  • TCCC Card
Available medications
Injury type
  • Chest wound (posterior left)
  • Chest wound below the left breast
  • Jugular vein, left side
  • Jugular vein, right side
  • Tracheal shift to the right side
Pathologies
  • pneumothorax, open, left
Scoring summary
  • R-Exposure
  • Displace Mammary Tissue
  • Disposition