This is the third scenario in the Tier 2/Combat Life Saver curriculum pack. The following scenarios will provide training on additional TCCC at the Tier 2 Level. There are new interventions in the Airway, Respirations, Circulation, Head Injury, Hypothermia, and Fracture portions of TCCC. Additionally, Tier 2 introduces you to new medications that can be used for pain as well as infection prevention and treatment. We will proceed sequentially through MARCH.
Tier 2 Airway Treatments (Airway and Facial Trauma Considerations): You are in a SAFE and SECURE location – The primary learning objective is to show you some important considerations when managing a patients airway when a severe facial injury is also present. The estimated time to complete this scenario is 5 minutes. This scenario occurs in the Tactical Field Care Phase. Equipment Available: Combat Life Saver Pack. Evacuation/Disposition is possible through the tablet. Selecting the patient’s disposition will end the exercise.
Patient Communication
Patient: Can you tell me your name?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Do you feel any pain?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Do you have any medical problems?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Do you have any allergies?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Do you take any medications?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Are you feeling dizzy or confused?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Are you having trouble breathing?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Can you see clearly?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Do you feel any swelling in your throat?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Are your lips or tongue swollen?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Is your voice hoarse or different?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Do you remember what happened?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Guided Steps
The patient was injured in a blast from a drone attack about 30 minutes ago and other soldiers dragged them to your location. You already washed your hands, put on your gloves, and did a search for massive hemorrhage which was normal. Next, perform an airway assessment. What is this patient's airway exam? Press and hold [B] to proceed to the next step.
The patient is not able to talk and has harsh breathing sounds called stridor that can be heard if you put your head close to the patient's face and mouth. Next, perform an initial airway maneuver to try treating the patient’s airway obstruction. Press and hold [B] to proceed to the next step.
If you tried a jaw thrust or head tilt chin lift or rolling the patient into the recovery position then good job! Next, reassess the patient’s airway to see if this helped or fixed the obstruction.
The patient still has stridor, which means the airway is still obstructed. What intervention would you like to provide for this patient next?
If you said BVM then good job! While N P A airways are often tried first to avoid requiring constant bagging, in this patient, placing an N P A could be harmful since the patient has a severe facial injury. Severe facial injuries can damage the bones in the patient's face, which can create a passage that allows the N P A to push up into the patient’s brain. Next, start to provide BVM ventilation assistance to the patient.
This concludes your scenario. Next, open your tablet [X], select the disposition tab, and select Medical Evacuation.
