This casualty was near a drone explosion that occurred 14 minutes ago. You started by providing Care Under Fire, where you saw MASSIVE HEMORRHAGE from both of the patient’s legs. You placed two hasty high and tight tourniquets. Then you moved the patient to safety were able to treat the right lower extremity hemorrhage and take the tourniquet down. You replaced the left lower extremity tourniquet with a deliberate tourniquet. The patient is maintaining their AIRWAY for now. The patient’s chest is clear, and they do not have a RESPIRATORY injury. You identified that the patient’s pelvis was unstable and placed a pelvic binder. You just rechecked the patient’s pulse, and it is still increasing. The patient also seems a little less alert; they were VERBAL on the AVPU scale. The patient has a bruise behind their ear, some bleeding from the ear and mild head trauma on the forehead. Also, their skin feels a bit clammy as it is cold and sweaty. You are still worried the patient is entering shock. You now have two 18 gauge intravenous lines. You already have gloves on. It will take at least two hours to get the patient to a higher level of care. You are at a Casualty Collection Point that has a cooler stocked with a full range of blood products.
The primary learning objective is to continue reviewing more advanced approaches to managing hemorrhagic shock in the CIRCULATION section of MARCH, focusing on the use of blood products for resuscitation. The estimated time to complete this scenario is 15 minutes. This scenario occurs in the Tactical Field Care Phase.
Patient: Can you tell me your name?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you remember what happened?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you feel any pain?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you have any medical problems?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you have any allergies?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you take any medications?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Are you feeling dizzy or confused?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Are you having trouble breathing?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Can you see clearly?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Do you feel any swelling in your throat?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Are your lips or tongue swollen?
Response: The patient is sleepy and looks confused
Location: Head
Patient: Is your voice hoarse or different?
Response: The patient is sleepy and looks confused
Location: Head
This site is okay to use, good job!
This site is okay to use, good job!
This site should not be used because of the pelvic injury.
This site should not be used because of the pelvic injury.
Good job remembering to document care. In the field, it would be important to record specific injuries and treatments provided. For this simulator, completing the documentation step is considered sufficient
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.
Events: Medication Administration: Give Calcium Gluconate 100mg/mL
Exam: Assessment: Check Carotid Pulse Right
Exam: Assessment: Check Carotid Pulse Left
Exam: Assesment: Check Radial Pulse Right
Exam: Assesment: Check Radial Pulse Left
Exam: Assesment: Check Femoral Pulse Right
Exam: Assesment: Check Femoral Pulse Left
Exam: Assesment: Check Pedial Pulse Right
Exam: Assesment: Check Pedial Pulse Left
Exam: Ask patient to move right leg
Exam: Ask patient to move left leg
Exam: Ask patient to move right arm
Exam: Ask patient to move left arm
Exam: Assessment: Complete TCCC card
Patient disposition: Medical Evacuation