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TCCC Practice Test

Tactical Combat Casualty Care · 25 Jan 2024

Questions:

All 100

Care Under Fire / Threat

5 questions

Question 1 of 5

Under effective hostile fire, the priority is:

AApply hemostatic dressings to all visible bleeding wounds

BReturn fire and take cover

CBegin airway management with a nasopharyngeal airway

DEstablish IV access for fluid resuscitation early

EDocument the time of injury on the casualty card

Question 2 of 5

Under fire, a tourniquet is applied:

ADistal to the wound to preserve some circulation

BDirectly on the skin 2-3 inches above the wound

COver the uniform, clearly proximal to the bleeding site

DOnly after the casualty is dragged into cover

EOnly if a hemostatic dressing has already failed

Question 3 of 5

When the bleeding site is not readily apparent under fire, place the tourniquet "___ and ___" on the injured limb.

Question 4 of 5

A casualty has a femoral arterial bleed and is still able to fight. Under effective hostile fire, the correct action is:

ADirect the casualty to apply self-aid if able

BDrag the casualty to cover, then apply the tourniquet yourself

CHold direct pressure on the wound while exposed to fire

DStart IV resuscitation while still actively returning fire

EBegin a surgical cricothyroidotomy immediately

Question 5 of 5

Airway management under fire is:

APerformed immediately for any casualty with facial trauma

BAlways performed before hemorrhage control measures

CRequired for any casualty who is unconscious

DGenerally deferred to the Tactical Field Care phase

ELimited to nasopharyngeal airway insertion only

Security & Triage

2 questions

Question 1 of 2

The first action upon reaching cover in Tactical Field Care is:

ABegin fluid resuscitation with crystalloid bolus

BEstablish a security perimeter

CDocument care on the TCCC casualty card first

DAdminister 2 grams of TXA before anything else

EPerform bilateral needle decompression preemptively

Question 2 of 2

A casualty arrives with altered mental status. According to TFC triage, the medic must immediately:

ATake away their weapons and communications equipment

BAdminister ketamine 50 mg IM for sedation

CPlace a nasopharyngeal airway as a precaution

DApply a junctional tourniquet to the femoral region

EInitiate hyperventilation to lower carbon dioxide

Massive Hemorrhage

10 questions

Question 1 of 10

The CoTCCC hemostatic dressing of choice is:

ACombat Gauze

BXStat

CCelox Gauze

DChitoGauze

EiTClamp

Question 2 of 10

Hemostatic dressings should be applied with at least how many minutes of direct pressure?

A1 minute

B2 minutes

C3 minutes

D5 minutes

E10 minutes

Question 3 of 10

A deep, narrow-tract junctional gunshot wound is best treated with:

ACombat Gauze with 3 minutes of direct pressure

BXStat

CiTClamp closure with no additional pressure

DA tourniquet placed high and tight on the limb

EA vented chest seal applied directly over the wound

Question 4 of 10

In Tactical Field Care, a limb tourniquet is placed:

ADistal to the wound to preserve some circulation

BOver the uniform, just below the bleeding site

CDirectly on the skin 2-3 inches above the bleeding

DDirectly over the bleeding wound itself

EOn the contralateral limb to prevent ischemia

Question 5 of 10

If the first tourniquet does not control bleeding, the correct action is to:

AApply a second tourniquet side-by-side with the first

BReplace it with a junctional tourniquet

CLoosen the first tourniquet to assess the wound

DConvert to a hemostatic dressing immediately

EWait 5 minutes before reassessing the bleeding

Question 6 of 10

Hemorrhagic shock in TCCC is defined by altered mental status without brain injury and/or a weak or absent ___ pulse.

Question 7 of 10

An iTClamp is being used on a hemorrhaging neck wound. Which precaution applies?

AThe clamp must remain in place for at least 3 minutes

BApply only after a vented chest seal is placed nearby

CFrequently monitor the airway and watch for an expanding hematoma

DThe clamp should never be combined with hemostatic dressings

EHyperventilate the casualty during the iTClamp application

Question 8 of 10

Which are CoTCCC-recognized alternative hemostatic adjuncts to Combat Gauze? Select all that apply.

Select ALL that apply.

ACelox Gauze

BChitoGauze

CXStat

DiTClamp

ECyanoacrylate (super glue)

Question 9 of 10

The iTClamp must NOT be applied:

AOn or near the eye or eyelid (within 1 cm of the orbit)

BOn any extremity wound regardless of severity

COn the scalp where the skull provides backing

DOn any wound deeper than 2 centimeters

EOn a wound packed with hemostatic dressing

Question 10 of 10

Under fire, a tourniquet was applied "high and tight" over the uniform. Now in cover, the medic should:

AMark the time on the tourniquet and leave it as placed

BLoosen the tourniquet briefly to confirm bleeding stopped

CExpose wound, replace tourniquet directly on skin 2-3 in above

DApply a second tourniquet on top of the uniform first

EConvert immediately to a pressure dressing while in cover

Airway Management

7 questions

Question 1 of 7

An unconscious casualty without a traumatic airway obstruction should be placed in the:

ATrendelenburg position with feet elevated 30 degrees

BRecovery position, head tilted back, chin away from chest

CSupine position with cervical collar in place

DProne position with the face turned to one side

ESitting position leaning forward to drain secretions

Question 2 of 7

A conscious casualty with facial trauma is best allowed to:

ALie supine with full cervical immobilization in place

BAssume any position that best protects the airway

CBe sedated with ketamine immediately for the procedure

DWear a non-rebreather oxygen mask at 15 L/min only

EReceive immediate surgical cricothyroidotomy regardless

Question 3 of 7

Cervical spine stabilization in TCCC is:

ARequired for all casualties with combat injuries

BRequired for any unconscious casualty regardless of mechanism

CAlways replaced with a soft collar after assessment

DNot necessary for casualties with only penetrating trauma

ERequired only when the casualty has facial burns

Question 4 of 7

Surgical cricothyroidotomy placement is verified with continuous ___ capnography.

Question 5 of 7

The cricothyroidotomy airway cannula specification is:

ALess than 10 mm OD, 6-7 mm ID, 5-8 cm intra-tracheal length

B12-15 mm OD, 9 mm ID, 3 cm intra-tracheal length

CAny standard endotracheal tube size 8.0 with cuff

DLess than 5 mm OD, 3 mm ID, 2-3 cm intra-tracheal length

ELess than 6 mm OD, 4 mm ID, 10 cm intra-tracheal length

Question 6 of 7

Indications to perform a surgical cricothyroidotomy in TFC include which of the following? Select all that apply.

Select ALL that apply.

ADirect airway injury that cannot be cleared by suction or positioning

BBlood occluding the airway when positioning fails to maintain patency

CSevere facial burns producing airway obstruction

DA conscious casualty who can sit up and protect their own airway

EMassive facial deformation preventing other airway maneuvers

Question 7 of 7

A conscious casualty requires surgical cricothyroidotomy. Per TCCC, the medic should:

ASkip lidocaine and proceed quickly to save time

BUse lidocaine before performing the procedure

CSedate with midazolam 5 mg IV first

DDefer the procedure until TACEVAC arrives on scene

EUse only an open standard technique without bougie

Respiration / Breathing

12 questions

Question 1 of 12

To suspect tension pneumothorax in TCCC, the casualty must have:

AAny visible chest wall bruising plus tachycardia

BSignificant torso trauma or primary blast injury, plus a supporting sign

CCoughing with associated facial bruising and hypotension

DAny altered mental status with shock present

EA respiratory rate over 30 breaths per minute alone

Question 2 of 12

Which is NOT a TCCC sign supporting tension pneumothorax?

ASevere or progressive respiratory distress and hypoxia

BAbsent or markedly decreased breath sounds on one side

CHemoglobin oxygen saturation less than 90 percent

DBradycardia in a casualty with no other injuries

ETraumatic cardiac arrest without obviously fatal wounds

Question 3 of 12

Needle decompression in TCCC uses a:

A14-gauge or 10-gauge, 3.25-inch needle/catheter unit

B22-gauge spinal needle, 4 inches in length

C16-gauge IV catheter, 1.25 inches in length

D8-gauge chest tube with one-way valve

E18-gauge butterfly needle, 1 inch length

Question 4 of 12

Approved sites for needle decompression are:

AOnly the 2nd ICS in the mid-clavicular line bilaterally

BOnly the 5th ICS in the anterior axillary line bilaterally

CThe 5th ICS anterior axillary line OR 2nd ICS mid-clavicular

DThe 4th ICS mid-axillary line OR 3rd ICS mid-clavicular

EThe xiphoid process or sternal angle on either chest

Question 5 of 12

When performing NDC at the 2nd ICS mid-clavicular line, the needle:

AShould be inserted medial to the nipple line for safety

BShould be angled toward the heart for correct placement

CShould NOT be inserted medial to the nipple line

DShould be inserted at a 45-degree angle to chest wall

EMust be a minimum of 5 inches in catheter length

Question 6 of 12

Insert the needle/catheter unit all the way to the hub and hold it in place for the seconds range to allow decompression. Type the range, e.g., "5-10".

Question 7 of 12

NDC is considered successful when oxygen saturation rises to:

A80% or greater on pulse oximetry monitoring

B85% or greater after the catheter is left in place

C90% or greater on pulse oximetry

D95% or greater within 60 seconds of insertion

E100% with no further intervention required

Question 8 of 12

If the initial NDC fails to relieve symptoms, the correct next step is:

ARepeat at the same site with the same catheter unit

BPerform second NDC same side, the other site, new catheter

CConvert immediately to chest tube placement at 5th ICS AAL

DDecompress the opposite side of the chest blindly

EDiscontinue care and prepare casualty for evacuation

Question 9 of 12

An open or sucking chest wound is initially treated with:

AA vented chest seal; if unavailable, a non-vented chest seal

BA non-vented chest seal as the only acceptable option

CA pressure dressing soaked with sterile saline solution

DCombat Gauze packed deep into the wound cavity

EBilateral needle decompression performed first

Question 10 of 12

A casualty with a vented chest seal develops worsening hypoxia, respiratory distress, and hypotension. Suspecting tension pneumothorax, the first action is:

ABurp or remove the chest seal to release pressure

BBegin chest compressions and ventilation immediately

CApply a second vented chest seal alongside the first

DStart a 1 liter crystalloid bolus through the existing IV

EPerform endotracheal intubation with cuff inflation

Question 11 of 12

Casualties with moderate to severe TBI should receive supplemental oxygen to maintain SpO2 greater than:

A80% to ensure cerebral oxygenation is adequate

B85% as the minimum acceptable threshold for TBI

C90%

D95% to maximize cerebral perfusion in TBI

E100% to prevent any cerebral hypoxic injury

Question 12 of 12

A casualty has significant torso trauma. Which findings would lead you to suspect tension pneumothorax? Select all that apply.

Select ALL that apply.

ASevere or progressive tachypnea

BShock

CSpO2 less than 90 percent

DEqual breath sounds bilaterally with normal SpO2

ETraumatic cardiac arrest without obviously fatal wounds

Circulation

14 questions

Question 1 of 14

An indication to apply a pelvic binder is:

AAny femur fracture in a conscious casualty

BSevere blunt or blast injury with pelvic pain or shock

CPenetrating chest trauma with subcutaneous emphysema

DAny closed head injury with associated extremity injury

EAny burn over 10% TBSA involving the abdominal area

Question 2 of 14

Tranexamic acid (TXA) must be administered no later than ___ hours after injury.

Question 3 of 14

The TCCC dose of TXA is:

A1 g IV/IO bolus over one minute

B2 g IV/IO slow push as soon as possible

C5 g IV/IO over 30 minutes infusion

D500 mg IM in the deltoid muscle

E10 g IV over 1 hour with monitoring

Question 4 of 14

Tourniquet conversion to a hemostatic or pressure dressing is permitted ONLY when:

AThe casualty is intubated, paralyzed, and adequately sedated

BThe tourniquet has been in place for more than six hours

CCasualty not in shock, wound monitorable, not on amputation

DWhole blood has been administered and BP is normal

EA second tourniquet has been applied as backup

Question 5 of 14

A tourniquet has been in place for 7 hours. Lab capability and close monitoring are not available. The correct action is:

ARemove it now and dress the wound carefully

BLoosen and reassess after 30 seconds of observation

CDo NOT remove the tourniquet

DReplace it with a pressure dressing immediately

EConvert it to a junctional tourniquet at the same site

Question 6 of 14

For IV access in TCCC, the preferred catheter is:

AAn 18-gauge IV or saline lock

BA 20-gauge IV in the antecubital fossa

CA central line in the subclavian vein

DTwo 14-gauge IVs placed bilaterally

EA peripherally inserted central catheter (PICC)

Question 7 of 14

If IV access cannot be quickly obtained, the next route is:

ASubcutaneous

BSublingual

CIntraosseous (IO)

DEndotracheal

ERectal

Question 8 of 14

The most preferred resuscitation fluid for hemorrhagic shock in TCCC is:

APlasma alone (reconstituted dried, liquid, or thawed)

BLactated Ringer's solution

CCold stored low titer O whole blood

DHextend (up to 1000 mL maximum total)

E0.9% normal saline solution

Question 9 of 14

Which of the following are indications to administer 2 grams of TXA per TCCC? Select all that apply.

Select ALL that apply.

AHemorrhagic shock

BPenetrating torso trauma

COne or more major amputations

DSignificant TBI or altered mental status from blast/blunt

EIsolated 5% TBSA burn without bleeding or shock

Question 10 of 14

Continue fluid administration until ONE of the following endpoints is reached:

AThe casualty has a systolic BP of 140 mmHg

BHeart rate is below 60 beats per minute

CPalpable radial pulse, improved mentation, or SBP 100

DThe fluid bag is completely empty

EThe casualty asks for fluids to be stopped

Question 11 of 14

After the first transfused product, the dose of calcium given is:

A100 mg total dose

B500 mg as calcium gluconate

C1 gram (30 mL of 10% gluconate or 10 mL of 10% chloride)

D5 grams over 10 minutes

E10 grams diluted in saline

Question 12 of 14

If Rh-negative blood is unavailable for a casualty in hemorrhagic shock, TCCC recommends:

AWithholding transfusion until Rh-negative arrives

BUse Rh-positive blood products

CUse only crystalloid until Rh-negative is found

DCross match in the field with available kits

EWait 30 minutes for blood typing to complete

Question 13 of 14

A TBI casualty with weak/absent radial pulse and BP monitoring available should be resuscitated to a target systolic BP of:

A80-90 mmHg

B90-100 mmHg

C100-110 mmHg

D110-120 mmHg

E130-140 mmHg

Question 14 of 14

A casualty in shock is not responding to fluid resuscitation. Which findings would support refractory shock from an untreated tension pneumothorax? Select all that apply.

Select ALL that apply.

AThoracic trauma

BPersistent respiratory distress

CAbsent breath sounds on one side

DHemoglobin oxygen saturation less than 90%

EEqual bilateral breath sounds with normal SpO2

Hypothermia Prevention

5 questions

Question 1 of 5

Hypothermia in trauma casualties is dangerous primarily because:

AIt causes peripheral vasodilation and shock

BIt impairs blood clotting and contributes to the lethal triad

CIt speeds blood loss through vessel dilation

DIt increases tissue oxygen demand significantly

EIt causes immediate cardiac arrest below 35 C

Question 2 of 5

An active heating blanket should be placed:

ADirectly against the skin and wrapped around the torso

BAnterior torso and under the arms in the axillae, NOT on skin

COnly over the legs from the hips down to the knees

DOnly over the head and neck for cerebral warming

EInside a sealed plastic bag with the casualty enclosed

Question 3 of 5

A battery-powered fluid warmer should deliver IV/IO fluids at up to 150 mL/min with an output temperature of ___ degrees Celsius.

Question 4 of 5

Hypothermia prevention measures should be:

ABegun only after the casualty is stable in a warm area

BInitiated while fluid resuscitation is being accomplished

CReserved for casualties with under 25% TBSA burns only

DApplied only after evacuation to surgical capability

ESkipped if the ambient temperature is above 70 degrees F

Question 5 of 5

Burn casualties are particularly susceptible to hypothermia because:

AThey produce excess sweat, accelerating heat loss

BTheir core body temperature is artificially elevated

CThey have lost the skin's barrier and thermoregulation

DBurned tissue conducts cold faster than normal

EThey lose all pain perception in burned regions

Traumatic Brain Injury

8 questions

Question 1 of 8

Moderate or severe TBI in TCCC is defined as:

AAny visible head wound regardless of consciousness level

BGlasgow Coma Scale less than 15 at any point post-injury

CUnable to follow commands with head trauma or blast/blunt mechanism

DLoss of consciousness for any duration after injury

EAny history of dizziness or headache post-injury

Question 2 of 8

The hypotension target in moderate/severe TBI is a systolic BP of:

A80-90 mmHg

B90-100 mmHg

C100-110 mmHg

D120-130 mmHg

E140-150 mmHg

Question 3 of 8

If the TBI casualty has hemorrhagic shock, fluid resuscitation should preferentially use:

ANormal saline

BLactated Ringer's

CWhole blood or plasma

DD5W

EHextend up to 1000 mL

Question 4 of 8

Signs of impending herniation include:

AEqual pupils with normal motor response on both sides

BDecreased respiratory rate as the only abnormal finding

CDeclining neurologic status with asymmetric or fixed/dilated pupil(s) or posturing

DMild headache and nausea without other findings

ETachycardia in the absence of any chest trauma

Question 5 of 8

For impending herniation, the dose of 23.4 percent hypertonic saline is:

A10 mL slow IV push over 10 minutes

B20 mL rapid IV push immediately

C30 mL slow IV/IO push over 10 minutes

D50 mL over 5 minutes

E250 mL over 30 minutes

Question 6 of 8

For impending herniation, the dose of 3 percent or 5 percent hypertonic saline is ___ mL slow IV/IO push over 10 minutes.

Question 7 of 8

When hyperventilating a herniating TBI casualty, the goal end-tidal CO2 (EtCO2) is:

A20-30 mmHg as low as possible

B32-38 mmHg

C40-45 mmHg in the normal range

D50-55 mmHg slightly elevated

EEtCO2 monitoring is unnecessary in this scenario

Question 8 of 8

Which interventions are part of the herniation protocol when en route to surgical decompression? Select all that apply.

Select ALL that apply.

AHypertonic saline IV/IO push

BElevate head 30 degrees if not in shock and tactically feasible

CLoosen cervical collar if present and keep head facing forward

DHyperventilate to EtCO2 32-38 mmHg

EAdminister high-dose corticosteroids

Penetrating Eye Trauma

3 questions

Question 1 of 3

A penetrating eye injury is best covered with:

AA pressure patch held firmly with elastic wrap

BA wet sterile gauze applied directly to the globe

CA rigid eye shield (NOT a pressure patch)

DAn iTClamp closed across the orbital rim

ECombat Gauze packed into the orbit gently

Question 2 of 3

A casualty with a penetrating eye injury who can take pills should receive:

ADoxycycline 100 mg by mouth twice a day

BMoxifloxacin 400 mg from the CWMP

CAmoxicillin 500 mg by mouth three times a day

DCephalexin 500 mg by mouth four times a day

ENo antibiotics until reaching surgical capability

Question 3 of 3

Before covering the injured eye, the medic should:

AIrrigate the globe with saline solution thoroughly

BPerform a rapid field test of visual acuity and document findings

CRemove any embedded foreign bodies first

DApply topical anesthetic drops to control pain

ECover both eyes to limit consensual movement

Monitoring

1 question

Question 1 of 1

In the Monitoring section of TFC, the directive is to:

APlace all casualties on continuous EKG without exception

BInitiate advanced electronic monitoring if indicated and equipment available

CAvoid all electronic monitoring in the field

DUse only manual pulse and respiratory rate checks

EApply 12-lead ECG monitoring on every TBI casualty

Analgesia

11 questions

Question 1 of 11

A casualty with mild to moderate pain who is still able to fight should receive (CWMP):

AAcetaminophen 500 mg, 2 tablets every 8 hours plus meloxicam 15 mg daily

BIbuprofen 800 mg every 4 hours plus aspirin 325 mg daily

COTFC 800 mcg buccal lozenge as a single dose

DKetamine 50 mg IM every 30 minutes as needed

EMorphine 10 mg IM every 4 hours as needed

Question 2 of 11

A casualty with moderate pain who is NOT in shock or respiratory distress should receive:

AKetamine 1-2 mg/kg slow IV push

BOTFC 800 micrograms (oral transmucosal fentanyl)

CMidazolam 5 mg IM

DMorphine 4 mg IM

ETramadol 50 mg by mouth

Question 3 of 11

A casualty in hemorrhagic shock with severe pain should receive analgesia with:

AOTFC 800 micrograms

BFentanyl 100 mcg intranasal repeated every 30 minutes

CKetamine 20-30 mg slow IV/IO push

DMorphine 10 mg IM

EAcetaminophen 1000 mg by mouth

Question 4 of 11

When titrating IV/IO ketamine for analgesia, the endpoint is control of pain or development of:

Question 5 of 11

For procedural dissociation requiring sedation, the initial IV/IO ketamine dose is:

A0.1-0.2 mg/kg slow IV push

B0.3 mg/kg infusion over 5-15 minutes

C1-2 mg/kg slow IV/IO push

D5 mg/kg slow IV bolus over 60 seconds

E10 mg/kg IM single dose

Question 6 of 11

For an emergence phenomenon following ketamine, the recommended treatment is:

ANaloxone 0.4 mg IV/IO

BDiazepam 10 mg IM stat

CMidazolam 0.5-2 mg IV/IO

DLorazepam 2 mg sublingual

EHaloperidol 5 mg IM

Question 7 of 11

Naloxone should be available at the dose of:

A0.04 mg IV/IO/IM/IN

B0.1 mg IV/IO/IM/IN only

C0.4 mg IV/IO/IM/IN

D2 mg IV/IO/IM/IN single dose

E10 mg IV/IO/IM/IN single dose

Question 8 of 11

For nausea or vomiting, ondansetron should be given:

A4 mg ODT/IV/IO/IM every 8 hours, max 8 mg/8 hours

B8 mg by mouth (regular tablet) every 4 hours as needed

C16 mg IV every 6 hours as needed for nausea

D2 mg sublingual every 2 hours as needed

E32 mg IV bolus single loading dose

Question 9 of 11

Mental status documentation before opioids or ketamine uses the ___ method.

Question 10 of 11

Which statements about TCCC analgesia are TRUE? Select all that apply.

Select ALL that apply.

ACasualties must be disarmed after OTFC, IV/IO fentanyl, ketamine, or midazolam

BTBI does not preclude the use of ketamine

CBenzodiazepines should NOT be used in conjunction with opioid analgesia

DIf a casualty is partially dissociated, give MORE ketamine, not benzodiazepine

ERoutine prophylactic benzodiazepines are recommended for all combat injuries

Question 11 of 11

Respirations decrease after opioids or ketamine. The first action is:

AReposition into a sniffing position

BAdminister naloxone 4 mg intranasal stat

CPerform an immediate cricothyroidotomy

DBegin chest compressions while waiting for help

EWithhold further analgesia for 24 hours

Antibiotics

3 questions

Question 1 of 3

Antibiotics in TCCC are recommended for:

AAll open combat wounds

BClosed extremity fractures only

CBurns greater than 30 percent TBSA

DAny casualty with a positive blood culture in the field

EPenetrating eye injuries only and nothing else

Question 2 of 3

A casualty able to take pills should receive:

ADoxycycline 100 mg by mouth twice a day

BMoxifloxacin 400 mg by mouth once a day

CAmoxicillin 875 mg by mouth twice a day

DCephalexin 500 mg by mouth four times a day

ECiprofloxacin 500 mg by mouth twice a day

Question 3 of 3

A casualty unable to take pills (shock, unconsciousness) should receive:

ACefazolin 2 g IV every 8 hours

BVancomycin 1 g IV every 12 hours

CErtapenem 1 g IV/IO/IM once a day

DCeftriaxone 2 g IV daily

EClindamycin 600 mg IV every 8 hours

Wounds & Evisceration

5 questions

Question 1 of 5

A casualty has abdominal evisceration with no bleeding and no bowel leakage. The medic may:

AForce the contents back into the abdomen quickly

BMake a single brief reduction attempt under 60 seconds

CSew the abdominal wall closed with available suture

DPack the bowel with Combat Gauze and apply pressure

EPlace an iTClamp across the wound to close it

Question 2 of 5

Reduction of an evisceration should NOT be attempted if there is:

AA small amount of dirt on the bowel surface

BEvidence of ruptured bowel or active bleeding

CMild discomfort reported by a conscious casualty

DVisible omentum protruding from the wound

EThe wound is more than 5 centimeters in length

Question 3 of 5

If reduction is not possible, the eviscerated organs should be covered with:

ADry sterile gauze, secured tightly with elastic wrap

BCombat Gauze packed firmly into the cavity

CWater-impermeable non-adhesive material, transparent preferred

DAn occlusive vented chest seal across the abdomen

EA pressure dressing soaked in povidone iodine

Question 4 of 5

A casualty with abdominal evisceration must be kept ___ (no oral intake).

Question 5 of 5

For initial bowel coverage in evisceration without active bleeding, use:

AA moist sterile dressing or sterile water-impermeable covering

BA dry sterile dressing only with no other covering

CA pressure dressing held in place by elastic wrap

DAn iTClamp pinching the wound edges closed

ECombat Gauze packed deep into the abdominal cavity

Burns

5 questions

Question 1 of 5

Total body surface area is estimated to the nearest 10 percent using the:

ALund and Browder chart for adults

BRule of Nines

CParkland formula percentage method

DWallace surface estimation chart

EUSAISR field calculator wheel only

Question 2 of 5

Per the USAISR Rule of Ten for an 80 kg adult with 30 percent TBSA burn, the initial fluid rate is:

A100 mL/hr

B200 mL/hr

C300 mL/hr

D500 mL/hr

E1000 mL/hr

Question 3 of 5

Fluid resuscitation for burns should be initiated when TBSA exceeds ___ percent.

Question 4 of 5

Hextend used for burn resuscitation is limited to a maximum of:

A500 mL

B1000 mL

C1500 mL

D2000 mL

EUnlimited until BP normalizes

Question 5 of 5

If a casualty has burns AND hemorrhagic shock, fluid resuscitation should:

AFollow the burn (Rule of Ten) protocol exclusively

BCombine both protocols at half rate each side by side

CTreat hemorrhagic shock first, taking precedence over burn shock

DWithhold all fluids until evacuation to surgical capability

EUse only oral rehydration in conscious casualties

Splints & CPR

3 questions

Question 1 of 3

After splinting a fracture, the medic must:

ARe-check pulses

BDocument only the time of splinting

CApply a tourniquet above the splint

DBegin IV fluids regardless of injury severity

EPlace a chest seal over the affected limb

Question 2 of 3

CPR on the battlefield for a casualty with blast or penetrating trauma and no signs of life:

AShould always be attempted for at least 20 minutes

BShould not be attempted; will not be successful

CIs required if there is any electrical activity on monitor

DShould be performed continuously during evacuation

EIs required only after epinephrine 1 mg IV/IO is given

Question 3 of 3

A casualty with torso trauma has no pulse and no respirations during TFC. Before discontinuing care, the medic should:

ABegin standard CPR with airway management

BPerform bilateral needle decompression

CPush a 1 liter crystalloid bolus quickly

DAdminister epinephrine 1 mg IV every 3 minutes

ECease care immediately without further intervention

Communication / Documentation / Evacuation

2 questions

Question 1 of 2

All clinical assessments, treatments, and changes in casualty status are documented on:

AThe TCCC Card (DD Form 1380)

BSF 600 Health Record

CSF 558 Emergency Care and Treatment

DDA Form 4137 Evidence Custody Document

EVerbal handoff only with no written record

Question 2 of 2

Communication with the evacuation system is coordinated through the:

ABattalion S-1 personnel section

BPatient Evacuation Coordination Cell

CTactical Operations Center directly

DHigher headquarters surgeon's office

EThe Joint Operations Center directly

Tactical Evacuation Care

4 questions

Question 1 of 4

"Tactical Evacuation" includes:

ACASEVAC and MEDEVAC

BMEDEVAC only with dedicated assets

CCASEVAC only with non-medical assets

DStrategic Aeromedical Evacuation only

ESelf-extraction by walking wounded only

Question 2 of 4

In TACEVAC airway management, an option not available in TFC is:

ASurgical cricothyroidotomy with bougie technique

BEndotracheal intubation in lieu of cricothyroidotomy if trained

CNasopharyngeal airway insertion in conscious casualties

DRecovery position with head tilt and chin lift

ESuctioning of the airway with rigid Yankauer

Question 3 of 4

CPR may be attempted during TACEVAC if:

AAny casualty has lost vital signs at any time

BThe casualty has obviously fatal wounds with massive trauma

CNo obviously fatal wounds AND surgical capability is short period away

DThe mission permits regardless of wound severity

EOther casualties are stable and surgery is over 4 hours away

Question 4 of 4

Casualties who may benefit from supplemental oxygen during TACEVAC include: Select all that apply.

Select ALL that apply.

ALow oxygen saturation by pulse oximetry

BCasualty with TBI (maintain saturation greater than 90 percent)

CCasualty in shock

DKnown or suspected smoke inhalation

ERoutine for every combat casualty regardless of injury

★ Final Score — TCCC Practice Test

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Score by Section

TCCC MISC Practice Test

Aligned to TCCC Guidelines 25 Jan 2024

Questions:

All 60

Burns — Rule of Tens (TCCC Section 15)

10 questions

Question 1 of 10

Per TCCC Section 15.e.2, the USAISR Rule of Tens initial fluid rate formula for adults weighing 40 to 80 kilograms is calculated as:

A%TBSA multiplied by 4 mL per kilogram per hour

B%TBSA multiplied by 10 mL per hour

CBody weight in kilograms multiplied by 4 mL per hour

D%TBSA multiplied by 100 mL per hour

E%TBSA multiplied by body weight in kilograms

Question 2 of 10

Per TCCC Section 15.e.2, the Rule of Tens base formula applies to adult casualties weighing:

A30 to 60 kilograms

B40 to 80 kilograms

C50 to 100 kilograms

D70 to 120 kilograms

EAny adult weight without adjustment

Question 3 of 10

Per TCCC Section 15.e.3, for every 10 kilograms ABOVE 80 kilograms, the initial fluid rate is increased by:

A50 mL per hour

B75 mL per hour

C100 mL per hour

D200 mL per hour

E500 mL per hour

Question 4 of 10

A casualty has a 40 percent total body surface area burn and weighs 100 kilograms. Per the Rule of Tens, the initial fluid rate is:

A400 mL per hour

B500 mL per hour

C600 mL per hour

D800 mL per hour

E1000 mL per hour

Question 5 of 10

Per TCCC Section 15.e.1, IV or IO fluid resuscitation should be initiated for burns greater than ___ percent total body surface area.

Question 6 of 10

Per TCCC Section 15.e.5, oral fluids may be considered for burns up to what percent total body surface area in conscious casualties able to swallow?

A10 percent

B15 percent

C25 percent

D30 percent

E50 percent

Question 7 of 10

Per TCCC Section 15.e.1, which fluids are listed for initiating burn resuscitation? Select all that apply.

Select ALL that apply.

ALactated Ringer's

BNormal saline (0.9 percent sodium chloride)

CHextend (no more than 1000 mL total)

DD5W (5 percent dextrose in water)

EHalf-normal saline (0.45 percent)

Question 8 of 10

Per TCCC Section 15.e.4, if a casualty has both burns AND hemorrhagic shock, fluid resuscitation should:

AFollow the Rule of Tens for burn shock exclusively

BFollow Section 6 (hemorrhagic shock) which takes precedence over burn shock resuscitation

CCombine both protocols at half rate side-by-side

DWithhold all fluids until evacuation to surgical capability

EUse only oral fluids regardless of hemorrhage status

Question 9 of 10

Per TCCC Section 15.c, total body surface area is estimated to the nearest ___ percent using the Rule of Nines.

Question 10 of 10

Per TCCC Section 15.d, for extensive burns greater than 20 percent TBSA, the medic should consider placing the casualty in:

AA standard wool blanket from the aid bag

BThe Heat-Reflective Shell or Blizzard Survival Blanket from the Hypothermia Prevention Kit

CA non-vented chest seal wrapped around the torso

DA pressure dressing over each burn site

EAn iTClamp securing all wound edges closed

Nystagmus — TCCC Ketamine Endpoint (Section 11)

5 questions

Question 1 of 5

Per TCCC Section 11, nystagmus is defined parenthetically as: rhythmic ___ movement of the eyes.

Question 2 of 5

Per TCCC Section 11 Option 3, nystagmus serves as the dosing endpoint for which medication?

AFentanyl

BMidazolam

CKetamine

DMorphine

ENaloxone

Question 3 of 5

Per TCCC Section 11 Option 3, the listed endpoints for slow IV/IO ketamine 20-30 mg are control of pain OR development of nystagmus. The endpoints apply to which dosing routes?

AIV/IO push only (and longer-duration IV/IO infusion)

BIM and IN routes only

COral only

DSubcutaneous only

EInhalational only

Question 4 of 5

Ketamine produces nystagmus by antagonizing which receptor in the central nervous system? (Background pharmacology)

AMu opioid receptor

BGamma-aminobutyric acid type A receptor

CN-methyl-D-aspartate receptor

DBeta-adrenergic receptor

EAcetylcholine receptor

Question 5 of 5

Outside of ketamine use, which conditions can produce nystagmus? Select all that apply. (Background clinical knowledge)

Select ALL that apply.

ATraumatic brain injury

BIncreased intracranial pressure

CBrainstem or cerebellar stroke

DInner ear (vestibular) disorders

EPulmonary embolism

Calcium with Blood (TCCC Section 6.e.4)

7 questions

Question 1 of 7

Per TCCC Section 6.e.4, the dose of calcium administered after the first transfused product is:

A100 milligrams

B500 milligrams

C1 gram

D2 grams

E5 grams

Question 2 of 7

Per TCCC Section 6.e.4, 1 gram of calcium equals 30 mL of 10 percent calcium gluconate OR ___ mL of 10 percent calcium chloride.

Question 3 of 7

Per TCCC Section 6.e.4, calcium is administered:

ABefore the first transfused product as a prophylactic dose

BAfter the first transfused product

COnly after the third or fourth transfused unit

DOnly if the casualty develops cardiac arrhythmia

EMixed directly into the blood bag prior to transfusion

Question 4 of 7

Per TCCC Section 6.e.4, the route of calcium administration is:

AOral by mouth

BIntramuscular only

CIntravenous or intraosseous

DSubcutaneous only

EIntranasal only

Question 5 of 7

Stored donor blood causes hypocalcemia in the recipient because the unit contains: (Background pathophysiology)

AHeparin

BCitrate as the anticoagulant

CEDTA

DExcess sodium chloride

EExcess potassium

Question 6 of 7

Calcium is required for the clotting cascade because it functions as: (Background pathophysiology)

AFactor I (fibrinogen)

BFactor II (prothrombin)

CFactor IV

DFactor VIII

EFactor X

Question 7 of 7

Hypocalcemia in a bleeding casualty causes which of the following? Select all that apply. (Background pathophysiology)

Select ALL that apply.

ACardiac dysfunction with weak contractility

BWorsened coagulopathy

CLoss of vascular smooth muscle tone

DIncreased platelet aggregation and faster clotting

EImproved blood pressure from a sympathetic surge

No Lactated Ringer's with Blood

5 questions

Question 1 of 5

Per TCCC Section 6.e.2, the most preferred resuscitation fluid for hemorrhagic shock is:

ALactated Ringer's solution

BCold stored low titer O whole blood

C0.9 percent normal saline

DD5W

EHextend

Question 2 of 5

The classical reason Lactated Ringer's should not be co-administered with citrated blood through the same intravenous line is: (Background doctrine)

ALactated Ringer's contains too much sodium

BThe calcium in Lactated Ringer's overwhelms citrate, allowing clot formation in the line

CLactated Ringer's is hypotonic and lyses red cells

DLactated Ringer's causes hemolysis from acidic pH

ELactated Ringer's contains potassium that activates platelets

Question 3 of 5

Lactated Ringer's contains approximately ___ milliequivalents of calcium per liter. (Background pharmacology)

Question 4 of 5

Per the TCCC fluid resuscitation hierarchy in Section 6.e.2, Lactated Ringer's is:

AThe first-line fluid for hemorrhagic shock

BThe second-line fluid behind cold stored whole blood

CNOT listed in the hemorrhagic shock fluid ladder; it is listed only as a burn resuscitation fluid in Section 15.e

DEquivalent to whole blood in efficacy

ERequired as a 1 liter bolus before any blood product

Question 5 of 5

If Lactated Ringer's is mixed with citrated blood in the same intravenous tubing, what can occur? (Background doctrine)

AHemolysis of red blood cells

BClot formation in the line that may be infused as emboli

CBacterial contamination of the line

DAir embolism formation

ESevere hyperkalemia in the recipient

Opioid vs Benzodiazepine (TCCC Section 11)

9 questions

Question 1 of 9

Per TCCC Section 11.c.8, the reversal agent that should be available when using opioid analgesics is:

AFlumazenil

BNaloxone

CAtropine

DActivated charcoal

ECalcium gluconate

Question 2 of 9

Per TCCC Section 11.c.8, the dose of naloxone that should be available when using opioid analgesics is:

A0.04 mg IV/IO/IM/IN

B0.1 mg IV/IO/IM/IN

C0.4 mg IV/IO/IM/IN

D2 mg IV/IO/IM/IN

E10 mg IV/IO/IM/IN

Question 3 of 9

The reversal agent for benzodiazepines is: (Background pharmacology)

ANaloxone

BFlumazenil

CPhysostigmine

DActivated charcoal

EAtropine

Question 4 of 9

Per TCCC Section 11.c.13, the routine use of benzodiazepines such as midazolam:

AIs recommended for analgesia in all combat casualties

BIs NOT recommended for analgesia

CIs mandatory before any opioid administration

DReplaces ketamine for moderate to severe pain

EIs required for all TBI casualties

Question 5 of 9

Per TCCC Section 11.c.14, polypharmacy is not recommended; benzodiazepines should NOT be used:

AFor seizure control under any circumstance

BFor ketamine emergence reactions

CIn conjunction with opioid analgesia

DIn any TACEVAC casualty

EIn casualties under 18 years of age

Question 6 of 9

Per TCCC Section 11.c.1, casualties need to be disarmed after being given which medications? Select all that apply.

Select ALL that apply.

AOral transmucosal fentanyl citrate (OTFC)

BIV/IO fentanyl

CKetamine

DMidazolam

EAcetaminophen 500 mg by mouth

Question 7 of 9

Per TCCC Section 11.c.15, if a casualty appears partially dissociated, it is safer to:

AAdminister more ketamine than to use a benzodiazepine

BGive midazolam 5 mg IV immediately

CStop all sedation and observe for 1 hour

DReverse with naloxone 0.4 mg

ESwitch to OTFC for sedation

Question 8 of 9

Pinpoint pupils (miosis) are a classic finding with: (Background clinical knowledge)

ABenzodiazepine intoxication

BOpioid intoxication

CKetamine dissociation

DTraumatic brain injury with herniation

ECardiac arrest only

Question 9 of 9

Which medications are classified as benzodiazepines? Select all that apply. (Background pharmacology)

Select ALL that apply.

AMidazolam (Versed)

BDiazepam (Valium)

CLorazepam (Ativan)

DFentanyl

EHydromorphone

Tranexamic Acid (TCCC Section 6.d)

9 questions

Question 1 of 9

Per TCCC Section 6.d, the TCCC dose of tranexamic acid is:

A1 gram

B2 grams

C5 grams

D10 grams

E1 gram per kilogram of body weight

Question 2 of 9

Per TCCC Section 6.d, tranexamic acid must be given as soon as possible but NOT later than ___ hours after injury.

Question 3 of 9

Per TCCC Section 6.d, tranexamic acid is administered via:

AIntramuscular injection in the deltoid

BSlow IV or IO push

COral tablet by mouth

DSubcutaneous infusion

EIntranasal spray

Question 4 of 9

Per TCCC Section 6.d, which of the following are stated indications for tranexamic acid? Select all that apply.

Select ALL that apply.

AHemorrhagic shock

BPenetrating torso trauma

COne or more major amputations

DSignificant TBI or altered mental status from blast or blunt trauma

EIsolated minor laceration without bleeding

Question 5 of 9

Per TCCC Section 6.d, "evidence of severe bleeding" qualifies a casualty for TXA when combined with what other criterion?

AThe casualty will likely need a blood transfusion

BThe casualty has a fever above 38 degrees Celsius

CThe casualty is over 65 years of age

DThe injury was sustained more than 6 hours prior

EThe casualty has a known clotting disorder

Question 6 of 9

Tranexamic acid is classified as a(n): (Background pharmacology)

AAnticoagulant

BAntiplatelet agent

CAntifibrinolytic

DProcoagulant clot former

EDirect thrombin inhibitor

Question 7 of 9

Tranexamic acid works by: (Background pharmacology)

AForming new clots directly at injury sites

BBlocking plasminogen from binding to fibrin, preventing clot breakdown

CStimulating platelet aggregation

DActivating Factor X directly

EIncreasing fibrinogen production by the liver

Question 8 of 9

The CRASH-2 trial showed that giving tranexamic acid more than 3 hours after injury: (Background evidence)

AReduced mortality further

BHad no effect on mortality

CIncreased mortality from bleeding

DCaused immediate cardiac arrest

EWas equivalent to placebo regardless of timing

Question 9 of 9

The harm caused by giving tranexamic acid after the 3-hour window is most likely due to: (Background pathophysiology)

AAllergic anaphylactic reaction

BPushing the casualty toward pathologic thrombosis without bleeding-control benefit

CDirect kidney toxicity

DSuppression of bone marrow function

ESeizure induction in the brain

Thrombosis vs Embolus

5 questions

Question 1 of 5

A thrombus is best defined as: (Background pathophysiology)

AA clot that travels through the bloodstream to a distant site

BA clot that forms inside a blood vessel and remains attached at the site of formation

CA bruise visible on the skin surface

DA platelet plug only, without fibrin involvement

EA vessel spasm with no actual clot

Question 2 of 5

An embolus is best defined as: (Background pathophysiology)

AA clot that stays attached to the vessel wall where it formed

BAnything traveling through the bloodstream that lodges in a vessel too small for it to pass

CA localized area of vessel wall thickening

DA specialized type of platelet

EAn arterial wall structural defect

Question 3 of 5

A clot that breaks loose from a deep leg vein and lodges in the lung is called a: (Background clinical knowledge)

ADeep vein thrombosis

BPulmonary embolism

CCerebral thrombosis

DCoronary thrombosis

EMesenteric thrombosis

Question 4 of 5

Which can be sources of embolic material in the bloodstream? Select all that apply. (Background clinical knowledge)

Select ALL that apply.

AA piece of clot that broke off from a thrombus

BFat from a long-bone fracture

CAir from a penetrating chest wound or IV line

DAmniotic fluid (in obstetric patients)

ERed blood cells from normal circulation

Question 5 of 5

Late administration of tranexamic acid (after 3 hours) increases the risk of: (Background clinical knowledge)

AHemorrhage only

BThrombotic complications such as deep vein thrombosis, pulmonary embolism, stroke, and myocardial infarction

CAllergic reactions only

DRenal failure only

ESeizures only

Vital Signs — Rate, Rhythm, Quality

4 questions

Question 1 of 4

The three components of a proper pulse assessment are: (Background clinical doctrine)

ARate, location, color

BRate, rhythm, quality

CStrength, speed, regularity

DVolume, force, timing

ESpeed, distance, location

Question 2 of 4

A normal adult pulse rate is: (Background clinical knowledge)

A40-60 beats per minute

B60-100 beats per minute

C80-120 beats per minute

D100-140 beats per minute

E120-160 beats per minute

Question 3 of 4

A normal adult respiratory rate is: (Background clinical knowledge)

A6-10 breaths per minute

B10-15 breaths per minute

C12-20 breaths per minute

D20-30 breaths per minute

E30-40 breaths per minute

Question 4 of 4

Per TCCC Section 3.d and 6.b, hemorrhagic shock is defined as altered mental status without brain injury and/or "weak or absent radial pulse." This is which component of vital signs?

ARate

BRhythm

CQuality

DLocation

EVolume

Antibiotics with Burns (TCCC Section 15.g)

6 questions

Question 1 of 6

Per TCCC Section 15.g, prehospital antibiotic therapy is:

AAlways given for burns over 10 percent total body surface area

BNOT indicated solely for burns

CGiven for any second-degree burn

DRequired within 1 hour of any burn

EMandatory for every burn casualty regardless of size

Question 2 of 6

Per TCCC Section 15.g, antibiotics ARE given to a burn casualty when:

AThe TBSA exceeds 10 percent

BThe casualty has a fever above 38 degrees Celsius

CIndicated to prevent infection in penetrating wounds

DThe burn has any visible blistering

EWhenever opioids are administered

Question 3 of 6

Per TCCC Section 12.b, a casualty able to take pills should receive which antibiotic?

ADoxycycline 100 mg by mouth twice daily

BMoxifloxacin 400 mg by mouth once daily (from the CWMP)

CAmoxicillin 500 mg by mouth three times daily

DCephalexin 500 mg by mouth four times daily

ENo antibiotics until reaching surgical capability

Question 4 of 6

Per TCCC Section 12.c, a casualty unable to take pills (shock, unconsciousness) should receive:

ACefazolin 2 grams IV every 8 hours

BVancomycin 1 gram IV every 12 hours

CErtapenem 1 gram IV / IO / IM once daily

DCeftriaxone 2 grams IV daily

EClindamycin 600 mg IV every 8 hours

Question 5 of 6

Per TCCC Section 15.h, all TCCC interventions can be performed:

AOnly on intact non-burned skin

BOn or through burned skin in a burn casualty

COnly after burns are debrided in the field

DOnly after evacuation to surgical capability

EOnly with surgeon authorization via radio

Question 6 of 6

Which statements about TCCC burn antibiotic doctrine are TRUE? Select all that apply.

Select ALL that apply.

AAntibiotics ARE given when penetrating wounds accompany the burn

BPer Section 12.a, antibiotics are recommended for all open combat wounds

CAll TCCC interventions can be performed on or through burned skin

DBurn casualties are particularly susceptible to hypothermia (Section 15.i)

EAntibiotics are required prophylactically for every burn regardless of size

★ Final Score — TCCC MISC Practice Test

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