# Answers

### What are the most reliable indicators of shock in a TFC setting?

The two most reliable indicators of shock in a TFC setting are an altered mental status in the absence of head injury and an absent or weak radial pulse.

### What is the definition of shock?

Progressive cellular and tissue hypoxia leading to organ damage and, if not treated, death.

### If all hemorrhage control measures have been applied and fluid resuscitation does not improve shock (refractory shock), what potentially unrecognized injury should be considered, and how would you treat it?

If these measures do not lead to improvement in the casualty status, consideration of an unrecognized tension pneumothorax should be suspected. Treatment with a needle decompression of the chest (NDC) should be considered. And, if two NDCs have failed to provide improvement, it may be necessary to perform a finger thoracostomy or insert a chest tube.

### Should you establish IV access on all casualties in case they deteriorate?

Not every casualty needs an IV, and some of them will be able to tolerate oral fluid replacement therapy, saving limited IV fluids and blood products for others.

### What is the proper protocol for administering tranexamic acid?

2 grams of tranexamic acid should be administered via slow IV or IO push as soon as possible but NOT later than 3 hours after injury.