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TCAR Exam Actual Exam 2025 | Trauma Care after Resuscitation
(TCAR) Exam | Complete Questions and Correct Answers |
What are the definitive options for pelvic fracture stabilization and hemorrhage control?` Q External Fixation Interventional Radiology Open reduction & Internal fixation How are closed mid-shaft femur fractures managed? Intramedullary nail fixation What makes a fracture comminuted? The bone is in multiple pieces Physiologic criteria for trauma center care? SBP< Resp rate <10 or > GCS < What is Kinematics? The process of predicting potential injuries based on analysis of the forces involved Dose of energy is? The nature and amount of force Characteristic of wounding agent? Type of energy and how it was applied Force The dose of energy involved Which gender is the majority of trauma? Male
Incidence of trauma peaks at what age? Teens and young adult Blunt trauma Classifications include? MVA Auto vs. pedestrian Falls Struck by or against an object Trauma mortality based on organ system failure? 1 organ system failure=4% 2 organ system failures=32% 3 organ system failures=67% 4 organ system failures=90% What are the four collisions?
- The vehicle
- The occupants
- The internal organs
- The secondary impacts Energy transmission in a rollover depends on? Deceleration distance Energy is dissipated over the distance of the roll and whether or not the occupants are restrained Car vs pedestrian injuries depend on? Point of contact with the care Height of hood & bumper Size & weight of vehicle Height of patient
2 ATP molecules Normal pH? Refernce range is 7.35-7.45, but actual normal range is 7.38-7. What is the footprint of shock? Lactic Acidosis What 2 things affect the amount of oxygen availalbe to the cells? Temperature & pH, which is the oxyhemoglobin dissociation curve Oxyhemoglobin dissociation shift to the right? Acidosis, elevated temp More oxygen available to the cells Oxyhemoglobin dissociation curve shift to the left? Hypothermia, alkalosis Less oxygen available to the cells H & H is a measure of? It is a measure of hemodilution rather than blood loss. What are the hormonal responses to shock? Promote body water retentions by secretion of ADH & activation of RAAS What are the inflammatory responses to shock? SIRS Which is a production of pro-inflammatory mediators, histamine release, and capillary leakage Inadvertent esophageal intubation assessment findings include? Gastric distention, absent breath sounds, minimal chest wall movement and rapid deterioration
What is the normal PaCO2 and what does it measure? Normal is 35-45 mmHg It is the measurement of ventilation Clinical assessment- rate, depth, and work of breathing What is the normal PaO2 and what does it measure? Normal is 80-100 mmHG It is a measurement of diffusion It reflects a problems with alveoli or pulmonary circulation How do you calculate expected PaO2? FIO2 x 5 If it's less than expected for a given FIO2, it is a diffusion problem What does of P:F ratio measure and how is it calculated? It measures the extent of pulmonary shunting. It quantifies the relationship between what goes into the lungs and what gets into the blood. PaO2/FiO What is a normal P:F ratio? Normal is >450, lower numbers are worse Patients who are very sensitive to supplemental oxygen are telling us they have what type of problems? It is a diffusion problem What is DO2? It is oxygen delivery. It is impacted by manipulating: SpO2, Hgb, and CO What is Vo2?
Blood loss is commonly the intercostal vessels Sub Q air is usually from? It is usually from a tracheal or broncheal tear Fiberoptic bronchscopy best facilitates visualization below the cords MOST BLUNT TEARS OCCUR WITH IN 1" OF CARINA A massive PE symptoms? Sudden change in mental status Neck vein distention Hemodynamic instability Low O2 sat What chamber of the heart is most commoly injured in blunt trauma? RV because the heart is rotated to the left Majority of injuires are myocardial contusions What is pericardial tamponade? Occurs when fluid accumulates in the pericardial sac, as volume in the sac increases, volume in the chambers decreases. Temporarily overcome this by aggressive preload. Emergent surgical repair is the preferred treatment. Will see a narrow pulse pressure What test can be used to screen for thoracic aortic disruption? Checking the BP in both arms, normally there should be less than 12 mHg difference in SBP between the arms. Avoid HTN to limit further dissection & avoid rupture What is permissive hypotension? Keeping SBP 80- 90 Aggressvie fluid resuscitation disrupts new clots, dilutes blood, promotes coagulopathies, and aggravates endothelial leakage NOT APPRORIATE FOR TBI
What are the 2 types of bleeding in a trauma patient? Mechanical & Coagulopathic Mechanical requires surgery to fix hole Coagulopathic- later in ICU, TIC-trauma induced coagulopathy What are the suggested lab studies for someone in Trauma induced cogulaopthy? Thromboelastography (TEG) Rotational Thromobelastometry (ROTEM) both testes provide real-time visual representation of clot formation and clot lysis Why is autotransfused blood better than banked blood? It is fresher, warmer, releases O2 better, and costs less Banked blood causes what electrolyte abnormalities? Elevated K-released from old or damaged blood cells Decreased Ca-citrate in blood binds with calcium so the ionized Ca level is low What nursing assessment would make you suspet low calcium? Carpal spasm (Trousseau Sign) while checking BP What does SBP estimate for you? SBP= CO--they go up & down together It is an indication of volume (preload) and contractility What does DBP estimate for you? DBP is a measure of vascular resistance-afterload DBP reflects vasoconstriction due to sympathetic compensation What is pulse pressure? The relationship between CO & the body's compensatory vasoconstrictive response Pulse Pressure= SBP-DBP
3% Saline What is the ratio for crystalloid replacement to blood loss? 3 or 4 : 1 What is the magic pressure numbers? (ICP, ACS) Approximately 20mm Hg is the pressure required to squeeze a capillary closed, regardless of where it is located, as soon as it closes, flow is impeded. What are early findings of end organ hypoperfusion? Widenend pulse pressure (dropping diastolic pressure) Decrease U/O, decreased pulse ox, increase resp rate, restlessness What are SIRS criteria? When 2 or more are met: Temp >38.3 or < RR >20, HR>90, PaCO2< 32 What is muscle compartment syndrome? Elevated fascial compartment pressure, higher than arterial pressure. MOST prominent symptom is unrelieved pain What is the ankle-brachial pressure index? SBP of ankle (lower leg) divided by SBP of brachial (upper arm), normal is 1, <0.8 means decreased flow What are symptoms of fat embolism syndrome and when do they occur? Respiratory (tachypnea), neuro (agitation, anxiety) and dermal (petechial rash on chest), occur 12-72 hours after pelvic or long bone fractures What is a diffuse brain injury?
Global, generalized. Directly affects consciousness, such as diffuse axonal injury or concussion What is a focal brain injury? Local, indirectly affects consciousness. Focal injuries are something you could point to like a skull fracture or bleed What events are typical of diffuse brain injuries? Following the injury, there is a transient loss of consciousness, then the brain re- boots What are clinical findings suggestive of TBI? Somatic-H/A, N&V, blurred vision, fatigue Cognitive-confusion, impaired judgement Emotional-depression, irritability, sleep disturbances What is the treatment for TBI? REST What is TBI and second impact syndrome? Occurs when an injured brain receives a SECOND blow in anywhere from minutes to weeks after the initial impact. This condition is often fatal Peri-orbital ecchymosis or 'raccoon eyes" are result of? Anterior fossa fracture Post-aricular hematoma or "Battle sign" is a result of? Middle fossa fracture. If patient has a tympanic tear, CSF leaks - otorrhea Pressure on which cranial nerve results in pupillary dilation and loss of reactivity? Cranial nerve III What is the most common site of an epidural hematoma? Under the temporal bone, at site of the middle meningeal artery. Blood accumulates under the dura. On CT the hematoma appears convex
Hypoxemia - SpO2 <90% Hypotension-SBP< What are the classic symptoms of brain herniation? Cushing's Triad-irregular respirations, bradycardia, systolic hypertension (widened pulse pressure) What are cervial spine patients at greatest risk for? Risk of respiratory comprimise C3, 4, 5- Keep diaphragm alive C3 function is not adequate to support ventilaton C4-can move diaphragm, minimally adequate C5-have diaphragm, lack intercostals What is a stable spinal cord injury? It is not a threat to the cord, fracture of spinous or transverse processes What is an unstable spinal cord injury? Fracture of vertebral body or ligament disruption What are negative effects of spinal/backboard immobilzation? Airway comprimise, aspiration, ICP, pain, agitation, and skin breakdown What is the best test to views bony structures and solid organs? CT What is the best test for viewing soft tissue structures? MRI What is the best test to view teeth, maxilla and mandible? Panoramic radiograph What is the best test to view vascular structures of neck, face, and brain vessels? CT angiography What test is best to identify free fluid and fluid-filled structures?
Ultrasound What symptoms will be seen with a spinal cord concussion? Sudden loss of motor & sensory function. Complete recovery occurs within 72 hours What are the causes of a spinal cord contusion? Caused by hemorrhage and edema around the cord, blossoms over times What area of the spinal cord has the fibers that control the upper extremities and torso? They are located in the center of the cord What area of the spinal cord has fibers that control the lower extremites? They run along the outer edges of the cord What does central cord damage produce? It causes paralegia, in which the leg function exceeds that of the arms They can sing and dance, but can't play the piano What is seen with Spinal Shock? Temporary loss of spinal reflex activity "Limp Noodles" Resolves in hours-to-weeks As it resolves, pt develops contractures, spasticity & hyperreflexion What is neurogenic shock & what happens? It is a distributive shock, causing massive vasodilation causing relative hypovolemia leading to inadequate tissue and organ perfusion. What symptoms are seen with neurogenic shock? Bradycardia, hypotension, and widened pulse pressure What are injuries seen with lap belts only? Lumbar spine fractures are a risk, and may not be evident until the patient stands
They are associated with hemorrhage and airway comprimise due to blood in the airway, edema, and unsupported facial bones. Keep patient sitting up and leaning forward. If they have resp effort, apply O2 by any means. What is hyphema and how is it treated? It is blood in the anterior chamber of the eye. Elevate HOB to pool blood in the lower portion of the anterior chamber. Avoid analgesics with antiplatelet effects - NSAIDS and ASA What is Zone 1 of the neck? It is the lowermost portion, from the sternal notch to cricoid cartilage What is Zone 2 of the neck? The majority of the neck, from cricoid to angle of the mandible What is Zone 3 of the neck? It is from the angle of the mandible to the base of the skull What does stridor indicate? It indicates significant airway obstruction What does BCVI-Blunt Cerebrovascular injury refer to? It refers to any blunt trauma to carotid or vertebral arteries. Any stroke like symptoms in the patient with head or neck trauma is cause for alarm What are symptoms of hematoma obstruction of the aerodigestive tract? Dyspnea, dysphonia, stridor, & dysphagia. Dysphonia is an early indicator of airway compression and vocal changes are highly significant What do coarse crackles indicate? Fluid in the lower airway What does coughing indicate? It is a protective reflex in response to laryngeal or subglottic irritation What can bloody sputum indicate? It indicates significant airway damage, but not necessarily an expanding hematoma
What is the "choking game"? It is a technique to induce hypoxia, causing temporary syncope and euphoria What is the initial priority with a rib fracture? Priority is pain management to allow for pulmonary toilet. It is the most important initial intervention. What is the most ominous finding in patients with flail chest? The most ominous finding is oxygenation failure. Pulmonary contusions (the extent of diffusion defects) determine injury severity to a greater degree than the actual chest wall defect What is traumatic asphyxia? It is a thoracic crushing condition that occurs when sudden blunt trauma to the chest forces retrograde blood blow through the superior vena cava into the head and neck What are the symptoms of traumatic asphyxia? Petecial & subconjunctival hemorrhage. The face is swollen, the face and upper torso are discolored blue-red to black-blue. Discoloration and petechiae are prominent on eyelids, nose and lips What are symptoms of bowel contusions? Include nausea, anorexia, mild diffuse abd pain, hypoactive bowel sounds How long do spleen injury patients have to avoid contact sports? For up to 8 weeks What do spleenectomy patients have a lifetime risk of? Pneumococcal sepsis and other infections What are symptoms of pancreatic trauma? Nausea, vomiting, and epigastric pain. Amylase and lipase may provide information about pancreas status. What are some infectious complications of bowel injuries? Abscess formation, peritonitis, abdominal wall infections, and sepsis
What does abdominal rebound tenderness suggest? Peritonitis What is abdominal compartment syndrome? It is elevated intraabdominal pressure caused by tissue edema or free fluid in the abd cavity Fetal demise in trauma is most likely due to? Placental abruption What is fetal distress an early indicator of? It is an early indicator of hypoxia, apply supplemental O2. Fetal distress is an early indicator of materal hypoperfusion What is Supine hypoperfusion in maternal patient? It is hypo-perfusion caused by compression of vena cava and aorta, it can be reversed by tilting the patient What is compartment syndrome and what are the symptoms? Increased pressure in fascial compartment that inhibits blood flow. It is pain out of proportion to injury. Symptoms include pain, parethesia, paresis, paralysis. What is rhabdomyolysis? It is a syndrome when skeletal muscles are destroyed and cellular contents get into serum. K, CK, and myoglobin are released. CK is best marker of tissue destruction. What are the symptoms of rhabdomolysis? Dark colored urine, dropping urine output, hyperkalemia, and elevated CK. CK is the best marker of the extent of tissue destruction What type of amputation is the best candidate for replantation? Someone without vascular disease, very recent injury, guillotine-style injury and one that occurred in a fairly clean environment Care of an amputated part includes?
Cleaning off any visible dbris, sealing amputated part in a plastic bag, and placing the bag in an ice water solution What is the treatment for acid burns? At least 30 minutes of irrigation What is the treatment for alkaline burns? Irrigation should continue until skin pH is normal, which could take several hours. An alkali agent will feel slippery or soapy due to the reaction of alkaline to skins fatty acids What is the treatment for tear gas agents or pepper spray? Time & fresh air are the definitive treatments. It is oil based, and is not water soluble, and will not remove the gas/pepper spray. Do no apply salve or grease, it will trap the particles What injuries are seen with high voltage injuries? Affect every tissue in the body. Most are knocked unconscious, and neurological complications are the most obvious and immediate manifestations. Can produce cardiac injuries and rhabdomyolysis. What is the Parkland formula for fluid replacement for 2nd & 3rd degree burns? 4 ml x kg x % if BSA burned. All given in 24 hours, half the volume in the first 8 hours What is the indicator of fluids resuscitation in burn patients? Urine output in a key indicator of adequate fluid resuscitation in the initial 24 hours post burn, goal is 0.5-1 ml/kg/hr When does the intermediate phase of burn care start? 48 hours after injury. There is a risk of compartment syndrome due to excess fluid and edema. What are the earliest inhalation injury findings? Vocal hoarseness, occasionally associated with a dry cough What is required to diagnose a inhalation injury?
