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TCAR POST // TCAR POST TEST EXAM 50 QUESTIONSANDCOR RECT
{VERIFIED} ANSWERSNEWEST//ALREADY, Exams of Nursing 3 questions to ask in trauma - ANSWER-what was the dose of energy?
- where did it go?
- what injuries are likely? 2 q's to ask in GSW - ANSWERcaliber type of gun
of entrance/exit wounds
high/low velocity 1st question to ask in any traumatic injury? - ANSWERwhat was the dose of energy involved? (was it high or low?) what is the caliber of a bullet? - ANSWERdiameter aka diameter of a bullet - ANSWERcaliber
what happens to projectiles when they enter the body - ANSWERprojectiles don't travel in a straight line consider temporary cavity wound what should you consider about tissue a projectile enounters - ANSWERtemporary cavitation primary goal of GSW surgery - ANSWERusually damage repair & not bullet removal
- if superficial, it may migrate the surface with time important thing to remember about retained projectiles - ANSWERthey may migrate over time. bullett migration might explain unexplained clinical findings (VP Cheney accidentally shot his friend while hunting in 2006. ICU and did great. moved to an inpatient unit. had a silent MI bc a shot gun pellets migrated into a canary artery causing an infract. so had a MI but fibrinolytic not the ANSWER in this case b/c it was a "projectile embolus" aka brestbone - ANSWERsternum what attaches the ribs to the sternum - ANSWERcartliage what breaks thoracic bones - ANSWERsignificant force
- 1 - 2nd ribs, posterior ribs, sternum, scapulae, T2- 10 gives us info about the force aka "dose" of energy received consider injury to internal structures b/c force
(1/2 of all rib fractures aren't identified at the POI CXR) identify a previous rib fracture on CXR - ANSWERonce healed, rib fractures form bony callouses and become more visible on CXR how to tell a pt has a pneumonia from a CXR - ANSWERdark spot that is not equal to the opposite side consider if a pt has a lower rib fracture - ANSWERliver & spleen injury acts like BBQ/marshmellow skewers how high does the diaphragm rise on inspiration - ANSWERlevel of 4th ICS risk of rib fractures - ANSWERcan puncture liver, spleen,, diaphragm pop lungs +2 adjacent rib fractures - ANSWERflail chest free floating sternum - ANSWERflail chest definition of flail chest - ANSWER+2 adjacent rib fracture free floating sternum why is flail chest a problem - ANSWERb/c breathing is a mechanical process
paradoxical chest movements - ANSWERin flail chest s/s of flail chest - ANSWERparadoxical chest wall movement where on the tissue oxygenation cascade is thoracic cage fractures a problem
- ANSWERventilation parameters to assess ventilation - ANSWERETCO2, PaCO2, clinical assessment what are considered "great vessels" - ANSWER thorax - ANSWER what type of injuries occur when the lungs are subjected to force? - ANSWERbruise = contusion tear = lacerations pop = punctures inhalation injury bruise on the lungs - ANSWERpulmonary contusion causes of pulmonary contusions - ANSWERhigh speed blunt or penetrating injury what happens to the lungs in pulmonary contusions - ANSWERbig boggy bruise on the lungs
*b/c 70% of pulmonary contusions aren't present on initial CXR. they "blossom" over time tear in lung tissue - ANSWERpulmonary laceration problem of pulmonary lacerations - ANSWERrisk of massive hemothoax b/c those vessels are very vascular simple v. tension v. open v. closed. v. hemothorax v. hemopneumothorax - ANSWER what is a simple pneumothorax - ANSWERany air that enters the pleural cavity can also leave at the same rate. lungs deflated but no increase in intrathroacic pressure. air in/out exits at the same rate. pt might be able to tolerate a simple pneumothraox causes a problem at the ventilation point at the tissue oxygen cascade intrathroacic pressure in simple pneumothorax - ANSWERair that enters the pleural cavity leaves at the same rate lungs are deflated but no increase in pressure air in/out at the same rate where is the problem in the tissue oxygenation cascade in simple pneumothroax - ANSWERventilation what happens in penumothorax - ANSWERlungs are collapsed/deflated aire enters space between the visceral & parietal
two layers of the lungs - ANSWERvisceral & parietal Q - in a pneumothorax, no ligaments attach the lung to the wall. so what holds it up? - ANSWERA - a thin layer of pleural fluid & negative pressure. the liquid helps it stick like how a spilled liquid forms a seal between a glass and a smooth table top difference between a simple and tension pneumo - ANSWER aka chest tube - ANSWERchest thoacotomy purpose of using a chest tube in simple pneumothorax - ANSWERto allow for negative pressure to reestablish. tension pnumothorax - ANSWERair enters under pressure but doesn't exit at the same rate. = accumulation of air under pressure example of tension pneumothorax - ANSWERlike using a bicycle pump to put more and more air into the lungs over time. no escape *pressure means no lung function on the side of the injury and compromises function on the un injured heart and great vessel compression (decreases preload/CO increases afterload effect of tension pneumothorax on heart function - ANSWERincreases intrathoracic pressure
pleuritic chest pain - ANSWERpain with breathing assessment of t. pneumothraox - ANSWERpleuritic chest pain (hurts to breathe) respiratory distress increased HR hyppoxemia agitation decreased LS chest dyspmetry hyperresonance late s/s of tension pneumothrax - ANSWERlow bp JVD tracheal deviation when do you get tracheal deviation - ANSWERlate sign of tension pneumothrax when isn't JVD & tracheal deviation obvious in tension pneumothroax - ANSWERnot obvious if obese, low bp, cervical collar also - it is a super late s/s intervention if you suspect tension pneumothrax - ANSWERneeds FAST
do immediate needle D w/o imaging mortality rate off tension pneumothorax - ANSWER100% of patients will die w/o intervention too much black on CXR - ANSWERhyperlucency needle "d" for tension pneumo - ANSWER"pop the bubble" with needle/finger. to restore CO. life saving finger thoracotomy - ANSWER purpose of "needle d" - ANSWERconvert tension pneumo to a simple pneumo. then put in chest tube how to convert a tension pneumothorax to a simple pneumo - ANSWER"needle D" open pneumothorax - ANSWERobject penetrates or a rib pokes out intervention for an ope. pneumothroax - ANSWERxeroform, gasoline bandage, chest seal.
VATS - ANSWERvideo-assisted thoracic surgery empyema - ANSWER added to blood products that may cause low Ca - ANSWERcitrate. purpose of citrate in blood products - ANSWERw/o citrate, blood will clot keeps blood in blood products from clotting - ANSWERcitrate priority in bleeding episodes - ANSWERstop bleeding CABC leading cause of early mortality in trauma - ANSWERhemorrhage cause of 30 - 40% of all patients who die of trauma - ANSWERhemorrhage why is it important to keep a hemorrhage pt warm - ANSWERkeep a trauma pt warm helps stop bleeding b/c you can't clot well if cold coagulopathy control in hemorrhage - ANSWERcan't clot if we only give RBC/crystallids needs plasma, cry, plt definitive bleeding management - ANSWEROR
field care for bleeding management - ANSWERhelping blood loss > replacing fludis IVF in hemorrhage - ANSWERIVF is not a substitution for aggressive hemorrhage control and can be harmful benefit of chest tube in trauam - ANSWERautotransufsion benefits of autotransfusion in massive hemorrhage - ANSWERperfect cross- match fresh blood k levels lower room temp no communicable disease many clotting factors no anticoagulation needed warm versus cold blood - ANSWERwarm blood pleases oxygen better problems with autotrausncusion - ANSWERcontained (GSW) coagulaopathies enhanced inflammatory response benefits of any trauma intervention.... - ANSWERoften depends on the circumstance
Rh factor in hemorrhage - ANSWERonsieration but not a contraindication in a massive hemorrhage. untyped female needs blood and Only O+ iOS available Rh- patient receives Rh+ blood mixing - ANSWERneeds Rhogam within 72hrs. passive immunization to prevent Rh sensitization and actual Rh formation universal plasma donr - ANSWERtype AB considered massive transfusion - ANSWER10 units air in soft tissue - ANSWERSubcutaneous emphysema what does subcutaneous emphysema indicate - ANSWERthere is a leak somewhere color of air on a CXR - ANSWERblack. the4re should not be air outside of the pleural cavity where can an air leak in the chest travel - ANSWERair leak in the chest can get up to the face. air travels along the facial planes between the muscles. air rises so it can rise to the neck/face bu8t can also move down to the scrotum what unique physical exam findings are associated w.SC emphysema - ANSWERrice crispies/bubble wrap under skin *air leak so air can rise up the facial planes between the muscles to the face (air rises) or can move down into he s rotum
skin feels like rice crispies/bubble wrap - ANSWERsubcutaneous emphysema how to identify tear location of trachea/broncha - ANSWERSC emphysema (rice crisps & bubble wrap) broncos ope (CXR only shows presence) treatment of SC emphysema - ANSWERno specific intervention. air is reabsorbed over time what does presence of SC emphysema incident cate - ANSWERstrongly suggests pneumo cost of most heart truma - ANSWERblunt injury like MVC most common heart related blunt chest injury - ANSWERcardiac contusion (blossoms over time) heart trauma injury assessment - ANSWERelectrical and mechanical failure treatment for a lung or heart bruise - ANSWER"blossoms" over time watch & supportive care what part of the heart is the most likely to be affected by blunt chest trauma - ANSWERright ventricle is the front of the heart so it is most commonly fluid around the heart - ANSWERpericardial fluid
muffled heart sounds - ANSWERconsider cardiac tamponade EKG of cardiac tamponade - ANSWERlow voltage Electrical alternans (alternating amplitude on EKG) - ANSWER where on the tissue oxygenation cascade does cardiac tamponade effect - ANSWERprob lem f CO (obstruction issue not hypovolemia) interventions for cardiac tamponade - ANSWERecho or FAST what can be lifesaving in cardiac tamponade - ANSWERremoving as little of 30ml you can leave in the needle w/a stockcock for later repeat drainage. frequently the blood is clotted an can't be removed. helps w/ s/s only but doens t actually fix the problem and helps until definitive care top 3 causes of death at the scene of traumatic injury - ANSWERmassive head trauma aortic care high spinal cord injury assessment findings that indicate great vessel injury - ANSWERmassive hemothroax
shock inability to resuscitate patient method of treatment - ANSWERmodality mesenteric injuries - ANSWER 3 layers of blood vessels - ANSWERendothelium (tunica intima) tunica media tunica adventitia what happens when the aorta is stretched - ANSWERthe most delicate/weakest layers tear first screening needed for thoracic trauma - ANSWERdecrease great vess3l injury bilateral bp why should you do bilateral bp to screen for aortic tear - ANSWERb/c blood normally flows in a forward direction but in a dissection blood flows downwards w/ a little backwards. it doesn't take much backward dissection to start obstructing flow to the L subclavian what happens in a dissection - ANSWERretrograde flow and potential obstruction of any vessel that branches off the aorta importance of the aorta - ANSWEReverything branches off the aorta
