Download TCRN Review: Extremity & Wound Trauma - Q&A on Musculoskeletal & Burn Trauma and more Exams Traumatology in PDF only on Docsity!
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
List some special considerations for abrasions. - correct answer Pain control - full thickness abrasions may be associated with nerve damage and may have less pain Evaporative heat loss - consider warming measures Evaporative fluid loss - consider need for fluid replacement Scarring - anesthetize wound and aggressively remove debris Define contusion. - correct answer Rupture of subcutaneous blood vessels with extravasation of erythrocytes. Define hematoma. - correct answer Rupture of artery or vein that will continue to expand until the pressure in the tissue exceeds the pressure in the ruptured vessel. Contusions and hematomas have the potential for what significant complication? - correct answer Compartment Syndrome List 2 special considerations related to contusions / hematomas. - correct answer Potential for enough blood loss to cause hypovolemia, especially in areas of the body with greater dispensability (like the thigh).
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
Blood is a medium for bacterial growth, therefore wounds with contusions and hematomas may have a greater risk for infection. What are the treatments for contusions / hematomas? - correct answer Elevation Application of Ice Packs Puncture wounds have a high rate of _____. - correct answer Infection What treatment should be done with puncture wounds? - correct answer Soaking At time of discharge, what teaching should be given to a patient who sustained a puncture wound? - correct answer Soak wound 2-3 times per day for 2-4 days What type of bites tend to be deep wounds involving crushing of the tissue or avulsion? - correct answer Dog Bites
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
Teeth marks over knuckles from "punching someone" are associated with _____. - correct answer Fractures of the third and fifth metacarpal, osteomyelitis and joint infection. Wounds caused by high pressure devices (paintball gun, grease gun) can cause _____. - correct answer Compartment Syndrome If a device triggers releasing foreign matter into the wound, it may travel deep into the tissue separating fascial planes and causing _____. - correct answer Compartment Syndrome _____ requires high triage prioritization and potential surgical intervention. - correct answer Compartment Syndrome List the 3 types of tissue damage that occur with gunshot wounds. - correct answer Permanent cavity Temporary cavity Pressure Wave What is the permanent cavity associated with a gunshot wound? - correct answer Penetrating trauma following the path of the projectile
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
What is the temporary cavity associated with a gunshot wound? - correct answer Crush injuries around the permanent cavity caused by temporary displacement of tissue as the projectile moves through the tissue. What is the pressure wave associated with a gunshot wound? - correct answer Damage in areas adjacent to the permanent cavity as the projectile moves through the tissue (increased damage to hollow organs). In gunshot wounds, the faster the projectile is moving as it passes through the tissue, the _____. - correct answer Greater the size of the temporary cavity and pressure wave. The longer the barre of the firearm, the _____ the projectile will strike the patient. - correct answer Faster The farther the patient is from the firearm when it is fired, the _____ the projectile will be moving as it enters the body. - correct answer Slower
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
List some characteristics of high velocity projectiles. - correct answer They may splinter bone, rupture blood vessels, and break apart, causing injury to tissue far from the initial pathway. Describe what a close range shotgun wound (birdshot) does. - correct answer At close range, pellets act as one mass causing massive tissue destruction. Describe what a far range shotgun wound (birdshot) does. - correct answer At farther range, pellets scatter and tissue penetration is significantly reduced to superficial skin or deep fascia. What is the priority with an amputation? - correct answer Control hemorrhage What are 4 ways to control hemorrhage on an amputation? - correct answer Direct pressure over stump Compress artery above the site Elevate the extremity Apply tourniquets as needed
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
Give 2 facts about tourniquet placement. - correct answer Place as close to the amputation as possible Release the tourniquet as soon as the hemorrhage is controlled Describe how to care for an amputated part. - correct answer Remove dirt and debris from exposed end Wrap in slightly saline-moistened sterile gauze Place in a sealed bag Place on ice Why do you not allow water onto an amputated limb? - correct answer Water is hypotonic and can cause tissue edema. Should you allow an amputated part to freeze? - correct answer No Define compartment syndrome - correct answer Increase in pressure inside a fascial compartment. What are the potential complications of a crush injury? - correct answer Compartment Syndrome
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
Describe the pressure associated with compartment syndrome - correct answer Limb feels tight or tense on palpation Skin may appear taut or shiny Describe the Pallor of compartment syndrome - correct answer Indication of poor perfusion (may include delayed capillary refill and cool temperature) Describe pulses in compartment syndrome - correct answer Weak or absent pulses are a poor indicator for positive outcomes Describe paresthesia in compartment syndrome. - correct answer Numbness, tingling, loss of sensation (may result in a loss of pain that may give a false sense of improvement) Describe paralysis in compartment syndrome. - correct answer Indicates injury to the nervous system. How is compartment syndrome diagnosed? - correct answer Measurement of intra-compartmental pressure using a manometer
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
What is normal compartment pressure? - correct answer 0-10 mmHg What is considered elevated compartment syndrome? - correct answer
20 mmHg What compartment pressure causes ischemia to the muscles and nerves? - correct answer >30 mmHg What are the treatments for Compartment Syndrome? - correct answer Remove external pressure (casts, splints, dressings) Elevate limb TO (not above) level of the heart Anticipate fasciotomy, surgical debridement or amputation In compartment syndrome, hyperkalemia peaks _____ hours after the injury. - correct answer 12-36 hours after the injury then steadily decreases What is the treatment for hyperkalemia in compartment syndrome? - correct answer Cardio-Protection: calcium gluconate Temporary K reduction: insulin/glucose and /or nebulized beta- adrenergic agonists (like albuterol)
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
Why should imbedded objects be left in place? - correct answer They may be tamponading underlying bleeding. Is hair removal around wounds encouraged or discouraged? - correct answer Discouraged. If needed, use scissors or clippers, do not shave. What solution should be used to irrigate wounds? - correct answer Copious amounts of normal saline What type of irrigation works best to remove smaller contaminants and bacteria? - correct answer high-pressure irrigation What body parts should not receive lidocaine with epi? - correct answer Digits Penis Ears Tip of the Nose Avulsions Grossly contaminated wounds
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
What types of foreign bodies are not seen on x-ray? - correct answer Vegetative matter such as splinters, thorns, cactus splines Plastic What diagnostics are used to find matter that does not show up on x- ray? - correct answer CT, Sono or MRI List and describe the 3 types of wound closure. - correct answer Primary - Immediate Wound Closure Secondary - Wounds are allowed to close on their own over time Tertiary - Wounds closure is delayed for a period of time What type of wound closure is used for wounds with significant bacterial contamination? - correct answer Tertiary What type of wound closure is used for wounds with significant tissue loss? - correct answer Secondary What type of wound closure is used for wounds with minimal tissue loss? - correct answer Primary
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
List 6 factors that may delay wound healing. - correct answer Poor tissue perfusion poor nutrition compromised vascular supply medications that slow collagen formation poor vascular supply advanced patient age What are some ways to increase tissue perfusion for wound healing? - correct answer Ensure adequate fluid resuscitation Ensure adequate patient oxygenation Hypothermia Pressure (frequent repositioning and early ambulation) What medical problems cause compromised vascular supply in wound healing? - correct answer history of smoking, diabetes, severe atherosclerosis What medications slow collagen formation in wound healing? - correct answer corticosteroids, phenytoin
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
What medical problems cause poor vascular supply in wound healing? - correct answer COPD, Anemia List three types of burns. - correct answer Thermal Electrical Chemical Describe airway burns. - correct answer Inhalation of heat can lead to edema in the upper airway with advancing airway obstruction. What are some symptoms of heat inhalation burns? - correct answer Hoarse voice Carbonaceous sputum Burns around mouth or nares Stridor What is the treatment for heat inhalation burns? - correct answer Prophylactic intubation
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
What are the symptoms of >60% carboxyhemoglobin conversion? - correct answer Cherry-Red Skin, Death What is the oxygen saturation for a patient with carbon monoxide poisoning? - correct answer Normal O2 sat What is the treatment for carbon monoxide poisoning? - correct answer 100% oxygen (until asymptomatic or COHb is less than 10%) Monitor cardiac rhythm and COHb level Hyperbaric chamber may be required for carbon monoxide poisoning resistant to oxygen or for pregnant patients Describe inhalation pulmonary injury - correct answer Caused by inhalation of noxious substances such as carbon or noxious fumes. List characteristics of pulmonary injury. - correct answer Damages mucosal cells or bronchioles Increases pulmonary capillary permeability (ARDS) Sloughing of damaged cells causing obstructed airways Decreased production of surfactant causing atelectasis
Trauma (Musculoskeletal Trauma,
Surface and Burn Trauma) (questions
and answers)
How long can symptoms of pulmonary injury be delayed? - correct answer Up to 24 hours after injury What is the treatment and goal of pulmonary injuries? - correct answer Deliver oxygen with a goal of an SpO2 between 94-98%. Burns covering more than _____ of the body surface area may cause systemic inflammatory response with systemic capillary leakage. - correct answer 20% What is the Modified Parkland Burn Formula for Adults? - correct answer TBSA x 2 mL x Body Weight in Kg What is the Modified Parkland Burn Formula for Peds? - correct answer TBSA x 3 mL x Body Weight in Kg Using the rule of 9's, what TBSA is the head? - correct answer 9% in adults and 18% in peds Using the rule of 9's, what TBSA is the abdomen? - correct answer 18% in both adults and peds
