Assessment and Treatment of Airway, Breathing, and Circulatory Emergencies, Exams of Nursing

Download Assessment and Treatment of Airway, Breathing, and Circulatory Emergencies and more Exams Nursing in PDF only on Docsity! TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ A (AVPU) - ANSAlert. Will be able to maintain airway once clear. A (Primary Survey) - ANSAirway and alertness with simultaneous cervical spinal stabilization. Airway Assessment - ANSInspect: tongue obstruction, loose/missing teeth, foreign objects, blood, vomitus, secretions, edema, burns or evidence of inhalation injury Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor) Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphysema Airway Interventions: - ANSSuction Remove foreign body if noted Jaw thrust maneuver (maintain cspine) Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag) Consider definitive airway Alertness Assessment - ANSA-Alert V-Verbal P-Painful U-Unresponsive B (Primary Survey) - ANSBreathing and Ventilation Breathing and Ventilation Assessment - ANSInspect: spontaneous breathing, symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use, diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic), contusions/abrasions/deformities (signs of underlying injury), open pneumothoraces (sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space midclavicular line and bases at the fifth intercostal space anterior axillary line Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV pulsations at suprasternal notch or supraclavicular area Life-threatening pulmonary injuries requiring immediate intervention: open pneumothorax, tension pneumothorax, flail chest, hemothorax. Breathing and Ventilation Intervention - ANSBreathing absent: jaw-thrust maneuver, oral airway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or higher. If ineffective: assist with bag-mask and determine need for definitive airway TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ C (Primary Survey) - ANSCirculation and Control of Hemorrhage Cardiogenic Shock - ANSResults from pump failure in the presence of adequate intravascular volume. There is a lack of cardiac output and end-organ perfusion secondary to a decrease in myocardial contractility and/or valvular insufficiency. Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic cause. Blunt cardiac injury may present similar to MI. Excess of volume administration or increased after load can result in pulmonary edema and increased myocardial ischemia. Inotropic support to improve contractility. Circulation and Control of Hemorrhage Assessment - ANSInspect: Uncontrolled external bleeding, skin color Auscultate: Muffled heart sounds - may indicate pericardial tamponade Palpate: carotid and/or femoral pulses for rate, rhythm, strength Circulation and Control of Hemorrhage Interventions - ANSControl and treat external bleeding: apply direct pressure, elevate bleeding extremity, apply pressure over arterial sites, consider use of a tourniquet. 2 large bore IVs, if unable consider IO, obtain labs and crossmatch. Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L. **Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis and may cause hypothermia. Component therapy, including administering RBC, plasma and platelets is a balanced approach so that O2 delivery is optimized, acidosis corrected and coagulopathy prevented. Classifications of Shock - ANSHypovolemic - decrease in the amount of circulating blood volume Obstructive - obstruction in either the vasculature or heart Cardiogenic - pump failure in the presence of adequate intravascular volume Distributive - maldistribution of an adequate circulating blood volume (septic, anaphylactic, neurogenic) TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ VERBAL 1. Makes no sounds 2. Makes sounds 3. Words 4. Confused, disoriented 5. Oriented, converses normally MOTOR 1. Makes no movements 2. Extension to painful stimuli (decerebrate) 3. Abnormal flexion to painful stimuli (decorticate) 4. Withdrawal to painful stimuli 5. Localizes painful stimuli 6. Obeys commands H (Secondary Survey) - ANSHistory Prehospital Report (MIST) M: MOI I: Injuries sustained S: Signs and symptoms in the field T: Treatment in field Patient History (SAMPLE): S: Symptoms A: Allergies and tetanus status M: Medications P: Past medical history L: Last oral intake E: Events and Environmental factors related to injury. H: Head and Face Head to Toe Assessment (secondary survey) - ANSSOFT TISSUE: Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled objects. Palpate: areas of tenderness, step-offs, crepitus BONY DEFORMITIES: Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter Palpate: depressions, angulations, tenderness Hepatic Injuries - ANSIn blunt trauma the liver may lacerate from increased abdominal pressure. TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Hematoma - bleeding contained within the capsule Laceration - the capsule is disrupted Findings: Cullen sign (ecchymosis around the umbilicus or RUQ), tenderness, guarding or rigidity RUQ, 9-12 rib FXs, elevated LFT Graded I-VI, I = minor trauma Nonoperative management is standard of care in hemodynamically stable patient. Observed with serial abdominal exams. Findings of contrast extravasation may be embolized by IR. For surgical patients - fluid resuscitation is essential. Risks of surgery include disruption of the natural tamponade process due to the evacuation of large amounts of blood resulting in hypovolemia. Hypovolemic Shock - ANSCaused by a decrease in the amount of circulating blood volume. In trauma typically results from hemorrhage, but can result in a precipitous loss of volume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranes leading to plasma and protein leakage. of body water, results in inadequate perfusion. Hyperventilation can cause increased intrathoracic pressure resulting in compression of the heart and decreased cardiac output. Initial Assessment - ANS1. Preparation and Triage 2. Primary Survey 3. Reevaluation 4. Secondary Survey 5. Reevaluation Adjuncts 6. Reevaluation and Post Resuscitation Care 7. Definitive Care or Transport Intraocular Foreign Body - ANS*TRUE EMERGENCY AND EARLY INTERVENTION IS ESSENTIAL. Findings: compromised visual acuity, misshapen pupils, pain TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Treatment: elevate HOB, ophthalmology, immobilize foreign body, patch UNAFFECTED eye to limit concomitant eye movement, globe closure ASAP, systemic and ophthalmic ABX, analgesics. Postop infection, retinal detachment and vision loss are common complications. lid injury - ANS Liver - ANSLargest solid organ of the body. RUQ, 6th to 10th ribs. Encased by Glisson capsule with blood vessels, lymphatics and nerves. Filters 1.7L of blood per minute. The liver filters out toxins, takes the nutrients and returns the blood to the heart via the hepatic veins. Hepatocyte cells are capable of regeneration allowing the liver to repair its own tissue. Functions: Store and metabolize lipids, transport nutrients, produce glucose and bilirubin, convert ammonia to urea, secrete electrolytes, lipids, lecithin, cholesterol and bile. Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary for clotting). Obstructive Shock - ANSResults from hypo perfusion of the tissue due to an obstruction in either the vasculature or heart. Tension pneumothorax - increased thoracic pressure leads to displacement of the vena cava, obstruction to atrial filling, decreased preload and decreased cardiac output. Cardiac tamponade - impedes diastolic expansion and filling leads to decreased preload, strokes volume and cardiac output and ultimately end organ perfusion. P (AVPU) - ANSPainful. Responds only to painful stimuli. (Airway adjunct may be needed while determining need for intubation) Reevaluation - ANSPortable radiograph - AP chest, pelvis. Can quickly identify potentially life-threatening injuries such as pneumothorax or pelvic fracture with uncontrolled internal hemorrhage. Can also confirm placement of ET tubes, chest tubes and gastric tubes. Consider need for transfer. shock - ANSInadequate tissue perfusion. Spleen - ANSEncapsulated organ LUQ level of 9th-11th ribs and curves around a portion of the stomach. Minimal elasticity and flexibility - most frequent injured organ in blunt trauma. TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a test that requires fluid to be sent to the lab and is considered the gold standard for identifying CSF - ANSBeta2-Transferrin ... is a test that requires fluid to be sent to the lab and is considered the gold standard for identifying CSF - ANSBeta2-Transferrin ... is a test that requires fluid to be sent to the lab and is considered the gold standard for identifying CSF - ANSBeta2-Transferrin ... is a triad of assessment findings; widening pulse pressure, bradycardia, and diminished respiratory effort - ANSCushing ( it is an attempt to increase MAP against elevated ICP, ultimately trying to cause a rise in CPP) ... is a triad of assessment findings; widening pulse pressure, bradycardia, and diminished respiratory effort - ANSCushing ( it is an attempt to increase MAP against elevated ICP, ultimately trying to cause a rise in CPP) ... is a triad of assessment findings; widening pulse pressure, bradycardia, and diminished respiratory effort - ANSCushing ( it is an attempt to increase MAP against elevated ICP, ultimately trying to cause a rise in CPP) ... is damaged brain tissue usually caused by blunt trauma - ANSCerebral contusion ... is damaged brain tissue usually caused by blunt trauma - ANSCerebral contusion ... is damaged brain tissue usually caused by blunt trauma - ANSCerebral contusion ... is defined as the pressure gradient across the brain tissue, or the difference between the pressures of the cerebral artery and venous vessels. - ANSCPP; CPP = map - icp ... is defined as the pressure gradient across the brain tissue, or the difference between the pressures of the cerebral artery and venous vessels. - ANSCPP; CPP = map - icp TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ ... is defined as the pressure gradient across the brain tissue, or the difference between the pressures of the cerebral artery and venous vessels. - ANSCPP; CPP = map - icp ... is the initial post traumatic inflammatory response. ... ... activates this response and ... are sent to the injury sites, activating signaling pathways that mobilize inflammatory cells. - ANSImmune response; tissue hypoxia;neutrophils ... is the initial post traumatic inflammatory response. ... ... activates this response and ... are sent to the injury sites, activating signaling pathways that mobilize inflammatory cells. - ANSImmune response; tissue hypoxia;neutrophils ... is the initial post traumatic inflammatory response. ... ... activates this response and ... are sent to the injury sites, activating signaling pathways that mobilize inflammatory cells. - ANSImmune response; tissue hypoxia;neutrophils ... is the shifting of brain tissue with displacement into another compartment as the result of bleeding or edema. - ANSHerniation ... is the shifting of brain tissue with displacement into another compartment as the result of bleeding or edema. - ANSHerniation ... is the shifting of brain tissue with displacement into another compartment as the result of bleeding or edema. - ANSHerniation ... pain is persistent and usually lasts longer than 3 to 6 months. - ANSChronic ... pain is persistent and usually lasts longer than 3 to 6 months. - ANSChronic ... pain is persistent and usually lasts longer than 3 to 6 months. - ANSChronic ... pain originates from organs and may lead to referred pain. (Trauma) - ANSVisceral ... pain originates from organs and may lead to referred pain. (Trauma) - ANSVisceral ... pain originates from organs and may lead to referred pain. (Trauma) - ANSVisceral ... pain originates from skin and musculoskeletal structures (burns) - ANSSomatic ... pain originates from skin and musculoskeletal structures (burns) - ANSSomatic ... pain originates from skin and musculoskeletal structures (burns) - ANSSomatic ... refers to a condition that occurs when the patient suffers a second milks TBI before recovery from the first - ANSSecond impact syndrome TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ ... refers to a condition that occurs when the patient suffers a second milks TBI before recovery from the first - ANSSecond impact syndrome ... refers to a condition that occurs when the patient suffers a second milks TBI before recovery from the first - ANSSecond impact syndrome ... results from a collection of blood forming between the dura Mater and the skull. This is frequently associated with fractures of the temporal or parietal skull that lacerated the .... - ANSEpidural hematoma ; middle meninges artery ... results from a collection of blood forming between the dura Mater and the skull. This is frequently associated with fractures of the temporal or parietal skull that lacerated the .... - ANSEpidural hematoma ; middle meninges artery ... results from a collection of blood forming between the dura Mater and the skull. This is frequently associated with fractures of the temporal or parietal skull that lacerated the .... - ANSEpidural hematoma ; middle meninges artery ... shock is from hemorrhage and is the leading cause of preventable deaths in trauma patients. Can also be caused by plasma loss in ... - ANSHypovolemic; burns ... shock is from hemorrhage and is the leading cause of preventable deaths in trauma patients. Can also be caused by plasma loss in ... - ANSHypovolemic; burns ... shock is from hemorrhage and is the leading cause of preventable deaths in trauma patients. Can also be caused by plasma loss in ... - ANSHypovolemic; burns ... shock occurs as a result of maldistribution of an adequate circulation blood volume with the loss of vascular tone or increased permeability. 3 examples. - ANSDistributive; anaphylactic, septic and neurogenic ... shock occurs as a result of maldistribution of an adequate circulation blood volume with the loss of vascular tone or increased permeability. 3 examples. - ANSDistributive; anaphylactic, septic and neurogenic ... shock occurs as a result of maldistribution of an adequate circulation blood volume with the loss of vascular tone or increased permeability. 3 examples. - ANSDistributive; anaphylactic, septic and neurogenic ... shock results from hypoperfusion of the tissue due to an obstruction in either the vasculature or heart. Two examples include.... - ANSObstructive;tension pneumothorax, cardiac tamponade. (With tension pneumo the increase in intrathoracic pressure leads to displacement of the vena cava, obstruction to arrival filling leading to decreased preload and decreased cardiac output) ( with cardiac tamponade there is an accumulation of fluid in the pericardial sac impeding diastolic expansion and filling leading to decreased preload, stroke volume,CO and end organ perfusion) TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ ...activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP - ANSChemoreceptors #1 Early Killer - ANSHemorrhage #1 Late Killer - ANSInfection & MODS `CPP - ANSMAP-ICP + gurgling over epigastrium - ANS-in stomach, pull out, preoxygenate, try again 1 Liter of O2 = ____% FiO2 - ANS4% 1 Liter of O2 = ____% FiO2 - ANS4% 1 unit of PRBC will raise HGB and HCT by how much? - ANSOnce hemostasis is achieve it is est that 1 unit will raise hgb by 1 g/dL and hct by 3%. 1. A- airway and Alertness with simultaneous cervical spinal stabilization 2. B- breathing and Ventilation 3. circulation and control of hemorrhage 4. D - disability (neurologic status) 5. F - full set of vitals and Family presence 6. G - Get resuscitation adjuncts L- Lab results (arterial gases, blood type and crossmatch) M- monitor for continuous cardiac rhythm and rate assessment N- naso or orogastric tube consideration O- oxygenation and ventilation analysis: Pulse oxygemetry and end-tidal caron dioxide (ETC02) monitoring and capnopgraphy H- History and head to toe assessment I- Inspect posterior surfaces - ANSABCDEFGHI 1. Apnea 2. GCS 8 or less 3. Maxillary fractures 4. Evidence of inhalation injury (facial burns) 5. Laryngeal or tracheal injury or neck hematoma 6. High risk of aspiration and patients inability to protect the airway 7. Compromised or ineffective ventilation - ANSFollowing conditions might require a definitive airway 1. bony fractures and possible rib fractures, which may impact ventilation 2. palpate for crepitus 3. subcutaneous emphysema which may be a sign for a pneumothorax TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ 4. soft tissue injury - ANSPalpate the chest for 1. Check the presence of adequate rise and fall of the chest with assisted ventilation 2. Absence of gurgling on auscultation over the epigastrium 3. Bilateral breath sounds present on auscultation 4. Presence of carbon dioxide (CO2) verified by a CO2 device or monitor - ANSIf the pt has a definitive airway in what should you do? 1. Dyspnea 2. Tachycardia 3. Decreased or absent breath sounds on the injured side 4. CP - ANSSimple Pneumo assessment: 1. equal breath sounds bilaterally at the second intercostal space midclavicular line and the bases for fifth intercostal space at the axillary line - ANSAuscultate the chest for: 1. Get a CT 2. Consider ABG 's if decreased LOC 3. Consider glucose check - ANSD Interventions 1. Hypotension 2. JVD 3. Muffled heart sounds - ANSBecks Triad: 1. open the airway, use jaw thrust 2. insert an oral airway 3. assist ventilations with a bag mask 4. prepare for definitive airway - ANSIf breathing is absent.. 1. pain - hallmark sign, early sign 2. pressure - early sign 3. pallor, pules, paresthesia, paralysis - late sign - ANSSix P's of compartment syndrome: 1. Preparation 2. Preoxygenation 3. Pretreatment 4. Paralysis and Induction 5. Protecting and positioning - v 6. Placement of proof - secure the tube 7. Post intubation - secure ETT Tube, get X-ray for placement - ANSSteps of Rapid Sequence Intubation 1. Preparation and Triage 2. Primary Survery (ABCDE) with resuscitation adjuncts (F,G) 3. Reevaluation (consideration of transfer) TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ 4. Secondary Survey (HI) with reevaluation adjuncts 5. Reevaluation and post resuscitation care 6. Definitive care of transfer to an appropriate trauma nurse - ANSInitial Assessment 1. Suction the airway 2, Use care to avoid stimulating the gag reflex 3. If the airway is obstructed by blood or vomitus secretions, use a rigid suction device If foreign body is noted, remove it carefully with forceps or another appropriate method - ANSIf Airway is not patent 1. The tongue obstructing the airway 2. loose or missing teeth 3. foreign objects 4. blood, vomit, or secretions' 5. edema 6. burns or evidence of inhalation injury Auscultiate or listen for: 1. Obstructive airway sounds such as snoring or gurgling 2. Possible occlusive maxillofacial bony deformity 3. Subcutaneous emphysema - ANSInspect the mouth for: 8 year old child with longitudinal thigh lacerations - ANSSign of child abuse 8 year old child with longitudinal thigh lacerations - ANSSign of child abuse 24 Hour Burn Fluid Calculation - ANSDosage x Kg x % - ml in first 24 hours -More than 20% of their TBSA burned require: *Adults: 2-4 ml of crystalloid solution x kg x % *Peds: 3-4 ml of crystalloid solution x kg x % *Infants: fluid with 5% dextrose at a maintenance rate in addition to the Peds rate protocol (1/2 the amount should be infused in first 8 hours) 24 Hour Burn Fluid Calculation - ANSDosage x Kg x % - ml in first 24 hours -More than 20% of their TBSA burned require: *Adults: 2-4 ml of crystalloid solution x kg x % *Peds: 3-4 ml of crystalloid solution x kg x % *Infants: fluid with 5% dextrose at a maintenance rate in addition to the Peds rate protocol (1/2 the amount should be infused in first 8 hours) 24 Hour Burn Fluid Calculation - ANSDosage x Kg x % - ml in first 24 hours -More than 20% of their TBSA burned require: TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ A prego trauma pt develops tachy, hypotension, a rigide board like uterus, and dark, red vaginal bleeding. she reports constant back pain which is increasing. the most likely cause of s/s is - ANSplacental abruption A several groups of people are at higher risk for maltreatment including children, elderly, prego, and ... - ANSpt's with disability A the nurse is preparing to cleanse an extensive abrasion contaminated with dirt and gravel. which of the following intervention is indicated - ANSus copious amounts of NS A The systemic inflammatory response is a normal part of the body's response to shock from traumatic injury. what best describes this response - ANSit is activated by tissue hypoxia and sends neutrophils to injury site A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - ANSIntentional;unintentional A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - ANSIntentional;unintentional A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - ANSIntentional;unintentional A what is an early assessment finding to increased ICP in pt with a brain injury - ANSvomiting A when providing care for the pedicatric pt with burns the post resuscitation care, how are fluids delivered - ANSparkland formula with maintainence fluidss A which of hte following nursing interventions would be best for traumitc __________ - ANSHOB 30 degrees A which of the following structures would be hte most affected by teh concept of caviation - ANSLiver A which of the following values is within the acceptable limits for trauma pt - ANSend tidal CO2 of 40 A- Alertness, Airway, Cspine - ANS-*APVU -*Hold c-spine and use jaw thrust if not talking (2 people) -*Determine patency and protection of airway using inspection, palpation, auscultation -*States need for OPA ABCDEFG(LMNOP)HI - ANSAirway+Alertness Breathing+Ventilation Circulation/Control of Hemorrhage TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Disability (neuro stat) Exposure/Environmental Control Full set of vitals + family Get resuscitation adjuncts -monitor cardiac rhythm, naso/gastric tube, oxygen, ETCO2, pain History +Head to toe Inspect posterior surface Abdominal Compartment Syndrome - ANSgut swelling, inflammatory process use foley catheter to measure pressure in bladder, if bladder pressure high=high intra- abdominal pressure Across-the-room Observation - ANSassess for obvious uncontrolled hemorrhage activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP - ANSChemoreceptors: Adequate perfusion of oxygen and supply of nutrients to the brain tissue is dependent on ... and ... - ANSCPP; CBF Adequate perfusion of oxygen and supply of nutrients to the brain tissue is dependent on ... and ... - ANSCPP; CBF Adequate perfusion of oxygen and supply of nutrients to the brain tissue is dependent on ... and ... - ANSCPP; CBF Adrenal response - ANSRelease of catecholamines (epi and norepi) that increase contractility and HR Air cannot escape intrapleural space.. can begin to compress heart. pt will have sever resp distress, hypotension, JVD. - ANSTension pneumo Air enters the intrapleural space but cannot escape on expiration. The increasing intrathoracic pressure causes the lung on the injured side to collapse. If pressure is not relieved, the mediastinum can shift toward the uninjured side compressing the heart/great vessels/and opposite lung. S & S: anxiety, severe restlessness, severe respiratory distress, significantly diminished or absent breath sounds on injured side, hypotension, distended neck/head/upper extremity veins, tracheal deviation, or a shift toward uninjured side. Treatment: Needle thoracentesis and chest tube insertion - ANSTension Pneumothorax Air enters the intrapleural space but cannot escape on expiration. The increasing intrathoracic pressure causes the lung on the injured side to collapse. If pressure is not TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ relieved, the mediastinum can shift toward the uninjured side compressing the heart/great vessels/and opposite lung. S & S: anxiety, severe restlessness, severe respiratory distress, significantly diminished or absent breath sounds on injured side, hypotension, distended neck/head/upper extremity veins, tracheal deviation, or a shift toward uninjured side. Treatment: Needle thoracentesis and chest tube insertion - ANSTension Pneumothorax Airway -*6 - ANS-tongue obstruction -loose or missing teeth -foreign objects -blood, vomitus, secretions -edema -snoring, stridor, gurgling Amputation - ANSIn bag, on ice Amylase level looks at _____________ - ANSPancreas Amylase level looks at _____________ - ANSPancreas An external force applied time of impact, ex. Steering wheels or dashboards that collide with or push up into a person. - ANSCompression force An external force applied time of impact, ex. Steering wheels or dashboards that collide with or push up into a person. - ANSCompression force An external force applied time of impact, ex. Steering wheels or dashboards that collide with or push up into a person. - ANSCompression force Anaphylactic - ANSVasodilation due to allergens, IM epi anaphylactic shock - ANSDistributive shock A severe reaction that occurs when an allergen is introduced to the bloodstream of an allergic individual. Histamines are released which cause bronchoconstriction, labored breathing, widespread vasodilation, increased vascular permeability, circulatory shock, and sometimes sudden death. any deformities? bleeding? contusions, lacs? skin temp?? place splints on deformities, pulses - ANSHead to toe assessment: Extremities any lacs? deformities? blood at the urtheral meatus palpate pelvis with high pressure over the iliac wings downward and medially - ANSHead to toe assessment: pelvis and perineum Aortic Dissection - ANSUnequal extremity pulse strength possibility of.. TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ B the unrestrained fron seat passenger in a MVC develops echymosis around umbillicus. this assessment finding is most commonly associated with: - ANSbleeding in the peritoneal cavity B thinning skin and diminished autonomic response in older adult can have what effect on primary assessment - ANScompromised thermoregulation B when assessing a pt following a MVC the nurses asks how fsat the car was going - ANSwhen volocity is doubled speed is quadroupled B WHich may lead to unreliable pulse ox reading - ANScarboxyhemoglobin B which of hte following significant assessment findigns is frequently found in a patient with complete cransiofacial separation involving the maxilla, zygoma, orbits, and bones of the cranial base. - ANSdiplopia B which of the following hemodynamic support strategies is the prioririty intervention for a pt with traumatic pulmonary contusion - ANSjudicios use of IV fluids B-breathing and ventilation - ANS-*determine effectiveness of breathing using inspection, palpation, auscultation -*state need for BVM (10-12/min) Baby ok Then decrease LOC Weak cry - ANSHypoglycemia Base Excess (BE) - ANSnormal = -2 to +2 mEq/L base deficit < -6 is poor prognosis and develop acute traumatic coagulopathy (ATC) within 30 min basilar - ANSbase of skull, CSF leaks, periorbital edema, mastoid ecchymosis is battles sign Bduring the primary survery which of the following has the greatest priority - ANScervical spine injury Beck triad of cardiac tamponade - ANShypotension, distended neck veins, distant heart sounds Beck's Triad for Cardiac Tamponade - ANS1. Positive JVD 2. Muffled Heart Sounds 3. HOTN Becks triad - ANShypotension, JVD, muffled heart sounds TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ pericardial surgery or aspiration of fluids Before the arrival of the pt - ANSWhen should PPE be placed: Bilaterally fixed and pinpoint pupils may indicate an injury where? - ANS@ the pons or be from the effects of opioids Bleeding around belly button - ANSCullen's Sign Bleeding around belly button - ANSCullen's Sign Blunt Cardiac Injury (BCI) - ANSBruising of the heart BLUNT ESOPHAGEAL INJURY - ANSair in the mediastinum with possible widening, sub q emphysema Bowel sounds heard in the L chest. What is this a symptom of? - ANSRuptured diaphragm Bowel sounds heard in the L chest. What is this a symptom of? - ANSRuptured diaphragm brachial pulse - ANSUnder age of 1 where do you find a pulse Breathing- *8 - ANS-spontaneous breathing -symmetrical chest rise and fall- flail -depth, pattern, rate of respiration -increase WOB -skin color -open wounds, deformities, sub q emphysema -tracheal deviation, JVD -breath sounds equal and present Breathing: To assess breathing expose the chest: 1. Inspect for a. spontaneous breathing b. symmetrical rise and fall c. depth, pattern, and rate of respiration d. signs of difficulty breathing such as accessory muscle use e. skin color (normal, pale, flushed, cyanotic) f. contusions, abrasions, deformities (flail chest) g. open pneumothoraces (sucking chest wounds) h. JVD i. signs of inhalation injury (singed nasal hairs, carbonaceous sputum) - ANSB C - ANScirculation and control of hemorrhage TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -3 inspects for uncontrolled hemorrhage, palates central pulse, inspects and palpates skin for color, temp and moisture. -assess patency of prehospital IV -need 2nd IV -warmed isotonic crystalloid with blood tubing at controlled rate C 32 wk pregnant lady arrives in er after trapped in a car that flipped. the initial assessment reveals s/s of shock, vaginal bleeding, a palpable asymmetrical uterus, and slowing fetal heart tones what is the most likely cause - ANSuterine rupture C a college student presents to the er stating afterarriving at a party , she awoke in a dorm rom. she didnt recognize with no memory of the previous evening the trauma nurse prepare for what exam. - ANSsexual assult C an adult pt involved in a brush fire arrives to the er. upon initial assessment in the er the most concerning finding is - ANShoarse voice and repeatedly decides to clear throat. C an older adult pt fell in the bathtub 3 days ago. now she is exihibiting decreasd LOC and difficulty with speaking and walking. which of the following injuries is most effective - ANSsubdural hematoma C effective pain management in hte pt iwth rib fxwill promote what - ANScough with ability to clear secretions C properly restrained 6 wk old kid was involved in a MVC. after the assessment and stabilization the pt becomes more difficult to rouse. responding with a weak cry to painful stimuli. the pupils remain brisk and reactive. the anterior fontanel is soft and flat. what is the most likely cause and pririty interventions - ANShypoglycemia C What are the primary benefits of a team approach to trauma care - ANSit provides a systemic approach to care and organizes care C what organ might be injured in left lower rib fx - ANSspleen C which of the following would be priority intervention for a pt with multiple rib fractures and chest wall instability follwoing a mvc collision - ANSassist with endotracheal intubation C which of the follwoing is a risk factor for DVT in the trauma pt. - ANSpelvic fx C-circulation and hemorrhage - ANS-*determine adequacy of circulation using inspection, auscultation, palpation -assess medic line -*2nd large bore IV, warm crystalloid infusing at controlled rate if not shocky TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Cerebral Perfusion Pressure (CPP) - ANSCPP = MAP - ICP Cerebral response - ANS-brain autoregulates so blood is shunted from other organs to brain -SBP >50 cerebral ischemia occurs and the increase in CO2 in the brain stimulates the CNS response Chest tube insertion site - ANS5th intracostal space Church fever/malaise - ANSBiologic Circulation and Control of Hemorrhage Inspect first for any uncontrolled bleeding Skin color palpate for central pulses - carotid and femoral - rate, rhythm, and strength Skin temp: cool, diaphoretic, or warm and dry - ANSC Circulation- *3 - ANS-uncontrolled hemorrhage-elevate to heart, pressure, tourniquet -central and peripheral pulses -skin color, temp, moisture, cap refill Class 1 hemorrhagic shock - ANS- Loss of 15% (less than 750mL) of blood volume - Minimal tachycardia - less than 100BPM - No measureable change in BP, Pulse pressure, and RR - Body can compensate well -Anxious Class 2 Hemorrhage - ANSVasoconstriction still maintains BP, but with difficulty Blood flow is increased to vital organs (midbrain, heart, kidneys?) - Flow is decreased to kidneys, intestines, and skin -Loos of 15-30% of blood volume (750-1,500mL) Effects - Patient may be aggitated - Pale, cool, dry or moist skin - Pulse pressure narrows - Rapid heart rate - over 100 - Respiratory rate increases -20-30 - Delayed capillary refill Class 3 Hemorrhage - ANSVasoconstriction no longer maintains BP -blood loss 30-40% or 1,500-2,000mL TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Cardiac output decreases and becomes life-threatening Effects - Patient becomes more confused, restless, and agitated - Rapid heart rate - over 120 - Decreased systolic BP - Rapid respiratory rate 30-40 - Pale, cool, clammy extremities Class 4 Hemorrhage - ANSVasoconstriction is problematic and further impairs tissue perfusion and cellular oxygenation -blood loss greater than 40% and 2,000mL. Effects - Severely decreased mental status or loss of consciousness - lethargic - Marked tachycardia - over 140 -RR over 35 - Ultimately leads to organ failure and death CO - ANS=stroke volume+HR Co2 ... causes dilation of cerebral arterial vasculature and increased blood flood and increased ICP. ... causes constriction and decreased blood flow.! - ANSHypercapnia; hypocapnia Co2 ... causes dilation of cerebral arterial vasculature and increased blood flood and increased ICP. ... causes constriction and decreased blood flow.! - ANSHypercapnia; hypocapnia Co2 ... causes dilation of cerebral arterial vasculature and increased blood flood and increased ICP. ... causes constriction and decreased blood flow.! - ANSHypercapnia; hypocapnia Collaborative Care of Flail Chest - ANS-Adequate Oxygenation-100% mask -Monitor for Hypoxemia-ABGs, SpO2 -Pain Management-Intercostal Block, Epidural, PCA -Possible Mechanical Ventilation Collaborative Care of Tension Pneumothorax - ANS-Oxygen -Needle Thoracentesis -Heimlich Valve: one way valve, allows air out but not in -Monitor SpO2, ABGs, RR, depth, BS -Chest Tube Collaborative Care: Early Phases - ANS-Airway, Breathing, Oxygenation TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -Circulation, Perfusion -IV Fluids -PRBCs first -Possible Vasopressors -Positioning: Modified Trendelenberg -Pain Control -Antibiotics -Tetanus Prophylaxis Collaborative Management of Pelvic Fractures - ANS-Prevent/Control Hemorrhage & Shock -Stabilize Pelvis -Bed rest> 5 days (risk of DVT) Collaborative Management of Spleen & Liver Injuries - ANS-Medical: monitor, Serial H/H -Surgical: repair vs remove organ (better not to remove) -Supportive Treatment: O2, blood, fluids, vasopressors Collection of blood in pericardial sac. Mechanism of injury is typically penetrating trauma. Compresses the heart and decreases ability of the ventricles to fill causing decreased SV and CO. S & S: hypotension, muffled heart sounds, distended neck veins, tachycardia or PEA, dyspnea, cyanosis, chest pain. Surgical evacuation will be needed. - ANSCardiac Tamponade Collection of blood in pericardial sac. Mechanism of injury is typically penetrating trauma. Compresses the heart and decreases ability of the ventricles to fill causing decreased SV and CO. S & S: hypotension, muffled heart sounds, distended neck veins, tachycardia or PEA, dyspnea, cyanosis, chest pain. Surgical evacuation will be needed. - ANSCardiac Tamponade Colorimetric CO2 detectors provide info about the presence or absence of CO2. A chemically treated indicator strip changes color revealing the presence or absence of exhaled CO2 - ANSQualitative Compartment syndrome - ANSPain Pulse Pallor Pressure Paralysis Parasthesia Compensated stage - ANS-SBP is normal, rising DBP, tachy bounding, lactate builds up Complete craniofacial separation involving maxilla, zygoma, orbits, and bones of the cranial base. Assessment findings include: massive facial edema, mobility and TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ D- disability - ANS-*GCS- eye opening, verbal response, motor -*pupils -*need for head CT, cspine Decrease cranial calcification - ANSCT normal without radio graphic abnormality Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define Hemothorax. - ANSAccumulation of blood in the pleural space. Define Hemothorax. - ANSAccumulation of blood in the pleural space. Define Hemothorax. - ANSAccumulation of blood in the pleural space. Define Hemothorax. - ANSAccumulation of blood in the pleural space. Define Hemothorax. - ANSAccumulation of blood in the pleural space. Define Minor Head Trauma. - ANSGCS 13-15 Define Minor Head Trauma. - ANSGCS 13-15 Define Minor Head Trauma. - ANSGCS 13-15 Define Minor Head Trauma. - ANSGCS 13-15 TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Define Minor Head Trauma. - ANSGCS 13-15 Define Moderate Head Trauma - ANSPostresuscitative state with GCS 9-13. Define Moderate Head Trauma - ANSPostresuscitative state with GCS 9-13. Define Moderate Head Trauma - ANSPostresuscitative state with GCS 9-13. Define Moderate Head Trauma - ANSPostresuscitative state with GCS 9-13. Define Moderate Head Trauma - ANSPostresuscitative state with GCS 9-13. Define Pneumothorax. - ANSResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total collapse of lung may ensue. An open pneumothorax results from wound through chest wall. Air enters pleural space both through the wound and trachea. Define Pneumothorax. - ANSResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total collapse of lung may ensue. An open pneumothorax results from wound through chest wall. Air enters pleural space both through the wound and trachea. Define Pneumothorax. - ANSResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total collapse of lung may ensue. An open pneumothorax results from wound through chest wall. Air enters pleural space both through the wound and trachea. Define Pneumothorax. - ANSResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total collapse of lung may ensue. An open pneumothorax results from wound through chest wall. Air enters pleural space both through the wound and trachea. Define Pneumothorax. - ANSResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total collapse of lung may ensue. An open pneumothorax results from wound through chest wall. Air enters pleural space both through the wound and trachea. TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Define Severe Head Trauma. - ANSPostresuscitative state with GCS score of 8 or less. Define Severe Head Trauma. - ANSPostresuscitative state with GCS score of 8 or less. Define Severe Head Trauma. - ANSPostresuscitative state with GCS score of 8 or less. Define Severe Head Trauma. - ANSPostresuscitative state with GCS score of 8 or less. Define Severe Head Trauma. - ANSPostresuscitative state with GCS score of 8 or less. Intubation is recommended Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Distributive - ANSNeurogenic Septic Anaphylactic Do not place ___________________ in head trauma patients - ANSnasogastric TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Do not place ___________________ in head trauma patients - ANSnasogastric don't forget flanks!!! inspect of lacs, puncture wounds, contusions, auscultate then palpate: bowel sounds? any rigidity, guarding? begin with light palpation start to palpate with side that does not hurt maybe do a fast scan? - ANSHead to toe assessment: Abdomen DOPE - ANSDisplace, obstructed, pneumo, equipment Dry chem exposure - ANSRemove pt clothing Dx of Spleen & Liver Injuries - ANSCT, DPL, FAST E - ANSExposure and environmental control -remove all clothing and inspect for uncontrolled bleeding or obvious injury -keep pt warm (blankets, warming lights, increased room temp, warmed fluids, warmed oxygen E-exposure - ANS-*need to remove all clothing and inspect for hemorrhage, injury, deformity -warm patient- blankets, fluids, temp -forensics Early findings of increased ICP include - ANSHeadache, nausea and vomiting, amnesia, behavior changes, altered level consciousness Early findings of increased ICP include - ANSHeadache, nausea and vomiting, amnesia, behavior changes, altered level consciousness Early findings of increased ICP include - ANSHeadache, nausea and vomiting, amnesia, behavior changes, altered level consciousness Early sign of Increased ICP - ANSN/V Early signs of ICP - ANSDecreased LOC - Amnesia Behavior changes- impaired judgment, restlessness, drowsiness) Pupil changes TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Vision abnormalities (brain swelling is putting pressure on the optic and oculomotor nerves) Headache Vomiting (pressure on the vagal nerve center of the brain that controls vomiting) Nuchal rigidity Early signs of ICP increase, CPP decrease - ANSNV, Ha, amnesia, AMS, LOC Energy can neither be created nor destroyed but rather I can change form - ANSLaw of conservation of energy Energy can neither be created nor destroyed but rather I can change form - ANSLaw of conservation of energy Energy can neither be created nor destroyed but rather I can change form - ANSLaw of conservation of energy Epidural hematoma - ANStemporal or parietal skull that lacerate the meningeal artery younger population, with skull fx, rapid accumulation of arterial blood in space transient LOC, rapid deterioation ETT - ANS-tube in trachea with cuff inflated -GCS<8 -inhalation injury, unable to breath due to pain, apnea, high risk for aspiration/decompensation Examples that can cause distributive shock - ANSAnaphylactic shock, septic shock, neurogenic shock Examples that can cause distributive shock - ANSAnaphylactic shock, septic shock, neurogenic shock Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - MI - Blunt cardiac injury - Mitral valve insufficiency - dysrhythmias - Cardiac Failure Explain Distributive Shock. - ANSResults from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Distributive Shock. - ANSResults from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Distributive Shock. - ANSResults from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Distributive Shock. - ANSResults from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Distributive Shock. - ANSResults from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Hepatic Response. - ANSLiver can store excess glucose as glycogen. As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hepatic Response. - ANSLiver can store excess glucose as glycogen. As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hepatic Response. - ANSLiver can store excess glucose as glycogen. As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hepatic Response. - ANSLiver can store excess glucose as glycogen. TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hepatic Response. - ANSLiver can store excess glucose as glycogen. As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes: - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). - Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium. - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes: - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). - Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium. - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Pulmonary Response. - ANSTachypnea happens for 2 reasons: 1. Maintain acid-base balance 2. Maintain increased supply of oxygen * Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli. Explain Pulmonary Response. - ANSTachypnea happens for 2 reasons: 1. Maintain acid-base balance 2. Maintain increased supply of oxygen * Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli. Explain Pulmonary Response. - ANSTachypnea happens for 2 reasons: 1. Maintain acid-base balance 2. Maintain increased supply of oxygen TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ * Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli. Explain Pulmonary Response. - ANSTachypnea happens for 2 reasons: 1. Maintain acid-base balance 2. Maintain increased supply of oxygen * Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli. Explain Pulmonary Response. - ANSTachypnea happens for 2 reasons: 1. Maintain acid-base balance 2. Maintain increased supply of oxygen * Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli. Exposure and Environmental Control Remove all clothes and assess for any obvious injuries and uncontrolled bleeding - ANSE F - ANSfull set of vitals facilitate family presence F- full set of vitals and family presence - ANS- full set of vitals -liaison for family Facial Fx - ANSCSF Family presence - ANSClear policies FiO2 - ANSinspired concentration of O2 Flail chest - ANS3 or more ribs fractured in 2 or more places, parodoxical rise and fall of chest wall Flail chest - ANSIntubate Flail chest - ANSParadoxical chest wall movement Focused Assessment Sonogram for Trauma (FAST) - ANS-Ultrasound TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -Non-Invasive, quick -Inexpensive -Accurate with good technician & reader -Helpful with unstable patients Focused Survey - ANS-Lab studies: trauma panel -Radiographic Studies (X-rays): C-spine, Chest, Pelvis -Injury Specific Diagnostics: CT, extremity, abdomen For every action there is an equal and opposite reaction - ANSNewton's third law For every action there is an equal and opposite reaction - ANSNewton's third law For every action there is an equal and opposite reaction - ANSNewton's third law Force = mass x acceleration - ANSNewton's second law Force = mass x acceleration - ANSNewton's second law Force = mass x acceleration - ANSNewton's second law from hemorrhage is leading cause. Hypovolemia is caused by decrease in the amount of circulating volume. Goal is to replace volume. - ANSHypovolemic Shock Full set of vitals and family presence - ANSF G - ANSGET resuscitation adjuncts LMNOP G- LMNOP - ANS- labs- lactate, ABG, type and cross, glucose -m-monitor -n-NG/OG -o-pulse ox -p-pain- pharma and nonpharm GCS breakdown - ANS GCS scores : I. Mild TBI II. Moderate TBI III. Severe TBI - ANS13-15; 9-12; 8 or less GCS scores : I. Mild TBI II. Moderate TBI III. Severe TBI - ANS13-15; 9-12; 8 or less TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ MOI Injuries sustained S s/s in the field T treatment in the field if patients family present get a better hx on them - ANSH How do you assess Mnemonic "D"? - ANSDISABILITY A = Alert V = Verbal P = Pain U = Unresponsive - GCS - PERRL? - Determine presence of lateralizing signs including: - Unilateral deterioration in motor movements or unequal pupils - Symptoms that help to locate area of injury in brain How do you confirm ET Tube/Alternative Airway Placement? - ANS- Visualization of the chords - Using bronchoscope to confirm placement - Listening to breath sounds over the epigastrum and chest walls while ventilating the pt - CO2 detector - Esophageal detection device - Chest x-ray How do you confirm ET Tube/Alternative Airway Placement? - ANS- Visualization of the chords - Using bronchoscope to confirm placement - Listening to breath sounds over the epigastrum and chest walls while ventilating the pt - CO2 detector - Esophageal detection device - Chest x-ray How do you confirm ET Tube/Alternative Airway Placement? - ANS- Visualization of the chords - Using bronchoscope to confirm placement - Listening to breath sounds over the epigastrum and chest walls while ventilating the pt - CO2 detector - Esophageal detection device - Chest x-ray How do you confirm ET Tube/Alternative Airway Placement? - ANS- Visualization of the chords - Using bronchoscope to confirm placement - Listening to breath sounds over the epigastrum and chest walls while ventilating the pt - CO2 detector TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Esophageal detection device - Chest x-ray How do you confirm ET Tube/Alternative Airway Placement? - ANS- Visualization of the chords - Using bronchoscope to confirm placement - Listening to breath sounds over the epigastrum and chest walls while ventilating the pt - CO2 detector - Esophageal detection device - Chest x-ray How do you inspect the chest for adequate ventilation? - ANSObserve: - mental status - RR and pattern - chest wall symmetry - any injuries - patient's skin color (cyanosis?) - JVD or tracheal deviation? (Tension pneumothorax) How do you inspect the chest for adequate ventilation? - ANSObserve: - mental status - RR and pattern - chest wall symmetry - any injuries - patient's skin color (cyanosis?) - JVD or tracheal deviation? (Tension pneumothorax) How do you inspect the chest for adequate ventilation? - ANSObserve: - mental status - RR and pattern - chest wall symmetry - any injuries - patient's skin color (cyanosis?) - JVD or tracheal deviation? (Tension pneumothorax) How do you inspect the chest for adequate ventilation? - ANSObserve: - mental status - RR and pattern - chest wall symmetry - any injuries - patient's skin color (cyanosis?) - JVD or tracheal deviation? (Tension pneumothorax) How do you inspect the chest for adequate ventilation? - ANSObserve: - mental status - RR and pattern TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - chest wall symmetry - any injuries - patient's skin color (cyanosis?) - JVD or tracheal deviation? (Tension pneumothorax) How external forces in the environment are transferred to the body - ANSMechanism of injury How external forces in the environment are transferred to the body - ANSMechanism of injury How external forces in the environment are transferred to the body - ANSMechanism of injury How should you dress a severed limb? - ANSSterile gauze with normal saline THEN put ice on it How should you dress a severed limb? - ANSSterile gauze with normal saline THEN put ice on it How to maintain ICP < 20mmHg - ANSElevated HOB 30 Degrees Provide sedation Loosen cervical collar Drain CSF Administer mannitol prn initiate insulin therapy promote normothemia How would you assess a patient with ocular, maxillofacial and neck trauma? - ANS(Initial assessment) HISTORY - MOI? - Acceleration/Deceleration? - What was it caused by? - Pt restrained? Airbags deployed? Etc. - What are the pt's complaints? - Pt normally wear glasses or contacts? - Pt have hx of eye problems? - Pt ever have eye surgery? - Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION: - Inspect eye, orbits, face and neck - Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas - Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas - Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents - Determine whether lid lac's - Assess pupil's (PERRL) - Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome - Bilateral fixed and pinpoint pupils = pontine lesion or drugs - Mildly dilated pupil w/sluggish response may early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Assess for consensual response - Assess redness, eye watering, blepharospasm - Assess extraocular movement, except when an open globe injury is known or suspected. - Limitation range of ocular motion may indicate orbital rim fx w/entrapment or paralysis of cranial nerve or ocular muscle - Perform visual acuity exam - Use Snellen or handheld chart. Check uninjured eye first - Assess for blurred or double vision with injured eye and then with both eyes open - Inspect for rhinorrhea or otorrhea - If drng present, may indicate CSF leak - Observe for impaled objects - Assess occlusion of mandible and maxilla - Malocclusion or inability to open + close mouth is highly indicative of maxillary or mandibular fx - Observe for uncontrolled bleeding PALPATION - Palpate periorbital area, face and neck for: - Tenderness - Edema - Step-off de How would you assess a patient with ocular, maxillofacial and neck trauma? - ANS(Initial assessment) HISTORY - MOI? - Acceleration/Deceleration? - What was it caused by? - Pt restrained? Airbags deployed? Etc. - What are the pt's complaints? - Pt normally wear glasses or contacts? - Pt have hx of eye problems? - Pt ever have eye surgery? - Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION: TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Inspect eye, orbits, face and neck - Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas - Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents - Determine whether lid lac's - Assess pupil's (PERRL) - Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome - Bilateral fixed and pinpoint pupils = pontine lesion or drugs - Mildly dilated pupil w/sluggish response may early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Assess for consensual response - Assess redness, eye watering, blepharospasm - Assess extraocular movement, except when an open globe injury is known or suspected. - Limitation range of ocular motion may indicate orbital rim fx w/entrapment or paralysis of cranial nerve or ocular muscle - Perform visual acuity exam - Use Snellen or handheld chart. Check uninjured eye first - Assess for blurred or double vision with injured eye and then with both eyes open - Inspect for rhinorrhea or otorrhea - If drng present, may indicate CSF leak - Observe for impaled objects - Assess occlusion of mandible and maxilla - Malocclusion or inability to open + close mouth is highly indicative of maxillary or mandibular fx - Observe for uncontrolled bleeding PALPATION - Palpate periorbital area, face and neck for: - Tenderness - Edema - Step-off de How would you assess a pt in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect: - LOC - Rate and quality of respirations - External bleeding? - Skin color and moisture - Assess jugular veins and peripheral veins Auscultate: - BP - Pulse pressure - Breath sounds - Heart sounds TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Bowel sounds Percuss: - Chest and abdomen Palpate: - Central pulse (carotid or femoral) - Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse - Palpate peripheral pulses - Palpate skin temp and moisture Diagnostic Procedures: - Xrays and other studies - Labs Planning and Implementation - Oxygen - IV's with warmed replacement fluids - Control external bleeding with direct pressure - Elevate LE's - NGT - Foley - Monitor and pulse oximeter - Monitor for development of coagulopathies - Surgery? How would you assess a pt in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect: - LOC - Rate and quality of respirations - External bleeding? - Skin color and moisture - Assess jugular veins and peripheral veins Auscultate: - BP - Pulse pressure - Breath sounds - Heart sounds - Bowel sounds Percuss: - Chest and abdomen Palpate: - Central pulse (carotid or femoral) - Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse - Palpate peripheral pulses - Palpate skin temp and moisture Diagnostic Procedures: TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates - Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Determine if pt uses eye meds - Abnormal posturing? - Inspect craniofacial area for ecchymosis/contusions - Periorbital ecchymosis - Mastoid's process ecchymosis - Blood behind tympanic membrane - Inspect nose and ears for drainage - Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF - If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF - Assess extraocular eye movement (Tests cranial nerves, III, IV, VI) - Performing extraocular eye movements indicates functioning brainstem - Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle - Determine LOC with GCS PALPATION - Palpate cranial area for: - Point tenderness - Depressions or deformities - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing - Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION - (Initial assessment) - Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 How would you assess a pt with a cranial injury? - ANS(Initial assessment) INSPECTION: - Assess airway - RR, pattern and effort - Assess pupil size and response to light - Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates - Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Determine if pt uses eye meds - Abnormal posturing? - Inspect craniofacial area for ecchymosis/contusions - Periorbital ecchymosis - Mastoid's process ecchymosis - Blood behind tympanic membrane - Inspect nose and ears for drainage - Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF - If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF - Assess extraocular eye movement (Tests cranial nerves, III, IV, VI) - Performing extraocular eye movements indicates functioning brainstem - Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle - Determine LOC with GCS PALPATION - Palpate cranial area for: - Point tenderness - Depressions or deformities - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing - Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION - (Initial assessment) - Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 How would you assess a pt with a cranial injury? - ANS(Initial assessment) INSPECTION: - Assess airway - RR, pattern and effort - Assess pupil size and response to light - Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates - Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Determine if pt uses eye meds - Abnormal posturing? - Inspect craniofacial area for ecchymosis/contusions - Periorbital ecchymosis - Mastoid's process ecchymosis - Blood behind tympanic membrane - Inspect nose and ears for drainage - Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF - If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF - Assess extraocular eye movement (Tests cranial nerves, III, IV, VI) - Performing extraocular eye movements indicates functioning brainstem - Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle - Determine LOC with GCS PALPATION - Palpate cranial area for: - Point tenderness - Depressions or deformities - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing - Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION - (Initial assessment) - Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 How would you assess a pt with a cranial injury? - ANS(Initial assessment) INSPECTION: - Assess airway - RR, pattern and effort - Assess pupil size and response to light - Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Percussion: - Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax) Palpation: - Palpate chest wall, clavicles and neck for: - Tenderness - Swelling or hematoma - Subcutaneous emphysema - Note presence of bony crepitus - Palpate central and peripheral pulses and compare quality between: - Right and left extremities - Upper and lower extremities - Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension pneumothorax or massive hemothorax) - Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate aortic injury). Auscultation: - Auscultate compare BP in both UE's and LE's - Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS = splinting. Shallow = b/c of pain). - Auscultate chest for presence of BS (diaphragmatic rupture) - Auscultate Heart sounds (muffled = pericardial tamponade) - Auscultate neck vessels for bruits (vascular injury) Diagnostic Procedures: - Xrays - Arteriography - Bronchoscopy and laryngoscopy - CT's - FAST - Labs (cardiac enzymes) - ECG, CVP How would you assess a pt with a thoracic injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe chest wall - Assess breathing effort and RR - Symmetry - Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or pericardial tamponade. Flat = external jugular veins may reflect hypovolemia) - Inspect upper abdominal region for injury Percussion: - Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax) Palpation: - Palpate chest wall, clavicles and neck for: TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Tenderness - Swelling or hematoma - Subcutaneous emphysema - Note presence of bony crepitus - Palpate central and peripheral pulses and compare quality between: - Right and left extremities - Upper and lower extremities - Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension pneumothorax or massive hemothorax) - Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate aortic injury). Auscultation: - Auscultate compare BP in both UE's and LE's - Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS = splinting. Shallow = b/c of pain). - Auscultate chest for presence of BS (diaphragmatic rupture) - Auscultate Heart sounds (muffled = pericardial tamponade) - Auscultate neck vessels for bruits (vascular injury) Diagnostic Procedures: - Xrays - Arteriography - Bronchoscopy and laryngoscopy - CT's - FAST - Labs (cardiac enzymes) - ECG, CVP How would you assess a pt with a thoracic injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe chest wall - Assess breathing effort and RR - Symmetry - Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or pericardial tamponade. Flat = external jugular veins may reflect hypovolemia) - Inspect upper abdominal region for injury Percussion: - Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax) Palpation: - Palpate chest wall, clavicles and neck for: - Tenderness - Swelling or hematoma - Subcutaneous emphysema - Note presence of bony crepitus TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Palpate central and peripheral pulses and compare quality between: - Right and left extremities - Upper and lower extremities - Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension pneumothorax or massive hemothorax) - Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate aortic injury). Auscultation: - Auscultate compare BP in both UE's and LE's - Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS = splinting. Shallow = b/c of pain). - Auscultate chest for presence of BS (diaphragmatic rupture) - Auscultate Heart sounds (muffled = pericardial tamponade) - Auscultate neck vessels for bruits (vascular injury) Diagnostic Procedures: - Xrays - Arteriography - Bronchoscopy and laryngoscopy - CT's - FAST - Labs (cardiac enzymes) - ECG, CVP How would you care for a pt with an Abdominal Injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe the lower chest for asymmetric chest wall movement. -Observe the contour of the abdomen. Distention may indicate bleeding -Inspect lower chest, abdomen, flanks, and back for seat belt abrasions or soft tissue injuries -Inspect pelvic area for soft tissue bruising Percussion: - Percuss for hyperresonance or dullness. Hyperresonance indicates air, dullness indicates fluid. Palpation: - Palpate all four quadrants. Press and quickly release to determine presence of rebound tenderness. -Palpate pelvis for bony instability, asymmetry, or pain. -Palpate flanks for tenderness -Palpate anal sphincter for presence or absence of tone Auscultation: -Auscultate the chest. If bowel sounds heard in chest may have diaphragmatic rupture with herniation of the stomach or small bowel -Auscultate bowel sounds. Absence indicative of visceral injury. Diagnostic Procedures: TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -Auscultate the chest. If bowel sounds heard in chest may have diaphragmatic rupture with herniation of the stomach or small bowel -Auscultate bowel sounds. Absence indicative of visceral injury. Diagnostic Procedures: - Xrays - MRI - IVP and DPL - CT's - FAST - Labs (cardiac enzymes) -Cystogram or urethrogram -Angiography Hr 146 RR increased BP decreased Moan to pain - ANSDecomp shock Hypercapnia causes _________________; Hypocapnia causes __________________ - ANSVasodilation; Vasoconstriction Hypercapnia causes _________________; Hypocapnia causes __________________ - ANSVasodilation; Vasoconstriction Hypotension and cerebral blood flow - ANS-CO2 causes dialation, if CPP outside of 50- 160, regulation fails and flow relies on MAP, MAP <60 hypoxic <60 edema Hypovolemia/ hemorraghic - ANS-loss of plasma, blood, volume -decrease preload -fluid resus ICP - ANSnormal is 0-15, >20 BAD ICP is a reflection of what three volumes? What happens when one increases? - ANS1. Brain 2. CSF 3. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. ICP is a reflection of what three volumes? What happens when one increases? - ANS1. Brain 2. CSF 3. Blood within the nonexpansible cranial vault TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. ICP is a reflection of what three volumes? What happens when one increases? - ANS1. Brain 2. CSF 3. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. ICP is a reflection of what three volumes? What happens when one increases? - ANS1. Brain 2. CSF 3. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. ICP is a reflection of what three volumes? What happens when one increases? - ANS1. Brain 2. CSF TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ 3. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. IF clothing is needed for evidence preserve in paper bag. Maintain body temp - cover the pt, turn up heat in room, administer warm fluids - ANSE Interventions: If injury causes the CPP to fall outside the range of 50 - 160, the brain loses its ability to ... and CBF is directly dependent on ... for perfusion - ANSAuto regulate ; MAP If injury causes the CPP to fall outside the range of 50 - 160, the brain loses its ability to ... and CBF is directly dependent on ... for perfusion - ANSAuto regulate ; MAP If injury causes the CPP to fall outside the range of 50 - 160, the brain loses its ability to ... and CBF is directly dependent on ... for perfusion - ANSAuto regulate ; MAP immobilize cervical spine, tenderness, tracheal deviation - ANSHead to toe assessment: Neck and cervical spine Impalements - ANS-DO NOT remove the object -Stabilize/Support the Object -Tape in Place if possible, prepare for OR -Object removed in OR in massive transfusion protocol... responsible for dissolving clots - ANSTXA In the ... ... response two catecholamines are released ... and ... . - ANSAdrenal gland response; epinephrine and norepinephrine In the ... ... response two catecholamines are released ... and ... . - ANSAdrenal gland response; epinephrine and norepinephrine In the ... ... response two catecholamines are released ... and ... . - ANSAdrenal gland response; epinephrine and norepinephrine TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ BMP Liver profile labs, wound care, tetanus, administer meds, prepare for transfer - ANSSecondary Reval Adjuncts Late assessment findings of increased ICP include: - ANS- DILATED, NON-REACTIVE PUPILS - UNRESPONSIVENESS to verbal/painful stimuli - ABNORMAL POSTURING (flexation, extension, flaccidity) - CUSHING RESPONSE Widening pulse pressure Reflex bradycardia Decreased respiratory effort Late findings of increased ICP include - ANSDilated, nonreactive pupils, unresponsiveness, abnormal posturing, Cushing response, bradycardia, decreased respiratory Effort Late findings of increased ICP include - ANSDilated, nonreactive pupils, unresponsiveness, abnormal posturing, Cushing response, bradycardia, decreased respiratory Effort Late findings of increased ICP include - ANSDilated, nonreactive pupils, unresponsiveness, abnormal posturing, Cushing response, bradycardia, decreased respiratory Effort Late signs of ICP increase - ANSnon reactive pupils, cushins, posturing Later Complications of Trauma - ANS-Thromboembolism (DVT & Pulmonary) -Fat Embolism with Ortho Trauma -Infection, Sepsis, Septic Shock -ARDS -Primary MODS -Compartment Syndrome -Rhabdomyolysis -Renal Failure -Death Leading cause of preventable death after injury - ANSHemorrhage Leading cause of preventable death after injury - ANSHemorrhage Lefort I - ANStransverse maxillary (above the teeth) TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Lefort II - ANSFrontal process of MAXILLA, NOSE bones , & inferior / medial ORBITAL WALL fractures Rhinorhea Lefort III - ANSComplete separation of midface including nasoethmoidal complex, zygomas, and the maxilla Level 1 Trauma Centers - ANS-Resources & Staff -24 hour in house surgeons & staff available -CPB capability -Multi-specialities (Neuro & Thoracic surgeons) -Research -Education, Prevention, & Outreach Programs Linear - ANSnondisplaced fx LMNOP - ANSLabs (blood samples, blood gas) Monitor (attaches pt to cardiac monitor N-naso/orogastric tube Oximeter and calnography. Pain -pharmacological and nonpharmacologcial pain measu Lower Rib Fractures - ANSpossible abdominal organ/vessel injury Ribs #11-12 free floating & can result in liver, spleen, or diaphragm injury Mandate report - ANS6 yr old loop bruising Mannitol - ANSosmotic diuretic but also used to help reduce ICP - it will not reduce ICP in hypovolemia so do not use on hypotensive pt. Bolus is better than infusion. Massive Blood Transfusion: Monitor ___________ levels: sodium acetate binds with ____ so levels decrease. - ANSCalcium Massive Blood Transfusion: Monitor ___________ levels: sodium acetate binds with ____ so levels decrease. - ANSCalcium MATCH - ANSMassive hemorrhage, Airway, Respiration, Circulation, Head Injury/Hypothermia maxillary fracture - ANSLefort I, II, III Meningeal artery - ANSEpidural hematoma TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Middle Meningeal Artery - ANSEpidural Hematoma (results from collection of blood that forms between dura mater and skull) Middle Meningeal Artery - ANSEpidural Hematoma (results from collection of blood that forms between dura mater and skull) MIST - ANSMechanism of action Injuries S/S Treatment Most common Ribs fractured - ANS#3-9 Most frequently injured organ - ANSLiver Most frequently injured organ - ANSLiver Most frequently injured organ from BLUNT trauma - ANSSpleen Most frequently injured organ from BLUNT trauma - ANSSpleen MTP - ANS1:1:1 monitor Ca bc citrate inhibits clotting cascade Muffled heart sounds - ANSCardiac tamponade? Pericardial fluid? Muffled heart sounds - ANSCardiac tamponade? Pericardial fluid? Multiple people are in the ER of different ages who all go to the same church. They all have the same symptoms. What is the most likely cause? - ANSBiologic Multiple people are in the ER of different ages who all go to the same church. They all have the same symptoms. What is the most likely cause? - ANSBiologic MVA diff breathing Tachycardia - ANSLiver lac Narrow pulse pressure (rising diastolic) could indicate - ANSPeriphreal Vasoconstriction, Hypo perfusion, stage 1 + 2 compensated shock, tension pneumothorax, pericardial tamponade Needle decompression insertion site - ANS2nd intracostal space Needle pericardiocentesis, but it is a temp solution. Requires surgical evaluation. (Ultrasound guided) - ANSCardiac Tamponade Intervention: TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -Cover open wounds with dry, sterile dressings. -Administer antibiotics, as prescribed -Inspect dressings frequently for continued bleeding -Administer tetanus prophylaxis, as indicated Nsg Interventions for Open Fracture - ANS-Irrigate any wound with sterile saline -Cover open wounds with dry, sterile dressings. -Administer antibiotics, as prescribed -Inspect dressings frequently for continued bleeding -Administer tetanus prophylaxis, as indicated Nsg Interventions for Open Fracture - ANS-Irrigate any wound with sterile saline -Cover open wounds with dry, sterile dressings. -Administer antibiotics, as prescribed -Inspect dressings frequently for continued bleeding -Administer tetanus prophylaxis, as indicated Nsg Interventions for Open Fracture - ANS-Irrigate any wound with sterile saline -Cover open wounds with dry, sterile dressings. -Administer antibiotics, as prescribed -Inspect dressings frequently for continued bleeding -Administer tetanus prophylaxis, as indicated Nsg Interventions for Pelvic Fracture - ANS-Stabilize pelvis by wrapping in folded sheet -Apply a pneumatic antishock garment to splint pelvic fractures -Prepare for application of an external fixator Nsg Interventions for Pelvic Fracture - ANS-Stabilize pelvis by wrapping in folded sheet -Apply a pneumatic antishock garment to splint pelvic fractures -Prepare for application of an external fixator Nsg Interventions for Pelvic Fracture - ANS-Stabilize pelvis by wrapping in folded sheet -Apply a pneumatic antishock garment to splint pelvic fractures -Prepare for application of an external fixator Nsg Interventions for Pelvic Fracture - ANS-Stabilize pelvis by wrapping in folded sheet -Apply a pneumatic antishock garment to splint pelvic fractures -Prepare for application of an external fixator Nuerogenic shock - ANSDistributive shock Develops from spinal cord injuries and results in the loss of sympathetic nervous system control of vascular tone, which produces venous and arterial vasodilation. With the loss of SNS unopposed vagal activity may result in bradycardia > atropine or tanscutaneous pacing. Nursing intervention prevent infection - ANSSaline gauze TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Nursing intervention shiney/tight - ANSLevel of heart Obese Increase abd pressure Decrease venous return - ANSEmboli Obese hypo-ventilation - ANSIncrease airway resistance Decrease chest wall compliance Increase intra-abd pressure Obstructive - ANS-inadequate circulating blood volume bc of obstruction of the great veins, aorta, pulm arteries, heart -cardiac tamponade (muffled heart sounds, tachy), tension pneumo (deviated trachea), tension hemo Occular nursing intervention - ANSElevate HOB occurs as a result of maldistribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. Ex: Anaphylactic - release of antihistamines Septic Shock - systemic release of bacterial endotoxins, resulting in increased vascular permeability and vasodilation. Neurogenic shock - spinal cord injury results of loss in sympathetic nervous system control of vascular tone. Goal: Volume replacement and vasoconstriction - ANSDistributive Shock Older adult intubation - ANS-relaxed oropharyngeal muscles -cervial arthritis Older adults are harder to intubate due to ______________ ____________ - ANScervical arthritis Older adults are harder to intubate due to ______________ ____________ - ANScervical arthritis oligoanalgesia - ANSUndertreating pain Oliguria is defined as - ANSDiminished urinary output - Urine output < 0.5 mL/kg per hour (40 mL/h for an 80 kg/175lb adult) OPA - ANS-no gag -temp measure Open Pneumothorax - ANSHole in chest wall where air gets pulled in & out of TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ not as life threatening, no build up in pressure or shift Other Early Complications from Traumatic Injuries - ANS-Fluid Overload -SIRS P - ANSPosterior surfaces -states need to maintain cervical spine -Inspects AND palpates posterior surfaces -consider removal of spinal cord PaCO2 - ANSPartial pressure of CO2 dissolved in blood PaCO2 effects on brain - ANSIncreased levels of PaCO2 cause vasodilation in brain = increased blood flow and increased ICP Pain Ladder: Step 1: Non-opioids for mild pain Step 2: Weak opioids for mild to moderate pain Step 3: Strong opioids for moderate to severe pain - ANS1: Tylenol, Ibuprofen, Ketorolac 2: Codeine 3: Morphine, Fentanyl, Dilaudid Pain Ladder: Step 1: Non-opioids for mild pain Step 2: Weak opioids for mild to moderate pain Step 3: Strong opioids for moderate to severe pain - ANS1: Tylenol, Ibuprofen, Ketorolac 2: Codeine 3: Morphine, Fentanyl, Dilaudid PaO2 - ANSPartial pressure of oxygen dissolved in arterial blood, low reading= hypoxia Paradoxical Movement with Flail Chest - ANSFlail area moves in opposite direction of chest cage Patient has GCS of 3, unequal pupils (one sluggish, one blown), and is posturing. What is the cause? - ANSHerniation Patient has GCS of 3, unequal pupils (one sluggish, one blown), and is posturing. What is the cause? - ANSHerniation Patient snoring = insert __________ airway - ANSOral Airway (OPA) Patient snoring = insert __________ airway - ANSOral Airway (OPA) TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ often seen with rib fx inflammatory process increased risk of SIRS/ARDs pulmonary contusion - ANSInjury or bruising of lung tissue that results in hemorrhage. swelling, blood and fluids in area, watch fluids, ECG shows PVCs, tach Pulmonary response - ANSIncrease RR to improve O2 and remove CO2 Pulse Pressure (PP) - ANSsystolic pressure - diastolic pressure Purpose of Diagnostic Procedures for suspected Abdominal Trauma - ANSto assess for free fluid (blood) in abdominal cavity Pyramidal maxillary bone fracture involving the mid-face area. The apex of the fracture transverses the bridge of the nose. Assessment findings include: massive facial edema, nasal swelling with obvious fracture of the nasal bones, malocclusion, CSF rhinorrhea - ANSLeFort II Pyramidal maxillary bone fracture involving the mid-face area. The apex of the fracture transverses the bridge of the nose. Assessment findings include: massive facial edema, nasal swelling with obvious fracture of the nasal bones, malocclusion, CSF rhinorrhea - ANSLeFort II Reevaluation and Consider the need to Transfer - ANSFinal step in primary survey Refers to the separation of tissue resulting from a sound and/or hydraulic wave force- the effect is a crushing pressure wave which creates a temporary cavity, followed by a rapid and violent closing of the cavity. - ANSCavitation Refers to the separation of tissue resulting from a sound and/or hydraulic wave force- the effect is a crushing pressure wave which creates a temporary cavity, followed by a rapid and violent closing of the cavity. - ANSCavitation Renal response - ANSVasoconstriction of arterioles and some veins, reabsorption of Na and H20 Renal Trauma (Retroperitoneal) - ANS-Usually Blunt Trauma -Isolated Renal Trauma Uncommon, Suspect Bladder/Bowel Injuries reorganize care to C-ABC - ANSIf uncontrolled hemorrhage .. TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Results from hypo perfusion of tissue due to an obstruction in either the vasculature or heart. Therapy aimed at relieving the obstruction and improving perfusion. - ANSObstructive Shock Results from hypo perfusion of tissue due to an obstruction in either the vasculature or heart. Therapy aimed at relieving the obstruction and improving perfusion. - ANSObstructive Shock results from hypo perfusion to the tissue due to an obstruction in either vasculature or heart. Goal is to relieve obstruction and improve perfusion. Ex: tension pneumo or cardiac tamponade are two classic examples that may result from trauma. - ANSObstructive Shock Results from pump failure in the presence of adequate intravascular volume. Lack of CO and end-organ perfusion secondary to a decrease in myocardial contractility and/or valvular insufficiency. Therapy includes inotropic support, antidysrhythmic medications, and correction or treatment of underlying cause. - ANSCardiogenic Shock Results from pump failure in the presence of adequate intravascular volume. Lack of CO and end-organ perfusion secondary to a decrease in myocardial contractility and/or valvular insufficiency. Therapy includes inotropic support, antidysrhythmic medications, and correction or treatment of underlying cause. - ANSCardiogenic Shock Results from pump failure in the presence of adequate intravascular volume. There is a lack of cardiac output and end organ perfusion secondary to a decrease in myocardial contractility and/or valvular insufficiency. Ex: MI's or dysrhythmia are common causes - ANSCariogenic Shock Results from the misdistribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. Treatment is to provide volume replacement, increase systemic vascular resistance with medications (pressors) and possible antibiotics. - ANSDistributive Shock Results from the misdistribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. Treatment is to provide volume replacement, increase systemic vascular resistance with medications (pressors) and possible antibiotics. - ANSDistributive Shock Resuscitation Adjuncts (LMNOP) - ANSL: Lab M: Monitor cardia rhythm and rate N: Naso or Oro-gastric tube insertion O: Oxygenation or ventilation analysis P: Pain assessment and management TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Resuscitation Adjuncts (LMNOP) - ANSL: Lab M: Monitor cardia rhythm and rate N: Naso or Oro-gastric tube insertion O: Oxygenation or ventilation analysis P: Pain assessment and management Revaluation adjuncts - ANS-cspine CT, -CXR, pelvis XR -CTA -reverse trauma score -FAST -clean and dress wounds -tetnus, abx Rhabdomyolysis--> Myoglobinuria - ANS-Myoglobin is a muscle pigment that is toxic to the proximal renal tubule -Burgundy (Port Wine) Urine -CPK & Myoglobin Increased in Urine -Acute Renal Failure: monitor K & Creatinine (increase as kidney function decreases) Rib fractures - ANSdoom, anxiety, vascular injuries, heart Rib Fractures - ANSmost common blunt chest injury Rib Fractures & Flail Chest - ANSfreely moving segment of rib cage called flail segment 3 or more ribs fx in 2 or more places Right breath sound ONLY following intubation = ________________ -- pull out - ANSMainstem Right breath sound ONLY following intubation = ________________ -- pull out - ANSMainstem Right Shoulder Pain - ANSLiver Room Air = ____% FiO2 - ANS21% Room Air = ____% FiO2 - ANS21% RSI 7 Ps - ANSPreparation, pre-oxygenate, pretreatment, paralysis, protection, placement with proof, postintubation management Ruptured diaphragm - ANSherniation of abdominal contents into the chest cavity, may hear bowel sounds in the chest TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -Bleeding -Lung Collapse S/S of Pulmonary Contusion - ANS-Hemoptysis -Decreased BS & Crackles over affected area -Decreased SpO2 (requires oxygen & possibly PEEP) S/S of Renal Injuries? - ANS-Hematuria -Flank or abdominal tenderness elicited during palpation -Ecchymosis over flank may occur, but normally develops 6 to 12 hours after injury S/S of Renal Injuries? - ANS-Hematuria -Flank or abdominal tenderness elicited during palpation -Ecchymosis over flank may occur, but normally develops 6 to 12 hours after injury S/S of Renal Injuries? - ANS-Hematuria -Flank or abdominal tenderness elicited during palpation -Ecchymosis over flank may occur, but normally develops 6 to 12 hours after injury S/S of Renal Injuries? - ANS-Hematuria -Flank or abdominal tenderness elicited during palpation -Ecchymosis over flank may occur, but normally develops 6 to 12 hours after injury S/S of Renal Trauma - ANS-Flank Ecchymosis -Pain -Hematuria S/S of Rib Fractures - ANS-Dyspnea -Pain with breathing -Bruising -Palpate chest wall for deformity & SQ air S/S of Tension Pneumothorax - ANS-No Breath Sounds of affected side -SOB -Chest pain -Low BP from decreased CO & Mediastinal Shift -Increased RR -Increased HR Sample is part of history S symptoms associated with injury A allergies and tetanus status M meds currently on including anticoagulant therapy P past medical hx L last oral intake E Events and environment factors related to the injury - ANSSAMPLE TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ SaO2 - ANSpercent of oxygen bound hg in the arterial blood Second impact syndrome - ANS2nd mild TBI (concussion) before healed = loss of auto reg and cerebral edema Secondary impact injury - ANSa brain injury that occurs after a first brain injury is not fully healed, athletes, second TBI Secondary Survey (FGHI) - ANSFahrenheit: keep pt warm, hypothermia causes coagulopathy Get VS (& add gadgets, NG/OG, Foley, Labs) Head-to-toe examination & history Inspect Posterior Surfaces: log roll with spine immobilization Then Reassess ABCD & VS Septic - ANSmediated by SIRS with hypotension and perfusion, endotoxins from bacterial cells cause vasodialtion septic shock - ANSDistributive shock a serious condition that occurs when an overwhelming bacterial infection affects the body - bacterial endotoxins are released causing increased vascular permeability and vasodilation. Tx: early antibiotics and possibly nor-epinephrine to vasoconstrict the peripheral vasculature, ^ blood volume return to heart, improve cardiac output. Sequelae of massive fluid resuscitation following trauma? - ANSHypothermia Coagulopathy acidosis electrolyte abnormalities Shock - ANSinadequate tissue perfusion, mismatch of O2 supply and demand Shock improve - ANSLactic acid Significant muscle damage and cellular destruction releases myoglobin: a muscle protein; into the bloodstream. Classic symptoms: muscle pain/numbness/changes in sensation, muscle weakness/paralysis, dark red/brown urine. - ANSRhabdomyolysis Significant muscle damage and cellular destruction releases myoglobin: a muscle protein; into the bloodstream. Classic symptoms: muscle pain/numbness/changes in sensation, muscle weakness/paralysis, dark red/brown urine. - ANSRhabdomyolysis TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Signs and symptoms of intracerebral hematoma include ... - ANSProgressive and rapid decline, headache, signs of increasing ICP, pupil abnormalities Signs and symptoms of intracerebral hematoma include ... - ANSProgressive and rapid decline, headache, signs of increasing ICP, pupil abnormalities Signs and symptoms of intracerebral hematoma include ... - ANSProgressive and rapid decline, headache, signs of increasing ICP, pupil abnormalities Signs of impending herniation - ANSunilateral or bilateral pupillary dilation asymmetric pupillary reactivity abnormal posturing **give brief period of hyperventilation until definitive measures** Signs of impending herniation include ... - ANSUnilateral or bulge risk pupillary dilation, asymmetric pupillary reactivity or abnormal posturing Signs of impending herniation include ... - ANSUnilateral or bulge risk pupillary dilation, asymmetric pupillary reactivity or abnormal posturing Signs of impending herniation include ... - ANSUnilateral or bulge risk pupillary dilation, asymmetric pupillary reactivity or abnormal posturing Signs of increased compartment syndrome - ANSIncreased pain, feels tight/very painful, but nothing looks wrong Signs of increased compartment syndrome - ANSIncreased pain, feels tight/very painful, but nothing looks wrong Single tube retroglottic device inserted into the esophagus and traps the glottis opening between an esophageal cuff and an oropharyngeal cuff. Designed with 2 ports/lumens each with a separate cuff. Does NOT provide protection against aspiration and is not indicated in children. It is a retroglottic airway. - ANSKing Tube Single tube retroglottic device inserted into the esophagus and traps the glottis opening between an esophageal cuff and an oropharyngeal cuff. Designed with 2 ports/lumens each with a separate cuff. Does NOT provide protection against aspiration and is not indicated in children. It is a retroglottic airway. - ANSKing Tube Six Ps of compartment Syndrome - ANSPain, Pallor, Pulses, Paresthesia, Paralysis, Pressure Six Ps of compartment Syndrome - ANSPain, Pallor, Pulses, Paresthesia, Paralysis, Pressure