TNCC EXAM, 8th Edition Complete Final Exam With Correct Answers 2024/2025, Exams of Nursing

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TNCC EXAM, 8th Edition Complete Final Exam

With Correct Answers 2024/

.. activation: .... are found in the carotid sinus and along the aortic arch, are sensitive to the degree of stretch in the arterial wall. When the receptors sense a decrease in stretch, they stimulate the sympathetic nervous system to release Epi, norepi, causing stimulation of cardiac activity and constriction of blood vessels, which causes a rise in heart rate and diastolic blood pressure - CORRECT ANSWER - Baroreceptors:

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 - CORRECT ANSWER - ABCDEFGHI
7. Apnea
8. 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 - CORRECT ANSWER - Following conditions might require a definitive airway
8. bony fractures and possible rib fractures, which may impact ventilation
9. palpate for crepitus
10. subcutaneous emphysema which may be a sign for a pneumothorax
11. soft tissue injury - CORRECT ANSWER - Palpate the chest for
12. Check the presence of adequate rise and fall of the chest with assisted ventilation
13. Absence of gurgling on auscultation over the epigastrium
14. Bilateral breath sounds present on auscultation
15. Presence of carbon dioxide (CO2) verified by a CO2 device or monitor - CORRECT ANSWER - If the pt has a definitive airway in what should you do?
16. Dyspnea
17. Tachycardia
18. Decreased or absent breath sounds on the injured side
19. CP - CORRECT ANSWER - Simple Pneumo assessment:
20. equal breath sounds bilaterally at the second intercostal space midclavicular line and the bases for fifth intercostal space at the axillary line - CORRECT ANSWER - Auscultate the chest for:
21. Get a CT
22. Consider ABG 's if decreased LOC
23. Consider glucose check - CORRECT ANSWER - D Interventions

1. Hypotension
2. JVD
3. Muffled heart sounds - CORRECT ANSWER - Becks Triad:
4. open the airway, use jaw thrust
5. insert an oral airway
6. assist ventilations with a bag mask
7. prepare for definitive airway - CORRECT ANSWER - If breathing is absent..
8. pain - hallmark sign, early sign
9. pressure - early sign
10. pallor, pules, paresthesia, paralysis - late sign - CORRECT ANSWER - Six P's of compartment syndrome:
11. Preparation
12. Preoxygenation
13. Pretreatment
14. Paralysis and Induction
15. Protecting and positioning - v
16. Placement of proof - secure the tube
17. Post intubation - secure ETT Tube, get X-ray for placement - CORRECT ANSWER - Steps of Rapid Sequence Intubation
18. Preparation and Triage
19. Primary Survery (ABCDE) with resuscitation adjuncts (F,G)
20. Reevaluation (consideration of transfer)
21. Secondary Survey (HI) with reevaluation adjuncts
22. Reevaluation and post resuscitation care
23. Definitive care of transfer to an appropriate trauma nurse - CORRECT ANSWER - Initial Assessment

1. Suction the airway 2, Use care to avoid stimulating the gag reflex
2. 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 - CORRECT ANSWER - If Airway is not patent
3. The tongue obstructing the airway
4. loose or missing teeth
5. foreign objects
6. blood, vomit, or secretions'
7. edema
8. burns or evidence of inhalation injury Auscultiate or listen for:
9. Obstructive airway sounds such as snoring or gurgling
10. Possible occlusive maxillofacial bony deformity
11. Subcutaneous emphysema - CORRECT ANSWER - Inspect the mouth for: 50 to 150 - CORRECT ANSWER - MAP Range 500 mL/hr - CORRECT ANSWER - You are treating a 27 y/o M in respiratory distress who was involved in a house fire. Calculating TBSA burned is deferred due to the need for emergent intubation. At what rate should you begin fluid resuscitation? A 14 gauge needle that is inserted into the 2nd intercostal space in the midclavicular line on the affected side over the top of the rib to avoid neuromuscular bundle that runs under the rib. Prepare for chest tube placement. - CORRECT ANSWER - Tension pneumo intervention

a 52 y/o diabetic male with a partial thickness burn to the left lower leg - CORRECT ANSWER - Which of the following patients warrants referral to a burn center? A breath every 5 to 6 seconds: 10-12 ventilations per minute - CORRECT ANSWER - Bag mask ventilation a pertinent medical hx is crucial - CORRECT ANSWER - Which of the following considerations is the most important when caring for a geriatric trauma pt? According to newtons law which of these two force is greater: size or force? - CORRECT ANSWER - Neither. For each force there is an equal and opposite reaction. acidosis - CORRECT ANSWER - Which of the following is a component of the trauma triad of death? 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 - CORRECT ANSWER - Chemoreceptors: advanced age - CORRECT ANSWER - Which of the following is most likely to contribute to inadequate oxygenation and ventilation? after a physical examination if the pt has no radiologic abnormalities on CT - CORRECT ANSWER - EMS arrives with the intoxicated driver of a car involved in a MVC. EMS reports significant damage to the drivers side of the car. The pt is asking to have the cervical collar removed. When it is appropriate to remove the cervical collar?

Air cannot escape intrapleural space.. can begin to compress heart. pt will have sever resp distress, hypotension, JVD. - CORRECT ANSWER - Tension pneumo any deformities? bleeding? contusions, lacs? skin temp?? place splints on deformities, pulses - CORRECT ANSWER - Head to toe assessment: Extremities any lacs? deformities? blood at the urtheral meatus palpate pelvis with high pressure over the iliac wings downward and medially - CORRECT ANSWER - Head to toe assessment: pelvis and perineum Aortic Dissection - CORRECT ANSWER - Unequal extremity pulse strength possibility of.. apply direct pressure to bleeding elevate extremity apply pressure over arterial sites Consider a pelvic binder for pelvic fractures consider a tourniquet cannulate two veins with large caliber IV - if unable to gain assess consider IO a. obtain labs, type and cross b. infuse warm isotonic fluids c. consider balanced resuscitation d. use rapid infusion device - CORRECT ANSWER - C Interventions:

apply splint and elevate above the level of the heart - CORRECT ANSWER - a 37 y/o F has a deformity of the L wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention? ask pt to pen his or her mouth - CORRECT ANSWER - While assessing airway the patient is alert and responds to verbal stimuli you should.. bardycardia and absent motor function below the level of injury - CORRECT ANSWER

• A pt with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? Before the arrival of the pt - CORRECT ANSWER - When should PPE be placed: Biomechanics - CORRECT ANSWER - Is the general study of forces and their effects. bowel - CORRECT ANSWER - Which of the following injuries is LEAST likely to be promptly identified? brachial pulse - CORRECT ANSWER - Under age of 1 where do you find a pulse 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) - CORRECT ANSWER - B calcium - CORRECT ANSWER - if a pt has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? can be caused by blunt trauma. air escapes from injured lung to pleural space and negative intrapleural pressure is lost causing partial or collapsed lung - CORRECT ANSWER - Simple Pneumothorax can result from penetrating wound through chest wall causing air to be trapped in to the intrapleural place. Might hear "sucking" Tx: nonporous dressing tapes on 3 sided, then Chest tube and would closure surgical repair. - CORRECT ANSWER - Open Pneumo: Capnography monitors numeric value, as well as continuous waveform, indicating real-time measurement and trending over time. - CORRECT ANSWER - Quantitative: Caused by blood in the intrapleural space/ May also occur from lac to live or spleen combined with injury to the diaphragm. Ensure two large bore IVS are placed. Prepare for thoracentesis and chest tube insertion. If open thoracotomy is done chest tube is deferred. - CORRECT ANSWER - Hemothorax: 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 - CORRECT ANSWER - C 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 - CORRECT ANSWER - Qualitative compensated - CORRECT ANSWER - A trauma pt is restless and repeatedly asking "where am i?" VS upon arrival: BP 110/60, HR96, RR 24. Her skin is cool and dry. Current VS are BP 104/84, HR 108, RR 28. The pt is demonstrating s/sx of which stage of shock? Complete - CORRECT ANSWER - EMS brings a pt from MVC. VS: BP 90/49, HR 48, RR 12, temp 97.2F (36.2 C). The pt exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the following types of spinal cord injury? D displaced tube O obstructed or kinked P pneumothorax E equipment failure , such as becoming detached from the equipment or loss of capnopgrahy - CORRECT ANSWER - DOPE Define central or transtentorial herniation. - CORRECT ANSWER - A 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. - CORRECT ANSWER - A downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define Cushing's triad - CORRECT ANSWER - Bradycardia, progressive hypertension (widening pulse pressure), and decreased respiratory effort Define Hemothorax. - CORRECT ANSWER - Accumulation of blood in the pleural space. Define Hemothorax. - CORRECT ANSWER - Accumulation of blood in the pleural space. Define Minor Head Trauma. - CORRECT ANSWER - GCS 13- 15 Define Minor Head Trauma. - CORRECT ANSWER - GCS 13- 15 Define Moderate Head Trauma - CORRECT ANSWER - Postresuscitative state with GCS 9-13. Define Moderate Head Trauma - CORRECT ANSWER - Postresuscitative state with GCS 9-13. Define Pneumothorax. - CORRECT ANSWER - Results 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. - CORRECT ANSWER - Results 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 Severe Head Trauma. - CORRECT ANSWER - Postresuscitative state with GCS score of 8 or less. Define Severe Head Trauma. - CORRECT ANSWER - Postresuscitative state with GCS score of 8 or less. Define tension pneumothorax. - CORRECT ANSWER - Life-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. - CORRECT ANSWER - Life-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 the characteristics of neurogenic shock - CORRECT ANSWER - Distributive shock with a T6 or higher injury results and vasodilation, bradycardia, flushed warm

dry skin. Risk for temperature instability. Nursing interventions include maintaining warmth and spinal stabilization. Define the characteristics of spinal shock - CORRECT ANSWER - Transient loss of function can include loss of reflexes and muscle tone below the level of industry with possible vascular response. Define the five mechanisms of injury in blast trauma. - CORRECT ANSWER - 1. Primary: Found in patients who were closest to the blast. Injuries are most commonly associated with air-filled organs

2. Secondary: Include fragment injuries, puncture wounds, lacerations, and impaled objects. Generally, these cause the most casualties
3. Tertiary: Result from the patient being blown into a large object. Injuries include pelvic or femur fractures an thoracic injuries.
4. Quaternary: Result from heat, flame, gas, and smoke and cause burn injuries.
5. Quinary: Injuries associated with radioactive, biological or chemical elements that may be present in the explosion. Define uncal herniation. - CORRECT ANSWER - The uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more common of the two types of herniation syndromes. Define uncal herniation. - CORRECT ANSWER - The uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more common of the two types of herniation syndromes. defusings - CORRECT ANSWER - All of these are considered a critical communication point in trauma care EXCEPT which of the following? Describe common patterns and severity of injuries in the bariatric trauma patient. - CORRECT ANSWER -

Describe effects of common medications in relation to the older adult trauma patient. - CORRECT ANSWER - Describe one fat embolism syndrome is most likely to occur in its characteristics - CORRECT ANSWER - With longform fractures. Tachycardia, Thrombocytopenia, and petechiae rash. Describe specific injuries associated with interpersonal violence and abuse. - CORRECT ANSWER - Describe steps to maintain the forensic chain of custody. - CORRECT ANSWER - Describe techniques to improve the intubation process for the bariatric trauma patient. - CORRECT ANSWER - Describe the 3 types of external forces of energy transfer in the context of trauma. - CORRECT ANSWER - Deceleration: Force from a sudden stop in the body's motion Acceleration: Force from a sudden onset in the body's motion Compression: Force from being crushed between objects Describe the 3 types of Internal forces of energy transfer in the context of trauma. - CORRECT ANSWER - Compression: The ability of the tissue to resist crush injury or force Tension: The ability to resist being pulled apart when stretched Shear: The ability to resist a force applied parallel to the tissue Describe the activities and associated factors related to low-energy trauma in the older adult. - CORRECT ANSWER -

Describe the characteristics of cardiogenic shock - CORRECT ANSWER - Cardiogenic shock results from pump failure in the presence of adequate intravascular volume. Lack of cardiac output and an organ perfusion occurs secondary to a decrease in myocardial contractility and or valvular insufficiency. This can happen with blunt cardiac trauma or an MI. Symptoms can include low blood pressure increase heart rate and respiratory rate chest pain shortness of breath dysrhythmias increase troponin and pale cool moist skin Describe the characteristics of distributive shock. - CORRECT ANSWER - Distributive shock occurs as a result of Mel distribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. This can occur with spinal cord injuries, sepsis, or anaphylaxis. Symptoms include low blood pressure heart rate respiratory rate preload and afterload, spinal tenderness, difficulty breathing, warm pink and dry skin with a cool core temperature. Describe the characteristics of hypovolemic shock - CORRECT ANSWER - Hypovolemia is caused by a decrease in the amount of circulating volume usually caused by massive bleeding, but also can be from vomiting and diarrhea. Characteristics include low blood pressure and preload, increase heart rate respiratory rate and afterload, with contractility unchanged. Signs include obvious bleeding, weak peripheral pulses, pale cool and moist skin, distended abdomen, pelvic fracture, or bruise swollen and deformed extremities especially long bones. Describe the characteristics of obstructive shock - CORRECT ANSWER - Obstructive shock is it mechanical problem that results from hypoperfusion of the tissue due to an obstruction in either the vasculature or the heart resulting in decreased cardiac output. Some causes include a tension pneumothorax, cardiac tamponade, or venous air embolism on the right side of the heart during systole in the pulmonary artery.Signs include anxiety, muffled heart sounds, JVD, hypertension, chest pain, difficulty breathing, or pulses paradoxes.

Describe the fluid resuscitation of an older adult patient related to fluid overload, when to administer red blood cells, and the use of anticoagulant medication. - CORRECT ANSWER - Describe the four types of spinal cord injury - CORRECT ANSWER - Central cord injury results in greater weakness distally, anterior injury includes motor loss or weakness below the cord level of injury yet sensory is intact, Brown-Sequard (hemicord) is weak on one side with sensory deficit on opposite side, posterior cord syndrome although rare is when the patient is unable to use sense vibration in proprioception Describe the measurement of an NPA - CORRECT ANSWER - Measure from the tip of the patient's nose to the tip of the patients earlobe. Describe the pathophysiologic changes of the systems of the bariatric patient and the effects on trauma resuscitation efforts. - CORRECT ANSWER - Describe the three impacts in the motor vehicle impact sequence - CORRECT ANSWER - 1. First Impact: Vehicle hits another object

2. Second Impact: Occupant hits the interior of the vehicle
3. Third Impact: Organcs hit other internal structures Describe the types of abuse and the associated signs of each. - CORRECT ANSWER - Describe the usefulness of the Haddon Matrix in prevention and reduction of injury - CORRECT ANSWER - Looks at 3 phases of the event: Pre-event, event, and post-event. Looks at 4 factors involved in the event: The host (patient), the agent (cause), the physical evironment, and the socioeconomic environment. Countermeasures can be applied at each phase to help reduce injury.

Differentiate between the three impacts of motor vehicle impact sequence. - CORRECT ANSWER - The first impact occurs when the vehicle collided with another object. The second impact occurs after the initial impact when the occupant continues to move in the original direction of travel until they collide with the interior of the vehicle or meet resistance. The third impact occurs when internal structures collide within the body cavity. Differentiate family and intimate partner violence from community violence. - CORRECT ANSWER - Disability - Neurologic Status

1. Assess pupils for equality, shape, and reactivity (PERRL)
2. Assess GCS (eye opening, verbal response, and motor response) - CORRECT ANSWER - D Discuss the use and insertion of nasogastric tubes in the bariatric patient. - CORRECT ANSWER - Disruptions of the bony structures of the skull can result in what? - CORRECT ANSWER - Displaced 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? - CORRECT ANSWER - Displaced 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 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? - CORRECT ANSWER - Head to toe assessment: Abdomen dressing removal - CORRECT ANSWER - A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital providers placed a nonporous dressing over the chest wound and taped it on three sides. he is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis and decreasing blood pressure. Which of the following is the MOST appropriate immediate intervention? dysrhythmias - CORRECT ANSWER - Patients with a crush injury should be monitored for which of the following conditions? elevating the extremity to the level of the heart - CORRECT ANSWER - A pt with a lower extremity fracture complains of severe pain and tightness in his calf, minimally by pain medications. Which of the following is the priority nursing intervention?

endotracheal tube - CORRECT ANSWER - The trauma nurse knows that placing a bariatric patient in a ramped position providers better visualization during the insertion of which device? Expedite transfer to the closest trauma center - CORRECT ANSWER - A 56 y/o M pt involved in a motor vehicle crash is brought to the ED of a rural critical access facility. He complains of neck pain, SOB, and diffuse abd pain. His GCS is 15. His VS: BP 98/71, HR 125, RR 26, SpO2 94% on high-flow O2 via NRB mask. Which of the following is the priority intervention for this patient? Explain adrenal gland response. - CORRECT ANSWER - When 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. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - CORRECT ANSWER - When 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. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain Cardiogenic Shock. - CORRECT ANSWER - Syndrome that results from ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes:

• MI
• Blunt cardiac injury
• Mitral valve insufficiency
• dysrhythmias
• Cardiac Failure Explain Cardiogenic Shock. - CORRECT ANSWER - Syndrome that results from ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes:
• MI
• Blunt cardiac injury

• Mitral valve insufficiency
• dysrhythmias
• Cardiac Failure Explain Distributive Shock. - CORRECT ANSWER - Results 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. - CORRECT ANSWER - Results 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. - CORRECT ANSWER - Liver 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. - CORRECT ANSWER - Liver 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. - CORRECT ANSWER - Most 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. - CORRECT ANSWER - Most 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 Irreversible Shock. - CORRECT ANSWER - Shock uncompensated or irreversible stages will cause compromises to most body systems.
• Inadequate venous return
• inadequate cardiac filling
• decreased coronary artery perfusion
• Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Irreversible Shock. - CORRECT ANSWER - Shock uncompensated or irreversible stages will cause compromises to most body systems.
• Inadequate venous return
• inadequate cardiac filling
• decreased coronary artery perfusion
• Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Obstructive Shock. - CORRECT ANSWER - Results 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. - CORRECT ANSWER - Results 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. - CORRECT ANSWER - Tachypnea 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. - CORRECT ANSWER - Tachypnea 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 - CORRECT ANSWER - E fat embolism - CORRECT ANSWER - a pt has been in the ED for several hrs waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and complaining of leg pain. His wife reported that he suddenly became anxious and confused. Upon reassessment, the pt is restless with respiratory distress and petechiae to his neck. The pt is exhibiting s/sx most commonly associated with which of the following conditions? Flail chest - CORRECT ANSWER - Paradoxical chest wall movement flucuation in the water seal chamber - CORRECT ANSWER - Which of the following is an expected finding in a pt with a tube thoracstomy connected to a chest drainage system? from hemorrhage is leading cause. Hypovolemia is caused by decrease in the amount of circulating volume. Goal is to replace volume. - CORRECT ANSWER - Hypovolemic Shock Full set of vitals and family presence - CORRECT ANSWER - F Get Resuscitation Adjuncts L - Labs (maybe a lactic acid), a b g 's, blood type M - monitors

N - naso or oro gastric tubes O Oxygen and ETC02 monitors P - pain assessment and management - CORRECT ANSWER - G globe rupture - CORRECT ANSWER - A 35 y/o M presents with facial trauma after being struck in the face with a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is suspected? H,I - CORRECT ANSWER - Secondary Survery hemoglobin does not readily release O2 for use by the tissues - CORRECT ANSWER - What is the effect of hypothermia on the oxyhemoglobin dissociation curve? History and Head to toe MIST - prehospital report MOI Injuries sustained S s/s in the field T treatment in the field if patients family present get a better hx on them - CORRECT ANSWER - H How do you assess Mnemonic "D"? - CORRECT ANSWER - DISABILITY 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