TNCC Exam Test Bank: 350 Verified Questions and Answers, Exams of Nursing

Download TNCC Exam Test Bank: 350 Verified Questions and Answers and more Exams Nursing in PDF only on Docsity! TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE A adult patient with a knife injury to the neck has an intact airway and ishemodynamicallystable.Theycomplainofdifficultyswallowingandspeaking.Inth eprimary survey, further assessment is indicated next for which of the followingconditions? a.Damagetothecervicalspine b.Anexpandingpneumoth orax c. Lacerationofthecarotidarte ry d. Injurytothethyroidgland-ansa.Damagetothecervicalspine A patient arrives at the emergency department by private vehicle after sustaining aninjurytotherightlowerextremitywhileusingasaw.Thereisalargegapingwoundto the right thigh area with significant bleeding. What is the priority intervention? a. Elevatetheextremitytothelevelofthe heart b. Initiatedirectpressure c. Applya tourniquet d. Covertheopenwoundwithsterilesalinedressings-ansb.Initiatedirectpressure A patient fell two weeks ago, striking their head. Today, the patient presented with apersistent headache and nausea and was diagnosed with a small subdural hematoma.The patient has been in the ED for 24 hours awaiting an inpatient bed. The night shiftnurse reports the patient has been anxious, restless, shaky, and vomited twice duringthenight.Thepatientstatestheycouldn'tsleepbecauseayoungchildkeptco mingintothe room. What is the most likely cause for these signs and symptoms? a.increaseintracranialpressure b. alcoholwithdrawa l c. rhabdomyolysis d. pulmonaryembolus-ansb.alcohol withdrawal ApatientinvolvedinaMVChassustainedafracturetothesecondriboftheanteriorleft chest. Which concurrent injury is most commonly associated with this fracture? a. Bluntcardiacinjury b. Brachialplexusinjur y c. Pneumothorax TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE d. Hemothorax-ansb.Brachialplexusinjury ApatientwithaspinalcordinjuryatC5isbeingcaredforintheemergencydepart mentwhile awaiting transport to a trauma center. Which of the following represents thehighest priority for ongoing assessment and management for this patient? a. maintainadequaterespiratorystatu s. b. administerbalancedresuscitationfl uid TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE The vital signs of a pregnant trauma patient at 30 weeks include a blood pressure of94/62 mm Hg and a heart rate of 108 beats/minute. Fetal heart tones are 124beats/minute.Theemergencynurseinterpretsthepatient'shemodynamicfi ndingsasan indication of which of the following? a.Decompensatedshock b.Normalvitalsignsinpregn ancy c. Compensatedshock d. Supinehypotensionsyndrome -ansb.Normalvitalsignsinpregnancy Treatmentforfrostbitecanincludewhichofthefollowinginter ventions? a. warmtheaffectedpartover30-60minutes b. usegentlefrictiontoimprovecirculati on c. administertissueplasminogenactiv ator d. leavealloftheblistersintact-ansc.administertissueplasminogen activator Understanding the kinematic concepts associated with the mechanism of injury andenergytransfercaninitiallyassistthetraumacareproviderinwhichofthe following? a. Anticipatingthetypesofinjuriesthatmaybepresent b. Decidingwhetherlawenforcementshouldbenoti fied c. Determiningneededlaboratorytests d. Predictingtheneedforasurgicalprocedure - ansa.Anticipatingthetypesofinjuriesthat may be present Whatistheappropriatetechniqueforpalpatingthepelvisfors tability? a. Applygentlepressureovertheiliaccrests,downwardandlate rally. b. Applygentlepressureovertheiliaccrests,downwardandme dially. c. Applyfirmpressureovertheiliaccrests,downwardand laterally. d. Applyfirmpressureovertheiliaccrests,downwardandmedi ally. - ansb.Applygentlepressure over the iliac crests, downward and medially. Whatisthebestmeasureoftheadequacyofcellularperfusionandcanhelptopredi ctthe outcome of resuscitation? TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE a. End- tidalcarbondioxide b. Hematocritlevel c. Basedeficit d. Oxygensaturation -ansc.Basedeficit Whatisthebestpositionformaintaininganopenairwayintheobese patient? a. Prone b.Supine TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE c. ReverseTrendelenburg d.Rightlateralrecumbent-ansc.ReverseTrendelenburg Whatistheleadingcauseofpreventabledeathforthetraumapatientintheprehospi talenvironm ent? a. Airway compromise b. Ineffectiveventilatio n c. Secondaryheadinjur y d. Uncontrolledexternalhemorrhage -ansd.Uncontrolledexternalhemorrhage Whichofthefollowingaccuratelydescribesventilationprinciplesassociatedwithuse ofa bag- mask device for an adult? a. Compressthebag-maskdeviceatarateofonebreathevery6 seconds. b. Delivers100%oxygen. c. Squeezethebag-maskdevicecompletelyforeach breath. d. Maintaintheoxygensaturationlevelsbetween92%and94%. - ansa.Compressthebag- mask device at a rate of one breath every 6 seconds. Whichofthefollowingisconsideredacornerstoneofahigh- performancetraumateam? a. Individualgoals b.Useof TeamSTEPPS c. Identificationofasingledecisionmaker d.Effectivecommunication-ansd.Effectivecommunication While performing an assessment on a 13-month-old involved in a motor vehiclecollision,thenurseidentifieswhichofthefollowingfindingsfromthepatientasa signofpo ssible altered mental status? a.Sunkenfontanel b.Crying,butconsolable c. Spontaneousmovementofarmsandlegs d.Cooperationwiththeassessment - ansd.CooperationwiththeassessmentA (AVPU) - ansAlert. Will be able to maintain airway once clear. A(PrimarySurvey)- ansAirwayandalertnesswithsimultaneouscervicalspinalstabilization. AirwayAssessment- TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE C(PrimarySurvey)-ansCirculationandControlofHemorrhage TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Cardiogenic Shock - ansResults from pump failure in the presence of adequateintravascularvolume.There is alack of cardiac output and end-organ perfusionsecondarytoadecreaseinmyocardialcontractilityand/orvalvula rinsufficie ncy. Acutecauses- myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryede maand increased myocardial ischemia. Inotropicsupporttoimprovecontractility. CirculationandControlofHemorrhageAssessment - ansInspect:Uncontrolledexternalbleeding, skin color Auscultate:Muffledheartsounds -mayindicatepericardialtamponade Palpate:carotidand/orfemoralpulsesforrate,rhythm, strength Circulation and Control of Hemorrhage Interventions - ansControl and treat externalbleeding:applydirectpressure,elevatebleedingextremity,appl ypressureoverarteri alsites, consider use of a tourniquet. 2largeboreIVs,ifunableconsiderIO,obtainlabsand crossmatch. InitiateIVFofwarmedisotoniccrystalloidsolution.Considerbloodproductsafter2L. **Largevolumesoffluidleadtodilutioncoagulopathywhichworsensmetabolicacid osisandm aycausehypothermia.Componenttherapy,includingadministeringRBC,plasmaa nd platelets is a balanced approach so that O2 delivery is optimized, acidosiscorrected and coagulopathy prevented. ClassificationsofShock-ansHypovolemic- decreaseintheamountofcirculatingbloodvolume Obstructive-obstructionineitherthevasculatureorheart TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Cardiogenic-pumpfailureinthepresenceofadequateintravascularvolume Distributive- maldistributionofanadequatecirculatingbloodvolume(septic,anaphylactic, neurogenic) CornealAbrasion- ansDamagetothecornealepithelium.Easytoevaluatewithfluorescein. Findings:photophobia,tearing,pain,injectedconjunctiva(redness),lidswelling,irri tation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophthalmicNSAIDStodecreaseswelling,oralanalgesics,Ophthalmicf/ uin24hours.(Do NOT patch - increases infection) CornealForeignBody-ansRoutinelymetal,plasticorwood. Findings:photophobia,pain,injectedconjunctiva(redness),lidswelling Treatment:topicalanesthetic,removalofforeignbody,ophthalmicABX,cycloplegic s,oral analgesia CornealLaceration - ansInvolvesoneormorelayersofthecornea.Visualizedwithaslitlamp. Findings:similartoabrasion,painoutofproportiontofindings,decreasedvision Treatment:treatsmalllacerationssimilartoanabrasion,largerlacerationsneedop hthalmolog y referral and possible surgery Cycloplegicagent- ansCycloplegiaisparalysisoftheciliarymuscleoftheeye,resultingin a loss of accommodation. Because of the paralysis of the ciliary muscle, thecurvature of the lens can no longer be adjusted to focus on nearby objects. D(PrimarySurvey)-ansDisability(NeurologicStatus) DisabilityAssessment-ansAssessGCSonarrivalandrepeatperpolicy. Assesspupilsforequality,shapeandreactivity (PERRL) TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE G(PrimarySurvey)-ansGetResuscitationAdjuncts:(LMNOP) L:Labs M:Monitorcardiacrateandrhythm N:Nasoororogastrictubeconsideration O:Oxygenation-SpO2and/oretCO2moni torP: Pain assessment and management GCS-ansGCS EYES 1:Doesnotopeneyes 2: Opens eyes in response to pain3:Openseyesinresponsetov oice 4: Opens eyes spontaneously VERBAL 1.Makesnosounds 2.Makes sounds 3.Words 4.Confused,disoriented 5.Oriented,conversesnormally MOTOR 1.Makesnomovements 2.Extensiontopainfulstimuli(decerebrate) 3.Abnormalflexiontopainfulstimuli (decorticate) 4.Withdrawaltopainfulstimuli 5.Localizespainfulstimuli 6.Obeys commands H(SecondarySurvey)- ansHistoryPrehospital Report (MIST) M:MOI I:Injuries sustained S:SignsandsymptomsinthefieldT: Treatment in field PatientHistory(SAMPLE):S: Symptoms TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE A:AllergiesandtetanusstatusM: Medications P:PastmedicalhistoryL: Last oral intake E:EventsandEnvironmentalfactorsrelatedto injury. H:Headand Face HeadtoToeAssessment(secondarysurvey)-ansSOFTTISSUE: Inspect:lacerations,puncturewounds,abrasions,contusions,edema,ecchymosi s,impaled objects. Palpate:areasoftenderness,step-offs, crepitus BONY DEFORMITIES: Inspect:asymmetryoffacialexpressions,exposedtissueorboneforbrainmatter Palpate:depressions,angulations,tenderness HepaticInjuries- ansInblunttraumathelivermaylaceratefromincreasedabdominalpressure. Hematoma-bleedingcontainedwithinthecapsule Laceration-thecapsuleisdisrupted Findings:Cullensign(ecchymosisaroundtheumbilicusorRUQ),tenderness,guar dingor rigidity RUQ, 9-12 rib FXs, elevated LFT GradedI-VI,I=minortrauma Nonoperativemanagementisstandardofcareinhemodynamicallystablepatient .Observed with serial abdominal exams. FindingsofcontrastextravasationmaybeembolizedbyIR. Forsurgicalpatients- fluidresuscitationisessential.Risksofsurgeryincludedisruptionof the natural tamponade process due to the evacuation of large amounts of bloodresulting in hypovolemia. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE HypovolemicShock- ansCausedbyadecreaseintheamountofcirculatingbloodvolume. Intraumatypicallyresultsfromhemorrhage,butcanresultinaprecipitouslossofv olume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranesleadingtoplasmaandproteinleakage.ofbodywater,resultsininadeq uateperfusi on. Hyperventilationcancauseincreasedintrathoracicpressureresultingincompressi onofthe heart and decreased cardiac output. InitialAssessment- ans1.PreparationandTriage 2. PrimarySurvey 3.Reevaluation 4.SecondarySurvey 5.ReevaluationAdjuncts 6.ReevaluationandPostResuscitationCare 7.DefinitiveCareorTransport IntraocularForeignBody- ans*TRUEEMERGENCYANDEARLYINTERVENTIONISESSENTIAL. Findings:compromisedvisualacuity,misshapenpupils,pain Treatment:elevateHOB,ophthalmology,immobilizeforeignbody,patchUNAFFEC TEDeye to limit concomitant eye movement, globe closure ASAP, systemic and ophthalmicABX, analgesics. Postopinfection,retinaldetachmentandvisionlossarecommon complications. lidinjury-ans Liver- ansLargestsolidorganofthebody.RUQ,6thto10thribs.EncasedbyGlissoncapsul e with blood vessels, lymphatics and nerves. Filters 1.7L of blood per minute. Theliverfiltersouttoxins,takesthenutrientsandreturnsthebloodtotheheartviat hehepatic veins. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE AirwayInterventions:- ansSuctionRemove foreign body if noted Jawthrustmaneuver(maintain cspine) Nasopharyngealairway(canbeconscious)Oropharyngealairway(nogag)Consid er definitive airway AlertnessAssessment- ansA- AlertV-Verbal P-Painful U-Unresponsive B(PrimarySurvey)-ansBreathingand 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(signsofunderlyinginjury),openpne umothora ces(sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate:presence,absenceandequalityofbreathsoundsat2ndintercostalspace midclavi cular line and bases at the fifth intercostal space anterior axillary line Palpate:bonystructures,possibleribfractures,SQemphysema,softtissueinjury,J Vpulsation s at suprasternal notch or supraclavicular area Life- threateningpulmonaryinjuriesrequiringimmediateintervention:openpneumotho rax, tension pneumothorax, flail chest, hemothorax. BreathingandVentilationIntervention-ansBreathingabsent:jaw- thrustmaneuver,oralairway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathingpresent:NRB.Determineifventilationeffective:etCO235- 45,SpO294%orhigher. If ineffective: assist with bag-mask and determine need for definitive airway C(PrimarySurvey)-ansCirculationandControlofHemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequateintravascularvolume.There is alack of cardiac output and TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE end-organ perfusionsecondarytoadecreaseinmyocardialcontractilityand/orvalvula rinsufficie ncy. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Acutecauses- myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryed emaand increased myocardial ischemia. Inotropicsupporttoimprovecontractility. CirculationandControlofHemorrhageAssessment - ansInspect:Uncontrolledexternalbleeding, skin color Auscultate:Muffledheartsounds -mayindicatepericardialtamponade Palpate:carotidand/orfemoralpulsesforrate,rhythm, strength Circulation and Control of Hemorrhage Interventions - ansControl and treat externalbleeding:applydirectpressure,elevatebleedingextremity,applypressureo verarteri alsites, consider use of a tourniquet. 2largeboreIVs,ifunableconsiderIO,obtainlabsand crossmatch. InitiateIVFofwarmedisotoniccrystalloidsolution.Considerbloodproductsafter2L. **Largevolumesoffluidleadtodilutioncoagulopathywhichworsensmetabolicacid osisandm aycausehypothermia.Componenttherapy,includingadministeringRBC,plasmaa nd platelets is a balanced approach so that O2 delivery is optimized, acidosiscorrected and coagulopathy prevented. ClassificationsofShock-ansHypovolemic- decreaseintheamountofcirculatingbloodvolume Obstructive-obstructionineitherthevasculatureorheart Cardiogenic-pumpfailureinthepresenceofadequateintravascularvolume Distributive-maldistributionofanadequate circulatingbloodvolume(septic,anaphylactic, neurogenic) TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE N:Nasoororogastrictubeconsider ation TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE O:Oxygenation-SpO2and/ oretCO2monitorP: Pain assessment and management GCS-ansGCS EYES 1:Doesnotopeneyes 2: Opens eyes in response to pain3:Openseyesinresponsetov oice 4: Opens eyes spontaneously VERBAL 1.Makesnosounds 2.Makes sounds 3.Words 4.Confused,disoriented 5.Oriented,conversesnormally MOTOR 1.Makesnomovements 2.Extensiontopainfulstimuli(decerebrate) 3.Abnormalflexiontopainfulstimuli(decorticate) 4.Withdrawaltopainfulstimuli 5.Localizespainfulstimuli 6.Obeys commands H(SecondarySurvey)- ansHistoryPrehospital Report (MIST) M:MOI I:Injuries sustained S:SignsandsymptomsinthefieldT: Treatment in field PatientHistory(SAMPLE): S: Symptoms A:AllergiesandtetanusstatusM: Medications P:PastmedicalhistoryL: Last oral intake E:EventsandEnvironmentalfactorsrelatedto injury. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE H:Headand Face HeadtoToeAssessment(secondarysurvey)-ansSOFTTISSUE: Inspect:lacerations,puncturewounds,abrasions,contusions,edema,ecchymosi s,impaled objects. Palpate:areasoftenderness,step-offs, crepitus BONYDEFORMITIES: Inspect:asymmetryoffacialexpressions,exposedtissueorboneforbrainmatter Palpate:depressions,angulations,tenderness HepaticInjuries- ansInblunttraumathelivermaylaceratefromincreasedabdominalpressure. Hematoma-bleedingcontainedwithinthecapsule Laceration-thecapsuleisdisrupted Findings:Cullensign(ecchymosisaroundtheumbilicusorRUQ),tenderness,guar dingor rigidity RUQ, 9-12 rib FXs, elevated LFT GradedI-VI,I=minortrauma Nonoperativemanagementisstandardofcareinhemodynamicallystablepatient .Observed with serial abdominal exams. FindingsofcontrastextravasationmaybeembolizedbyIR. Forsurgicalpatients- fluidresuscitationisessential.Risksofsurgeryincludedisruptionof the natural tamponade process due to the evacuation of large amounts of bloodresulting in hypovolemia. HypovolemicShock- ansCausedbyadecreaseintheamountofcirculatingbloodvolume. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE bile.MetabolizesvitaminKandproducesthrombinandfibrinogen(allnecessaryforcl otting). ObstructiveShock- ansResultsfromhypoperfusionofthetissueduetoanobstructionin either the vasculature or heart. Tensionpneumothorax- increasedthoracicpressureleadstodisplacementofthevenacava, obstruction to atrial filling, decreased preload and decreased cardiac output. Cardiactamponade- impedesdiastolicexpansionandfillingleadstodecreasedpreload, strokes volume and cardiac output and ultimately end organ perfusion. P(AVPU)-ansPainful.Respondsonlytopainfulstimuli. (Airwayadjunctmaybeneededwhiledeterminingneedfor intubation) Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identifypotentially life-threatening injuries such as pneumothorax or pelvic fracture withuncontrolledinternalhemorrhage.CanalsoconfirmplacementofETtubes,ch esttubesan d gastric tubes. Considerneedfortransfer. shock-ansInadequatetissueperfusion. Spleen-ansEncapsulatedorganLUQlevelof9th- 11thribsandcurvesaroundaportionof the stomach. Minimal elasticity and flexibility - most frequent injured organ in blunttrauma. Secondary lymph organ that filters and cleanses the blood. Removes old RBCs andholdsareserveofblood.Itrecyclesiron.Itremovesantibody- coatedbacteria.Supplieslymphocytes to stimulate an immune response to blood borne microorganisms. Stores200-300ml of blood and leads to hemodynamic instability quickly if damaged. SplenicInjuries- ansInblunttraumathespleenmaylaceratefromincreasedabdominalpressure. GradedI-V,I=minortrauma Assessmentfindings:signsoftraumaLUQ,abdominaldistention,asymmetry,abnor TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE malcontou r, tenderness, guarding, rigidity, pain left shoulder when supine. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption,intraparenchymalhematomaorsubcapsularhematoma.Contrastblusho rextrava sation - hyperdenseareathatrepresenttraumaticdisruption.Activeextravasationimplieso ngoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12- 24hours,minimaltransfusionrequirements(<2units),gradeIorIIwithoutblush,ag e<55,alert able to assist in assessment of abdomen. Surgicaloptions:totalsplenectomyforsevereinjury,forlesssevere - directpressurepacking, embolization, splenorrhaphy (suturing spleen), partial removal. Asplenicpatientshavedifficultydestroyingencapsulatedbacteria - Streptococcuspneumonia, Neisseria meningitides and Haemophilus influenza. At risk forpneumococcal sepsis. Need annual flu shot and q5yr meningococcal andpneumococcal vaccines. U(AVPU)-ansUnresponsive.Doesnotrespondtoanystimuli. V (AVPU) - ansVerbal. Needs verbal stimuli to respond. (Airwayadjunctmaybeneededtopreventtongueobstructi on) A(AVPU)-ansAlert.Willbeabletomaintainairwayonceclear. A(PrimarySurvey)- ansAirwayandalertnesswithsimultaneouscervicalspinalstabilization. AirwayAssessment- ansInspect:tongueobstruction,loose/missingteeth,foreignobjects,blood, vomitus, secretions, edema,burns or evidence ofinhalation injury Auscultate:listenforobstructiveairwaysounds(ie.snoring,gurgling,stridor) Palpate:palpateforpossibleocclusivemaxillofacialbonydeformity,subcutaneous emphysem a AirwayInterventions:- ansSuctionRemove foreign TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryede maand increased myocardial ischemia. Inotropicsupporttoimprovecontractility. CirculationandControlofHemorrhageAssessment - ansInspect:Uncontrolledexternalbleeding, skin color Auscultate:Muffledheartsounds-mayindicatepericardialtamponade Palpate:carotidand/orfemoralpulsesforrate,rhythm, strength Circulation and Control of Hemorrhage Interventions - ansControl and treat externalbleeding:applydirectpressure,elevatebleedingextremity,applypressur eoverarteri alsites, consider use of a tourniquet. 2largeboreIVs,ifunableconsiderIO,obtainlabsand crossmatch. InitiateIVFofwarmedisotoniccrystalloidsolution.Considerbloodproductsafter2L. **Largevolumesoffluidleadtodilutioncoagulopathywhichworsensmetabolicacid osisandm aycausehypothermia.Componenttherapy,includingadministeringRBC,plasmaa nd platelets is a balanced approach so that O2 delivery is optimized, acidosiscorrected and coagulopathy prevented. ClassificationsofShock-ansHypovolemic- decreaseintheamountofcirculatingbloodvolume Obstructive-obstructionineitherthevasculatureorheart Cardiogenic-pumpfailureinthepresenceofadequateintravascularvolume Distributive- maldistributionofanadequatecirculatingbloodvolume(septic,anaphylactic, neurogenic) CornealAbrasion- ansDamagetothecornealepithelium.Easytoevaluatewithfluorescein. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Findings:photophobia,tearing,pain,injectedconjunctiva(redness),lidswelling,irri tation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophthalmicNSAIDStodecreaseswelling,oralanalgesics,Ophthalmicf/ uin24hours.(Do NOT patch - increases infection) CornealForeignBody-ansRoutinelymetal,plasticorwood. Findings:photophobia,pain,injectedconjunctiva(redness),lidswelling Treatment:topicalanesthetic,removalofforeignbody,ophthalmicABX,cycloplegic s,oral analgesia CornealLaceration - ansInvolvesoneormorelayersofthecornea.Visualizedwithaslitlamp. Findings:similartoabrasion,painoutofproportiontofindings,decreasedvision Treatment:treatsmalllacerationssimilartoanabrasion,largerlacerationsneedop hthalmolog y referral and possible surgery Cycloplegicagent- ansCycloplegiaisparalysisoftheciliarymuscleoftheeye,resultingin a loss of accommodation. Because of the paralysis of the ciliary muscle, thecurvature of the lens can no longer be adjusted to focus on nearby objects. D(PrimarySurvey)-ansDisability(NeurologicStatus) DisabilityAssessment-ansAssessGCSonarrivalandrepeatperpolicy. Assesspupilsforequality,shapeandreactivity (PERRL) Disabilityinterventions- ansEvaluateforneedforCT.AssumeAMStobetheresultofCNS injury until proven otherwise. ConsiderABGs- AMSmaybeindicatorofdecreasedcerebralperfusion,hypoventilation or acid- base imbalance. Considerbedsideglucose. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE GCS-ansGCS EYES 1:Doesnotopeneyes 2: Opens eyes in response to pain3:Openseyesinresponsetov oice 4: Opens eyes spontaneously VERBAL 1.Makesnosounds 2.Makes sounds 3.Words 4.Confused,disoriented 5.Oriented,conversesnormally MOTOR 1.Makesnomovements 2.Extensiontopainfulstimuli(decerebrate) 3.Abnormalflexiontopainfulstimuli(decorticate) 4.Withdrawaltopainfulstimuli 5.Localizespainfulstimuli 6.Obeys commands H(SecondarySurvey)- ansHistoryPrehospital Report (MIST) M:MOI I:Injuries sustained S:SignsandsymptomsinthefieldT: Treatment in field PatientHistory(SAMPLE): S: Symptoms A:Allergiesandtetanusstat usM: Medications P:PastmedicalhistoryL: Last oral intake E:EventsandEnvironmentalfactorsrelatedto injury. H:Headand Face HeadtoToeAssessment(secondary survey)-ansSOFTTISSUE: TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Inspect:lacerations,puncturewounds,abrasions,contusions,edema,ecchymosi s,impaled objects. Palpate:areasoftenderness,step-offs, crepitus BONY DEFORMITIES: Inspect:asymmetryoffacialexpressions,exposedtissueorboneforbrainmatter Palpate:depressions,angulations,tenderness HepaticInjuries- ansInblunttraumathelivermaylaceratefromincreasedabdominalpressure. Hematoma-bleedingcontainedwithinthecapsule Laceration-thecapsuleisdisrupted Findings:Cullensign(ecchymosisaroundtheumbilicusorRUQ),tenderness,guar dingor rigidity RUQ, 9-12 rib FXs, elevated LFT GradedI-VI,I=minortrauma Nonoperativemanagementisstandardofcareinhemodynamicallystablepatient .Observed with serial abdominal exams. FindingsofcontrastextravasationmaybeembolizedbyIR. Forsurgicalpatients- fluidresuscitationisessential.Risksofsurgeryincludedisruptionof the natural tamponade process due to the evacuation of large amounts of bloodresulting in hypovolemia. HypovolemicShock- ansCausedbyadecreaseintheamountofcirculatingbloodvolume. Intraumatypicallyresultsfromhemorrhage,butcanresultinaprecipitouslossofv olume, ie vomiting or diarrhea. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Burn trauma can result in hypovolemic shock from damage to the cell membranesleadingtoplasmaandproteinleakage.ofbodywater,resultsininadeq uateperfusi on. Hyperventilationcancauseincreasedintrathoracicpressureresultingincompressi onofthe heart and decreased cardiac output. InitialAssessment- ans1.PreparationandTriage 2. PrimarySurvey 3.Reevaluation 4.SecondarySurvey 5.ReevaluationAdjuncts 6.ReevaluationandPostResuscitationCare 7.DefinitiveCareorTransport IntraocularForeignBody- ans*TRUEEMERGENCYANDEARLYINTERVENTIONISESSENTIAL. Findings:compromisedvisualacuity,misshapenpupils,pain Treatment:elevateHOB,ophthalmology,immobilizeforeignbody,patchUNAFFEC TEDeye to limit concomitant eye movement, globe closure ASAP, systemic and ophthalmicABX, analgesics. Postopinfection,retinaldetachmentandvisionlossarecommon complications. lidinjury-ans Liver- ansLargestsolidorganofthebody.RUQ,6thto10thribs.EncasedbyGlissoncapsul e with blood vessels, lymphatics and nerves. Filters 1.7L of blood per minute. Theliverfiltersouttoxins,takesthenutrientsandreturnsthebloodtotheheartviat hehepatic veins. Hepatocytecellsarecapableofregenerationallowingthelivertorepairitsowntissue. Functions: Store and metabolize lipids, transport nutrients, produce glucose andbilirubin,convertammoniatourea,secreteelectrolytes,lipids,lecithin,cholester olandbile. Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary forclotting). TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE - hyperdenseareathatrepresenttraumaticdisruption.Activeextravasationimplieso ngoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12 - 24hours,minimaltransfusionrequirements(<2units),gradeIorIIwithoutblush,ag e<55,alert able to assist in assessment of abdomen. Surgicaloptions:totalsplenectomyforsevereinjury,forlesssevere - directpressurepacking, embolization, splenorrhaphy (suturing spleen), partial removal. Asplenicpatientshavedifficultydestroyingencapsulatedbacteria - Streptococcuspneumonia, Neisseria meningitides and Haemophilus influenza. At risk forpneumococcal sepsis. Need annual flu shot and q5yr meningococcal andpneumococcal vaccines. U(AVPU)-ansUnresponsive.Doesnotrespondtoanystimuli. V (AVPU) - ansVerbal. Needs verbal stimuli to respond. (Airwayadjunctmaybeneededtopreventtongueobstructi on) A(AVPU)-ansAlert.Willbeabletomaintainairwayonceclear. A(PrimarySurvey)-ansAirwayandalertnesswithsimultaneouscervical spinalstabilization. AirwayAssessment- ansInspect:tongueobstruction,loose/missingteeth,foreignobjects,blood, vomitus, secretions, edema,burns or evidence ofinhalation injury Auscultate:listenforobstructiveairwaysounds(ie.snoring,gurgling,stridor) Palpate:palpateforpossibleocclusivemaxillofacialbonydeformity,subcutaneous emphysem a AirwayInterventions:- ansSuctionRemove foreign body if noted Jawthrustmaneuver(maintain cspine) Nasopharyngealairway(canbeconscious)Oropharyngealairway(nogag)Consi der definitive airway TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE AlertnessAssessment-ansA-Alert TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE V- VerbalP - Painful U-Unresponsive B(PrimarySurvey)-ansBreathingand 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(signsofunderlyinginjury),openpne umothora ces(sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate:presence,absenceandequalityofbreathsoundsat2ndintercostalspace midclavi cular line and bases at the fifth intercostal space anterior axillary line Palpate:bonystructures,possibleribfractures,SQemphysema,softtissueinjury,J Vpulsation s at suprasternal notch or supraclavicular area Life- threateningpulmonaryinjuriesrequiringimmediateintervention:openpneumotho rax, tension pneumothorax, flail chest, hemothorax. BreathingandVentilationIntervention-ansBreathingabsent:jaw- thrustmaneuver,oralairway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathingpresent:NRB.Determineifventilationeffective:etCO2 35- 45,SpO294%orhigher. If ineffective: assist with bag-mask and determine need for definitive airway C(PrimarySurvey)-ansCirculationandControlofHemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequateintravascularvolume.There is alack of cardiac output and end-organ perfusionsecondarytoadecreaseinmyocardialcontractilityand/orvalvula rinsufficie ncy. Acutecauses- myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophthalmicNSAIDStodecreaseswelling,oralanalgesics,Ophthalmicf/ uin24hours.(Do NOT patch - increases infection) CornealForeignBody-ansRoutinelymetal,plasticorwood. Findings:photophobia,pain,injectedconjunctiva(redness),lidswelling Treatment:topicalanesthetic,removalofforeignbody,ophthalmicABX,cycloplegic s,oral analgesia CornealLaceration - ansInvolvesoneormorelayersofthecornea.Visualizedwithaslitlamp. Findings:similartoabrasion,painoutofproportiontofindings,decreasedvision Treatment:treatsmalllacerationssimilartoanabrasion,largerlacerationsneedop hthalmolog y referral and possible surgery Cycloplegicagent- ansCycloplegiaisparalysisoftheciliarymuscleoftheeye,resultingin a loss of accommodation. Because of the paralysis of the ciliary muscle, thecurvature of the lens can no longer be adjusted to focus on nearby objects. D(PrimarySurvey)-ansDisability(NeurologicStatus) DisabilityAssessment-ansAssessGCSonarrivalandrepeatperpolicy. Assesspupilsforequality,shapeandreactivity (PERRL) Disabilityinterventions- ansEvaluateforneedforCT.AssumeAMStobetheresultofCNS injury until proven otherwise. ConsiderABGs- AMSmaybeindicatorofdecreasedcerebralperfusion,hypoventilation or acid- base imbalance. Considerbedsideglucose. DistributiveShock- ansOccursasaresultofmaldistributionofanadequatecirculatingvolume with a loss of vascular tone or increased permeability. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Diffusevasodilationlowersthesystemicpressure,creatingarelativehypovolemiao rreduction of the mean systemic volume and venous return to the heart or drop inpreload, resulting in distributive shock. Anaphylactic:releaseofinflammatorymediators,suchashistamine,whichcontra ctsbronchia l smooth muscle and increases vascular permeability and vasodilation. SepticShock:systemicreleaseofbacterialendotoxins,resultinginanincreasedvasc ular permeability and vasodilation Neurogenic shock: loss of sympathetic nervous system control of vascular tone, whichproducesvenousandarterialvasodilation.Withthelossofsympatheticnervo ussystemi nput in spinal cord injury, unopposed vagal activity may result in decreased cardiacoutput through bradycardia. TREATMENT: increase systemic resistance, controlled volume replacement.Vasoconstrictionandinsomecases(neurogenic)Atropinetocounteract bradyc ardia. E(PrimarySurvey)-ansExposureandEnvironmental Control ExposureandEnvironmentalControl - ansCarefullyandcompletelyundressthepatient.Inspect for uncontrolled bleeding and note any obvious injuries. Preventheatloss.Hypothermiacombinedwithhypotensionandacidosisisapoten tiallylethal combination in the injured patient. Consider: warm blankets, keep ambienttemperature warm, warm IVF, forced air warmers, radiant warming lights. F(PrimarySurvey)-ansFullSetofVS&FamilyPresence G(PrimarySurvey)-ansGetResuscitationAdjuncts:(LMNOP) L:Labs M:Monitorcardiacrateandrhythm N:Nasoororogastrictubeconsideration O:Oxygenation-SpO2and/oretCO2moni torP: Pain assessment and management GCS-ansGCS TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE EYES TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Hyperventilationcancauseincreasedintrathoracicpressureresultingincompressi onofthe heart and decreased cardiac output. InitialAssessment- ans1.PreparationandTriage 2. PrimarySurvey 3.Reevaluation 4.SecondarySurvey 5.ReevaluationAdjuncts 6.ReevaluationandPostResuscitationCare 7.DefinitiveCareorTransport IntraocularForeignBody- ans*TRUEEMERGENCYANDEARLYINTERVENTIONISESSENTIAL. Findings:compromisedvisualacuity,misshapenpupils,pain Treatment:elevateHOB,ophthalmology,immobilizeforeignbody,patchUNAFFEC TEDeye to limit concomitant eye movement, globe closure ASAP, systemic and ophthalmicABX, analgesics. Postopinfection,retinaldetachmentandvisionlossarecommon complications. lidinjury-ans Liver- ansLargestsolidorganofthebody.RUQ,6thto10thribs.EncasedbyGlissoncapsul e with blood vessels, lymphatics and nerves. Filters 1.7L of blood per minute. Theliverfiltersouttoxins,takesthenutrientsandreturnsthebloodtotheheartviat hehepatic veins. Hepatocytecellsarecapableofregenerationallowingthelivertorepairitsowntissue. Functions: Store and metabolize lipids, transport nutrients, produce glucose andbilirubin,convertammoniatourea,secreteelectrolytes,lipids,lecithin,cholester olandbile. Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary forclotting). ObstructiveShock- ansResultsfromhypoperfusionofthetissueduetoanobstructionin either the vasculature or heart. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Tensionpneumothorax- increasedthoracicpressureleadstodisplacementofthevenacava, obstruction to atrial filling, decreased preload and decreased cardiac output. Cardiactamponade- impedesdiastolicexpansionandfillingleadstodecreasedpreload, strokes volume and cardiac output and ultimately end organ perfusion. P(AVPU)-ansPainful.Respondsonlytopainfulstimuli. (Airwayadjunctmaybeneededwhiledeterminingneedfor intubation) Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identifypotentially life-threatening injuries such as pneumothorax or pelvic fracture withuncontrolledinternalhemorrhage.CanalsoconfirmplacementofETtubes,ch esttubesan d gastric tubes. Considerneedfortransfer. shock-ansInadequatetissueperfusion. Spleen-ansEncapsulatedorganLUQlevelof9th- 11thribsandcurvesaroundaportionof the stomach. Minimal elasticity and flexibility - most frequent injured organ in blunttrauma. Secondary lymph organ that filters and cleanses the blood. Removes old RBCs andholdsareserveofblood.Itrecyclesiron.Itremovesantibody- coatedbacteria.Supplieslymphocytes to stimulate an immune response to blood borne microorganisms. Stores200-300ml of blood and leads to hemodynamic instability quickly if damaged. SplenicInjuries- ansInblunttraumathespleenmaylaceratefromincreasedabdominalpressure. GradedI-V,I=minortrauma Assessmentfindings:signsoftraumaLUQ,abdominaldistention,asymmetry,abno rmalconto ur, tenderness, guarding, rigidity, pain left shoulder when supine. CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption,intraparenchymalhematomaorsubcapsularhematoma.Contrastblusho rextrava sation - TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE hyperdenseareathatrepresenttraumaticdisruption.Activeextravasationimplieso ngoing bleeding. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE B(PrimarySurvey)-ansBreathingand 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(signsofunderlyinginjury),openpne umothora ces(sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate:presence,absenceandequalityofbreathsoundsat2ndintercostalspace midclavi cular line and bases at the fifth intercostal space anterior axillary line Palpate:bonystructures,possibleribfractures,SQemphysema,softtissueinjury,J Vpulsation s at suprasternal notch or supraclavicular area Life- threateningpulmonaryinjuriesrequiringimmediateintervention:openpneumotho rax, tension pneumothorax, flail chest, hemothorax. BreathingandVentilationIntervention-ansBreathingabsent:jaw- thrustmaneuver,oralairway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathingpresent:NRB.Determineifventilationeffective:etCO235- 45,SpO294%orhigher. If ineffective: assist with bag-mask and determine need for definitive airway C(PrimarySurvey)-ansCirculationandControlofHemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequateintravascularvolume.There is alack of cardiac ou tput and end-organ perfusionsecondarytoadecreaseinmyocardialcontractilityand/orvalvula rinsufficie ncy. Acutecauses- myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryede TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE maand increased myocardial ischemia. Inotropicsupporttoimprovecontractility. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE CirculationandControlofHemorrhageAssessment - ansInspect:Uncontrolledexternalbleeding, skin color Auscultate:Muffledheartsounds -mayindicatepericardialtamponade Palpate:carotidand/orfemoralpulsesforrate,rhythm, strength Circulation and Control of Hemorrhage Interventions - ansControl and treat externalbleeding:applydirectpressure,elevatebleedingextremity,applypressureo verarteri alsites, consider use of a tourniquet. 2largeboreIVs,ifunableconsiderIO,obtainlabsand crossmatch. InitiateIVFofwarmedisotoniccrystalloidsolution.Considerbloodproductsafter2L. **Largevolumesoffluidleadtodilutioncoagulopathywhichworsensmetabolicacid osisandm aycausehypothermia.Componenttherapy,includingadministeringRBC,plasmaa nd platelets is a balanced approach so that O2 delivery is optimized, acidosiscorrected and coagulopathy prevented. ClassificationsofShock-ansHypovolemic- decreaseintheamountofcirculatingbloodvolume Obstructive-obstructionineitherthevasculatureorheart Cardiogenic-pumpfailureinthepresenceofadequateintravascularvolume Distributive- maldistributionofanadequatecirculatingbloodvolume(septic,anaphylactic, neurogenic) CornealAbrasion- ansDamagetothecornealepithelium.Easytoevaluatewithfluorescein. Findings:photophobia,tearing,pain,injectedconjunctiva(redness),lidswelling,irri tation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophthalmicNSAIDStodecreaseswelling,oralanalgesics,Ophthalmicf/ uin24hours.(Do NOT patch - increases infection) TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE oice 4: Opens eyes spontaneously TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE VERBAL 1.Makesnosounds 2.Makes sounds 3.Words 4.Confused,disoriented 5.Oriented,conversesnormally MOTOR 1.Makesnomovements 2.Extensiontopainfulstimuli(decerebrate) 3.Abnormalflexiontopainfulstimuli(decorticate) 4.Withdrawaltopainfulstimuli 5.Localizespainfulstimuli 6.Obeys commands H(SecondarySurvey)- ansHistoryPrehospital Report (MIST) M:MOI I:Injuries sustained S:SignsandsymptomsinthefieldT: Treatment in field PatientHistory(SAMPLE): S: Symptoms A:AllergiesandtetanusstatusM: Medications P:PastmedicalhistoryL: Last oral intake E:EventsandEnvironmentalfactorsrelatedto injury. H:Headand Face HeadtoToeAssessment(secondarysurvey)-ansSOFTTISSUE: Inspect:lacerations,puncturewounds,abrasions,contusions,edema,ecchymosi s,impaled objects. Palpate:areasoftenderness,step-offs, crepitus BONY DEFORMITIES: TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Inspect:asymmetryoffacialexpressions,exposedtissueorboneforbrainmatter Palpate:depressions,angulations,tenderness HepaticInjuries- ansInblunttraumathelivermaylaceratefromincreasedabdominalpressure. Hematoma-bleedingcontainedwithinthecapsule Laceration-thecapsuleisdisrupted Findings:Cullensign(ecchymosisaroundtheumbilicusorRUQ),tenderness,guar dingor rigidity RUQ, 9-12 rib FXs, elevated LFT GradedI-VI,I=minortrauma Nonoperativemanagementisstandardofcareinhemodynamicallystablepatient .Observed with serial abdominal exams. FindingsofcontrastextravasationmaybeembolizedbyIR. Forsurgicalpatients- fluidresuscitationisessential.Risksofsurgeryincludedisruptionof the natural tamponade process due to the evacuation of large amounts of bloodresulting in hypovolemia. HypovolemicShock- ansCausedbyadecreaseintheamountofcirculatingbloodvolume. Intraumatypicallyresultsfromhemorrhage,butcanresultinaprecipitouslossofv olume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranesleadingtoplasmaandproteinleakage.ofbodywater,resultsininadeq uateperfusi on. Hyperventilationcancauseincreasedintrathoracicpressureresultingincompressi onofthe heart and decreased cardiac output. InitialAssessment- ans1.PreparationandTriage 2. PrimarySurvey TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE P(AVPU)-ansPainful.Respondsonlytopainfulstimuli. (Airwayadjunctmaybeneededwhiledeterminingneedfor intubation) Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identifypotentially life-threatening injuries such as pneumothorax or pelvic fracture withuncontrolledinternalhemorrhage.CanalsoconfirmplacementofETtubes,ch esttubesan d gastric tubes. Considerneedfortransfer. shock-ansInadequatetissueperfusion. Spleen-ansEncapsulatedorganLUQlevelof9th- 11thribsandcurvesaroundaportionof the stomach. Minimal elasticity and flexibility - most frequent injured organ in blunttrauma. Secondary lymph organ that filters and cleanses the blood. Removes old RBCs andholdsareserveofblood.Itrecyclesiron.Itremovesantibody- coatedbacteria.Supplieslymphocytes to stimulate an immune response to blood borne microorganisms. Stores200-300ml of blood and leads to hemodynamic instability quickly if damaged. SplenicInjuries- ansInblunttraumathespleenmaylaceratefromincreasedabdominalpressure. GradedI-V,I=minortrauma Assessmentfindings:signsoftraumaLUQ,abdominaldistention,asymmetry,abnor malcontou r, tenderness, guarding, rigidity, pain left shoulder when supine. CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption,intraparenchymalhematomaorsubcapsularhematoma.Contrastblusho rextrava sation - hyperdenseareathatrepresenttraumaticdisruption.Activeextravasationimplieso ngoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12- 24hours,minimaltransfusionrequirements(<2units),gradeIorIIwithoutblush,ag e<55,alert able to assist in assessment of abdomen. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Surgicaloptions:totalsplenectomyforsevereinjury,forlesssevere - directpressurepacking, embolization, splenorrhaphy (suturing spleen), partial removal. Asplenicpatientshavedifficultydestroyingencapsulatedbacteria - Streptococcuspneumonia, Neisseria meningitides and Haemophilus influenza. At risk forpneumococcal sepsis. Need annual flu shot and q5yr meningococcal andpneumococcal vaccines. U(AVPU)-ansUnresponsive.Doesnotrespondtoanystimuli. V(AVPU)-ansVerbal.Needsverbalstimulitorespond. (Airwayadjunctmaybeneededtopreventtongueobstruction)A(AVPU)- ansAlert.Willbe able to maintain airway once clear. A(PrimarySurvey)- ansAirwayandalertnesswithsimultaneouscervicalspinalstabilization. AirwayAssessment- ansInspect:tongueobstruction,loose/missingteeth,foreignobjects,blood, vomitus, secretions, edema,burns or evidence ofinhalation injury Auscultate:listenforobstructiveairwaysounds(ie.snoring,gurgling,stridor) Palpate:palpateforpossibleocclusivemaxillofacialbonydeformity,subcutaneous emphysem a AirwayInterventions:- ansSuctionRemove foreign body if noted Jawthrustmaneuver(maintain cspine) Nasopharyngealairway(canbeconscious)Oropharyngealairway(nogag)Consi der definitive airway AlertnessAssessment- ansA- AlertV-Verbal P-Painful U-Unresponsive B(PrimarySurvey)-ansBreathingand Ventilation TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE 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(signsofunderlyinginjury),openpne umothora ces(sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate:presence,absenceandequalityofbreathsoundsat2ndintercostalspace midclavi cular line and bases at the fifth intercostal space anterior axillary line Palpate:bonystructures,possibleribfractures,SQemphysema,softtissueinjury,J Vpulsation s at suprasternal notch or supraclavicular area Life- threateningpulmonaryinjuriesrequiringimmediateintervention:openpneumotho rax, tension pneumothorax, flail chest, hemothorax. BreathingandVentilationIntervention-ansBreathingabsent:jaw- thrustmaneuver,oralairway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathingpresent:NRB.Determineifventilationeffective:etCO235- 45,SpO294%orhigher. If ineffective: assist with bag-mask and determine need for definitive airway C(PrimarySurvey)-ansCirculationandControlofHemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequateintravascularvolume.There is alack of cardiac output and end-organ perfusionsecondarytoadecreaseinmyocardialcontractilityand/orvalvula rinsufficie ncy. Acutecauses- myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryede maand increased myocardial ischemia. Inotropicsupporttoimprovecontractility. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Treatment:topicalanesthetic,removalofforeignbody,ophthalmicABX,cycloplegic s,oral analgesia CornealLaceration - ansInvolvesoneormorelayersofthecornea.Visualizedwithaslitlamp. Findings:similartoabrasion,painoutofproportiontofindings,decreasedvision Treatment:treatsmalllacerationssimilartoanabrasion,largerlacerationsneedop hthalmolog y referral and possible surgery Cycloplegicagent- ansCycloplegiaisparalysisoftheciliarymuscleoftheeye,resultingin a loss of accommodation. Because of the paralysis of the ciliary muscle, thecurvature of the lens can no longer be adjusted to focus on nearby objects. D(PrimarySurvey)-ansDisability(NeurologicStatus) DisabilityAssessment-ansAssessGCSonarrivalandrepeatperpolicy. Assesspupilsforequality,shapeandreactivity (PERRL) Disabilityinterventions- ansEvaluateforneedforCT.AssumeAMStobetheresultofCNS injury until proven otherwise. ConsiderABGs- AMSmaybeindicatorofdecreasedcerebralperfusion,hypoventilation or acid- base imbalance. Considerbedsideglucose. DistributiveShock- ansOccursasaresultofmaldistributionofanadequatecirculatingvolume with a loss of vascular tone or increased permeability. Diffusevasodilationlowersthesystemicpressure,creatingarelativehypovolemiao rreduction of the mean systemic volume and venous return to the heart or drop inpreload, resulting in distributive shock. Anaphylactic:releaseofinflammatorymediators,suchashistamine,whichcontra ctsbronchia l smooth muscle and increases vascular permeability and TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE vasodilation. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE SepticShock:systemicreleaseofbacterialendotoxins,resultinginanincreasedvasc ular permeability and vasodilation Neurogenic shock: loss of sympathetic nervous system control of vascular tone, whichproducesvenousandarterialvasodilation.Withthelossofsympatheticnervo ussystemi nput in spinal cord injury, unopposed vagal activity may result in decreased cardiacoutput through bradycardia. TREATMENT: increase systemic resistance, controlled volume replacement.Vasoconstrictionandinsomecases(neurogenic)Atropinetocounteract bradyc ardia. E(PrimarySurvey)-ansExposureandEnvironmental Control ExposureandEnvironmentalControl - ansCarefullyandcompletelyundressthepatient.Inspect for uncontrolled bleeding and note any obvious injuries. Preventheatloss.Hypothermiacombinedwithhypotensionandacidosisisapoten tiallylethal combination in the injured patient. Consider: warm blankets, keep ambienttemperature warm, warm IVF, forced air warmers, radiant warming lights. F(PrimarySurvey)-ansFullSetofVS&FamilyPresence G(PrimarySurvey)-ansGetResuscitationAdjuncts:(LMNOP) L:Labs M:Monitorcardiacrateandrhythm N:Nasoororogastrictubeconsideration O:Oxygenation-SpO2and/oretCO2moni torP: Pain assessment and management GCS-ansGCS EYES 1:Doesnotopeneyes 2: Opens eyes in response to pain3:Openseyesinresponsetov oice 4: Opens eyes spontaneously VERBAL TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Palpate:depressions,angulations,tenderness HepaticInjuries- ansInblunttraumathelivermaylaceratefromincreasedabdominalpressure. Hematoma-bleedingcontainedwithinthecapsule Laceration-thecapsuleisdisrupted Findings:Cullensign(ecchymosisaroundtheumbilicusorRUQ),tenderness,guar dingor rigidity RUQ, 9-12 rib FXs, elevated LFT GradedI-VI,I=minortrauma Nonoperativemanagementisstandardofcareinhemodynamicallystablepatient .Observed with serial abdominal exams. FindingsofcontrastextravasationmaybeembolizedbyIR. Forsurgicalpatients- fluidresuscitationisessential.Risksofsurgeryincludedisruptionof the natural tamponade process due to the evacuation of large amounts of bloodresulting in hypovolemia. HypovolemicShock- ansCausedbyadecreaseintheamountofcirculatingbloodvolume. Intraumatypicallyresultsfromhemorrhage,butcanresultinaprecipitouslossofv olume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranesleadingtoplasmaandproteinleakage.ofbodywater,resultsininadeq uateperfusi on. Hyperventilationcancauseincreasedintrathoracicpressureresultingincompressi onofthe heart and decreased cardiac output. InitialAssessment- ans1.PreparationandTriage 2. PrimarySurvey 3.Reevaluation 4.SecondarySurvey 5.ReevaluationAdjuncts TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE 6.ReevaluationandPostResuscitationCare 7.DefinitiveCareorTransport IntraocularForeignBody- ans*TRUEEMERGENCYANDEARLYINTERVENTIONISESSENTIAL. Findings:compromisedvisualacuity,misshapenpupils,pain Treatment:elevateHOB,ophthalmology,immobilizeforeignbody,patchUNAFFEC TEDeye to limit concomitant eye movement, globe closure ASAP, systemic and ophthalmicABX, analgesics. Postopinfection,retinaldetachmentandvisionlossarecommon complications. lidinjury-ans Liver- ansLargestsolidorganofthebody.RUQ,6thto10thribs.EncasedbyGlissoncapsul e with blood vessels, lymphatics and nerves. Filters 1.7L of blood per min ute. Theliverfiltersouttoxins,takesthenutrientsandreturnsthebloodtotheheartviat hehepatic veins. Hepatocytecellsarecapableofregenerationallowingthelivertorepairitsowntissue. Functions: Store and metabolize lipids, transport nutrients, produce glucose andbilirubin,convertammoniatourea,secreteelectrolytes,lipids,lecithin,cholester olandbile. Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary forclotting). ObstructiveShock- ansResultsfromhypoperfusionofthetissueduetoanobstructionin either the vasculature or heart. Tensionpneumothorax- increasedthoracicpressureleadstodisplacementofthevenacava, obstruction to atrial filling, decreased preload and decreased cardiac output. Cardiactamponade- impedesdiastolicexpansionandfillingleadstodecreasedpreload, strokes volume and cardiac output and ultimately end organ perfusion. P(AVPU)-ansPainful.Respondsonlytopainfulstimuli. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE (Airwayadjunctmaybeneededwhiledeterminingneedfor intubation) TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE contusions/abrasions/ deformities(signsofunderlyinginjury),openpneumothoraces(suckin g chest wound), JVD, tracheal position, signs of inhalation injury Auscultate:presence,absenceandequalityofbreathsoundsat2ndintercostalspace midclavi cular line and bases at the fifth intercostal space anterior axillary line Palpate:bonystructures,possibleribfractures,SQemphysema,softtissueinjury,J Vpulsation s at suprasternal notch or supraclavicular area Life- threateningpulmonaryinjuriesrequiringimmediateintervention:openpneumothor ax, tension pneumothorax, flail chest, hemothorax. BreathingandVentilationIntervention-ansBreathingabsent:jaw- thrustmaneuver,oralairway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathingpresent:NRB.Determineifventilationeffective:etCO235- 45,SpO294%orhigher. If ineffective: assist with bag-mask and determine need for definitive airway C(PrimarySurvey)-ansCirculationandControlofHemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequateintravascularvolume.There is alack of cardiac output and end-organ perfusionsecondarytoadecreaseinmyocardialcontractilityand/orvalvula rinsufficie ncy. Acutecauses- myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryede maand increased myocardial ischemia. Inotropicsupporttoimprovecontractility. CirculationandControlofHemorrhageAssessment - ansInspect:Uncontrolledexternalbleeding, skin color TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Auscultate:Muffledheartsounds -mayindicatepericardialtamponade Palpate:carotidand/orfemoralpulsesforrate,rhythm, strength TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Circulation and Control of Hemorrhage Interventions - ansControl and treat externalbleeding:applydirectpressure,elevatebleedingextremity,applypressureo verarteri alsites, consider use of a tourniquet. 2largeboreIVs,ifunableconsiderIO,obtainlabsand crossmatch. InitiateIVFofwarmedisotoniccrystalloidsolution.Considerbloodproductsafter2L. **Largevolumesoffluidleadtodilutioncoagulopathywhichworsensmetabolicaci dosisandm aycausehypothermia.Componenttherapy,includingadministeringRBC,plasma and platelets is a balanced approach so that O2 delivery is optimized, acidosiscorrected and coagulopathy prevented. ClassificationsofShock-ansHypovolemic- decreaseintheamountofcirculatingbloodvolume Obstructive-obstructionineitherthevasculatureorheart Cardiogenic-pumpfailureinthepresenceofadequateintravascularvolume Distributive- maldistributionofanadequatecirculatingbloodvolume(septic,anaphylactic, neurogenic) CornealAbrasion- ansDamagetothecornealepithelium.Easytoevaluatewithfluorescein. Findings:photophobia,tearing,pain,injectedconjunctiva(redness),lidswelling,irri tation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophthalmicNSAIDStodecreaseswelling,oralanalgesics,Ophthalmicf/ uin24hours.(Do NOT patch - increases infection) CornealForeignBody-ansRoutinelymetal,plasticorwood. Findings:photophobia,pain,injectedconjunctiva(redness),lidswelling Treatment:topicalanesthetic,removalofforeignbody,ophthalmicABX,cycloplegic s,oral analgesia TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Neurogenic shock: loss of sympathetic nervous system control of vascular tone, whichproducesvenousandarterialvasodilation.Withthelossofsympatheticnervo ussystemi nput in spinal cord injury, unopposed vagal activity may result in decreased cardiacoutput through bradycardia. TREATMENT: increase systemic resistance, controlled volume replacement.Vasoconstrictionandinsomecases(neurogenic)Atropinetocounteract bradyc ardia. E(PrimarySurvey)-ansExposureandEnvironmental Control ExposureandEnvironmentalControl - ansCarefullyandcompletelyundressthepatient.Inspect for uncontrolled bleeding and note any obvious injuries. Preventheatloss.Hypothermiacombinedwithhypotensionandacidosisisapoten tiallylethal combination in the injured patient. Consider: warm blankets, keep ambienttemperature warm, warm IVF, forced air warmers, radiant warming lights. F(PrimarySurvey)-ansFullSetofVS&FamilyPresence G(PrimarySurvey)-ansGetResuscitationAdjuncts:(LMNOP) L:Labs M:Monitorcardiacrateandrhythm N:Nasoororogastrictubeconsideration O:Oxygenation-SpO2and/oretCO2moni torP: Pain assessment and management GCS-ansGCS EYES 1:Doesnotopeneyes 2: Opens eyes in response to pain3:Openseyesinresponsetov oice 4: Opens eyes spontaneously VERBAL 1.Makesnosounds 2.Makes sounds 3.Words TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE 4.Confused,disoriented TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE 5.Oriented,conversesnormally MOTOR 1.Makesnomovements 2.Extensiontopainfulstimuli(decerebrate) 3.Abnormalflexiontopainfulstimuli(decorticate) 4.Withdrawaltopainfulstimuli 5.Localizespainfulstimuli 6.Obeys commands H(SecondarySurvey)- ansHistoryPrehospital Report (MIST) M:MOI I:Injuries sustained S:Signsandsymptomsinthefie ldT: Treatment in field PatientHistory(SAMPLE): S: Symptoms A:AllergiesandtetanusstatusM: Medications P:PastmedicalhistoryL: Last oral intake E:EventsandEnvironmentalfactorsrelatedto injury. H:Headand Face HeadtoToeAssessment(secondarysurvey)-ansSOFTTISSUE: Inspect:lacerations,puncturewounds,abrasions,contusions,edema,ecchymosi s,impaled objects. Palpate:areasoftenderness,step-offs, crepitus BONY DEFORMITIES: Inspect:asymmetryoffacialexpressions,exposedtissueorboneforbrainmatter Palpate:depressions,angulations,tenderness TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identifypotentially life-threatening injuries such as pneumothorax or pelvic fracture withuncontrolledinternalhemorrhage.CanalsoconfirmplacementofETtubes,ch esttubesan d gastric tubes. Considerneedfortransfer. shock-ansInadequatetissueperfusion. Spleen-ansEncapsulatedorganLUQlevelof9th- 11thribsandcurvesaroundaportionof the stomach. Minimal elasticity and flexibility - most frequent injured organ in blunttrauma. Secondary lymph organ that filters and cleanses the blood. Removes old RBCs andholdsareserveofblood.Itrecyclesiron.Itremovesantibody- coatedbacteria.Supplieslymphocytes to stimulate an immune response to blood borne microorganisms. Stores200-300ml of blood and leads to hemodynamic instability quickly if damaged. SplenicInjuries- ansInblunttraumathespleenmaylaceratefromincreasedabdominalpressure. GradedI-V,I=minortrauma Assessmentfindings:signsoftraumaLUQ,abdominaldistention,asymmetry,abnor malcontou r, tenderness, guarding, rigidity, pain left shoulder when supine. CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption,intraparenchymalhematomaorsubcapsularhematoma.Contrastblusho rextrava sation - hyperdenseareathatrepresenttraumaticdisruption.Activeextravasationimplieso ngoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12- 24hours,minimaltransfusionrequirements(<2units),gradeIorIIwithoutblush,ag e<55,alert able to assist in assessment of abdomen. Surgicaloptions:totalsplenectomyforsevereinjury,forlesssevere - directpressurepacking, embolization, splenorrhaphy (suturing spleen), partial removal. TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE Asplenicpatientshavedifficultydestroyingencapsulatedbacteria - Streptococcuspneumonia, Neisseria meningitides and Haemophilus influenza. At risk for TNCC ACTUAL FINAL EXAM TEST BANK 350 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES(VERIFIEDANSWERS)ALREADYGRA DED A+ 100% COMPLETE pneumococcalsepsis.Needannualflushotandq5yrmeningococcalandpneumococ cal vaccines. U(AVPU)-ansUnresponsive.Doesnotrespondtoanystimuli. V(AVPU)-ansVerbal.Needsverbalstimulitorespond. (Airwayadjunctmaybeneededtopreventtongueobstruction)A(AVPU)- ansAlert.Willbe able to maintain airway once clear. A(PrimarySurvey)-ansAirwayandalertnesswith simultaneouscervicalspinalstabilization. AirwayAssessment- ansInspect:tongueobstruction,loose/missingteeth,foreignobjects,blood, vomitus, secretions, edema,burns or evidence ofinhalation injury Auscultate:listenforobstructiveairwaysounds(ie.snoring,gurgling,stridor) Palpate:palpateforpossibleocclusivemaxillofacialbonydeformity,subcutaneous emphysem a AirwayInterventions:- ansSuctionRemove foreign body if noted Jawthrustmaneuver(maintain cspine) Nasopharyngealairway(canbeconscious)Oropharyngealairway(nogag)Consi der definitive airway AlertnessAssessment- ansA- AlertV-Verbal P-Painful U-Unresponsive B(PrimarySurvey)-ansBreathingand 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(signsofunderlyinginjury),openpne umothora ces(sucking chest wound), JVD, tracheal position, signs of inhalation injury