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ANS: Baroreceptors, Hypovolemia, Obstructive Shock, and Compartment Syndrome, Exams of Nursing

Detailed answers with rationales for open book questions related to the autonomic nervous system (ans), specifically baroreceptors, hypovolemia, obstructive shock, and compartment syndrome. Topics include ans baroreceptor activation, symptoms of hypovolemia, distributive and obstructive shock causes and symptoms, and six ps of compartment syndrome.

Typology: Exams

2023/2024

Available from 02/15/2024

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Download ANS: Baroreceptors, Hypovolemia, Obstructive Shock, and Compartment Syndrome and more Exams Nursing in PDF only on Docsity! TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ A 5-year old child presents to the ED with bruises to the upper arms and buttocks in various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities found based on the pediatric assessment triangle or primary survey. Which of the following is the priority nursing intervention? A) report your suspicion of the maltreatment in accordance with local regulations B) apply ice to the bruises and consult wound care C) engage in therapeutic communication to determine the MOI D) provide the family with injury prevention recourses - ANSA) report your suspicion of the maltreatment in accordance with local regulations A 20-year old male presents to the ED c/o severe lower abd pain after landing hard on the bicycle cross bars which performing an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the nurse questions? A) Fast exam B) CT scan C) straight cath for urine sample D) ice and elevation of the scrotum - ANSC) straight cath for urine sample A 35-year old male presents with facial trauma after bring struck in the face with a baseball. a tear-drop shaped left pupil is noted on exam. What type of injury is suspected? A) oculomotor nerve palsy B) globe rupture *** C) Uncal herniation D) retinal detachment - ANSB) globe rupture A 36-year old female has a deformity of the left wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention? A) apply a sling and elevate the extremity to the level of the heart. B) apply a splint and elevate above the level of the heart C) Apply a sling and elevate the extremity above the level of the heart D) apply a splint and elevate the extremity to the level of the heart. - ANSB) apply a splint and ELEVATE ABOVE THE LEVEL OF THE HEART A 49-year old restrained driver involved in a MVC presents to the trauma center c/o abd, pelvic, and bil lower extremity pain Vitals signs are stable. The nurse can anticipate all of these negative fast exam except which of the following? A. Diagnostic peritoneal lavage B. Serial FAST exams C. Abdominal and pelvic CT scans TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ D. Serial abdominal assessments - ANSA) diagnostic peritoneal lavage The FAST exam is done at the bedside to identify pathological fluid in the abdominal and pelvic cavities. FAST exams reduce the use of more invasive diagnostic peritoneal lavage and can be repeated if clinical changes or hemodynamic changes occur. A negative FAST study does not rule out injury and may warrant a follow-up computed tomography scan. Serial FAST exams can identify increasing abdominal fluid collections from hemorrhage. Diagnostic peritoneal lavage/diagnostic peritoneal aspiration is performed by the surgical team to rapidly identify the presence of hemorrhage in patients who are hemodynamically unstable after trauma. A 56-year- male patient involved in a MVC is brought to the ED of a rural critical access facility. He c/o neck pain, SOB, and diffuse abd pain. His GCS is 15. His vitals are as follows: BP 98/71 HR 125 beats/min RR 26 breaths/min SpO2 94% on high flow O2 via NRB mask which of the following is the priority intervention for this patient? A) Expedite transport to the CT scanner B) prepare the patient for spinal radiographs C) expedite transfer to the closest trauma center D) notify the patients family - ANSC) expedite transfer to the closest trauma center A passenger is brought to the emergency department of a rural hospital following a high-speed MVC. When significant abdominal and pelvic injuries are noted in the primary survey, which of the following is the priority interventions? A) initiate transfer to a trauma center B) provide report to the operating room nurse C) Obtained imaging studies D) Place a gastric tube - ANSA) initiate transfer to a trauma center 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 tapes it on 3 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 interventions? A) needle decompression B) tube thoracostomy C) dressing removal D) surgical repair - ANSC) dressing removal TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ A) call for a portable CXR stat B) chest to make sure the ventilator is plugged in C) suction the ET tube D) confirm ET tube placement - ANSD) confirm ET tube placement An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored respiratory, and dusky skin. the trauma team has administered medications for drug assisted intubation and attempted intubation but was unsuccessful. What is the most appropriate immediate next step? A) Ventilate with a BVM B) Prepare for cricothyroidotomy C) administer reversal medications D) contact anesthesia for assistance - ANSA) Ventilate with a BVM Caregivers carry a 2-year old into the ED who fell out of 2nd story window. The patient is awake and crying with increased work of breathing and pale skin. which of the following interventions has the highest priority? A) padding the upper back while stabilizing the cervical spine *** B) applying a tight-fitting NRB mask with an attached resevior C) establishing intravenous access and administering a 20mL/kg bolus D) preparing for drug assisted intubation - ANSA) padding the upper back while stabilizing the cervical spine During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. Which priority nursing interventions should be performed next? A) open the airway with the head-tilt/chin lift maneuver B) auscultate bilateral breath sounds to assess ventilatory status C) assist respirations using a BVM D) insert an oropharyngeal airway if there is no gag reflex - ANSD) insert an oropharyngeal airway if there is no gag reflex 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 patient is asking to have the cervical color removed. when is it appropriate to remove the cervical collar? A) after a physical examination if the patient has no radiologic abnormalities on a computed tomography scan *** B) after physician evaluation if the patient has not neurologic abnormalities on exam C) after palpation of the spine if the patient has no point tenderness the the vertebral column TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ D) after physical examination if the patient has not neck pain with movement - ANSA) after a physical examination if the patient has no radiologic abnormalities on a computed tomography scan EMS brings a patient who fell riding his bicycle. Using the American College of Surgeons screening guidelines, which assessment finding would prompt the nurse to prepare the patient for radiologic spine clearance? A) Alert with no neurologic deficits B) Multiple abrasions to the extremities C) Multiple requests of water D) Smell of alcohol on breath - ANSD) Smell of alcohol on breath Following a review of recent drills and a real disaster event, a hospital has identified deficiencies and is taking steps to minimize the impact of future disaster. Which phase of the disaster life cycle does this describe? A) mitigation B) preparedness C) response D) recovery - ANSA) mitigation If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? A) potassium B) magnesium C) sodium D) calcium - ANSD) calcium Patients with a crush injury should be monitored for which of the following conditions? A) Hypernatremia B) Hypercalcemia C) Dysrhythmias D) polyuria - ANSC) Dysrhythmias Tearing of the bridging veins is most frequently associated with which brain injury? A) epidural hematoma B) subdural hematoma *** C) diffuse axonal injury D) intracerebral hematoma - ANSB) subdural hematoma TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ The most reassuring finding for a male patient with hop pain after a fall is which of the following? A) a normal prostate exam B) absence of abdominal distension C) a normal fast exam D) pelvic stability - ANSD) pelvic stability The nurse is caring for a 120 kg male is brought in after a warehouse fire and is calculating the patient's fluid resuscitation needs. He has painful red blistering to the entire surface of both upper extremities and superficial burns to the anterior chest. Using the modified Lund and Browder chart to calculate the total BSA burned, how much IV fluids would be administered in the first 8 hours? A) 2280 mL B) 3840 mL C) 4560 mL D) 7680 mL - ANSA) 2280 mL (upper arm 4+4 / lower arm 3+3 / hand 2.5+2.5) = 19% TBSA. 120 kg x (2 mL) x (19% TBSA) = 4560 mL 4560 / 2 (half of fluids given in first 8 hours) = 2280 mL The trauma nurse knows that placing a bariatric patients in a "ramped position" provides better visualization during the insertion of which device? A) Intraosseous line B) orogastric tube C) ET tube *** D) urinary catheter - ANSC) ET tube What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation? A) pulse oximetry and capnogaphy ** B) respiratory rate and capnography C) pulse oximetry and respiratory rate D) capnography and capnometry - ANSA) pulse oximetry and capnogaphy What factor contributes most the kinetic energy of a body in motion? A) acceleration B) mass TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ A) it causes less spinal motion than the lift and slide maneuver B) it is recommended for patients with unstable pelvic fractures C) it can worsen cord damage from an unstable spinal injury *** D) it does not increases the risk of life threatening hemorrhage from unstable injuries - ANSC) it can worsen cord damage from an unstable spinal injury Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? A) ABC B) MARCH C) AVPU D) VIPP - ANSB) MARCH Which of the following occurs during the third impact of a motor vehicle crash? A) The driver of the vehicle collides with the steering wheel B) the vehicle collides with a tree C) the aorta is torn at its attachment with the ligamentum arteriosum D) the airbag deploys and strikes the front seat passenger - ANSC) the aorta is torn at its attachment with the ligamentum arteriosum Which of the following patients warrants referral to a burn center? A) a 21- year old female with a partial thickness burn to the right forearm B) a 40-year old hypertensive male with a superficial burn to the back C) a 52-year old diabetic male with partial thickness burn to the left lower leg D) a 35-year old hyperlipidemic female with superficial burns to the anterior thorax. - ANSC) a 52-year old diabetic male with partial thickness burn to the left lower leg Which of the following values indicates the need for alcohol withdrawal interventions? A) CIWA-Ar of 36 *** B) GCS 13 C) ETCo2 of 48 mm Hg D) heart rate of 45 beats/min - ANSA) CIWA-Ar of 36 Which pulse pressure description is an indication of early hypovolemic shock? A) widened B) narrowed C) bounding D) weak - ANSB) narrowed TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Why is a measure of serum lactate obtained in the initial assessment of the trauma patient? a) to measure oxygenation and ventilation b) to quantify the base deficit for the adequacy of cellular perfusion c) to gauge end-organ perfusion and tissue hypoxia d) to determine the underlying cause of shock - ANSc) to gauge end-organ perfusion and tissue hypoxia You are caring for a patient who was involved in a MVA and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal high at the costal margin, and some dark bloody show. Varying, accelerations and decelerations are noted on the cardiotocography. These findings are most consistent with which of the following? A) placental abruption B) preterm labor C) uterine rupture D) fetal demise - ANSA) placental abruption You are treating a 27-year old male in respiratory distress who was involved in a house fire. Calculating TBSA burned is deferred d/t the need for emergent intubation. At what rate should you begin fluid resuscitation? A) 1000 mL/hr B) 500 mL/hr C) 250 mL/hr D) 125 mL/hr - ANSB) 500 mL/hr A (AVPU) - ANSAlert. Will be able to maintain airway once clear. A (Primary Survey) - ANSAirway and alertness with simultaneous cervical spinal stabilization. Airway Assessment - ANSInspect: tongue obstruction, loose/missing teeth, foreign objects, blood, vomitus, secretions, edema, burns or evidence of inhalation injury Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor) Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphysema Airway Interventions: - ANSSuction Remove foreign body if noted Jaw thrust maneuver (maintain cspine) TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag) Consider definitive airway Alertness Assessment - ANSA-Alert V-Verbal P-Painful U-Unresponsive B (Primary Survey) - ANSBreathing and Ventilation Breathing and Ventilation Assessment - ANSInspect: spontaneous breathing, symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use, diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic), contusions/abrasions/deformities (signs of underlying injury), open pneumothoraces (sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space midclavicular line and bases at the fifth intercostal space anterior axillary line Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV pulsations at suprasternal notch or supraclavicular area Life-threatening pulmonary injuries requiring immediate intervention: open pneumothorax, tension pneumothorax, flail chest, hemothorax. Breathing and Ventilation Intervention - ANSBreathing absent: jaw-thrust maneuver, oral airway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or higher. If ineffective: assist with bag-mask and determine need for definitive airway C (Primary Survey) - ANSCirculation and Control of Hemorrhage Cardiogenic Shock - ANSResults from pump failure in the presence of adequate intravascular volume. There is a lack of cardiac output and end-organ perfusion secondary to a decrease in myocardial contractility and/or valvular insufficiency. Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic cause. Blunt cardiac injury may present similar to MI. Excess of volume administration or increased after load can result in pulmonary edema and increased myocardial ischemia. TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Neurogenic shock: loss of sympathetic nervous system control of vascular tone, which produces venous and arterial vasodilation. With the loss of sympathetic nervous system input in spinal cord injury, unopposed vagal activity may result in decreased cardiac output through bradycardia. TREATMENT: increase systemic resistance, controlled volume replacement. Vasoconstriction and in some cases (neurogenic) Atropine to counteract bradycardia. E (Primary Survey) - ANSExposure and Environmental Control Exposure and Environmental Control - ANSCarefully and completely undress the patient. Inspect for uncontrolled bleeding and note any obvious injuries. Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentially lethal combination in the injured patient. Consider: warm blankets, keep ambient temperature warm, warm IVF, forced air warmers, radiant warming lights. F (Primary Survey) - ANSFull Set of VS & Family Presence G (Primary Survey) - ANSGet Resuscitation Adjuncts: (LMNOP) L: Labs M: Monitor cardiac rate and rhythm N: Naso or orogastric tube consideration O: Oxygenation - SpO2 and/or etCO2 monitor P: Pain assessment and management GCS - ANSGCS EYES 1: Does not open eyes 2: Opens eyes in response to pain 3: Opens eyes in response to voice 4: Opens eyes spontaneously VERBAL 1. Makes no sounds 2. Makes sounds 3. Words 4. Confused, disoriented 5. Oriented, converses normally MOTOR TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ 1. Makes no movements 2. Extension to painful stimuli (decerebrate) 3. Abnormal flexion to painful stimuli (decorticate) 4. Withdrawal to painful stimuli 5. Localizes painful stimuli 6. Obeys commands H (Secondary Survey) - ANSHistory Prehospital Report (MIST) M: MOI I: Injuries sustained S: Signs and symptoms in the field T: Treatment in field Patient History (SAMPLE): S: Symptoms A: Allergies and tetanus status M: Medications P: Past medical history L: Last oral intake E: Events and Environmental factors related to injury. H: Head and Face Head to Toe Assessment (secondary survey) - ANSSOFT TISSUE: Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled objects. Palpate: areas of tenderness, step-offs, crepitus BONY DEFORMITIES: Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter Palpate: depressions, angulations, tenderness Hepatic Injuries - ANSIn blunt trauma the liver may lacerate from increased abdominal pressure. Hematoma - bleeding contained within the capsule Laceration - the capsule is disrupted TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Findings: Cullen sign (ecchymosis around the umbilicus or RUQ), tenderness, guarding or rigidity RUQ, 9-12 rib FXs, elevated LFT Graded I-VI, I = minor trauma Nonoperative management is standard of care in hemodynamically stable patient. Observed with serial abdominal exams. Findings of contrast extravasation may be embolized by IR. For surgical patients - fluid resuscitation is essential. Risks of surgery include disruption of the natural tamponade process due to the evacuation of large amounts of blood resulting in hypovolemia. Hypovolemic Shock - ANSCaused by a decrease in the amount of circulating blood volume. In trauma typically results from hemorrhage, but can result in a precipitous loss of volume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranes leading to plasma and protein leakage. of body water, results in inadequate perfusion. Hyperventilation can cause increased intrathoracic pressure resulting in compression of the heart and decreased cardiac output. Initial Assessment - ANS1. Preparation and Triage 2. Primary Survey 3. Reevaluation 4. Secondary Survey 5. Reevaluation Adjuncts 6. Reevaluation and Post Resuscitation Care 7. Definitive Care or Transport Intraocular Foreign Body - ANS*TRUE EMERGENCY AND EARLY INTERVENTION IS ESSENTIAL. Findings: compromised visual acuity, misshapen pupils, pain Treatment: elevate HOB, ophthalmology, immobilize foreign body, patch UNAFFECTED eye to limit concomitant eye movement, globe closure ASAP, systemic and ophthalmic ABX, analgesics. Postop infection, retinal detachment and vision loss are common complications. TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ ______________ Shock: Spinal cord injury at any level. Transient loss of reflex below the level of injury. Variable duration. S & S: flaccidity, loss of reflexes, bowel/bladder dysfunction. - ANSSpinal ______________ Shock: Spinal cord injury at any level. Transient loss of reflex below the level of injury. Variable duration. S & S: flaccidity, loss of reflexes, bowel/bladder dysfunction. - ANSSpinal __________________ Shock: Spinal cord injury at T6 or above. Temporary loss of vasomotor tone and sympathetic innervation. Temporary duration usually <72 hours. S & S: hypotension, bradycardia, loss of ability to sweat below level of injury. - ANSNeurogenic __________________ Shock: Spinal cord injury at T6 or above. Temporary loss of vasomotor tone and sympathetic innervation. Temporary duration usually <72 hours. S & S: hypotension, bradycardia, loss of ability to sweat below level of injury. - ANSNeurogenic ___________________: Impairs thrombin production and platelet function _____________ ______________: Impairs thrombin production _______________________: Results in depletion of clotting factors through hemodilution and the impaired ability to produce clotting factors. - ANSTrauma Triad of Death 1. Hypothermia 2. Metabolic Acidosis 3. Coagulopathy ___________________: Impairs thrombin production and platelet function _____________ ______________: Impairs thrombin production _______________________: Results in depletion of clotting factors through hemodilution and the impaired ability to produce clotting factors. - ANSTrauma Triad of Death 1. Hypothermia 2. Metabolic Acidosis 3. Coagulopathy ???;.][''''''''''''''''''' - ANSthis card was created by a cat. enjoy. .. 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 - ANSBaroreceptors: TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a test that requires fluid to be sent to the lab and is considered the gold standard for identifying CSF - ANSBeta2-Transferrin ... is a test that requires fluid to be sent to the lab and is considered the gold standard for identifying CSF - ANSBeta2-Transferrin ... is a test that requires fluid to be sent to the lab and is considered the gold standard for identifying CSF - ANSBeta2-Transferrin ... is a triad of assessment findings; widening pulse pressure, bradycardia, and diminished respiratory effort - ANSCushing ( it is an attempt to increase MAP against elevated ICP, ultimately trying to cause a rise in CPP) ... is a triad of assessment findings; widening pulse pressure, bradycardia, and diminished respiratory effort - ANSCushing ( it is an attempt to increase MAP against elevated ICP, ultimately trying to cause a rise in CPP) ... is a triad of assessment findings; widening pulse pressure, bradycardia, and diminished respiratory effort - ANSCushing ( it is an attempt to increase MAP against elevated ICP, ultimately trying to cause a rise in CPP) ... is damaged brain tissue usually caused by blunt trauma - ANSCerebral contusion ... is damaged brain tissue usually caused by blunt trauma - ANSCerebral contusion ... is damaged brain tissue usually caused by blunt trauma - ANSCerebral contusion ... is defined as the pressure gradient across the brain tissue, or the difference between the pressures of the cerebral artery and venous vessels. - ANSCPP; CPP = map - icp TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ ... is defined as the pressure gradient across the brain tissue, or the difference between the pressures of the cerebral artery and venous vessels. - ANSCPP; CPP = map - icp ... is defined as the pressure gradient across the brain tissue, or the difference between the pressures of the cerebral artery and venous vessels. - ANSCPP; CPP = map - icp ... is the initial post traumatic inflammatory response. ... ... activates this response and ... are sent to the injury sites, activating signaling pathways that mobilize inflammatory cells. - ANSImmune response; tissue hypoxia;neutrophils ... is the initial post traumatic inflammatory response. ... ... activates this response and ... are sent to the injury sites, activating signaling pathways that mobilize inflammatory cells. - ANSImmune response; tissue hypoxia;neutrophils ... is the initial post traumatic inflammatory response. ... ... activates this response and ... are sent to the injury sites, activating signaling pathways that mobilize inflammatory cells. - ANSImmune response; tissue hypoxia;neutrophils ... is the shifting of brain tissue with displacement into another compartment as the result of bleeding or edema. - ANSHerniation ... is the shifting of brain tissue with displacement into another compartment as the result of bleeding or edema. - ANSHerniation ... is the shifting of brain tissue with displacement into another compartment as the result of bleeding or edema. - ANSHerniation ... pain is persistent and usually lasts longer than 3 to 6 months. - ANSChronic ... pain is persistent and usually lasts longer than 3 to 6 months. - ANSChronic ... pain is persistent and usually lasts longer than 3 to 6 months. - ANSChronic ... pain originates from organs and may lead to referred pain. (Trauma) - ANSVisceral ... pain originates from organs and may lead to referred pain. (Trauma) - ANSVisceral ... pain originates from organs and may lead to referred pain. (Trauma) - ANSVisceral ... pain originates from skin and musculoskeletal structures (burns) - ANSSomatic ... pain originates from skin and musculoskeletal structures (burns) - ANSSomatic TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ .... are frequently associated with minor injury in older adults, patients taking anticoagulation medications and patients with chronic alcohol abuse. - ANSChronic subdural Hematoma .... are frequently associated with minor injury in older adults, patients taking anticoagulation medications and patients with chronic alcohol abuse. - ANSChronic subdural Hematoma .... are frequently associated with minor injury in older adults, patients taking anticoagulation medications and patients with chronic alcohol abuse. - ANSChronic subdural Hematoma .... can produce bleeding that may not be evident until several hours after injury - ANSBasilar skull fractures .... can produce bleeding that may not be evident until several hours after injury - ANSBasilar skull fractures .... can produce bleeding that may not be evident until several hours after injury - ANSBasilar skull fractures .... is suspected in any patient with multi system trauma. - ANSCervical spine injury .... is suspected in any patient with multi system trauma. - ANSCervical spine injury .... is suspected in any patient with multi system trauma. - ANSCervical spine injury .... is the major cause of preventable death after injury - ANSUncontrolled hemorrhage .... is the major cause of preventable death after injury - ANSUncontrolled hemorrhage .... is the major cause of preventable death after injury - ANSUncontrolled hemorrhage .... is the study of energy transfer as it applies to identifying actual or potential injuries - ANSKinematics .... is the study of energy transfer as it applies to identifying actual or potential injuries - ANSKinematics .... is the study of energy transfer as it applies to identifying actual or potential injuries - ANSKinematics TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ ...activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP - ANSChemoreceptors ...activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP - ANSChemoreceptors ...activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP - ANSChemoreceptors #1 Early Killer - ANSHemorrhage #1 Late Killer - ANSInfection & MODS `CPP - ANSMAP-ICP + gurgling over epigastrium - ANS-in stomach, pull out, preoxygenate, try again 1 Liter of O2 = ____% FiO2 - ANS4% 1 Liter of O2 = ____% FiO2 - ANS4% 1 unit of PRBC will raise HGB and HCT by how much? - ANSOnce hemostasis is achieve it is est that 1 unit will raise hgb by 1 g/dL and hct by 3%. 1. A- airway and Alertness with simultaneous cervical spinal stabilization 2. B- breathing and Ventilation 3. circulation and control of hemorrhage 4. D - disability (neurologic status) 5. F - full set of vitals and Family presence 6. G - Get resuscitation adjuncts L- Lab results (arterial gases, blood type and crossmatch) M- monitor for continuous cardiac rhythm and rate assessment N- naso or orogastric tube consideration O- oxygenation and ventilation analysis: Pulse oxygemetry and end-tidal caron dioxide (ETC02) monitoring and capnopgraphy H- History and head to toe assessment I- Inspect posterior surfaces - ANSABCDEFGHI TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ 1. Apnea 2. GCS 8 or less 3. Maxillary fractures 4. Evidence of inhalation injury (facial burns) 5. Laryngeal or tracheal injury or neck hematoma 6. High risk of aspiration and patients inability to protect the airway 7. Compromised or ineffective ventilation - ANSFollowing conditions might require a definitive airway 1. bony fractures and possible rib fractures, which may impact ventilation 2. palpate for crepitus 3. subcutaneous emphysema which may be a sign for a pneumothorax 4. soft tissue injury - ANSPalpate the chest for 1. Check the presence of adequate rise and fall of the chest with assisted ventilation 2. Absence of gurgling on auscultation over the epigastrium 3. Bilateral breath sounds present on auscultation 4. Presence of carbon dioxide (CO2) verified by a CO2 device or monitor - ANSIf the pt has a definitive airway in what should you do? 1. Dyspnea 2. Tachycardia 3. Decreased or absent breath sounds on the injured side 4. CP - ANSSimple Pneumo assessment: 1. equal breath sounds bilaterally at the second intercostal space midclavicular line and the bases for fifth intercostal space at the axillary line - ANSAuscultate the chest for: 1. Get a CT 2. Consider ABG 's if decreased LOC 3. Consider glucose check - ANSD Interventions 1. Hypotension 2. JVD 3. Muffled heart sounds - ANSBecks Triad: 1. open the airway, use jaw thrust 2. insert an oral airway 3. assist ventilations with a bag mask 4. prepare for definitive airway - ANSIf breathing is absent.. 1. pain - hallmark sign, early sign 2. pressure - early sign TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ A - ANS-AVPU -Cervical spine (2nd person and jaw-thrust maneuver - inspect palate ausvultate + 4 issues -state need for OPA -or definitive airway -reassess airway after insertion of opa (no snoring heard) A ... fracture is a complete craniofacial separation - ANSLefort III A ... fracture is a complete craniofacial separation - ANSLefort III A ... fracture is a complete craniofacial separation - ANSLefort III 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. - ANSTension pneumo intervention A a 22 yr old was struck by a vehicle while crossing the street, sustaining multiple fx she is alert and answering qestions and crying what is the best method for initial pain assessment for this pt - ANSself report scale A a pt sustrained a penetrating injury of his upper leg. the pre hospital personnel states a large amount of blood loss before hemostasiswas achieved. he presents to the ER responding to painful stimuli with moaning. he is tachy 142 b/p 104/96 and RR 24 - ANSdecompensated A an unrestrained driver was involved in a frontal collision without airbag deployment. he is hypotensive and tachycardic with shallow respirations, distended JVD and muffled heart tones the nurse prepare for what - ANSpericardiocentesis A body at rest will remain at rest, a body in motion will stay in motion - ANSNewton's first law A body at rest will remain at rest, a body in motion will stay in motion - ANSNewton's first law A body at rest will remain at rest, a body in motion will stay in motion - ANSNewton's first law A breath every 5 to 6 seconds: 10-12 ventilations per minute - ANSBag mask ventilation A during assessment of an extremety with suspected pulses are - ANScan be normal TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ A for a ptwho has undergone recent bariatric surgery, flouroscopy is recommended to place - ANSNG tube A identification of vulnerabilities is an example of what phase of disaster management - ANSmitigation A in mass casualty "doing the greatest good for the greatest number of people refers to a situation where - ANSthere may be more patients than resources A in neurogenic shock, alterations in vital signs include hypotension and which other abnormal VS - ANSbradycardia A In the primary survey AVPU is performed to determine if the patient can: - ANSProtect their aiway A moderately dilated pupil with sluggish response may be an early sign of what? - ANSherniation syndrome from increased ICP A prego trauma pt develops tachy, hypotension, a rigide board like uterus, and dark, red vaginal bleeding. she reports constant back pain which is increasing. the most likely cause of s/s is - ANSplacental abruption A several groups of people are at higher risk for maltreatment including children, elderly, prego, and ... - ANSpt's with disability A the nurse is preparing to cleanse an extensive abrasion contaminated with dirt and gravel. which of the following intervention is indicated - ANSus copious amounts of NS A The systemic inflammatory response is a normal part of the body's response to shock from traumatic injury. what best describes this response - ANSit is activated by tissue hypoxia and sends neutrophils to injury site A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - ANSIntentional;unintentional A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - ANSIntentional;unintentional A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - ANSIntentional;unintentional A what is an early assessment finding to increased ICP in pt with a brain injury - ANSvomiting TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ A when providing care for the pedicatric pt with burns the post resuscitation care, how are fluids delivered - ANSparkland formula with maintainence fluidss A which of hte following nursing interventions would be best for traumitc __________ - ANSHOB 30 degrees A which of the following structures would be hte most affected by teh concept of caviation - ANSLiver A which of the following values is within the acceptable limits for trauma pt - ANSend tidal CO2 of 40 A- Alertness, Airway, Cspine - ANS-*APVU -*Hold c-spine and use jaw thrust if not talking (2 people) -*Determine patency and protection of airway using inspection, palpation, auscultation -*States need for OPA ABCDEFG(LMNOP)HI - ANSAirway+Alertness Breathing+Ventilation Circulation/Control of Hemorrhage Disability (neuro stat) Exposure/Environmental Control Full set of vitals + family Get resuscitation adjuncts -monitor cardiac rhythm, naso/gastric tube, oxygen, ETCO2, pain History +Head to toe Inspect posterior surface Abdominal Compartment Syndrome - ANSgut swelling, inflammatory process use foley catheter to measure pressure in bladder, if bladder pressure high=high intra- abdominal pressure Across-the-room Observation - ANSassess for obvious uncontrolled hemorrhage activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP - ANSChemoreceptors: Adequate perfusion of oxygen and supply of nutrients to the brain tissue is dependent on ... and ... - ANSCPP; CBF TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ As ICP increases CPP decreases resulting in ... - ANSCerebral ischemia, hypoxemia and lethal secondary insult As ICP increases CPP decreases resulting in ... - ANSCerebral ischemia, hypoxemia and lethal secondary insult As ICP increases CPP decreases resulting in ... - ANSCerebral ischemia, hypoxemia and lethal secondary insult ask pt to pen his or her mouth - ANSWhile assessing airway the patient is alert and responds to verbal stimuli you should.. Assessment findings with maxillary fractures include - ANSFacial edema, ecchymoses and diplopoa (lefort III) Assessment findings with maxillary fractures include - ANSFacial edema, ecchymoses and diplopoa (lefort III) Assessment findings with maxillary fractures include - ANSFacial edema, ecchymoses and diplopoa (lefort III) Avoid _______________ when administering oxygen/ventilation - ANShyperoxia Avoid _______________ when administering oxygen/ventilation - ANShyperoxia AVPU - ANSAlert, Verbal, Pain, Unresponsive AVPU - ANSID pt Need intubation B - ANS-Determine breathing effectiveness -state need for assisted ventilation with bag-valve mask device -assess ET placement -Et secure, number at teeth documented -need for manuel ventilation B a pt father arrives in teh ER and needs to be told his son was severely injured in a MVC and is in surgery, the father si agitated, yelling, and smells of alcohol. in planning to talk with the father the trauma nurse will - ANSdeliver information regarding the son;s care in a calm voice TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ B a pt involved in an MVC develops asymmetric pupillary reactivity, bilateral pupillary dilation and abnormal motor posturing. what does the nurse suspect as the most likely cause - ANSherniation syndrome B a pt with injury to the middle meningeal artery is at risk for which of the following - ANSepidural hematoma B an occlusive dressing has been applied to a pt with a penetrating injury to the chest. upon assessment the nurse notes that the patient is in respiratory distress nad has absnet breath sounds on hte affected side. what is the priroruty intervention - ANSremove the dressing to the wound B an unrestrained driver inlvolved in a MVC in which alcohol was involed. he denies any pain and numbness and tinlging. according to NEXUS critera which factors indicate need for radiological - ANSsuspected alcohol abuse B Demonstrates and describes techniques for determining breathing effectiveness using components of inspection, auscultation, and palpation. identifies at least FOUR - ANS-is there spontaneous breathing -is there symmetrical chest rise -what are the depth, pattern and rate of respirations -is there increased work of breathing -skin color -open wounds or deformities, subcutaneous emphysema -tracheal deviation or jugular venous distention -great sounds present and equal B pt to ER after being pinned to brick retaining wall. knwoing crushing injuries can result to significant damage to muslces the priority asessment for trauma nruse is for - ANSmyoglobinemia nd renal failure B the most common cause of shock in the trauma pt is - ANSloss of circ volume B the unrestrained fron seat passenger in a MVC develops echymosis around umbillicus. this assessment finding is most commonly associated with: - ANSbleeding in the peritoneal cavity B thinning skin and diminished autonomic response in older adult can have what effect on primary assessment - ANScompromised thermoregulation B when assessing a pt following a MVC the nurses asks how fsat the car was going - ANSwhen volocity is doubled speed is quadroupled B WHich may lead to unreliable pulse ox reading - ANScarboxyhemoglobin TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ B which of hte following significant assessment findigns is frequently found in a patient with complete cransiofacial separation involving the maxilla, zygoma, orbits, and bones of the cranial base. - ANSdiplopia B which of the following hemodynamic support strategies is the prioririty intervention for a pt with traumatic pulmonary contusion - ANSjudicios use of IV fluids B-breathing and ventilation - ANS-*determine effectiveness of breathing using inspection, palpation, auscultation -*state need for BVM (10-12/min) Baby ok Then decrease LOC Weak cry - ANSHypoglycemia Base Excess (BE) - ANSnormal = -2 to +2 mEq/L base deficit < -6 is poor prognosis and develop acute traumatic coagulopathy (ATC) within 30 min basilar - ANSbase of skull, CSF leaks, periorbital edema, mastoid ecchymosis is battles sign Bduring the primary survery which of the following has the greatest priority - ANScervical spine injury Beck triad of cardiac tamponade - ANShypotension, distended neck veins, distant heart sounds Beck's Triad for Cardiac Tamponade - ANS1. Positive JVD 2. Muffled Heart Sounds 3. HOTN Becks triad - ANShypotension, JVD, muffled heart sounds pericardial surgery or aspiration of fluids Before the arrival of the pt - ANSWhen should PPE be placed: Bilaterally fixed and pinpoint pupils may indicate an injury where? - ANS@ the pons or be from the effects of opioids Bleeding around belly button - ANSCullen's Sign Bleeding around belly button - ANSCullen's Sign TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Can be caused by blunt trauma. Air escapes from the injured lung into the pleural space, and negative intrapleural pressure is lost resulting in partial or complete collapse of the lung. S & S: dyspnea, tachypnea, decreased/absent breath sounds on injured side, chest pain. Treatment: based on size, symptoms, and stability. Chest tube may be placed to evacuate pleural air and maintain lung expansion - ANSPneumothorax Can be caused by blunt trauma. Air escapes from the injured lung into the pleural space, and negative intrapleural pressure is lost resulting in partial or complete collapse of the lung. S & S: dyspnea, tachypnea, decreased/absent breath sounds on injured side, chest pain. Treatment: based on size, symptoms, and stability. Chest tube may be placed to evacuate pleural air and maintain lung expansion - ANSPneumothorax 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. - ANSOpen Pneumo: Capnography monitors numeric value, as well as continuous waveform, indicating real- time measurement and trending over time. - ANSQuantitative: Cardiac Tamponade - ANScompression of heart due to fluid accumulation within pericardium Cardiac tamponade - ANSPericardial window Cardiogenic - ANS-ineffective perfusion caused by inadequate contractility of heart -blunt cardiac injury -pressors, dop, epi, NO FLUIDS Cardiogenic shock - ANSAntiarrythmics Care of Amputations - ANS-Remember ABCDs -Focus on Life-Threatening Injuries -Circulation: control bleeding, elevate & apply pressure on artery -Vasoconstriction reflex: decreases bleeding Save life over limb! Cause of Spleen & Liver Injuries - ANSMVC/T-bone Caused by a sudden stop of the body's motion - ANSDeceleration forces Caused by a sudden stop of the body's motion - ANSDeceleration forces TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Caused by a sudden stop of the body's motion - ANSDeceleration forces 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. - ANSHemothorax: Caused from a sudden and rapid onset of motion ( a Parker car being hit by another vehicle) - ANSAcceleration forces Caused from a sudden and rapid onset of motion ( a Parker car being hit by another vehicle) - ANSAcceleration forces Caused from a sudden and rapid onset of motion ( a Parker car being hit by another vehicle) - ANSAcceleration forces Causes of Hemothorax - ANS-Rib Fx -Heart or Great Vessel Injury Causes of oligoanalgesia include... - ANSFailure to assess initial pain; failure to implement guidelines and protocols; failure to document pain; failure to meet patients expectations Causes of oligoanalgesia include... - ANSFailure to assess initial pain; failure to implement guidelines and protocols; failure to document pain; failure to meet patients expectations Causes of oligoanalgesia include... - ANSFailure to assess initial pain; failure to implement guidelines and protocols; failure to document pain; failure to meet patients expectations Causes of Thoracic Injuries - ANS1. Blunt Thoracic Injuries: front or side impact with MVCs 2. Penetrating Thoracic Injuries: assaults, firearms, stabbings Cavitation - ANSLiver Cerebral contusion - ANS-damage to capillary vasculature, 18-36 hours after time of injury TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Cerebral Perfusion Pressure (CPP) - ANSCPP = MAP - ICP Cerebral response - ANS-brain autoregulates so blood is shunted from other organs to brain -SBP >50 cerebral ischemia occurs and the increase in CO2 in the brain stimulates the CNS response Chest tube insertion site - ANS5th intracostal space Church fever/malaise - ANSBiologic Circulation and Control of Hemorrhage Inspect first for any uncontrolled bleeding Skin color palpate for central pulses - carotid and femoral - rate, rhythm, and strength Skin temp: cool, diaphoretic, or warm and dry - ANSC Circulation- *3 - ANS-uncontrolled hemorrhage-elevate to heart, pressure, tourniquet -central and peripheral pulses -skin color, temp, moisture, cap refill Class 1 hemorrhagic shock - ANS- Loss of 15% (less than 750mL) of blood volume - Minimal tachycardia - less than 100BPM - No measureable change in BP, Pulse pressure, and RR - Body can compensate well -Anxious Class 2 Hemorrhage - ANSVasoconstriction still maintains BP, but with difficulty Blood flow is increased to vital organs (midbrain, heart, kidneys?) - Flow is decreased to kidneys, intestines, and skin -Loos of 15-30% of blood volume (750-1,500mL) Effects - Patient may be aggitated - Pale, cool, dry or moist skin - Pulse pressure narrows - Rapid heart rate - over 100 - Respiratory rate increases -20-30 - Delayed capillary refill Class 3 Hemorrhage - ANSVasoconstriction no longer maintains BP TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Parasthesia Compensated stage - ANS-SBP is normal, rising DBP, tachy bounding, lactate builds up Complete craniofacial separation involving maxilla, zygoma, orbits, and bones of the cranial base. Assessment findings include: massive facial edema, mobility and depression of zygomatic bones, ecchymoses, diplopia, and open bite or malocclusion. - ANSLeFort III Complete craniofacial separation involving maxilla, zygoma, orbits, and bones of the cranial base. Assessment findings include: massive facial edema, mobility and depression of zygomatic bones, ecchymoses, diplopia, and open bite or malocclusion. - ANSLeFort III Complications of Abdominal Compartment Syndrome - ANS-Decreased Venous Return b/c gut pushing on vena cava -Falsely elevates CVP -Pushes on Diaphragm Control bleeding with direct pressure, elevate, apply tourniquets. - ANSAmputation Control bleeding with direct pressure, elevate, apply tourniquets. - ANSAmputation CPP range - ANS50-70 Crush Injuries - ANS-Skeletal muscle damage causes Myoglobin release= Rhabdomyolysis --> Myoglobinuria -Soft Tissue swelling -Pain -Compartment Syndrome -Loss of Neurovascular Integrity distal to injury -Possible Bone injury -Life-threatening if involves legs or pelvis Crush injury - ANSMyoglobinuria Renal failure CT Scan - ANS-more expensive -Diagnoses Retroperitoneal & Intraperitoneal Bleeding -need to stabilize patient first Cthe term worried well when refering to disaster preparedness planning refers to: - ANSindividuals hwo think they have been affected by the event but are asymptomatic TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Cthe trauma nurse would prepare for a definitive airwya for which of the following condition. - ANSGCS of 8 or ls Cullen sign - ANSbruising around umbilicus Cullen's Sign - ANSEcchymosis in Umbilical Area, Associated with Intraperitoneal Bleeding Cushing - ANSpressure on brain stem causes wide pulse pressure, brady, decreased RR Cushing response - ANSTraid of widening pulse pressure, reflex brady, diminished resp effect. Attempt to incrased MAP against an elevated ICP causing a rise in CPP Cushing's triad/response - ANSr/t loss of auto regulation due to ICP Signs of increased intracranial pressure: 1. hypertension 2. bradycardia 3. irregular respirations D - ANSdisability (neurologic status) -GCS (best eye opening, best verbal response, best motor reaponse) -assess pupils -states need for CT of head and cervical spine D An unrestrained driver is brought into the emergency department following a frontal impact MVC. she is pale, anxious, and c/o SOB. what is the potential injury - ANSLumbar fx D displaced tube O obstructed or kinked P pneumothorax E equipment failure , such as becoming detached from the equipment or loss of capnopgrahy - ANSDOPE D elevated comaprtment pressure can be the result of - ANShemorrhage from within the muscle D pt with amputation of an index finger with a knife. amputaiton is brought in with pt. it is wrapped in sterile gauze with saline and sealed in a plastic bag. the next step amputation care is - ANSplace the bag on ice TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ D restrained driver is involved in a severe head on MVC and presnts with a seatbelt mark along the neck and upper chest area. bilateral decreased breath sounds, hemoptysis and diffuse sub q emphysemato the neck and upper chest area - ANStracheobronchial injury D which of the following diagnostic intervention is most appropriate for the unstable pt with a suspectedinternal hemorrhage - ANSfocused assessment with sonography for trauma D which physiological change in airway of an odler adult pt places the pt at risk for difficult intubation - ANScervical arthritis D- disability - ANS-*GCS- eye opening, verbal response, motor -*pupils -*need for head CT, cspine Decrease cranial calcification - ANSCT normal without radio graphic abnormality Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define Hemothorax. - ANSAccumulation of blood in the pleural space. Define Hemothorax. - ANSAccumulation of blood in the pleural space. Define Hemothorax. - ANSAccumulation of blood in the pleural space. TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define uncal herniation. - ANSThe 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. - ANSThe 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. - ANSThe 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. - ANSThe 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. - ANSThe 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. TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Definitive treatment of a Tension Pneumothorax - ANSChest Tube demonstrates and describes techniques for determining latency of airway using inspection, ausculataton, and palpation. Identifies at least FOUR - ANS-is tongue obstructing airway -are there any lose or missing teeth -are there any foreign bodies is there any blood, vomitus or other secretions -is there any edema -is there any snoring, gurgling, or stridor Depressed - ANSextends below surface of head Describe a Grade I Hyphema. - ANSBlood occupying less than one third of the anterior eye chamber. Describe a Grade II Hyphema. - ANSBlood occupying one third to half of the anterior eye chamber. Describe a Grade III Hyphema. - ANSBlood occupying half but less than total filling of the anterior eye chamber. Describe a Grade IV Hyphema. - ANSBlood occupying the entire anterior eye chamber. Diagnostic Peritoneal Lavage (DPL) - ANS-Rapid test for Intraperitoneal Bleeding -Invasive -Peritoneal catheter inserted into abdomen (right below umbilicus) & warm NS or LR instilled then drained -Drop bag below level of bed -If bag filled with blood, yellow, green, food, particles, stool= Positive DPL & go to OR Diaphragmatic Rupture - ANS-Stomach in Thoracic Cavity -Bowel Sounds heard in chest Difficult intubation elderly - ANSCervical arthritis Diffuse anoxal - ANSsweating, posturing, sym storm, HTN, hyperthermia shearing and tearing immediate unconciousness Diffuse Axinal vs. Herniation Syndrome - ANSDA Unconsciousness Increased ICP TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Posturing HTN Hyper-thermia Sweating HS Asymmetric pupils Unilateral or bilateral pupil dilation Posturing Cushings Loss of reflexes Diplopia - ANSLefort III Disability - Neurologic Status 1. Assess pupils for equality, shape, and reactivity (PERRL) 2. Assess GCS (eye opening, verbal response, and motor response) - ANSD Disaster management - Vulnerable - ANSMitigation Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ ETT - ANS-tube in trachea with cuff inflated -GCS<8 -inhalation injury, unable to breath due to pain, apnea, high risk for aspiration/decompensation Examples that can cause distributive shock - ANSAnaphylactic shock, septic shock, neurogenic shock Examples that can cause distributive shock - ANSAnaphylactic shock, septic shock, neurogenic shock Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ 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. - ANSSyndrome that results from ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: MI, Blunt cardiac injury, Mitral valve insufficiency, dysrhythmias, Cardiac Failure Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: MI, Blunt cardiac injury, Mitral valve insufficiency, dysrhythmias, Cardiac Failure Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: MI, Blunt cardiac injury, Mitral valve insufficiency, dysrhythmias, Cardiac Failure Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: MI, Blunt cardiac injury, Mitral valve insufficiency, dysrhythmias, Cardiac Failure Explain Cardiogenic Shock. - ANSSyndrome 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. - ANSResults from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may 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. TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. Explain Irreversible Shock. - ANSShock 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. - ANSShock 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. - ANSShock 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. - ANSShock 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. - ANSShock uncompensated or irreversible stages will cause compromises to most body systems. TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - 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. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes: - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). - Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium. - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes: - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). - Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium. - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes: - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). - Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium. - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Focused Assessment Sonogram for Trauma (FAST) - ANS-Ultrasound -Non-Invasive, quick -Inexpensive -Accurate with good technician & reader -Helpful with unstable patients Focused Survey - ANS-Lab studies: trauma panel -Radiographic Studies (X-rays): C-spine, Chest, Pelvis -Injury Specific Diagnostics: CT, extremity, abdomen For every action there is an equal and opposite reaction - ANSNewton's third law For every action there is an equal and opposite reaction - ANSNewton's third law For every action there is an equal and opposite reaction - ANSNewton's third law Force = mass x acceleration - ANSNewton's second law Force = mass x acceleration - ANSNewton's second law Force = mass x acceleration - ANSNewton's second law from hemorrhage is leading cause. Hypovolemia is caused by decrease in the amount of circulating volume. Goal is to replace volume. - ANSHypovolemic Shock Full set of vitals and family presence - ANSF G - ANSGET resuscitation adjuncts LMNOP G- LMNOP - ANS- labs- lactate, ABG, type and cross, glucose -m-monitor -n-NG/OG -o-pulse ox -p-pain- pharma and nonpharm GCS breakdown - ANS GCS scores : I. Mild TBI II. Moderate TBI III. Severe TBI - ANS13-15; 9-12; 8 or less GCS scores : I. Mild TBI TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ II. Moderate TBI III. Severe TBI - ANS13-15; 9-12; 8 or less GCS scores : I. Mild TBI II. Moderate TBI III. Severe TBI - ANS13-15; 9-12; 8 or less General study of forces and their effects on living tissue and the human body - ANSBiomechanics General study of forces and their effects on living tissue and the human body - ANSBiomechanics 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 - ANSG Glascow Coma Scale (GCS) - ANSNeurologic assessment of a patient's BEST verbal response, eye opening, and motor function. Lowest score is a 3, highest is 15, Intubate at 8. Goal of Primary Survey - ANSidentify life-threatening injuries Goal of Secondary Survey - ANSidentify all injuries Goals of Early Surgical Tx of Abdominal Trauma - ANS-Control Hemorrhage -Remove dead tissue -Lavage the abdominal cavity -Control contamination -Close the abdomen without tension Gray Turner Sign - ANSEcchymosis in flank area associated with Retroperitoneal Bleeding Grey turner sign - ANSBruising of the flanks. Between last rib and top of hip GSW chest - ANSThoracic injury GSW to Abdomen Risk - ANS1. Hemorrhage 2. Hollow Viscus Perforation with Peritonitis TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ H - ANSHistory MIST Mechanism of injury Injuries sustained Signs and symptoms in field Treatment in field H- hx and head to toe - ANS-hx: MIST, past medical hx -head to toe H,I - ANSSecondary Survery Head to toe - ANS-face -neck- c-spine -chest- lung and heart -abdomen and flanks -pelvis and perineum- gentle pressure over iliac crest, pubic symphysis, foley -extremities- neurovascular -posterior- spinal board Head to toe assessment - ANS1) Inspects AND palpates face/neck 2) inspects AND palpates neck for injuries, demonstrate removal AND replacement of cervical collar for assessment 3) Inspects AND palpates chest 4) auscultate heart and lung sounds 5) inspects abdomen and flanks 6) auscultate and palpates abdomen 7)inspects pelvis and perineum 8) applies gentle pressure over iliac crests downward and medially 9)gentle pressure to symphysis pubis 10)urinary catheter unless contraindicated 11) Inspects AND palpates 4 extremities Hemopneumothorax - ANSair & blood (need 2 chest tubes) Hemorrhage is the leading cause. Can result from vomiting, diarrhea, and burn trauma. Decreased circulating volume --> decreased preload. Therapy includes replacing the type of volume that was lost. - ANSHypovolemic Shock Hemorrhage is the leading cause. Can result from vomiting, diarrhea, and burn trauma. Decreased circulating volume --> decreased preload. Therapy includes replacing the type of volume that was lost. - ANSHypovolemic Shock TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ How do you inspect the chest for adequate ventilation? - ANSObserve: - mental status - RR and pattern - chest wall symmetry - any injuries - patient's skin color (cyanosis?) - JVD or tracheal deviation? (Tension pneumothorax) How do you inspect the chest for adequate ventilation? - ANSObserve: - mental status - RR and pattern - chest wall symmetry - any injuries - patient's skin color (cyanosis?) - JVD or tracheal deviation? (Tension pneumothorax) How external forces in the environment are transferred to the body - ANSMechanism of injury How external forces in the environment are transferred to the body - ANSMechanism of injury How external forces in the environment are transferred to the body - ANSMechanism of injury How should you dress a severed limb? - ANSSterile gauze with normal saline THEN put ice on it How should you dress a severed limb? - ANSSterile gauze with normal saline THEN put ice on it How to maintain ICP < 20mmHg - ANSElevated HOB 30 Degrees Provide sedation Loosen cervical collar Drain CSF Administer mannitol prn initiate insulin therapy promote normothemia How would you assess a patient with ocular, maxillofacial and neck trauma? - ANS(Initial assessment) HISTORY - MOI? - Acceleration/Deceleration? TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - What was it caused by? - Pt restrained? Airbags deployed? Etc. - What are the pt's complaints? - Pt normally wear glasses or contacts? - Pt have hx of eye problems? - Pt ever have eye surgery? - Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION: - Inspect eye, orbits, face and neck - Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas - Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents - Determine whether lid lac's - Assess pupil's (PERRL) - Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome - Bilateral fixed and pinpoint pupils = pontine lesion or drugs - Mildly dilated pupil w/sluggish response may early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Assess for consensual response - Assess redness, eye watering, blepharospasm - Assess extraocular movement, except when an open globe injury is known or suspected. - Limitation range of ocular motion may indicate orbital rim fx w/entrapment or paralysis of cranial nerve or ocular muscle - Perform visual acuity exam - Use Snellen or handheld chart. Check uninjured eye first - Assess for blurred or double vision with injured eye and then with both eyes open - Inspect for rhinorrhea or otorrhea - If drng present, may indicate CSF leak - Observe for impaled objects - Assess occlusion of mandible and maxilla - Malocclusion or inability to open + close mouth is highly indicative of maxillary or mandibular fx - Observe for uncontrolled bleeding PALPATION - Palpate periorbital area, face and neck for: - Tenderness - Edema - Step-off de How would you assess a patient with ocular, maxillofacial and neck trauma? - ANS(Initial assessment) TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ HISTORY - MOI? - Acceleration/Deceleration? - What was it caused by? - Pt restrained? Airbags deployed? Etc. - What are the pt's complaints? - Pt normally wear glasses or contacts? - Pt have hx of eye problems? - Pt ever have eye surgery? - Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION: - Inspect eye, orbits, face and neck - Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas - Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents - Determine whether lid lac's - Assess pupil's (PERRL) - Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome - Bilateral fixed and pinpoint pupils = pontine lesion or drugs - Mildly dilated pupil w/sluggish response may early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Assess for consensual response - Assess redness, eye watering, blepharospasm - Assess extraocular movement, except when an open globe injury is known or suspected. - Limitation range of ocular motion may indicate orbital rim fx w/entrapment or paralysis of cranial nerve or ocular muscle - Perform visual acuity exam - Use Snellen or handheld chart. Check uninjured eye first - Assess for blurred or double vision with injured eye and then with both eyes open - Inspect for rhinorrhea or otorrhea - If drng present, may indicate CSF leak - Observe for impaled objects - Assess occlusion of mandible and maxilla - Malocclusion or inability to open + close mouth is highly indicative of maxillary or mandibular fx - Observe for uncontrolled bleeding PALPATION - Palpate periorbital area, face and neck for: - Tenderness - Edema - Step-off de TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Observe for uncontrolled bleeding PALPATION - Palpate periorbital area, face and neck for: - Tenderness - Edema - Step-off de How would you assess a pt in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect: - LOC - Rate and quality of respirations - External bleeding? - Skin color and moisture - Assess jugular veins and peripheral veins Auscultate: - BP - Pulse pressure - Breath sounds - Heart sounds - Bowel sounds Percuss: - Chest and abdomen Palpate: - Central pulse (carotid or femoral) - Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse - Palpate peripheral pulses - Palpate skin temp and moisture Diagnostic Procedures: - Xrays and other studies - Labs Planning and Implementation - Oxygen - IV's with warmed replacement fluids - Control external bleeding with direct pressure - Elevate LE's - NGT - Foley - Monitor and pulse oximeter - Monitor for development of coagulopathies - Surgery? TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ How would you assess a pt in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect: - LOC - Rate and quality of respirations - External bleeding? - Skin color and moisture - Assess jugular veins and peripheral veins Auscultate: - BP - Pulse pressure - Breath sounds - Heart sounds - Bowel sounds Percuss: - Chest and abdomen Palpate: - Central pulse (carotid or femoral) - Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse - Palpate peripheral pulses - Palpate skin temp and moisture Diagnostic Procedures: - Xrays and other studies - Labs Planning and Implementation - Oxygen - IV's with warmed replacement fluids - Control external bleeding with direct pressure - Elevate LE's - NGT - Foley - Monitor and pulse oximeter - Monitor for development of coagulopathies - Surgery? How would you assess a pt in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect: - LOC - Rate and quality of respirations - External bleeding? - Skin color and moisture - Assess jugular veins and peripheral veins TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Auscultate: - BP - Pulse pressure - Breath sounds - Heart sounds - Bowel sounds Percuss: - Chest and abdomen Palpate: - Central pulse (carotid or femoral) - Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse - Palpate peripheral pulses - Palpate skin temp and moisture Diagnostic Procedures: - Xrays and other studies - Labs Planning and Implementation - Oxygen - IV's with warmed replacement fluids - Control external bleeding with direct pressure - Elevate LE's - NGT - Foley - Monitor and pulse oximeter - Monitor for development of coagulopathies - Surgery? How would you assess a pt in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect: - LOC - Rate and quality of respirations - External bleeding? - Skin color and moisture - Assess jugular veins and peripheral veins Auscultate: - BP - Pulse pressure - Breath sounds - Heart sounds - Bowel sounds Percuss: - Chest and abdomen TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Assess extraocular eye movement (Tests cranial nerves, III, IV, VI) - Performing extraocular eye movements indicates functioning brainstem - Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle - Determine LOC with GCS PALPATION - Palpate cranial area for: - Point tenderness - Depressions or deformities - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing - Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION - (Initial assessment) - Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 How would you assess a pt with a cranial injury? - ANS(Initial assessment) INSPECTION: - Assess airway - RR, pattern and effort - Assess pupil size and response to light - Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome - Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates - Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Determine if pt uses eye meds - Abnormal posturing? - Inspect craniofacial area for ecchymosis/contusions - Periorbital ecchymosis - Mastoid's process ecchymosis - Blood behind tympanic membrane - Inspect nose and ears for drainage - Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF - Assess extraocular eye movement (Tests cranial nerves, III, IV, VI) - Performing extraocular eye movements indicates functioning brainstem - Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle - Determine LOC with GCS PALPATION - Palpate cranial area for: - Point tenderness - Depressions or deformities - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing - Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION - (Initial assessment) - Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 How would you assess a pt with a cranial injury? - ANS(Initial assessment) INSPECTION: - Assess airway - RR, pattern and effort - Assess pupil size and response to light - Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome - Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates - Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Determine if pt uses eye meds - Abnormal posturing? - Inspect craniofacial area for ecchymosis/contusions - Periorbital ecchymosis - Mastoid's process ecchymosis - Blood behind tympanic membrane - Inspect nose and ears for drainage TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF - If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF - Assess extraocular eye movement (Tests cranial nerves, III, IV, VI) - Performing extraocular eye movements indicates functioning brainstem - Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle - Determine LOC with GCS PALPATION - Palpate cranial area for: - Point tenderness - Depressions or deformities - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing - Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION - (Initial assessment) - Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 How would you assess a pt with a thoracic injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe chest wall - Assess breathing effort and RR - Symmetry - Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or pericardial tamponade. Flat = external jugular veins may reflect hypovolemia) - Inspect upper abdominal region for injury Percussion: - Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax) Palpation: - Palpate chest wall, clavicles and neck for: TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Palpate central and peripheral pulses and compare quality between: - Right and left extremities - Upper and lower extremities - Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension pneumothorax or massive hemothorax) - Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate aortic injury). Auscultation: - Auscultate compare BP in both UE's and LE's - Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS = splinting. Shallow = b/c of pain). - Auscultate chest for presence of BS (diaphragmatic rupture) - Auscultate Heart sounds (muffled = pericardial tamponade) - Auscultate neck vessels for bruits (vascular injury) Diagnostic Procedures: - Xrays - Arteriography - Bronchoscopy and laryngoscopy - CT's - FAST - Labs (cardiac enzymes) - ECG, CVP How would you assess a pt with a thoracic injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe chest wall - Assess breathing effort and RR - Symmetry - Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or pericardial tamponade. Flat = external jugular veins may reflect hypovolemia) - Inspect upper abdominal region for injury Percussion: - Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax) Palpation: - Palpate chest wall, clavicles and neck for: - Tenderness - Swelling or hematoma - Subcutaneous emphysema - Note presence of bony crepitus - Palpate central and peripheral pulses and compare quality between: - Right and left extremities TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Upper and lower extremities - Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension pneumothorax or massive hemothorax) - Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate aortic injury). Auscultation: - Auscultate compare BP in both UE's and LE's - Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS = splinting. Shallow = b/c of pain). - Auscultate chest for presence of BS (diaphragmatic rupture) - Auscultate Heart sounds (muffled = pericardial tamponade) - Auscultate neck vessels for bruits (vascular injury) Diagnostic Procedures: - Xrays - Arteriography - Bronchoscopy and laryngoscopy - CT's - FAST - Labs (cardiac enzymes) - ECG, CVP How would you care for a pt with an Abdominal Injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe the lower chest for asymmetric chest wall movement. -Observe the contour of the abdomen. Distention may indicate bleeding -Inspect lower chest, abdomen, flanks, and back for seat belt abrasions or soft tissue injuries -Inspect pelvic area for soft tissue bruising Percussion: - Percuss for hyperresonance or dullness. Hyperresonance indicates air, dullness indicates fluid. Palpation: - Palpate all four quadrants. Press and quickly release to determine presence of rebound tenderness. -Palpate pelvis for bony instability, asymmetry, or pain. -Palpate flanks for tenderness -Palpate anal sphincter for presence or absence of tone Auscultation: -Auscultate the chest. If bowel sounds heard in chest may have diaphragmatic rupture with herniation of the stomach or small bowel -Auscultate bowel sounds. Absence indicative of visceral injury. Diagnostic Procedures: TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Xrays - MRI - IVP and DPL - CT's - FAST - Labs (cardiac enzymes) -Cystogram or urethrogram -Angiography How would you care for a pt with an Abdominal Injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe the lower chest for asymmetric chest wall movement. -Observe the contour of the abdomen. Distention may indicate bleeding -Inspect lower chest, abdomen, flanks, and back for seat belt abrasions or soft tissue injuries -Inspect pelvic area for soft tissue bruising Percussion: - Percuss for hyperresonance or dullness. Hyperresonance indicates air, dullness indicates fluid. Palpation: - Palpate all four quadrants. Press and quickly release to determine presence of rebound tenderness. -Palpate pelvis for bony instability, asymmetry, or pain. -Palpate flanks for tenderness -Palpate anal sphincter for presence or absence of tone Auscultation: -Auscultate the chest. If bowel sounds heard in chest may have diaphragmatic rupture with herniation of the stomach or small bowel -Auscultate bowel sounds. Absence indicative of visceral injury. Diagnostic Procedures: - Xrays - MRI - IVP and DPL - CT's - FAST - Labs (cardiac enzymes) -Cystogram or urethrogram -Angiography How would you care for a pt with an Abdominal Injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ ICP is a reflection of what three volumes? What happens when one increases? - ANS1. Brain 2. CSF 3. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. ICP is a reflection of what three volumes? What happens when one increases? - ANS1. Brain 2. CSF 3. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. ICP is a reflection of what three volumes? What happens when one increases? - ANS1. Brain 2. CSF 3. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. ICP is a reflection of what three volumes? What happens when one increases? - ANS1. Brain 2. CSF 3. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. IF clothing is needed for evidence preserve in paper bag. Maintain body temp - cover the pt, turn up heat in room, administer warm fluids - ANSE Interventions: If injury causes the CPP to fall outside the range of 50 - 160, the brain loses its ability to ... and CBF is directly dependent on ... for perfusion - ANSAuto regulate ; MAP If injury causes the CPP to fall outside the range of 50 - 160, the brain loses its ability to ... and CBF is directly dependent on ... for perfusion - ANSAuto regulate ; MAP If injury causes the CPP to fall outside the range of 50 - 160, the brain loses its ability to ... and CBF is directly dependent on ... for perfusion - ANSAuto regulate ; MAP immobilize cervical spine, tenderness, tracheal deviation - ANSHead to toe assessment: Neck and cervical spine Impalements - ANS-DO NOT remove the object -Stabilize/Support the Object -Tape in Place if possible, prepare for OR -Object removed in OR in massive transfusion protocol... responsible for dissolving clots - ANSTXA TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ In the ... ... response two catecholamines are released ... and ... . - ANSAdrenal gland response; epinephrine and norepinephrine In the ... ... response two catecholamines are released ... and ... . - ANSAdrenal gland response; epinephrine and norepinephrine In the ... ... response two catecholamines are released ... and ... . - ANSAdrenal gland response; epinephrine and norepinephrine In the adrenal gland response ... is released to raise blood glucose and promote renal retention of water and sodium. - ANSCortisol In the adrenal gland response ... is released to raise blood glucose and promote renal retention of water and sodium. - ANSCortisol In the adrenal gland response ... is released to raise blood glucose and promote renal retention of water and sodium. - ANSCortisol In those with traumatic brain injury where should you maintain the systolic pressure? - ANSgreater than 90 mmHG Inflammatory response - ANSactivated by hypoxia, neutrophils travel to injury site Initial fluid management for patient in shock - ANS1L -2L warmed fluid bolus (NS or LR - crystolloids - pref towards LR as to not cause hyperchloremic metabolic acidosis from large amount of NS) if no evidence of CHF inspect for lacs, abrasions, asymmetry of facial expressions palate for depressions and tenderness look at ears for drainage - ANSHead to toe assessment: Head and face inspect posterior surfaces blogroll with at least 3 people. maintain c spine take out backboard Rectal tone per MD - ANSI inspect, auscultate, palpate TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -Infection, Sepsis, Septic Shock -ARDS -Primary MODS -Compartment Syndrome -Rhabdomyolysis -Renal Failure -Death Leading cause of preventable death after injury - ANSHemorrhage Leading cause of preventable death after injury - ANSHemorrhage Lefort I - ANStransverse maxillary (above the teeth) Lefort II - ANSFrontal process of MAXILLA, NOSE bones , & inferior / medial ORBITAL WALL fractures Rhinorhea Lefort III - ANSComplete separation of midface including nasoethmoidal complex, zygomas, and the maxilla Level 1 Trauma Centers - ANS-Resources & Staff -24 hour in house surgeons & staff available -CPB capability -Multi-specialities (Neuro & Thoracic surgeons) -Research -Education, Prevention, & Outreach Programs Linear - ANSnondisplaced fx LMNOP - ANSLabs (blood samples, blood gas) Monitor (attaches pt to cardiac monitor N-naso/orogastric tube Oximeter and calnography. Pain -pharmacological and nonpharmacologcial pain measu Lower Rib Fractures - ANSpossible abdominal organ/vessel injury Ribs #11-12 free floating & can result in liver, spleen, or diaphragm injury Mandate report - ANS6 yr old loop bruising TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Mannitol - ANSosmotic diuretic but also used to help reduce ICP - it will not reduce ICP in hypovolemia so do not use on hypotensive pt. Bolus is better than infusion. Massive Blood Transfusion: Monitor ___________ levels: sodium acetate binds with ____ so levels decrease. - ANSCalcium Massive Blood Transfusion: Monitor ___________ levels: sodium acetate binds with ____ so levels decrease. - ANSCalcium MATCH - ANSMassive hemorrhage, Airway, Respiration, Circulation, Head Injury/Hypothermia maxillary fracture - ANSLefort I, II, III Meningeal artery - ANSEpidural hematoma Middle Meningeal Artery - ANSEpidural Hematoma (results from collection of blood that forms between dura mater and skull) Middle Meningeal Artery - ANSEpidural Hematoma (results from collection of blood that forms between dura mater and skull) MIST - ANSMechanism of action Injuries S/S Treatment Most common Ribs fractured - ANS#3-9 Most frequently injured organ - ANSLiver Most frequently injured organ - ANSLiver Most frequently injured organ from BLUNT trauma - ANSSpleen Most frequently injured organ from BLUNT trauma - ANSSpleen MTP - ANS1:1:1 monitor Ca bc citrate inhibits clotting cascade Muffled heart sounds - ANSCardiac tamponade? Pericardial fluid? Muffled heart sounds - ANSCardiac tamponade? Pericardial fluid? TNCC FINAL EXAM TEST 2022 OPEN BOOK QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Multiple people are in the ER of different ages who all go to the same church. They all have the same symptoms. What is the most likely cause? - ANSBiologic Multiple people are in the ER of different ages who all go to the same church. They all have the same symptoms. What is the most likely cause? - ANSBiologic MVA diff breathing Tachycardia - ANSLiver lac Narrow pulse pressure (rising diastolic) could indicate - ANSPeriphreal Vasoconstriction, Hypo perfusion, stage 1 + 2 compensated shock, tension pneumothorax, pericardial tamponade Needle decompression insertion site - ANS2nd intracostal space Needle pericardiocentesis, but it is a temp solution. Requires surgical evaluation. (Ultrasound guided) - ANSCardiac Tamponade Intervention: Neurogenic - ANS-loss of vasomotor tone due to decrease in sympathetic control -vasodilation, SCI, BRADY no gurgling, decreased breath sounds L - ANS-in too far, pull out to 3xlength of tube Non-Specific S/S of BCI - ANS-Chest Pain not relieved with Nitro -Dysrhythmias: ST, A fib, BBB, Heart Blocks, PVCs, PACs -Non-Specific ST changes -Cardiac Enzyme elevations don't predict complications -Anterior Chest Wall bruising Normal Co2 ... - ANS35-45 Normal Co2 ... - ANS35-45 Normal Co2 ... - ANS35-45 Normal CPP is ... Acceptable CPP is ... During this auto regulation maintains in a steady state. - ANS60 to 100; 50 to 70 Normal CPP is ... Acceptable CPP is ... During this auto regulation maintains in a steady state. - ANS60 to 100; 50 to 70