Download TNCC TEST 2025 ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRA and more Exams Nursing in PDF only on Docsity! TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE A adult patient with a knife injury to the neck has an intact airway and ishemodynamicallystable.Theycomplainofdifficultyswallowingandspeaking.Intheprimary survey, further assessment is indicated next for which of the followingconditions? a. Damagetothecervicalspine b. Anexpandingpneumothorax c. Lacerationofthecarotidartery d. Injurytothethyroidgland-ansa.Damagetothecervicalspine A patient arrives at the emergency department by private vehicle after sustaining aninjurytotherightlowerextremitywhileusingasaw.Thereisalargegapingwoundtothe right thigh area with significant bleeding. What is the priority intervention? a. Elevatetheextremitytothelevelofthe heart b. Initiatedirectpressure c. Applya tourniquet d. Covertheopenwoundwithsterilesalinedressings-ansb.Initiatedirectpressure A patient fell two weeks ago, striking their head. Today, the patient presented with apersistent headache and nausea and was diagnosed with a small subdural hematoma.The patient has been in the ED for 24 hours awaiting an inpatient bed. The night shiftnurse reports the patient has been anxious, restless, shaky, and vomited twice duringthenight.Thepatientstatestheycouldn'tsleepbecauseayoungchildkeptcomingintothe room. What is the most likely cause for these signs and symptoms? a.increaseintracranialpressure b. alcoholwithdrawal c. rhabdomyolysis d. pulmonaryembolus-ansb.alcohol withdrawal ApatientinvolvedinaMVChassustainedafracturetothesecondriboftheanteriorleftchest. Which concurrent injury is most commonly associated with this fracture? a. Bluntcardiacinjury b. Brachialplexusinjury c. Pneumothorax d. Hemothorax-ansb.Brachialplexusinjury ApatientwithaspinalcordinjuryatC5isbeingcaredforintheemergencydepartmentwhile awaiting transport to a trauma center. Which of the following represents thehighest priority for ongoing assessment and management for this patient? a. maintainadequaterespiratorystatus. b. administerbalancedresuscitationfluid TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE c. performserialassessmentsofneurologicfunction d. maintaincoretemperature-ansa.maintainadequaterespiratorystatus A trauma nurse cared for a child with devastating burns two weeks ago. The nursecalledinsickforacoupleofdaysandisnowbackworkingontheteam.Whichofthefollowin g behaviors would indicate this nurse is coping well? a. Theyaretalkingabouttakingtheemergencynursingcertificationexamination. b. Theykeeprequestingtobeassignedtothewalk-in/ambulatoryarea c. Theyareimpatientandsnapattheircoworkers. d. Theyarethinkingabouttransferringoutoftheemergencydepartment. -ansa.Theyare talking about taking the emergency nursing certification examination. Followingabombexplosion,fragmentationinjuriesfromthebomborobjectsintheenvironment are examples of which phase of injury? a. primary b. secondary c. tertiary d. quaternary-ansb.secondary Inapatientwithseveretraumaticbraininjury,hypocapniacauseswhichcondition? a. Respiratoryacidosis b. Metabolicacidosis c. Neurogenicshock d. Cerebralvasoconstriction-ansd.Cerebralvasoconstriction Thegeneralimpressionstepintheinitialassessmentprovidesthe opportunitytodowhich of the following? a. Assessforuncontrolledinternalhemorrhage b. Accuratelytriagethepatient c. Reprioritizecirculationbeforeairwayorbreathing. d. Activatethetraumateam-ansc.Reprioritizecirculationbeforeairwayorbreathing. Thenurseisobtainingahistoryforapatientwhopresentsfollowingsexualassault.Thishistory is completed using which of the following techniques? a. Bringthefamilyintotheinterviewroom. b. Usedirectquotestorecordinformation. c. Obtaininformationspecificonlytotheassault. d. Providefoodanddrinktohelpcreaterapport. - ansb.Usedirectquotestorecordinformation. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Auscultate:listenforobstructiveairwaysounds(ie.snoring,gurgling,stridor) Palpate:palpateforpossibleocclusivemaxillofacialbonydeformity,subcutaneousemphysem a AirwayInterventions:- ansSuctionRemove foreign body if noted Jawthrustmaneuver(maintain cspine) Nasopharyngealairway(canbeconscious)Oropharyngealairway(nogag)Consider definitive airway AlertnessAssessment-ansA- AlertV-Verbal P-Painful U-Unresponsive B(PrimarySurvey)-ansBreathingand Ventilation Breathing and Ventilation Assessment - ansInspect: spontaneous breathing,symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use,diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic),contusions/abrasions/deformities(signsofunderlyinginjury),openpneumothora ces(sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate:presence,absenceandequalityofbreathsoundsat2ndintercostalspacemidclavi cular line and bases at the fifth intercostal space anterior axillary line Palpate:bonystructures,possibleribfractures,SQemphysema,softtissueinjury,JVpulsation s at suprasternal notch or supraclavicular area Life-threateningpulmonaryinjuriesrequiringimmediateintervention:openpneumothorax, tension pneumothorax, flail chest, hemothorax. BreathingandVentilationIntervention-ansBreathingabsent:jaw- thrustmaneuver,oralairway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathingpresent:NRB.Determineifventilationeffective:etCO235-45,SpO294%orhigher. If ineffective: assist with bag-mask and determine need for definitive airway C(PrimarySurvey)-ansCirculationandControlofHemorrhage TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Cardiogenic Shock - ansResults from pump failure in the presence of adequateintravascularvolume.There is alack of cardiac output and end-organ perfusionsecondarytoadecreaseinmyocardialcontractilityand/orvalvularinsufficie ncy. Acutecauses-myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryedemaand increased myocardial ischemia. Inotropicsupporttoimprovecontractility. CirculationandControlofHemorrhageAssessment - ansInspect:Uncontrolledexternalbleeding, skin color Auscultate:Muffledheartsounds -mayindicatepericardialtamponade Palpate:carotidand/orfemoralpulsesforrate,rhythm, strength Circulation and Control of Hemorrhage Interventions - ansControl and treat externalbleeding:applydirectpressure,elevatebleedingextremity,applypressureoverarteri alsites, consider use of a tourniquet. 2largeboreIVs,ifunableconsiderIO,obtainlabsand crossmatch. InitiateIVFofwarmedisotoniccrystalloidsolution.Considerbloodproductsafter2L. **Largevolumesoffluidleadtodilutioncoagulopathywhichworsensmetabolicacidosisandm aycausehypothermia.Componenttherapy,includingadministeringRBC,plasmaand platelets is a balanced approach so that O2 delivery is optimized, acidosiscorrected and coagulopathy prevented. ClassificationsofShock-ansHypovolemic-decreaseintheamountofcirculatingbloodvolume Obstructive-obstructionineitherthevasculatureorheart TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Cardiogenic-pumpfailureinthepresenceofadequateintravascularvolume Distributive-maldistributionofanadequatecirculatingbloodvolume(septic,anaphylactic, neurogenic) CornealAbrasion-ansDamagetothecornealepithelium.Easytoevaluatewithfluorescein. Findings:photophobia,tearing,pain,injectedconjunctiva(redness),lidswelling,irritation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophthalmicNSAIDStodecreaseswelling,oralanalgesics,Ophthalmicf/uin24hours.(Do NOT patch - increases infection) CornealForeignBody-ansRoutinelymetal,plasticorwood. Findings:photophobia,pain,injectedconjunctiva(redness),lidswelling Treatment:topicalanesthetic,removalofforeignbody,ophthalmicABX,cycloplegics,oral analgesia CornealLaceration -ansInvolvesoneormorelayersofthecornea.Visualizedwithaslitlamp. Findings:similartoabrasion,painoutofproportiontofindings,decreasedvision Treatment:treatsmalllacerationssimilartoanabrasion,largerlacerationsneedophthalmolog y referral and possible surgery Cycloplegicagent-ansCycloplegiaisparalysisoftheciliarymuscleoftheeye,resultingin a loss of accommodation. Because of the paralysis of the ciliary muscle, thecurvature of the lens can no longer be adjusted to focus on nearby objects. D(PrimarySurvey)-ansDisability(NeurologicStatus) DisabilityAssessment-ansAssessGCSonarrivalandrepeatperpolicy. Assesspupilsforequality,shapeandreactivity (PERRL) TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE A:AllergiesandtetanusstatusM: Medications P:PastmedicalhistoryL: Last oral intake E:EventsandEnvironmentalfactorsrelatedto injury. H:Headand Face HeadtoToeAssessment(secondarysurvey)-ansSOFTTISSUE: Inspect:lacerations,puncturewounds,abrasions,contusions,edema,ecchymosis,impaled objects. Palpate:areasoftenderness,step-offs, crepitus BONY DEFORMITIES: Inspect:asymmetryoffacialexpressions,exposedtissueorboneforbrainmatter Palpate:depressions,angulations,tenderness HepaticInjuries-ansInblunttraumathelivermaylaceratefromincreasedabdominalpressure. Hematoma-bleedingcontainedwithinthecapsule Laceration-thecapsuleisdisrupted Findings:Cullensign(ecchymosisaroundtheumbilicusorRUQ),tenderness,guardingor rigidity RUQ, 9-12 rib FXs, elevated LFT GradedI-VI,I=minortrauma Nonoperativemanagementisstandardofcareinhemodynamicallystablepatient.Observed with serial abdominal exams. FindingsofcontrastextravasationmaybeembolizedbyIR. Forsurgicalpatients-fluidresuscitationisessential.Risksofsurgeryincludedisruptionof the natural tamponade process due to the evacuation of large amounts of bloodresulting in hypovolemia. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE HypovolemicShock-ansCausedbyadecreaseintheamountofcirculatingbloodvolume. Intraumatypicallyresultsfromhemorrhage,butcanresultinaprecipitouslossofvolume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranesleadingtoplasmaandproteinleakage.ofbodywater,resultsininadequateperfusi on. Hyperventilationcancauseincreasedintrathoracicpressureresultingincompressionofthe heart and decreased cardiac output. InitialAssessment-ans1.PreparationandTriage 2. PrimarySurvey 3. Reevaluation 4. SecondarySurvey 5. ReevaluationAdjuncts 6. ReevaluationandPostResuscitationCare 7. DefinitiveCareorTransport IntraocularForeignBody- ans*TRUEEMERGENCYANDEARLYINTERVENTIONISESSENTIAL. Findings:compromisedvisualacuity,misshapenpupils,pain Treatment:elevateHOB,ophthalmology,immobilizeforeignbody,patchUNAFFECTEDeye to limit concomitant eye movement, globe closure ASAP, systemic and ophthalmicABX, analgesics. Postopinfection,retinaldetachmentandvisionlossarecommoncomplications. lidinjury-ans Liver-ansLargestsolidorganofthebody.RUQ,6thto10thribs.EncasedbyGlissoncapsule with blood vessels, lymphatics and nerves. Filters 1.7L of blood per minute. Theliverfiltersouttoxins,takesthenutrientsandreturnsthebloodtotheheartviathehepatic veins. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Hepatocytecellsarecapableofregenerationallowingthelivertorepairitsowntissue. Functions: Store and metabolize lipids, transport nutrients, produce glucose andbilirubin,convertammoniatourea,secreteelectrolytes,lipids,lecithin,cholesterolandbile. Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary forclotting). ObstructiveShock-ansResultsfromhypoperfusionofthetissueduetoanobstructionin either the vasculature or heart. Tensionpneumothorax-increasedthoracicpressureleadstodisplacementofthevenacava, obstruction to atrial filling, decreased preload and decreased cardiac output. Cardiactamponade-impedesdiastolicexpansionandfillingleadstodecreasedpreload, strokes volume and cardiac output and ultimately end organ perfusion. P(AVPU)-ansPainful.Respondsonlytopainfulstimuli. (Airwayadjunctmaybeneededwhiledeterminingneedfor intubation) Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identifypotentially life-threatening injuries such as pneumothorax or pelvic fracture withuncontrolledinternalhemorrhage.CanalsoconfirmplacementofETtubes,chesttubesan d gastric tubes. Considerneedfortransfer. shock-ansInadequatetissueperfusion. Spleen-ansEncapsulatedorganLUQlevelof9th-11thribsandcurvesaroundaportionof the stomach. Minimal elasticity and flexibility - most frequent injured organ in blunttrauma. Secondary lymph organ that filters and cleanses the blood. Removes old RBCs andholdsareserveofblood.Itrecyclesiron.Itremovesantibody- coatedbacteria.Supplieslymphocytes to stimulate an immune response to blood borne microorganisms. Stores200-300ml of blood and leads to hemodynamic instability quickly if damaged. SplenicInjuries- ansInblunttraumathespleenmaylaceratefromincreasedabdominalpressure. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Acutecauses-myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryedemaand increased myocardial ischemia. Inotropicsupporttoimprovecontractility. CirculationandControlofHemorrhageAssessment - ansInspect:Uncontrolledexternalbleeding, skin color Auscultate:Muffledheartsounds -mayindicatepericardialtamponade Palpate:carotidand/orfemoralpulsesforrate,rhythm, strength Circulation and Control of Hemorrhage Interventions - ansControl and treat externalbleeding:applydirectpressure,elevatebleedingextremity,applypressureoverarteri alsites, consider use of a tourniquet. 2largeboreIVs,ifunableconsiderIO,obtainlabsand crossmatch. InitiateIVFofwarmedisotoniccrystalloidsolution.Considerbloodproductsafter2L. **Largevolumesoffluidleadtodilutioncoagulopathywhichworsensmetabolicacidosisandm aycausehypothermia.Componenttherapy,includingadministeringRBC,plasmaand platelets is a balanced approach so that O2 delivery is optimized, acidosiscorrected and coagulopathy prevented. ClassificationsofShock-ansHypovolemic-decreaseintheamountofcirculatingbloodvolume Obstructive-obstructionineitherthevasculatureorheart Cardiogenic-pumpfailureinthepresenceofadequateintravascularvolume Distributive-maldistributionofanadequate circulatingbloodvolume(septic,anaphylactic, neurogenic) TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE CornealAbrasion-ansDamagetothecornealepithelium.Easytoevaluatewithfluorescein. Findings:photophobia,tearing,pain,injectedconjunctiva(redness),lidswelling,irritation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophthalmicNSAIDStodecreaseswelling,oralanalgesics,Ophthalmicf/uin24hours.(Do NOT patch - increases infection) CornealForeignBody-ansRoutinelymetal,plasticorwood. Findings:photophobia,pain,injectedconjunctiva(redness),lidswelling Treatment:topicalanesthetic,removalofforeignbody,ophthalmicABX,cycloplegics,oral analgesia CornealLaceration -ansInvolvesoneormorelayersofthecornea.Visualizedwithaslitlamp. Findings:similartoabrasion,painoutofproportiontofindings,decreasedvision Treatment:treatsmalllacerationssimilartoanabrasion,largerlacerationsneedophthalmolog y referral and possible surgery Cycloplegicagent-ansCycloplegiaisparalysisoftheciliarymuscleoftheeye,resultingin a loss of accommodation. Because of the paralysis of the ciliary muscle, thecurvature of the lens can no longer be adjusted to focus on nearby objects. D(PrimarySurvey)-ansDisability(NeurologicStatus) DisabilityAssessment-ansAssessGCSonarrivalandrepeatperpolicy. Assesspupilsforequality,shapeandreactivity (PERRL) Disabilityinterventions-ansEvaluateforneedforCT.AssumeAMStobetheresultofCNS injury until proven otherwise. ConsiderABGs-AMSmaybeindicatorofdecreasedcerebralperfusion,hypoventilation or acid-base imbalance. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Considerbedsideglucose. DistributiveShock-ansOccursasaresultofmaldistributionofanadequatecirculatingvolume with a loss of vascular tone or increased permeability. Diffusevasodilationlowersthesystemicpressure,creatingarelativehypovolemiaorreduction of the mean systemic volume and venous return to the heart or drop inpreload, resulting in distributive shock. Anaphylactic:releaseofinflammatorymediators,suchashistamine,whichcontractsbronchia l smooth muscle and increases vascular permeability and vasodilation. SepticShock:systemicreleaseofbacterialendotoxins,resultinginanincreasedvascular permeability and vasodilation Neurogenic shock: loss of sympathetic nervous system control of vascular tone, whichproducesvenousandarterialvasodilation.Withthelossofsympatheticnervoussystemi nput in spinal cord injury, unopposed vagal activity may result in decreased cardiacoutput through bradycardia. TREATMENT: increase systemic resistance, controlled volume replacement.Vasoconstrictionandinsomecases(neurogenic)Atropinetocounteractbradyc ardia. E(PrimarySurvey)-ansExposureandEnvironmental Control ExposureandEnvironmentalControl - ansCarefullyandcompletelyundressthepatient.Inspect for uncontrolled bleeding and note any obvious injuries. Preventheatloss.Hypothermiacombinedwith hypotensionandacidosisisapotentiallylethal combination in the injured patient. Consider: warm blankets, keep ambienttemperature warm, warm IVF, forced air warmers, radiant warming lights. F(PrimarySurvey)-ansFullSetofVS&FamilyPresence G(PrimarySurvey)-ansGetResuscitationAdjuncts:(LMNOP) L:Labs M:Monitorcardiacrateandrhythm N:Nasoororogastrictubeconsideration TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Intraumatypicallyresultsfromhemorrhage,butcanresultinaprecipitouslossofvolume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranesleadingtoplasmaandproteinleakage.ofbodywater,resultsininadequateperfusi on. Hyperventilationcancauseincreasedintrathoracicpressureresultingincompressionofthe heart and decreased cardiac output. InitialAssessment-ans1.PreparationandTriage 2. PrimarySurvey 3. Reevaluation 4. SecondarySurvey 5. ReevaluationAdjuncts 6. ReevaluationandPostResuscitationCare 7. DefinitiveCareorTransport IntraocularForeignBody- ans*TRUEEMERGENCYANDEARLYINTERVENTIONISESSENTIAL. Findings:compromisedvisualacuity,misshapenpupils,pain Treatment:elevateHOB,ophthalmology,immobilizeforeignbody,patchUNAFFECTEDeye to limit concomitant eye movement, globe closure ASAP, systemic and ophthalmicABX, analgesics. Postopinfection,retinaldetachmentandvisionlossarecommoncomplications. lidinjury-ans Liver-ansLargestsolidorganofthebody.RUQ,6thto10thribs.EncasedbyGlissoncapsule with blood vessels, lymphatics and nerves. Filters 1.7L of blood per minute. Theliverfiltersouttoxins,takesthenutrientsandreturnsthebloodtotheheartviathehepatic veins. Hepatocytecellsarecapableofregenerationallowingthelivertorepairitsowntissue. Functions: Store and metabolize lipids, transport nutrients, produce glucose andbilirubin,convertammoniatourea,secreteelectrolytes,lipids,lecithin,cholesteroland TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE bile.MetabolizesvitaminKandproducesthrombinandfibrinogen(allnecessaryforclotting). ObstructiveShock-ansResultsfromhypoperfusionofthetissueduetoanobstructionin either the vasculature or heart. Tensionpneumothorax-increasedthoracicpressureleadstodisplacementofthevenacava, obstruction to atrial filling, decreased preload and decreased cardiac output. Cardiactamponade-impedesdiastolicexpansionandfillingleadstodecreasedpreload, strokes volume and cardiac output and ultimately end organ perfusion. P(AVPU)-ansPainful.Respondsonlytopainfulstimuli. (Airwayadjunctmaybeneededwhiledeterminingneedfor intubation) Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identifypotentially life-threatening injuries such as pneumothorax or pelvic fracture withuncontrolledinternalhemorrhage.CanalsoconfirmplacementofETtubes,chesttubesan d gastric tubes. Considerneedfortransfer. shock-ansInadequatetissueperfusion. Spleen-ansEncapsulatedorganLUQlevelof9th-11thribsandcurvesaroundaportionof the stomach. Minimal elasticity and flexibility - most frequent injured organ in blunttrauma. Secondary lymph organ that filters and cleanses the blood. Removes old RBCs andholdsareserveofblood.Itrecyclesiron.Itremovesantibody- coatedbacteria.Supplieslymphocytes to stimulate an immune response to blood borne microorganisms. Stores200-300ml of blood and leads to hemodynamic instability quickly if damaged. SplenicInjuries- ansInblunttraumathespleenmaylaceratefromincreasedabdominalpressure. GradedI-V,I=minortrauma Assessmentfindings:signsoftraumaLUQ,abdominaldistention,asymmetry,abnormalcontou r, tenderness, guarding, rigidity, pain left shoulder when supine. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption,intraparenchymalhematomaorsubcapsularhematoma.Contrastblushorextrava sation -hyperdenseareathatrepresenttraumaticdisruption.Activeextravasationimpliesongoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12- 24hours,minimaltransfusionrequirements(<2units),gradeIorIIwithoutblush,age<55,alert able to assist in assessment of abdomen. Surgicaloptions:totalsplenectomyforsevereinjury,forlesssevere -directpressurepacking, embolization, splenorrhaphy (suturing spleen), partial removal. Asplenicpatientshavedifficultydestroyingencapsulatedbacteria - Streptococcuspneumonia, Neisseria meningitides and Haemophilus influenza. At risk forpneumococcal sepsis. Need annual flu shot and q5yr meningococcal andpneumococcal vaccines. U(AVPU)-ansUnresponsive.Doesnotrespondtoanystimuli. V (AVPU) - ansVerbal. Needs verbal stimuli to respond.(Airwayadjunctmaybeneededtopreventtongueobstructi on) A(AVPU)-ansAlert.Willbeabletomaintainairwayonceclear. A(PrimarySurvey)-ansAirwayandalertnesswithsimultaneouscervicalspinalstabilization. AirwayAssessment- ansInspect:tongueobstruction,loose/missingteeth,foreignobjects,blood, vomitus, secretions, edema,burns or evidence ofinhalation injury Auscultate:listenforobstructiveairwaysounds(ie.snoring,gurgling,stridor) Palpate:palpateforpossibleocclusivemaxillofacialbonydeformity,subcutaneousemphysem a AirwayInterventions:- ansSuctionRemove foreign body if noted Jawthrustmaneuver(maintain cspine) Nasopharyngealairway(canbeconscious)Oropharyngealairway(nogag) TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Findings:photophobia,tearing,pain,injectedconjunctiva(redness),lidswelling,irritation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophthalmicNSAIDStodecreaseswelling,oralanalgesics,Ophthalmicf/uin24hours.(Do NOT patch - increases infection) CornealForeignBody-ansRoutinelymetal,plasticorwood. Findings:photophobia,pain,injectedconjunctiva(redness),lidswelling Treatment:topicalanesthetic,removalofforeignbody,ophthalmicABX,cycloplegics,oral analgesia CornealLaceration -ansInvolvesoneormorelayersofthecornea.Visualizedwithaslitlamp. Findings:similartoabrasion,painoutofproportiontofindings,decreasedvision Treatment:treatsmalllacerationssimilartoanabrasion,largerlacerationsneedophthalmolog y referral and possible surgery Cycloplegicagent-ansCycloplegiaisparalysisoftheciliarymuscleoftheeye,resultingin a loss of accommodation. Because of the paralysis of the ciliary muscle, thecurvature of the lens can no longer be adjusted to focus on nearby objects. D(PrimarySurvey)-ansDisability(NeurologicStatus) DisabilityAssessment-ansAssessGCSonarrivalandrepeatperpolicy. Assesspupilsforequality,shapeandreactivity (PERRL) Disabilityinterventions-ansEvaluateforneedforCT.AssumeAMStobetheresultofCNS injury until proven otherwise. ConsiderABGs-AMSmaybeindicatorofdecreasedcerebralperfusion,hypoventilation or acid-base imbalance. Considerbedsideglucose. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE DistributiveShock-ansOccursasaresultofmaldistributionofanadequatecirculatingvolume with a loss of vascular tone or increased permeability. Diffusevasodilationlowersthesystemicpressure,creatingarelativehypovolemiaorreduction of the mean systemic volume and venous return to the heart or drop inpreload, resulting in distributive shock. Anaphylactic:releaseofinflammatorymediators,suchashistamine,whichcontractsbronchia l smooth muscle and increases vascular permeability and vasodilation. SepticShock:systemicreleaseofbacterialendotoxins,resultinginanincreasedvascular permeability and vasodilation Neurogenic shock: loss of sympathetic nervous system control of vascular tone, whichproducesvenousandarterialvasodilation.Withthelossofsympatheticnervoussystemi nput in spinal cord injury, unopposed vagal activity may result in decreased cardiacoutput through bradycardia. TREATMENT: increase systemic resistance, controlled volume replacement.Vasoconstrictionandinsomecases(neurogenic)Atropinetocounteractbradyc ardia. E(PrimarySurvey)-ansExposureandEnvironmental Control ExposureandEnvironmentalControl - ansCarefullyandcompletelyundressthepatient.Inspect for uncontrolled bleeding and note any obvious injuries. Preventheatloss.Hypothermiacombinedwithhypotensionandacidosisisapotentiallylethal combination in the injured patient. Consider: warm blankets, keep ambienttemperature warm, warm IVF, forced air warmers, radiant warming lights. F(PrimarySurvey)-ansFullSetofVS&FamilyPresence G(PrimarySurvey)-ansGetResuscitationAdjuncts:(LMNOP) L:Labs M:Monitorcardiacrateandrhythm N:Nasoororogastrictubeconsideration O:Oxygenation-SpO2and/oretCO2monitorP: Pain assessment and management TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE GCS-ansGCS EYES 1:Doesnotopeneyes 2: Opens eyes in response to pain3:Openseyesinresponsetovoice 4: Opens eyes spontaneously VERBAL 1. Makesnosounds 2. Makes sounds 3. Words 4. Confused,disoriented 5. Oriented,conversesnormally MOTOR 1. Makesnomovements 2. Extensiontopainfulstimuli(decerebrate) 3. Abnormalflexiontopainfulstimuli(decorticate) 4. Withdrawaltopainfulstimuli 5. Localizespainfulstimuli 6. Obeys commands H(SecondarySurvey)- ansHistoryPrehospital Report (MIST) M:MOI I:Injuries sustained S:SignsandsymptomsinthefieldT: Treatment in field PatientHistory(SAMPLE): S: Symptoms A:AllergiesandtetanusstatusM: Medications P:PastmedicalhistoryL: Last oral intake E:EventsandEnvironmentalfactorsrelatedto injury. H:Headand Face HeadtoToeAssessment(secondary survey)-ansSOFTTISSUE: TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE ObstructiveShock-ansResultsfromhypoperfusionofthetissueduetoanobstructionin either the vasculature or heart. Tensionpneumothorax-increasedthoracicpressureleadstodisplacementofthevenacava, obstruction to atrial filling, decreased preload and decreased cardiac output. Cardiactamponade-impedesdiastolicexpansionandfillingleadstodecreasedpreload, strokes volume and cardiac output and ultimately end organ perfusion. P(AVPU)-ansPainful.Respondsonlytopainfulstimuli. (Airwayadjunctmaybeneededwhiledeterminingneedfor intubation) Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identifypotentially life-threatening injuries such as pneumothorax or pelvic fracture withuncontrolledinternalhemorrhage.CanalsoconfirmplacementofETtubes,chesttubesan d gastric tubes. Considerneedfortransfer. shock-ansInadequatetissueperfusion. Spleen-ansEncapsulatedorganLUQlevelof9th-11thribsandcurvesaroundaportionof the stomach. Minimal elasticity and flexibility - most frequent injured organ in blunttrauma. Secondary lymph organ that filters and cleanses the blood. Removes old RBCs andholdsareserveofblood.Itrecyclesiron.Itremovesantibody- coatedbacteria.Supplieslymphocytes to stimulate an immune response to blood borne microorganisms. Stores200-300ml of blood and leads to hemodynamic instability quickly if damaged. SplenicInjuries- ansInblunttraumathespleenmaylaceratefromincreasedabdominalpressure. GradedI-V,I=minortrauma Assessmentfindings:signsoftraumaLUQ,abdominaldistention,asymmetry,abnormalcontou r, tenderness, guarding, rigidity, pain left shoulder when supine. CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption,intraparenchymalhematomaorsubcapsularhematoma.Contrastblushorextrava sation TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE -hyperdenseareathatrepresenttraumaticdisruption.Activeextravasationimpliesongoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12- 24hours,minimaltransfusionrequirements(<2units),gradeIorIIwithoutblush,age<55,alert able to assist in assessment of abdomen. Surgicaloptions:totalsplenectomyforsevereinjury,forlesssevere -directpressurepacking, embolization, splenorrhaphy (suturing spleen), partial removal. Asplenicpatientshavedifficultydestroyingencapsulatedbacteria - Streptococcuspneumonia, Neisseria meningitides and Haemophilus influenza. At risk forpneumococcal sepsis. Need annual flu shot and q5yr meningococcal andpneumococcal vaccines. U(AVPU)-ansUnresponsive.Doesnotrespondtoanystimuli. V (AVPU) - ansVerbal. Needs verbal stimuli to respond.(Airwayadjunctmaybeneededtopreventtongueobstructi on) A(AVPU)-ansAlert.Willbeabletomaintainairwayonceclear. A(PrimarySurvey)-ansAirwayandalertnesswithsimultaneouscervical spinalstabilization. AirwayAssessment- ansInspect:tongueobstruction,loose/missingteeth,foreignobjects,blood, vomitus, secretions, edema,burns or evidence ofinhalation injury Auscultate:listenforobstructiveairwaysounds(ie.snoring,gurgling,stridor) Palpate:palpateforpossibleocclusivemaxillofacialbonydeformity,subcutaneousemphysem a AirwayInterventions:- ansSuctionRemove foreign body if noted Jawthrustmaneuver(maintain cspine) Nasopharyngealairway(canbeconscious)Oropharyngealairway(nogag)Consider definitive airway AlertnessAssessment-ansA-Alert TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE V- VerbalP- Painful U-Unresponsive B(PrimarySurvey)-ansBreathingand Ventilation Breathing and Ventilation Assessment - ansInspect: spontaneous breathing,symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use,diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic),contusions/abrasions/deformities(signsofunderlyinginjury),openpneumothora ces(sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate:presence,absenceandequalityofbreathsoundsat2ndintercostalspacemidclavi cular line and bases at the fifth intercostal space anterior axillary line Palpate:bonystructures,possibleribfractures,SQemphysema,softtissueinjury,JVpulsation s at suprasternal notch or supraclavicular area Life-threateningpulmonaryinjuriesrequiringimmediateintervention:openpneumothorax, tension pneumothorax, flail chest, hemothorax. BreathingandVentilationIntervention-ansBreathingabsent:jaw- thrustmaneuver,oralairway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathingpresent:NRB.Determineifventilationeffective:etCO2 35-45,SpO294%orhigher. If ineffective: assist with bag-mask and determine need for definitive airway C(PrimarySurvey)-ansCirculationandControlofHemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequateintravascularvolume.There is alack of cardiac output and end-organ perfusionsecondarytoadecreaseinmyocardialcontractilityand/orvalvularinsufficie ncy. Acutecauses-myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryedemaand increased myocardial ischemia. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Diffusevasodilationlowersthesystemicpressure,creatingarelativehypovolemiaorreduction of the mean systemic volume and venous return to the heart or drop inpreload, resulting in distributive shock. Anaphylactic:releaseofinflammatorymediators,suchashistamine,whichcontractsbronchia l smooth muscle and increases vascular permeability and vasodilation. SepticShock:systemicreleaseofbacterialendotoxins,resultinginanincreasedvascular permeability and vasodilation Neurogenic shock: loss of sympathetic nervous system control of vascular tone, whichproducesvenousandarterialvasodilation.Withthelossofsympatheticnervoussystemi nput in spinal cord injury, unopposed vagal activity may result in decreased cardiacoutput through bradycardia. TREATMENT: increase systemic resistance, controlled volume replacement.Vasoconstrictionandinsomecases(neurogenic)Atropinetocounteractbradyc ardia. E(PrimarySurvey)-ansExposureandEnvironmental Control ExposureandEnvironmentalControl - ansCarefullyandcompletelyundressthepatient.Inspect for uncontrolled bleeding and note any obvious injuries. Preventheatloss.Hypothermiacombinedwithhypotensionandacidosisisapotentiallylethal combination in the injured patient. Consider: warm blankets, keep ambienttemperature warm, warm IVF, forced air warmers, radiant warming lights. F(PrimarySurvey)-ansFullSetofVS&FamilyPresence G(PrimarySurvey)-ansGetResuscitationAdjuncts:(LMNOP) L:Labs M:Monitorcardiacrateandrhythm N:Nasoororogastrictubeconsideration O:Oxygenation-SpO2and/oretCO2monitorP: Pain assessment and management GCS-ansGCS EYES TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE 1:Doesnotopeneyes 2: Opens eyes in response to pain3:Openseyesinresponsetovoice 4: Opens eyes spontaneously VERBAL 1. Makesnosounds 2. Makes sounds 3. Words 4. Confused,disoriented 5. Oriented,conversesnormally MOTOR 1. Makesnomovements 2. Extensiontopainfulstimuli(decerebrate) 3. Abnormalflexiontopainfulstimuli(decorticate) 4. Withdrawaltopainfulstimuli 5. Localizespainfulstimuli 6. Obeys commands H(SecondarySurvey)- ansHistoryPrehospital Report (MIST) M:MOI I:Injuries sustained S:SignsandsymptomsinthefieldT: Treatment in field PatientHistory(SAMPLE): S: Symptoms A:AllergiesandtetanusstatusM: Medications P:PastmedicalhistoryL: Last oral intake E:EventsandEnvironmentalfactorsrelatedto injury. H:Headand Face HeadtoToeAssessment(secondarysurvey)-ansSOFTTISSUE: Inspect:lacerations,puncturewounds,abrasions,contusions,edema,ecchymosis,impaled objects. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Palpate:areasoftenderness,step-offs, crepitus BONY DEFORMITIES: Inspect:asymmetryoffacialexpressions,exposedtissueorboneforbrainmatter Palpate:depressions,angulations,tenderness HepaticInjuries-ansInblunttraumathelivermaylaceratefromincreasedabdominalpressure. Hematoma-bleedingcontainedwithinthecapsule Laceration-thecapsuleisdisrupted Findings:Cullensign(ecchymosisaroundtheumbilicusorRUQ),tenderness,guardingor rigidity RUQ, 9-12 rib FXs, elevated LFT GradedI-VI,I=minortrauma Nonoperativemanagementisstandardofcareinhemodynamicallystablepatient.Observed with serial abdominal exams. FindingsofcontrastextravasationmaybeembolizedbyIR. Forsurgicalpatients-fluidresuscitationisessential.Risksofsurgeryincludedisruptionof the natural tamponade process due to the evacuation of large amounts of bloodresulting in hypovolemia. HypovolemicShock-ansCausedbyadecreaseintheamountofcirculatingbloodvolume. Intraumatypicallyresultsfromhemorrhage,butcanresultinaprecipitouslossofvolume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranesleadingtoplasmaandproteinleakage.ofbodywater,resultsininadequateperfusi on. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Nonoperative management is preferred if hemodynamically stable, stable H/H x 12- 24hours,minimaltransfusionrequirements(<2units),gradeIorIIwithoutblush,age<55,alert able to assist in assessment of abdomen. Surgicaloptions:totalsplenectomyforsevereinjury,forlesssevere -directpressurepacking, embolization, splenorrhaphy (suturing spleen), partial removal. Asplenicpatientshavedifficultydestroyingencapsulatedbacteria - Streptococcuspneumonia, Neisseria meningitides and Haemophilus influenza. At risk forpneumococcal sepsis. Need annual flu shot and q5yr meningococcal andpneumococcal vaccines. U(AVPU)-ansUnresponsive.Doesnotrespondtoanystimuli. V(AVPU)-ansVerbal.Needsverbalstimulitorespond. (Airwayadjunctmaybeneededtopreventtongueobstruction)A(AVPU)-ansAlert.Willbe able to maintain airway once clear. A(PrimarySurvey)-ansAirwayandalertnesswithsimultaneouscervicalspinalstabilization. AirwayAssessment- ansInspect:tongueobstruction,loose/missingteeth,foreignobjects,blood, vomitus, secretions, edema,burns or evidence ofinhalation injury Auscultate:listenforobstructiveairwaysounds(ie.snoring,gurgling,stridor) Palpate:palpateforpossibleocclusivemaxillofacialbonydeformity,subcutaneousemphysem a AirwayInterventions:- ansSuctionRemove foreign body if noted Jawthrustmaneuver(maintain cspine) Nasopharyngealairway(canbeconscious)Oropharyngealairway(nogag)Consider definitive airway AlertnessAssessment-ansA- AlertV-Verbal P-Painful U-Unresponsive TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE B(PrimarySurvey)-ansBreathingand Ventilation Breathing and Ventilation Assessment - ansInspect: spontaneous breathing,symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use,diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic),contusions/abrasions/deformities(signsofunderlyinginjury),openpneumothora ces(sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate:presence,absenceandequalityofbreathsoundsat2ndintercostalspacemidclavi cular line and bases at the fifth intercostal space anterior axillary line Palpate:bonystructures,possibleribfractures,SQemphysema,softtissueinjury,JVpulsation s at suprasternal notch or supraclavicular area Life-threateningpulmonaryinjuriesrequiringimmediateintervention:openpneumothorax, tension pneumothorax, flail chest, hemothorax. BreathingandVentilationIntervention-ansBreathingabsent:jaw- thrustmaneuver,oralairway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathingpresent:NRB.Determineifventilationeffective:etCO235-45,SpO294%orhigher. If ineffective: assist with bag-mask and determine need for definitive airway C(PrimarySurvey)-ansCirculationandControlofHemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequateintravascularvolume.There is alack of cardiac ou tput and end-organ perfusionsecondarytoadecreaseinmyocardialcontractilityand/orvalvularinsufficie ncy. Acutecauses-myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryedemaand increased myocardial ischemia. Inotropicsupporttoimprovecontractility. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE CirculationandControlofHemorrhageAssessment - ansInspect:Uncontrolledexternalbleeding, skin color Auscultate:Muffledheartsounds -mayindicatepericardialtamponade Palpate:carotidand/orfemoralpulsesforrate,rhythm, strength Circulation and Control of Hemorrhage Interventions - ansControl and treat externalbleeding:applydirectpressure,elevatebleedingextremity,applypressureoverarteri alsites, consider use of a tourniquet. 2largeboreIVs,ifunableconsiderIO,obtainlabsand crossmatch. InitiateIVFofwarmedisotoniccrystalloidsolution.Considerbloodproductsafter2L. **Largevolumesoffluidleadtodilutioncoagulopathywhichworsensmetabolicacidosisandm aycausehypothermia.Componenttherapy,includingadministeringRBC,plasmaand platelets is a balanced approach so that O2 delivery is optimized, acidosiscorrected and coagulopathy prevented. ClassificationsofShock-ansHypovolemic-decreaseintheamountofcirculatingbloodvolume Obstructive-obstructionineitherthevasculatureorheart Cardiogenic-pumpfailureinthepresenceofadequateintravascularvolume Distributive-maldistributionofanadequatecirculatingbloodvolume(septic,anaphylactic, neurogenic) CornealAbrasion-ansDamagetothecornealepithelium.Easytoevaluatewithfluorescein. Findings:photophobia,tearing,pain,injectedconjunctiva(redness),lidswelling,irritation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophthalmicNSAIDStodecreaseswelling,oralanalgesics,Ophthalmicf/uin24hours.(Do NOT patch - increases infection) TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE VERBAL 1. Makesnosounds 2. Makes sounds 3. Words 4. Confused,disoriented 5. Oriented,conversesnormally MOTOR 1. Makesnomovements 2. Extensiontopainfulstimuli(decerebrate) 3. Abnormalflexiontopainfulstimuli(decorticate) 4. Withdrawaltopainfulstimuli 5. Localizespainfulstimuli 6. Obeys commands H(SecondarySurvey)- ansHistoryPrehospital Report (MIST) M:MOI I:Injuries sustained S:SignsandsymptomsinthefieldT: Treatment in field PatientHistory(SAMPLE): S: Symptoms A:AllergiesandtetanusstatusM: Medications P:PastmedicalhistoryL: Last oral intake E:EventsandEnvironmentalfactorsrelatedto injury. H:Headand Face HeadtoToeAssessment(secondarysurvey)-ansSOFTTISSUE: Inspect:lacerations,puncturewounds,abrasions,contusions,edema,ecchymosis,impaled objects. Palpate:areasoftenderness,step-offs, crepitus BONY DEFORMITIES: TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Inspect:asymmetryoffacialexpressions,exposedtissueorboneforbrainmatter Palpate:depressions,angulations,tenderness HepaticInjuries-ansInblunttraumathelivermaylaceratefromincreasedabdominalpressure. Hematoma-bleedingcontainedwithinthecapsule Laceration-thecapsuleisdisrupted Findings:Cullensign(ecchymosisaroundtheumbilicusorRUQ),tenderness,guardingor rigidity RUQ, 9-12 rib FXs, elevated LFT GradedI-VI,I=minortrauma Nonoperativemanagementisstandardofcareinhemodynamicallystablepatient.Observed with serial abdominal exams. FindingsofcontrastextravasationmaybeembolizedbyIR. Forsurgicalpatients-fluidresuscitationisessential.Risksofsurgeryincludedisruptionof the natural tamponade process due to the evacuation of large amounts of bloodresulting in hypovolemia. HypovolemicShock-ansCausedbyadecreaseintheamountofcirculatingbloodvolume. Intraumatypicallyresultsfromhemorrhage,butcanresultinaprecipitouslossofvolume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranesleadingtoplasmaandproteinleakage.ofbodywater,resultsininadequateperfusi on. Hyperventilationcancauseincreasedintrathoracicpressureresultingincompressionofthe heart and decreased cardiac output. InitialAssessment-ans1.PreparationandTriage 2. PrimarySurvey TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE 3. Reevaluation 4. SecondarySurvey 5. ReevaluationAdjuncts 6. ReevaluationandPostResuscitationCare 7. DefinitiveCareorTransport IntraocularForeignBody- ans*TRUEEMERGENCYANDEARLYINTERVENTIONISESSENTIAL. Findings:compromisedvisualacuity,misshapenpupils,pain Treatment:elevateHOB,ophthalmology,immobilizeforeignbody,patchUNAFFECTEDeye to limit concomitant eye movement, globe closure ASAP, systemic and ophthalmicABX, analgesics. Postopinfection,retinaldetachmentandvisionlossarecommoncomplications. lidinjury-ans Liver-ansLargestsolidorganofthebody.RUQ,6thto10thribs.EncasedbyGlissoncapsule with blood vessels, lymphatics and nerves. Filters 1.7L of blood per minute. Theliverfiltersouttoxins,takesthenutrientsandreturnsthebloodtotheheartviathehepatic veins. Hepatocytecellsarecapableofregenerationallowingthelivertorepairitsowntissue. Functions: Store and metabolize lipids, transport nutrients, produce glucose andbilirubin,convertammoniatourea,secreteelectrolytes,lipids,lecithin,cholesterolandbile. Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary forclotting). ObstructiveShock-ansResultsfromhypoperfusionofthetissueduetoanobstructionin either the vasculature or heart. Tensionpneumothorax-increasedthoracicpressureleadstodisplacementofthevenacava, obstruction to atrial filling, decreased preload and decreased cardiac output. Cardiactamponade-impedesdiastolicexpansionandfillingleadstodecreasedpreload, strokes volume and cardiac output and ultimately end organ perfusion. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Breathing and Ventilation Assessment - ansInspect: spontaneous breathing,symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use,diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic),contusions/abrasions/deformities(signsofunderlyinginjury),openpneumothora ces(sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate:presence,absenceandequalityofbreathsoundsat2ndintercostalspacemidclavi cular line and bases at the fifth intercostal space anterior axillary line Palpate:bonystructures,possibleribfractures,SQemphysema,softtissueinjury,JVpulsation s at suprasternal notch or supraclavicular area Life-threateningpulmonaryinjuriesrequiringimmediateintervention:openpneumothorax, tension pneumothorax, flail chest, hemothorax. BreathingandVentilationIntervention-ansBreathingabsent:jaw- thrustmaneuver,oralairway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathingpresent:NRB.Determineifventilationeffective:etCO235-45,SpO294%orhigher. If ineffective: assist with bag-mask and determine need for definitive airway C(PrimarySurvey)-ansCirculationandControlofHemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequateintravascularvolume.There is alack of cardiac output and end-organ perfusionsecondarytoadecreaseinmyocardialcontractilityand/orvalvularinsufficie ncy. Acutecauses-myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryedemaand increased myocardial ischemia. Inotropicsupporttoimprovecontractility. CirculationandControlofHemorrhageAssessment - ansInspect:Uncontrolledexternalbleeding, skin color TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Auscultate:Muffledheartsounds -mayindicatepericardialtamponade Palpate:carotidand/orfemoralpulsesforrate,rhythm, strength Circulation and Control of Hemorrhage Interventions - ansControl and treat externalbleeding:applydirectpressure,elevatebleedingextremity,applypressureoverarteri alsites, consider use of a tourniquet. 2largeboreIVs,ifunableconsiderIO,obtainlabsand crossmatch. InitiateIVFofwarmedisotoniccrystalloidsolution.Considerbloodproductsafter2L. **Largevolumesoffluidleadtodilutioncoagulopathywhichworsensmetabolic acidosisandmaycausehypothermia.Componenttherapy,includingadministeringRBC,plas maand platelets is a balanced approach so that O2 delivery is optimized, acidosiscorrected and coagulopathy prevented. ClassificationsofShock-ansHypovolemic-decreaseintheamountofcirculatingbloodvolume Obstructive-obstructionineitherthevasculatureorheart Cardiogenic-pumpfailureinthepresenceofadequateintravascularvolume Distributive-maldistributionofanadequatecirculatingbloodvolume(septic,anaphylactic, neurogenic) CornealAbrasion-ansDamagetothecornealepithelium.Easytoevaluatewithfluorescein. Findings:photophobia,tearing,pain,injectedconjunctiva(redness),lidswelling,irritation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophthalmicNSAIDStodecreaseswelling,oralanalgesics,Ophthalmicf/uin24hours.(Do NOT patch - increases infection) CornealForeignBody-ansRoutinelymetal,plasticorwood. Findings:photophobia,pain,injectedconjunctiva(redness),lidswelling TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Treatment:topicalanesthetic,removalofforeignbody,ophthalmicABX,cycloplegics,oral analgesia CornealLaceration -ansInvolvesoneormorelayersofthecornea.Visualizedwithaslitlamp. Findings:similartoabrasion,painoutofproportiontofindings,decreasedvision Treatment:treatsmalllacerationssimilartoanabrasion,largerlacerationsneedophthalmolog y referral and possible surgery Cycloplegicagent-ansCycloplegiaisparalysisoftheciliarymuscleoftheeye,resultingin a loss of accommodation. Because of the paralysis of the ciliary muscle, thecurvature of the lens can no longer be adjusted to focus on nearby objects. D(PrimarySurvey)-ansDisability(NeurologicStatus) DisabilityAssessment-ansAssessGCSonarrivalandrepeatperpolicy. Assesspupilsforequality,shapeandreactivity (PERRL) Disabilityinterventions-ansEvaluateforneedforCT.AssumeAMStobetheresultofCNS injury until proven otherwise. ConsiderABGs-AMSmaybeindicatorofdecreasedcerebralperfusion,hypoventilation or acid-base imbalance. Considerbedsideglucose. DistributiveShock-ansOccursasaresultofmaldistributionofanadequatecirculatingvolume with a loss of vascular tone or increased permeability. Diffusevasodilationlowersthesystemicpressure,creatingarelativehypovolemiaorreduction of the mean systemic volume and venous return to the heart or drop inpreload, resulting in distributive shock. Anaphylactic:releaseofinflammatorymediators,suchashistamine,whichcontractsbronchia l smooth muscle and increases vascular permeability and vasodilation. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Palpate:depressions,angulations,tenderness HepaticInjuries-ansInblunttraumathelivermaylaceratefromincreasedabdominalpressure. Hematoma-bleedingcontainedwithinthecapsule Laceration-thecapsuleisdisrupted Findings:Cullensign(ecchymosisaroundtheumbilicusorRUQ),tenderness,guardingor rigidity RUQ, 9-12 rib FXs, elevated LFT GradedI-VI,I=minortrauma Nonoperativemanagementisstandardofcareinhemodynamicallystablepatient.Observed with serial abdominal exams. FindingsofcontrastextravasationmaybeembolizedbyIR. Forsurgicalpatients-fluidresuscitationisessential.Risksofsurgeryincludedisruptionof the natural tamponade process due to the evacuation of large amounts of bloodresulting in hypovolemia. HypovolemicShock-ansCausedbyadecreaseintheamountofcirculatingbloodvolume. Intraumatypicallyresultsfromhemorrhage,butcanresultinaprecipitouslossofvolume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranesleadingtoplasmaandproteinleakage.ofbodywater,resultsininadequateperfusi on. Hyperventilationcancauseincreasedintrathoracicpressureresultingincompressionofthe heart and decreased cardiac output. InitialAssessment-ans1.PreparationandTriage 2. PrimarySurvey 3. Reevaluation 4. SecondarySurvey 5. ReevaluationAdjuncts TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE 6. ReevaluationandPostResuscitationCare 7. DefinitiveCareorTransport IntraocularForeignBody- ans*TRUEEMERGENCYANDEARLYINTERVENTIONISESSENTIAL. Findings:compromisedvisualacuity,misshapenpupils,pain Treatment:elevateHOB,ophthalmology,immobilizeforeignbody,patchUNAFFECTEDeye to limit concomitant eye movement, globe closure ASAP, systemic and ophthalmicABX, analgesics. Postopinfection,retinaldetachmentandvisionlossarecommoncomplications. lidinjury-ans Liver-ansLargestsolidorganofthebody.RUQ,6thto10thribs.EncasedbyGlissoncapsule with blood vessels, lymphatics and nerves. Filters 1.7L of blood per minute. Theliverfiltersouttoxins,takesthenutrientsandreturnsthebloodtotheheartviathehepatic veins. Hepatocytecellsarecapableofregenerationallowingthelivertorepairitsowntissue. Functions: Store and metabolize lipids, transport nutrients, produce glucose andbilirubin,convertammoniatourea,secreteelectrolytes,lipids,lecithin,cholesterolandbile. Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary forclotting). ObstructiveShock-ansResultsfromhypoperfusionofthetissueduetoanobstructionin either the vasculature or heart. Tensionpneumothorax-increasedthoracicpressureleadstodisplacementofthevenacava, obstruction to atrial filling, decreased preload and decreased cardiac output. Cardiactamponade-impedesdiastolicexpansionandfillingleadstodecreasedpreload, strokes volume and cardiac output and ultimately end organ perfusion. P(AVPU)-ansPainful.Respondsonlytopainfulstimuli. (Airwayadjunctmaybeneededwhiledeterminingneedfor intubation) TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identifypotentially life-threatening injuries such as pneumothorax or pelvic fracture withuncontrolledinternalhemorrhage.CanalsoconfirmplacementofETtubes,chesttubesan d gastric tubes. Considerneedfortransfer. shock-ansInadequatetissueperfusion. Spleen-ansEncapsulatedorganLUQlevelof9th-11thribsandcurvesaroundaportionof the stomach. Minimal elasticity and flexibility - most frequent injured organ in blunttrauma. Secondary lymph organ that filters and cleanses the blood. Removes old RBCs andholdsareserveofblood.Itrecyclesiron.Itremovesantibody- coatedbacteria.Supplieslymphocytes to stimulate an immune response to blood borne microorganisms. Stores200-300ml of blood and leads to hemodynamic instability quickly if damaged. SplenicInjuries- ansInblunttraumathespleenmaylaceratefromincreasedabdominalpressure. GradedI-V,I=minortrauma Assessmentfindings:signsoftraumaLUQ,abdominaldistention,asymmetry,abnormalcontou r, tenderness, guarding, rigidity, pain left shoulder when supine. CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption,intraparenchymalhematomaorsubcapsularhematoma.Contrastblushorextrava sation -hyperdenseareathatrepresenttraumaticdisruption.Activeextravasationimpliesongoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12- 24hours,minimaltransfusionrequirements(<2units),gradeIorIIwithoutblush,age<55,alert able to assist in assessment of abdomen. Surgicaloptions:totalsplenectomyforsevereinjury,forlesssevere -directpressurepacking, embolization, splenorrhaphy (suturing spleen), partial removal. TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Circulation and Control of Hemorrhage Interventions - ansControl and treat externalbleeding:applydirectpressure,elevatebleedingextremity,applypressureoverarteri alsites, consider use of a tourniquet. 2largeboreIVs,ifunableconsiderIO,obtainlabsand crossmatch. InitiateIVFofwarmedisotoniccrystalloidsolution.Considerbloodproductsafter2L. **Largevolumesoffluidleadtodilutioncoagulopathywhichworsensmetabolicacidosisandm aycausehypothermia.Componenttherapy,includingadministeringRBC,plasmaand platelets is a balanced approach so that O2 delivery is optimized, acidosiscorrected and coagulopathy prevented. ClassificationsofShock-ansHypovolemic-decreaseintheamountofcirculatingbloodvolume Obstructive-obstructionineitherthevasculatureorheart Cardiogenic-pumpfailureinthepresenceofadequateintravascularvolume Distributive-maldistributionofanadequatecirculatingbloodvolume(septic,anaphylactic, neurogenic) CornealAbrasion-ansDamagetothecornealepithelium.Easytoevaluatewithfluorescein. Findings:photophobia,tearing,pain,injectedconjunctiva(redness),lidswelling,irritation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophthalmicNSAIDStodecreaseswelling,oralanalgesics,Ophthalmicf/uin24hours.(Do NOT patch - increases infection) CornealForeignBody-ansRoutinelymetal,plasticorwood. Findings:photophobia,pain,injectedconjunctiva(redness),lidswelling Treatment:topicalanesthetic,removalofforeignbody,ophthalmicABX,cycloplegics,oral analgesia TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE CornealLaceration -ansInvolvesoneormorelayersofthecornea.Visualizedwithaslitlamp. Findings:similartoabrasion,painoutofproportiontofindings,decreasedvision Treatment:treatsmalllacerationssimilartoanabrasion,largerlacerationsneedophthalmolog y referral and possible surgery Cycloplegicagent-ansCycloplegiaisparalysisoftheciliarymuscleoftheeye,resultingin a loss of accommodation. Because of the paralysis of the ciliary muscle, thecurvature of the lens can no longer be adjusted to focus on nearby objects. D(PrimarySurvey)-ansDisability(NeurologicStatus) DisabilityAssessment-ansAssessGCSonarrivalandrepeatperpolicy. Assesspupilsforequality,shapeandreactivity (PERRL) Disabilityinterventions-ansEvaluateforneedforCT.AssumeAMStobetheresultofCNS injury until proven otherwise. ConsiderABGs-AMSmaybeindicatorofdecreasedcerebralperfusion,hypoventilation or acid-base imbalance. Considerbedsideglucose. DistributiveShock-ansOccursasaresultofmaldistributionofanadequatecirculatingvolume with a loss of vascular tone or increased permeability. Diffusevasodilationlowersthesystemicpressure,creatingarelativehypovolemiaorreduction of the mean systemic volume and venous return to the heart or drop inpreload, resulting in distributive shock. Anaphylactic:releaseofinflammatorymediators,suchashistamine,whichcontractsbronchia l smooth muscle and increases vascular permeability and vasodilation. SepticShock:systemicreleaseofbacterialendotoxins,resultinginanincreasedvascular permeability and vasodilation TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Neurogenic shock: loss of sympathetic nervous system control of vascular tone, whichproducesvenousandarterialvasodilation.Withthelossofsympatheticnervoussystemi nput in spinal cord injury, unopposed vagal activity may result in decreased cardiacoutput through bradycardia. TREATMENT: increase systemic resistance, controlled volume replacement.Vasoconstrictionandinsomecases(neurogenic)Atropinetocounteractbradyc ardia. E(PrimarySurvey)-ansExposureandEnvironmental Control ExposureandEnvironmentalControl - ansCarefullyandcompletelyundressthepatient.Inspect for uncontrolled bleeding and note any obvious injuries. Preventheatloss.Hypothermiacombinedwithhypotensionandacidosisisapotentiallylethal combination in the injured patient. Consider: warm blankets, keep ambienttemperature warm, warm IVF, forced air warmers, radiant warming lights. F(PrimarySurvey)-ansFullSetofVS&FamilyPresence G(PrimarySurvey)-ansGetResuscitationAdjuncts:(LMNOP) L:Labs M:Monitorcardiacrateandrhythm N:Nasoororogastrictubeconsideration O:Oxygenation-SpO2and/oretCO2monitorP: Pain assessment and management GCS-ansGCS EYES 1:Doesnotopeneyes 2: Opens eyes in response to pain3:Openseyesinresponsetovoice 4: Opens eyes spontaneously VERBAL 1. Makesnosounds 2. Makes sounds 3. Words 4. Confused,disoriented TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE IntraocularForeignBody- ans*TRUEEMERGENCYANDEARLYINTERVENTIONISESSENTIAL. Findings:compromisedvisualacuity,misshapenpupils,pain Treatment:elevateHOB,ophthalmology,immobilizeforeignbody,patchUNAFFECTEDeye to limit concomitant eye movement, globe closure ASAP, systemic and ophthalmicABX, analgesics. Postopinfection,retinaldetachmentandvisionlossarecommoncomplications. lidinjury-ans Liver-ansLargestsolidorganofthebody.RUQ,6thto10thribs.EncasedbyGlissoncapsule with blood vessels, lymphatics and nerves. Filters 1.7L of blood per minute. Theliverfiltersouttoxins,takesthenutrientsandreturnsthebloodtotheheartviathehepatic veins. Hepatocytecellsarecapableofregenerationallowingthelivertorepairitsowntissue. Functions: Store and metabolize lipids, transport nutrients, produce glucose andbilirubin,convertammoniatourea,secreteelectrolytes,lipids,lecithin,cholesterolandbile. Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary forclotting). ObstructiveShock-ansResultsfromhypoperfusionofthetissueduetoanobstructionin either the vasculature or heart. Tensionpneumothorax-increasedthoracicpressureleadstodisplacementofthevenacava, obstruction to atrial filling, decreased preload and decreased cardiac output. Cardiactamponade-impedesdiastolicexpansionandfillingleadstodecreasedpreload, strokes volume and cardiac output and ultimately end organ perfusion. P(AVPU)-ansPainful.Respondsonlytopainfulstimuli. (Airwayadjunctmaybeneededwhiledeterminingneedfor intubation) TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identifypotentially life-threatening injuries such as pneumothorax or pelvic fracture withuncontrolledinternalhemorrhage.CanalsoconfirmplacementofETtubes,chesttubesan d gastric tubes. Considerneedfortransfer. shock-ansInadequatetissueperfusion. Spleen-ansEncapsulatedorganLUQlevelof9th-11thribsandcurvesaroundaportionof the stomach. Minimal elasticity and flexibility - most frequent injured organ in blunttrauma. Secondary lymph organ that filters and cleanses the blood. Removes old RBCs andholdsareserveofblood.Itrecyclesiron.Itremovesantibody- coatedbacteria.Supplieslymphocytes to stimulate an immune response to blood borne microorganisms. Stores200-300ml of blood and leads to hemodynamic instability quickly if damaged. SplenicInjuries- ansInblunttraumathespleenmaylaceratefromincreasedabdominalpressure. GradedI-V,I=minortrauma Assessmentfindings:signsoftraumaLUQ,abdominaldistention,asymmetry,abnormalcontou r, tenderness, guarding, rigidity, pain left shoulder when supine. CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption,intraparenchymalhematomaorsubcapsularhematoma.Contrastblushorextrava sation -hyperdenseareathatrepresenttraumaticdisruption.Activeextravasationimpliesongoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12- 24hours,minimaltransfusionrequirements(<2units),gradeIorIIwithoutblush,age<55,alert able to assist in assessment of abdomen. Surgicaloptions:totalsplenectomyforsevereinjury,forlesssevere -directpressurepacking, embolization, splenorrhaphy (suturing spleen), partial removal. Asplenicpatientshavedifficultydestroyingencapsulatedbacteria - Streptococcuspneumonia, Neisseria meningitides and Haemophilus influenza. At risk for TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE pneumococcalsepsis.Needannualflushotandq5yrmeningococcalandpneumococcal vaccines. U(AVPU)-ansUnresponsive.Doesnotrespondtoanystimuli. V(AVPU)-ansVerbal.Needsverbalstimulitorespond. (Airwayadjunctmaybeneededtopreventtongueobstruction)A(AVPU)-ansAlert.Willbe able to maintain airway once clear. A(PrimarySurvey)-ansAirwayandalertnesswith simultaneouscervicalspinalstabilization. AirwayAssessment- ansInspect:tongueobstruction,loose/missingteeth,foreignobjects,blood, vomitus, secretions, edema,burns or evidence ofinhalation injury Auscultate:listenforobstructiveairwaysounds(ie.snoring,gurgling,stridor) Palpate:palpateforpossibleocclusivemaxillofacialbonydeformity,subcutaneousemphysem a AirwayInterventions:- ansSuctionRemove foreign body if noted Jawthrustmaneuver(maintain cspine) Nasopharyngealairway(canbeconscious)Oropharyngealairway(nogag)Consider definitive airway AlertnessAssessment-ansA- AlertV-Verbal P-Painful U-Unresponsive B(PrimarySurvey)-ansBreathingand Ventilation Breathing and Ventilation Assessment - ansInspect: spontaneous breathing,symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use,diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic),contusions/abrasions/deformities(signsofunderlyinginjury),openpneumothora ces(sucking chest wound), JVD, tracheal position, signs of inhalation injury TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE CornealLaceration -ansInvolvesoneormorelayersofthecornea.Visualizedwithaslitlamp. Findings:similartoabrasion,painoutofproportiontofindings,decreasedvision Treatment:treatsmalllacerationssimilartoanabrasion,largerlacerationsneedophthalmolog y referral and possible surgery Cycloplegicagent-ansCycloplegiaisparalysisoftheciliarymuscleoftheeye,resultingin a loss of accommodation. Because of the paralysis of the ciliary muscle, thecurvature of the lens can no longer be adjusted to focus on nearby objects. D(PrimarySurvey)-ansDisability(NeurologicStatus) DisabilityAssessment-ansAssessGCSonarrivalandrepeatperpolicy. Assesspupilsforequality,shapeandreactivity (PERRL) Disabilityinterventions-ansEvaluateforneedforCT.AssumeAMStobetheresultofCNS injury until proven otherwise. ConsiderABGs-AMSmaybeindicatorofdecreasedcerebralperfusion,hypoventilation or acid-base imbalance. Considerbedsideglucose. DistributiveShock-ansOccursasaresultofmaldistributionofanadequatecirculatingvolume with a loss of vascular tone or increased permeability. Diffusevasodilationlowersthesystemicpressure,creatingarelativehypovolemiaorreduction of the mean systemic volume and venous return to the heart or drop inpreload, resulting in distributive shock. Anaphylactic:releaseofinflammatorymediators,suchashistamine,whichcontractsbronchia l smooth muscle and increases vascular permeability and vasodilation. SepticShock:systemicreleaseofbacterialendotoxins,resultinginanincreasedvascular permeability and vasodilation TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Neurogenic shock: loss of sympathetic nervous system control of vascular tone, whichproducesvenousandarterialvasodilation.Withthelossofsympatheticnervoussystemi nput in spinal cord injury, unopposed vagal activity may result in decreased cardiacoutput through bradycardia. TREATMENT: increase systemic resistance, controlled volume replacement.Vasoconstrictionandinsomecases(neurogenic)Atropinetocounteractbradyc ardia. E(PrimarySurvey)-ansExposureandEnvironmental Control ExposureandEnvironmentalControl - ansCarefullyandcompletelyundressthepatient.Inspect for uncontrolled bleeding and note any obvious injuries. Preventheatloss.Hypothermiacombinedwithhypotensionandacidosisisapotentiallylethal combination in the injured patient. Consider: warm blankets, keep ambienttemperature warm, warm IVF, forced air warmers, radiant warming lights. F(PrimarySurvey)-ansFullSetofVS&FamilyPresence G(PrimarySurvey)-ansGetResuscitationAdjuncts:(LMNOP) L:Labs M:Monitorcardiacrateandrhythm N:Nasoororogastrictubeconsideration O:Oxygenation-SpO2and/oretCO2monitorP: Pain assessment and management GCS-ansGCS EYES 1:Doesnotopeneyes 2: Opens eyes in response to pain3:Openseyesinresponsetovoice 4: Opens eyes spontaneously VERBAL 1. Makesnosounds 2. Makes sounds 3. Words 4. Confused,disoriented TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE 5. Oriented,conversesnormally MOTOR 1. Makesnomovements 2. Extensiontopainfulstimuli(decerebrate) 3. Abnormalflexiontopainfulstimuli(decorticate) 4. Withdrawaltopainfulstimuli 5. Localizespainfulstimuli 6. Obeys commands H(SecondarySurvey)- ansHistoryPrehospital Report (MIST) M:MOI I:Injuries sustained S:SignsandsymptomsinthefieldT: Treatment in field PatientHistory(SAMPLE): S: Symptoms A:AllergiesandtetanusstatusM: Medications P:PastmedicalhistoryL: Last oral intake E:EventsandEnvironmentalfactorsrelatedto injury. H:Headand Face HeadtoToeAssessment(secondarysurvey)-ansSOFTTISSUE: Inspect:lacerations,puncturewounds,abrasions,contusions,edema,ecchymosis,impaled objects. Palpate:areasoftenderness,step-offs, crepitus BONY DEFORMITIES: Inspect:asymmetryoffacialexpressions,exposedtissueorboneforbrainmatter Palpate:depressions,angulations,tenderness TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identifypotentially life-threatening injuries such as pneumothorax or pelvic fracture withuncontrolledinternalhemorrhage.CanalsoconfirmplacementofETtubes,chesttubesan d gastric tubes. Considerneedfortransfer. shock-ansInadequatetissueperfusion. Spleen-ansEncapsulatedorganLUQlevelof9th-11thribsandcurvesaroundaportionof the stomach. Minimal elasticity and flexibility - most frequent injured organ in blunttrauma. Secondary lymph organ that filters and cleanses the blood. Removes old RBCs andholdsareserveofblood.Itrecyclesiron.Itremovesantibody- coatedbacteria.Supplieslymphocytes to stimulate an immune response to blood borne microorganisms. Stores200-300ml of blood and leads to hemodynamic instability quickly if damaged. SplenicInjuries- ansInblunttraumathespleenmaylaceratefromincreasedabdominalpressure. GradedI-V,I=minortrauma Assessmentfindings:signsoftraumaLUQ,abdominaldistention,asymmetry,abnormalcontou r, tenderness, guarding, rigidity, pain left shoulder when supine. CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption,intraparenchymalhematomaorsubcapsularhematoma.Contrastblushorextrava sation -hyperdenseareathatrepresenttraumaticdisruption.Activeextravasationimpliesongoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12- 24hours,minimaltransfusionrequirements(<2units),gradeIorIIwithoutblush,age<55,alert able to assist in assessment of abdomen. Surgicaloptions:totalsplenectomyforsevereinjury,forlesssevere -directpressurepacking, embolization, splenorrhaphy (suturing spleen), partial removal. Asplenicpatientshavedifficultydestroyingencapsulatedbacteria - Streptococcuspneumonia, Neisseria meningitides and Haemophilus influenza. At risk for TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE pneumococcalsepsis.Needannualflushotandq5yrmeningococcalandpneumococcal vaccines. U(AVPU)-ansUnresponsive.Doesnotrespondtoanystimuli. V(AVPU)-ansVerbal.Needsverbalstimulitorespond. (Airwayadjunctmaybeneededtopreventtongueobstruction)A(AVPU)-ansAlert.Willbe able to maintain airway once clear. A(PrimarySurvey)-ansAirwayandalertnesswithsimultaneouscervicalspinalstabilization. AirwayAssessment- ansInspect:tongueobstruction,loose/missingteeth,foreignobjects,blood, vomitus, secretions, edema,burns or evidence ofinhalation injury Auscultate:listenforobstructiveairwaysounds(ie.snoring,gurgling,stridor) Palpate:palpateforpossibleocclusivemaxillofacialbonydeformity,subcutaneousemphysem a AirwayInterventions:- ansSuctionRemove foreign body if noted Jawthrustmaneuver(maintain cspine) Nasopharyngealairway(canbeconscious)Oropharyngealairway(nogag)Consider definitive airway AlertnessAssessment-ansA- AlertV-Verbal P-Painful U-Unresponsive B(PrimarySurvey)-ansBreathingand Ventilation Breathing and Ventilation Assessment - ansInspect: spontaneous breathing,symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use,diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic),contusions/abrasions/deformities(signsofunderlyinginjury),openpneumothora ces(sucking chest wound), JVD, tracheal position, signs of inhalation injury TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Auscultate:presence,absenceandequalityofbreathsoundsat2ndintercostalspacemidclavi cular line and bases at the fifth intercostal space anterior axillary line Palpate:bonystructures,possibleribfractures,SQemphysema,softtissueinjury,JVpulsation s at suprasternal notch or supraclavicular area Life-threateningpulmonaryinjuriesrequiringimmediateintervention:openpneumothorax, tension pneumothorax, flail chest, hemothorax. BreathingandVentilationIntervention-ansBreathingabsent:jaw- thrustmaneuver,oralairway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathingpresent:NRB.Determineifventilationeffective:etCO235-45,SpO294%orhigher. If ineffective: assist with bag-mask and determine need for definitive airway C(PrimarySurvey)-ansCirculationandControlofHemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequateintravascularvolume.There is alack of cardiac output and end-organ perfusionsecondarytoadecreaseinmyocardialcontractilityand/orvalvularinsufficie ncy. Acutecauses-myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryedemaand increased myocardial ischemia. Inotropicsupporttoimprovecontractility. CirculationandControlofHemorrhageAssessment - ansInspect:Uncontrolledexternalbleeding, skin color Auscultate:Muffledheartsounds -mayindicatepericardialtamponade Palpate:carotidand/orfemoralpulsesforrate,rhythm, strength TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Neurogenic shock: loss of sympathetic nervous system control of vascular tone, whichproducesvenousandarterialvasodilation.Withthelossofsympatheticnervoussystemi nput in spinal cord injury, unopposed vagal activity may result in decreased cardiacoutput through bradycardia. TREATMENT: increase systemic resistance, controlled volume replacement.Vasoconstrictionandinsomecases(neurogenic)Atropinetocounteractbradyc ardia. E(PrimarySurvey)-ansExposureandEnvironmental Control ExposureandEnvironmentalControl - ansCarefullyandcompletelyundressthepatient.Inspect for uncontrolled bleeding and note any obvious injuries. Preventheatloss.Hypothermiacombinedwithhypotensionandacidosisisapotentiallylethal combination in the injured patient. Consider: warm blankets, keep ambienttemperature warm, warm IVF, forced air warmers, radiant warming lights. F(PrimarySurvey)-ansFullSetofVS&FamilyPresence G(PrimarySurvey)-ansGetResuscitationAdjuncts:(LMNOP) L:Labs M:Monitorcardiacrateandrhythm N:Nasoororogastrictubeconsideration O:Oxygenation-SpO2and/oretCO2monitorP: Pain assessment and management GCS-ansGCS EYES 1:Doesnotopeneyes 2: Opens eyes in response to pain3:Openseyesinresponsetovoice 4: Opens eyes spontaneously VERBAL 1. Makesnosounds 2. Makes sounds 3. Words 4. Confused,disoriented TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE 5. Oriented,conversesnormally MOTOR 1. Makesnomovements 2. Extensiontopainfulstimuli(decerebrate) 3. Abnormalflexiontopainfulstimuli(decorticate) 4. Withdrawaltopainfulstimuli 5. Localizespainfulstimuli 6. Obeys commands H(SecondarySurvey)- ansHistoryPrehospital Report (MIST) M:MOI I:Injuries sustained S:SignsandsymptomsinthefieldT: Treatment in field PatientHistory(SAMPLE): S: Symptoms A:AllergiesandtetanusstatusM: Medications P:PastmedicalhistoryL: Last oral intake E:EventsandEnvironmentalfactorsrelatedto injury. H:Headand Face HeadtoToeAssessment(secondarysurvey)-ansSOFTTISSUE: Inspect:lacerations,puncturewounds,abrasions,contusions,edema,ecchymosis,impaled objects. Palpate:areasoftenderness,step-offs, crepitus BONY DEFORMITIES: Inspect:asymmetryoffacialexpressions,exposedtissueorboneforbrainmatter Palpate:depressions,angulations,tenderness TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE HepaticInjuries-ansInblunttraumathelivermaylaceratefromincreasedabdominalpressure. Hematoma-bleedingcontainedwithinthecapsule Laceration-thecapsuleisdisrupted Findings:Cullensign(ecchymosisaroundtheumbilicusorRUQ),tenderness,guardingor rigidity RUQ, 9-12 rib FXs, elevated LFT GradedI-VI,I=minortrauma Nonoperativemanagementisstandardofcareinhemodynamicallystablepatient.Observed with serial abdominal exams. FindingsofcontrastextravasationmaybeembolizedbyIR. Forsurgicalpatients-fluidresuscitationisessential.Risksofsurgeryincludedisruptionof the natural tamponade process due to the evacuation of large amounts of bloodresulting in hypovolemia. HypovolemicShock-ansCausedbyadecreaseintheamountofcirculatingbloodvolume. Intraumatypicallyresultsfromhemorrhage,butcanresultinaprecipitouslossofvolume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranesleadingtoplasmaandproteinleakage.ofbodywater,resultsininadequateperfusi on. Hyperventilationcancauseincreasedintrathoracicpressureresultingincompressionofthe heart and decreased cardiac output. InitialAssessment-ans1.PreparationandTriage 2. PrimarySurvey 3. Reevaluation 4. SecondarySurvey 5. ReevaluationAdjuncts 6. ReevaluationandPostResuscitationCare 7. DefinitiveCareorTransport TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE pneumococcalsepsis.Needannualflushotandq5yrmeningococcalandpneumococcal vaccines. U(AVPU)-ansUnresponsive.Doesnotrespondtoanystimuli. V(AVPU)-ansVerbal.Needsverbalstimulitorespond. (Airwayadjunctmaybeneededtopreventtongueobstruction)A(AVPU)-ansAlert.Willbe able to maintain airway once clear. A(PrimarySurvey)-ansAirwayandalertnesswithsimultaneouscervicalspinalstabilization. AirwayAssessment- ansInspect:tongueobstruction,loose/missingteeth,foreignobjects,blood, vomitus, secretions, edema,burns or evidence ofinhalation injury Auscultate:listenforobstructiveairwaysounds(ie.snoring,gurgling,stridor) Palpate:palpateforpossibleocclusivemaxillofacialbonydeformity,subcutaneousemphysem a AirwayInterventions:- ansSuctionRemove foreign body if noted Jawthrustmaneuver(maintain cspine) Nasopharyngealairway(canbeconscious)Oropharyngealairway(nogag)Consider definitive airway AlertnessAssessment-ansA- AlertV-Verbal P-Painful U-Unresponsive B(PrimarySurvey)-ansBreathingand Ventilation Breathing and Ventilation Assessment - ansInspect: spontaneous breathing,symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use,diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic),contusions/abrasions/deformities(signsofunderlyinginjury),openpneumothora ces(sucking chest wound), JVD, tracheal position, signs of inhalation injury TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Auscultate:presence,absenceandequalityofbreathsoundsat2ndintercostalspacemidclavi cular line and bases at the fifth intercostal space anterior axillary line Palpate:bonystructures,possibleribfractures,SQemphysema,softtissueinjury,JVpulsation s at suprasternal notch or supraclavicular area Life-threateningpulmonaryinjuriesrequiringimmediateintervention:openpneumothorax, tension pneumothorax, flail chest, hemothorax. BreathingandVentilationIntervention-ansBreathingabsent:jaw- thrustmaneuver,oralairway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathingpresent:NRB.Determineifventilationeffective:etCO235-45,SpO294%orhigher. If ineffective: assist with bag-mask and determine need for definitive airway C(PrimarySurvey)-ansCirculationandControlofHemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequateintravascularvolume.There is alack of cardiac output and end-organ perfusionsecondarytoadecreaseinmyocardialcontractilityand/orvalvularinsufficie ncy. Acutecauses-myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryedemaand increased myocardial ischemia. Inotropicsupporttoimprovecontractility. CirculationandControlofHemorrhageAssessment - ansInspect:Uncontrolledexternalbleeding, skin color Auscultate:Muffledheartsounds -mayindicatepericardialtamponade Palpate:carotidand/orfemoralpulsesforrate,rhythm, strength TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Circulation and Control of Hemorrhage Interventions - ansControl and treat externalbleeding:applydirectpressure,elevatebleedingextremity,applypressureoverarteri alsites, consider use of a tourniquet. 2largeboreIVs,ifunableconsiderIO,obtainlabsand crossmatch. InitiateIVFofwarmedisotoniccrystalloidsolution.Considerbloodproductsafter2L. **Largevolumesoffluidleadtodilutioncoagulopathywhichworsensmetabolicacidosisandm aycausehypothermia.Componenttherapy,includingadministeringRBC,plasmaand platelets is a balanced approach so that O2 delivery is optimized, acidosiscorrected and coagulopathy prevented. ClassificationsofShock-ansHypovolemic-decreaseintheamountofcirculatingbloodvolume Obstructive-obstructionineitherthevasculatureorheart Cardiogenic-pumpfailureinthepresenceofadequateintravascularvolume Distributive-maldistributionofanadequatecirculatingbloodvolume(septic,anaphylactic, neurogenic) CornealAbrasion-ansDamagetothecornealepithelium.Easytoevaluatewithfluorescein. Findings:photophobia,tearing,pain,injectedconjunctiva(redness),lidswelling,irritation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophthalmicNSAIDStodecreaseswelling,oralanalgesics,Ophthalmicf/uin24hours.(Do NOT patch - increases infection) CornealForeignBody-ansRoutinelymetal,plasticorwood. Findings:photophobia,pain,injectedconjunctiva(redness),lidswelling Treatment:topicalanesthetic,removalofforeignbody,ophthalmicABX,cycloplegics,oral analgesia TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE 5. Oriented,conversesnormally MOTOR 1. Makesnomovements 2. Extensiontopainfulstimuli(decerebrate) 3. Abnormalflexiontopainfulstimuli(decorticate) 4. Withdrawaltopainfulstimuli 5. Localizespainfulstimuli 6. Obeys commands H(SecondarySurvey)- ansHistoryPrehospital Report (MIST) M:MOI I:Injuries sustained S:SignsandsymptomsinthefieldT: Treatment in field PatientHistory(SAMPLE): S: Symptoms A:AllergiesandtetanusstatusM: Medications P:PastmedicalhistoryL: Last oral intake E:EventsandEnvironmentalfactorsrelatedto injury. H:Headand Face HeadtoToeAssessment(secondarysurvey)-ansSOFTTISSUE: Inspect:lacerations,puncturewounds,abrasions,contusions,edema,ecchymosis,impaled objects. Palpate:areasoftenderness,step-offs, crepitus BONY DEFORMITIES: Inspect:asymmetryoffacialexpressions,exposedtissueorboneforbrainmatter Palpate:depressions,angulations,tenderness TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE HepaticInjuries-ansInblunttraumathelivermaylaceratefromincreasedabdominalpressure. Hematoma-bleedingcontainedwithinthecapsule Laceration-thecapsuleisdisrupted Findings:Cullensign(ecchymosisaroundtheumbilicusorRUQ),tenderness,guardingor rigidity RUQ, 9-12 rib FXs, elevated LFT GradedI-VI,I=minortrauma Nonoperativemanagementisstandardofcareinhemodynamicallystablepatient.Observed with serial abdominal exams. FindingsofcontrastextravasationmaybeembolizedbyIR. Forsurgicalpatients-fluidresuscitationisessential.Risksofsurgeryincludedisruptionof the natural tamponade process due to the evacuation of large amounts of bloodresulting in hypovolemia. HypovolemicShock-ansCausedbyadecreaseintheamountofcirculatingbloodvolume. Intraumatypicallyresultsfromhemorrhage,butcanresultinaprecipitouslossofvolume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranesleadingtoplasmaandproteinleakage.ofbodywater,resultsininadequateperfusi on. Hyperventilationcancauseincreasedintrathoracicpressureresultingincompressionofthe heart and decreased cardiac output. InitialAssessment-ans1.PreparationandTriage 2. PrimarySurvey 3. Reevaluation 4. SecondarySurvey 5. ReevaluationAdjuncts 6. ReevaluationandPostResuscitationCare 7. DefinitiveCareorTransport TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE IntraocularForeignBody- ans*TRUEEMERGENCYANDEARLYINTERVENTIONISESSENTIAL. Findings:compromisedvisualacuity,misshapenpupils,pain Treatment:elevateHOB,ophthalmology,immobilizeforeignbody,patchUNAFFECTEDeye to limit concomitant eye movement, globe closure ASAP, systemic and ophthalmicABX, analgesics. Postopinfection,retinaldetachmentandvisionlossarecommoncomplications. lidinjury-ans Liver-ansLargestsolidorganofthebody.RUQ,6thto10thribs.EncasedbyGlissoncapsule with blood vessels, lymphatics and nerves. Filters 1.7L of blood per minute. Theliverfiltersouttoxins,takesthenutrientsandreturnsthebloodtotheheartviathehepatic veins. Hepatocytecellsarecapableofregenerationallowingthelivertorepairitsowntissue. Functions: Store and metabolize lipids, transport nutrients, produce glucose andbilirubin,convertammoniatourea,secreteelectrolytes,lipids,lecithin,cholesterolandbile. Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary forclotting). ObstructiveShock-ansResultsfromhypoperfusionofthetissueduetoanobstructionin either the vasculature or heart. Tensionpneumothorax-increasedthoracicpressureleadstodisplacementofthevenacava, obstruction to atrial filling, decreased preload and decreased cardiac output. Cardiactamponade-impedesdiastolicexpansionandfillingleadstodecreasedpreload, strokes volume and cardiac output and ultimately end organ perfusion. P(AVPU)-ansPainful.Respondsonlytopainfulstimuli. (Airwayadjunctmaybeneededwhiledeterminingneedfor intubation) TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Auscultate:presence,absenceandequalityofbreathsoundsat2ndintercostalspacemidclavi cular line and bases at the fifth intercostal space anterior axillary line Palpate:bonystructures,possibleribfractures,SQemphysema,softtissueinjury,JVpulsation s at suprasternal notch or supraclavicular area Life-threateningpulmonaryinjuriesrequiringimmediateintervention:openpneumothorax, tension pneumothorax, flail chest, hemothorax. BreathingandVentilationIntervention-ansBreathingabsent:jaw- thrustmaneuver,oralairway adjunct, assist ventilation with bag-mask device, prepare for definitive airway Breathingpresent:NRB.Determineifventilationeffective:etCO235-45,SpO294%orhigher. If ineffective: assist with bag-mask and determine need for definitive airway C(PrimarySurvey)-ansCirculationandControlofHemorrhage Cardiogenic Shock - ansResults from pump failure in the presence of adequateintravascularvolume.There is alack of cardiac output and end-organ perfusionsecondarytoadecreaseinmyocardialcontractilityand/orvalvularinsufficie ncy. Acutecauses-myocardialinfarction,dysrhythmiasortoxicologicpathologies.Heartfailure is a chronic cause. BluntcardiacinjurymaypresentsimilartoMI. Excessofvolumeadministrationorincreasedafterloadcanresultinpulmonaryedemaand increased myocardial ischemia. Inotropicsupporttoimprovecontractility. CirculationandControlofHemorrhageAssessment - ansInspect:Uncontrolledexternalbleeding, skin color Auscultate:Muffledheartsounds -mayindicatepericardialtamponade Palpate:carotidand/orfemoralpulsesforrate,rhythm, strength TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE Circulation and Control of Hemorrhage Interventions - ansControl and treat externalbleeding:applydirectpressure,elevatebleedingextremity,applypressureoverarteri alsites, consider use of a tourniquet. 2largeboreIVs,ifunableconsiderIO,obtainlabsand crossmatch. InitiateIVFofwarmedisotoniccrystalloidsolution.Considerbloodproductsafter2L. **Largevolumesoffluidleadtodilutioncoagulopathywhichworsensmetabolicacidosisandm aycausehypothermia.Componenttherapy,includingadministeringRBC,plasmaand platelets is a balanced approach so that O2 delivery is optimized, acidosiscorrected and coagulopathy prevented. ClassificationsofShock-ansHypovolemic-decreaseintheamountofcirculatingbloodvolume Obstructive-obstructionineitherthevasculatureorheart Cardiogenic-pumpfailureinthepresenceofadequateintravascularvolume Distributive-maldistributionofanadequate circulatingbloodvolume(septic,anaphylactic, neurogenic) CornealAbrasion-ansDamagetothecornealepithelium.Easytoevaluatewithfluorescein. Findings:photophobia,tearing,pain,injectedconjunctiva(redness),lidswelling,irritation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophthalmicNSAIDStodecreaseswelling,oralanalgesics,Ophthalmicf/uin24hours.(Do NOT patch - increases infection) CornealForeignBody-ansRoutinelymetal,plasticorwood. Findings:photophobia,pain,injectedconjunctiva(redness),lidswelling Treatment:topicalanesthetic,removalofforeignbody,ophthalmicABX,cycloplegics,oral analgesia TNCC ACTUAL FINAL EXAM TEST BANK 350QUESTIONS AND CORRET DETAILED ANSWERS WITHRATIONALES(VERIFIEDANSWERS)ALREADYGRA DEDA+100% COMPLETE CornealLaceration -ansInvolvesoneormorelayersofthecornea.Visualizedwithaslitlamp. Findings:similartoabrasion,painoutofproportiontofindings,decreasedvision Treatment:treatsmalllacerationssimilartoanabrasion,largerlacerationsneedophthalmolog y referral and possible surgery Cycloplegicagent-ansCycloplegiaisparalysisoftheciliarymuscleoftheeye,resultingin a loss of accommodation. Because of the paralysis of the ciliary muscle, thecurvature of the lens can no longer be adjusted to focus on nearby objects. D(PrimarySurvey)-ansDisability(NeurologicStatus) DisabilityAssessment-ansAssessGCSonarrivalandrepeatperpolicy. Assesspupilsforequality,shapeandreactivity (PERRL) Disabilityinterventions-ansEvaluateforneedforCT.AssumeAMStobetheresultofCNS injury until proven otherwise. ConsiderABGs-AMSmaybeindicatorofdecreasedcerebralperfusion,hypoventilation or acid-base imbalance. Considerbedsideglucose. DistributiveShock-ansOccursasaresultofmaldistributionofanadequatecirculatingvolume with a loss of vascular tone or increased permeability. Diffusevasodilationlowersthesystemicpressure,creatingarelativehypovolemiaorreduction of the mean systemic volume and venous return to the heart or drop inpreload, resulting in distributive shock. Anaphylactic:releaseofinflammatorymediators,suchashistamine,whichcontractsbronchia l smooth muscle and increases vascular permeability and vasodilation. SepticShock:systemicreleaseofbacterialendotoxins,resultinginanincreasedvascular permeability and vasodilation