TNCC Trauma Nursing Core Course 18th Edition ENA Test Bank Graded A+ pass (1) (1) (2).pdf, Exams of Nursing

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Edition ENA Test Bank |Graded A+ pass

1. Which of the following requires you to develop a plan of action, initiate the plan, reassess the plan as care for the patient moves forward, and adjust the plan as the patient's condition or circumstances change? A. Principles of PHTLS B. The Golden Period C. The XABCDE assessment D. Critical thinking process - ansQuestion 1: D To help achieve the PHTLS goals, you will apply your critical thinking skills in the field. Critical thinking in medicine is a process in which the healthcare practitioner assesses the situation, the patient, and the resources available and uses the information to decide on and provide the best care for the patient.
2. You and your partner are responding to a call for a 2-year-old patient with a burn injury to the hand. He has a visible burn to the left hand, ending at the level above the wrist, red color, and wet in appearance. What type of burn do you suspect the patient has sustained? A. Superficial (first degree) B. Partial thickness (second degree) C. Full thickness (third degree) D. Subdermal (fourth degree) - ansQuestion 1: B Scald burns are the most common burns seen in the pediatric population ages 1 to 5 years. Scalds are partial thickness burns. The dermal layer is damaged, and blisters are present or popped. It is also the most painful type of burn.
3. You are called to the scene of a possible mass casualty motor vehicle collision on the highway. Once you arrive on scene, what is your first priority? A. Immediately begin triaging patients. B. Treat the patient with the most visible blood loss. C. Determine the need for additional resources. D. Assess the scene and ensure it is safe. - ansQuestion 1: D Ensure safety for responders, bystanders, and patient(s). The first consideration when approaching any scene is the safety of all emergency responders. When EMS personnel become victims, they not only can no longer assist others, but also add to the number of patients.
4. You are called to the scene of an explosion and fire at a chemical plant where you find multiple casualties.Triage has begun. Your first patient is a 40 - year-old man who was near the source of the explosion. He is unconscious and has extensive injuries. You note gurgling respirations. Why should you use the trauma jaw thrust maneuver first when dealing with a trauma patient? A. It's an easy technique that always works to open the airway.

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B. It allows you to open the airway with little or no movement of the head and cervical spine. C. Other techniques and interventions don't work as well. D. It can relieve a variety of anatomic airway obstructions in patients who are breathing spontaneously. - ansQuestion 1: B Manual maneuvers like the trauma jaw thrust or chin lift are always the first airway maneuver you should make when treating a trauma patient. In patients with suspected head, neck, orfacial trauma, the cervical spine is maintained in a neutral in-line position.The trauma jaw thrust maneuver allows you to open the airway with little or no movement of the head and cervical spine.

1. You are responding to a call for 25-year-old, fit and healthy female who fell off a mountain bike. Upon arrival, you find the patient walking around. She is alert but complaining of pain in her clavicle and on her right side when she inhales. You notice that her helmet is split in two. What is the first thing you need to do? A. Complete a review of the ABCs. B. Check motor and sensory function. C. Perform manual in-line stabilization. D. Place her on a backboard. - ansQuestion 1: C Because there's a possibility of spinal injury, you should bring the patient's head into a neutral in-line position.
2. You have been performing ongoing management on a 35-year-old female patient who sustained thoracic trauma when a car hit her as she crossed the street. Originally, your electronic monitoring devices all produce results consistent with your patient's clinical condition. However, en route the trauma center, the monitors start to differ from your patient's current clinical condition each time you reassess. How should you handle this situation? A. Treat the patient's condition, not the monitor results. B. Continue to reassess the patient and record the results for the trauma center. C. Treat your patient based on the test results. D. Stop testing and wait until you arrive at the trauma center for them to perform an assessment. - ansQuestion 1: A If there are inconsistent data from electronic monitoring devices, reassess to be sure the monitor matches the patient's current clinical condition. However, it is most important to treat the patient, not the monitor, so use other signs and symptoms of potential patient deterioration.
3. You're called out to an assisted living facility for a 72 - year-old woman complaining of a severe headache and experiencing increased confusion. Staff reports she fell out of her wheelchair earlier in the week but didn't appear to be hurt; however, she's become increasingly disoriented over the last day or so. Vital signs show: BP 110/90; heartrate 118 and irregularly regular; ventilation rate 20 and slightly labored; SpO2 93% on room

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air. She is taking warfarin for a clotting issue. Which of the following should you suspect? A. Cerebral contusion B. Epidural hematoma C. Subarachnoid hemorrhage D. Subdural hematoma - ansQuestion 1: D The patient's age, use of a blood thinner, and the fact she fell recently point to a subdural hematoma.

1. Your partner is compressing the bleeding site of a male patient who was stabbed multiple times in the left chest. The bleeding seems to be controlled, yet the patient becomes combative. He is pale and is breathing rapidly, yet states that he "can't breathe" and feels that he is about to die. Your next step in patient management is to: A. start assisted ventilation. B. give high-flow oxygen. C. decompress the left chest. D. give a 250 - mL fluid bolus. - ansQuestion 1: C After X come A and B. You can quickly auscultate the lungs (pneumothorax is almost certain with multiple stabs in the chest) and decompress the chest. Decompressing a tension pneumothorax is the quickest way to treat shock.
2. Your patient is experiencing severe pain after sustaining a femur fracture in a motorcycle crash. You have a 20 minute transport to the nearest trauma center. There are no other injuries noted on your primary and secondary assessments. Which of the following medications would be the best pain management choice? A. NSAIDs B. Acetaminophen C. Fentanyl D. Morphine - ansQuestion 1: C Fentanyl is often a first-line agent due to speed of onset, short duration of action, and minimal effect on hemodynamics. Fentanyl can beadministered IN, IM, IO, or IV. The IV route provides effects instantly whereasthe IN and IM route have an onset of < minutes. The duration of fentanyl is short at 30 minutes to an hour. This will provide enough time to ease pain during transport and let the traumacenter decide pain management upon arrival.
3. A trauma patient from the highway incident is holding her right arm, and you note a significant amount of blood steadily flowing from a long gash. This is an example of what type of hemorrhage? A. Capillary bleeding B. Venous bleeding C. Arterial bleeding D. Road rash - ansQuestion 2: B Venous bleeding typically results in a steady flow of dark red blood.

Edition ENA Test Bank |Graded A+ pass

2. During primary survey, you find the following: . LOC: alert and oriented; speaking in full sentences . GCS: 15 . Airway: good air entry to bases . Breathing: bilateral . Circulation: skin warm, flushed, dry . Pulse rate: 112 bpm, strong andregular . BP: 90/42 mm Hg . Pain: Patient complains of severe pain at clavicle site and pain on inspiration at site of possible fractured ribs. No other injuries detected. What is your next step? A. Apply a cervical collar and in-line immobilization device. B. Treat for hypovolemic shock. C. Apply an arm sling for the clavicle injury. D. Administer pain medication. - ansQuestion 2: A Although the patient's GCS is normal, she does have a distracting injury, and the state of her helmet indicates possible spinal compression/flexion, so you should immobilize the patient.
3. The patient becomes apneic. You suspect he has a cervical injury. Which type of airway should you use? A. Supraglottic airway B. Blind nasotracheal intubation C. Oropharyngeal airway D. Surgical airway - ansQuestion 2: A The supraglottic airway's greatest advantage is that it can be inserted independent of the patient's position, which may be especially important in trauma patients with high suspicion of cervical injury.
4. The patient's care giver is a babysitter who reports the child was crawling on the counter and placed his hand in a pot of water that was boiling on the stove. She is applying ice to the burn and the child is shivering. What is your next step? A. Administer analgesia for pain. B. Cover the patient with a blanket to stop the shivering. C. Start IV for fluid resuscitation. D. Stop the burning process and remove the ice pack. - ansQuestion 2: D A common error that results in damage to the zone of stasis is the application of ice by a bystander or prehospital care practitioner. When ice is applied to a burn, the patient will experience some reduction in pain; however, the pain relief will be at the expense of additional tissue destruction.
5. The patient's respiration improves markedly, but he remains confused. He has an absent radial pulse, and his carotid pulse is fast and thready. Your partner asks if he can let the compression go to put in an IV. How should you respond?

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A. "Oh yes, that's a great idea!" B. "Yes, but we have to immobilize him first" C. "Take a blood pressure first to see if he needs an IV." D. "No, keep the pressure and let's get out of here!" - ansQuestion 2: D This patient is likely in decompensated shock with internal bleeding, so rapid transport is the next priority. You should maintain pressure on the wound, because having massive external bleeding start up again is the last thing you want in this situation.

2. Upon examination, you find the patient responsive to your presence, although she is clearly confused. Motor response shows reduced pain response but normal flexion. What's her GCS score? A. 15 B. 12 C. 10 D. 8 - ansQuestion 2: B Eye opening: 4; verbal response: 4; motor response: 4 = 12
3. When using the XABCDE assessment, which of the following takes precedence over all other actions? A. Controlling severe bleeding from a limb or other compressible site B. Airway stabilization and assessing circulatory status C. Exposing the body to allow a thorough evaluation D. Ensuring adequate breathing - ansQuestion 2: A The "X" placed before "ABCDE" in the primary survey refers to the need to address exsanguinating hemorrhage immediately after establishing scene safety and before addressing airway. Severe exsanguinating hemorrhage, particularly arterial bleeding, has the potential to lead to loss of total or near total blood volume in a relatively short period of time.
4. You are responding to a call to an MVC involving one patient. When you perform your primary survey, you find a patent airway, but abnormalities with breathing and circulation. You suspect hypovolemic shock, but cannot determine the source. What does this finding most likely indicate? A. Hemothorax B. Intra-abdominal bleed C. Blunt cardiac injury D. Diaphragmatic rupture - ansQuestion 2: B The most reliable indicator of an intraabdominal bleed is the presence of hypovolemic shock from an unexplained source.
5. You have determined that you are going to need to perform orotracheal intubation on a 50-year-old male motor vehicle crash (MVC) critically injured trauma patient due to prolonged transport time. What do you need to do first?

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A. Preoxygenate to maximize oxygen saturation. B. Place the patient in a "sniffing"position. C. Clear the mouth of any obstructions. D. Prepare the patient for immediate transport. - ansQuestion 2: A Before insertion of any invasive airway, the patient is preoxygenated with a high concentration of oxygen using a simple airway adjunct or manual airway procedure.

3. After exposing the patient, no other burn injuries were found, but blisters have started to form on the hand and the child is crying from pain. How should you manage the blisters? A. Lance the blisters to drain the fluidand relieve the pressure. B. Cover the injury with a dry, loose, sterile dressing, being sure to leave the blisters intact. C. Use a topical antibiotic ointment and firmly wrap the burn injury. D. Establish an IV for fluid resuscitation. - ansQuestion 3: B In the prehospital setting, blisters are generally best left alone during the relatively short transport time. Blisters that have already ruptured should be covered with a clean, dry dressing.
4. What does the GCS score indicate? A. Mild TBI B. Moderate TBI C. Severe TBI D. No TBI - ansQuestion 3: B A total GCS score of 13 to 15 likely indicates a mild TBI whereas a score of 9 to 12 is indicative of moderate TBI. A GCS score of 3 to 8 suggests severe TBI.
5. What is the best way to control the bleeding? A. Direct pressure B. Elevation of the arm above the heart C. Tourniquet D. Occlusive dressing - ansQuestion 3: A With venous bleeds, direct pressure isusually sufficient to stop the flow.
6. When securing a patient to a backboard, which body part should you secure first? A. Head B. Torso C. Legs D. Pelvis - ansQuestion 3: B When immobilizing a patient, you should secure the torso first, then the head, the legs, and the pelvis.
7. Which of the following is the basis on which a patient's chance of survival is maximized?

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A. Preferences B. Phases C. Principles D. Transport - ansQuestion 3: C The science of medicine provides the principles of medical care. Simply stated, principles define the duties required of the prehospital care practitioner in optimizing patient survival and outcome.

3. While en route to the hospital, you manage to put an 18-gauge IV in the right arm. Your patient is still confused, and you still have no radial pulse. Your next move is to: A. give 1 - L fluid bolus. B. give one 250 - mL fluid bolus, and then stop. C. give fluid until you get a radial pulse. D. administer TXA. - ansQuestion 3: C Now is the time to titrate IV fluids to restore tissue perfusion. Giving 1 liter blindly could overshoot your target pressure and reinforce internal bleeding. TXA is not a priority, although it can run parallel to fluids.
4. Why might it be more difficult to deal with an airway obstruction in a child? A. Children have longer tracheas. B. Children have larger heads and tongues so there is a greater potential for airway obstruction. C. Children have smaller heads, so there is less room to clear the obstruction. D. A child's epiglottis is smaller and stiffer than an adult's. - ansQuestion 3: B Children have larger heads and tongues as compared to an adult so there is a greater potential for airway obstruction in a pediatric patient. You must pay special attention to the proper positioning of a pediatric patient to maintain a patent airway.
5. You are oxygenating a pediatric patient using a properly fitted oxygen mask and the "squeeze-release-release" timing technique. As you watch for the rise and fall of the chest, you check end-tidal CO2 (ETCO2) monitoring aiming to maintain what level? A. Between 40 and 45 mm Hg B. Between 30 and 35 mm Hg C. Between 35 and 40 mm Hg D. The level is irrelevant because capnography is inaccurate in pediatric patients. - ansQuestion 3: C The proper level to maintain is between 35 and 40 mm Hg.
6. You are transporting a 37 - year-old male patient with a suspected intraabdominal bleed. His blood pressure is 70/50 mm Hg (MAP 57), and his skin is pale and diaphoretic. How will you manage fluid resuscitation for this patient? A. Aggressively administer IV fluids to compensate for internal blood loss. B. Do not administer IV fluids to patients with intra-abdominal bleeding.

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C. Obtain the patient's medical records and resuscitate to his normal blood pressure reading. D. Carefully administer IV fluids to raise the patient's systolic blood pressure to between 80 and 90 mm Hg. - ansQuestion 3: D Abdominal trauma represents one of the key situations in which a balanced resuscitation is indicated. Aggressive administration of IV fluid may elevate the patient's blood pressure to levels that will disrupt any clot that has formed and result in recurrence of bleeding that had ceased because of blood clotting and hypotension. Prehospital care practitioners must achieve a delicate balance: maintain a blood pressure that provides perfusion to vital organs without restoring blood pressure to elevated or even normal ranges, which may reinitiate bleeding sites in the abdomen or pelvis. In the absence of TBI, the target systolic blood pressure is 80 to 90 mm Hg (mean arterial pressure of 60 to 65 mmHg).

4. After 400 mL of lactated Ringer solution, you get a radial pulse and his level of consciousness improves. The monitor shows heart rate 110 beats/minute, blood pressure 85/60mm Hg, SpO2 95%, ventilation rate 25 breaths/minute. What should you do? A. Give an additional 500 mL of lactated Ringer solution. B. Stop fluids and give 2 g of TXA. C. Give TXA and 500 mL of normal saline. D. Give 2 mg of morphine for analgesia. - ansQuestion 4: B The patient does not need more fluids right now. Giving morphine in a shocked patient is a risky move and could lead to dangerous hypotension.
5. The patient is wearing long sleeves, and you are having trouble visualizing the wound. What should you do? A. Cut the cloth away from the site until the entire wound site is visible. B. Leave the clothing in place. Put gauze over the wound. C. Remove the patient's shirt. D. Cut through the slash on the sleeve, and use the material as a makeshift tourniquet. - ansQuestion 4: A Clothing can be quickly removed by cutting. You cannot treat what you cannot see.
6. What is one reason to use capnography as part of your patient reassessment? A. To get accurate readings for blood pressure B. To assure proper ET tube placement C. To measure arterial blood saturation D. To ensure proper placement for needle decompression - ansQuestion 4: B Capnography can monitor proper endotracheal tube placement. It doesn't read blood pressure, so it cannot beused to determine if a patient is hypotensive. Pulse oximetry, not capnography, measures arterial blood saturation. Capnography is not useful in needle decompression.

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4. What type of padding should you provide for this patient? A. Use compressible padding under the shoulders and torso to prevent hyperflexion. B. Use firm padding between the back of the head and the backboard to prevent hyperextension. C. Do not use any padding. It can cause extension or flexion in the neck. D. No padding needed, but to avoid decreased venous return you should tip the backboard to a left lateral position. - ansQuestion 4: B Because the patient is an adult, you should use firm padding between the back of the head and the backboard to prevent hyperextension. You would pad a child's shoulder and torso to prevent hyperflexion, and you would tip the backboard for a pregnant patient to prevent decreased venous return.
5. When you examine the patient's pupils, you notice the right one is dilated significantly and her motor response on the left is delayed. What does this suggest? A. Coup-countercoup injury B. Hyphema C. Hypoxia D. Uncal herniation - ansQuestion 4: D When the medial portion of the temporal lobe (uncus) is pushed toward the tentorium and puts pressure on the brain stem, herniation compresses CN III, the motor tract, and the reticular activating system on the same side, resulting in a dilated or blown pupil on the same side, motor weakness on the opposite side, and respiratory dysfunction, progressing to coma.
6. Which of the following is a goal of the Golden Period? A. Provide written documentation from field care to receiving hospital. B. Expedite the field care and transport of the patient. C. Use a team approach for optimal patient care. D. Use the XABCDE approach to patient assessment. - ansQuestion 4: B One of your most importantresponsibilities as a prehospital carepractitioner is to spend as little time onthe scene as possible and expedite yourfield care and transport of the patient.Studies show that the time from injuryto arrival at the appropriate site fordefinitive care is critical to survival.
7. Why might you consider early mechanical ventilation via bag-mask device in a geriatric patient? A. Shorter tracheas in geriatric patients create the need for ventilation assistance. B. Laxity of the rib cage makes hyperventilation more likely. C. Geriatric patients have greatly limited physiologic reserve. D. Geriatric patients have a greater alveolar surface area of the lungs. - ansQuestion 4: C

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Early mechanical ventilation via bag mask device or advanced airway measures should be considered in geriatric trauma patients because of their greatly limited physiologic reserve.

5. Which of the following signs would be most concerning at this point? A. A drop in systolic blood pressure to 88 mm Hg B. SpO₂ of 93% C. A field GCS motor score of 4 D. Hemiplegia on the left side - ansQuestion 5: A A systolic blood pressure of less than 90 mm Hg indicates secondary brain injury. Her SpO2 is > 90%, and a motor score of 4 is not as concerning.
6. While attempting to lay the patient supine for spinal motion restriction she becomes increasingly distressed and complains of shortness of breath and difficulty breathing. The fractured clavicle appears to move distally and increases the difficulty of breathing as the patient lies back. What should you do? A. Tip the backboard to a left lateral position. B. Raise the back of the stretcher. C. Let her sit up in a position of comfort. D. Administer morphine. - ansQuestion 5: B Because laying the patient supine increases the risk of airway/ventilation problems, raising the back of the stretchers slightly fundamentally maintains spinal alignment while reducing the ventilation issues.
7. You now perform a secondary survey. You notice a sternotomy scar. Your patient tells you he is on oral clopidogrel since he had a coronary artery bypass graft 2 years ago. Is this information useful? A. No, he should stop talking and breathe. B. Yes, he should see a cardiologist once in the local hospital. C. Yes, he will need platelets and a heart surgeon ASAP. D. Yes, you should raise his blood pressure up to 130 mm Hg systolic. - ansQuestion 5: C Because he is on clopidogrel, his platelets are out of order for at least 5 days, so he will require urgent platelet transfusion.
8. According to the Monro-Kellie doctrine, what happens to the brain when it is still in a compensated state after a TBI? A. CSF, ICP, heart rate, and blood pressure are still within normal range. B. CSF increases, ICP decreases, heart rate increases, and blood pressure decreases. C. CSF and blood volume decrease, while heart rate and blood pressure are still within normál range. D. CSF decreases, ICP increases, heart rate decreases, and blood pressure increases.

• ansQuestion 6: C

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In a compensated state, CSF and blood volume decrease, while heart rate and blood pressure are still within normal range. therapy is now suggested for fluid resuscitation to replace patient losses, including administering PRBCs, plasma, and platelets. - ansCOMPONENT THERAPY ch. 5, p. 45 , which can occur in resuscitation, is a common IATROGENIC cause of INCREASED intrathoracic pressure resulting in COMPRESSION of the heart and DECREASED cardiac output. - ansHYPERVENTILATION ch. 7, p. 74 55% of spinal injuries occur to which part of spine? - anscervical ch. 13, p. 179 A rapid, thready pulse may indicate (a. ), and an irregular pulse may warn of potential (b. ). - ansa. HYPOVOLEMIA b. CARDIAC DYSFUNCTION ch. 5, p. 45 ABGs provide values of oxygen, CO2 and base excess, which are... - ansReflective endpoint measurements of the effectiveness of cellular perfusion, adequacy of ventilation, and the success of the resuscitation. An abnormal base deficit may indicate poor perfusion and tissue hypoxia, which results in the generation of hydrogen ions and metabolic acidosis. ch. 5, p. 46 Activation of the SYMPATHETIC NERVOUS SYSTEM causes the ADRENAL glands to release TWO catecholamines - EPINEPHRINE and NOREPINEPHRINE. These cause... - ans- HIGH levels of EPINEPHRINE cause smooth muscle relaxation in the airways and causes arteriole smooth muscle contractility (potentiating inotrophic effect). EPI also INCREASES heart rate (positive chronotrophic effect), peripheral vasocontriction, and glycogenolysis (breakdown of glycogen stores in liver into glucose for cellular use)

• NOREPINEPHRINE increases heart rate, vascular tone through alpha-adrenergic receptor activation, and blood flow to skeletal muscle and triggers the release of glucose from energy stores.

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ch. 7, p. 77 Additional history includes the following (MIST mnemonic) prehospital report: - ans- MOI

• Injuries sustained
• Signs and Symptoms (in the field)
• Treatment (in the field) ch. 5, p. 47 All open fractures are considered contaminated due to exposure to the environment and are at risk for infection. These sites of injury have poor wound healing with a risk of.... - ansOSTEOMYELITIS and SEPSIS ch. 14, p. 197 Anterior cord syndrome - ansloss of pain and temperature sensation with weakness, paresthesia, and urinary retention ch. 13, p. 182 AORTIC DISRUPTION - ansAssessment findings
• Fractures of sternum, first or second rib or scapula
• CARDIAC MURMURS
• BACK, CHEST PAIN
• UNEQUAL EXTREMITY PULSE STRENGTH or BLOOD PRESSURE (Significantly greater in upper extremities)
• HYPOTENSION
• TACHYCARDIA
• SKIN CHANGES: diaphoresis, pallor, cyanosis
• PHARAPLEGIA (due to disruption of spinal perfusion from aortic injury)
• Radiograph findings include- left hemothorax, right-sided tracheal deviation, widened mediastinum Interventions
• Prepare for surgery or angiography
• Consider massive transfusion protocol ch. 11, p. 146 Are the lumen contents of the small bowel considered sterile? What is the pH? - ansneutral pH, and sterile ch. 12, p. 164

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As ICP rises, CPP , resulting in cerebral ischemia, hypoxemia, and lethal secondary insult. - ansDECREASES Ch. 9, p. 109 As shock progresses, primary goal of the body is to maintain perfusion to vital organs. Sympathetic stimulation has little effect on the cerebral and coronary vessels since they are capable of autoregulation. Cerebral autoregulation maintains a constant... - anscerebral vascular blood flow as long as the MAP is maintained between 50-150... when autoregulation in the brain fails, perfusion becomes dependent solely on pressure. ch. 7, p. 78 Assess pupils for... - ansEquality, shape, and reactivity (PERRL) ch. 5, p. 45 Assessment findings for MILD, MODERATE, and SEVERE TRAUMATIC BRAIN INJURY INCLUDE: - ansMILD

• GCS 13 - 15
• Brief (<30 min) LOC
• POST-TRAUMATIC AMNESIA < 24 hours
• No change on neuron aging studies MODERATE
• GCS score 9 - 12
• Wide variety of symptoms, including ALTERATIONS IN CONSCIOUSNESS, CONFUSION, AMNESIA, and FOCAL NEUROLOGICAL DEFICITS
• May deteriorate to severe head injury over time SEVERE
• GCS score <
• Significant alterations in consciousness
• ABNORMAL PUPILLARY RESPONSE
• ABNORMAL POSTURING Ch. 9, p. 115 Assessment findings for renal injuries include - ans- Turner sign (bruising by 11th and 12th ribs)
• Hematuria
• Frank tenderness, costovertebral angle tenderness, palpable flank mass
• Structural damage or leakage of contrast on intravenous pyelogram (IVP)

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• If patient hemodyanmically unstable for CT, a single-infusion IVP can be performed at bedside followed by complete study once patient is stable
• Positive urine dipstick for microscopic blood or leukocyte esterase
• Abnormal or elevated BUN and creatinine 90% of injuries are minor. Anticipate nephrology consultation in more severe injures; surgical repair is required within 12 hours to salvage an ischemic kidney ch. 12, p. 167 Assessment findings of a CHRONIC SUBDURAL HEMATOMA - ans- ALTERED or STEADY DECLINE IN LOC
• HEADACHE
• LOSS OF MEMORY or ALTERED REASONING
• MOTOR DEFICIT: CONTRALATERAL HEMIPARESIS, HEMIPLEGIA, OR ABNORMAL MOTOR POSTURING OR ATAXIA
• APHASIA
• IPSILATERAL UNILATERAL FIXED and DILATED PUPIL
• INCONTINENCE
• SEIZURES Ch. 9, p. 114 Assessment findings of a DIFFUSE INJURY - ansInjuries that occur over a wide spread area, not always identifiable on CT because damage involves contusions or hearing and stretching of micro vascular, not a localized hematoma. These injuries commonly follow a direct blow to the head and are often sports-related. Patients can have varying degrees of symptoms that last minutes to hours. Assessment findings include:
• TRANSIENT LOC
• HEADACHE, DIZZINESS
• NAUSEA, VOMITING
• CONFUSION, DISORIENTATION
• MEMORY LOSS and CONCENTRATION DIFFICULTY
• IRRITABILITY and FATIGUE Ch. 9, p. 115 Assessment findings of a EPIDURAL HEMATOMA - ans- TRANSIENT LOC followed by lucid period lasting minutes to hours
• HEADACHE, DIZZINESS
• NAUSEA, VOMITING
• CONTRALATERAL HEMIPARESIS
• HEMIPLEGIA

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- ABNORMAL MOTOR POSTURING (FLEXION/EXTENSION)

Extension is associated with brainstem HERNIATION and poor outcomes

• IPSILATERAL UNILATERAL FIXED, DILATED PUPIL
• RAPID DETERIORATION IN NEURO STATUS Ch. 9, p. 114 Assessment findings of a HERNIATION SYNDROME - ans- ASYMMETRIC PUPILLARY REACTIVITY
• UNILATERAL or BILATERAL PUPILLARY DILATION
• ABNORMAL MOTOR POSTURING
• other evidence of neurologic deterioration (loss of normal, reflexes, paralysis, or change in LOC) Ch. 9, p. 115 Assessment findings of a INTRACEREBRAL HEMATOMA - ans- PROGRESSIVE, RAPID DECLINE IN LOC
• HEADACHE
• SIGNS OF INCREASING ICP
• PUPIL ABNORMALITIES
• CONTRALATERAL HEMIPARESIS
• HEMIPLEGIA
• ABNORMAL POSTURING Ch. 9, p. 114 Assessment findings of an ACUTE SUBDURAL HEMATOMA - ans- SEVERE HEADACHE
• CHANGES IN LOC
• IPSILATERAL DILATED or NONREACTIVE PUPIL
• CONTRALATERAL HEMIPARESIS Ch. 9, p. 114 Assessment findings of DIFFUSE AXONAL INJURY - ans- UNCONSCIOUSNESS Mild DAI lasts 6 - 24 hrs Severe DAI lasts weeks to months
• INCREASED ICP
• ABNORMAL POSTURING
• HTN (systolic BP between 140 - 160)
• HYPERTHERMIA (104- 105 F)
• EXCESSIVE SWEATING

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• MILD TO SEVERE MEMORY LOSS; COGNITIVE, BEHAVIORAL, and INTELLECTUAL DEFICITS Ch. 9, p. 116 AXIAL LOADING - ansetiology/cause- direct force transmitted along the length of vertebral column rest of injury- deformity of vertebral column, secondary edema of spinal cord resulting in neurologic effects example- diver striking head on bottom of pool ch. 13, p. 179 Because calcium is a vital part of the clotting casade, hypocalcemia, as a result of a massive transfusion, can actually worsen hypovolemic shock by... - ansPermitting continued bleeding Signs of hypocalemia include- dysrhythmias, muscle tremors, and seizures ch. 7, p. 81 BLUNT ESOPHAGEAL INJURY - ansInjury to esophagus, rare, results form blunt trauma Assessment findings include
• AIR in MEDIASTINUM with possible widening
• CONCURRENT LEFT PNEUMOTHORAX or HEMOTHORAX
• ESOPHAGEAL MATTER IN CHEST TUBE
• SUBCUTANEOUS EMPHYSEMA Interventions
• Prepare for surgery Ch. 11, p. 143 Brown-squared syndrome - ansContralateral loss of pain and temperature sensation and ipsilateral paralysis with reduced touch sensation ch. 13, p. 182 CARDIAC TAMPONADE - ansAssessment findings

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Beck's Triad- HYPOTENSION, MUFFLED HEART SOUNDS, DISTENDED NECK VEINS

• CHEST PAIN
• TACHYCARDIA
• DYSPNEA
• CYANOSIS
• Pulsus paradoxus greater than 10 mm Hg Interventions
• Prepare for pericardial decompression
• 3 to 4 cm incision made just left of xiphoid process
• Needle percardiocentesis may also be used to relieve symptoms of cardiac tamponade but its only temporary solution ch. 11, p. 146 Cavitation refers to the... - ansSeparation of surrounding tissue resulting from a sound and/or hydraulic wave force. This rapid motion can lead to crushing, tearing, and shearing forces on tissue. The impact of cavitation is dependent on the characterists of the affected tissue. Additional considerations include:
• Air-filled organs such as lungs or stomach, are elastic, so this tissue tolerates high- velocity cavitation relatively well compared to other tissues
• Solid organs such as the liver, have a greater propensity to shear or tear under the same forces
• If those same forces are instead released inside the cranium, bone will resist expansion, augmenting soft tissue crushing, until the tensile strength of the bone is exceeded and an explosive release of pressure results ch. 4, p. 32 Central cord syndrome - ansloss of motor function in upper extremities that is greater than that of lower extremities. often sacral sparing. bladder function may be affected ch. 13, p. 182 Classifications of acute pain are based on the source and origin and include... - ansSOMATIC pain originates from skin and muscloskeletal structures VISCERAL PAIN originates from organs and may lead to referred pain ch. 8, p. 93 Components of CUS and its purpose - ansC: I am Concerned U: I am Uncomfortable

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S: This is a Safety issue/ I am Stressed Purpose- used to "stop the line" if a team member senses or discovers an essential safety breach p. 7 Components of DESC and its purpose - ansD: Describe the specific situation or behavior E: Express your concerns or how the situation makes you feel S: Suggest alternatives and seek agreement C: State consequences in terms of impact on performance goals Purpose- used in conflict management; paraphrasing the other person's comments is an important technique that should be done throughout the DESC script. Following discussion of consequences, team members should work towards consensus. p. 7 Components of SBAR and its purpose - ansS: Situation B: Background A: Assessment R: Recommendation Purpose- to provide framework for communication amount members of the healthcare team p. 7 Compression may occur from the effects of chemical substances and can cause.. - ansEdema, restricting or obstructing the airways, oxygenation, and ventilation. This can result from aspiration of liquids or inhalation of powder or noxious gas. ch. 4, p. 33 - 34 Compression strength refers to the tissue's ability to: - ansResist crush force

• Compression injuries to organs occur when the organs are crushed from surrounding internal organs or structures such as a seatbelt worn up across the abdomen causing compression of the small bowel or a fracture to the lumbar spine p. 27 Consider ABGs. A decreased level of consciousness may be an indicator of... - ansDecreased cerebral perfusion, hypoventilation, or acid-base imbalance. ch. 5, p. 46

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Define biomechanics - ansThe general study of forces and their effects p. 25 Define kinematics - ansThe study of energy transfer as it applies to identifying actual or intentional injuries p. 25 Define mechanism of injury (MOI) - ansHow external energy forces in the environment are transferred to the body p. 25 Define trauma - ans- Trauma is injury to living tissue caused by extrinsic agent

• Regardless of MOI, trauma creates stressors that exceed the tissue's or organ's ability to compensate p. 9 Depending on the motorcycle design and rider positioning, the lower extremities can collide with the handlebars, resulting in... - ansFemur and pelvis fractures and hip dislocations p. 31 Describe ANAPHYLACTIC SHOCK - ansResults from release of inflammatory mediators (e.g. histamine) which contracts bronchial smooth muscles and increases vascular permeability and vasodilation. ch. 7, p. 75 Describe DISTRIBUTIVE SHOCK - ansOccurs as result of maldistribution of an adequate circulating blood volume with loss of vascular tone or increased permeability. ch. 7, p. 75 Describe energy forms - ans- Mechanical (energy transfer from one object to another in the form of motion)
  • Thermal (energy transfer of heat in environment to the host)
• Chemical (heat energy transfer from active chemical substances such as chlorine, drain cleaner, acids, or plants)
• Electrical (energy transfer from light socket, power lines, or lightning)

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• Radiant (energy transfer from blast sound waves, radioactivity such as a nuclear facility, or rays of the sun) p. 26 Describe FOCAL BRAIN INJURIES - ansOccur in localized area with grossly observable and identifiable brain lesions. They include...
• CEREBRAL CONTUSION
• INTRACEREBRAL HEMATOMA
• EPIDURAL HEMATOMA
• SUBDURAL HEMATOMA
• HERNIATION SYNDROMES Ch. 9, p. 113 Describe NEUROGENIC SHOCK - ansOccurs with SCI results in the loss of SNS control of vascular tone, which produces venous and arterial vasodilation. ch. 7, p. 75 Describe SEPTIC SHOCK - ansCaused by systemic release of bacterial endotoxins, resulting in an increased vascular permeability and vasodilation. ch. 7, p. 75 Describe the MOI associated with brain, cranial, and maxillofacial trauma - ansBLUNT injury - falls, MVCs, sports-related injuries, recreation PENETRATING injury - firearms or exploding objects or projectiles Ch. 9, p. 108 Describe the three E's of injury control - ansEngineering: technological interventions such as side impact airbags, automated blind spot alarms, ignition lock devices for those with DUIs. In playgrounds and sports, this involves surface material under playground equipment and athletic safety gear. Another intervention is improved use of smoke alarms in fire prevention Enforcement and legislation: include laws at all jurisdictional levels regarding driving while intoxicated, booster seats, primary seatbelt use, and distracted driving. For sports this includes rules regarding illegal hits, examination after impact, and return-to-play requirements after a head injury

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Education: these can be community-based initiatives such as public service announcements for improved seatbelt use, education regarding risks of distracted driving, programs to commit to no texting while driving, and promotions for bicycle helmet giveaways with instructions for proper use p. 11 Disadvantages of auto-transfusion include: - ans- Risk of contamination

• RBCs might become hemolyzed during hemorrhage
• Coagulation factors, including platelets and cryoprecipitate may be destroyed, increasing d-dimer in collected blood ch. 7, p. 81 During primary survey... - ansLife-threatening conditions are identified and immediately corrected, beginning immediately upon the patient's arrival to the trauma room. ch. 5, p. 40 During the secondary survey in patient with thoracic or neck trauma, what questions do you want to ask? - ansIf patient is complaining of:
• DYSPNEA
• DYSPHAGIA
• DYSPHONIA Was there a cardiac event prior to injury? If CPR is being performed, when was it started?
• Important information in determining the indications for performing an emergency thoracotomy or when to consider withdrawal of support Ch. 11, p. 143 Early assessment findings of increased ICP include: - ans- HEADACHE
• NAUSEA/VOMITING
• AMNESIA
• BEHAVIOR CHANGES (IMPAIRED JUDGEMENT, RESTLESSNESS, DROWSINESS)
• ALTERED LEVEL OF CONSCIOUSNESS ( HYPO/HYPERAROUSABILITY) Ch. 9, p. 109

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Early treatment for septic shock includes... - ansEarly administration of antibiotics and potential need for norepinephrine to vasoconstrict the peripheral vasculature, increase blood volume return to heart, and improve cardiac output. ch. 7, p. 75 Examples of referred pain include... - ans- radiating to left shoulder (Kehr sign)

• referred to testicle may be indicative of duodenal injury
• always begin palpation away from inital site of pain by assessing the painful area last ch. 12, p. 158 Explain 3 phases of injury prevention - ansPrimary: prevention of the occurrence of the injury Secondary: Reduction in the severity of the injury that has occurred Tertiary: Improvement of outcomes related to the traumatic injury p. 10 Explain definitive care on pancreatic trauma - ans- Non-op management including complete bowel rest, nutritional support, serial CT scanning with observation
• Pseudocyst formations may be managed with percutaneous drainage
• Pancreatic ductal injuries may need distal pancreatectomy
• complications from pancreatic injury include, secondary hemorrhage, pancreatic fistula, abdominal abscess
• s/s of infection occur often 7 - 10 days after injury and usually include fever, elevated WBC, nausea, vomiting ch. 12, p. 164 Explain emergency thoracotomy - ansDone when patient arrives with unstable vital signs or impending arrest... Indications for performing this include:
• PERICARDIAL TAMPONADE needed to be evacuated
• IMMEDIATE CONTROL OF MASSIVE INTRATHROATIC BLEEDING
• PENETRATING TRAUMA with witnessed CARDIAC ARREST permitting open cardiac massage, or with massive hemorrhage in peritoneal cavity needing cross-clamping of aorta
• It is rarely successful in patients with blunt chest trauma Ch. 11, p. 142 - 143 Explain eye irrigation when used for the removal of chemicals, foreign bodies, and debris from eye - ansCONTRAINDICATED in patients who may have RUPTURED GLOBE

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• Prior to procedure, check eye pH then instill anesthetic drops unless contraindicated.
• Use warmed NS or LR, warmed to body temp 37 C to limit risk of thermal injury
• Morgan lens or intravenous tubing may be used to direct flow, remember the shorter the tubing, the greater the flow and pressure
• Direct stream across eye from inner to outer eye
• Irrigation continued until eye pH reaches neutral (7.0-7.3) Ch. 10, p. 133 Explain GLOBE RUPTURE - ans- Considered a genuine EMERGENCY
• Occurs when full thickness injury occurs to cornea or sclera or both
• Once Dx is confirmed, it is important to protect eye from further injury Assessment findings include:
• ANTERIOR CHAMBER APPEARING FLAT/SHALLOW
• IRREGULAR or TEARDROP-SHAPED PUPILS or PRESENCE of what looks like a secondary pupil due to a tear in the ciliary body (traumatic iridodialysis)
• PERIORBIAL ECCHYMOSIS
• DECREASED VISUAL ACUITY and EOM
• SEVERE SUBCONJUNCTIVAL HEMORRHAGE
• NAUSEA
• PAIN Treatment includes:
• AVOID ANY TYPE OF PRESSURE TO GLOBE - DO NOT PERFORM TONOMETRY
• APPLICATION OF RIGID SHIELD to protect affected eye
• Administration of antiemetics
• AVOID USE OF OPHTHALMIC DROPS or MEDICATIONS
• CONSULTS

• Pain not always present in globe penetration Ch. 10, p. 131 Ch. Ch. 10, p. 131 - 132 Explain how to assess circulation and control of hemorrhage in relation to thoracic trauma - ansAuscultation for:

• MUFFLED HEART SOUNDS or MURMURS Palate for:
• CENTRAL PULSES compare quality between left and right and lower and upper

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extremities

• EXTERNAL JUGULAR VEIN DISTENTION
• EXTREMITIES FOR MOTOR and SENSORY function Lower extremity paresis or paralysis may indicate an aortic injury Ch. 11, p. 142 Explain HYPHEMA - ansCollection of blood in anterior chamber of eye - classified as spontaneous or traumatic Assessment findings include:
• PAIN, PHOTOPHOBIA
• NOTICEABLE COLLECTION OF BLOOD IN EYE CHAMBER
• BLURRY VISION due to blood in chamber
• INCREASED IOP, NAUSEA, and SEVERE PAIN with grade 4 Treatment includes:
• ELEVATING HOB 30 degrees
• protecting eye with METAL SHIELD
• TOPICAL OPHTHALMIC CYCLOPLEGICS and OPHTHALMIC STEROIDS, OPHTHALMIC BETA-BLOCKERS if IOP is ELEVATED
• Avoid aspirin and NSAIDs as they increase risk of re-bleeding
• Risk of re-bleeding greatest 3 - 5 days after injury Ch. 10, p. 131 Explain NEUROGENIC SHOCK and what are the assessment findings - ansOccurs with SC damage at T6 or higher, resulting in sympathetic regulation disruption of vagal tone leading to loss of vascular resistance and generalized vasodilation Assessment findings
• BRADYCARDIA
• HYPOTENSION
• WARM, NORMAL COLOR SKIN
• CORE TEMPERATURE INSTABILITY ch. 13, p. 181 Explain OBITAL FRACTURE - ans- NOT CONSIDERED OPHTHALMOLOGIC EMERGENCY unless there is IMPAIRED VISION or GLOBE RUPTURE
• Usually result from DIRECT BLOW TO EYE
• Complication of this type of fracture is ENTRAPMENT OF THE INFERIOR RECTUS or INFERIOR OBLIQUE MUSCLE

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Assessment findings include:

• PERIORBIAL ECCHYMOSIS
• DIPLOPIA WITH UPWARD GAZE
• ENOPHTHALMOS
• INFRAORBITAL NUMBNESS
• DECREASED EOM Treatment includes:
• ORAL ANTIBIOTICS
• COOL COMPRESSES
• CONSULT with possible surgical repair if pt continues to have DIPLOPIA or ENOPHTHALMOS 1 - 2 weeks after swelling has decreased
• Discharge instructions include: advise pt to AVOID BLOWING NOSE, SNEEZING, and/or PERFORMING A VASALVA MANEUVER BEARING DOWN Ch. 10, p. 130 - 131 Explain oligoanalgesia - ansthe concept of undertreatment of pain ch. 8, p. 94 Explain pancreatic injuries - ans- Penetrating pancreatic injuries often sustain concurrent duodenal injuries
• Less than 10% of those with a pancreatic injury will have a single-system injury
• Suspicion for spinal fractures when the pancreas is crushed between anterior abdominal wall and spinal column ch. 12, p. 164 Explain pericardial tamponade and its assessment findings - ansWhen there is a rapid accumulation of blood in pericardial sac, resulting in compression of heart making it difficult for heart to fill during diastole, causing decreased cardiac output. Assessment findings include:
• HYPOTENSION
• TACHYCARDIA
• MUFFLED HEART SOUNDS
• NECK VEIN DISTENTION Ch. 11, p. 141 Explain RETROBULBAR HEMATOMA - ansTRUE OPHTHALMOLOGIC EMERGENCY