TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSI, Exams of Nursing

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EDITION ENA PRACTICE QUESTION AND ANSWERS

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_________ 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

EDITION ENA PRACTICE QUESTION AND ANSWERS

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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. 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

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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 As ICP rises, CPP ________, resulting in cerebral ischemia, hypoxemia, and lethal secondary insult. - ansDECREASES Ch. 9, p. 109

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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

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- 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)
• 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

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- 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
• ABNORMAL MOTOR POSTURING (FLEXION/EXTENSION) Extension is associated with brainstem HERNIATION and poor outcomes
• IPSILATERAL UNILATERAL FIXED, DILATED PUPIL

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- 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

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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
• 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

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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 Beck's Triad- HYPOTENSION, MUFFLED HEART SOUNDS, DISTENDED NECK VEINS
• CHEST PAIN
• TACHYCARDIA
• DYSPNEA

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- 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

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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 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

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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 Define biomechanics - ansThe general study of forces and their effects p. 25

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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.

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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)
• 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

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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 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

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• 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

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- BEHAVIOR CHANGES (IMPAIRED JUDGEMENT, RESTLESSNESS, DROWSINESS)

- ALTERED LEVEL OF CONSCIOUSNESS ( HYPO/HYPERAROUSABILITY)

Ch. 9, p. 109 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

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• 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
• 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

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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.

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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 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

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• 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 Assessment findings include:
• PERIORBIAL ECCHYMOSIS

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- 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

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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 Hemorrhage into space behind globe; bleeding causes increased pressure behind globe causing elevation in IOP that compresses optic nerve and blood vessels. Early recognition is imperative to save vision. Assessment findings include:
• SEVERE PAIN
• DECREASED VISION
• REDUCED EYE MOVEMENT
• IOP > 40 mm Hg Treatment include:
• Emergency decompression via LATERAL CANTHOTOMY indicated with IOP > 40 mm Hg Ch. 10, p. 131

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Explain stable and unstable pelvic fractures - ansStable- does not involve pelvic ring or there is minial displacement of pelvic ring Unstable fractures- 2 or more fractures of pelvic ring that have outward rotational displacement ch. 12, p. 166 Explain the AVPU mnemonic - ansUsed to quickly assess patient's level of alertness A- ALERT (If any of the responses below are elicited at this point, the airway may be compromised) V- responds to VERBAL stimuli, airway adjunct may be needed to keep tongue from obstructing airway P - responds to PAIN. U- UNRESPONSIVE. If patient is unresponsive, announce loudly to the team and direct someone to check if the patient has a pulse while assessing if the cause of the problem is the airway. Consider reprioritizing the assessment priority to ABC ch. 5, p. 42 Explain the B2-Transferrin test - ansGold standard for identifying CSF otorrhea or rhinorrhea ch. 5, p. 48 Explain the Cushing response - ansLoss of auto regulation (cerebral blood flow) can result in cerebral and brainstem ischemia, initiating a central nervous system response known as Cushing response. It is characterized by a triad of assessment findings:

• widening pulse pressure
• reflex bradycardia

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• diminished respiratory effort Ch. 9, p. 107 Explain the LMNOP mnemonic - ansUsed to remember resuscitation adjuncts L - Lab studies (ABGs, blood type and crossmatch)
  • Lactic acid is an excellent reflection of tissue perfusion M - Monitor cardiac rate and rhythm: compare patient's pulse to the monitor's rhythm
  • Dysrhythmias (PVCs, a fib, or ST segment changes) may indicate blunt cardiac trauma
  • PEA may point to cardiac tamponade, tension pneumothorax, or profound hypovolemia N - Naso- or orogastric tube consideration: insertion provides stomach content evacuation and relief of gastric distention O - Oxygenation and ventilation assessment
  • Pulse ox may only be accurate if there is adequate peripheral perfusion
  • ETCO2 monitoring (capnography) provides instantaneous information about the ventilation, perfusion, and metabolism of carbon dioxide (35-45 is normal) ch. 5, p. 47 Explain the MARCH mnemonic - ansM: MASSIVE HEMORRHAGE A: AIRWAY