TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS, Exams of Nursing

Download TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS and more Exams Nursing in PDF only on Docsity! TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - ANSPrehospital shock index pg. 85 ____________ ___________ Injury: shearing or tearing. Diagnosed with MRI. Widespread microscopic hemorrhage. - ANSDiffuse Axonal Injury (Cannot recover from this; shearing/tearing portion DOES NOT heal) ____________ ___________ Injury: shearing or tearing. Diagnosed with MRI. Widespread microscopic hemorrhage. - ANSDiffuse Axonal Injury (Cannot recover from this; shearing/tearing portion DOES NOT heal) ______________ Shock: Spinal cord injury at any level. Transient loss of reflex below the level of injury. Variable duration. S & S: flaccidity, loss of reflexes, bowel/bladder dysfunction. - ANSSpinal ______________ Shock: Spinal cord injury at any level. Transient loss of reflex below the level of injury. Variable duration. S & S: flaccidity, loss of reflexes, bowel/bladder dysfunction. - ANSSpinal __________________ Shock: Spinal cord injury at T6 or above. Temporary loss of vasomotor tone and sympathetic innervation. Temporary duration usually <72 hours. S & S: hypotension, bradycardia, loss of ability to sweat below level of injury. - ANSNeurogenic __________________ Shock: Spinal cord injury at T6 or above. Temporary loss of vasomotor tone and sympathetic innervation. Temporary duration usually <72 hours. S & S: hypotension, bradycardia, loss of ability to sweat below level of injury. - ANSNeurogenic ___________________: Impairs thrombin production and platelet function _____________ ______________: Impairs thrombin production _______________________: Results in depletion of clotting factors through hemodilution and the impaired ability to produce clotting factors. - ANSTrauma Triad of Death 1. Hypothermia 2. Metabolic Acidosis 3. Coagulopathy ___________________: Impairs thrombin production and platelet function _____________ ______________: Impairs thrombin production _______________________: Results in depletion of clotting factors through hemodilution and the impaired ability to produce clotting factors. - ANSTrauma Triad of Death 1. Hypothermia 2. Metabolic Acidosis 3. Coagulopathy TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ ???;.][''''''''''''''''''' - ANSthis card was created by a cat. enjoy. .. activation: .... are found in the carotid sinus and along the aortic arch, are sensitive to the degree of stretch in the arterial wall. When the receptors sense a decrease in stretch, they stimulate the sympathetic nervous system to release Epi, norepi, causing stimulation of cardiac activity and constriction of blood vessels, which causes a rise in heart rate and diastolic blood pressure - ANSBaroreceptors: ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a test that requires fluid to be sent to the lab and is considered the gold standard for identifying CSF - ANSBeta2-Transferrin ... is a test that requires fluid to be sent to the lab and is considered the gold standard for identifying CSF - ANSBeta2-Transferrin ... is a test that requires fluid to be sent to the lab and is considered the gold standard for identifying CSF - ANSBeta2-Transferrin ... is a triad of assessment findings; widening pulse pressure, bradycardia, and diminished respiratory effort - ANSCushing ( it is an attempt to increase MAP against elevated ICP, ultimately trying to cause a rise in CPP) ... is a triad of assessment findings; widening pulse pressure, bradycardia, and diminished respiratory effort - ANSCushing ( it is an attempt to increase MAP against elevated ICP, ultimately trying to cause a rise in CPP) ... is a triad of assessment findings; widening pulse pressure, bradycardia, and diminished respiratory effort - ANSCushing ( it is an attempt to increase MAP against elevated ICP, ultimately trying to cause a rise in CPP) ... is damaged brain tissue usually caused by blunt trauma - ANSCerebral contusion TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ ... shock occurs as a result of maldistribution of an adequate circulation blood volume with the loss of vascular tone or increased permeability. 3 examples. - ANSDistributive; anaphylactic, septic and neurogenic ... shock results from hypoperfusion of the tissue due to an obstruction in either the vasculature or heart. Two examples include.... - ANSObstructive;tension pneumothorax, cardiac tamponade. (With tension pneumo the increase in intrathoracic pressure leads to displacement of the vena cava, obstruction to arrival filling leading to decreased preload and decreased cardiac output) ( with cardiac tamponade there is an accumulation of fluid in the pericardial sac impeding diastolic expansion and filling leading to decreased preload, stroke volume,CO and end organ perfusion) ... shock results from hypoperfusion of the tissue due to an obstruction in either the vasculature or heart. Two examples include.... - ANSObstructive;tension pneumothorax, cardiac tamponade. (With tension pneumo the increase in intrathoracic pressure leads to displacement of the vena cava, obstruction to arrival filling leading to decreased preload and decreased cardiac output) ( with cardiac tamponade there is an accumulation of fluid in the pericardial sac impeding diastolic expansion and filling leading to decreased preload, stroke volume,CO and end organ perfusion) ... shock results from hypoperfusion of the tissue due to an obstruction in either the vasculature or heart. Two examples include.... - ANSObstructive;tension pneumothorax, cardiac tamponade. (With tension pneumo the increase in intrathoracic pressure leads to displacement of the vena cava, obstruction to arrival filling leading to decreased preload and decreased cardiac output) ( with cardiac tamponade there is an accumulation of fluid in the pericardial sac impeding diastolic expansion and filling leading to decreased preload, stroke volume,CO and end organ perfusion) .... activation: .... are found in the carotid sinus and along the aortic arch, are sensitive to the degree of stretch in the arterial wall. When the receptors sense a decrease in stretch, they stimulate the sympathetic nervous system to release Epi, norepi, causing stimulation of cardiac activity and constriction of blood vessels, which causes a rise in heart rate and diastolic blood pressure - ANSBaroreceptor activation; baroreceptors .... activation: .... are found in the carotid sinus and along the aortic arch, are sensitive to the degree of stretch in the arterial wall. When the receptors sense a decrease in stretch, they stimulate the sympathetic nervous system to release Epi, norepi, causing stimulation of cardiac activity and constriction of blood vessels, which causes a rise in heart rate and diastolic blood pressure - ANSBaroreceptor activation; baroreceptors .... activation: .... are found in the carotid sinus and along the aortic arch, are sensitive to the degree of stretch in the arterial wall. When the receptors sense a decrease in stretch, they stimulate the sympathetic nervous system to release Epi, norepi, causing stimulation of cardiac activity and constriction of blood vessels, which causes a rise in heart rate and diastolic blood pressure - ANSBaroreceptor activation; baroreceptors TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ .... are frequently associated with minor injury in older adults, patients taking anticoagulation medications and patients with chronic alcohol abuse. - ANSChronic subdural Hematoma .... are frequently associated with minor injury in older adults, patients taking anticoagulation medications and patients with chronic alcohol abuse. - ANSChronic subdural Hematoma .... are frequently associated with minor injury in older adults, patients taking anticoagulation medications and patients with chronic alcohol abuse. - ANSChronic subdural Hematoma .... can produce bleeding that may not be evident until several hours after injury - ANSBasilar skull fractures .... can produce bleeding that may not be evident until several hours after injury - ANSBasilar skull fractures .... can produce bleeding that may not be evident until several hours after injury - ANSBasilar skull fractures .... is suspected in any patient with multi system trauma. - ANSCervical spine injury .... is suspected in any patient with multi system trauma. - ANSCervical spine injury .... is suspected in any patient with multi system trauma. - ANSCervical spine injury .... is the major cause of preventable death after injury - ANSUncontrolled hemorrhage .... is the major cause of preventable death after injury - ANSUncontrolled hemorrhage .... is the major cause of preventable death after injury - ANSUncontrolled hemorrhage .... is the study of energy transfer as it applies to identifying actual or potential injuries - ANSKinematics .... is the study of energy transfer as it applies to identifying actual or potential injuries - ANSKinematics .... is the study of energy transfer as it applies to identifying actual or potential injuries - ANSKinematics TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ ...activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP - ANSChemoreceptors ...activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP - ANSChemoreceptors ...activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP - ANSChemoreceptors #1 Early Killer - ANSHemorrhage #1 Late Killer - ANSInfection & MODS `CPP - ANSMAP-ICP + gurgling over epigastrium - ANS-in stomach, pull out, preoxygenate, try again 1 Liter of O2 = ____% FiO2 - ANS4% 1 Liter of O2 = ____% FiO2 - ANS4% 1 unit of PRBC will raise HGB and HCT by how much? - ANSOnce hemostasis is achieve it is est that 1 unit will raise hgb by 1 g/dL and hct by 3%. 1. A- airway and Alertness with simultaneous cervical spinal stabilization 2. B- breathing and Ventilation 3. circulation and control of hemorrhage 4. D - disability (neurologic status) 5. F - full set of vitals and Family presence 6. G - Get resuscitation adjuncts L- Lab results (arterial gases, blood type and crossmatch) M- monitor for continuous cardiac rhythm and rate assessment N- naso or orogastric tube consideration O- oxygenation and ventilation analysis: Pulse oxygemetry and end-tidal caron dioxide (ETC02) monitoring and capnopgraphy H- History and head to toe assessment I- Inspect posterior surfaces - ANSABCDEFGHI 1. Apnea 2. GCS 8 or less TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -More than 20% of their TBSA burned require: *Adults: 2-4 ml of crystalloid solution x kg x % *Peds: 3-4 ml of crystalloid solution x kg x % *Infants: fluid with 5% dextrose at a maintenance rate in addition to the Peds rate protocol (1/2 the amount should be infused in first 8 hours) 24 Hour Burn Fluid Calculation - ANSDosage x Kg x % - ml in first 24 hours -More than 20% of their TBSA burned require: *Adults: 2-4 ml of crystalloid solution x kg x % *Peds: 3-4 ml of crystalloid solution x kg x % *Infants: fluid with 5% dextrose at a maintenance rate in addition to the Peds rate protocol (1/2 the amount should be infused in first 8 hours) 24 Hour Burn Fluid Calculation - ANSDosage x Kg x % - ml in first 24 hours -More than 20% of their TBSA burned require: *Adults: 2-4 ml of crystalloid solution x kg x % *Peds: 3-4 ml of crystalloid solution x kg x % *Infants: fluid with 5% dextrose at a maintenance rate in addition to the Peds rate protocol (1/2 the amount should be infused in first 8 hours) 50 to 150 - ANSMAP Range A ____ and ___ approach is used by all members of the trauma team to provide optimal care for the trauma pt. - ANSSystematic , Organized A ____ and ___ approach is used by all members of the trauma team to provide optimal care for the trauma pt. - ANSSystematic , Organized A ____ and ___ approach is used by all members of the trauma team to provide optimal care for the trauma pt. - ANSSystematic , Organized A - ANS-AVPU -Cervical spine (2nd person and jaw-thrust maneuver - inspect palate ausvultate + 4 issues -state need for OPA -or definitive airway -reassess airway after insertion of opa (no snoring heard) A ... fracture is a complete craniofacial separation - ANSLefort III TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ A ... fracture is a complete craniofacial separation - ANSLefort III A ... fracture is a complete craniofacial separation - ANSLefort III A 14 gauge needle that is inserted into the 2nd intercostal space in the midclavicular line on the affected side over the top of the rib to avoid neuromuscular bundle that runs under the rib. Prepare for chest tube placement. - ANSTension pneumo intervention A a 22 yr old was struck by a vehicle while crossing the street, sustaining multiple fx she is alert and answering qestions and crying what is the best method for initial pain assessment for this pt - ANSself report scale A a pt sustrained a penetrating injury of his upper leg. the pre hospital personnel states a large amount of blood loss before hemostasiswas achieved. he presents to the ER responding to painful stimuli with moaning. he is tachy 142 b/p 104/96 and RR 24 - ANSdecompensated A an unrestrained driver was involved in a frontal collision without airbag deployment. he is hypotensive and tachycardic with shallow respirations, distended JVD and muffled heart tones the nurse prepare for what - ANSpericardiocentesis A body at rest will remain at rest, a body in motion will stay in motion - ANSNewton's first law A body at rest will remain at rest, a body in motion will stay in motion - ANSNewton's first law A body at rest will remain at rest, a body in motion will stay in motion - ANSNewton's first law A breath every 5 to 6 seconds: 10-12 ventilations per minute - ANSBag mask ventilation A during assessment of an extremety with suspected pulses are - ANScan be normal A for a ptwho has undergone recent bariatric surgery, flouroscopy is recommended to place - ANSNG tube A identification of vulnerabilities is an example of what phase of disaster management - ANSmitigation A in mass casualty "doing the greatest good for the greatest number of people refers to a situation where - ANSthere may be more patients than resources TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ A in neurogenic shock, alterations in vital signs include hypotension and which other abnormal VS - ANSbradycardia A In the primary survey AVPU is performed to determine if the patient can: - ANSProtect their aiway A moderately dilated pupil with sluggish response may be an early sign of what? - ANSherniation syndrome from increased ICP A prego trauma pt develops tachy, hypotension, a rigide board like uterus, and dark, red vaginal bleeding. she reports constant back pain which is increasing. the most likely cause of s/s is - ANSplacental abruption A several groups of people are at higher risk for maltreatment including children, elderly, prego, and ... - ANSpt's with disability A the nurse is preparing to cleanse an extensive abrasion contaminated with dirt and gravel. which of the following intervention is indicated - ANSus copious amounts of NS A The systemic inflammatory response is a normal part of the body's response to shock from traumatic injury. what best describes this response - ANSit is activated by tissue hypoxia and sends neutrophils to injury site A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - ANSIntentional;unintentional A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - ANSIntentional;unintentional A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - ANSIntentional;unintentional A what is an early assessment finding to increased ICP in pt with a brain injury - ANSvomiting A when providing care for the pedicatric pt with burns the post resuscitation care, how are fluids delivered - ANSparkland formula with maintainence fluidss A which of hte following nursing interventions would be best for traumitc __________ - ANSHOB 30 degrees A which of the following structures would be hte most affected by teh concept of caviation - ANSLiver A which of the following values is within the acceptable limits for trauma pt - ANSend tidal CO2 of 40 TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ any deformities? bleeding? contusions, lacs? skin temp?? place splints on deformities, pulses - ANSHead to toe assessment: Extremities any lacs? deformities? blood at the urtheral meatus palpate pelvis with high pressure over the iliac wings downward and medially - ANSHead to toe assessment: pelvis and perineum Aortic Dissection - ANSUnequal extremity pulse strength possibility of.. Aortic injuries - ANSmay not have pulses in LE or one arm apply direct pressure to bleeding elevate extremity apply pressure over arterial sites Consider a pelvic binder for pelvic fractures consider a tourniquet cannulate two veins with large caliber IV - if unable to gain assess consider IO a. obtain labs, type and cross b. infuse warm isotonic fluids c. consider balanced resuscitation d. use rapid infusion device - ANSC Interventions: As ICP increases CPP decreases resulting in ... - ANSCerebral ischemia, hypoxemia and lethal secondary insult As ICP increases CPP decreases resulting in ... - ANSCerebral ischemia, hypoxemia and lethal secondary insult As ICP increases CPP decreases resulting in ... - ANSCerebral ischemia, hypoxemia and lethal secondary insult ask pt to pen his or her mouth - ANSWhile assessing airway the patient is alert and responds to verbal stimuli you should.. Assessment findings with maxillary fractures include - ANSFacial edema, ecchymoses and diplopoa (lefort III) Assessment findings with maxillary fractures include - ANSFacial edema, ecchymoses and diplopoa (lefort III) TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Assessment findings with maxillary fractures include - ANSFacial edema, ecchymoses and diplopoa (lefort III) Avoid _______________ when administering oxygen/ventilation - ANShyperoxia Avoid _______________ when administering oxygen/ventilation - ANShyperoxia AVPU - ANSAlert, Verbal, Pain, Unresponsive AVPU - ANSID pt Need intubation B - ANS-Determine breathing effectiveness -state need for assisted ventilation with bag-valve mask device -assess ET placement -Et secure, number at teeth documented -need for manuel ventilation B a pt father arrives in teh ER and needs to be told his son was severely injured in a MVC and is in surgery, the father si agitated, yelling, and smells of alcohol. in planning to talk with the father the trauma nurse will - ANSdeliver information regarding the son;s care in a calm voice B a pt involved in an MVC develops asymmetric pupillary reactivity, bilateral pupillary dilation and abnormal motor posturing. what does the nurse suspect as the most likely cause - ANSherniation syndrome B a pt with injury to the middle meningeal artery is at risk for which of the following - ANSepidural hematoma B an occlusive dressing has been applied to a pt with a penetrating injury to the chest. upon assessment the nurse notes that the patient is in respiratory distress nad has absnet breath sounds on hte affected side. what is the priroruty intervention - ANSremove the dressing to the wound B an unrestrained driver inlvolved in a MVC in which alcohol was involed. he denies any pain and numbness and tinlging. according to NEXUS critera which factors indicate need for radiological - ANSsuspected alcohol abuse B Demonstrates and describes techniques for determining breathing effectiveness using components of inspection, auscultation, and palpation. identifies at least FOUR - ANS-is there spontaneous breathing -is there symmetrical chest rise -what are the depth, pattern and rate of respirations -is there increased work of breathing -skin color TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -open wounds or deformities, subcutaneous emphysema -tracheal deviation or jugular venous distention -great sounds present and equal B pt to ER after being pinned to brick retaining wall. knwoing crushing injuries can result to significant damage to muslces the priority asessment for trauma nruse is for - ANSmyoglobinemia nd renal failure B the most common cause of shock in the trauma pt is - ANSloss of circ volume B the unrestrained fron seat passenger in a MVC develops echymosis around umbillicus. this assessment finding is most commonly associated with: - ANSbleeding in the peritoneal cavity B thinning skin and diminished autonomic response in older adult can have what effect on primary assessment - ANScompromised thermoregulation B when assessing a pt following a MVC the nurses asks how fsat the car was going - ANSwhen volocity is doubled speed is quadroupled B WHich may lead to unreliable pulse ox reading - ANScarboxyhemoglobin B which of hte following significant assessment findigns is frequently found in a patient with complete cransiofacial separation involving the maxilla, zygoma, orbits, and bones of the cranial base. - ANSdiplopia B which of the following hemodynamic support strategies is the prioririty intervention for a pt with traumatic pulmonary contusion - ANSjudicios use of IV fluids B-breathing and ventilation - ANS-*determine effectiveness of breathing using inspection, palpation, auscultation -*state need for BVM (10-12/min) Baby ok Then decrease LOC Weak cry - ANSHypoglycemia Base Excess (BE) - ANSnormal = -2 to +2 mEq/L base deficit < -6 is poor prognosis and develop acute traumatic coagulopathy (ATC) within 30 min basilar - ANSbase of skull, CSF leaks, periorbital edema, mastoid ecchymosis is battles sign Bduring the primary survery which of the following has the greatest priority - ANScervical spine injury TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ C which of the following would be priority intervention for a pt with multiple rib fractures and chest wall instability follwoing a mvc collision - ANSassist with endotracheal intubation C which of the follwoing is a risk factor for DVT in the trauma pt. - ANSpelvic fx C-circulation and hemorrhage - ANS-*determine adequacy of circulation using inspection, auscultation, palpation -assess medic line -*2nd large bore IV, warm crystalloid infusing at controlled rate if not shocky can be caused by blunt trauma. air escapes from injured lung to pleural space and negative intrapleural pressure is lost causing partial or collapsed lung - ANSSimple Pneumothorax Can be caused by blunt trauma. Air escapes from the injured lung into the pleural space, and negative intrapleural pressure is lost resulting in partial or complete collapse of the lung. S & S: dyspnea, tachypnea, decreased/absent breath sounds on injured side, chest pain. Treatment: based on size, symptoms, and stability. Chest tube may be placed to evacuate pleural air and maintain lung expansion - ANSPneumothorax Can be caused by blunt trauma. Air escapes from the injured lung into the pleural space, and negative intrapleural pressure is lost resulting in partial or complete collapse of the lung. S & S: dyspnea, tachypnea, decreased/absent breath sounds on injured side, chest pain. Treatment: based on size, symptoms, and stability. Chest tube may be placed to evacuate pleural air and maintain lung expansion - ANSPneumothorax can result from penetrating wound through chest wall causing air to be trapped in to the intrapleural place. Might hear "sucking" Tx: nonporous dressing tapes on 3 sided, then Chest tube and would closure surgical repair. - ANSOpen Pneumo: Capnography monitors numeric value, as well as continuous waveform, indicating real- time measurement and trending over time. - ANSQuantitative: Cardiac Tamponade - ANScompression of heart due to fluid accumulation within pericardium Cardiac tamponade - ANSPericardial window Cardiogenic - ANS-ineffective perfusion caused by inadequate contractility of heart -blunt cardiac injury -pressors, dop, epi, NO FLUIDS Cardiogenic shock - ANSAntiarrythmics TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Care of Amputations - ANS-Remember ABCDs -Focus on Life-Threatening Injuries -Circulation: control bleeding, elevate & apply pressure on artery -Vasoconstriction reflex: decreases bleeding Save life over limb! Cause of Spleen & Liver Injuries - ANSMVC/T-bone Caused by a sudden stop of the body's motion - ANSDeceleration forces Caused by a sudden stop of the body's motion - ANSDeceleration forces Caused by a sudden stop of the body's motion - ANSDeceleration forces Caused by blood in the intrapleural space/ May also occur from lac to live or spleen combined with injury to the diaphragm. Ensure two large bore IVS are placed. Prepare for thoracentesis and chest tube insertion. If open thoracotomy is done chest tube is deferred. - ANSHemothorax: Caused from a sudden and rapid onset of motion ( a Parker car being hit by another vehicle) - ANSAcceleration forces Caused from a sudden and rapid onset of motion ( a Parker car being hit by another vehicle) - ANSAcceleration forces Caused from a sudden and rapid onset of motion ( a Parker car being hit by another vehicle) - ANSAcceleration forces Causes of Hemothorax - ANS-Rib Fx -Heart or Great Vessel Injury Causes of oligoanalgesia include... - ANSFailure to assess initial pain; failure to implement guidelines and protocols; failure to document pain; failure to meet patients expectations Causes of oligoanalgesia include... - ANSFailure to assess initial pain; failure to implement guidelines and protocols; failure to document pain; failure to meet patients expectations TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Causes of oligoanalgesia include... - ANSFailure to assess initial pain; failure to implement guidelines and protocols; failure to document pain; failure to meet patients expectations Causes of Thoracic Injuries - ANS1. Blunt Thoracic Injuries: front or side impact with MVCs 2. Penetrating Thoracic Injuries: assaults, firearms, stabbings Cavitation - ANSLiver Cerebral contusion - ANS-damage to capillary vasculature, 18-36 hours after time of injury Cerebral Perfusion Pressure (CPP) - ANSCPP = MAP - ICP Cerebral response - ANS-brain autoregulates so blood is shunted from other organs to brain -SBP >50 cerebral ischemia occurs and the increase in CO2 in the brain stimulates the CNS response Chest tube insertion site - ANS5th intracostal space Church fever/malaise - ANSBiologic Circulation and Control of Hemorrhage Inspect first for any uncontrolled bleeding Skin color palpate for central pulses - carotid and femoral - rate, rhythm, and strength Skin temp: cool, diaphoretic, or warm and dry - ANSC Circulation- *3 - ANS-uncontrolled hemorrhage-elevate to heart, pressure, tourniquet -central and peripheral pulses -skin color, temp, moisture, cap refill Class 1 hemorrhagic shock - ANS- Loss of 15% (less than 750mL) of blood volume - Minimal tachycardia - less than 100BPM - No measureable change in BP, Pulse pressure, and RR - Body can compensate well -Anxious Class 2 Hemorrhage - ANSVasoconstriction still maintains BP, but with difficulty Blood flow is increased to vital organs (midbrain, heart, kidneys?) - Flow is decreased to kidneys, intestines, and skin TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Colorimetric CO2 detectors provide info about the presence or absence of CO2. A chemically treated indicator strip changes color revealing the presence or absence of exhaled CO2 - ANSQualitative Compartment syndrome - ANSPain Pulse Pallor Pressure Paralysis Parasthesia Compensated stage - ANS-SBP is normal, rising DBP, tachy bounding, lactate builds up Complete craniofacial separation involving maxilla, zygoma, orbits, and bones of the cranial base. Assessment findings include: massive facial edema, mobility and depression of zygomatic bones, ecchymoses, diplopia, and open bite or malocclusion. - ANSLeFort III Complete craniofacial separation involving maxilla, zygoma, orbits, and bones of the cranial base. Assessment findings include: massive facial edema, mobility and depression of zygomatic bones, ecchymoses, diplopia, and open bite or malocclusion. - ANSLeFort III Complications of Abdominal Compartment Syndrome - ANS-Decreased Venous Return b/c gut pushing on vena cava -Falsely elevates CVP -Pushes on Diaphragm Control bleeding with direct pressure, elevate, apply tourniquets. - ANSAmputation Control bleeding with direct pressure, elevate, apply tourniquets. - ANSAmputation CPP range - ANS50-70 Crush Injuries - ANS-Skeletal muscle damage causes Myoglobin release= Rhabdomyolysis --> Myoglobinuria -Soft Tissue swelling -Pain -Compartment Syndrome -Loss of Neurovascular Integrity distal to injury -Possible Bone injury -Life-threatening if involves legs or pelvis Crush injury - ANSMyoglobinuria Renal failure TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ CT Scan - ANS-more expensive -Diagnoses Retroperitoneal & Intraperitoneal Bleeding -need to stabilize patient first Cthe term worried well when refering to disaster preparedness planning refers to: - ANSindividuals hwo think they have been affected by the event but are asymptomatic Cthe trauma nurse would prepare for a definitive airwya for which of the following condition. - ANSGCS of 8 or ls Cullen sign - ANSbruising around umbilicus Cullen's Sign - ANSEcchymosis in Umbilical Area, Associated with Intraperitoneal Bleeding Cushing - ANSpressure on brain stem causes wide pulse pressure, brady, decreased RR Cushing response - ANSTraid of widening pulse pressure, reflex brady, diminished resp effect. Attempt to incrased MAP against an elevated ICP causing a rise in CPP Cushing's triad/response - ANSr/t loss of auto regulation due to ICP Signs of increased intracranial pressure: 1. hypertension 2. bradycardia 3. irregular respirations D - ANSdisability (neurologic status) -GCS (best eye opening, best verbal response, best motor reaponse) -assess pupils -states need for CT of head and cervical spine D An unrestrained driver is brought into the emergency department following a frontal impact MVC. she is pale, anxious, and c/o SOB. what is the potential injury - ANSLumbar fx D displaced tube O obstructed or kinked P pneumothorax E equipment failure , such as becoming detached from the equipment or loss of capnopgrahy - ANSDOPE D elevated comaprtment pressure can be the result of - ANShemorrhage from within the muscle TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ D pt with amputation of an index finger with a knife. amputaiton is brought in with pt. it is wrapped in sterile gauze with saline and sealed in a plastic bag. the next step amputation care is - ANSplace the bag on ice D restrained driver is involved in a severe head on MVC and presnts with a seatbelt mark along the neck and upper chest area. bilateral decreased breath sounds, hemoptysis and diffuse sub q emphysemato the neck and upper chest area - ANStracheobronchial injury D which of the following diagnostic intervention is most appropriate for the unstable pt with a suspectedinternal hemorrhage - ANSfocused assessment with sonography for trauma D which physiological change in airway of an odler adult pt places the pt at risk for difficult intubation - ANScervical arthritis D- disability - ANS-*GCS- eye opening, verbal response, motor -*pupils -*need for head CT, cspine Decrease cranial calcification - ANSCT normal without radio graphic abnormality Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define Hemothorax. - ANSAccumulation of blood in the pleural space. Define Hemothorax. - ANSAccumulation of blood in the pleural space. TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more common of the two types of herniation syndromes. Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more common of the two types of herniation syndromes. Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more common of the two types of herniation syndromes. Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more common of the two types of herniation syndromes. Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more common of the two types of herniation syndromes. Definitive treatment of a Tension Pneumothorax - ANSChest Tube TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ demonstrates and describes techniques for determining latency of airway using inspection, ausculataton, and palpation. Identifies at least FOUR - ANS-is tongue obstructing airway -are there any lose or missing teeth -are there any foreign bodies is there any blood, vomitus or other secretions -is there any edema -is there any snoring, gurgling, or stridor Depressed - ANSextends below surface of head Describe a Grade I Hyphema. - ANSBlood occupying less than one third of the anterior eye chamber. Describe a Grade II Hyphema. - ANSBlood occupying one third to half of the anterior eye chamber. Describe a Grade III Hyphema. - ANSBlood occupying half but less than total filling of the anterior eye chamber. Describe a Grade IV Hyphema. - ANSBlood occupying the entire anterior eye chamber. Diagnostic Peritoneal Lavage (DPL) - ANS-Rapid test for Intraperitoneal Bleeding -Invasive -Peritoneal catheter inserted into abdomen (right below umbilicus) & warm NS or LR instilled then drained -Drop bag below level of bed -If bag filled with blood, yellow, green, food, particles, stool= Positive DPL & go to OR Diaphragmatic Rupture - ANS-Stomach in Thoracic Cavity -Bowel Sounds heard in chest Difficult intubation elderly - ANSCervical arthritis Diffuse anoxal - ANSsweating, posturing, sym storm, HTN, hyperthermia shearing and tearing immediate unconciousness Diffuse Axinal vs. Herniation Syndrome - ANSDA Unconsciousness Increased ICP Posturing HTN Hyper-thermia Sweating TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ HS Asymmetric pupils Unilateral or bilateral pupil dilation Posturing Cushings Loss of reflexes Diplopia - ANSLefort III Disability - Neurologic Status 1. Assess pupils for equality, shape, and reactivity (PERRL) 2. Assess GCS (eye opening, verbal response, and motor response) - ANSD Disaster management - Vulnerable - ANSMitigation Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: MI, Blunt cardiac injury, Mitral valve insufficiency, dysrhythmias, Cardiac Failure TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: MI, Blunt cardiac injury, Mitral valve insufficiency, dysrhythmias, Cardiac Failure Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: MI, Blunt cardiac injury, Mitral valve insufficiency, dysrhythmias, Cardiac Failure Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: MI, Blunt cardiac injury, Mitral valve insufficiency, dysrhythmias, Cardiac Failure Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: - MI - Blunt cardiac injury - Mitral valve insufficiency - dysrhythmias - Cardiac Failure Explain Distributive Shock. - ANSResults from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Distributive Shock. - ANSResults from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Some causes: - Blood loss - Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages will cause compromises to most body systems. - Inadequate venous return - inadequate cardiac filling - decreased coronary artery perfusion - Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages will cause compromises to most body systems. - Inadequate venous return - inadequate cardiac filling TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - decreased coronary artery perfusion - Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages will cause compromises to most body systems. - Inadequate venous return - inadequate cardiac filling - decreased coronary artery perfusion - Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages will cause compromises to most body systems. - Inadequate venous return - inadequate cardiac filling - decreased coronary artery perfusion - Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages will cause compromises to most body systems. - Inadequate venous return - inadequate cardiac filling - decreased coronary artery perfusion - Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes: - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). - Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium. - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes: TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). - Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium. - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes: - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). - Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium. - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes: - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). - Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium. - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes: - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). - Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium. - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Pulmonary Response. - ANSTachypnea happens for 2 reasons: 1. Maintain acid-base balance 2. Maintain increased supply of oxygen TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -n-NG/OG -o-pulse ox -p-pain- pharma and nonpharm GCS breakdown - ANS GCS scores : I. Mild TBI II. Moderate TBI III. Severe TBI - ANS13-15; 9-12; 8 or less GCS scores : I. Mild TBI II. Moderate TBI III. Severe TBI - ANS13-15; 9-12; 8 or less GCS scores : I. Mild TBI II. Moderate TBI III. Severe TBI - ANS13-15; 9-12; 8 or less General study of forces and their effects on living tissue and the human body - ANSBiomechanics General study of forces and their effects on living tissue and the human body - ANSBiomechanics Get Resuscitation Adjuncts L - Labs (maybe a lactic acid), a b g 's, blood type M - monitors N - naso or oro gastric tubes O Oxygen and ETC02 monitors P - pain assessment and management - ANSG Glascow Coma Scale (GCS) - ANSNeurologic assessment of a patient's BEST verbal response, eye opening, and motor function. Lowest score is a 3, highest is 15, Intubate at 8. Goal of Primary Survey - ANSidentify life-threatening injuries Goal of Secondary Survey - ANSidentify all injuries Goals of Early Surgical Tx of Abdominal Trauma - ANS-Control Hemorrhage -Remove dead tissue -Lavage the abdominal cavity -Control contamination TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -Close the abdomen without tension Gray Turner Sign - ANSEcchymosis in flank area associated with Retroperitoneal Bleeding Grey turner sign - ANSBruising of the flanks. Between last rib and top of hip GSW chest - ANSThoracic injury GSW to Abdomen Risk - ANS1. Hemorrhage 2. Hollow Viscus Perforation with Peritonitis H - ANSHistory MIST Mechanism of injury Injuries sustained Signs and symptoms in field Treatment in field H- hx and head to toe - ANS-hx: MIST, past medical hx -head to toe H,I - ANSSecondary Survery Head to toe - ANS-face -neck- c-spine -chest- lung and heart -abdomen and flanks -pelvis and perineum- gentle pressure over iliac crest, pubic symphysis, foley -extremities- neurovascular -posterior- spinal board Head to toe assessment - ANS1) Inspects AND palpates face/neck 2) inspects AND palpates neck for injuries, demonstrate removal AND replacement of cervical collar for assessment 3) Inspects AND palpates chest 4) auscultate heart and lung sounds 5) inspects abdomen and flanks 6) auscultate and palpates abdomen 7)inspects pelvis and perineum 8) applies gentle pressure over iliac crests downward and medially 9)gentle pressure to symphysis pubis 10)urinary catheter unless contraindicated 11) Inspects AND palpates 4 extremities Hemopneumothorax - ANSair & blood (need 2 chest tubes) TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Hemorrhage is the leading cause. Can result from vomiting, diarrhea, and burn trauma. Decreased circulating volume --> decreased preload. Therapy includes replacing the type of volume that was lost. - ANSHypovolemic Shock Hemorrhage is the leading cause. Can result from vomiting, diarrhea, and burn trauma. Decreased circulating volume --> decreased preload. Therapy includes replacing the type of volume that was lost. - ANSHypovolemic Shock Hemothorax - ANSblood in the pleural space Herniation syndrome - ANSuncontrolled increases in ICP, uncal and central (shift down) or transtentorial, midline shift is seen with uncal herniation History and Head to toe MIST - prehospital report MOI Injuries sustained S s/s in the field T treatment in the field if patients family present get a better hx on them - ANSH How do you assess Mnemonic "D"? - ANSDISABILITY A = Alert V = Verbal P = Pain U = Unresponsive - GCS - PERRL? - Determine presence of lateralizing signs including: - Unilateral deterioration in motor movements or unequal pupils - Symptoms that help to locate area of injury in brain How do you confirm ET Tube/Alternative Airway Placement? - ANS- Visualization of the chords - Using bronchoscope to confirm placement - Listening to breath sounds over the epigastrum and chest walls while ventilating the pt - CO2 detector - Esophageal detection device - Chest x-ray How do you confirm ET Tube/Alternative Airway Placement? - ANS- Visualization of the chords - Using bronchoscope to confirm placement - Listening to breath sounds over the epigastrum and chest walls while ventilating the pt - CO2 detector TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ HISTORY - MOI? - Acceleration/Deceleration? - What was it caused by? - Pt restrained? Airbags deployed? Etc. - What are the pt's complaints? - Pt normally wear glasses or contacts? - Pt have hx of eye problems? - Pt ever have eye surgery? - Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION: - Inspect eye, orbits, face and neck - Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas - Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents - Determine whether lid lac's - Assess pupil's (PERRL) - Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome - Bilateral fixed and pinpoint pupils = pontine lesion or drugs - Mildly dilated pupil w/sluggish response may early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Assess for consensual response - Assess redness, eye watering, blepharospasm - Assess extraocular movement, except when an open globe injury is known or suspected. - Limitation range of ocular motion may indicate orbital rim fx w/entrapment or paralysis of cranial nerve or ocular muscle - Perform visual acuity exam - Use Snellen or handheld chart. Check uninjured eye first - Assess for blurred or double vision with injured eye and then with both eyes open - Inspect for rhinorrhea or otorrhea - If drng present, may indicate CSF leak - Observe for impaled objects - Assess occlusion of mandible and maxilla - Malocclusion or inability to open + close mouth is highly indicative of maxillary or mandibular fx - Observe for uncontrolled bleeding PALPATION - Palpate periorbital area, face and neck for: - Tenderness - Edema - Step-off de TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ How would you assess a patient with ocular, maxillofacial and neck trauma? - ANS(Initial assessment) HISTORY - MOI? - Acceleration/Deceleration? - What was it caused by? - Pt restrained? Airbags deployed? Etc. - What are the pt's complaints? - Pt normally wear glasses or contacts? - Pt have hx of eye problems? - Pt ever have eye surgery? - Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION: - Inspect eye, orbits, face and neck - Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas - Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents - Determine whether lid lac's - Assess pupil's (PERRL) - Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome - Bilateral fixed and pinpoint pupils = pontine lesion or drugs - Mildly dilated pupil w/sluggish response may early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Assess for consensual response - Assess redness, eye watering, blepharospasm - Assess extraocular movement, except when an open globe injury is known or suspected. - Limitation range of ocular motion may indicate orbital rim fx w/entrapment or paralysis of cranial nerve or ocular muscle - Perform visual acuity exam - Use Snellen or handheld chart. Check uninjured eye first - Assess for blurred or double vision with injured eye and then with both eyes open - Inspect for rhinorrhea or otorrhea - If drng present, may indicate CSF leak - Observe for impaled objects - Assess occlusion of mandible and maxilla - Malocclusion or inability to open + close mouth is highly indicative of maxillary or mandibular fx - Observe for uncontrolled bleeding PALPATION - Palpate periorbital area, face and neck for: - Tenderness - Edema - Step-off de TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ How would you assess a patient with ocular, maxillofacial and neck trauma? - ANS(Initial assessment) HISTORY - MOI? - Acceleration/Deceleration? - What was it caused by? - Pt restrained? Airbags deployed? Etc. - What are the pt's complaints? - Pt normally wear glasses or contacts? - Pt have hx of eye problems? - Pt ever have eye surgery? - Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION: - Inspect eye, orbits, face and neck - Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas - Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents - Determine whether lid lac's - Assess pupil's (PERRL) - Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome - Bilateral fixed and pinpoint pupils = pontine lesion or drugs - Mildly dilated pupil w/sluggish response may early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Assess for consensual response - Assess redness, eye watering, blepharospasm - Assess extraocular movement, except when an open globe injury is known or suspected. - Limitation range of ocular motion may indicate orbital rim fx w/entrapment or paralysis of cranial nerve or ocular muscle - Perform visual acuity exam - Use Snellen or handheld chart. Check uninjured eye first - Assess for blurred or double vision with injured eye and then with both eyes open - Inspect for rhinorrhea or otorrhea - If drng present, may indicate CSF leak - Observe for impaled objects - Assess occlusion of mandible and maxilla - Malocclusion or inability to open + close mouth is highly indicative of maxillary or mandibular fx - Observe for uncontrolled bleeding PALPATION - Palpate periorbital area, face and neck for: - Tenderness - Edema TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Assess jugular veins and peripheral veins Auscultate: - BP - Pulse pressure - Breath sounds - Heart sounds - Bowel sounds Percuss: - Chest and abdomen Palpate: - Central pulse (carotid or femoral) - Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse - Palpate peripheral pulses - Palpate skin temp and moisture Diagnostic Procedures: - Xrays and other studies - Labs Planning and Implementation - Oxygen - IV's with warmed replacement fluids - Control external bleeding with direct pressure - Elevate LE's - NGT - Foley - Monitor and pulse oximeter - Monitor for development of coagulopathies - Surgery? How would you assess a pt in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect: - LOC - Rate and quality of respirations - External bleeding? - Skin color and moisture - Assess jugular veins and peripheral veins Auscultate: - BP - Pulse pressure - Breath sounds - Heart sounds - Bowel sounds Percuss: - Chest and abdomen Palpate: TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - Central pulse (carotid or femoral) - Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse - Palpate peripheral pulses - Palpate skin temp and moisture Diagnostic Procedures: - Xrays and other studies - Labs Planning and Implementation - Oxygen - IV's with warmed replacement fluids - Control external bleeding with direct pressure - Elevate LE's - NGT - Foley - Monitor and pulse oximeter - Monitor for development of coagulopathies - Surgery? How would you assess a pt in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect: - LOC - Rate and quality of respirations - External bleeding? - Skin color and moisture - Assess jugular veins and peripheral veins Auscultate: - BP - Pulse pressure - Breath sounds - Heart sounds - Bowel sounds Percuss: - Chest and abdomen Palpate: - Central pulse (carotid or femoral) - Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse - Palpate peripheral pulses - Palpate skin temp and moisture Diagnostic Procedures: - Xrays and other studies - Labs Planning and Implementation - Oxygen TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - IV's with warmed replacement fluids - Control external bleeding with direct pressure - Elevate LE's - NGT - Foley - Monitor and pulse oximeter - Monitor for development of coagulopathies - Surgery? How would you assess a pt with a cranial injury? - ANS(Initial assessment) INSPECTION: - Assess airway - RR, pattern and effort - Assess pupil size and response to light - Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome - Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates - Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Determine if pt uses eye meds - Abnormal posturing? - Inspect craniofacial area for ecchymosis/contusions - Periorbital ecchymosis - Mastoid's process ecchymosis - Blood behind tympanic membrane - Inspect nose and ears for drainage - Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF - If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF - Assess extraocular eye movement (Tests cranial nerves, III, IV, VI) - Performing extraocular eye movements indicates functioning brainstem - Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle - Determine LOC with GCS PALPATION - Palpate cranial area for: - Point tenderness - Depressions or deformities - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing - Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - (Initial assessment) - Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 How would you assess a pt with a cranial injury? - ANS(Initial assessment) INSPECTION: - Assess airway - RR, pattern and effort - Assess pupil size and response to light - Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome - Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates - Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Determine if pt uses eye meds - Abnormal posturing? - Inspect craniofacial area for ecchymosis/contusions - Periorbital ecchymosis - Mastoid's process ecchymosis - Blood behind tympanic membrane - Inspect nose and ears for drainage - Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF - If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF - Assess extraocular eye movement (Tests cranial nerves, III, IV, VI) - Performing extraocular eye movements indicates functioning brainstem - Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle - Determine LOC with GCS PALPATION - Palpate cranial area for: - Point tenderness - Depressions or deformities - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing - Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - (Initial assessment) - Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 How would you assess a pt with a thoracic injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe chest wall - Assess breathing effort and RR - Symmetry - Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or pericardial tamponade. Flat = external jugular veins may reflect hypovolemia) - Inspect upper abdominal region for injury Percussion: - Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax) Palpation: - Palpate chest wall, clavicles and neck for: - Tenderness - Swelling or hematoma - Subcutaneous emphysema - Note presence of bony crepitus - Palpate central and peripheral pulses and compare quality between: - Right and left extremities - Upper and lower extremities - Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension pneumothorax or massive hemothorax) - Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate aortic injury). Auscultation: - Auscultate compare BP in both UE's and LE's - Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS = splinting. Shallow = b/c of pain). - Auscultate chest for presence of BS (diaphragmatic rupture) - Auscultate Heart sounds (muffled = pericardial tamponade) - Auscultate neck vessels for bruits (vascular injury) Diagnostic Procedures: - Xrays - Arteriography - Bronchoscopy and laryngoscopy TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ - CT's - FAST - Labs (cardiac enzymes) - ECG, CVP How would you assess a pt with a thoracic injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe chest wall - Assess breathing effort and RR - Symmetry - Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or pericardial tamponade. Flat = external jugular veins may reflect hypovolemia) - Inspect upper abdominal region for injury Percussion: - Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax) Palpation: - Palpate chest wall, clavicles and neck for: - Tenderness - Swelling or hematoma - Subcutaneous emphysema - Note presence of bony crepitus - Palpate central and peripheral pulses and compare quality between: - Right and left extremities - Upper and lower extremities - Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension pneumothorax or massive hemothorax) - Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate aortic injury). Auscultation: - Auscultate compare BP in both UE's and LE's - Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS = splinting. Shallow = b/c of pain). - Auscultate chest for presence of BS (diaphragmatic rupture) - Auscultate Heart sounds (muffled = pericardial tamponade) - Auscultate neck vessels for bruits (vascular injury) Diagnostic Procedures: - Xrays - Arteriography - Bronchoscopy and laryngoscopy - CT's - FAST - Labs (cardiac enzymes) - ECG, CVP TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -Inspect lower chest, abdomen, flanks, and back for seat belt abrasions or soft tissue injuries -Inspect pelvic area for soft tissue bruising Percussion: - Percuss for hyperresonance or dullness. Hyperresonance indicates air, dullness indicates fluid. Palpation: - Palpate all four quadrants. Press and quickly release to determine presence of rebound tenderness. -Palpate pelvis for bony instability, asymmetry, or pain. -Palpate flanks for tenderness -Palpate anal sphincter for presence or absence of tone Auscultation: -Auscultate the chest. If bowel sounds heard in chest may have diaphragmatic rupture with herniation of the stomach or small bowel -Auscultate bowel sounds. Absence indicative of visceral injury. Diagnostic Procedures: - Xrays - MRI - IVP and DPL - CT's - FAST - Labs (cardiac enzymes) -Cystogram or urethrogram -Angiography How would you care for a pt with an Abdominal Injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe the lower chest for asymmetric chest wall movement. -Observe the contour of the abdomen. Distention may indicate bleeding -Inspect lower chest, abdomen, flanks, and back for seat belt abrasions or soft tissue injuries -Inspect pelvic area for soft tissue bruising Percussion: - Percuss for hyperresonance or dullness. Hyperresonance indicates air, dullness indicates fluid. Palpation: - Palpate all four quadrants. Press and quickly release to determine presence of rebound tenderness. -Palpate pelvis for bony instability, asymmetry, or pain. -Palpate flanks for tenderness -Palpate anal sphincter for presence or absence of tone Auscultation: TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -Auscultate the chest. If bowel sounds heard in chest may have diaphragmatic rupture with herniation of the stomach or small bowel -Auscultate bowel sounds. Absence indicative of visceral injury. Diagnostic Procedures: - Xrays - MRI - IVP and DPL - CT's - FAST - Labs (cardiac enzymes) -Cystogram or urethrogram -Angiography How would you care for a pt with an Abdominal Injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe the lower chest for asymmetric chest wall movement. -Observe the contour of the abdomen. Distention may indicate bleeding -Inspect lower chest, abdomen, flanks, and back for seat belt abrasions or soft tissue injuries -Inspect pelvic area for soft tissue bruising Percussion: - Percuss for hyperresonance or dullness. Hyperresonance indicates air, dullness indicates fluid. Palpation: - Palpate all four quadrants. Press and quickly release to determine presence of rebound tenderness. -Palpate pelvis for bony instability, asymmetry, or pain. -Palpate flanks for tenderness -Palpate anal sphincter for presence or absence of tone Auscultation: -Auscultate the chest. If bowel sounds heard in chest may have diaphragmatic rupture with herniation of the stomach or small bowel -Auscultate bowel sounds. Absence indicative of visceral injury. Diagnostic Procedures: - Xrays - MRI - IVP and DPL - CT's - FAST - Labs (cardiac enzymes) -Cystogram or urethrogram -Angiography How would you care for a pt with an Abdominal Injury? - ANS(Initial assessment) TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Obtain Hx. PHYSICAL: Inspection: - Observe the lower chest for asymmetric chest wall movement. -Observe the contour of the abdomen. Distention may indicate bleeding -Inspect lower chest, abdomen, flanks, and back for seat belt abrasions or soft tissue injuries -Inspect pelvic area for soft tissue bruising Percussion: - Percuss for hyperresonance or dullness. Hyperresonance indicates air, dullness indicates fluid. Palpation: - Palpate all four quadrants. Press and quickly release to determine presence of rebound tenderness. -Palpate pelvis for bony instability, asymmetry, or pain. -Palpate flanks for tenderness -Palpate anal sphincter for presence or absence of tone Auscultation: -Auscultate the chest. If bowel sounds heard in chest may have diaphragmatic rupture with herniation of the stomach or small bowel -Auscultate bowel sounds. Absence indicative of visceral injury. Diagnostic Procedures: - Xrays - MRI - IVP and DPL - CT's - FAST - Labs (cardiac enzymes) -Cystogram or urethrogram -Angiography Hr 146 RR increased BP decreased Moan to pain - ANSDecomp shock Hypercapnia causes _________________; Hypocapnia causes __________________ - ANSVasodilation; Vasoconstriction Hypercapnia causes _________________; Hypocapnia causes __________________ - ANSVasodilation; Vasoconstriction Hypotension and cerebral blood flow - ANS-CO2 causes dialation, if CPP outside of 50- 160, regulation fails and flow relies on MAP, MAP <60 hypoxic <60 edema Hypovolemia/ hemorraghic - ANS-loss of plasma, blood, volume TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ immobilize cervical spine, tenderness, tracheal deviation - ANSHead to toe assessment: Neck and cervical spine Impalements - ANS-DO NOT remove the object -Stabilize/Support the Object -Tape in Place if possible, prepare for OR -Object removed in OR in massive transfusion protocol... responsible for dissolving clots - ANSTXA In the ... ... response two catecholamines are released ... and ... . - ANSAdrenal gland response; epinephrine and norepinephrine In the ... ... response two catecholamines are released ... and ... . - ANSAdrenal gland response; epinephrine and norepinephrine In the ... ... response two catecholamines are released ... and ... . - ANSAdrenal gland response; epinephrine and norepinephrine In the adrenal gland response ... is released to raise blood glucose and promote renal retention of water and sodium. - ANSCortisol In the adrenal gland response ... is released to raise blood glucose and promote renal retention of water and sodium. - ANSCortisol In the adrenal gland response ... is released to raise blood glucose and promote renal retention of water and sodium. - ANSCortisol In those with traumatic brain injury where should you maintain the systolic pressure? - ANSgreater than 90 mmHG Inflammatory response - ANSactivated by hypoxia, neutrophils travel to injury site Initial fluid management for patient in shock - ANS1L -2L warmed fluid bolus (NS or LR - crystolloids - pref towards LR as to not cause hyperchloremic metabolic acidosis from large amount of NS) if no evidence of CHF inspect for lacs, abrasions, asymmetry of facial expressions palate for depressions and tenderness look at ears for drainage - ANSHead to toe assessment: Head and face inspect posterior surfaces blogroll with at least 3 people. maintain c spine TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ take out backboard Rectal tone per MD - ANSI inspect, auscultate, palpate any spontaneous breathing, rate, depth, and degree of effort, use of accessory muscles lacs, contusions, auscilate lung sounds and heart sounds - ANSHead to toe assessment: Chest Internal Abdominal Injuries - ANS-Most common "Missed Injury" -Vulnerable Organs: spleen, liver, bladder, bowel, kidneys, aorta -Ongoing assessment needed Intracerebral hematoma - ANSdeep in brain tissue, HA, increased ICP, LOC, pupil changes, frontal lobe more risk for sig herniation Intracranial pressure - ANSNormal ranges 0-15 mm Hg. Intubation with RSI-assess 5 - ANS-assess placement with CO2 detector, bilateral chest rise and fall, auscultation of breath sounds and epigastrium, 5-6 breaths CO2, skin color Intubation- post assessment - ANS- secure at the lip, number at the teeth -state need for a vent Irreversible damage - ANSobtunded comatose, sbp 50-60, brady, shallow resp death Ischemia develops -- Pressure Fasical Development -- Impaired Blood Flow. 6 P's: Pressure, pallor, pulses, paresthesia, paralysis. Extremity goes to level of the ___________!!! NO ______!! - ANSCompartment Syndrome: Level of heart; NO ice!! Ischemia develops -- Pressure Fasical Development -- Impaired Blood Flow. 6 P's: Pressure, pallor, pulses, paresthesia, paralysis. Extremity goes to level of the ___________!!! NO ______!! - ANSCompartment Syndrome: Level of heart; NO ice!! jaw thrust maneuver to open airway and assess for obstruction. If pt has a suspected csi, the jaw thrust procedure should be done by two providers. One provider can maintain c-spine and the other can perform the jaw thrust maneuver. - ANSWhile assessing airway pt is unable to open mouth, responds only to pain, or is unresponsive you should.. TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Kehr sign - ANSshoulder pain referred from the diaphragm when it is irritated by blood within the abdominal cavity Kinect is energy is equal to ... - ANS1/2 the mass x by the velocity squared (v^2) Kinect is energy is equal to ... - ANS1/2 the mass x by the velocity squared (v^2) Kinect is energy is equal to ... - ANS1/2 the mass x by the velocity squared (v^2) Lab evidence of cellular perfusion - ANSBase Excess (Less than -6 is BAD) Lab evidence of cellular perfusion - ANSBase Excess (Less than -6 is BAD) Lab studies for shock pt - ANSINR/PT/Ptt - ongoing ABG with lactate - ongoing Calcium Level Toxicology screen Type+Screen CBC w/Diff H+H BUN +Cre BMP Liver profile labs, wound care, tetanus, administer meds, prepare for transfer - ANSSecondary Reval Adjuncts Late assessment findings of increased ICP include: - ANS- DILATED, NON-REACTIVE PUPILS - UNRESPONSIVENESS to verbal/painful stimuli - ABNORMAL POSTURING (flexation, extension, flaccidity) - CUSHING RESPONSE Widening pulse pressure Reflex bradycardia Decreased respiratory effort Late findings of increased ICP include - ANSDilated, nonreactive pupils, unresponsiveness, abnormal posturing, Cushing response, bradycardia, decreased respiratory Effort Late findings of increased ICP include - ANSDilated, nonreactive pupils, unresponsiveness, abnormal posturing, Cushing response, bradycardia, decreased respiratory Effort Late findings of increased ICP include - ANSDilated, nonreactive pupils, unresponsiveness, abnormal posturing, Cushing response, bradycardia, decreased respiratory Effort TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Multiple people are in the ER of different ages who all go to the same church. They all have the same symptoms. What is the most likely cause? - ANSBiologic MVA diff breathing Tachycardia - ANSLiver lac Narrow pulse pressure (rising diastolic) could indicate - ANSPeriphreal Vasoconstriction, Hypo perfusion, stage 1 + 2 compensated shock, tension pneumothorax, pericardial tamponade Needle decompression insertion site - ANS2nd intracostal space Needle pericardiocentesis, but it is a temp solution. Requires surgical evaluation. (Ultrasound guided) - ANSCardiac Tamponade Intervention: Neurogenic - ANS-loss of vasomotor tone due to decrease in sympathetic control -vasodilation, SCI, BRADY no gurgling, decreased breath sounds L - ANS-in too far, pull out to 3xlength of tube Non-Specific S/S of BCI - ANS-Chest Pain not relieved with Nitro -Dysrhythmias: ST, A fib, BBB, Heart Blocks, PVCs, PACs -Non-Specific ST changes -Cardiac Enzyme elevations don't predict complications -Anterior Chest Wall bruising Normal Co2 ... - ANS35-45 Normal Co2 ... - ANS35-45 Normal Co2 ... - ANS35-45 Normal CPP is ... Acceptable CPP is ... During this auto regulation maintains in a steady state. - ANS60 to 100; 50 to 70 Normal CPP is ... Acceptable CPP is ... During this auto regulation maintains in a steady state. - ANS60 to 100; 50 to 70 Normal CPP is ... Acceptable CPP is ... During this auto regulation maintains in a steady state. - ANS60 to 100; 50 to 70 TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Normal ICP range - ANS0-15 mmHg. Maintain below 20 mmHg NPA - ANS-if pt has a gag -90 degree angle and down -contraindicated in facial trauma or skull fx Nsg Interventions for Compartment Syndrome - ANS-Elevate the limb to the level of the heart to promote venous outflow and prevent further swelling. Elevation above the heart may decrease perfusion to a compromised extremity -Assist with measurement of fascial compartment pressure -Prepare for fasciotomy to preven muscle or neurovascular damage Nsg Interventions for Compartment Syndrome - ANS-Elevate the limb to the level of the heart to promote venous outflow and prevent further swelling. Elevation above the heart may decrease perfusion to a compromised extremity -Assist with measurement of fascial compartment pressure -Prepare for fasciotomy to preven muscle or neurovascular damage Nsg Interventions for Compartment Syndrome - ANS-Elevate the limb to the level of the heart to promote venous outflow and prevent further swelling. Elevation above the heart may decrease perfusion to a compromised extremity -Assist with measurement of fascial compartment pressure -Prepare for fasciotomy to preven muscle or neurovascular damage Nsg Interventions for Compartment Syndrome - ANS-Elevate the limb to the level of the heart to promote venous outflow and prevent further swelling. Elevation above the heart may decrease perfusion to a compromised extremity -Assist with measurement of fascial compartment pressure -Prepare for fasciotomy to preven muscle or neurovascular damage Nsg Interventions for Crush Injury - ANS-Administer intravenous isotonic crystalloid solution to increase urinary output and facilitate excretion of myoglobin -Elevate the injured extremity above the level of the heart to reduce swelling and pain unless compartment syndrome is suspected. For compartment syndrome, maintain at level of the heart -Gently clean open wounds -Prepare the patient for surgical debridement, fasciotomy, or amputation Nsg Interventions for Crush Injury - ANS-Administer intravenous isotonic crystalloid solution to increase urinary output and facilitate excretion of myoglobin -Elevate the injured extremity above the level of the heart to reduce swelling and pain unless compartment syndrome is suspected. For compartment syndrome, maintain at level of the heart -Gently clean open wounds -Prepare the patient for surgical debridement, fasciotomy, or amputation TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Nsg Interventions for Crush Injury - ANS-Administer intravenous isotonic crystalloid solution to increase urinary output and facilitate excretion of myoglobin -Elevate the injured extremity above the level of the heart to reduce swelling and pain unless compartment syndrome is suspected. For compartment syndrome, maintain at level of the heart -Gently clean open wounds -Prepare the patient for surgical debridement, fasciotomy, or amputation Nsg Interventions for Crush Injury - ANS-Administer intravenous isotonic crystalloid solution to increase urinary output and facilitate excretion of myoglobin -Elevate the injured extremity above the level of the heart to reduce swelling and pain unless compartment syndrome is suspected. For compartment syndrome, maintain at level of the heart -Gently clean open wounds -Prepare the patient for surgical debridement, fasciotomy, or amputation Nsg Interventions for Open Fracture - ANS-Irrigate any wound with sterile saline -Cover open wounds with dry, sterile dressings. -Administer antibiotics, as prescribed -Inspect dressings frequently for continued bleeding -Administer tetanus prophylaxis, as indicated Nsg Interventions for Open Fracture - ANS-Irrigate any wound with sterile saline -Cover open wounds with dry, sterile dressings. -Administer antibiotics, as prescribed -Inspect dressings frequently for continued bleeding -Administer tetanus prophylaxis, as indicated Nsg Interventions for Open Fracture - ANS-Irrigate any wound with sterile saline -Cover open wounds with dry, sterile dressings. -Administer antibiotics, as prescribed -Inspect dressings frequently for continued bleeding -Administer tetanus prophylaxis, as indicated Nsg Interventions for Open Fracture - ANS-Irrigate any wound with sterile saline -Cover open wounds with dry, sterile dressings. -Administer antibiotics, as prescribed -Inspect dressings frequently for continued bleeding -Administer tetanus prophylaxis, as indicated Nsg Interventions for Pelvic Fracture - ANS-Stabilize pelvis by wrapping in folded sheet -Apply a pneumatic antishock garment to splint pelvic fractures -Prepare for application of an external fixator Nsg Interventions for Pelvic Fracture - ANS-Stabilize pelvis by wrapping in folded sheet -Apply a pneumatic antishock garment to splint pelvic fractures TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ 2: Codeine 3: Morphine, Fentanyl, Dilaudid PaO2 - ANSPartial pressure of oxygen dissolved in arterial blood, low reading= hypoxia Paradoxical Movement with Flail Chest - ANSFlail area moves in opposite direction of chest cage Patient has GCS of 3, unequal pupils (one sluggish, one blown), and is posturing. What is the cause? - ANSHerniation Patient has GCS of 3, unequal pupils (one sluggish, one blown), and is posturing. What is the cause? - ANSHerniation Patient snoring = insert __________ airway - ANSOral Airway (OPA) Patient snoring = insert __________ airway - ANSOral Airway (OPA) Patients who sustain a mild TBI may develop .... . Typically it will manifest several days or moths after head trauma. - ANSPostconcussive syndrome Patients who sustain a mild TBI may develop .... . Typically it will manifest several days or moths after head trauma. - ANSPostconcussive syndrome Patients who sustain a mild TBI may develop .... . Typically it will manifest several days or moths after head trauma. - ANSPostconcussive syndrome Pediatric Assessment Triangle 1. General appearance - muscle tone, interactiveness, consoloability, poor or gaze, speech or cry 2. Work of breathing - inadequate or excessive, accessory muscle use, retractions, tripod position, abnormal upper airway sounds 3. Circulation of the skin - color, mottling or central or peripheral cyanosis, diaphoresis - ANSPAT Pelvic Fractures - ANS-Bladder can be ruptured -Cause the most deaths from skeletal injury -Ring Structure with many bones -Major nerves & blood vessels can be injured -Major Neuromuscular Compromise to lower extremities -can repair internally or externally -do not turn patient unless stablized Penetrating Cardiac Injuries (hole in heart) - ANS-Stabbings, GSW, Impalements -Right Ventricle commonly injured because more Anterior -HIGH mortality d/t tamponade or exsanguination TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ -Most deaths within 4-5 minutes Pericardiocentesis - ANSfluid aspirated from the pericardium with needle Post concussive syndrome - ANSHa, NV, dizzy, memory impairment, depression Post concussive syndrome - ANSMild TBI Nausea Dizzy HA Memory/judgement impaired Insomnia Irritability Noise/light sensitivity Attention problems Pregnant misshape uterus - ANSUterine rupture Pregnant supine hypo-tension - ANSTilt spine board preparation and triage - ANStrauma team activated prep complete (rapid infuser, chest trauma equipment) don ppe Preventable cause of death - ANSuncontrolled hemorrhage Primary concern when a person cannot stop coughing/clearing their throat following house fire/smoke? - ANSAirway/Intubate Primary concern when a person cannot stop coughing/clearing their throat following house fire/smoke? - ANSAirway/Intubate Primary Survey (ABCDE) - ANSAirway & C-spine stabilization Breathing Circulation: start 2 Iarge bore IVs, Pulses palpated Disability: Neuro, LOC, AVPU, pupils Expose Patient: undress Principle that people have to take action after suffering a loss in order to decrease severity, seriousness, or painfulness - ANSMitigation Principle that people have to take action after suffering a loss in order to decrease severity, seriousness, or painfulness - ANSMitigation Prior to having a concussion (TBI), the patient had a brain injury that was not fully healed. What is the cause? - ANS2nd Impact Syndrome TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Prior to having a concussion (TBI), the patient had a brain injury that was not fully healed. What is the cause? - ANS2nd Impact Syndrome Priority Lab - ANSBlood Typing & Cross Matching Progressive (uncompensated) - ANSSNS fails, body cant perfuse organs, low SBP, confused, disoriented, narrow pulse pressure Pt allergic to contrast dye. How do you premed? - ANSSteroids and antihistamine. Though this is not a guarantee. Pt is at hospital in the right amount of time, right care, right trauma facility, right resources - ANSSafe Care: Pulmonary Contusion - ANSbrusing & bleeding into lung tissue (white out area) often seen with rib fx inflammatory process increased risk of SIRS/ARDs pulmonary contusion - ANSInjury or bruising of lung tissue that results in hemorrhage. swelling, blood and fluids in area, watch fluids, ECG shows PVCs, tach Pulmonary response - ANSIncrease RR to improve O2 and remove CO2 Pulse Pressure (PP) - ANSsystolic pressure - diastolic pressure Purpose of Diagnostic Procedures for suspected Abdominal Trauma - ANSto assess for free fluid (blood) in abdominal cavity Pyramidal maxillary bone fracture involving the mid-face area. The apex of the fracture transverses the bridge of the nose. Assessment findings include: massive facial edema, nasal swelling with obvious fracture of the nasal bones, malocclusion, CSF rhinorrhea - ANSLeFort II Pyramidal maxillary bone fracture involving the mid-face area. The apex of the fracture transverses the bridge of the nose. Assessment findings include: massive facial edema, nasal swelling with obvious fracture of the nasal bones, malocclusion, CSF rhinorrhea - ANSLeFort II Reevaluation and Consider the need to Transfer - ANSFinal step in primary survey TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Right breath sound ONLY following intubation = ________________ -- pull out - ANSMainstem Right Shoulder Pain - ANSLiver Room Air = ____% FiO2 - ANS21% Room Air = ____% FiO2 - ANS21% RSI 7 Ps - ANSPreparation, pre-oxygenate, pretreatment, paralysis, protection, placement with proof, postintubation management Ruptured diaphragm - ANSherniation of abdominal contents into the chest cavity, may hear bowel sounds in the chest S/S of Compartment Syndrome - ANS-Out of proportion pain to what site looks like -Tense skin -Loss of 2 point discrimination -Loss of pulse (Late Sign) S/S of Esophageal Injury? - ANS-Subcutaneous emphysema -Peritoneal irritation -Pain radiating to the neck, chest, shoulders, or throughout the abdomen -Gross blood in gastric aspirate S/S of Esophageal Injury? - ANS-Subcutaneous emphysema -Peritoneal irritation -Pain radiating to the neck, chest, shoulders, or throughout the abdomen -Gross blood in gastric aspirate S/S of Esophageal Injury? - ANS-Subcutaneous emphysema -Peritoneal irritation -Pain radiating to the neck, chest, shoulders, or throughout the abdomen -Gross blood in gastric aspirate S/S of Esophageal Injury? - ANS-Subcutaneous emphysema -Peritoneal irritation -Pain radiating to the neck, chest, shoulders, or throughout the abdomen -Gross blood in gastric aspirate S/S of Flail Chest - ANS-Dyspnea -Pain -Possible Chest Wall bruising -Hemoptysis TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ S/S of Gastric Injury? - ANS-Abdominal Pain -Peritoneal irritation -Evisceration of stomach -Gross blood in gastric aspirate S/S of Gastric Injury? - ANS-Abdominal Pain -Peritoneal irritation -Evisceration of stomach -Gross blood in gastric aspirate S/S of Gastric Injury? - ANS-Abdominal Pain -Peritoneal irritation -Evisceration of stomach -Gross blood in gastric aspirate S/S of Gastric Injury? - ANS-Abdominal Pain -Peritoneal irritation -Evisceration of stomach -Gross blood in gastric aspirate S/S of Hemothorax - ANS-SOB -HOTN from blood loss -Dullness to Percussion -Tachycardia S/S of Intra-Abdominal Bleeding - ANS-Abdominal Pain -Rigid Abdominal Muscles -Rebound tenderness/Guarding -Hypoactive BS -Flank or Umbilical Ecchymosis (make take hours to develop) -Positive DPL or FAST ultrasound S/S of Large and Small Bowel Injuries? - ANS-Peritoneal irritation manifested by abdominal wall muscle rigidity, spasm, involuntary guarding, rebound tenderness, or pain -Evisceration of small bowel or stomach -Hypovolemic Shock -Gross blood from rectum S/S of Large and Small Bowel Injuries? - ANS-Peritoneal irritation manifested by abdominal wall muscle rigidity, spasm, involuntary guarding, rebound tenderness, or pain -Evisceration of small bowel or stomach -Hypovolemic Shock -Gross blood from rectum TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ S/S of Large and Small Bowel Injuries? - ANS-Peritoneal irritation manifested by abdominal wall muscle rigidity, spasm, involuntary guarding, rebound tenderness, or pain -Evisceration of small bowel or stomach -Hypovolemic Shock -Gross blood from rectum S/S of Large and Small Bowel Injuries? - ANS-Peritoneal irritation manifested by abdominal wall muscle rigidity, spasm, involuntary guarding, rebound tenderness, or pain -Evisceration of small bowel or stomach -Hypovolemic Shock -Gross blood from rectum S/S of Open Pneumothorax - ANS-Crepitus -SQ Emphysema -Bleeding -Lung Collapse S/S of Pulmonary Contusion - ANS-Hemoptysis -Decreased BS & Crackles over affected area -Decreased SpO2 (requires oxygen & possibly PEEP) S/S of Renal Injuries? - ANS-Hematuria -Flank or abdominal tenderness elicited during palpation -Ecchymosis over flank may occur, but normally develops 6 to 12 hours after injury S/S of Renal Injuries? - ANS-Hematuria -Flank or abdominal tenderness elicited during palpation -Ecchymosis over flank may occur, but normally develops 6 to 12 hours after injury S/S of Renal Injuries? - ANS-Hematuria -Flank or abdominal tenderness elicited during palpation -Ecchymosis over flank may occur, but normally develops 6 to 12 hours after injury S/S of Renal Injuries? - ANS-Hematuria -Flank or abdominal tenderness elicited during palpation -Ecchymosis over flank may occur, but normally develops 6 to 12 hours after injury S/S of Renal Trauma - ANS-Flank Ecchymosis -Pain -Hematuria S/S of Rib Fractures - ANS-Dyspnea -Pain with breathing -Bruising TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Single tube retroglottic device inserted into the esophagus and traps the glottis opening between an esophageal cuff and an oropharyngeal cuff. Designed with 2 ports/lumens each with a separate cuff. Does NOT provide protection against aspiration and is not indicated in children. It is a retroglottic airway. - ANSKing Tube Single tube retroglottic device inserted into the esophagus and traps the glottis opening between an esophageal cuff and an oropharyngeal cuff. Designed with 2 ports/lumens each with a separate cuff. Does NOT provide protection against aspiration and is not indicated in children. It is a retroglottic airway. - ANSKing Tube Six Ps of compartment Syndrome - ANSPain, Pallor, Pulses, Paresthesia, Paralysis, Pressure Six Ps of compartment Syndrome - ANSPain, Pallor, Pulses, Paresthesia, Paralysis, Pressure Six Ps of compartment Syndrome - ANSPain, Pallor, Pulses, Paresthesia, Paralysis, Pressure Six Ps of compartment Syndrome - ANSPain, Pallor, Pulses, Paresthesia, Paralysis, Pressure Spleen & Liver Injuries - ANS-Bleeding is common -May be life-threatening -Severity of Injury graded (I-V): hematoma, laceration, vascular injury Spleen Injuries - ANS-Kehr's Sign: spleen pain referred to left shoulder -Treat by observation or OR Splenic injury-narrowing PP - ANSOn going blood loss SpO2 - ANSpercent of o2 saturation stabilized vital signs, improved mental status, improved urine output - ANSWhat are indicators of increased perfusion? Stages of Shock (3) - ANS1. Compensated 2. Decompensated vs Progressive 3. Irreversible Stages of Shock (3) - ANS1. Compensated 2. Decompensated vs Progressive 3. Irreversible Stroke volume - ANS-preload, after load, contractibility TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Stroke Volume X HR - ANSCardiac Output = Study of energy transfer as it applies to identifying actual or potential injuries - ANSKinematics Study of energy transfer as it applies to identifying actual or potential injuries - ANSKinematics Subdural hematoma - ANSaccel or decell injury, venous in nature, acute or chronic, elderly, alcoholics, anticaogulants, 72 hrs-2 wks, seizures, aphaisa unilateral fixed dialated pupil Sudden stop/fall - ANSDeceleration Surgical airways - ANS-performed only when ETT can not be done -cricothyroid membrane -hemorrhage, lac to cricoid ring, vocal cord damage Suspected shock type with a spinal cord injury - ANSDistributive Shock (Includes neurogenic) Suspected shock type with a spinal cord injury - ANSDistributive Shock (Includes neurogenic) Symptoms of __________________: include muffled heart sounds and hypotension - ANSPericardiocentesis Symptoms of __________________: include muffled heart sounds and hypotension - ANSPericardiocentesis Tamponade - ANSMuffled heart tones JVD Hypo-tension Tamponade Tx - ANSPeri-cardio-centesis Tension Pneumothorax - ANS-Air is entering into the thoracic cavity & can't get out -Chest wall intact -Blunt Trauma -Medical Emergency -Tracheal & Mediastinal Deviation toward unaffected side -Life Threatening -Heart cannot fill & empty well tension pneumothorax - ANSa pneumothorax with rapid accumulation of air in the pleural space, needle decompress TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ The components of the neurological system involved with pain transmission include... - ANSNeurons, neuron synapses and neurotransmitters The components of the neurological system involved with pain transmission include... - ANSNeurons, neuron synapses and neurotransmitters The components of the neurological system involved with pain transmission include... - ANSNeurons, neuron synapses and neurotransmitters the decrease coagulopathy .. you will you bleed more - ANSThe colder you are the more acidic you are.. The general study of forces and their effects - ANSBiomechanics The general study of forces and their effects - ANSBiomechanics The general study of forces and their effects - ANSBiomechanics The meninges consist of three layers of protective coverings ... - ANS(PAD) pia matter, arachnoid matter and dura matter The meninges consist of three layers of protective coverings ... - ANS(PAD) pia matter, arachnoid matter and dura matter The meninges consist of three layers of protective coverings ... - ANS(PAD) pia matter, arachnoid matter and dura matter The most reliable and valid tool for pain assessment is ... - ANSSelf-report The most reliable and valid tool for pain assessment is ... - ANSSelf-report The most reliable and valid tool for pain assessment is ... - ANSSelf-report The three areas of basilar skull fractures include ... - ANSPeriodontal D.C. my Isra (raccoon eyes - fossa fracture) Mastoid process ecchymoses (behind the ear) Hemotympanum (blood in the tympanic membrane/middle ear) The three areas of basilar skull fractures include ... - ANSPeriodontal D.C. my Isra (raccoon eyes - fossa fracture) Mastoid process ecchymoses (behind the ear) TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Tx is based on size, presence of sx, and stability. For those are aysmpomatic and stable. Observation with or without oxygen. Larger pneumo who are unstable or likely to deteriorate a chest tube is placed. - ANSSimple pneumo interventions: Tx of Abdominal Compartment Syndrome - ANSWound Vac: sucks air & fluid out to allow for bowel to swell & decompresses Tx of BCI - ANS-Prevent -Treat complications -Observation Tx of Cardiac Tamponade - ANSPericardiocentesis, May need fluid challenge Tx of Compartment Syndrome - ANSFasciotomy: opening of the compartment to relieve pressure Tx of Hemothorax - ANS-Chest Tube -Surgery Tx of Renal Trauma - ANS-Minor: Medical Management -Surgical: repair or removal Tx of Rhabdomyolysis - ANSIncrease IV fluids to maintain UO of at least 100-150 ml/hr Tx of Tension Pneumothorax - ANSNeedle Decompression TXA - ANSantifibtinolytic, slow down the dissolution of established clots TXA - ANStranexamic acid inhibits activation of plasminogen (dissolves clots) TXA reduces clot breakdown safely reducing bleeding types of distributive shock - ANSneurogenic, anaphylactic, septic Types of shock - ANS*Hypovolemic*: hemorrhage/burns *Distributive*: Neuro/anaphylactic/Septic *Cardiogenic*: MI/Dysrythmias/blunt cardiac trauma *Obstructive*: Cardiac Tamponade/Tension pneumo/Tension hemo Types of Shock (4) - ANSHypovolemic, Obstructive, Cardiogenic, Distributive Types of Shock (4) - ANSHypovolemic, Obstructive, Cardiogenic, Distributive Uncontrolled Hemorrhage - ANSMajor cause of preventable death: Unilateral fixed and dilated pupil - ANSherniation with CN III compression from increased ICP TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? - ANSA tight-fitting nonrebreather mask at 12-15 lpm. Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? - ANSA tight-fitting nonrebreather mask at 12-15 lpm. Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? - ANSA tight-fitting nonrebreather mask at 12-15 lpm. Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? - ANSA tight-fitting nonrebreather mask at 12-15 lpm. Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? - ANSA tight-fitting nonrebreather mask at 12-15 lpm. Used at the beginning of the initial assessment 1. A Alert. If the pt is alert he or she will be able to maintain his or her airway once it is clear. 2. V responds to verbal stimuli responds to pain. If the patient needs verbal stimulation to respond, an airway adjunct may be needed to keep the tongue from obstructing the airway. 3. P responds to pain. If the pt. responds only to pain, he or she may not be able to maintain his or her airway adjunct may need to be placed while further assessment is made to determine the need for intubation. 4. U Unresponsive. If the pt. is unresponsive, announce it loudly to the team and direct someone to chk in the pt is pulseless while assessing if the cause of the problem is the airway. - ANSAirway and AVPU: Used in OR; does not provide protection against aspiration and not recommended in patients who have eaten recently. It is a supraglottic airway. - ANSLaryngeal Mask Airway Used in OR; does not provide protection against aspiration and not recommended in patients who have eaten recently. It is a supraglottic airway. - ANSLaryngeal Mask Airway Usually seen in athletes, second TBI, 2nd injury occurs BEFORE 1st injury recovers, rare but usually fatal. - ANSSecond Impact Syndrome Usually seen in athletes, second TBI, 2nd injury occurs BEFORE 1st injury recovers, rare but usually fatal. - ANSSecond Impact Syndrome Ventilator Setting that Increases the Risk of Developing a Tension Pneumothorax? - ANSPEEP TNCC 9TH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ Vital signs Interventions Primary survey Pain - ANSPost resuscitation care parameters that are continuously evaluated: What are aortic injuries S/S? - ANS- Hypotension - Decreased LOC - Hypertension in UE's - Decreased quality (amplitude) of femoral pulses compared to UE pulses - Loud systolic murmur in parascapular region - Chest pain - Chest wall ecchymosis - Widened mediastinum on chest xray - Paraplegia What are aortic injuries S/S? - ANS- Hypotension - Decreased LOC - Hypertension in UE's - Decreased quality (amplitude) of femoral pulses compared to UE pulses - Loud systolic murmur in parascapular region - Chest pain - Chest wall ecchymosis - Widened mediastinum on chest xray - Paraplegia What are aortic injuries S/S? - ANS- Hypotension - Decreased LOC - Hypertension in UE's - Decreased quality (amplitude) of femoral pulses compared to UE pulses - Loud systolic murmur in parascapular region - Chest pain - Chest wall ecchymosis - Widened mediastinum on chest xray - Paraplegia What are aortic injuries S/S? - ANS- Hypotension - Decreased LOC - Hypertension in UE's - Decreased quality (amplitude) of femoral pulses compared to UE pulses - Loud systolic murmur in parascapular region - Chest pain - Chest wall ecchymosis - Widened mediastinum on chest xray - Paraplegia