A transcranial doppler is obtained for a patient with a traumatic subarachnoid hemorrhage. The
doppler is positive for vasospasm. The trauma nurse would ... [Show More] expect which of the following
medications to be prescribed? - Answer A vasospasm is a known complication of subarachnoid
hemorrhages. Calcium channel blockers are used to prevent or reverse vasospasms and are
frequently used in the treatment of a subarachnoid hemorrhage. Metoprolol, Hydralazine and
Lisinopril are not calcium channel blockers and would not be effective to prevent and treat
vasospasms caused by a subarachnoid hemorrhage
Which chamber of the heart is most likely to be affected in blunt cardiac injuries? - Answer
Given the anatomical position of the heart in the chest, the right ventricle is most exposed to
the anterior portion of the chest wall and is most likely to be injured in a blunt cardiac injury.
Patients with blunt cardiac injuries frequently experience signs of right ventricular failure.
Additional findings that are associated with blunt cardiac injuries include hypotension, atrial
fibrillation, unexplained sinus tachycardia, multiple PVCs, ST segment changes and right bundle
branch blocks. The left atrium, right atrium and left ventricle are less likely to be injured in a
blunt cardiac injury.
A widened mediastinum is noted on the chest x-ray of a traumatically injured hypotensive
patient. The trauma nurse would anticipate gathering which of the following pieces of
equipment as the highest priority in this scenario? - Answer A widened mediastinum on chest xray, accompanied by hypotension, is strongly indicative of an aortic injury. One of the most lifethreatening complications of an aortic injury is blood loss, which can be treated by giving blood
products via a rapid transfuser. Although patient assessment may be enhanced by inserting an
arterial line, this is less of a priority than giving fluids rapidly. A chest tube is placed in the
pleural space rather than the mediastinum and is therefore not indicated in this scenario.
Similarly, there is nothing in this scenario that indicates a pericardiocentesis is indicated so this
is not a higher priority than preparing a rapid transfuser.
A properly applied pelvic binder sits across the: - Answer A properly applied pelvic binder is
applied across the greater trochanters of the femur. This allows for optimal compression of the
pelvis to control bleeding. Applying it across the midshaft of the femur is too low and would
provide no therapeutic benefit. Applying it across the pelvic ring or the iliac crests is too high
and could actually separate the pelvis further, increasing bleeding and internal damage.
Treatment for an extraperitoneal bladder rupture will most likely include: - Answer Bladder
lacerations that are located below the pelvic peritoneum are diagnosed as an extraperitoneal
bladder rupture. If a laceration is found along with pelvic peritoneum, it would then be
classified as an intraperitoneal bladder rupture. Management of an extraperitoneal bladder
rupture involves urinary catheterization (urethral or suprapubic) to facilitate urinary drainage
from the bladder. Intraperitoneal bladder ruptures require surgical intervention for definitive
closure. An isolated extraperitoneal bladder rupture does not require emergent surgical repair
or interventional radiology.
Hyperextension of the neck is known to cause: - Answer Hyperextension of the neck (the head
snapping backwards commonly seen in "whiplash" injuries) causes compression and damage to
the posterior portion of the spinal cord. In anterior cord syndrome, the mechanism of injury is
the opposite of posterior cord syndrome (a hyperflexion injury where the neck hyperextends
forward - chin to chest) causing injury to the anterior portion of the spinal cord. A cauda equina
syndrome causes injury to the sacral nerve roots within the spinal canal and is caused by falling
directly on the sacrum. Brown-Sequard Syndrome caused by penetrating trauma to the lateral
aspect of the spinal cord will cause a left to right phenomenon instead of a top down
phenomenon.
A patient has a Zone II penetrating neck injury with penetration through the platysma. The
trauma nurse knows that this patient is at increased risk of injury to: - Answer The platysma is a
muscle in the neck that gives support and protection to the vital structures underneath it. Any
time there is penetration through the platysma, there is an increased risk of damage to the
underlying structures in the neck. The neck is divided into three zones. Zone I extends from the
sternal notch and clavicle up to the cricothyroid cartilage. Zone II extends from the cricothyroid
cartilage upward to the angle of the mandible. Zone III extends from the angle of the mandible
to the base of the skull. Structures found in Zone I include the subclavian artery, vertebral
artery, lung apices, trachea, thyroid and esophagus. Zone II includes the internal jugular vein,
esophagus, larynx, vagus nerve, carotid artery and vertebral artery. Zone III includes the salivary
and parotid glands, cranial nerves IX-XII, vertebral artery, distal carotid artery, and distal jugular
vein.
A pregnant patient's fundal height is palpated 6 cm above the umbilicus. What is the estimated
gestational age of the fetus? - Answer Fundal height is defined as the distance from the pubic
bone to the top of the uterus in centimeters. In general, the fundus reaches the umbilicus by 20
weeks. Every centimeter past that point is measured as 1 week. If every one centimeter above
the umbilicus equals one week, then the patient is approximately 26 weeks gestation.
Appropriate care for an amputated body part includes: - Answer When caring for an amputated
body part, the trauma nurse should clean the part removing any dirt and debris, wrapping the
part in a slightly saline moistened gauze, and then placing it in a sealed plastic bag. At this time,
the part should be placed in a second bag containing a mixture of ice and water. It is imperative
that the part does not freeze or does not come into contact with water (which is hypotonic to
body tissue). Also ensure that the amputated part is properly labeled with the patient
information.
Decontamination with water is discouraged in patients exposed to powdered: - Answer Dry
chemicals that should not be irrigated with water include dry lime, elemental metals (including
sodium, potassium, magnesium lithium and phosphorus) and phenol. When exposed to water
these substances will cause a harmful exothermic or "heat producing" reaction burning the
patient's skin. They may also release possible hazardous byproducts into the air. Sulfuric acid,
muriatic acid and cement can all be irrigated with copious amounts of water (although a much
of the dry chemical as possible should be brushed off before irrigation with water is initiated) [Show Less]
