TCRN Quick Notes Exam 177 Questions with Verified Answers
Trauma Assessment (A-I) - CORRECT ANSWER Rapid Assessment!!
•Airway / Cervical spine
... [Show More] (C-Spine)
•Breathing - lung sounds
•Circulation - IV access / blood transfusion
•Disabilities - Neuro assessment /GCS/Pupil
•Exposed/Environmental control
•Full set of VS: Family
•Give comfort measures L- labs, M- monitor, N-NG Tube, O-Oxygen, P-Pain
Secondary Assessment starts now:
•History & physical
•Inspection
Glascow Coma Scale (GCS) - CORRECT ANSWER Neurologic assessment of a patient's best verbal response, eye opening, and motor function.
basilar skull fracture - CORRECT ANSWER Fracture at the base of the skull.
Anterior Fossa- Raccoon eyes (periorbital ecchymosis), Rhinorrhea with CSF leakage
Middle Fossa- Battle's sign (mastoid ecchymosis), Otorrhea with CSF leakage, Hemotympanum (Blood behind ear drum)
Interventions to reduce ICP - CORRECT ANSWER Positioning - HOB 30-45
Avoidance of coughing, straining, and bright lights
Avoid hypotension, hypoxia (keep O2 98%), hypercarbia (keep CO2 35-37) and hyponatremia.
Minimizing environmental stimuli - dark, quiet, low voices/no voices
Remove rigid collar, keep neck midline
Maintain normothermia - tx fever aggressively
Introduce nutrition and physical therapy early
Provide early prophylaxis for venous thrombosis and stress ulcers
Prevent hyperglycemia
Beck's Triad - CORRECT ANSWER Jugular Venous distension, muffled heart sounds, decreased BP -----> Cardiac Tamponade
Cushing's Triad - CORRECT ANSWER three classic signs—bradycardia, wide pulse pressure (increased SBP) and irregular slow respirations —seen with pressure on the medulla as a result of brain stem herniation
compartment syndrome - CORRECT ANSWER any compartment over 20 mm Hg.
Le Fort Fractures I, II, III - CORRECT ANSWER Le Fort 1 - free floating maxilla, lip laceration
Le Fort II- mallocclusion, epitaxis, lengthening of face
Le Fort III- commonly unresponsive, immense swelling "beach ball", severe hemorrhage
epidural hematoma - CORRECT ANSWER a collection of blood in the space between the skull and dura mater char arrived by
-sudden loss of consciousness or,
-shirt period of unconsciousness followed by Lucid period and subsequent deterioration.
-Cushing triad
subdural hematoma - CORRECT ANSWER collection of blood under the dura mater characterized by
- progressive or decreasing loss of consciousness from venous bleed
- headache
-vomiting
-more coming in older and alcoholics
-shaken impact syndrome
- May evolve weeks after initial traumatic insult
normal cerebral perfusion pressure - CORRECT ANSWER 70-90 mmHg 80-100 - must keep over 60!
Cerebral Perfusion Pressure (CPP) - CORRECT ANSWER CPP = MAP - ICP
MAP = (systolic + (diastolic x2))/3
Intracranial Pressure (ICP) - normal range - CORRECT ANSWER 0-15 mm Hg, tx if over 20 mmHg
Normal Mean Arterial Pressure (MAP) - CORRECT ANSWER 90 mmHg
Herniation syndromes - CORRECT ANSWER Displacement of portion of brain through or around linings of brain or openings within the intracranial cavity
Uncal (Lateral from epidural hematoma)
Central (downward from edema)
Uncal herniation - CORRECT ANSWER Medially displaced medial temporal lobe over free margin of tentorium.
S+S
-Ipsilateral (same side) pupil dilation early, bilaterally fixed and dilated late
-Contralateral (opposite side) hemiparesis to abnormal posturing.
central herniation - CORRECT ANSWER Downward herniation of the brainstem from edema
S+S
-Change in LOC - restless progressing to coma
-Dilated nonreactive pupils
-Bradycardia
-Abnormal breathing pattern (Cheyne-Stokes)
Types of shock - CORRECT ANSWER Hypovolemic
Distributive
Cardiogenic
Obstructive
Types of Shock: Cardiogenic - CORRECT ANSWER inability of heart to pump enough blood
ex: MODS, heart failure, Blunt trauma to heart
Types of Shock: Hypovolemic - CORRECT ANSWER A condition in which low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion.
Types of Shock: Distributive - CORRECT ANSWER Volume is there but in the wrong place - vasodilates and pools in extremities not going back to get O2.
Low BP includes Septic (severe infection), Neurogenic (damage to the spinal cord), Anaphylactic (reaction to substance), Psychogenic (feinting)
Neurogenic shock - CORRECT ANSWER Distributive shock: Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread vasodilation + brady cardia; seen in patients with spinal cord injuries or sympathetic area of brain.
s+s: Warm, dry, & pink/flushed skin below the level of the injury. Cool and clammy above level of injury.
tx: Assist breathing + intubation, IV fluids + vasopressors to ^ BP, prevent hypotension, hypoxia, aspiration, urinary retention, and skin breakdown.
Types of Shock: Obstructive - CORRECT ANSWER Shock that occurs when there is a block to blood flow to/from the heart or great vessels, causing an insufficient blood supply to the body's tissues.
ex: Pregnant woman laying flat in last trimester compressing the vena cava (lay on L side), tension pneumothorax (chest tube), excessive PEEP (reduce PEEP), Aortic aneurysm (surgery), pulmonary embolism (thrombolytics).
Beta 1 receptors - CORRECT ANSWER predominant receptor found on the heart.
^ HR, ^ Contractility, ^ automaticity (electrical speed)
Beta 2 receptors - CORRECT ANSWER Think 2 - for 2 lungs.
^ respiration, bronchodilation.
Inflammatory response causes: - CORRECT ANSWER Vasodilation (low BP), ^ capillary permeability, ^ coagulation
Anterior cord - CORRECT ANSWER decending motor nerves
Posterior Cord - CORRECT ANSWER ascending sensory nerves (light touch, proprioception (position sense), vibration)
Lateral Cord - CORRECT ANSWER Ascending sensory nerves (pain, temperature, crude touch)
Anterior Cord Syndrome - CORRECT ANSWER - caused by flexion injuries
- occurs when 2/3 of the anterior cord is lost
- *motor function, pain, and temperature sensation lost bilaterally below the lesion* (*flaccidity* below the lesion)
the only thing intact is proprioception (position sense) and vibratory sensation
worse prognosis of incomplete injuries with only 10-20% recovery of motor fnx
Central Cord Syndrome - CORRECT ANSWER occurs with hyperextension of the cervical area. Symptoms include weakness or paresthesia in the upper extremities but normal strength in lower. Typical in the elderly.
Brown-Sequard Syndrome - CORRECT ANSWER Hemi-section of the cord (by stab or GSW)
- ipsilateral (same side) spastic paralysis and loss of position sense aka loss of motor fnx
- contralateral (opposite side) loss of pain and temp sense
good prognosis! 90% revovery of ambulation
What masks the early signs of shock? - CORRECT ANSWER Beta Blockers (Carvedilol, Metoprolol, labetalol etc.) b/s they help to control HR and BP.
What should you worry about in cheek laceration? - CORRECT ANSWER Parotid duct (you can see saliva in the blood coming out of the laceration)
What areas should you use caution applying lidocaine with epinephrine? - CORRECT ANSWER Nose and ears b/c decreased circulation can lead to increased risk of infection.
Orbital Fracture - CORRECT ANSWER Caused by direct trauma to the eyeball. Signs: blurred vision, diplopia, restricted eye movement/limited upward gaze, downward displacement of the eye, soft-tissue swelling and hemorrhaging, numbness.
Hyphema - CORRECT ANSWER Blood in anterior chamber of the eye. Needs to be evaluated daily by optothalmologist. Keep HOB up 30 degree, do not blood nose, do not take aspirin or NSAID, do not lean forward. If increased pain go to ED.
Retinal Detachement (3 things) - CORRECT ANSWER Visual Floaters, flashes of light, curtain/veil vision
Globe Rupture - CORRECT ANSWER Tear drop shaped pupil, decreased IOP, aqueous or vitreous humor leakage. Secure impaled object do not use eye drops.
Zygomatic Fracture - CORRECT ANSWER TIDES
Trismus: reduced ability to open jaw related to mucsle spasm
Infraorbital hypesthesia: loss os sentation to heat, cold, touch, pain
Diplopia: double vision
Epistaxis: nosebleed
Symmetrical: subcutaneous emphysema of the face, flattening of the cheek on the affected side.
When is mannitol contraindicated? - CORRECT ANSWER Hypovolemia/hypotension
SCIWORA - CORRECT ANSWER spinal cord injury without radiographic abnormality
Happens in pediatrics due to weak neck muscles typically under age of 8 must have MRI to diagnose
Pediatric Burn Formula - CORRECT ANSWER 3mL x kg's x %TBSA
pediatric minimum SBP - CORRECT ANSWER 70 + (2xage in years)
Normal fetal heart rate - CORRECT ANSWER 110-160 beats per minute; fetal distress is tachycardia, bradycardia is severe distress.
What is the approximate age of a fetus if you can feel the fundal height at the umbilicus? - CORRECT ANSWER approx 20 weeks
uterine rupture - CORRECT ANSWER A tear in the wall of the uterus. Who is at risk- prior C-sections, large babies, contractions too close to each other, multiple babies, rapid labor, prior abortion/uterine manipulation with window or scarring in uterus.
s+s=
Sudden onset of intense abd. pain
- momentarily pain w/ diffuse pain thereafter
vaginal bleed: spotting-severe hemorrhage
Tachycardia
palpate fetal parts over the abdomen
Asymmetry of the uterus
placenta abruptio - CORRECT ANSWER A life-threatening emergency condition in which the placenta peels away from the wall of the uterus, causing massive bleeding., severe back pain, dark red vaginal bleeding, increased fundal height
placenta previa - CORRECT ANSWER implantation of the placenta over the cervical opening or in the lower region of the uterus
painless with bright red vaginal bleeding.
what medication stops contractions/preterm labor? - CORRECT ANSWER Magnesium Sulfate (tocolytic)
Nitrazine test - CORRECT ANSWER 1. A Nitrazine test strip is used to detect presence of amniotic fluid in vaginal secretions.
2. Vaginal secretions have a pH of 4.5 to 5.5; they do not affect yellow color of Nitrazine strip or swab
3. Amniotic fluid has a pH of 7.0 to 7.5 and turn yellow Nitrazine strip or swab a *blue color*.
4. Interventions
a. Place client in dorsal lithotomy position
b. Touch test tape to fluid
c. Asses test tape for a blue-green, blue-gray, or deep blue color, which indicates that membranes are probably ruptured.
magnesium toxicity symptoms and tx - CORRECT ANSWER diarrhea, alkalosis, dehydration, hypotension, slurred speech, difficulty breathing, hyporeflexia
tx: calcium gluconate
Kleihauer-Betke test - CORRECT ANSWER used to detect fetal blood in maternal circulation. Pt will possibly need Rhogam and c-section.
Grey Turner's sign - CORRECT ANSWER discoloration/bruising over the flanks suggesting intra-abdominal/retroperitoneal bleeding.
Kehr's sign - CORRECT ANSWER Pain that radiates to the left shoulder and sometimes down the left arm; results from a spleen injury or rupture/bleeding in peritoneal cavity.
Perform a FAST!
Cullen's sign - CORRECT ANSWER ecchymosis in umbilical area, seen with pancreatitis or injured liver
Monitor H+H
Saegessar's Sign - CORRECT ANSWER referred neck pain
flail chest treatment - CORRECT ANSWER Free-floating section of ribs. S+S paradoxical chest movement. "see saw" respirations.
BVM is best treatment, secure with a bulky dressing, consider rapid transport, may need to intubate. Can place injured side down. End goal is surgical rib fixation.
tension pneumothorax - CORRECT ANSWER A life-threatening collection of air within the pleural space; the volume and pressure have both collasped the involved lung and caused a shift of the mediastinal structures to the opposite side that can cause obstructive shock.
s+s
Severe restlessness
significantly diminished sounds in injured side
Hypotension
Distended neck and head veins
Tracheal deviation toward uninjured side
cyanosis (late sign)
tx: needle decompression and/or chest tube.
cadiac tamponade - CORRECT ANSWER Pericardial sac fills with blood form blunt trauma and causes cardiogenic shock.
s+s
chest pain
tachycardia or PEA
Dyspnea or Cyanosis
Electrical alternans & Kussmauls sign
Pulsus Paradoxus (where SBP drops of 10 mmHG with inspiration)
Becks Triad
Beck's triad - CORRECT ANSWER hypotension, JVD, muffled heart sounds
What vent settings can you adjust to increase/decrease PaO2 - CORRECT ANSWER PEEP or FiO2
What vent settings can you adjust to increase/decrease PaCO2 - CORRECT ANSWER Tidal Volume and Respiratory rate (^ to blow off CO2)
traumatic asphyxia - CORRECT ANSWER A pattern of injuries seen after a severe force is applied to the chest, forcing blood from the great vessels back into the head and neck.
S+S
Subconjuncteval hemorrhage, discoloration of lips, nose+eyelids, PVCs on EKG, chest wall pain, blueish above injury.
Tx: care of associated injuries and supportive
Bronchial rupture - CORRECT ANSWER cause: blunt chest trauma
s+s: dyspnea, dysphonia, hemoptysis, hammans crunch, SQ emphysema.
Sx: persistent pneumothorax despite chest tube and pneumomediastinum with SQ air.
Right main bronchus most commonly injured typically an inch from carina.
Dx: CT, bronchoscopy, surgery.
Tx: most die within first hour but surgery
Diaphragmatic rupture - CORRECT ANSWER Herniation of the abdominal viscera into the chest occurs (usually on L side) when there is a traumatic defect in the diaphragm produced by blunt or penetrating trauma to the upper abdomen or lower thorax. Shifts mediastinum to the right.
s+s: SOB, dysphagia, bowel (peristaltic) sounds in chest, Kehr's sign, decreased breath sounds on injured side.
Tx: surgery
1st and 2nd ribs fractures - CORRECT ANSWER bad news! Look out for great vessel injury.
90% of aortic injuries occur at the ligamentum of arteriosum which secures the heart to the aorta. Rapid acceleration/deceleration injuries can tear the aorta decreasing L arm BP etc
Aortic Tear - CORRECT ANSWER Traumatic tearing or laceration of the aorta
>90% @ aortic isthmus (where heart and aorta connect)
Symptoms: Many do NOT have visual signs of chest pain. Change or altered in mental status, L arm BP decreased, new onset murmur, obscured aortic knob, widened mediastinum on xray possible 1st or 2nd rib fracture.
Imaging: *CT modality of choice
tx: emergency surgery. maintain pulse 60-80, SBP 100-120 with fluids and beta-blockers
Tx for stable pt with pulmonary contusion? - CORRECT ANSWER Judicious use of IV fluids to decrease risk of pt going into ARDS.
splenic injury grades - CORRECT ANSWER Grade 1 - hematoma <10% surface area, laceration <1cm depth
Grade 11 - hematoma 10-50% surface area, laceration 1-3cm depth
Grade 111 - >50% surface area, laceration >3cm depth
Grade 1V- devascularization >25% of spleen
Grade V - completly shattered, hilar vascular injury that devascularizes spleen.
Urethral injury - CORRECT ANSWER Posterior Urethral Injury
- signs of POSTERIOR urethral injury
i. blood at meatus
ii. inability to void
iii. high riding prostate
Anatomy of Posterior Urethra - includes
i. prostatic urethra
ii. membranous urethra
- when you see additionally a PERINEAL OR SCROTAL HEMATOMA, THINK CAUSE = PELVIC FRACTURE CAUSED BOTH URETHRAL INJURY + HEMATOMA
- on suspicion of POSTERIOR urethral injury - DO RETROGRADE URETHROGRAM BEFORE INSERTION FOLEY CATHETER (blind insertion can cause infection of periurethral hematoma)
- Tx of Posterior Urethral injury - after retrograde urethrogram - do URINARY DIVERSION VIA SUPRAPUBIC CATHETER WHILE PRIMARY INJURY + ASSOC HEMATOMAS ARE ALLOWED TO HEAL; after healing complete, repair residual damage
Anterior Urethral Injury
- in case of ANTERIOR urethral injury - IMMEDIATE SURGICAL REPAIR
- urethra portion that is distal to urogenital diaphragm
- causes may be:
i. BLUNT TRAUMA TO PERINEUM AKA STRADDLE INJURIES
ii. INSTRUMENTATION TO URETHRA
- Findings/Presentation
i. perineal tenderness or hematoma
ii. normal prostate (vs "high riding prostate)
iii. bleeding from urethra (versus blood at meatus)
iv. retain ability to void (versus posterior urethral injury)
v. may see delayed presentation - patient may first present when there is SEPSIS DUE TO EXTRAVASATION OF URINE INTO SCROTUM, PERINEUM, OR ABD WALL
lap belt injury - CORRECT ANSWER from MVA
chance fracture (flexion disruption of lumbar spine T12-L2)
damage to hollow organs- bowel perforation, stomach or bladder
Monitoring abdominal compartment pressures through bladder pressure readings - CORRECT ANSWER 1. Pt supine
2. Tranducer leveled at symphysis pubis
3. do not add more than 50mL of sterile saline before reading pressure
4. notify MD is reading over 20 mmhg
-NORMAL reading is 12-15mm Hg
Abdominal compartment syndrome - CORRECT ANSWER sustained intra-abdominal pressure exceeding 20 mmHg associated with new organ dysfunction or failure. Increased peak airway pressure, low urine output, and urinary bladder >20 mmHg
Abdominal Perfusion Pressure (APP) - CORRECT ANSWER = MAP - IAP
Target APP is above 60 mmHg
intra-abdominal pressure - CORRECT ANSWER as diaphragm contracts, pressure exerted on abdominal cavity is created in opposite direction to this movement. Normal IAP is 5- 7 mmHm. Intra-abdominal hypertenison is over 12 mmHg
In blunt abdominal traumas which organ injury commonly goes undetected sue to its asymptomatic initial presentation? - CORRECT ANSWER Pancreas
Rule of 9's adult - CORRECT ANSWER
Parkland Burn Formula - CORRECT ANSWER V = Pt Weight (kg) x Body Surface Burned (%) x 4
First half is to be given of first 8 hours with the remaining amount given over the remaining 16 hours.
American Burn Association Modified parkland Formula - CORRECT ANSWER adults with over 20% burned need fluid resuscitation:
LR at 2 mL x kg x BSA for adult thermal burns, 3 for pediatrics, 4 for electrical burns.
First half is to be given of first 8 hours with the remaining amount given over the remaining 16 hours.
Pediatric Burns: Rule of "10s" - CORRECT ANSWER Head & Neck = 20% Trunk = 20 + 20 Extremities = 10 each (arms & legs equal)
burn zones - CORRECT ANSWER Coagulation: irreversible injury;
Stasis: may die w/o special treatment - rapid fluid resuscitation
Hyperemia: minimal injury, should recover (most peripheral)
Normal Carboxyhemoglobin Level and tx & s+s for high levels (Carbon monoxide, COHb) - CORRECT ANSWER normal COHb = <10%, give high flow O2 (15L non-rebreather) until it normalizes. Pulse ox is not reliable. Half life of CO is 4 hours.
CO less than 20% usually no s+s
CO 20-30% nausea + vomiting
CO 30-40% confusion
CO 40-60% coma
CO over 60% death
*note: pregnant women are more likely to need a hyperbarics chamber to support fetal circulation.
What is the most common finding in those struck by lightening? - CORRECT ANSWER ruptured tympanic membrane. Over 50% of all victims will have at least one.
Lichtenberg figures - CORRECT ANSWER pathognomonic for lightning strike (Fern leaf burns) -not true burns - arborizing fernlike marks that occur in 20-30% of cases
*disappear within a few hours and not considered a thermal injury b/c it lacks histological features of a burn
Electric/lightening burns - CORRECT ANSWER Do not mark entrance or exit. Use C-Spine precautions. Most of the burn will be unseen. use formula 4 mL x kg x BSA for fluid resuscitation.
Watch otu for rhabdomyolsis (dark urine, hyperkalemia, renal failure)
Compartment Syndrome S/S - CORRECT ANSWER 5 P's!!!
1. Pain (out of proportion, deep throbbing, wont go away with meds)
2. Paresthesia - loss of sensation in most distally
3. Paralysis Passive stretch(w/hyperextension),
4. Pallor,
5. Pulselesness - Absent/diminished pulses
Any compartment over 20mmHg pressure. Forearms and lower leg most affected.
Tx of compartment syndrome - CORRECT ANSWER Remove cast/split, elevate limb to the level of heart NOT above
- fasciotomy or escharotomoy w/burns
- I&D
- delayed closure
-possible amputation
Burn Center Referral Criteria - CORRECT ANSWER 1. Partial thickness burns greater than 10% area (TBSA).
2. Face, hands, feet, genitalia, perineum, or major joints involvement
3. Third degree (full thickness) burns in any age group
4. Electrical burns, including lightning injury
5. Chemical burns
6. Inhalation injury
7. Pt. has preexisting medical disorders that could complicate management, prolong recovery, or affect mortality.
8. Any pt. with burns and concomitant trauma
9. Burned children in hospitals without qualified personnel or equipment for the care of children.
10. Burn injury in patients who will require special social, emotional, or rehabilitative intervention.
Asphalt burn tx - CORRECT ANSWER use fat emollients (like mayo or bactracin) to loosen, peel off when cool
Alakline burns - CORRECT ANSWER ex: lye or ammonia
use large volumes of irrigation due to saponification (destroy tissue) does deep worse than acid burns
phenol (carbolic acid) burn - CORRECT ANSWER causes whitening of the exposed area; if ingested patient should drink large amounts of water and be referred for medical evaluation
copious irrigation with 50% PEG (Miralax) and water
Hydrofluoric acid burns - CORRECT ANSWER Irrigate for at least 30min, until pain relief, then apply 2.5% calcium gluconate gel.
Dry chemical burns - CORRECT ANSWER lightly brush off the dry chemical use soap and water after
To assess pelvic fractures apply pressure.. - CORRECT ANSWER gently press inward over the iliac crest and downward over the symphysis pubis. Do not apply pressure if one is suspected.
Cauda Equina Syndrome - CORRECT ANSWER from hard fall on bottom
-Injury at the L1 level and below (to L5) resulting in a LMN lesion
S+S
-saddle anesthsia
-loss of bowel or bladder function
-lower extremity weakness that can progress to Flaccid paralysis w/no spinal reflex activity if not caught and treated.
Imaging used = CT or MRI
First thing to do in pelvic fractures? - CORRECT ANSWER Apply a pelvic binder, even if on a pregnant woman, to decrease the area for blood to pool and to stabilize the pelvis. Then fluid resus, massive blood transfusion protocol, need interventional radiologist and angio-embolization (REBOA).
s+s
frog leg in open book fracture
externally rotated hip
swelling of the scrotum
blood at urinary meatus
blood in urine
shortening of leg
Lateral compression fracture of pelvis - CORRECT ANSWER Most common (60-70%)
Typically from MVA side on collision
Hemorrhage not likeyl but bladder injury possible
internal rotation
AP compression / open book pelvis fracture - CORRECT ANSWER 15-20% frequency with 50% mortality
typically from auto vs ped or motorcycle crash, direct crush injury to pelvis
pelvic ring opens = hemorrhage from posterior pelvic venous complex
tear of posterior osseous ligamentous complex
internal iliac artery may also be involved
vertical shear pelvic fracture - CORRECT ANSWER -fall off roof
-land on 1 leg
-through SI joint
- ligaments disrupted
FOOSH injury - CORRECT ANSWER fall on outstretched hand
Radial fracture w/ dorsal displacement, dinner-fork deformity (colles)
farmers hoe (Smiths)
axial loading injuries - CORRECT ANSWER Injuries in which load is applied along the vertical or longitudinal axis of the spine, which results in load being transmitted along the entire length of the vertebral column; for example, falling from a height and landing on the feet in an upright position. May have bilateral calcaneal fracture but also spine injury and/or tibial plateau injury that are commonly associated with the injury.
How long are sutures left in for? - CORRECT ANSWER Face = 3-5 days
Extremity = 7 days
Scalp and trunk = 7-10 days
Joint = 14 days
in general no suture will be left in over 14 days
Boxer's fracture - CORRECT ANSWER 4th or 5th metacarpal fracture typically after punching an object. Splint the wrist in a mild extension for 3-4 weeks.
Ulnar fracture - CORRECT ANSWER Defense injury
Scaphoid fracture - CORRECT ANSWER injury of the snuffbox (anterior between thumb and index finger)!!! Typically not seen on xray unless specifically xraying for it
Fat Emoblism - CORRECT ANSWER a type of embolism that is often caused by "physical trauma" such as fracture of (long bones, soft tissue trauma, and burns).
s+s
present 24-72 hr after injury/long bone fx
-altered mental status
-respiratory distress
-*petechial rash* to head, neck, torso, anterior thoraz, conjunctiva, buccal mucousa membranes or axillae (60%)
Tx: is supportive - ventilation/oxygenation
When do you remove a turniquet? - CORRECT ANSWER When the surgeon says so.
Turniquet rule of 2s - CORRECT ANSWER Place 2in above laceration
should be 2in in width
Place a second 2 in above first if 1st doesn't control it
Knee dislocation - CORRECT ANSWER EMERGENT REDUCTION due to compressed popliteal injury. A vascular injury may occur in up to 40% of these patients, with half requiring amputation
posterior hip dislocation - CORRECT ANSWER EMERGENT REDUCTION "dashboard knee" from MVA
Radial nerve injury - CORRECT ANSWER extend thumb "hitchhikers"
Median nerve injury - CORRECT ANSWER Opponents splint (thumb spica), C-bar (hand in C position)
Ulna nerve - CORRECT ANSWER supplies most hand muscles, fan out fingers
what injury has a high chance for osteomylitis - CORRECT ANSWER human bite/ fight bites
shot gun pellets - CORRECT ANSWER risk for emboli
high-pressure grease or hydraulic fluid injection injury - CORRECT ANSWER IMMEDIATE surgical debridement
List the 5 stages of grief - CORRECT ANSWER 1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
Appropriate response to grief - CORRECT ANSWER RESPOND
Reassure
Establish rapport
Support,
plan & manage pain
Offer hope
Never deliver bad news alone
Determine the pts needs
PTSD (Post Traumatic Stress Disorder) - CORRECT ANSWER a disorder characterized by flashbacks, nightmares, insomnia that lingers for four weeks or more, difficulty concentrating, being easily startled (hypervigilance), and isolation after a traumatic experience. In depression there are often thoughts of hopelessness or "better being off dead."
Expression of traumatic grief - CORRECT ANSWER 1. Somatic - physical complaints: headache, sleep disturbances, nausea
2. Cognitive - hopelessness, helplessness, seems unreal
3. Affective - guilt, resentment, depression
4. Behavioral - agitation, fatigue, crying, social isolation
shaken impact syndrome (shaken baby) - CORRECT ANSWER generally occurs in children under 2 years old.
s+s
bilateral ecchymosis on the torso
retinal hemorrhages
crepitus over ribs
What do you worry about after surgery? - CORRECT ANSWER Emboli, sepsis
Systemic Inflammatory Response Syndrome (SIRS) - CORRECT ANSWER Widespread uncontrolled acute inflammatory response to a severe insult (infection, burn, trauma, cancer).
^ mediator release
^ vasodilatation
^ capillary permeability
decrease BP
3rd spacing
get a lactate and ABG for base deficit (normal is -2 to +2)
SIRS criteria - CORRECT ANSWER 2/4 of the criteria
Temp > 38.5 (101.4F) or < 35 (95 F)
Pulse > 90
Resp > 20
WBC > 12,000, < 4000, > 10% bands
Class hemorrhage and hemodynamic effects. - CORRECT ANSWER
Optimal urinary output in adult and pediatric - CORRECT ANSWER 0.5-1mL/kg/hr adult
1-2mL/kg/hr ped
hemorrhagic shock fluid resuscitation in pediatric pt - CORRECT ANSWER 2 cyrstalloid bolus at 20 ml/kg .. no improvement? PRBCs at 10cc/kg
What hgb do you transfuse? - CORRECT ANSWER < 7g/dL
Which electrolyte imbalances should you watch out for after transfusions? - CORRECT ANSWER Hypocalcemia, hypomagnesmia, potassium irregularities
permissive hypotension - CORRECT ANSWER SBP 80-90 to decrease blood loss in trauma pt until they reach surgery. contraindicated in head trauma
why can crystalloid fluid be bad in trauma - CORRECT ANSWER it can cause/worsen hypothermia, metaolic acidosis, and coagulapathy.
Mean Arterial Pressure (MAP) - CORRECT ANSWER pressure forcing blood into tissues, averaged over cardiac cycle Normal 60-100 mm Hg
Cardiac Output (CO) - CORRECT ANSWER measurement of the amount of blood ejected per minute from either ventricle of the heart
Normal: 4-8 L/min
Cardiac Index (CI) - CORRECT ANSWER Normal range 2.5 to 4 L/min.
< 2.1 inconsistent for weaning.
Central Venous Pressure (CVP) - CORRECT ANSWER the pressure of blood in the thoracic vena cava, near the right atrium of the heart; reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system
Normal 2-6 mm Hg
Pulmonary Artery Systolic Pressure (PAS) - CORRECT ANSWER Normal: 15-30 mm Hg
Pulmonary Artery Diastolic Pressure (PAD) - CORRECT ANSWER Normal: 8-15 mm Hg
Pulmonary Artery Occlusive Pressure (PAOP) - CORRECT ANSWER Left pressure
Normal: 6-12 mm Hg
Pulmonary Vascular Resistance (PVR) - CORRECT ANSWER Opposition encountered by the right ventricle
<250 dynes
Systemic Vascular Resistance (SVR) - CORRECT ANSWER the pressure in the peripheral blood vessels that the heart must overcome to pump blood into the system
Normal: 800-1200 dynes
Stroke Volume (SV) - CORRECT ANSWER measurement of the amount of blood ejected from a ventricle in one contraction
Normal: 60-100 mL
Stroke volume Index (SVI) - CORRECT ANSWER 40-50 ml/m2
Mixed Venous Saturation (SvO2) - CORRECT ANSWER 60-80%
Thromboelastography (TEG) - CORRECT ANSWER It predicts the need for transfusion and guides transfusion strategy. It tests clot formation and strength, platelet function, and coagulation.
Haddon Matrix - CORRECT ANSWER A way of conceptualizing injury prevention strategies based on the phase and whether the strategy is targeted to the host, the vehicle, or the environment.
Pre-event: posting appropriate speed limit
Intra-event: using occupant safety restraints in automobiles: advocating for crash-resistant roadside barriers
Post event: ensuring adequate receiving facility trauma readiness.
Four E's of Injury Prevention - CORRECT ANSWER Engineering
Enforcement
Education
Economic Incentives
- CORRECT ANSWER e
Blast Injuries - CORRECT ANSWER Primary = blast wind/pressure wave often lethal impact
Secondary = flying debris (fragment injuries, puncture wounds, lacerations/impaled objects)
Tertiary = patient displacement, blunt object impacts from winds
Quarternary = collapse building inhalation or external burns
Quinary = exposure to radioactive, biological or chemical compents of blast
wolf model of trauma nursing - CORRECT ANSWER knowledge, critical application, and advocating/moral agency
injuries associated with lateral impact - CORRECT ANSWER same side sholder, clavicle and ribs, pelivc fractures, liver, spleen
injuries associated with frontal impact - CORRECT ANSWER aoritc and cardiac, rib fractures, spleen injuires, posterior hip dislocation, knee and femur.
injuries associated with rear-end impact - CORRECT ANSWER neck hyperextension/hyperfelxtion
injuries associated with roll over - CORRECT ANSWER DAI
injuries associated with ejection - CORRECT ANSWER 4x more likely to be lethal
Waddell's Triad - CORRECT ANSWER injury for pediatric pedestrian struck by MVC
femur #
intra thoracic/intra abd injury
contralateral head injury
What holds the greats potential for injury? - CORRECT ANSWER Velocity. ex: handgun is medicum velocity while shot gun is high velocity.
Criteria for transferring to a Level 1 or 2 - CORRECT ANSWER penetrating injury or open skull fracture, GCS below 14 or lateralizing neurological signs, spinal fracture or spinal cord deficit, more than 2 unilateral rib fractures with pulmonary contusion, open long bone fracture, and/or significant torso injury with advanced co-morbitiy disease.
American College of Surgeons ____ trauma centers - CORRECT ANSWER validates
sate and local level ______ trauma centers - CORRECT ANSWER designate
autonomy - CORRECT ANSWER self-determination is pt's right (DNR, right to refuse)
beneficence - CORRECT ANSWER the care that is in the best interest of the client
-care for unresponsive pt
Nonmaleficence - CORRECT ANSWER do no harm
Justice - CORRECT ANSWER treating pt fairly
Utility - CORRECT ANSWER overall good outweighs individual need
veracity - CORRECT ANSWER truth telling, admitting an error
fidelity - CORRECT ANSWER honor commitments, loyalty
Disaster Management: Mitigation - CORRECT ANSWER Hazards vulnerability analysis
Disaster Management: Preparedness - CORRECT ANSWER Develop mutual aid agreements, stockpile, disaster drills
Disaster Management: Response - CORRECT ANSWER Disaster triage
Disaster Management: Recovery - CORRECT ANSWER replenish supplies, dispose of waste, psychological care
Disaster Management Cycle - CORRECT ANSWER mitigation, preparedness, response, recovery
Steps in the Research Process - CORRECT ANSWER 1. Identify the problem
2. Conduct a review of the literature
3. Identify a theoretical framework
4. choose appropriate methodology
5. Sampling (who is in study)
6. Institutional Review Board approval
7. data collection / management
8. Determine data validity (right instrument) and reliability (same result)
9. Data analysis
10. Results, conclusions and recommendations.
Goal for CPP - CORRECT ANSWER Maintain pressure greater than 60 mmHg but lower than 70
When someone has a severe TBI goals are: - CORRECT ANSWER 1. Maintain normothermia 36-37 C
2. Keep ICP below 20
3. Keep CPP above 60
4. Keep BP
5. Keep PaCO2 35-45
Complete Cord Injury - CORRECT ANSWER All voluntary movement below the level of trauma is lost
at what level of injury is the diagram affected? - CORRECT ANSWER C4 level or higher and require ventilator [Show Less]