TCRN FINAL STUDY GUIDE 2026
COMPLETE QUESTIONS AND ANSWERS.
◉ CT scan. Ans: Hemodynamically stable patients may be taken to CT
◉ Angiography. Ans: Embolization is useful in treating patient with
unstable pelvic fractures, liver and splenic hemorrhage. Use of hybrid
OR suites to allow for surgical and interventional radiology methods of
treatment simultaneously.
◉ Diagnostic laparoscopy. Ans: Can be used to detect or exclude finding
so f hemoperitoneum, organ injury, intestinal spillage or peritoneal
penetration. Most useful in evaluating possible diaphragmatic injuries,
espectially in penetrating thoracoabdominal injuries on the left site
◉ Diaphragmatic injuries. Ans: Usually resultant of penetrating
throacoabdominal injuries on the left side, including 11-12 rib fractures
on the left.
◉ Small intestine injuries. Ans: Result from shearing forces in MVC or
direct blows that crush intestine between force and the vertebrae. Most
commonly intra-abd injury in penetrating trauma. Occurs often with
spinal injury. Pancreatic/solid organ injury are predictive of increased
risk for hollow viscus injury. Signs of peritonitis develop. Any blow to
,the abd/penetrating injury to the lower chest/abd should increase
suspicion of injury
◉ Treatment of small intestine injury. Ans: Control bleeding prior to
exploration. Debridement and closure and ligation of bleeders. Resection
for multiple defects. Observe for wound infection/abscess development
◉ Cause of duodenum injuries. Ans: Penetrating trauma most frequent
cause. Usually conconcurrent mult-organ injuries. Usually found
intraoperatively, commonly missed during exlap. Blunt force injury
cause by vetebral compression.
◉ Duodenal injury treatment. Ans: Identification with CT scan.
Commonly patients have midepigastric or back pain with evolving
peritoneal signs 6-24 hrs after injury. Primary closure in OR, closed
drainage system. Goals are to control hemorrhage, debride devitalized
tissue and provide drainage. Non operative management requires close
observation for expanding or ruptured hematomas causing bleeding or
peritoneal contamination.
◉ Jejunum and ileum injuries. Ans: Jejunum lies in umbilical region,
ileum lies in the hypogastric/pelvice regions. Lap belt can cause bowel
to be crushed between the vertebrae and a solid object. Incorrect wearing
of seatbelt increases chance for injury
, ◉ Stomach injury. Ans: Rare, more common in children. Penetrating
trauma most common cause. May find free air on cxr/fua. Pain to
epigastric/abd area, tenderness, signs of peritonitis. Bloody output from
gastric tube. Surgical intervention, is gastric content leakage, copious
peritoneal irrigation and delayed primary closure
◉ Large intestine. Ans: Rectal injuries may be associated with severe
pelvic fracture. Lethal due to sepsis related to fecal contamination. Most
are due to penetrating trauma. Transverse colon most often injured. Most
injuries are contusions. Laparotomy with primary repair and colostomy
is performed when perforation to the colon or rectum is suspected.
Abscesses can be percutaneously drained.
◉ Liver injuries. Ans: Commonly injured due to size and location.
Cause of injury is blunt and penetrating trauma. MVC most common
cause. Greatest mortality risk is hemorrhage.
High velocity GSW cause more widespread damage that creates massive
hemorrhage. Suspect liver injury in any patient with blunt injury to right
side. FAST scan to rule out free fluid. CT scan in hemodynamically
stable patient. Graded I to IV.
◉ Treatment of liver injuries. Ans: Nonoperative in select patient. OR
for complex lacerations/arterial blush. Angioembolization for patients
with contrast pooling or arterial blush. Pack and stabilize bleeding and
return to OR 24-36 hours later for removal of packing and definitive
management of liver/possible closure. Aggressive intraoperative
COMPLETE QUESTIONS AND ANSWERS.
◉ CT scan. Ans: Hemodynamically stable patients may be taken to CT
◉ Angiography. Ans: Embolization is useful in treating patient with
unstable pelvic fractures, liver and splenic hemorrhage. Use of hybrid
OR suites to allow for surgical and interventional radiology methods of
treatment simultaneously.
◉ Diagnostic laparoscopy. Ans: Can be used to detect or exclude finding
so f hemoperitoneum, organ injury, intestinal spillage or peritoneal
penetration. Most useful in evaluating possible diaphragmatic injuries,
espectially in penetrating thoracoabdominal injuries on the left site
◉ Diaphragmatic injuries. Ans: Usually resultant of penetrating
throacoabdominal injuries on the left side, including 11-12 rib fractures
on the left.
◉ Small intestine injuries. Ans: Result from shearing forces in MVC or
direct blows that crush intestine between force and the vertebrae. Most
commonly intra-abd injury in penetrating trauma. Occurs often with
spinal injury. Pancreatic/solid organ injury are predictive of increased
risk for hollow viscus injury. Signs of peritonitis develop. Any blow to
,the abd/penetrating injury to the lower chest/abd should increase
suspicion of injury
◉ Treatment of small intestine injury. Ans: Control bleeding prior to
exploration. Debridement and closure and ligation of bleeders. Resection
for multiple defects. Observe for wound infection/abscess development
◉ Cause of duodenum injuries. Ans: Penetrating trauma most frequent
cause. Usually conconcurrent mult-organ injuries. Usually found
intraoperatively, commonly missed during exlap. Blunt force injury
cause by vetebral compression.
◉ Duodenal injury treatment. Ans: Identification with CT scan.
Commonly patients have midepigastric or back pain with evolving
peritoneal signs 6-24 hrs after injury. Primary closure in OR, closed
drainage system. Goals are to control hemorrhage, debride devitalized
tissue and provide drainage. Non operative management requires close
observation for expanding or ruptured hematomas causing bleeding or
peritoneal contamination.
◉ Jejunum and ileum injuries. Ans: Jejunum lies in umbilical region,
ileum lies in the hypogastric/pelvice regions. Lap belt can cause bowel
to be crushed between the vertebrae and a solid object. Incorrect wearing
of seatbelt increases chance for injury
, ◉ Stomach injury. Ans: Rare, more common in children. Penetrating
trauma most common cause. May find free air on cxr/fua. Pain to
epigastric/abd area, tenderness, signs of peritonitis. Bloody output from
gastric tube. Surgical intervention, is gastric content leakage, copious
peritoneal irrigation and delayed primary closure
◉ Large intestine. Ans: Rectal injuries may be associated with severe
pelvic fracture. Lethal due to sepsis related to fecal contamination. Most
are due to penetrating trauma. Transverse colon most often injured. Most
injuries are contusions. Laparotomy with primary repair and colostomy
is performed when perforation to the colon or rectum is suspected.
Abscesses can be percutaneously drained.
◉ Liver injuries. Ans: Commonly injured due to size and location.
Cause of injury is blunt and penetrating trauma. MVC most common
cause. Greatest mortality risk is hemorrhage.
High velocity GSW cause more widespread damage that creates massive
hemorrhage. Suspect liver injury in any patient with blunt injury to right
side. FAST scan to rule out free fluid. CT scan in hemodynamically
stable patient. Graded I to IV.
◉ Treatment of liver injuries. Ans: Nonoperative in select patient. OR
for complex lacerations/arterial blush. Angioembolization for patients
with contrast pooling or arterial blush. Pack and stabilize bleeding and
return to OR 24-36 hours later for removal of packing and definitive
management of liver/possible closure. Aggressive intraoperative
