TCRN CERTIFICATION EVALUATION TEST
PAPER QUESTIONS AND SOLUTIONS
VERIFIED COMPLETE
●● Base deficit
Answer: Base deficit more than -6 indicates the need for agressive
resuscitation and determination of the etiology
●● CXR
Answer: Most important tool providing useful information in the early
minutes. Can identify major sources of blood loss from injuries in the
chest or elevated diaphragm with displacement of abdominal organs
●● Tracheobronchial injury
Answer: Should be suspected if after chest tube placement a significant
air leak is present
●● Diagnostic Peritoneal Lavage
Answer: Alternative to FAST scan to detect abd bleeding. A urinary
catheter and gastric tube should be in place prior to procedure.
●● FAST
,Answer: Focused Assessment with Sonography in Trauma. Used to
detect free fluid in peritoneum or hemoperitoneum. Free fluid appears
"black" on the screen. Has replaced DPL when available.
●● Positive FAST scan
Answer: Hemodynamically unstable trauma patient with a positive fast
are taken directly to the OR for laparotomy
●● Ultrasound abd exam
Answer: Not useful to detect injuries to the diaphragm, intestine and
pancreas. In patients with obesity, ascites and/or subQ emphysema the
accuracy is reduced.
●● CT scan
Answer: Hemodynamically stable patients may be taken to CT
●● Angiography
Answer: 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
, Answer: 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
Answer: Usually resultant of penetrating throacoabdominal injuries on
the left side, including 11-12 rib fractures on the left.
●● Small intestine injuries
Answer: 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
Answer: 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
PAPER QUESTIONS AND SOLUTIONS
VERIFIED COMPLETE
●● Base deficit
Answer: Base deficit more than -6 indicates the need for agressive
resuscitation and determination of the etiology
●● CXR
Answer: Most important tool providing useful information in the early
minutes. Can identify major sources of blood loss from injuries in the
chest or elevated diaphragm with displacement of abdominal organs
●● Tracheobronchial injury
Answer: Should be suspected if after chest tube placement a significant
air leak is present
●● Diagnostic Peritoneal Lavage
Answer: Alternative to FAST scan to detect abd bleeding. A urinary
catheter and gastric tube should be in place prior to procedure.
●● FAST
,Answer: Focused Assessment with Sonography in Trauma. Used to
detect free fluid in peritoneum or hemoperitoneum. Free fluid appears
"black" on the screen. Has replaced DPL when available.
●● Positive FAST scan
Answer: Hemodynamically unstable trauma patient with a positive fast
are taken directly to the OR for laparotomy
●● Ultrasound abd exam
Answer: Not useful to detect injuries to the diaphragm, intestine and
pancreas. In patients with obesity, ascites and/or subQ emphysema the
accuracy is reduced.
●● CT scan
Answer: Hemodynamically stable patients may be taken to CT
●● Angiography
Answer: 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
, Answer: 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
Answer: Usually resultant of penetrating throacoabdominal injuries on
the left side, including 11-12 rib fractures on the left.
●● Small intestine injuries
Answer: 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
Answer: 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
