TNCC 8th Edition Question with complete solution 2023

TNCC 8th Edition Question with complete solution 2023MARCH mneumonic Massive Hemorrhage: Control with combat gauze, celox gauze, or chito gauze; replacement of blood loss with whole blood or 1:1:1 ratio of plasma, RBC, and platelets to achieve SBP of 80-90mmHg. Airway: Establish and maintain patent airway Respiration: Decompress suspected tension pneumothorax, seal open chest wounds, and support ventilation and oxygenation as required. Circulation: Provide vascular access (IV/IO) and administer fluids as required to treat shock Head injury/Hypothermia: Prevent or treat hypotension and hypoxia to prevent worsening of TBI and prevent or treat hypothermia. AVPU Assessing Alertness A: Alert and oriented V: Responds to verbal stimuli P: Responds only to painful stimuli U: Unresponsive LACE Soft Tissue Injuries L: Lacerations A: Abrasions, Avulsions C: Contusions E: Edema, Ecchymosis Urinary Catheter Contraindications if urethral transsection is suspected: -blood at the urethral meatus -perineal ecchymosis -scrotal ecchymosis -high-riding or nonpalpable prostate Breathing Intervention Reassessment 1. Attach CO2 detector 2. Listen over epigastrum 3. Bilateral breath sounds at midaxillary and midclavicular lines 4. Color change after 6 breaths 5. Monitor skin color; get xr Troubleshooting Ventilator Alarms D: Displaced Tube O: Obstructed or Kinked Tube P: Pneumothorax E: Equipment failure, such as the patient becoming detached from the equipment or loss of capnography Seven P's of RSI -Preparation: ensure you have all necessary equipment and personnel. Verify IV sites -Preoxygenation: high flow oxygen for minimum of 3 minutes. Position is HOB elevated to 20 degrees. For spinal precautions, reverse Trendelenburg at 30 degrees. -Pre-intubation optimization: Lidocaine (may reduce risk of rise in ICP during intubation) or Fentanyl (mitigates sympathetic response increased HR and BP during intubation) administration -Paralysis with induction -Protection: after neuromuscular blocking agent is administered, protect the airway from aspiration by avoiding BVM, which can result in regurgitation and aspiration. -Placement with proof: inflate ETT cuff, secure, use ETCO2 for confirmation -Post-intubation management: secure tube and note measurement; xr. Inductions Agents for RSI Etomidate Ketamine Midazolam Propofol Paralysis Agents for RSI Succinylcholine Rocuronium Vecuronium Cerebral Perfusion Pressure (CPP) Normal: 60-100 mm Hg Acceptable: 50-70 mm Hg Hypercarbia PaCO2 45 mmHg Excess of Co2 in the blood, indicated by an elevated PaCO2 as determined by blood gas analysis Intracranial Pressure (ICP) 0-15mmHg The pressure of the CSF in the subarachnoid space Mean Arterial Pressure (MAP) 50-150mmHg The average blood pressure in a single cardiac cycle, roughly calculated as the SBP + 2 x the DBP/3 Avoid hypoxemia in the patient with head trauma A single episode of hypoxemia (PaO2 60mmHg) can be detrimental to the patient's outcome. Maintain pulse ox at 95% or greater and obtain ABG measurement asap for patient with severe TBI. Maintain ETCO2 between 35-45 mmHg Manage ICP in the patient with head trauma An ICP sustained at greater than 22 mmHg and unresponsive to treatment is associated with poor outcomes Increased ICP Assessment Findings Early: Headache; n/v; amnesia; behavior changes (restlessness, impaired judgement; drowsiness); altered level of consciousness (hyperarousability and hypoarousability) Late: Dilated, nonreactive pupils; unresponsive to verbal or painful stimuli; abnormal motor posturing (flexion, extension, flaccidity); Cushing response: Widening pulse pressure, reflex bradycardia, and decreased respiratory effort. Corneal Injury Assessment Findings: Photophobia, pain, eye redness, lid swelling, FB sensation Treatment: Topical anesthesia, topical ophthalmic NSAID, no eye patch, remove FB, may need topical abx for laceration. Follow up: with ophthalmologist in 24-48 hours; ophthalmology consultation for deep and large FB Orbital Fracture Assessment Findings: Periorbital ecchymosis, facial swelling, double vision, enophthalmos (posterior displacement of eyeball within orbit, ptosis. Treatment: Nasal decongestant, ice packs to the orbit for 48 hours, oral abx Follow up: May require surgery, ophthalmology. Avoid blowing nose, sneezing, and Valsalva maneuver Retrobulbar hematoma Assessment Findings: Severe pain, decreased vision or loss of vision, reduced eye movement, double vision, IOP 40mmHg Treatment: Administer medications to decrease IOP, emergency decompression via lateral canthotomy Follow up: Emergent consultation with ophthalmology Globe Rupture Assessment Findings: Irregular or teardrop-shaped pupils, periorbital ecchymosis, decreased visual acuity and EOM, severe subconjunctival hemorrhage, deep eye pain, nausea Treatment: Avoid any pressure on the globe, apply a rigid shielf to protect the affected eye, consider tetanus vaccine, keep patient NPO, assess and treat pain, administer antiemetics to decrease risk of n/v, elevate the HOB to decrease IOP, avoid ophthalmic drops or medications, administer systemic abx Follow up: Emergency consultation with ophthalmology; prepare pt for CT scan and OR Ocular Burns Assessment Findings: Swelling of the sclera, conjunctival irritation, corneal clouding (may be indicative of severe burn, pain Treatment: Determine baseline pH of the eye, topical anesthesia, immediate copious irrigation until the pH returns to normal range (7.4) which may require 2L of irrigating solution, visual acuity reassessment Follow up: Ophthalmology consultation and close follow up.