TCAR 2025 UPDATE|MOST TESTED
QUESTIONS AND VERIFIED SOLUTIONS
(ALREADY GRADED A+)|ASSURED
SUCCESS !!!
3 questions to ask in trauma - ANSWER -what was the dose of
energy?
-where did it go?
-what injuries are likely?
2 q's to ask in GSW - ANSWER caliber
type of gun
# of entrance/exit wounds
high/low velocity
1st question to ask in any traumatic injury? - ANSWER what was
the dose of energy involved?
(was it high or low?)
what is the caliber of a bullet? - ANSWER diameter
aka diameter of a bullet - ANSWER caliber
what happens to projectiles when they enter the body - ANSWER
projectiles don't travel in a straight line
consider temporary cavity wound
what should you consider about tissue a projectile enounters -
ANSWER temporary cavitation
primary goal of GSW surgery - ANSWER usually damage repair &
not bullet removal
-if superficial, it may migrate the surface with time
important thing to remember about retained projectiles - ANSWER
they may migrate over time. bullett migration might explain unexplained
clinical findings
,(VP Cheney accidentally shot his friend while hunting in 2006. ICU and did
great. moved to an inpatient unit. had a silent MI bc a shot gun pellets
migrated into a canary artery causing an infract. so had a MI but
fibrinolytic not the answer in this case b/c it was a "projectile embolus"
aka brestbone - ANSWER sternum
what attaches the ribs to the sternum - ANSWER cartliage
what breaks thoracic bones - ANSWER significant force
-1-2nd ribs, posterior ribs, sternum, scapulae, T2-10
gives us info about the force aka "dose" of energy received
consider injury to internal structures b/c force
ribs that are the most frequently broken - ANSWER ribs 4-9 b/c
long, thin, and poorly protecte
it is harder to break a short pencil (T1-2) and easier to break a longer one
*ask how many and where to understand the force involved
what is the significance of posterior rib fractures - ANSWER
unusual direction of injury
shorter stubby ribs
good muscle profection
**posterior rib fractures have a lot of force so need a high dose.
***PRF need a lot of force so high dose of energy. big red flag for t-spine
injury
indication of c-spine injury - ANSWER to injure c-spine, you don't
need a big energy blow. all it takes is shaking around.
c spine versus t spine fractures - ANSWER c-spine doesn't need a
big energy blow. just some shaking around
t-spine needs a great strong direct blow (not just a shock_
treatment for rib fractures - ANSWER largely supportive nursing
care like pulmonary toilet
CXR and rib fractures - ANSWER simple rib fractures are difficult
to see on CXR and can be commonly missed
(1/2 of all rib fractures aren't identified at the POI CXR)
,identify a previous rib fracture on CXR - ANSWER once healed,
rib fractures form bony callouses and become more visible on CXR
how to tell a pt has a pneumonia from a CXR - ANSWER dark spot
that is not equal to the opposite side
consider if a pt has a lower rib fracture - ANSWER liver & spleen
injury
acts like BBQ/marshmellow skewers
how high does the diaphragm rise on inspiration - ANSWER level
of 4th ICS
risk of rib fractures - ANSWER can puncture liver, spleen,,
diaphragm
pop lungs
+2 adjacent rib fractures - ANSWER flail chest
free floating sternum - ANSWER flail chest
definition of flail chest - ANSWER +2 adjacent rib fracture
free floating sternum
why is flail chest a problem - ANSWER b/c breathing is a
mechanical process
paradoxical chest movements - ANSWER in flail chest
s/s of flail chest - ANSWER paradoxical chest wall movement
where on the tissue oxygenation cascade is thoracic cage fractures a
problem - ANSWER ventilation
parameters to assess ventilation - ANSWER ETCO2, PaCO2,
clinical assessment
what are considered "great vessels" - ANSWER
thorax - ANSWER
what type of injuries occur when the lungs are subjected to force? -
ANSWER bruise = contusion
tear = lacerations
pop = punctures
inhalation injury
bruise on the lungs - ANSWER pulmonary contusion
, causes of pulmonary contusions - ANSWER high speed blunt or
penetrating injury
what happens to the lungs in pulmonary contusions - ANSWER
big boggy bruise on the lungs
diffusion problems
when it becomes contused & edematous, it becomes difficult for oxygen to
move from the alveoli into the capillaries
where on the tissue oxygenation cascade do pulmonary contusions cause
their problems - ANSWER diffusion
all contusions over time - ANSWER all contusions "blossom" over
time. the full extent of the injury is not initially apparent
important thing to remember when you are evaluating a patient for
pulmonary contusions - ANSWER 70% of pulmonary contusions
aren't initial on the initial CXR
what should you monitor when a pt has trauma to the throax -
ANSWER closely monitor for pulmonary contustiobs = 70% not present
on the initial CXR and "blossom" over time
-monitor for progress e deterioration in hours/days post injury
*might look ok in ER
best parameter of serial monitoring for pt's who have risk factors for
pulmonary contusions - ANSWER anticipate "blossoming" over
time b/c 70% of pulmonary contusions aren't present on the initial CXR
P:F ratio
problem of using CXR as a definitive clinical dx tool - ANSWER
CXR may lag behind clinical status
*b/c 70% of pulmonary contusions aren't present on initial CXR. they
"blossom" over time
tear in lung tissue - ANSWER pulmonary laceration
problem of pulmonary lacerations - ANSWER risk of massive
hemothoax b/c those vessels are very vascular
simple v. tension v. open v. closed. v. hemothorax v. hemopneumothorax -
ANSWER
what is a simple pneumothorax - ANSWER any air that enters the
pleural cavity can also leave at the same rate. lungs deflated but no
QUESTIONS AND VERIFIED SOLUTIONS
(ALREADY GRADED A+)|ASSURED
SUCCESS !!!
3 questions to ask in trauma - ANSWER -what was the dose of
energy?
-where did it go?
-what injuries are likely?
2 q's to ask in GSW - ANSWER caliber
type of gun
# of entrance/exit wounds
high/low velocity
1st question to ask in any traumatic injury? - ANSWER what was
the dose of energy involved?
(was it high or low?)
what is the caliber of a bullet? - ANSWER diameter
aka diameter of a bullet - ANSWER caliber
what happens to projectiles when they enter the body - ANSWER
projectiles don't travel in a straight line
consider temporary cavity wound
what should you consider about tissue a projectile enounters -
ANSWER temporary cavitation
primary goal of GSW surgery - ANSWER usually damage repair &
not bullet removal
-if superficial, it may migrate the surface with time
important thing to remember about retained projectiles - ANSWER
they may migrate over time. bullett migration might explain unexplained
clinical findings
,(VP Cheney accidentally shot his friend while hunting in 2006. ICU and did
great. moved to an inpatient unit. had a silent MI bc a shot gun pellets
migrated into a canary artery causing an infract. so had a MI but
fibrinolytic not the answer in this case b/c it was a "projectile embolus"
aka brestbone - ANSWER sternum
what attaches the ribs to the sternum - ANSWER cartliage
what breaks thoracic bones - ANSWER significant force
-1-2nd ribs, posterior ribs, sternum, scapulae, T2-10
gives us info about the force aka "dose" of energy received
consider injury to internal structures b/c force
ribs that are the most frequently broken - ANSWER ribs 4-9 b/c
long, thin, and poorly protecte
it is harder to break a short pencil (T1-2) and easier to break a longer one
*ask how many and where to understand the force involved
what is the significance of posterior rib fractures - ANSWER
unusual direction of injury
shorter stubby ribs
good muscle profection
**posterior rib fractures have a lot of force so need a high dose.
***PRF need a lot of force so high dose of energy. big red flag for t-spine
injury
indication of c-spine injury - ANSWER to injure c-spine, you don't
need a big energy blow. all it takes is shaking around.
c spine versus t spine fractures - ANSWER c-spine doesn't need a
big energy blow. just some shaking around
t-spine needs a great strong direct blow (not just a shock_
treatment for rib fractures - ANSWER largely supportive nursing
care like pulmonary toilet
CXR and rib fractures - ANSWER simple rib fractures are difficult
to see on CXR and can be commonly missed
(1/2 of all rib fractures aren't identified at the POI CXR)
,identify a previous rib fracture on CXR - ANSWER once healed,
rib fractures form bony callouses and become more visible on CXR
how to tell a pt has a pneumonia from a CXR - ANSWER dark spot
that is not equal to the opposite side
consider if a pt has a lower rib fracture - ANSWER liver & spleen
injury
acts like BBQ/marshmellow skewers
how high does the diaphragm rise on inspiration - ANSWER level
of 4th ICS
risk of rib fractures - ANSWER can puncture liver, spleen,,
diaphragm
pop lungs
+2 adjacent rib fractures - ANSWER flail chest
free floating sternum - ANSWER flail chest
definition of flail chest - ANSWER +2 adjacent rib fracture
free floating sternum
why is flail chest a problem - ANSWER b/c breathing is a
mechanical process
paradoxical chest movements - ANSWER in flail chest
s/s of flail chest - ANSWER paradoxical chest wall movement
where on the tissue oxygenation cascade is thoracic cage fractures a
problem - ANSWER ventilation
parameters to assess ventilation - ANSWER ETCO2, PaCO2,
clinical assessment
what are considered "great vessels" - ANSWER
thorax - ANSWER
what type of injuries occur when the lungs are subjected to force? -
ANSWER bruise = contusion
tear = lacerations
pop = punctures
inhalation injury
bruise on the lungs - ANSWER pulmonary contusion
, causes of pulmonary contusions - ANSWER high speed blunt or
penetrating injury
what happens to the lungs in pulmonary contusions - ANSWER
big boggy bruise on the lungs
diffusion problems
when it becomes contused & edematous, it becomes difficult for oxygen to
move from the alveoli into the capillaries
where on the tissue oxygenation cascade do pulmonary contusions cause
their problems - ANSWER diffusion
all contusions over time - ANSWER all contusions "blossom" over
time. the full extent of the injury is not initially apparent
important thing to remember when you are evaluating a patient for
pulmonary contusions - ANSWER 70% of pulmonary contusions
aren't initial on the initial CXR
what should you monitor when a pt has trauma to the throax -
ANSWER closely monitor for pulmonary contustiobs = 70% not present
on the initial CXR and "blossom" over time
-monitor for progress e deterioration in hours/days post injury
*might look ok in ER
best parameter of serial monitoring for pt's who have risk factors for
pulmonary contusions - ANSWER anticipate "blossoming" over
time b/c 70% of pulmonary contusions aren't present on the initial CXR
P:F ratio
problem of using CXR as a definitive clinical dx tool - ANSWER
CXR may lag behind clinical status
*b/c 70% of pulmonary contusions aren't present on initial CXR. they
"blossom" over time
tear in lung tissue - ANSWER pulmonary laceration
problem of pulmonary lacerations - ANSWER risk of massive
hemothoax b/c those vessels are very vascular
simple v. tension v. open v. closed. v. hemothorax v. hemopneumothorax -
ANSWER
what is a simple pneumothorax - ANSWER any air that enters the
pleural cavity can also leave at the same rate. lungs deflated but no
