TCAR Exam|Actual Questions and Answers Latest Updated 2025/2026 (Graded A+)
3 questions to ask in trauma ✔️-what was the dose of energy?
-where did it go?
-what injuries are likely?
2 q's to ask in GSW ✔️caliber
type of gun
# of entrance/exit wounds
high/low velocity
1st question to ask in any traumatic injury? ✔️what was the dose of energy involved?
(was it high or low?)
what is the caliber of a bullet? ✔️diameter
aka diameter of a bullet ✔️caliber
what happens to projectiles when they enter the body ✔️projectiles don't travel in a straight line
consider temporary cavity wound
what should you consider about tissue a projectile enounters ✔️temporary cavitation
primary goal of GSW surgery ✔️usually damage repair & not bullet removal
-if superficial, it may migrate the surface with time
important thing to remember about retained projectiles ✔️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 ✔️sternum
what attaches the ribs to the sternum ✔️cartliage
what breaks thoracic bones ✔️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 ✔️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 ✔️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 ✔️to injure c-spine, you don't need a big energy blow. all it takes is shaking around.
c spine versus t spine fractures ✔️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 ✔️largely supportive nursing care like pulmonary toilet
CXR and rib fractures ✔️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 ✔️once healed, rib fractures form bony callouses and become more visible on CXR
how to tell a pt has a pneumonia from a CXR ✔️dark spot that is not equal to the opposite side
consider if a pt has a lower rib fracture ✔️liver & spleen injury
acts like BBQ/marshmellow skewers
how high does the diaphragm rise on inspiration ✔️level of 4th ICS
risk of rib fractures ✔️can puncture liver, spleen,, diaphragm
pop lungs
+2 adjacent rib fractures ✔️flail chest
free floating sternum ✔️flail chest
definition of flail chest ✔️+2 adjacent rib fracture
free floating sternum
why is flail chest a problem ✔️b/c breathing is a mechanical process
paradoxical chest movements ✔️in flail chest
s/s of flail chest ✔️paradoxical chest wall movement
where on the tissue oxygenation cascade is thoracic cage fractures a problem ✔️ventilation
parameters to assess ventilation ✔️ETCO2, PaCO2, clinical assessment
what are considered "great vessels" ✔️
thorax ✔️
what type of injuries occur when the lungs are subjected to force? ✔️bruise = contusion
tear = lacerations
pop = punctures
inhalation injury
bruise on the lungs ✔️pulmonary contusion
causes of pulmonary contusions ✔️high speed blunt or penetrating injury
what happens to the lungs in pulmonary contusions ✔️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 ✔️diffusion
all contusions over time ✔️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 ✔️70% of pulmonary contusions aren't initial on the
initial CXR
what should you monitor when a pt has trauma to the throax ✔️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 ✔️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 ✔️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 ✔️pulmonary laceration
problem of pulmonary lacerations ✔️risk of massive hemothoax b/c those vessels are very vascular
simple v. tension v. open v. closed. v. hemothorax v. hemopneumothorax ✔️
what is a simple pneumothorax ✔️any air that enters the pleural cavity can also leave at the same rate. lungs deflated but no increase in
intrathroacic pressure. air in/out exits at the same rate. pt might be able to tolerate a simple pneumothraox
causes a problem at the ventilation point at the tissue oxygen cascade
intrathroacic pressure in simple pneumothorax ✔️air that enters the pleural cavity leaves at the same rate
lungs are deflated but no increase in pressure
air in/out at the same rate
where is the problem in the tissue oxygenation cascade in simple pneumothroax ✔️ventilation
what happens in penumothorax ✔️lungs are collapsed/deflated
aire enters space between the visceral & parietal
two layers of the lungs ✔️visceral & parietal
Q - in a pneumothorax, no ligaments attach the lung to the wall. so what holds it up? ✔️A - a thin layer of pleural fluid & negative pressure. the
liquid helps it stick like how a spilled liquid forms a seal between a glass and a smooth table top
difference between a simple and tension pneumo ✔️
aka chest tube ✔️chest thoacotomy
purpose of using a chest tube in simple pneumothorax ✔️to allow for negative pressure to reestablish .
tension pnumothorax ✔️air enters under pressure but doesn't exit at the same rate. = accumulation of air under pressure
example of tension pneumothorax ✔️like using a bicycle pump to put more and more air into the lungs over time. no escape
*pressure means no lung function on the side of the injury and compromises function on the un injured heart and great vessel compression
(decreases preload/CO
increases afterload
, effect of tension pneumothorax on heart function ✔️increases intrathoracic pressure
decreases preload/CO
increases afterload
normal pressure in the vena cavas ✔️normally is low
similar to the central venous pressure which is similar to right atrial pressure (2-8mm hg) so very little increase in pressure to impede venous
return to the heart
what part on the tissue oxygenation cascade is affected by tension pneumothorax ✔️ventilation r/t collapsed lung
CO b/c pressure
why is tension pneumothorax more life threatening than simple pneumothorax ✔️tension pneuma is more life threatening than simple b/c of
the pressure it puts on the great vessels so decreased CO
considerations of chest trauma ✔️pneumonia, great vessel trauma, pressure so low CO
when is a hospitalized chest patient the most likely to develop tension pneumothrax ✔️when we initiate positive pressure ventilation
what can rapidly convert a simple pneumothorax to a tension pneumothraox ✔️positive pressure can rapidly convert a simple pneumothorax to
a tension pneumothorax (BVM or m. ventilation) or if a chest tube is kinked/clamped/occluded
chest pain w/breathign ✔️pleuritic
pleuritic chest pain ✔️pain with breathing
assessment of t. pneumothraox ✔️pleuritic chest pain (hurts to breathe)
respiratory distress
increased HR
hyppoxemia
agitation
decreased LS
chest dyspmetry
hyperresonance
late s/s of tension pneumothrax ✔️low bp
JVD
tracheal deviation
when do you get tracheal deviation ✔️late sign of tension pneumothrax
when isn't JVD & tracheal deviation obvious in tension pneumothroax ✔️not obvious if obese, low bp, cervical collar
also - it is a super late s/s
intervention if you suspect tension pneumothrax ✔️needs FAST
do immediate needle D w/o imaging
mortality rate off tension pneumothorax ✔️100% of patients will die w/o intervention
too much black on CXR ✔️hyperlucency
needle "d" for tension pneumo ✔️"pop the bubble" with needle/finger.
3 questions to ask in trauma ✔️-what was the dose of energy?
-where did it go?
-what injuries are likely?
2 q's to ask in GSW ✔️caliber
type of gun
# of entrance/exit wounds
high/low velocity
1st question to ask in any traumatic injury? ✔️what was the dose of energy involved?
(was it high or low?)
what is the caliber of a bullet? ✔️diameter
aka diameter of a bullet ✔️caliber
what happens to projectiles when they enter the body ✔️projectiles don't travel in a straight line
consider temporary cavity wound
what should you consider about tissue a projectile enounters ✔️temporary cavitation
primary goal of GSW surgery ✔️usually damage repair & not bullet removal
-if superficial, it may migrate the surface with time
important thing to remember about retained projectiles ✔️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 ✔️sternum
what attaches the ribs to the sternum ✔️cartliage
what breaks thoracic bones ✔️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 ✔️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 ✔️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 ✔️to injure c-spine, you don't need a big energy blow. all it takes is shaking around.
c spine versus t spine fractures ✔️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 ✔️largely supportive nursing care like pulmonary toilet
CXR and rib fractures ✔️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 ✔️once healed, rib fractures form bony callouses and become more visible on CXR
how to tell a pt has a pneumonia from a CXR ✔️dark spot that is not equal to the opposite side
consider if a pt has a lower rib fracture ✔️liver & spleen injury
acts like BBQ/marshmellow skewers
how high does the diaphragm rise on inspiration ✔️level of 4th ICS
risk of rib fractures ✔️can puncture liver, spleen,, diaphragm
pop lungs
+2 adjacent rib fractures ✔️flail chest
free floating sternum ✔️flail chest
definition of flail chest ✔️+2 adjacent rib fracture
free floating sternum
why is flail chest a problem ✔️b/c breathing is a mechanical process
paradoxical chest movements ✔️in flail chest
s/s of flail chest ✔️paradoxical chest wall movement
where on the tissue oxygenation cascade is thoracic cage fractures a problem ✔️ventilation
parameters to assess ventilation ✔️ETCO2, PaCO2, clinical assessment
what are considered "great vessels" ✔️
thorax ✔️
what type of injuries occur when the lungs are subjected to force? ✔️bruise = contusion
tear = lacerations
pop = punctures
inhalation injury
bruise on the lungs ✔️pulmonary contusion
causes of pulmonary contusions ✔️high speed blunt or penetrating injury
what happens to the lungs in pulmonary contusions ✔️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 ✔️diffusion
all contusions over time ✔️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 ✔️70% of pulmonary contusions aren't initial on the
initial CXR
what should you monitor when a pt has trauma to the throax ✔️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 ✔️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 ✔️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 ✔️pulmonary laceration
problem of pulmonary lacerations ✔️risk of massive hemothoax b/c those vessels are very vascular
simple v. tension v. open v. closed. v. hemothorax v. hemopneumothorax ✔️
what is a simple pneumothorax ✔️any air that enters the pleural cavity can also leave at the same rate. lungs deflated but no increase in
intrathroacic pressure. air in/out exits at the same rate. pt might be able to tolerate a simple pneumothraox
causes a problem at the ventilation point at the tissue oxygen cascade
intrathroacic pressure in simple pneumothorax ✔️air that enters the pleural cavity leaves at the same rate
lungs are deflated but no increase in pressure
air in/out at the same rate
where is the problem in the tissue oxygenation cascade in simple pneumothroax ✔️ventilation
what happens in penumothorax ✔️lungs are collapsed/deflated
aire enters space between the visceral & parietal
two layers of the lungs ✔️visceral & parietal
Q - in a pneumothorax, no ligaments attach the lung to the wall. so what holds it up? ✔️A - a thin layer of pleural fluid & negative pressure. the
liquid helps it stick like how a spilled liquid forms a seal between a glass and a smooth table top
difference between a simple and tension pneumo ✔️
aka chest tube ✔️chest thoacotomy
purpose of using a chest tube in simple pneumothorax ✔️to allow for negative pressure to reestablish .
tension pnumothorax ✔️air enters under pressure but doesn't exit at the same rate. = accumulation of air under pressure
example of tension pneumothorax ✔️like using a bicycle pump to put more and more air into the lungs over time. no escape
*pressure means no lung function on the side of the injury and compromises function on the un injured heart and great vessel compression
(decreases preload/CO
increases afterload
, effect of tension pneumothorax on heart function ✔️increases intrathoracic pressure
decreases preload/CO
increases afterload
normal pressure in the vena cavas ✔️normally is low
similar to the central venous pressure which is similar to right atrial pressure (2-8mm hg) so very little increase in pressure to impede venous
return to the heart
what part on the tissue oxygenation cascade is affected by tension pneumothorax ✔️ventilation r/t collapsed lung
CO b/c pressure
why is tension pneumothorax more life threatening than simple pneumothorax ✔️tension pneuma is more life threatening than simple b/c of
the pressure it puts on the great vessels so decreased CO
considerations of chest trauma ✔️pneumonia, great vessel trauma, pressure so low CO
when is a hospitalized chest patient the most likely to develop tension pneumothrax ✔️when we initiate positive pressure ventilation
what can rapidly convert a simple pneumothorax to a tension pneumothraox ✔️positive pressure can rapidly convert a simple pneumothorax to
a tension pneumothorax (BVM or m. ventilation) or if a chest tube is kinked/clamped/occluded
chest pain w/breathign ✔️pleuritic
pleuritic chest pain ✔️pain with breathing
assessment of t. pneumothraox ✔️pleuritic chest pain (hurts to breathe)
respiratory distress
increased HR
hyppoxemia
agitation
decreased LS
chest dyspmetry
hyperresonance
late s/s of tension pneumothrax ✔️low bp
JVD
tracheal deviation
when do you get tracheal deviation ✔️late sign of tension pneumothrax
when isn't JVD & tracheal deviation obvious in tension pneumothroax ✔️not obvious if obese, low bp, cervical collar
also - it is a super late s/s
intervention if you suspect tension pneumothrax ✔️needs FAST
do immediate needle D w/o imaging
mortality rate off tension pneumothorax ✔️100% of patients will die w/o intervention
too much black on CXR ✔️hyperlucency
needle "d" for tension pneumo ✔️"pop the bubble" with needle/finger.
