TCAR COMPREHENSIVE QUESTIONS AND
ANSWERS SET A+
✔✔blood loss s/s in a spleen injury - ✔✔Kehr's
tachycardia
lw bp
✔✔Kehr's sign - ✔✔Referred pain down the left shoulder; indicative of a ruptured
spleen.
✔✔cause of Kehr's sign - ✔✔pain form diaphragm irritation that refers to shoulder
typically a result of blood under the left hemidraiphram
common in spleen injuruies
✔✔goals of FAST - ✔✔rapidly identify free flowing blood which is usually
✔✔what injuries can't a FAST detect - ✔✔bowel or retroperitoneal injury
✔✔what happens too bleeding in spleen/liver/kidney - ✔✔all are encapsulated organs
so the blood stays in the capsule and causes a sub capsular hematoma
if a laceration = will bleed
✔✔repair of the spleen - ✔✔splenorrhaphy
✔✔management of spleen injury - ✔✔can manage noninvasively
angioembolization, remove the spleen, splehorrharpy - repair
✔✔-harpy - ✔✔surgical repair
✔✔how to gauge how long a person with a spleen injury needs to stay in the hospital -
✔✔grade the spleen injury 1-VI
each grade = 10 + 1 day
6 is not survivablew
,✔✔contact sports precautions post spleen injury - ✔✔severity grade (convert to weeks)
+ 2 weeks
✔✔retroperitoneal steructures - ✔✔kidney
pancreas
vena ava
spine
aortA
✔✔indications for MRI, CT, US, CXR - ✔✔`
✔✔consideration if a pt bends over in a car accident - ✔✔jackknife injuries
✔✔transsection - ✔✔process of cutting across
✔✔cutting actross - ✔✔transsection
✔✔worse case scenario for shock - ✔✔if the tank is empty
✔✔what often happens in retroperitoneal bleeding - ✔✔retroperitoneal bleeding often
tamponades itself so non-operative is an option
✔✔labs in pancreatic injury - ✔✔serial amylase and lipase
✔✔delayed onset burning epigastria pain - ✔✔pancreqase
✔✔diffuse tender rigid abodmen - ✔✔solid organ injury
✔✔air filled structures of the abd - ✔✔lugns, stomach, intestines
✔✔most common bunt abdominal trauma injury versus penetrating - ✔✔blunt = spleen
penetrating = bowel
✔✔important to remember about contusions anywhere - ✔✔"blossom" over time
✔✔monitor if bowel injury - ✔✔s/s of infection
fever & leukocytosis
✔✔high WBC - ✔✔leukocytosis
✔✔leukocytossi - ✔✔high WBC
✔✔when aren't s/s of infection easy to detect - ✔✔elderly or immunosuppressed
,✔✔peritoneal signs - ✔✔Guarding/Rebound/Rigidity: PE findings indicating a rupture in
the abdomen
✔✔radiographic evidence of a bowel rupture - ✔✔air outside the GI tract indicates a
ruptured hollow organ
✔✔radiographic evidence of free air in the abodmen - ✔✔not good
✔✔abd cavity & blood volume capacity - ✔✔abdomen cavity has enough space to hold
the entire blood volume
✔✔REBOA stands for - ✔✔resuscitative endovascular balloon occlusion of the aorta
✔✔use for REBOA - ✔✔exsanguination abd/throacic/pelvic injuries
*occludes all forward blood volume and stops hemorrhage below the balloon
✔✔trauma triad - ✔✔hypothermia, acidosis, coagulopathy
✔✔problem of open belly in truama - ✔✔hypothermia
(triad of death)
✔✔what is the most important part of the trauma triad of death to correct - ✔✔acidosis
and coagulopathy can't be corrected until the patient is warmed
✔✔Plasma-Lyte - ✔✔crystalloids
✔✔most common bowel injury postop - ✔✔extensive edema, infection, abscess,
peritonitis, sepsis
(which is why drains are common)
✔✔tonicity - ✔✔the ability of a surrounding solution to cause a cell to gain or lose water
✔✔hypo/hyper/iso IVR - ✔✔tonicity = ability of the surrounding solutions cause a cell to
gain or lose water
✔✔location of 2/34 of body water - ✔✔2/3 of body water is inside the cells
✔✔dextrose containing IVF & tonicity - ✔✔isotonic or hypER tonic in the bag
moves into the cells so then becomes hyPO tonic
✔✔3 types of patients who need hyPOtonic IVF - ✔✔hydrate, maintenance, dehydration
increase glucose/Na, GI losses
, ✔✔3L of NS or LR - ✔✔stays in the extracellular space and doesn't enter the cells
*3L of isotonic crystallizes increase circulating volume by 3 cups. the rest (2250ml) goes
between the cells so increases isotonic VIF. puff up fluid between cells makes it more
difficult lt to get fluid to the cells
*healthy individuals n red 3:1 or 4:1 replacement of IVF per blood loss
more needed to replace if shock/septic
✔✔why do you need more IVF in shock/septic - ✔✔b/c replaces blood loss b;/c the
body's inflammatory responsive mainly to capillary leak
IVF we give also contributes to endothe,lial damage and capillary leak
✔✔what type of IVF is Plasma-Lyte - ✔✔isotonic
✔✔problem of volume resuscitation with high amounts of Normal Saline -
✔✔hypERcholermic acidosis
✔✔IVF that is the solution closest to the chemical composition of blood serum -
✔✔Plasma-Lyte
✔✔colloids - ✔✔large particles that are normally incapable of passing through the
endothelium
✔✔examples of colloids - ✔✔albumin
blood
dextram
hetastrach
mannitol
✔✔where do colloids go - ✔✔stays in the vascular space
100% vascular
✔✔Normal Saline in resuscitation - ✔✔NS is not the most optimal IVF
✔✔calories in 1L of D5W - ✔✔1L of D5W = 170 - 200 calories
enough glucose to meet needs but not enough to feed
✔✔reversing needed if bleeding - ✔✔stop the bleed
normalize physiology (temp/pH, oxygen iso we can clot and deliver oxygen to cells)
REMEMBER = a person does't bleed NS/LR
✔✔Harrahill technique - ✔✔test for intraabdominal pressure
✔✔test for intraabdominal pressure - ✔✔Harrahill technique
ANSWERS SET A+
✔✔blood loss s/s in a spleen injury - ✔✔Kehr's
tachycardia
lw bp
✔✔Kehr's sign - ✔✔Referred pain down the left shoulder; indicative of a ruptured
spleen.
✔✔cause of Kehr's sign - ✔✔pain form diaphragm irritation that refers to shoulder
typically a result of blood under the left hemidraiphram
common in spleen injuruies
✔✔goals of FAST - ✔✔rapidly identify free flowing blood which is usually
✔✔what injuries can't a FAST detect - ✔✔bowel or retroperitoneal injury
✔✔what happens too bleeding in spleen/liver/kidney - ✔✔all are encapsulated organs
so the blood stays in the capsule and causes a sub capsular hematoma
if a laceration = will bleed
✔✔repair of the spleen - ✔✔splenorrhaphy
✔✔management of spleen injury - ✔✔can manage noninvasively
angioembolization, remove the spleen, splehorrharpy - repair
✔✔-harpy - ✔✔surgical repair
✔✔how to gauge how long a person with a spleen injury needs to stay in the hospital -
✔✔grade the spleen injury 1-VI
each grade = 10 + 1 day
6 is not survivablew
,✔✔contact sports precautions post spleen injury - ✔✔severity grade (convert to weeks)
+ 2 weeks
✔✔retroperitoneal steructures - ✔✔kidney
pancreas
vena ava
spine
aortA
✔✔indications for MRI, CT, US, CXR - ✔✔`
✔✔consideration if a pt bends over in a car accident - ✔✔jackknife injuries
✔✔transsection - ✔✔process of cutting across
✔✔cutting actross - ✔✔transsection
✔✔worse case scenario for shock - ✔✔if the tank is empty
✔✔what often happens in retroperitoneal bleeding - ✔✔retroperitoneal bleeding often
tamponades itself so non-operative is an option
✔✔labs in pancreatic injury - ✔✔serial amylase and lipase
✔✔delayed onset burning epigastria pain - ✔✔pancreqase
✔✔diffuse tender rigid abodmen - ✔✔solid organ injury
✔✔air filled structures of the abd - ✔✔lugns, stomach, intestines
✔✔most common bunt abdominal trauma injury versus penetrating - ✔✔blunt = spleen
penetrating = bowel
✔✔important to remember about contusions anywhere - ✔✔"blossom" over time
✔✔monitor if bowel injury - ✔✔s/s of infection
fever & leukocytosis
✔✔high WBC - ✔✔leukocytosis
✔✔leukocytossi - ✔✔high WBC
✔✔when aren't s/s of infection easy to detect - ✔✔elderly or immunosuppressed
,✔✔peritoneal signs - ✔✔Guarding/Rebound/Rigidity: PE findings indicating a rupture in
the abdomen
✔✔radiographic evidence of a bowel rupture - ✔✔air outside the GI tract indicates a
ruptured hollow organ
✔✔radiographic evidence of free air in the abodmen - ✔✔not good
✔✔abd cavity & blood volume capacity - ✔✔abdomen cavity has enough space to hold
the entire blood volume
✔✔REBOA stands for - ✔✔resuscitative endovascular balloon occlusion of the aorta
✔✔use for REBOA - ✔✔exsanguination abd/throacic/pelvic injuries
*occludes all forward blood volume and stops hemorrhage below the balloon
✔✔trauma triad - ✔✔hypothermia, acidosis, coagulopathy
✔✔problem of open belly in truama - ✔✔hypothermia
(triad of death)
✔✔what is the most important part of the trauma triad of death to correct - ✔✔acidosis
and coagulopathy can't be corrected until the patient is warmed
✔✔Plasma-Lyte - ✔✔crystalloids
✔✔most common bowel injury postop - ✔✔extensive edema, infection, abscess,
peritonitis, sepsis
(which is why drains are common)
✔✔tonicity - ✔✔the ability of a surrounding solution to cause a cell to gain or lose water
✔✔hypo/hyper/iso IVR - ✔✔tonicity = ability of the surrounding solutions cause a cell to
gain or lose water
✔✔location of 2/34 of body water - ✔✔2/3 of body water is inside the cells
✔✔dextrose containing IVF & tonicity - ✔✔isotonic or hypER tonic in the bag
moves into the cells so then becomes hyPO tonic
✔✔3 types of patients who need hyPOtonic IVF - ✔✔hydrate, maintenance, dehydration
increase glucose/Na, GI losses
, ✔✔3L of NS or LR - ✔✔stays in the extracellular space and doesn't enter the cells
*3L of isotonic crystallizes increase circulating volume by 3 cups. the rest (2250ml) goes
between the cells so increases isotonic VIF. puff up fluid between cells makes it more
difficult lt to get fluid to the cells
*healthy individuals n red 3:1 or 4:1 replacement of IVF per blood loss
more needed to replace if shock/septic
✔✔why do you need more IVF in shock/septic - ✔✔b/c replaces blood loss b;/c the
body's inflammatory responsive mainly to capillary leak
IVF we give also contributes to endothe,lial damage and capillary leak
✔✔what type of IVF is Plasma-Lyte - ✔✔isotonic
✔✔problem of volume resuscitation with high amounts of Normal Saline -
✔✔hypERcholermic acidosis
✔✔IVF that is the solution closest to the chemical composition of blood serum -
✔✔Plasma-Lyte
✔✔colloids - ✔✔large particles that are normally incapable of passing through the
endothelium
✔✔examples of colloids - ✔✔albumin
blood
dextram
hetastrach
mannitol
✔✔where do colloids go - ✔✔stays in the vascular space
100% vascular
✔✔Normal Saline in resuscitation - ✔✔NS is not the most optimal IVF
✔✔calories in 1L of D5W - ✔✔1L of D5W = 170 - 200 calories
enough glucose to meet needs but not enough to feed
✔✔reversing needed if bleeding - ✔✔stop the bleed
normalize physiology (temp/pH, oxygen iso we can clot and deliver oxygen to cells)
REMEMBER = a person does't bleed NS/LR
✔✔Harrahill technique - ✔✔test for intraabdominal pressure
✔✔test for intraabdominal pressure - ✔✔Harrahill technique
