TCAR EVALUATION EXAM QUESTIONS AND
ANSWERS SET A+
✔✔how does the shape of the thigh change in a femur fracture - ✔✔normal thigh =
cone shaped
femur fracture = quad muscles make the bones override each other -shortens thing and
more spherical shape (per algebra, a sphere can hold more volume that a cone so more
space available to hold hemorrhage.) fracture of the thigh makes the space more
spherical. a sphere creates more volume than a cone
NEEEDS TRACTION FOR A MID-SHAFT FEMUR FRACTURE
✔✔what fracture needs a traction splint - ✔✔FEMUR
normal thigh = cone shaped
femur fracture makes the quad muscles close make the bones override each other.
shortens the thigh and makes it more of a spherical shape. per algebra, a sphere holds
more volume than a cone so more space available to hold a hemorrhage. thus, need a
traction-splint for mid-shaft femur fraction
✔✔goal of traction splinting for femur fractures - ✔✔limit hemorrhage by reestablishing
a cone shaped thigh and decrease pain by decreasing motion and spasms
✔✔mortality of WW1 femur fractures - ✔✔80% b/c they didn't know that they should
provide traction
after traction was introduced, mortality dropped to 8%
✔✔how does a traction splint work - ✔✔for mid-shaft femur fractures
PULL on ankle
PUSH on pelvis
*can do for open femur fractures
✔✔contraindication to traction splinting for femur fractures - ✔✔unstable pelvis fracture
(okay to do if stable pelvis fracture), tib-fib fracture
b/c of how traction works
,PULL on ankle
PUSH on pelvis
✔✔intervention for all real/suspected fractures - ✔✔immediate immobility
decreased pain, decreased bleed, decreased further injury
✔✔adult blood volume - ✔✔4-6L
✔✔important thing to remember if a heavy object falls and pins a patient - ✔✔likely
acting as a tourniquet so need to apply tourniquet before remove
✔✔point on the tissue oxygenation cascade where fracture/ortho injuries are affected -
✔✔hemoglobin availability
CO
✔✔what happens to blood in/around a fracture site - ✔✔edema fluid that leaves the
vascular space and is evenly reestaborbed into the lymph systme
blood leaving the vascular space, it is a one way trip and isn't reabsorbed and never
contributes to recirculating volume again. all RBC lost forever
blood in tissue is irritating, aggravates pain, limits function, contributes to scar tissue
formation
✔✔RICE - ✔✔hemostasis interventions
✔✔blood outside the vessels - ✔✔irritating
isn't reabsorbed. never contributes to circulating volume against. RBC is lost
✔✔when should you initiate pt transfer if your facility cannot accommodate what they
need - ✔✔within 15minutes
✔✔needed for pt transfer - ✔✔transfer agreement
accepting MID
handoff
sent pt to same or higher level of care
pt consent only needed if emergency
✔✔imaging studies and transfer to a more capable facility - ✔✔imaging studies should
never delay transfer auto a trauma center that is capable of providing definitive care
okay if needed to ID steps too stabilize
✔✔effect of pt transfer to a higher escehlon of care - ✔✔emotional, family logistics,
eventual return, follow up
to family a long-distance transfer feels like other side of the galaxy
, ✔✔percutaneously - ✔✔through the skin
✔✔performed through the skin - ✔✔percutaneously
✔✔gelfoam - ✔✔type of absorbable gelatin hemostatic agent that is made from purified
pork skin gelatin; available in either pad or powder form; it is placed over an area of
bleeding to control hemorrhage
✔✔hemostatic agent that is a pad or powder put over bleeding to control - ✔✔gelfoam
✔✔options for OR care of pelvic fractures - ✔✔open reduction, closed reduction,
interventional radiography, ORIF
✔✔external fixation for pelvic fractures - ✔✔stabilize the pelvic rings
may use peritoneal packign
✔✔internal rods for pelvic fractures - ✔✔internal fixation
✔✔goal of agiography for pelvic fracrues - ✔✔doesn't stabilize the fracture but does
identify bleeding spot and uses gel foam or coils to symbolize bleeding arteries. most
bleeding is venous or osseous rather than arterial
✔✔most invasive form of pelvic fracture intervetion - ✔✔ORIF
✔✔closed mid=shaft femur management - ✔✔external fixation, plates/screws,
flexible/rigid IM nail
most common = intramedullary rodding
✔✔open tib/fib fracture intervention - ✔✔debridement, fixation
not casted b/c needs wound care
✔✔position limbs using external fixation rod - ✔✔surgeons may let you move the rod to
move the limb b/c that is the most tstable
ask the surgeon for permission.
lifting from below is disrupts nd is painful
also ask the surgeon before you put weight on the fixated limb
✔✔agent used to clean pin sites - ✔✔cholohexidine
✔✔lab markers of anaerobic metabollism - ✔✔lactate
pH
base deficit
✔✔spot orthodox surgery labs - ✔✔markers of anaerobic metabolic, rhabdo, bleedign
ANSWERS SET A+
✔✔how does the shape of the thigh change in a femur fracture - ✔✔normal thigh =
cone shaped
femur fracture = quad muscles make the bones override each other -shortens thing and
more spherical shape (per algebra, a sphere can hold more volume that a cone so more
space available to hold hemorrhage.) fracture of the thigh makes the space more
spherical. a sphere creates more volume than a cone
NEEEDS TRACTION FOR A MID-SHAFT FEMUR FRACTURE
✔✔what fracture needs a traction splint - ✔✔FEMUR
normal thigh = cone shaped
femur fracture makes the quad muscles close make the bones override each other.
shortens the thigh and makes it more of a spherical shape. per algebra, a sphere holds
more volume than a cone so more space available to hold a hemorrhage. thus, need a
traction-splint for mid-shaft femur fraction
✔✔goal of traction splinting for femur fractures - ✔✔limit hemorrhage by reestablishing
a cone shaped thigh and decrease pain by decreasing motion and spasms
✔✔mortality of WW1 femur fractures - ✔✔80% b/c they didn't know that they should
provide traction
after traction was introduced, mortality dropped to 8%
✔✔how does a traction splint work - ✔✔for mid-shaft femur fractures
PULL on ankle
PUSH on pelvis
*can do for open femur fractures
✔✔contraindication to traction splinting for femur fractures - ✔✔unstable pelvis fracture
(okay to do if stable pelvis fracture), tib-fib fracture
b/c of how traction works
,PULL on ankle
PUSH on pelvis
✔✔intervention for all real/suspected fractures - ✔✔immediate immobility
decreased pain, decreased bleed, decreased further injury
✔✔adult blood volume - ✔✔4-6L
✔✔important thing to remember if a heavy object falls and pins a patient - ✔✔likely
acting as a tourniquet so need to apply tourniquet before remove
✔✔point on the tissue oxygenation cascade where fracture/ortho injuries are affected -
✔✔hemoglobin availability
CO
✔✔what happens to blood in/around a fracture site - ✔✔edema fluid that leaves the
vascular space and is evenly reestaborbed into the lymph systme
blood leaving the vascular space, it is a one way trip and isn't reabsorbed and never
contributes to recirculating volume again. all RBC lost forever
blood in tissue is irritating, aggravates pain, limits function, contributes to scar tissue
formation
✔✔RICE - ✔✔hemostasis interventions
✔✔blood outside the vessels - ✔✔irritating
isn't reabsorbed. never contributes to circulating volume against. RBC is lost
✔✔when should you initiate pt transfer if your facility cannot accommodate what they
need - ✔✔within 15minutes
✔✔needed for pt transfer - ✔✔transfer agreement
accepting MID
handoff
sent pt to same or higher level of care
pt consent only needed if emergency
✔✔imaging studies and transfer to a more capable facility - ✔✔imaging studies should
never delay transfer auto a trauma center that is capable of providing definitive care
okay if needed to ID steps too stabilize
✔✔effect of pt transfer to a higher escehlon of care - ✔✔emotional, family logistics,
eventual return, follow up
to family a long-distance transfer feels like other side of the galaxy
, ✔✔percutaneously - ✔✔through the skin
✔✔performed through the skin - ✔✔percutaneously
✔✔gelfoam - ✔✔type of absorbable gelatin hemostatic agent that is made from purified
pork skin gelatin; available in either pad or powder form; it is placed over an area of
bleeding to control hemorrhage
✔✔hemostatic agent that is a pad or powder put over bleeding to control - ✔✔gelfoam
✔✔options for OR care of pelvic fractures - ✔✔open reduction, closed reduction,
interventional radiography, ORIF
✔✔external fixation for pelvic fractures - ✔✔stabilize the pelvic rings
may use peritoneal packign
✔✔internal rods for pelvic fractures - ✔✔internal fixation
✔✔goal of agiography for pelvic fracrues - ✔✔doesn't stabilize the fracture but does
identify bleeding spot and uses gel foam or coils to symbolize bleeding arteries. most
bleeding is venous or osseous rather than arterial
✔✔most invasive form of pelvic fracture intervetion - ✔✔ORIF
✔✔closed mid=shaft femur management - ✔✔external fixation, plates/screws,
flexible/rigid IM nail
most common = intramedullary rodding
✔✔open tib/fib fracture intervention - ✔✔debridement, fixation
not casted b/c needs wound care
✔✔position limbs using external fixation rod - ✔✔surgeons may let you move the rod to
move the limb b/c that is the most tstable
ask the surgeon for permission.
lifting from below is disrupts nd is painful
also ask the surgeon before you put weight on the fixated limb
✔✔agent used to clean pin sites - ✔✔cholohexidine
✔✔lab markers of anaerobic metabollism - ✔✔lactate
pH
base deficit
✔✔spot orthodox surgery labs - ✔✔markers of anaerobic metabolic, rhabdo, bleedign
