TCAR REVIEW TIPS QUESTIONS AND ANSWERS
SET A+
✔✔what happens to blood in bruises - ✔✔if a bruise happens, the RBC's involved are
lost
✔✔Q to ask if pt hits head - ✔✔are you on blood thinners?
minor bump can have a huge impact if on blood thinners and they are undertriaged
✔✔Rx you should ask about if pt is in a truma - ✔✔blood thinners?
on Beta blockers/CaChB b/c a hemorrhaging pt can't mount an effect SNS response to
hemorrhage . trauma pt's NEED to vasoconstrictor and increase HR. s/s of SNS
response alerts us t troubleq
✔✔why is it important to know if a trauma patient is on Beta Blockers or CaChB - ✔✔b/c
a hemorrhaging pt can't mount an effective SNS response to heonrrhage
✔✔importance of intervening for scalp lacerations - ✔✔very vascular so can
exsanguinate
✔✔why are serial near checks important - ✔✔b/c brain injuries "blossom"
✔✔earliest s/s of neurological deficitis - ✔✔altered LOC (drowsy)
goofy-agitated-combative-somnolent-stuporous-unarousable
**don't think "good, he finally calmed down and went to sleep*. goofy patients are
actually telling us "my brain is shifting"
✔✔what should we consider if a patient is acting "goofy" - ✔✔intoxication, brain shifting
into herniation, hypoxia
✔✔nonspecific early s.s of brain shifting - ✔✔nonspecific
"goofy...agitated...lethargic...stupor"
nonspecific like AOx__, N/V, irritable, HA, drowsy, disoriented
, **we can't wait until the most classic s/s
✔✔classic s/s of brain injury - ✔✔early - goofy/agitiated/lethargic/stupor
AOx_, N/V, irritable, HA, drowsy, disoriented
posturing, pupils, seizures, cushing's triad, vs changes
✔✔Cushing's triad - ✔✔brain injury late s/s
✔✔options for warfarin reversal - ✔✔vitamin K, KCentra, FFP
**but needs lots of FFP as much as 6 units to get INR within range
✔✔alternative use for FFP - ✔✔can use it for warfarin reversal but need as much as 6
units to get INR within range
✔✔KCentra - ✔✔pro clot agent.
prothrombin complex concentrate
-specifically approved for warfarin reversal
(30 minute or less infusion. short time to work)
✔✔normal ICP - ✔✔0-15 mm hg
✔✔range for intracranial HTN - ✔✔over 20 mm hg
✔✔ways to measure ICP -3 - ✔✔venticulostomy cathether
subdural bolt
intraparenchymal sensor
✔✔what type of ICP monitor allows for ICP drainage - ✔✔ventriculostomy
✔✔fastest way to reduce ICP - ✔✔remove CSF
can use a ventriculostomy to drain CSF
✔✔Ventriculostomy Catheter - ✔✔measures ICP and can also remove CSF
✔✔what explains why ICP is high if a brain hematoma is evacuated - ✔✔brain edema
✔✔what is a contributing factor to secondary brain injury - ✔✔compression (edema)
✔✔what problem does cerebral edema cause in the tissue oxygenation cascade -
✔✔cerebral edema is a form of tissue oxygen utilization
✔✔examples of secondary brain injuries - ✔✔tissue ischemia/hypoxia, inflammation,
edema, metabolic disturbances, biochemical changes
SET A+
✔✔what happens to blood in bruises - ✔✔if a bruise happens, the RBC's involved are
lost
✔✔Q to ask if pt hits head - ✔✔are you on blood thinners?
minor bump can have a huge impact if on blood thinners and they are undertriaged
✔✔Rx you should ask about if pt is in a truma - ✔✔blood thinners?
on Beta blockers/CaChB b/c a hemorrhaging pt can't mount an effect SNS response to
hemorrhage . trauma pt's NEED to vasoconstrictor and increase HR. s/s of SNS
response alerts us t troubleq
✔✔why is it important to know if a trauma patient is on Beta Blockers or CaChB - ✔✔b/c
a hemorrhaging pt can't mount an effective SNS response to heonrrhage
✔✔importance of intervening for scalp lacerations - ✔✔very vascular so can
exsanguinate
✔✔why are serial near checks important - ✔✔b/c brain injuries "blossom"
✔✔earliest s/s of neurological deficitis - ✔✔altered LOC (drowsy)
goofy-agitated-combative-somnolent-stuporous-unarousable
**don't think "good, he finally calmed down and went to sleep*. goofy patients are
actually telling us "my brain is shifting"
✔✔what should we consider if a patient is acting "goofy" - ✔✔intoxication, brain shifting
into herniation, hypoxia
✔✔nonspecific early s.s of brain shifting - ✔✔nonspecific
"goofy...agitated...lethargic...stupor"
nonspecific like AOx__, N/V, irritable, HA, drowsy, disoriented
, **we can't wait until the most classic s/s
✔✔classic s/s of brain injury - ✔✔early - goofy/agitiated/lethargic/stupor
AOx_, N/V, irritable, HA, drowsy, disoriented
posturing, pupils, seizures, cushing's triad, vs changes
✔✔Cushing's triad - ✔✔brain injury late s/s
✔✔options for warfarin reversal - ✔✔vitamin K, KCentra, FFP
**but needs lots of FFP as much as 6 units to get INR within range
✔✔alternative use for FFP - ✔✔can use it for warfarin reversal but need as much as 6
units to get INR within range
✔✔KCentra - ✔✔pro clot agent.
prothrombin complex concentrate
-specifically approved for warfarin reversal
(30 minute or less infusion. short time to work)
✔✔normal ICP - ✔✔0-15 mm hg
✔✔range for intracranial HTN - ✔✔over 20 mm hg
✔✔ways to measure ICP -3 - ✔✔venticulostomy cathether
subdural bolt
intraparenchymal sensor
✔✔what type of ICP monitor allows for ICP drainage - ✔✔ventriculostomy
✔✔fastest way to reduce ICP - ✔✔remove CSF
can use a ventriculostomy to drain CSF
✔✔Ventriculostomy Catheter - ✔✔measures ICP and can also remove CSF
✔✔what explains why ICP is high if a brain hematoma is evacuated - ✔✔brain edema
✔✔what is a contributing factor to secondary brain injury - ✔✔compression (edema)
✔✔what problem does cerebral edema cause in the tissue oxygenation cascade -
✔✔cerebral edema is a form of tissue oxygen utilization
✔✔examples of secondary brain injuries - ✔✔tissue ischemia/hypoxia, inflammation,
edema, metabolic disturbances, biochemical changes
