TNCC EXAM WITH COMPLETE SOLUTION

TNCC EXAM WITH COMPLETE SOLUTION Primary concern when a person cannot stop coughing/clearing their throat following house fire/smoke? - answerAirway/Intubate Lab evidence of cellular perfusion - answerBase Excess (Less than -6 is BAD) Multiple people are in the ER of different ages who all go to the same church. They all have the same symptoms. What is the most likely cause? - answerBiologic Suspected shock type with a spinal cord injury - answerDistributive Shock (Includes neurogenic) Patient has GCS of 3, unequal pupils (one sluggish, one blown), and is posturing. What is the cause? - answerHerniation Middle Meningeal Artery - answerEpidural Hematoma (results from collection of blood that forms between dura mater and skull) Prior to having a concussion (TBI), the patient had a brain injury that was not fully healed. What is the cause? - answer2nd Impact Syndrome Bowel sounds heard in the L chest. What is this a symptom of? - answerRuptured diaphragm Symptoms of : include muffled heart sounds and hypotension - answerPericardiocentesis How should you dress a severed limb? - answerSterile gauze with normal saline THEN put ice on it Amylase level looks at - answerPancreas What should you do if your patient has hyphema (collection of blood inside the front part of the eye?) - answerSit HOB up to 30 degrees Principle that people have to take action after suffering a loss in order to decrease severity, seriousness, or painfulness - answerMitigation What organ is most at risk following a gunshot - answerLiver 8 year old child with longitudinal thigh lacerations - answerSign of child abuse Bleeding around belly button - answerCullen's Sign What would cause an inaccurate reading from an 02 saturation probe? - answerCarboxyhemoglobin (increase FiO2 to 100%) General study of forces and their effects on living tissue and the human body - answerBiomechanics Study of energy transfer as it applies to identifying actual or potential injuries - answerKinematics Refers to the separation of tissue resulting from a sound and/or hydraulic wave force- the effect is a crushing pressure wave which creates a temporary cavity, followed by a rapid and violent closing of the cavity. - answerCavitation This rapid motion can lead to crushing, tearing, and shearing forces on tissue - answerCavitation Used in OR; does not provide protection against aspiration and not recommended in patients who have eaten recently. It is a supraglottic airway. - answerLaryngeal Mask Airway Single tube retroglottic device inserted into the esophagus and traps the glottis opening between an esophageal cuff and an oropharyngeal cuff. Designed with 2 ports/lumens each with a separate cuff. Does NOT provide protection against aspiration and is not indicated in children. It is a retroglottic airway. - answerKing Tube Types of Shock (4) - answerHypovolemic, Obstructive, Cardiogenic, Distributive Hemorrhage is the leading cause. Can result from vomiting, diarrhea, and burn trauma. Decreased circulating volume --> decreased preload. Therapy includes replacing the type of volume that was lost. - answerHypovolemic Shock Results from hypo perfusion of tissue due to an obstruction in either the vasculature or heart. Therapy aimed at relieving the obstruction and improving perfusion. - answerObstructive Shock Two classic examples of obstructive shock - answerCardiac tamponade and tension pneumothorax Results from pump failure in the presence of adequate intravascular volume. Lack of CO and end-organ perfusion secondary to a decrease in myocardial contractility and/or valvular insufficiency. Therapy includes inotropic support, antidysrhythmic medications, and correction or treatment of underlying cause. - answerCardiogenic Shock Results from the misdistribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. Treatment is to provide volume replacement, increase systemic vascular resistance with medications (pressors) and possible antibiotics. - answerDistributive Shock Examples that can cause distributive shock - answerAnaphylactic shock, septic shock, neurogenic shock : Impairs thrombin production and platelet function : Impairs thrombin production : Results in depletion of clotting factors through hemodilution and the impaired ability to produce clotting factors. - answerTrauma Triad of Death 1. Hypothermia 2. Metabolic Acidosis 3. Coagulopathy Stages of Shock (3) - answer1. Compensated 2. Decompensated vs Progressive 3. Irreversible Complete craniofacial separation involving maxilla, zygoma, orbits, and bones of the cranial base. Assessment findings include: massive facial edema, mobility and depression of zygomatic bones, ecchymoses, diplopia, and open bite or malocclusion. - answerLeFort III Transverse maxillary bone fracture that occurs above the level of the teeth from the maxilla. Assessment findings include: independent moment of the maxilla from the rest of the face, slight swelling of the maxillary area, lip laceration or fractured teeth, malocclusion. - answerLeFort I Pyramidal maxillary bone fracture involving the mid-face area. The apex of the fracture transverses the bridge of the nose. Assessment findings include: massive facial edema, nasal swelling with obvious fracture of the nasal bones, malocclusion, CSF rhinorrhea - answerLeFort II Can be caused by blunt trauma. Air escapes from the injured lung into the pleural space, and negative intrapleural pressure is lost resulting in partial or complete collapse of the lung. S & S: dyspnea, tachypnea, decreased/absent breath sounds on injured side, chest pain. Treatment: based on size, symptoms, and stability. Chest tube may be placed to evacuate pleural air and maintain lung expansion - answerPneumothorax Air enters the intrapleural space but cannot escape on expiration. The increasing intrathoracic pressure causes the lung on the injured side to collapse. If pressure is not relieved, the mediastinum can shift toward the uninjured side compressing the heart/great vessels/and opposite lung. S & S: anxiety, severe restlessness, severe respiratory distress, significantly diminished or absent breath sounds on injured side, hypotension, distended neck/head/upper extremity veins, tracheal deviation, or a shift toward uninjured side. Treatment: Needle thoracentesis and chest tube insertion - answerTension Pneumothorax Collection of blood in pericardial sac. Mechanism of injury is typically penetrating trauma. Compresses the heart and decreases ability of the ventricles to fill causing decreased SV and CO. S & S: hypotension, muffled heart sounds, distended neck veins, tachycardia or PEA, dyspnea, cyanosis, chest pain. Surgical evacuation will be needed. - answerCardiac Tamponade Shock: Spinal cord injury at T6 or above. Temporary loss of vasomotor tone and sympathetic innervation. Temporary duration usually <72 hours. S & S: hypotension, bradycardia, loss of ability to sweat below level of injury. - answerNeurogenic Shock: Spinal cord injury at any level. Transient loss of reflex below the level of injury. Variable duration. S & S: flaccidity, loss of reflexes, bowel/bladder dysfunction. - answerSpinal Significant muscle damage and cellular destruction releases myoglobin: a muscle protein; into the bloodstream. Classic symptoms: muscle pain/numbness/changes in sensation, muscle weakness/paralysis, dark red/brown urine. - answerRhabdomyolysis What does MIST mnemonic mean? - answerM: Mechanism of Injury I: Injuries sustained S: S&S in the field T: Treatment in the field Older adults are harder to intubate due to - answercervical arthritis Leading cause of preventable death after injury - answerHemorrhage Room Air = % FiO2 - answer21% 1 Liter of O2 = % FiO2 - answer4% Patient snoring = insert airway - answerOral Airway (OPA) Avoid when administering oxygen/ventilation - answerhyperoxia Resuscitation Adjuncts (LMNOP) - answerL: Lab M: Monitor cardia rhythm and rate N: Naso or Oro-gastric tube insertion O: Oxygenation or ventilation analysis P: Pain assessment and management Do not place in head trauma patients - answernasogastric Right breath sound ONLY following intubation = -- pull out - answerMainstem Massive Blood Transfusion: Monitor levels: sodium acetate binds with so levels decrease. - answerCalcium Hypercapnia causes ; Hypocapnia causes - answerVasodilation; Vasoconstriction Usually seen in athletes, second TBI, 2nd injury occurs BEFORE 1st injury recovers, rare but usually fatal. - answerSecond Impact Syndrome Injury: shearing or tearing. Diagnosed with MRI. Widespread microscopic hemorrhage. - answerDiffuse Axonal Injury (Cannot recover from this; shearing/tearing portion DOES NOT heal) Muffled heart sounds - answerCardiac tamponade? Pericardial fluid? Most frequently injured organ - answerLiver Most frequently injured organ from BLUNT trauma - answerSpleen Pain Ladder: Step 1: Non-opioids for mild pain Step 2: Weak opioids for mild to moderate pain Step 3: Strong opioids for moderate to severe pain - answer1: Tylenol, Ibuprofen, Ketorolac 2: Codeine 3: Morphine, Fentanyl, Dilaudid Signs of increased compartment syndrome - answerIncreased pain, feels tight/very painful, but nothing looks wrong Ischemia develops -- Pressure Fasical Development -- Impaired Blood Flow. 6 P's: Pressure, pallor, pulses, paresthesia, paralysis. Extremity goes to level of the !!! NO !! - answerCompartment Syndrome: Level of heart; NO ice!! Control bleeding with direct pressure, elevate, apply tourniquets. - answerAmputation Wrap in saline gauze, put in bag, then put that bag in another bag filled with ice. Label bag. -answerRemoved limb