TNCC FINAL EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS || ALREADY GRADED A+ LATEST VERSION

TNCC FINAL EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS || ALREADY GRADED A+ LATEST VERSION 1. What are you looking for when auscultating lung sounds? - ANSWER Absence of BS: - Pneumothorax - Hemothorax - Airway Obstruction Diminished BS: - Splinting or shallow BS may be a result of pain 2. What are you looking for when percussing the chest? - ANSWER Dullness: - hemothorax Hyperresonance - Pneumothorax 3. What are you looking for when palpating the chest wall, clavicles and neck? - ANSWER - Tenderness - Swelling - subcutaneous emphysema - step-off deformities = These may indicate: esophageal, pleural, tracheal or bronchial injuries. Palpate trachea above suprasternal notch. Tracheal deviation may indicate a tension pneumothorax or massive hemothorax. 4. What is the DOPE mnemonic? - ANSWER D - Displaced tube O - Obstruction: Check secretions or pt biting tube P - Pneumothorax: Condition may occur from original trauma or barotrauma from ventilator E - Equipment failure: pt may have become detached from equipment or there's a kink in the tubing 5. Explain Hypovolemic Shock. - ANSWER Most common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. 6. Explain Cardiogenic Shock. - ANSWER Syndrome that results from ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: - MI - Blunt cardiac injury - Mitral valve insufficiency - dysrhythmias - Cardiac Failure 7. Explain Obstructive Shock. - ANSWER Results from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes: - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). - Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium. - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock 8. Explain Distributive Shock. - ANSWER Results from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. 9. What is vascular response? - ANSWER As blood volume decreases, peripheral blood vessels vasoconstrict as a result of sympathetic stimulation via inhibition of baroreceptors. Arterioles constrict to increase TPR and BP. 10. What is renal response? - ANSWER Renal ischemia activates release of renin. Kidneys do not receive adequate blood supply, renin is release into circulation. Renin causes angiotensinogen, normal plasma protein, to release angiotensin I. Angiotensin-converting enzyme from the lungs converts into angiotensin II. Angiotensin II causes: - Vasoconstriction of arterioles and some veins - Stimulation of sympathetic nervous system - Retention of water by kidneys - Stimulation of release of aldosterone from the adrenal cortex (sodium retention hormone) *Decreased urinary output = early sign renal hypoperfusion and an indicator that there's systemic hypoperfusion. 11. Explain adrenal gland response. - ANSWER When adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. 12. Which abdominal organs are most susceptible to tearing or shearing from sudden deceleration or acceleration forces resulting in a tearing or avulsion injury? - ANSWER - Small bowel - Large bowel - Ureters - Urethra - Esophagus 13. What is cavatation? - ANSWER As a missile passes through tissue, it decelerates, dissipating and transferring kinetic energy to the tissues; this is what causes the injury. ... Temporary cavitation can be especially damaging when it affects delicate tissues such as the brain, as occurs in penetrating head trauma.. 14. What is the likely cause of open book fracture? - ANSWER - direct crush - MVC vs Pedestrian -Fall from greater than 12 feet (adults) 15. Explain Hepatic Response. - ANSWER Liver can store excess glucose as glycogen. As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. 16. Explain Pulmonary Response. - ANSWER Tachypnea happens for 2 reasons: 1. Maintain acid-base balance 2. Maintain increased supply of oxygen * Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli. 17. Explain Irreversible Shock. - ANSWER Shock uncompensated or irreversible stages will cause compromises to most body systems. - Inadequate venous return - inadequate cardiac filling - decreased coronary artery perfusion - Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. 18. ICP is a reflection of what three volumes? What happens when one increases? - ANSWER 1. Brain 2. CSF 3. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. 19. What are the early signs and symptoms of increased ICP? - ANSWER - Headache - N/V - Amnesia regarding events around the injury - Altered LOC - Restlessness, drowsiness, changes in speech, or loss of judgement 20. What is indicated by unilaterally fixed and dilated pupils? - ANSWER Oculomotor nerve compression from increased ICP & Heniation syndrome 21. What is indicated by bilaterally fixed and pinpoint pupils? - ANSWER Injury at the pons or Opioid use 22. What is indicated by moderately dilated pupil with sluggish response? - ANSWER Early sign of herniation syndrome