TCAR-POST TEST REAL EXAM
Questions and Answers ALREADY
GRADED A+ Latest Versions 2025
why is tension pneumothorax more life threatening than simple pneumothorax - tension
pneuma is more life threatening than simple b/c of the pressure it puts on the great
vessels so decreased CO
considerations of chest trauma - pneumonia, great vessel trauma, pressure so low CO
when is a hospitalized chest patient the most likely to develop tension pneumothrax -
when we initiate positive pressure ventilation
what can rapidly convert a simple pneumothorax to a tension pneumothraox - positive
pressure can rapidly convert a simple pneumothorax to a tension pneumothorax (BVM
or m. ventilation) or if a chest tube is kinked/clamped/occluded
chest pain w/breathign - pleuritic
pleuritic chest pain - pain with breathing
assessment of t. pneumothraox - pleuritic chest pain (hurts to breathe)
respiratory distress
increased HR
hyppoxemia
agitation
decreased LS
chest dyspmetry
hyperresonance
late s/s of tension pneumothrax - low bp
JVD
tracheal deviation
when do you get tracheal deviation - late sign of tension pneumothrax
when isn't JVD & tracheal deviation obvious in tension pneumothroax - not obvious if
obese, low bp, cervical collar
also - it is a super late s/s
intervention if you suspect tension pneumothrax - needs FAST
do immediate needle D w/o imaging
mortality rate off tension pneumothorax - 100% of patients will die w/o intervention
too much black on CXR - hyperlucency
,needle "d" for tension pneumo - "pop the bubble" with needle/finger.
to restore CO. life saving
finger thoracotomy -
purpose of "needle d" - convert tension pneumo to a simple pneumo.
then put in chest tube
how to convert a tension pneumothorax to a simple pneumo - "needle D"
open pneumothorax - object penetrates or a rib pokes out
intervention for an ope. pneumothroax - xeroform, gasoline bandage, chest seal.
assessment of the site of a chest tube site - consider how it might be a potential site of
an open pneumo
hemothorax causes problems at what point of the tissue oxygen cascade - hgb
availability
ventilation issue b/c lung collapses
CO problem if enough blood is lost
small venin/arteries below each fib so a broken rib could cause hemothraox
bleeding from intercostal vessels should not be extensive and taper off quickly so
continuous bleeding is likely a different vessel
considered too much chest tube drainage - 1-1.5L at initial palcement
50-200ml over 2-4hrs
how much blood can be in one hemothroax - 500 - 3L
,% blood loss that is tolerable versus not tolerable - most people can tolerate a 10%
blood volume loss but most can't tolerate 40%
how to tell if something is blood or air on a CXR - blood = white
black = air
intervention if hemothorax - needs CT
later will need intrapleura tPA or VATS
VATS - video-assisted thoracic surgery
empyema -
added to blood products that may cause low Ca - citrate.
purpose of citrate in blood products - w/o citrate, blood will clot
keeps blood in blood products from clotting - citrate
priority in bleeding episodes - stop bleeding
CABC
leading cause of early mortality in trauma - hemorrhage
cause of 30 - 40% of all patients who die of trauma - hemorrhage
why is it important to keep a hemorrhage pt warm - keep a trauma pt warm helps stop
bleeding b/c you can't clot well if cold
coagulopathy control in hemorrhage - can't clot if we only give RBC/crystallids
needs plasma, cry, plt
definitive bleeding management - OR
field care for bleeding management - helping blood loss > replacing fludis
IVF in hemorrhage - IVF is not a substitution for aggressive hemorrhage control and can
be harmful
benefit of chest tube in trauam - autotransufsion
benefits of autotransfusion in massive hemorrhage - perfect cross-match
fresh blood
k levels lower
room temp
, no communicable disease
many clotting factors
no anticoagulation needed
warm versus cold blood - warm blood pleases oxygen better
problems with autotrausncusion - contained (GSW)
coagulaopathies
enhanced inflammatory response
benefits of any trauma intervention.... - often depends on the circumstance
how long does it take to cross-match - 1 hour
what type of blood is always preferred - fully cross-matched
universal donor - O-
blood types by US population % - AB neg = 0.6%
A+ = 36%
B+ = 8.5%
O+ =34%
O- = 6.6%
3/4 of US has A+ or O+ blood
85% are Rh+
Rh negative patients who receive Rh_ - Rh neg patients who receive Rh+ blood can
develop antibodies to the Rh antigen
reservation of type O neg RBC's - type O negative RBC's are reserved for anyone who
could potentially become pregnant in the future including little girls.
if you give a little girl who is Rh- blood that is O+ then later she gets pregnant and her
spouse/baby are Rh+. then the Rh negative mom may have antibodies against the Rh +
fetus and attack it
Rh factor in hemorrhage - onsieration but not a contraindication in a massive
hemorrhage. untyped female needs blood and Only O+ iOS available
Rh- patient receives Rh+ blood mixing - needs Rhogam within 72hrs.
passive immunization to prevent Rh sensitization and actual Rh formation
universal plasma donr - type AB
considered massive transfusion - 10 units
air in soft tissue - Subcutaneous emphysema
Questions and Answers ALREADY
GRADED A+ Latest Versions 2025
why is tension pneumothorax more life threatening than simple pneumothorax - tension
pneuma is more life threatening than simple b/c of the pressure it puts on the great
vessels so decreased CO
considerations of chest trauma - pneumonia, great vessel trauma, pressure so low CO
when is a hospitalized chest patient the most likely to develop tension pneumothrax -
when we initiate positive pressure ventilation
what can rapidly convert a simple pneumothorax to a tension pneumothraox - positive
pressure can rapidly convert a simple pneumothorax to a tension pneumothorax (BVM
or m. ventilation) or if a chest tube is kinked/clamped/occluded
chest pain w/breathign - pleuritic
pleuritic chest pain - pain with breathing
assessment of t. pneumothraox - pleuritic chest pain (hurts to breathe)
respiratory distress
increased HR
hyppoxemia
agitation
decreased LS
chest dyspmetry
hyperresonance
late s/s of tension pneumothrax - low bp
JVD
tracheal deviation
when do you get tracheal deviation - late sign of tension pneumothrax
when isn't JVD & tracheal deviation obvious in tension pneumothroax - not obvious if
obese, low bp, cervical collar
also - it is a super late s/s
intervention if you suspect tension pneumothrax - needs FAST
do immediate needle D w/o imaging
mortality rate off tension pneumothorax - 100% of patients will die w/o intervention
too much black on CXR - hyperlucency
,needle "d" for tension pneumo - "pop the bubble" with needle/finger.
to restore CO. life saving
finger thoracotomy -
purpose of "needle d" - convert tension pneumo to a simple pneumo.
then put in chest tube
how to convert a tension pneumothorax to a simple pneumo - "needle D"
open pneumothorax - object penetrates or a rib pokes out
intervention for an ope. pneumothroax - xeroform, gasoline bandage, chest seal.
assessment of the site of a chest tube site - consider how it might be a potential site of
an open pneumo
hemothorax causes problems at what point of the tissue oxygen cascade - hgb
availability
ventilation issue b/c lung collapses
CO problem if enough blood is lost
small venin/arteries below each fib so a broken rib could cause hemothraox
bleeding from intercostal vessels should not be extensive and taper off quickly so
continuous bleeding is likely a different vessel
considered too much chest tube drainage - 1-1.5L at initial palcement
50-200ml over 2-4hrs
how much blood can be in one hemothroax - 500 - 3L
,% blood loss that is tolerable versus not tolerable - most people can tolerate a 10%
blood volume loss but most can't tolerate 40%
how to tell if something is blood or air on a CXR - blood = white
black = air
intervention if hemothorax - needs CT
later will need intrapleura tPA or VATS
VATS - video-assisted thoracic surgery
empyema -
added to blood products that may cause low Ca - citrate.
purpose of citrate in blood products - w/o citrate, blood will clot
keeps blood in blood products from clotting - citrate
priority in bleeding episodes - stop bleeding
CABC
leading cause of early mortality in trauma - hemorrhage
cause of 30 - 40% of all patients who die of trauma - hemorrhage
why is it important to keep a hemorrhage pt warm - keep a trauma pt warm helps stop
bleeding b/c you can't clot well if cold
coagulopathy control in hemorrhage - can't clot if we only give RBC/crystallids
needs plasma, cry, plt
definitive bleeding management - OR
field care for bleeding management - helping blood loss > replacing fludis
IVF in hemorrhage - IVF is not a substitution for aggressive hemorrhage control and can
be harmful
benefit of chest tube in trauam - autotransufsion
benefits of autotransfusion in massive hemorrhage - perfect cross-match
fresh blood
k levels lower
room temp
, no communicable disease
many clotting factors
no anticoagulation needed
warm versus cold blood - warm blood pleases oxygen better
problems with autotrausncusion - contained (GSW)
coagulaopathies
enhanced inflammatory response
benefits of any trauma intervention.... - often depends on the circumstance
how long does it take to cross-match - 1 hour
what type of blood is always preferred - fully cross-matched
universal donor - O-
blood types by US population % - AB neg = 0.6%
A+ = 36%
B+ = 8.5%
O+ =34%
O- = 6.6%
3/4 of US has A+ or O+ blood
85% are Rh+
Rh negative patients who receive Rh_ - Rh neg patients who receive Rh+ blood can
develop antibodies to the Rh antigen
reservation of type O neg RBC's - type O negative RBC's are reserved for anyone who
could potentially become pregnant in the future including little girls.
if you give a little girl who is Rh- blood that is O+ then later she gets pregnant and her
spouse/baby are Rh+. then the Rh negative mom may have antibodies against the Rh +
fetus and attack it
Rh factor in hemorrhage - onsieration but not a contraindication in a massive
hemorrhage. untyped female needs blood and Only O+ iOS available
Rh- patient receives Rh+ blood mixing - needs Rhogam within 72hrs.
passive immunization to prevent Rh sensitization and actual Rh formation
universal plasma donr - type AB
considered massive transfusion - 10 units
air in soft tissue - Subcutaneous emphysema
