TCAR-POST TEST REAL EXAM
Questions With 100% Correct
Answers Already GRADED A+
NEWEST 2025
what is the significance of posterior rib fractures - unusual direction of injury
shorter stubby ribs
good muscle profection
**posterior rib fractures have a lot of force so need a high dose.
***PRF need a lot of force so high dose of energy. big red flag for t-spine injury
indication of c-spine injury - to injure c-spine, you don't need a big energy blow. all it
takes is shaking around.
c spine versus t spine fractures - c-spine doesn't need a big energy blow. just some
shaking around
t-spine needs a great strong direct blow (not just a shock_
treatment for rib fractures - largely supportive nursing care like pulmonary toilet
CXR and rib fractures - simple rib fractures are difficult to see on CXR and can be
commonly missed
(1/2 of all rib fractures aren't identified at the POI CXR)
identify a previous rib fracture on CXR - once healed, rib fractures form bony callouses
and become more visible on CXR
how to tell a pt has a pneumonia from a CXR - dark spot that is not equal to the
opposite side
consider if a pt has a lower rib fracture - liver & spleen injury
acts like BBQ/marshmellow skewers
how high does the diaphragm rise on inspiration - level of 4th ICS
risk of rib fractures - can puncture liver, spleen,, diaphragm
pop lungs
+2 adjacent rib fractures - flail chest
free floating sternum - flail chest
definition of flail chest - +2 adjacent rib fracture
free floating sternum
,why is flail chest a problem - b/c breathing is a mechanical process
paradoxical chest movements - in flail chest
s/s of flail chest - paradoxical chest wall movement
,where on the tissue oxygenation cascade is thoracic cage fractures a problem -
ventilation
parameters to assess ventilation - ETCO2, PaCO2, clinical assessment
what are considered "great vessels" -
thorax -
what type of injuries occur when the lungs are subjected to force? - bruise = contusion
tear = lacerations
pop = punctures
inhalation injury
what part on the tissue oxygenation cascade is affected by tension pneumothorax -
ventilation r/t collapsed lung
CO b/c pressure
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
Questions With 100% Correct
Answers Already GRADED A+
NEWEST 2025
what is the significance of posterior rib fractures - unusual direction of injury
shorter stubby ribs
good muscle profection
**posterior rib fractures have a lot of force so need a high dose.
***PRF need a lot of force so high dose of energy. big red flag for t-spine injury
indication of c-spine injury - to injure c-spine, you don't need a big energy blow. all it
takes is shaking around.
c spine versus t spine fractures - c-spine doesn't need a big energy blow. just some
shaking around
t-spine needs a great strong direct blow (not just a shock_
treatment for rib fractures - largely supportive nursing care like pulmonary toilet
CXR and rib fractures - simple rib fractures are difficult to see on CXR and can be
commonly missed
(1/2 of all rib fractures aren't identified at the POI CXR)
identify a previous rib fracture on CXR - once healed, rib fractures form bony callouses
and become more visible on CXR
how to tell a pt has a pneumonia from a CXR - dark spot that is not equal to the
opposite side
consider if a pt has a lower rib fracture - liver & spleen injury
acts like BBQ/marshmellow skewers
how high does the diaphragm rise on inspiration - level of 4th ICS
risk of rib fractures - can puncture liver, spleen,, diaphragm
pop lungs
+2 adjacent rib fractures - flail chest
free floating sternum - flail chest
definition of flail chest - +2 adjacent rib fracture
free floating sternum
,why is flail chest a problem - b/c breathing is a mechanical process
paradoxical chest movements - in flail chest
s/s of flail chest - paradoxical chest wall movement
,where on the tissue oxygenation cascade is thoracic cage fractures a problem -
ventilation
parameters to assess ventilation - ETCO2, PaCO2, clinical assessment
what are considered "great vessels" -
thorax -
what type of injuries occur when the lungs are subjected to force? - bruise = contusion
tear = lacerations
pop = punctures
inhalation injury
what part on the tissue oxygenation cascade is affected by tension pneumothorax -
ventilation r/t collapsed lung
CO b/c pressure
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
