TCAR Post-Test – Real Exam Questions with Correct Answers (A+ Graded, Verified Content)

TCAR Post-Test – Real Exam Questions
with Correct Answers (A+ Graded,
Verified Content)



 3 questions to ask in trauma ...Answer Is...-what was the dose of energy?
 -where did it go?
 -what injuries are likely?



 2 q's to ask in GSW ...Answer Is...caliber
 type of gun
 # of entrance/exit wounds
 high/low velocity



 1st question to ask in any traumatic injury? ...Answer Is...what was the dose of energy
involved?
 (was it high or low?)



 what is the caliber of a bullet? ...Answer Is...diameter



 aka diameter of a bullet ...Answer Is...caliber



 what happens to projectiles when they enter the body ...Answer Is...projectiles don't travel in
a straight line
 consider temporary cavity wound



 what should you consider about tissue a projectile enounters ...Answer Is...temporary
cavitation



 primary goal of GSW surgery ...Answer Is...usually damage repair & not bullet removal
 -if superficial, it may migrate the surface with time

, important thing to remember about retained projectiles ...Answer Is...they may migrate over
time. bullett migration might explain unexplained clinical findings
 (VP Cheney accidentally shot his friend while hunting in 2006. ICU and did great. moved to an
inpatient unit. had a silent MI bc a shot gun pellets migrated into a canary artery causing an
infract. so had a MI but fibrinolytic not the answer in this case b/c it was a "projectile
embolus"



 aka brestbone ...Answer Is...sternum



 what attaches the ribs to the sternum ...Answer Is...cartliage



 what breaks thoracic bones ...Answer Is...significant force
 -1-2nd ribs, posterior ribs, sternum, scapulae, T2-10
 gives us info about the force aka "dose" of energy received
 consider injury to internal structures b/c force



 ribs that are the most frequently broken ...Answer Is...ribs 4-9 b/c long, thin, and poorly
protecte
 it is harder to break a short pencil (T1-2) and easier to break a longer one
 *ask how many and where to understand the force involved



 what is the significance of posterior rib fractures ...Answer Is...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 ...Answer Is...to injure c-spine, you don't need a big energy blow.
all it takes is shaking around.



 c spine versus t spine fractures ...Answer Is...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 ...Answer Is...largely supportive nursing care like pulmonary toilet



 CXR and rib fractures ...Answer Is...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 ...Answer Is...once healed, rib fractures form bony
callouses and become more visible on CXR



 how to tell a pt has a pneumonia from a CXR ...Answer Is...dark spot that is not equal to the
opposite side



 consider if a pt has a lower rib fracture ...Answer Is...liver & spleen injury
 acts like BBQ/marshmellow skewers



 how high does the diaphragm rise on inspiration ...Answer Is...level of 4th ICS



 risk of rib fractures ...Answer Is...can puncture liver, spleen,, diaphragm
 pop lungs



 +2 adjacent rib fractures ...Answer Is...flail chest



 free floating sternum ...Answer Is...flail chest



 definition of flail chest ...Answer Is...+2 adjacent rib fracture
 free floating sternum



 why is flail chest a problem ...Answer Is...b/c breathing is a mechanical process



 paradoxical chest movements ...Answer Is...in flail chest

,  s/s of flail chest ...Answer Is...paradoxical chest wall movement



 where on the tissue oxygenation cascade is thoracic cage fractures a problem ...Answer
Is...ventilation



 parameters to assess ventilation ...Answer Is...ETCO2, PaCO2, clinical assessment



 what are considered "great vessels" ...Answer Is...



 thorax ...Answer Is...



 what type of injuries occur when the lungs are subjected to force? ...Answer Is...bruise =
contusion
 tear = lacerations
 pop = punctures
 inhalation injury



 bruise on the lungs ...Answer Is...pulmonary contusion



 causes of pulmonary contusions ...Answer Is...high speed blunt or penetrating injury



 what happens to the lungs in pulmonary contusions ...Answer Is...big boggy bruise on the
lungs
 diffusion problems
 when it becomes contused & edematous, it becomes difficult for oxygen to move from the
alveoli into the capillaries



 where on the tissue oxygenation cascade do pulmonary contusions cause their
problems ...Answer Is...diffusion



 all contusions over time ...Answer Is...all contusions "blossom" over time. the full extent of
the injury is not initially apparent