TNCC 9th Edition Final Exam Study Guide Questions And Answers Verified 100% Correct

TNCC 9th Edition Final Exam Study Guide Questions And Answers Verified 100% Correct Mean Arterial Pressure (MAP) - ANSWER 50-150mmHg The average blood pressure in a single cardiac cycle, roughly calculated as the SBP + 2 x the DBP/3 Avoid hypoxemia in the patient with head trauma - ANSWER A single episode of hypoxemia (PaO2 <60mmHg) can be detrimental to the patient's outcome. Maintain pulse ox at 95% or greater and obtain ABG measurement asap for patient with severe TBI. Maintain ETCO2 between 35-45 mmHg Manage ICP in the patient with head trauma - ANSWER An ICP sustained at greater than 22 mmHg and unresponsive to treatment is associated with poor outcomes Increased ICP Assessment Findings - ANSWER Early: Headache; n/v; amnesia; behavior changes (restlessness, impaired judgement; drowsiness); altered level of consciousness (hyperarousability and hypoarousability) Late: Dilated, nonreactive pupils; unresponsive to verbal or painful stimuli; abnormal motor posturing (flexion, extension, flaccidity); Cushing response: Widening pulse pressure, reflex bradycardia, and decreased respiratory effort. Corneal Injury - ANSWER Assessment Findings: Photophobia, pain, eye redness, lid swelling, FB sensation Treatment: Topical anesthesia, topical ophthalmic NSAID, no eye patch, remove FB, may need topical abx for laceration. Follow up: with ophthalmologist in 24-48 hours; ophthalmology consultation for deep and large FB Orbital Fracture - ANSWER Assessment Findings: Periorbital ecchymosis, facial swelling, double vision, enophthalmos (posterior displacement of eyeball within orbit, ptosis. Treatment: Nasal decongestant, ice packs to the orbit for 48 hours, oral abx Follow up: May require surgery, ophthalmology. Avoid blowing nose, sneezing, and Valsalva maneuver Retrobulbar hematoma - ANSWER Assessment Findings: Severe pain, decreased vision or loss of vision, reduced eye movement, double vision, IOP >40mmHg Treatment: Administer medications to decrease IOP, emergency decompression via lateral canthotomy Follow up: Emergent consultation with ophthalmology Globe Rupture - ANSWER Assessment Findings: Irregular or teardrop-shaped pupils, periorbital ecchymosis, decreased visual acuity and EOM, severe subconjunctival hemorrhage, deep eye pain, nausea Treatment: Avoid any pressure on the globe, apply a rigid shielf to protect the affected eye, consider tetanus vaccine, keep patient NPO, assess and treat pain, administer antiemetics to decrease risk of n/v, elevate the HOB to decrease IOP, avoid ophthalmic drops or medications, administer systemic abx Follow up: Emergency consultation with ophthalmology; prepare pt for CT scan and OR Ocular Burns - ANSWER Assessment Findings: Swelling of the sclera, conjunctival irritation, corneal clouding (may be indicative of severe burn, pain Treatment: Determine baseline pH of the eye, topical anesthesia, immediate copious irrigation until the pH returns to normal range (7.4) which may require >2L of irrigating solution, visual acuity reassessment Follow up: Ophthalmology consultation and close follow up. Neck Injuries - ANSWER 3 zones. Mortality is the highest with injuries to zone 1 and patients who have dysphonia, dysphagia, subcutaneous emphysema, or hematomas to the neck region indicating vascular trauma, airway injuries, or esophageal injuries that may not be diagnosed on imaging studies. Penetrating thoracic wound below the fourth intercostal space - ANSWER Penetration into the abdominal cavity is suspected until proven otherwise Thoracic Skeletal Fractures and Associated Injuries - ANSWER Sternal: Blunt cardiac injury; pneumothorax First and second rib: Great vessel injuries, brachial plexus injuries, head and spinal cord injuries Multiple ribs and flail chest: pulmonary contusion; pneumothorax; hemothorax Lower ribs 7-12: Liver for right sided; spleen for left sided Beck's Triad - ANSWER Three signs of acute cardiac tamponade: 1. Low arterial blood pressure 2. Distant, muffled heart sounds