TCAR TEST COMPLETE QUESTIONS WITH CORRECT ANSWERS

TCAR TEST COMPLETE QUESTIONS WITH CORRECT ANSWERS .3 questions to ask in trauma - Answer--what was the dose of energy? -where did it go? -what injuries are likely? .2 q's to ask in GSW - Answer-caliber type of gun # of entrance/exit wounds high/low velocity .1st question to ask in any traumatic injury? - Answer-what was the dose of energy involved? (was it high or low?) .what is the caliber of a bullet? - Answer-diameter .aka diameter of a bullet - Answer-caliber .what happens to projectiles when they enter the body - Answer-projectiles don't travel in a straight line consider temporary cavity wound .what should you consider about tissue a projectile enounters - Answer-temporary cavitation .primary goal of GSW surgery - Answer-usually damage repair & not bullet removal -if superficial, it may migrate the surface with time .important thing to remember about retained projectiles - Answer-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-sternum .what attaches the ribs to the sternum - Answer-cartliage .what breaks thoracic bones - Answer-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-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-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-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-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-largely supportive nursing care like pulmonary toilet .CXR and rib fractures - Answer-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-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-dark spot that is not equal to the opposite side .consider if a pt has a lower rib fracture - Answer-liver & spleen injury acts like BBQ/marshmellow skewers .how high does the diaphragm rise on inspiration - Answer-level of 4th ICS .risk of rib fractures - Answer-can puncture liver, spleen,, diaphragm pop lungs .+2 adjacent rib fractures - Answer-flail chest .free floating sternum - Answer-flail chest .definition of flail chest - Answer-+2 adjacent rib fracture free floating sternum .why is flail chest a problem - Answer-b/c breathing is a mechanical process .paradoxical chest movements - Answer-in flail chest .s/s of flail chest - Answer-paradoxical chest wall movement .where on the tissue oxygenation cascade is thoracic cage fractures a problem - Answer-ventilation .parameters to assess ventilation - Answer-ETCO2, PaCO2, clinical assessment .what type of injuries occur when the lungs are subjected to force? - Answer-bruise = contusion tear = lacerations pop = punctures inhalation injury .bruise on the lungs - Answer-pulmonary contusion .causes of pulmonary contusions - Answer-high speed blunt or penetrating injury .what happens to the lungs in pulmonary contusions - Answer-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-diffusion .all contusions over time - Answer-all contusions "blossom" over time. the full extent of the injury is not initially apparent .important thing to remember when you are evaluating a patient for pulmonary contusions - Answer-70% of pulmonary contusions aren't initial on the initial CXR .what should you monitor when a pt has trauma to the throax - Answer-closely monitor for pulmonary contustiobs = 70% not present on the initial CXR and "blossom" over time -monitor for progress e deterioration in hours/days post injury *might look ok in ER .best parameter of serial monitoring for pt's who have risk factors for pulmonary contusions - Answer-anticipate "blossoming" over time b/c 70% of pulmonary contusions aren't present on the initial CXR P:F ratio .problem of using CXR as a definitive clinical dx tool - Answer-CXR may lag behind clinical status *b/c 70% of pulmonary contusions aren't present on initial CXR. they "blossom" over time .tear in lung tissue - Answer-pulmonary laceration .problem of pulmonary lacerations - Answer-risk of massive hemothoax b/c those vessels are very vascular .what is a simple pneumothorax - Answer-any air that enters the pleural cavity can also leave at the same rate. lungs deflated but no increase in intrathroacic pressure. air in/out exits at the same rate. pt might be able to tolerate a simple pneumothraox causes a problem at the ventilation point at the tissue oxygen cascade .intrathroacic pressure in simple pneumothorax - Answer-air that enters the pleural cavity leaves at the same rate lungs are deflated but no increase in pressure air in/out at the same rate .where is the problem in the tissue oxygenation cascade in simple pneumothroax - Answer-ventilation