TCRN Solheim Review UPDATED ACTUAL Questions and CORRECT Answers
1. blood typing RBCs have antigens on cell surface (blood type designation) with opposite anti-
bodies in the plasma
2. blood transfu- antigens are exposed to matching antibodies, leading to clumping of cells
sion reactions oc-
cur when ex. can't give B type blood to A type person (A antibodies in the B type blood with
bind to A antigens in A type blood)
3. after cen- all antigens
trifuged, packed
RBCs have O- is universal donor (no antigens, so any antibodies in recipient will be unattect-
ed)
4. after cen- all antibodies
trifuged, plasma
has AB is universal donor (no antibodies in AB plasma, will not bind with any antigens)
5. risks of massive cold blood/fluids can decrease thrombin production and platelet function (risk
transfusion for bleeding and coagulopathies) WARM fluids
citrate can cause hypocalcemia and lead to cardiac dysrhythmias, tremors,
seizures REPLACE calcium
pH of banked blood is 7.1, can cause acidosis that will impair thrombin and
clotting factor production PREVENT acidosis
TRALI
6. TRALI non cardiogenic pulmonary edema, inflammatory reaction that usually begins 2-6
hours post transfusion
causes hypoxia, fever, hypotension, tachypnea/dyspnea, increased cap perme-
ability in the lungs
, STOP transfusion, give O2, may need to intubate, give blood pressure support
7. Goals of treat- stable H/H
ment for hypo- platelets/clotting times WNL
volemic shock -- normal pH
laboratory values Base excess between -2 and +2
declining lactate
normal BUN:Cr ratio (1:10)
8. goals of treat- normal SpO2, EtCO2
ment for hypo- normothermia, normotension
volemic shock -- stable HR and RR
Vitals Urine output of at least 0.5 ml/kg/hr
9. permissive hy- choosing not to aggressively treat a hemorrhagic hypotensive pt, because in-
potension crease in pressure can increase blood loss at opening and prevent formation of
clots
MAP of 50 has higher survival rates, decreases with higher MAP, but drops
significantly if less than 50
works best with younger/healthier patients, and penetrating trauma (no head
injuries)
10. Pediatric airway large tongue with smaller oral cavity -- needs more aggressive suctioning
considerations
obligate nose breathers (until 4-6months), suction blood/secretions from nose
soft airway cartilage and poorly developed neck muscles -- potential for airway
obstruction if hyperextended neck (goal is sniflng position)
11. soft/cartilaginous sternum and ribs -- less protected cardiac/thoracic
, pediatric breath- broken ribs associated with abuse because very diflcult to break
ing considera-
tions small chest size -- auscultate at midaxillary to separate sides of lung
thin chest walls -- easy to sustain pulmonary contusions, even without broken ribs
may have breath holding spells up to 20 seconds
flat diaphragm means gastric dissension can cause respiratory distress -- decom-
press quickly
12. pediatric circula- circulating BV is 80ml/kg for children, and 90ml/kg for infants
tion considera-
tions can compensate for 25% of blood loss with HR and PVR
blood pressure is unreliable to indicate shock b/c of compensation, use capillary
refill instead
cap refill should be <2 seconds, blanch forehead, sole of foot, palm of hand,
13. fluid resuscita- bolus: 20 ml/kg
tion for pedi- one unit of whole blood: 20ml/kg
atrics one unit of PRBC: 10 ml/kg, 1:1:1 replacement
platelets: 10 ml/kg
FFP: 10ml/kg
normal urine output: infants 2ml/kg, children 0.5-1ml/kg
14. disability in pedi- large heads and poor fusion of skull bones
atric trauma
prone to head injuries
risk for pinched/injured spinal cord without permanent change in vertebrae/ra-
diology
, prone to brain injury due to open fontanels
large occiput may tip head forward/occlude head, place towel roll under shoul-
ders to maintain alignment
15. signs of de- restlessness, crying, fussiness, agitation, irritability, combativeness
creased cerebral
perfusion in in-
fants
16. normal pediatric 0-5 years, >40
cerebral perfu- 5-17 years, >50
sion pressures
17. environmental much higher risk for hypothermia, which worsens O2 consumption, shock, acido-
control of sis, coagulopathies
pediatric trauma
large BSA:BM ratio
more brown adipose tissue but low body fat so cannot hold onto heat
inability to shiver
immature thalamus
18. pediatric labs in lower glycogen stores, prone to hypoglycemia
trauma
higher metabolism which is why they eat so frequently
can lead to decreased cardiac contractility, altered LOC, seizures, and acidosis
19. general pediatric eye level communication
principles
be honest about pain
1. blood typing RBCs have antigens on cell surface (blood type designation) with opposite anti-
bodies in the plasma
2. blood transfu- antigens are exposed to matching antibodies, leading to clumping of cells
sion reactions oc-
cur when ex. can't give B type blood to A type person (A antibodies in the B type blood with
bind to A antigens in A type blood)
3. after cen- all antigens
trifuged, packed
RBCs have O- is universal donor (no antigens, so any antibodies in recipient will be unattect-
ed)
4. after cen- all antibodies
trifuged, plasma
has AB is universal donor (no antibodies in AB plasma, will not bind with any antigens)
5. risks of massive cold blood/fluids can decrease thrombin production and platelet function (risk
transfusion for bleeding and coagulopathies) WARM fluids
citrate can cause hypocalcemia and lead to cardiac dysrhythmias, tremors,
seizures REPLACE calcium
pH of banked blood is 7.1, can cause acidosis that will impair thrombin and
clotting factor production PREVENT acidosis
TRALI
6. TRALI non cardiogenic pulmonary edema, inflammatory reaction that usually begins 2-6
hours post transfusion
causes hypoxia, fever, hypotension, tachypnea/dyspnea, increased cap perme-
ability in the lungs
, STOP transfusion, give O2, may need to intubate, give blood pressure support
7. Goals of treat- stable H/H
ment for hypo- platelets/clotting times WNL
volemic shock -- normal pH
laboratory values Base excess between -2 and +2
declining lactate
normal BUN:Cr ratio (1:10)
8. goals of treat- normal SpO2, EtCO2
ment for hypo- normothermia, normotension
volemic shock -- stable HR and RR
Vitals Urine output of at least 0.5 ml/kg/hr
9. permissive hy- choosing not to aggressively treat a hemorrhagic hypotensive pt, because in-
potension crease in pressure can increase blood loss at opening and prevent formation of
clots
MAP of 50 has higher survival rates, decreases with higher MAP, but drops
significantly if less than 50
works best with younger/healthier patients, and penetrating trauma (no head
injuries)
10. Pediatric airway large tongue with smaller oral cavity -- needs more aggressive suctioning
considerations
obligate nose breathers (until 4-6months), suction blood/secretions from nose
soft airway cartilage and poorly developed neck muscles -- potential for airway
obstruction if hyperextended neck (goal is sniflng position)
11. soft/cartilaginous sternum and ribs -- less protected cardiac/thoracic
, pediatric breath- broken ribs associated with abuse because very diflcult to break
ing considera-
tions small chest size -- auscultate at midaxillary to separate sides of lung
thin chest walls -- easy to sustain pulmonary contusions, even without broken ribs
may have breath holding spells up to 20 seconds
flat diaphragm means gastric dissension can cause respiratory distress -- decom-
press quickly
12. pediatric circula- circulating BV is 80ml/kg for children, and 90ml/kg for infants
tion considera-
tions can compensate for 25% of blood loss with HR and PVR
blood pressure is unreliable to indicate shock b/c of compensation, use capillary
refill instead
cap refill should be <2 seconds, blanch forehead, sole of foot, palm of hand,
13. fluid resuscita- bolus: 20 ml/kg
tion for pedi- one unit of whole blood: 20ml/kg
atrics one unit of PRBC: 10 ml/kg, 1:1:1 replacement
platelets: 10 ml/kg
FFP: 10ml/kg
normal urine output: infants 2ml/kg, children 0.5-1ml/kg
14. disability in pedi- large heads and poor fusion of skull bones
atric trauma
prone to head injuries
risk for pinched/injured spinal cord without permanent change in vertebrae/ra-
diology
, prone to brain injury due to open fontanels
large occiput may tip head forward/occlude head, place towel roll under shoul-
ders to maintain alignment
15. signs of de- restlessness, crying, fussiness, agitation, irritability, combativeness
creased cerebral
perfusion in in-
fants
16. normal pediatric 0-5 years, >40
cerebral perfu- 5-17 years, >50
sion pressures
17. environmental much higher risk for hypothermia, which worsens O2 consumption, shock, acido-
control of sis, coagulopathies
pediatric trauma
large BSA:BM ratio
more brown adipose tissue but low body fat so cannot hold onto heat
inability to shiver
immature thalamus
18. pediatric labs in lower glycogen stores, prone to hypoglycemia
trauma
higher metabolism which is why they eat so frequently
can lead to decreased cardiac contractility, altered LOC, seizures, and acidosis
19. general pediatric eye level communication
principles
be honest about pain
