TCAR CORRECT FINAL QUESTIONS AND
ANSWERS SET A+
✔✔top 3 causes of death at the scene of traumatic injury - ✔✔massive head trauma
aortic care
high spinal cord injury
✔✔assessment findings that indicate great vessel injury - ✔✔massive hemothroax
shock
inability to resuscitate patient
✔✔method of treatment - ✔✔modality
✔✔mesenteric injuries - ✔✔
✔✔3 layers of blood vessels - ✔✔endothelium (tunica intima)
tunica media
tunica adventitia
✔✔what happens when the aorta is stretched - ✔✔the most delicate/weakest layers
tear first
✔✔screening needed for thoracic trauma - ✔✔decrease great vess3l injury
bilateral bp
✔✔why should you do bilateral bp to screen for aortic tear - ✔✔b/c blood normally flows
in a forward direction but in a dissection blood flows downwards w/ a little backwards. it
doesn't take much backward dissection to start obstructing flow to the L subclavian
✔✔what happens in a dissection - ✔✔retrograde flow and potential obstruction of any
vessel that branches off the aorta
✔✔importance of the aorta - ✔✔everything branches off the aorta
,✔✔problem of femoral artery occlusion - ✔✔compromises flow of lower extremities
✔✔classic CXR findings in aortic injury - ✔✔widened mediastium
✔✔what are you looking for on the CXR if you suspect a dissection - ✔✔widened
mediastium
✔✔widened mediastinum on CXR - ✔✔dissection
✔✔cause of the widened mediastinum on CXR in a dissection - ✔✔shadow of the
hematoma as it balloons out from the aorta
✔✔heparin in truma - ✔✔never a good idea in a trauma pt
✔✔TVAR - ✔✔thoracic endovascular aortic repair
✔✔REBOA - ✔✔resuscitative endovaqscular balloon occlusion of the aorta
✔✔treatment of aortic injury - ✔✔stent through the femoral artery to the occlusion of the
tear and channel blood back into the true lumen
✔✔ECMO - ✔✔extracorporeal membrane oxygenation
✔✔type of cardiac bypass - ✔✔ECMO = extracorporeal membrane oxygenation
✔✔bleed out - ✔✔exsanguination
✔✔interventions prior to aortic repair - ✔✔deliberately keep BP low (esmolol) to
decrease stress on artery
(exception to the goal of high Bp in most trauma)
MAP goal 60-70, HR less than 80 b/c if you don't you will exsanguinate blood into the
chest
✔✔vital sign goals in aortic injury - ✔✔deliberate keep BP low w/esmolol to decrease
stress on the artery
MAP goal 60 - 70
HR less than 80
✔✔MAP goal if aortic injuiry - ✔✔under 80
✔✔HR goal if aortic injury - ✔✔less than 80
,✔✔rx given if aortic dissection - ✔✔Beta Blockers to keep BP low, MAP between 60-70,
HR less than 80
✔✔permissive low bp - ✔✔
✔✔damage control resuscitation - ✔✔
✔✔problem of aggressive IVF in trauma - ✔✔increases BP
shear force
pops clots
dilutes blood
endothelial leakage
promotes coagulopathy
✔✔goals of permissive hypotension - ✔✔SBP 80 - 90
plug holes
preferably replace w/blood rather than IVF
✔✔when isn't permissive hypotensive appropriate - ✔✔Brian injury
decreased BP is one of the worst things you can do for neural tissue
✔✔most important vital sign to monitor in brain injury - ✔✔BP.
b/c deased BP is one of the worst things you can do for neural tissue
✔✔how to do internal cardiac massage - ✔✔
✔✔options when you open the chest in emergency thoracotomy - ✔✔plug holes
w/fingers/stitches/staples, packing, clamp vessels cross-clamp, cardiac massage,
internally defibrillate
✔✔when is resuscitative thoracotomy apopropriate - ✔✔penetrating thoracic injury just
lost but still has signs of life like reactive pupils, atonal breathing heart electrical
activities
✔✔aphesis platelets - ✔✔
✔✔freeze dried plasma - ✔✔military are testing. lyophilized plasma
✔✔what is a "unit" of blood - ✔✔1 unit is the amount donated by one donor
✔✔only blood product that carries oxygen - ✔✔_PRBC
✔✔hematocrit of PRBC - ✔✔55-70%
so it thickness is prone to lysis
, ✔✔lifespan of RBC's - ✔✔up to 120 days in the body
✔✔lifespan of RBC's on a shelf - ✔✔42 days
✔✔shelf life of plt - ✔✔5 days. needs to be continuously agitated in lab at room
temperatue
✔✔indication fo platelet transufsion - ✔✔under 50K
✔✔what is the most important thing with consideration of plt transfusion - ✔✔plt is not
solely about the total number
dysfunction is more important
✔✔when are plt transfusions indicated - ✔✔for non-specific coagulation deficiencies
and volume resuscitation
✔✔shelf life of plasma - ✔✔7 years
✔✔how long does it take to thaw FFP - ✔✔15 - 30 minutes
✔✔what is taken out of cryoprecipitate - ✔✔water and albumin
✔✔what do you use to make cryoprecipitate - ✔✔FFP
✔✔ROTEM - ✔✔method of measuring hemostasis quality via the visoelastic properties
of a blood clot and is designed for patient blood management
-rapid assessment of clot development (clot formation, clot firmness, and clot
fibrinolysis)
✔✔metabolic derangement - ✔✔
✔✔what do hemophilias need - ✔✔clotting factors
✔✔what type of blood products do burn pt need - ✔✔plasma
✔✔coagulopathies - ✔✔
✔✔what do we do if we don't have whole blood for trauma patientsq - ✔✔we can
remake it
1:1:1 damage control resuscitation
RBC:FFP:plt
✔✔components of damage control resuscitation - ✔✔1:1:1
ANSWERS SET A+
✔✔top 3 causes of death at the scene of traumatic injury - ✔✔massive head trauma
aortic care
high spinal cord injury
✔✔assessment findings that indicate great vessel injury - ✔✔massive hemothroax
shock
inability to resuscitate patient
✔✔method of treatment - ✔✔modality
✔✔mesenteric injuries - ✔✔
✔✔3 layers of blood vessels - ✔✔endothelium (tunica intima)
tunica media
tunica adventitia
✔✔what happens when the aorta is stretched - ✔✔the most delicate/weakest layers
tear first
✔✔screening needed for thoracic trauma - ✔✔decrease great vess3l injury
bilateral bp
✔✔why should you do bilateral bp to screen for aortic tear - ✔✔b/c blood normally flows
in a forward direction but in a dissection blood flows downwards w/ a little backwards. it
doesn't take much backward dissection to start obstructing flow to the L subclavian
✔✔what happens in a dissection - ✔✔retrograde flow and potential obstruction of any
vessel that branches off the aorta
✔✔importance of the aorta - ✔✔everything branches off the aorta
,✔✔problem of femoral artery occlusion - ✔✔compromises flow of lower extremities
✔✔classic CXR findings in aortic injury - ✔✔widened mediastium
✔✔what are you looking for on the CXR if you suspect a dissection - ✔✔widened
mediastium
✔✔widened mediastinum on CXR - ✔✔dissection
✔✔cause of the widened mediastinum on CXR in a dissection - ✔✔shadow of the
hematoma as it balloons out from the aorta
✔✔heparin in truma - ✔✔never a good idea in a trauma pt
✔✔TVAR - ✔✔thoracic endovascular aortic repair
✔✔REBOA - ✔✔resuscitative endovaqscular balloon occlusion of the aorta
✔✔treatment of aortic injury - ✔✔stent through the femoral artery to the occlusion of the
tear and channel blood back into the true lumen
✔✔ECMO - ✔✔extracorporeal membrane oxygenation
✔✔type of cardiac bypass - ✔✔ECMO = extracorporeal membrane oxygenation
✔✔bleed out - ✔✔exsanguination
✔✔interventions prior to aortic repair - ✔✔deliberately keep BP low (esmolol) to
decrease stress on artery
(exception to the goal of high Bp in most trauma)
MAP goal 60-70, HR less than 80 b/c if you don't you will exsanguinate blood into the
chest
✔✔vital sign goals in aortic injury - ✔✔deliberate keep BP low w/esmolol to decrease
stress on the artery
MAP goal 60 - 70
HR less than 80
✔✔MAP goal if aortic injuiry - ✔✔under 80
✔✔HR goal if aortic injury - ✔✔less than 80
,✔✔rx given if aortic dissection - ✔✔Beta Blockers to keep BP low, MAP between 60-70,
HR less than 80
✔✔permissive low bp - ✔✔
✔✔damage control resuscitation - ✔✔
✔✔problem of aggressive IVF in trauma - ✔✔increases BP
shear force
pops clots
dilutes blood
endothelial leakage
promotes coagulopathy
✔✔goals of permissive hypotension - ✔✔SBP 80 - 90
plug holes
preferably replace w/blood rather than IVF
✔✔when isn't permissive hypotensive appropriate - ✔✔Brian injury
decreased BP is one of the worst things you can do for neural tissue
✔✔most important vital sign to monitor in brain injury - ✔✔BP.
b/c deased BP is one of the worst things you can do for neural tissue
✔✔how to do internal cardiac massage - ✔✔
✔✔options when you open the chest in emergency thoracotomy - ✔✔plug holes
w/fingers/stitches/staples, packing, clamp vessels cross-clamp, cardiac massage,
internally defibrillate
✔✔when is resuscitative thoracotomy apopropriate - ✔✔penetrating thoracic injury just
lost but still has signs of life like reactive pupils, atonal breathing heart electrical
activities
✔✔aphesis platelets - ✔✔
✔✔freeze dried plasma - ✔✔military are testing. lyophilized plasma
✔✔what is a "unit" of blood - ✔✔1 unit is the amount donated by one donor
✔✔only blood product that carries oxygen - ✔✔_PRBC
✔✔hematocrit of PRBC - ✔✔55-70%
so it thickness is prone to lysis
, ✔✔lifespan of RBC's - ✔✔up to 120 days in the body
✔✔lifespan of RBC's on a shelf - ✔✔42 days
✔✔shelf life of plt - ✔✔5 days. needs to be continuously agitated in lab at room
temperatue
✔✔indication fo platelet transufsion - ✔✔under 50K
✔✔what is the most important thing with consideration of plt transfusion - ✔✔plt is not
solely about the total number
dysfunction is more important
✔✔when are plt transfusions indicated - ✔✔for non-specific coagulation deficiencies
and volume resuscitation
✔✔shelf life of plasma - ✔✔7 years
✔✔how long does it take to thaw FFP - ✔✔15 - 30 minutes
✔✔what is taken out of cryoprecipitate - ✔✔water and albumin
✔✔what do you use to make cryoprecipitate - ✔✔FFP
✔✔ROTEM - ✔✔method of measuring hemostasis quality via the visoelastic properties
of a blood clot and is designed for patient blood management
-rapid assessment of clot development (clot formation, clot firmness, and clot
fibrinolysis)
✔✔metabolic derangement - ✔✔
✔✔what do hemophilias need - ✔✔clotting factors
✔✔what type of blood products do burn pt need - ✔✔plasma
✔✔coagulopathies - ✔✔
✔✔what do we do if we don't have whole blood for trauma patientsq - ✔✔we can
remake it
1:1:1 damage control resuscitation
RBC:FFP:plt
✔✔components of damage control resuscitation - ✔✔1:1:1
