TNCC Written Exam with verified correct answers

What is the best measure of the adequacy of cellular perfusion and helps predict the outcome of resuscitation? Base deficit used in conjunction with serum lactate Will hypocapnia cause vasoconstriction or vasodilation, especially in the cerebral vasculature? Vasoconstriction What results from tissue hypo perfusion and oxygen deficit? Metabolic acidosis What type of shock results in generalized vasodilation? Neurogenic shock Spinal cord injuries at C3-C5 causes loss of what nerves function, resulting in what? Phrenic nerve; paralyzed diaphragm and inability to breath Extremity elevation AT the level of the heart is beneficial for what type of injury? Compartment Syndrome What is a high risk of frostbite? Thrombus formation What two medications can be administered to maintain perfusion after a frostbite injury along with rewarming? Tissue plasminogen activator or non steroidal anti-inflammatory medication (NSAIDS) An rise in diastolic blood pressures is a sign of increasing what? Peripheral resistance What position will benefit the airway and work of breathing for the bariatric patient? Reverse Trendelenburg Which phase of a blast results from flying debris, projectiles, and bomb fragments causing lacerations or penetrating injuries? Secondary Phase What phase of a blast results from any explosion-related illness or injury including hyperglycemia, hypertension, angina, asthma, COPD, or sepsis? Quaternary Phase What phase of a blast results from individuals being thrown by the blast and impacting walls, ground, or any hard object? Tertiary Phase What phase of a blast results from impact of the over and under pressurization wave with body surfaces. Injuries include blast lung, tympanic membrane rupture, abdominal hemorrhage, globe rupture, and mild traumatic brain injury? Primary Phase Signs of what include muscle pain or weakness, dark red or brown urine, general weakness or malaise, and elevated creatinine kinase levels? Rhabdomyolosis Signs of what include anxiety, pleuritic chest pain, dyspnea, hypoxemia, hemoptysis, cough, orthopnea, adventitious lung sounds, decreased lung sounds, jugular vein distention, or hypotension? Pulmonary Embolus Signs of what include headache, nausea and vomiting, amnesia, behavioral changes, altered level of consciousness? Increased intracranial pressure Signs of what include asymmetric pupillary reactivity, unilateral dilation, widening pulse pressure, abnormal motor posturing, bradycardia, and decreased respiratory effort? Late signs of increased ICP with Herniation Syndrome What is caused by the tear of the bridging veins or middle meningeal artery? Subdural and Epidural Hematoma Affect concentration, memory, sleep, mode, and libido. Causes headaches, dizziness and nausea. Postconcussive Syndrome/ Mild Traumatic Brain Injury Signs and symptoms similar to early signs of increased ICP but do not worsen. Postconcussive Syndrome/ Mild Traumatic Brain Injury Cerebral Perfusion Pressure = ______-______ MAP - ICP What is the range for CO2 to maximize perfusion? 35-45 Does hypoventilation cause dilation or constriction? Increase or decrease ICP? Dilation and increase in ICP due to high CO2 Hyperventilation cause dilation or constriction? Constriction d/t low CO2 Pupils with pressure on cranial nerve Fixed and dilated Pupils with opiates vs stimulants small; large Pupils with anticholinergics such as atropine, ipratropium, and scopolamine large Sluggish reaction of pupils is an early sign of what? Increasing ICP Glasgow Coma Score with Mild, Moderate, and Severe TBI Mild = 13-15 Moderate = 9-12 Severe = 3-8 Goal value for ICP <15 Goal value for Cerebral Perfusion Pressure (CPP) >60 Le Fort Fracture Fracture of the maxilla What decrease ICP by decreasing cellular edema? Osmotic diuretics (such as 3% saline and mannitol) Becks Triad is a sign of what? And includes what three symptoms? Cardiac Tamponade; 1. Hypotension 2. JVD 3. Muffled heart sounds What is pulsus paradoxus? And what is it a sign of? Drop in blood pressure with inspiration, sign of cardiac tamponade Tachycarida, weak pulses, hypotension, cool periphery, delayed cap refill, anxiety and agitation are signs of what type of shock? Seen with what? Obstructive Shock; Cardiac Tamponade Persistent blood loss following chest tube insertion is a sign of what? Hemothorax Ipsilateral diminished breath sounds and chest movement is a sign of what? Hemothorax Tearing chest/back pain, unequal blood pressure and pulses are a sign of what? Caused by a high mechanism of injury. Thoracic Aortic Disruption Dysrhythmia, ischemic changes, and persistent unexplained tachycardia are signs of what? Myocardial contusion from Blunt Cardiac Injury Decreased/absent breath sounds ipsilaterally, JVD, hypotension, and tracheal deviation to the contralateral side (late sign) is seen with what? Can lead to what? Tension Pneumothorax; PEA Hemoptysis, ineffective cough, crackles in affected lung, hypoxia/hypercapnia, and alveolar opacities are signs of what? Pulmonary Contusion Paradoxical chest wall movement, bony crepitus, rib segment depressed with inhalation and elevated with exhalation are signs of what? Flail Chest (caused by chest wall injury) Open wound on chest wall resulting in sucking sound, decreased breath sounds, chest movement, and hyper-resonance ipsilaterally, subcutaneous emphysema, and tachycardia are signs of what? Open Pneumothorax Hear bowel sounds in chest and Kehr's sign seen with what? Traumatic Diaphragmatic Tear Referred pain down the left shoulder; indicative of a ruptured spleen. Kehr's Sign Diaphragmatic Tears are seen with what types of injuries? Penetrating injuries between T4-T12, or rapid deceleration causing severe blunt trauma to the torso. Incision with blood clot, edges approximated with suture closer, and results in a fine scar. This is __________ Intention. Primary Irregular large wound with blood clot, no closure, granulation tissue fills in the wound, results in large scar. This is ________ Intention. Secondary Contaminated wound, granulation tissue, delayed closure with suture. This is _______ Intention. Tertiary Soft, dry, red wound with intact skin that blanches with pressure. No blistering or sloughing. What degree burn? First degree; superficial Moist wound, weeping, red or pink edematous skin that blanches with pressure, some blisters. What degree burn? Second degree; superficial partial thickness Wet, waxy, red to pale skin that does not blanch, multiple sisters. What degree burn? Second degree; deep partial thickness Waxy white to leathery gray to charred skin that is dry and firm with absent hair, no blanching. What degree burn? Third degree; full thickness Burn extends into the fascia and/or muscle. What degree burn? Fourth degree; full thickness