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TCAR TNCC Questions and Answers 2023/2024( A+ GRADED 100% VERIFIED).
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TCAR TNCC Questions and Answers 2023/2024( A+ GRADED 100% VERIFIED).
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TCAR TNCC3rd question to ask in trauma - ANS -what was the dose of energy?
-where did it go?
-what injuries are likely?
2nd question to ask in GSW - ANS caliber
type of gun
# of entrance/exit wounds
high/low velocity
1st question to ask in any traumatic injury? - ANS what was the dose of energy
involved?
(was it high or low?)
what is the caliber of a bullet? - ANS diameter
aka diameter of a bullet - ANS caliber
what happens to projectiles when they enter the body - ANS projectiles don't travel in a
straight line
consider temporary cavity wound
what should you consider about tissue a projectile encounters - ANS temporary
cavitation
primary goal of GSW surgery - ANS usually damage repair & not bullet removal
-if superficial, it may migrate the surface with time
important thing to remember about retained projectiles - ANS 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 shotgun pellets migrated into a canary
artery causing an infarct. so had a MI but fibrinolytic not the answer in this case b/c it
was a "projectile embolus"
aka breastbone - ANS sternum
what attaches the ribs to the sternum - ANS cartilage
,what breaks thoracic bones - ANS 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 - ANS ribs 4-9 b/c long, thin, and poorly
protected
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 - ANS unusual direction of injury
shorter stubby ribs
good muscle profection
**posterior rib fractures have a lot of force so need a high dose.
***PRF needs a lot of force, so a high dose of energy. big red flag for t-spine injury
indication of c-spine injury - ANS to injure c-spine, you don't need a big energy blow. all
it takes is shaking around.
c spine versus t spine fractures - ANS 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 - ANS largely supportive nursing care like pulmonary toilet
CXR and rib fractures - ANS 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 - ANS once healed, rib fractures form bony
calluses and become more visible on CXR
how to tell a pt has a pneumonia from a CXR - ANS dark spot that is not equal to the
opposite side
consider if a pt has a lower rib fracture - ANS liver & spleen injury
acts like BBQ/marshmallow skewers
,how high does the diaphragm rise on inspiration - ANS level of 4th ICS
risk of rib fractures - ANS can puncture liver, spleen,, diaphragm
pop lungs
+2 adjacent rib fractures - ANS flail chest
free floating sternum - ANS flail chest
definition of flail chest - ANS +2 adjacent rib fracture
free floating sternum
why is flail chest a problem - ANS b/c breathing is a mechanical process
paradoxical chest movements - ANS in flail chest
s/s of flail chest - ANS paradoxical chest wall movement
where on the tissue oxygenation cascade is thoracic cage fractures a problem - ANS
ventilation
parameters to assess ventilation - ANS ETCO2, PaCO2, clinical assessment
what are considered "great vessels" - ANS
thorax - ANS
What type of injuries occur when the lungs are subjected to force? - ANS bruise =
contusion
tear = lacerations
pop = punctures
inhalation injury
bruise on the lungs - ANS pulmonary contusion
causes of pulmonary contusions - ANS high speed blunt or penetrating injury
what happens to the lungs in pulmonary contusions - ANS 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 - ANS diffusion
all concussions over time - ANS 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 - ANS 70% of pulmonary contusions aren't initial on the initial CXR
what should you monitor when a pt has trauma to the thorax - ANS closely monitor for
pulmonary contusions = 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 - ANS 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 - ANS 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 - ANS pulmonary laceration
problem of pulmonary lacerations - ANS risk of massive hemothoax b/c those vessels
are very vascular
simple v. tension v. open v. closed. v. hemothorax v. hemopneumothorax - ANS
what is a simple pneumothorax - ANS 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
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