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LATEST TCRN PRACTICE QUESTIONS ALREADY ANSWERED
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LATEST TCRN PRACTICE QUESTIONS ALREADY ANSWERED
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TCRN QUESTIONS ALREADY ANSWEREDKehr's Sign - Ans✔✔Referred Left Shoulder Pain, Usually Indicates A Splenic
Injury
Base Deficit - Ans✔✔Base Deficit More Than -6 Indicates The Need For Agressive
Resuscitation And Determination Of The Etiology
CXR - Ans✔✔Most Important Tool Providing Useful Information In The Early
Minutes. Can Identify Major Sources Of Blood Loss From Injuries In The Chest Or
Elevated Diaphragm With Displacement Of Abdominal Organs
Tracheobronchial Injury - Ans✔✔Should Be Suspected If After Chest Tube
Placement A Significant Air Leak Is Present
Diagnostic Peritoneal Lavage - Ans✔✔Alternative To FAST Scan To Detect Abd
Bleeding. A Urinary Catheter And Gastric Tube Should Be In Place Prior To
Procedure.
FAST - Ans✔✔Focused Assessment With Sonography In Trauma. Used To Detect
Free Fluid In Peritoneum Or Hemoperitoneum. Free Fluid Appears "Black" On The
Screen. Has Replaced DPL When Available.
Positive FAST Scan - Ans✔✔Hemodynamically Unstable Trauma Patient With A
Positive Fast Are Taken Directly To The OR For Laparotomy
Ultrasound Abd Exam - Ans✔✔Not Useful To Detect Injuries To The Diaphragm,
Intestine And Pancreas. In Patients With Obesity, Ascites And/Or Subq
Emphysema The Accuracy Is Reduced.
CT Scan - Ans✔✔Hemodynamically Stable Patients May Be Taken To CT
Angiography - Ans✔✔Embolization Is Useful In Treating Patient With Unstable
Pelvic Fractures, Liver And Splenic Hemorrhage. Use Of Hybrid OR Suites To
Allow For Surgical And Interventional Radiology Methods Of Treatment
Simultaneously.
Diagnostic Laparoscopy - Ans✔✔Can Be Used To Detect Or Exclude Finding So F
Hemoperitoneum, Organ Injury, Intestinal Spillage Or Peritoneal Penetration.
, Most Useful In Evaluating Possible Diaphragmatic Injuries, Espectially In
Penetrating Thoracoabdominal Injuries On The Left Site
Diaphragmatic Injuries - Ans✔✔Usually Resultant Of Penetrating
Throacoabdominal Injuries On The Left Side, Including 11-12 Rib Fractures On
The Left.
Small Intestine Injuries - Ans✔✔Result From Shearing Forces In MVC Or Direct
Blows That Crush Intestine Between Force And The Vertebrae. Most Commonly
Intra-Abd Injury In Penetrating Trauma. Occurs Often With Spinal Injury.
Pancreatic/Solid Organ Injury Are Predictive Of Increased Risk For Hollow Viscus
Injury. Signs Of Peritonitis Develop. Any Blow To The Abd/Penetrating Injury To
The Lower Chest/Abd Should Increase Suspicion Of Injury
Treatment Of Small Intestine Injury - Ans✔✔Control Bleeding Prior To
Exploration. Debridement And Closure And Ligation Of Bleeders. Resection For
Multiple Defects. Observe For Wound Infection/Abscess Development
Cause Of Duodenum Injuries - Ans✔✔Penetrating Trauma Most Frequent Cause.
Usually Conconcurrent Mult-Organ Injuries. Usually Found Intraoperatively,
Commonly Missed During Exlap. Blunt Force Injury Cause By Vetebral
Compression.
Duodenal Injury Treatment - Ans✔✔Identification With CT Scan. Commonly
Patients Have Midepigastric Or Back Pain With Evolving Peritoneal Signs 6-24
Hrs After Injury. Primary Closure In OR, Closed Drainage System. Goals Are To
Control Hemorrhage, Debride Devitalized Tissue And Provide Drainage. Non
Operative Management Requires Close Observation For Expanding Or Ruptured
Hematomas Causing Bleeding Or Peritoneal Contamination.
Jejunum And Ileum Injuries - Ans✔✔Jejunum Lies In Umbilical Region, Ileum Lies
In The Hypogastric/Pelvice Regions. Lap Belt Can Cause Bowel To Be Crushed
Between The Vertebrae And A Solid Object. Incorrect Wearing Of Seatbelt
Increases Chance For Injury
Stomach Injury - Ans✔✔Rare, More Common In Children. Penetrating Trauma
Most Common Cause. May Find Free Air On Cxr/Fua. Pain To Epigastric/Abd
Area, Tenderness, Signs Of Peritonitis. Bloody Output From Gastric Tube.
Surgical Intervention, Is Gastric Content Leakage, Copious Peritoneal Irrigation
And Delayed Primary Closure
Large Intestine - Ans✔✔Rectal Injuries May Be Associated With Severe Pelvic
Fracture. Lethal Due To Sepsis Related To Fecal Contamination. Most Are Due To
Penetrating Trauma. Transverse Colon Most Often Injured. Most Injuries Are
Contusions. Laparotomy With Primary Repair And Colostomy Is Performed When
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