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TCRN Test Review Questions and Answers - Trunk
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TCRN Test Review Questions and Answers - Trunk
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TCRN Review - TrunkWhat is a collection of excess fluid between the visceral pericardium and the parietal pericardium? -
Answer -Pericardial Tamponade
What are the classic signs and symptoms of a pericardial tamponade? - Answer -Beck's Triad
What are the 3 findings in Beck's Triad? - Answer -Muffled heart tones
Systemic Hypotension
Distended Neck Veins (may not be present with hypovolemia)
What are the cardiovascular effects of Pericardial Tamponade? - Answer -Elevated CVP
Narrowed Pulse Pressure
Rapidly falling cardiac output
Tachycardia
Pulsus alternans
Blunting of the QRS complex
Pulseless Electrical Activity
Pulsus paradoxus or paradoxical pulse
What is Pulsus Alternans? - Answer -Alternating morphology of the QRS complex
,What is pulsus paradoxus or paradoxical pulse? - Answer -A change of more than 10 mmHg in arterial
pressure during inspiration
How is pulsus paradoxus or paradoxical pulse found? - Answer -Usually seen as a decreased amplitude
on the arterial waveform, but may also be palpated as a reduction in the strength of the radial pulse
during inspiration.
What are the non-cardiac indications of a pericardial tamponade? - Answer -Grey, death-like appearance
Extreme anxiety
Inability to lie supine
Dyspnea
Cyanosis
How is pericardial tamponade diagnosed? - Answer -Clinically or via FAST exam
What is the treatment for pericardial tamponade? - Answer -Pericardiocentesis
Observe monitor for ventricular irritation during insertion
How do you determine if blood aspirated from a pericardiocentesis is pericardial blood or ventricular
blood? - Answer -Pericardial blood WILL NOT clot
Ventricular blood WILL clot
In blunt cardiac injury, what part of the heart is most likely to be injured? - Answer -Right ventricle
(anterior chest)
Blunt cardiac injury is frequently associated with _____ and _____. - Answer -External chest wall trauma
Fractures of the sternum or ribs overlying the heart
What are the symptoms of blunt cardiac injury? - Answer -Electrical disturbances
Chest Pain
,Heart Failure
Describe electrical disturbances associated with blunt cardiac injury. - Answer -PVC's
A-Fib
Atrioventricular blocks
S-T segment changes
What is the treatment for electrical disturbances associated with blunt cardiac injury? - Answer -
Continuous ECG monitoring
Antiarrhythmics for clinically significant arrhythmias
Describe chest pain associated with blunt cardiac injury and its treatment. - Answer -Does not radiate or
respond to standard treatment for chest pain.
Treatments: analgesia and treat as per MI
Describe heart failure associated with blunt cardiac injury. - Answer -Right sided heart failure (JVD,
Hypotension, Tachycardia)
What is the treatment for heart failure associated with blunt cardiac injury? - Answer -IV fluids per
hemodynamic parameters
Inotropic drugs
List the Great Vessels - Answer -Aorta
3 branches of the aorta: brachiocephalic, left common carotid, left subclavian
Pulmonary artery and veins
Superior Vena Cava
What percentage of aortic injuries die on scene? - Answer -80%
, Of the patients with aortic injuries that make it to the hospital, how many will die within 6 hours? -
Answer -30%
Of the patients with aortic injuries that make it to the hospital, how many will die with 24 hours? -
Answer -40%
What is the mortality rate in patients with pulmonary vascular trauma? - Answer -60%
Of patients with great vessel injuries, what percentage are asymptomatic? - Answer -30-50%
What are the subjective symptoms of great vessel injuries? - Answer -Chest pain (ripping or tearing)
Radiates through to the back
Difficulty breathing
Vagal complaints
Dysphagia
What are the objective symptoms of great vessel injuries? - Answer -Signs of hemorrhagic shock
Dyspnea
Asymmetric pulse pressure (stronger upper extremity pulses as opposed to femoral pulses)
Vascular bruits over precordium or intrascapular region
Focal neurological findings
Hoarseness
What injury does asymmetric pulse pressure indicate? - Answer -Vascular injury to the descending aorta
What are the treatments for great vessel injuries? - Answer -Keep the patient calm and quiet
Type and cross 10 units of blood (assure blood is readily available)
Beta-blockade with a goal of: SBP: 80-100 and HR 60-80
Operative management
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