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TCAR-POST TEST REAL EXAM WITH 100% VERIFIED QUESTIONS AND CORRECT ANSWERS ALREADY GRADED A+ NEWEST

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TCAR-POST TEST REAL EXAM WITH 100% VERIFIED QUESTIONS AND CORRECT ANSWERS ALREADY GRADED A+ NEWEST

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  • July 17, 2024
  • 54
  • 2023/2024
  • Exam (elaborations)
  • Questions & answers

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  • tcar post test real exam with
  • tcar post test real exam with 100 verified ques
  • tcar post test real exam with 100 verified ques
  • tcar post test real exam with 100 verified ques

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TCAR-POST TEST REAL EXAM WITH 100% VERIFIED QUESTIONS
AND CORRECT ANSWERS ALREADY GRADED A+ NEWEST 2024-
2025

bruise on the lungs - pulmonary contusion

causes of pulmonary contusions - high speed blunt or penetrating injury

what happens to the lungs in pulmonary contusions - 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 - diffusion

all contusions over time - 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 - 70% of pulmonary contusions aren't initial on the initial CXR

what should you monitor when a pt has trauma to the throax - closely monitor for
pulmonary contustiobs = 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 - 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 - 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 - pulmonary laceration

problem of pulmonary lacerations - risk of massive hemothoax b/c those vessels are
very vascular

simple v. tension v. open v. closed. v. hemothorax v. hemopneumothorax -

,what is a simple pneumothorax - 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

intrathroacic pressure in simple pneumothorax - air that enters the pleural cavity leaves
at the same rate
lungs are deflated but no increase in pressure
air in/out at the same rate

where is the problem in the tissue oxygenation cascade in simple pneumothroax -
ventilation

what happens in penumothorax - lungs are collapsed/deflated
aire enters space between the visceral & parietal

two layers of the lungs - visceral & parietal

Q - in a pneumothorax, no ligaments attach the lung to the wall. so what holds it up? - A
- a thin layer of pleural fluid & negative pressure. the liquid helps it stick like how a
spilled liquid forms a seal between a glass and a smooth table top

difference between a simple and tension pneumo -

aka chest tube - chest thoacotomy

purpose of using a chest tube in simple pneumothorax - to allow for negative pressure
to reestablish .

tension pnumothorax - air enters under pressure but doesn't exit at the same rate. =
accumulation of air under pressure

example of tension pneumothorax - like using a bicycle pump to put more and more air
into the lungs over time. no escape
*pressure means no lung function on the side of the injury and compromises function on
the un injured heart and great vessel compression
(decreases preload/CO
increases afterload

effect of tension pneumothorax on heart function - increases intrathoracic pressure
decreases preload/CO
increases afterload

normal pressure in the vena cavas - normally is low
similar to the central venous pressure which is similar to right atrial pressure (2-8mm
hg) so very little increase in pressure to impede venous return to the heart

,3 questions to ask in trauma - -what was the dose of energy?
-where did it go?
-what injuries are likely?

2 q's to ask in GSW - caliber
type of gun
# of entrance/exit wounds
high/low velocity

1st question to ask in any traumatic injury? - what was the dose of energy involved?
(was it high or low?)

what is the caliber of a bullet? - diameter

aka diameter of a bullet - caliber

what happens to projectiles when they enter the body - projectiles don't travel in a
straight line
consider temporary cavity wound

what should you consider about tissue a projectile enounters - temporary cavitation

primary goal of GSW surgery - usually damage repair & not bullet removal
-if superficial, it may migrate the surface with time

important thing to remember about retained projectiles - 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 shot gun pellets migrated into a canary
artery causing an infract. so had a MI but fibrinolytic not the answer in this case b/c it
was a "projectile embolus"

aka brestbone - sternum

what attaches the ribs to the sternum - cartliage

what breaks thoracic bones - 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 - ribs 4-9 b/c long, thin, and poorly protecte
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 - unusual direction of injury
shorter stubby ribs
good muscle profection
**posterior rib fractures have a lot of force so need a high dose.
***PRF need a lot of force so high dose of energy. big red flag for t-spine injury

indication of c-spine injury - to injure c-spine, you don't need a big energy blow. all it
takes is shaking around.

c spine versus t spine fractures - 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 - largely supportive nursing care like pulmonary toilet

CXR and rib fractures - 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 - once healed, rib fractures form bony callouses
and become more visible on CXR

how to tell a pt has a pneumonia from a CXR - dark spot that is not equal to the
opposite side

consider if a pt has a lower rib fracture - liver & spleen injury
acts like BBQ/marshmellow skewers

how high does the diaphragm rise on inspiration - level of 4th ICS

risk of rib fractures - can puncture liver, spleen,, diaphragm
pop lungs

+2 adjacent rib fractures - flail chest

free floating sternum - flail chest

definition of flail chest - +2 adjacent rib fracture
free floating sternum

why is flail chest a problem - b/c breathing is a mechanical process

paradoxical chest movements - in flail chest

s/s of flail chest - paradoxical chest wall movement

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