PAM TCRN Exam 226 Questions with Verified Answers,100% CORRECT

PAM TCRN Exam 226 Questions with Verified Answers Initial assessment - CORRECT ANSWER A-J, airway first unless massive hemorrhage Open airway - manuever - CORRECT ANSWER Jaw thrust GCS 40 - CORRECT ANSWER E: spont, verbal, pressure, none V: orient, confused, words, sounds, none M: obeys, local, w/d, abnl flex, extension, none Pupils unreactive to light: -2, -1, 0 Monroe-Kellie Doctrine and CPP - CORRECT ANSWER When one content in the skull increases, another must decrease to compensate and maintain normal ICP. MAP-ICP = CPP. Keep >60 in TBI, no hypotension Normal ICP: adults, older children, young children, infants - CORRECT ANSWER Adults: 0-15 Older children: 10-15 Young children: 3-7 Infants: 2-6 Head and facial fractures, airway, G-tube, surgical airway, intubation med - CORRECT ANSWER No nasal intubation or NGT, cricothyroidotomy (needle if under 12), lidocaine to prevent increase in ICP Succinylcholine risks - CORRECT ANSWER Avoid in DAI, risk of hyperkalemia (crush injury/burn), risk of malignant hyperthermia Cushing's triad - CORRECT ANSWER Hypertension with wide PP, bradycardia, irregular respirations. Suspect SCI if similar s/s but hypotensive. Basilar skull fracture, anterior and middle - CORRECT ANSWER Anterior: periorbital ecchymosis, rhinorrhea, anosmia Middle: otorrhea, mastoid ecchymosis, hemotympanum (increased risk of infection) Epidural hematoma - 4 points - CORRECT ANSWER a. Middle meningeal artery from temporal skull fx b. Rapid onset w/ lucid interval c. Uncal herniation: ipsilateral pupil, contralateral hemiparesis d. Burr hole Subdural hematoma - 4 points - CORRECT ANSWER a. Tearing of venous bridging veins b. Slower decamp of mental status c. Elderly on blood thinners, ETOH d. Shaken impact syndrome: SDH, retinal hemorrhage, posterior rib fx Concussion - 3 points - CORRECT ANSWER a. Cognitive rest b. No ASA or NSAIDS - APAP only c. Graduated return to play Diffuse axonal injury - CORRECT ANSWER Prolonged coma, hyperthermia, HTN, profuse sweating, posturing Pharmacological mgmt of increased ICP - CORRECT ANSWER Hypertonic saline if hypotensive Mannitol - osmotic diuretic, 1 gm/kg, onset 1-5 min, peak 20-60 minutes. Monitor for pulmonary edema, K, Na, serum osmolality (300-320), Treatment of increased ICP - CORRECT ANSWER SBP >100, no permissive hypotension CO2 35-37 Elevate HOB 30-45, neutral alignment Limit stimulation, treat anxiety and pain Treat fevers aggressively Early interventions to avoid long term complications of TBI - CORRECT ANSWER Early nutrition - reduces stress ulcers, sepsis, helps with wound healing DVT prophylaxis and early mobilization Treat hyperglycemia (80-120) Welder with metal in eye - CORRECT ANSWER Check for rust ring in 24-48 hours Ocular burns - alkaline - CORRECT ANSWER Worse than acid, irrigate with warm saline until pH 7-7.4 Ruptured globe - CORRECT ANSWER Teardrop-shaped pupil Orbital fracture - CORRECT ANSWER Exophthalmos - blow out, enophthalmos - blow in. Pressure on CN3, pain and limited upward gaze Hyphema - CORRECT ANSWER Blood in anterior chamber, reddish hue to vision, keep upright, biggest re-bleed risk 3-5 days Specialty consult - facial injuries - CORRECT ANSWER Lac of vermillion border, lacrimal gland disruption Facial injuries - general considerations - CORRECT ANSWER Don't shave - especially eyebrows, caution using xylocaine with epi in ear/nose Mandibular fracture - CORRECT ANSWER Malocclusion, lower lip/jaw parasthesia, airway issues 2/2 loss of tongue control LeFort fractures - CORRECT ANSWER I: free-floating maxilla, lip lac II: pyramid-shaped, nasal fracture III: complete cranio-facial separation Strangulation - CORRECT ANSWER Consider stroke-like symptoms from blood clots Neck zones - CORRECT ANSWER 1. Clavicle to cricoid cartilage 2. Cricoid cartilage to angle of the mandible 3. Angle of mandible to base of skull Most COMMON in 2, most LETHAL in 1 Tracheobronchial injury - CORRECT ANSWER Clothesline-type or penetrating injury Hamman's sign (crunch w/heartbeat) and SQ emphysema Dysphonia, stridor, increasing hematoma Fiberoptic intubation, surgical repair SCI falls from height numbers - CORRECT ANSWER 3x height - child >20 feet, adults Canadian C-Spine rule - CORRECT ANSWER dangerous MOI, numbness/tingling NEXUS criteria - CORRECT ANSWER Distracting injury, intoxication, cervical tenderness, alertness, focal deficit Chance fracture - CORRECT ANSWER Seat belt fracture, assoc w/ hollow organ injury SCIWORA in young children - CORRECT ANSWER Get MRI Neurogenic shock - CORRECT ANSWER Distributive - low SVR Unopposed parasympathetic Bradycardia, bradypnea, poikilothermia, priapism, anhydrosis, hypotension Fluids and pressers Spinal shock - CORRECT ANSWER Transient flaccidity Horner's syndrome - CORRECT ANSWER "PAM is Horny" -Ptosis -Anhidrosis -Miosis (constricted pupil) High cervical lesions Incomplete SCI - CORRECT ANSWER Anterior: most common, motor loss, V/P spared Central: motor, upper, distal Brown-sequard: ipsilateral motor, contralateral pain and temp usually penetrating Rib fracture locations and injuries - CORRECT ANSWER 1-2: great vessle Lower R: liver Lower L: spleen Aortic dissection - mechanism and location - CORRECT ANSWER Blunt trauma, ligamentum arteriosum Aortic dissection treatment - CORRECT ANSWER Labetalol to keep HR 60-80 and SBP 100-120, IVF Aortic dissection s/s - CORRECT ANSWER New systolic murmur, widened mediastinum, obscured aortic knob on CXR Pulmonary contusion s/s, considerations - CORRECT ANSWER Wheezing/crackles, risk of ARDS, careful with fluids, O2 PRN ARDS: P/F ratio and treatment - CORRECT ANSWER <200, recruit alveoli with low Vt and PEEP, prone positioning and HF ventilation Pulmonary embolism - CORRECT ANSWER Sudden onset of restlessness, dyspnea, hypoxemia. CT PE is gold standard. Flail chest - CORRECT ANSWER Fractures of >2 adjacent ribs in 2 or more places, fixation required Open pneumothorax - CORRECT ANSWER Sucking chest wound, 3-sided occlusive dressing, remove if worried about tension PTX Tension pneumothorax - CORRECT ANSWER Life-threatening, concern for obstructive shock/PEA, respiratory distress, JVD, tracheal deviation to uninjured side, reduced or absent breath sounds. Needle decompression. Autotransfusion - chest drainage - CORRECT ANSWER Blunt chest trauma, hemothorax, no transfusion rxn, decreased risk communicable disease, lower K level, better O2 carrying capacity, risk of contamination FOCA mnemonic - CORRECT ANSWER Fluctuation in water seal chamber Output Color of drainage Air leak Blunt cardiac injury - CORRECT ANSWER May be associated with sternal fracture, arrhythmias, ST elevation, troponin, echo, RV Pericardial tamponade and Beck's triad - CORRECT ANSWER Muffled heart tones, JVD, hypotension; obstructive shock, tachycardia, anxiety, restlessness, ECG changes, pulsus paradoxus REBOA - CORRECT ANSWER Zone 1 for abdominal hemorrhage, zone 3 for pelvic trauma LEMON airway - CORRECT ANSWER Look, evaluate (3-3-2), Mallampati, obstruction, neck mobility Pediatric ET tubes - CORRECT ANSWER Age/4 + 3.5 DOPE mnemonic - CORRECT ANSWER Displacement Obstruction Pneumothorax Equipment failure Oxyhemoglobin dissociation curve - CORRECT ANSWER Left shift = hemoglobin hangs on to O2 (hypothermia) Right shift = hemoglobin delivers more to cells (acidosis), does the RIGHT thing Obstetrics - pelvic exam in vaginal bleeding - CORRECT ANSWER After ultrasound if vaginal bleeding Fundal height at umbilicus - CORRECT ANSWER Viable fetus, 20-24 wks Normal FHT rate - CORRECT ANSWER 120-160, tachycardia is first sign of distress Mother Rh- - CORRECT ANSWER Give Rhogam Uterine rupture basics - CORRECT ANSWER Hemorrhagic shock, palpable fetal parts, increased risk if previous CS Abruptio placentae - CORRECT ANSWER Premature separation of placenta from uterine wall, ripping abdominal/back pain with scant dark red bleeding Pregnant woman, pelvic fractures - CORRECT ANSWER Still apply pelvic binder if open book fracture Prior to DPL insert - CORRECT ANSWER Gastric tube and urinary catheter Ruptured diaphragm - CORRECT ANSWER Penetrating injury below 4th ICS, peristaltic gurgling sounds in left chest, progressively scaphoid abdomen, Kehr's sign worse when supine. EMERGENCY X-LAP not thoracotomy. Splenic injury - frequency in blunt trauma, pain and special sign - CORRECT ANSWER #1 in blunt trauma, LUQ radiating to left shoulder, Kehr's sign (irritation of phrenic nerve) Splenic injury grading - CORRECT ANSWER IV: >25% spleen V: completely shattered spleen Splenectomy post op considerations - CORRECT ANSWER WBC elevation is normal, pneumococcal, meningococcal, influenza vaccines, seek medical attn if animal bites, risk of malaria Liver injury sign/symptom and special sign - CORRECT ANSWER RUQ pain and signs of shock, Cullen's sign (bruising around umbilicus) Liver injury labs and grades - CORRECT ANSWER Coags, H&H, LFTs; 1=hematoma, 6=vascular avulsion Liver injury treatment - low grade vs high grade - CORRECT ANSWER Low = serial H&H High = damage control surgery to control bleeding Bowel rupture - assoc injuries, most commonly injured - CORRECT ANSWER Chance fx (T12-L2), lap restraint injury, transverse colon most commonly injured Pancreatic injury, location, sign, labs - CORRECT ANSWER Commonly missed, retroperitoneal, Grey-Turner's signs, epigastric pain radiating to back. Monitor labs - glucose, lipase, amylase. Abdominal compartment syndrome - high risk groups - CORRECT ANSWER Pregnancy, chronic ascites, obesity, major abdominal surgery, peritonitis APP = - CORRECT ANSWER MAP-IAP ACS pressure monitoring - CORRECT ANSWER Level transducer at level of symphysis pubis with patient in supine position, normal is 12-15, above 20 may require decompression Bladder/urethral injury symptom, assoc injury, dx - CORRECT ANSWER Urge to urinate, cannot pass, get uro consult No catheter if blood present - - CORRECT ANSWER At urethral meatus Urethral injury diagnosis - CORRECT ANSWER Retrograme urethrogram, contrast may cause pre-renal failure Administer TIG if ... - CORRECT ANSWER Dirty wound, unsure of immunization status Puncture wound - CORRECT ANSWER Soak 2-3 times/day for several days due to high risk for infection High pressure injection wound considerations - CORRECT ANSWER Separation of fascial planes, high triage priority, compartment syndrome, surgical intervention Radial nerve assessment - CORRECT ANSWER Thumbs up Median nerve - CORRECT ANSWER Touch thumb to little finger, make a fist Ulnar nerve - CORRECT ANSWER Fan out fingers Femoral nerve - CORRECT ANSWER Flex hip against resistance Tibial nerve - CORRECT ANSWER Push down on gas pedal Peroneal nerve - CORRECT ANSWER Pull foot up Clavicle/scapula fracture - CORRECT ANSWER Great vessel injury Open fracture risks - CORRECT ANSWER Hemorrhage and infection Elbow injury concern - CORRECT ANSWER Brachial artery injury Front impact MVC passenger - CORRECT ANSWER Knee to dashboard, patella fracture Forearm fracture - Monteggia's, splint - CORRECT ANSWER FOOSH, proximal 1/3 of ulna, splint at 90 degrees and wrist/elbow in sling Smith fracture - CORRECT ANSWER Fall on back of hand Colles fracture - CORRECT ANSWER Fall on palm Scaphoid fracture - CORRECT ANSWER Pain at anatomic snuff box, splint with thumb in opposition, thumb spica Boxer's fracture - CORRECT ANSWER 5th metacarpal, ulnar splint Pelvic stability assessment - CORRECT ANSWER Gentle pressure inward and downward Massive transfusion protocol monitor - CORRECT ANSWER Calcium Pelvic binder location - CORRECT ANSWER Greater trochanter Pelvic fracture REBOA option - CORRECT ANSWER Zone 3 Femur fracture s/s - CORRECT ANSWER Deformity, shortening and rotation, shock, traction splint, MTP Calcaneal fracture assoc injuries - CORRECT ANSWER Spine, tibia, AXIAL LOADING Dislocations, general principle - CORRECT ANSWER Frequent vascular checks and reduction ASAP Hip dislocation risks (2) - CORRECT ANSWER Avascular necrosis of femoral head and sciatic nerve compression Knee dislocation risk - CORRECT ANSWER Peroneal nerve injury Fat embolism syndrome timing and assoc fracture - CORRECT ANSWER Most within 48 hours post long-bone fracture (femur) Fat embolism syndrome s/s - CORRECT ANSWER Resp distress, restless, altered LOC, low O2 sats, petechial rash on chest, axillae and conjunctivae GSW considerations - CORRECT ANSWER Speed more a factor than mass, hollow points are less likely to exit, lower velocity - tumbling; shotgun - pellets scatter, emboli Amputation priority - CORRECT ANSWER Hemorrhage control, 2 TQ if needed Tourniquet application site - CORRECT ANSWER As close to amputation site as possible, mark time applied, may need second 2" above first, tight, don't release too soon Care of amputated part - CORRECT ANSWER Gently rinse, saline-moistened gauze in bag, place bag on top of ice Crush injury risks - CORRECT ANSWER Rhabdo (renal failure), compartment syndrome Rhabdo s/s - CORRECT ANSWER Severe muscle pain, dark red or brown urine, elevated CK, myoglobin and K levels Rhabdo tx - CORRECT ANSWER Fluids, UO 100-300/hr, urine alkaline with NaHCO3, mannitol, HD Rhabdo complications - CORRECT ANSWER ATN, hyperK - treat w/ Ca, insulin/glucose, and/or diuresis Compartment syndrome s/s - CORRECT ANSWER Pain out of proportion, unrelieved by analgesics, on passive movement, shiny taught skin, most in lower leg or forearm, weak or absent pulses are ominous sign Normal compartment pressures - CORRECT ANSWER 0-10, if above 30, fasciotomy Ankle-brachial index - CORRECT ANSWER Ratio of BP in ankle to brachial artery. Normal is 0.9-1.2, under 0.9 means potential peripheral vascular injury, may also assess arterial pressure index. Burns - secure airway immediately if .... - CORRECT ANSWER Hoarse voice, stridor, carbonaceous sputum CO levels - toxic vs lethal % - CORRECT ANSWER Toxic > 25, lethal >60 O2 sats and ST segment in CO poisoning - CORRECT ANSWER Normal O2 sats, may have ST depression CO poisoning treatment - CORRECT ANSWER 100% O2 until COHb <10% (1 hour), pregnant pt to hyperbaric chamber Hydrogen cyanide antidote - CORRECT ANSWER Hydroxocobalamin Superficial burn injury - CORRECT ANSWER Epidermis, no blisters Partial-thickness burn - CORRECT ANSWER Blisters, blanches Deep-thickness burn - CORRECT ANSWER Deep dermis, cherry red, doesn't blanch Full-thickness burn - CORRECT ANSWER Leathery appearance, requires grafting Circumferential burns may require - CORRECT ANSWER Escharotomy Hand and foot burn risks - CORRECT ANSWER Contractures Zone of coagulation - CORRECT ANSWER Most damage, grafting Zone of stasis - CORRECT ANSWER Moderately damaged Zone of hyperemia - CORRECT ANSWER Outermost area Rule of palms - CORRECT ANSWER Palm of burn victim is 1% of total body surface Rule of Nines (adult) - CORRECT ANSWER Rule of Nines (peds) - CORRECT ANSWER Burn transfer criteria - CORRECT ANSWER Partial thickness >10%; face, hands, feet, genitalia, major joints, pre-existing conditions Burn fluids - before calculation - CORRECT ANSWER 14 and up: 500/hr 6-13: 250/hr 5 or less: 125/hr Burn formula - fluids - CORRECT ANSWER LR Adult thermal 2 x Kg x % BSA Child thermal 3 x Kg x % BSA Adult electrical 4 x Kg x % BSA Burn UO, adults and peds - CORRECT ANSWER Adult 0.5-1 ml/kg/hr Peds 1-2 ml/kg/hr Electrical burn risks - CORRECT ANSWER Don't document entrance and exit, rhabdo, hand-to-hand increases risk for cardiac damage, IVF for UO of 75-100/hr, Lichentenberg figures in lightning burns Chemical burns - first steps - CORRECT ANSWER Reduce exposure to self/others, don PPE Chemical burn decontamination zones - CORRECT ANSWER Hot: suited Warm: decon Cold: treatment Dry chemicals - CORRECT ANSWER Must be brushed off of the skin before flushing the area with water Hydrofluoric acid burns - CORRECT ANSWER Calcium to inactive fluoride Asphalt (tar) burns - CORRECT ANSWER Fat emollient and cool immediately Phenol burns - CORRECT ANSWER PEG irrigation (50%) Radiation exposure first step and s/s - CORRECT ANSWER Decon; N/V/D, malaise, anorexia, GIB, reddened skin Family death notification RESPOND - CORRECT ANSWER Reassure Establish rapport Support manage Pain Offer hope Never alone Determine family needs First stage of grief - CORRECT ANSWER Shock and denial Typical onset of PTSD - CORRECT ANSWER 3 months after event Secondary traumatic stress - CORRECT ANSWER Recurring thoughts and dreams about patients, sleep disturbances Critical incident stress debriefings - CORRECT ANSWER Held within 24-72 hours, voluntary and supports resilience Cardiac output equation - CORRECT ANSWER CO = HR x SV Stroke volume is dependent on - CORRECT ANSWER Preload (CVP and PAOP) Afterload (SVR) Contractility What do baroreceptors do in shock? - CORRECT ANSWER Sense a decrease in stretch and stimulate SNS What do chemoreceptors do in shock? - CORRECT ANSWER Detect low O2 and increase RR and BP What does SNS do in shock? - CORRECT ANSWER Release catecholamines from adrenal glands, increasing HR and contractility, vasoconstriction and GLYCOGENOLYSIS (breakdown of glycogen to glucose) Hypoperfusion of the kidneys triggers - CORRECT ANSWER Renin to activate angiotensin 1 into angiotensin 2 and stimulate aldosterone and ADH Labs in shock to determine degree of acidosis and oxygen debt - CORRECT ANSWER Lactate, base deficit, pH Initial blood glucose in shock - CORRECT ANSWER Elevated Pulse pressure equals - CORRECT ANSWER SBP-DBP, narrows in early shock, wide in ICP Lethal triad of trauma - CORRECT ANSWER Hypothermia, coagulopathy, acidosis Compensated shock - CORRECT ANSWER Restlessness, narrow PP Decompensated shock - CORRECT ANSWER Decreased LOC, hr>100, thready pulses, cool skin, low BP Irreversible shock - CORRECT ANSWER Mutlisystem failure, unresponsive, bradycardia, marked hypotension Classes of shock - CORRECT ANSWER 1. pulse <100, PP narrow 2. pulse 100-120 3. SBP drops 4. pulse >140 Permissive hypotension - CORRECT ANSWER Less clot dislodgment, mostly in pelvic fx and penetrating abd injury. NOT IN PEDS, ELDERLY, TBI. Shock index - CORRECT ANSWER HR/SBP, normal 0.5-0.7, 0.9=poor prognosis Hypovolemic shock - CORRECT ANSWER Volume Cardiogenic shock - CORRECT ANSWER Pump failure Obstructive - CORRECT ANSWER Mechanical problem Distributive shock - CORRECT ANSWER Maldistribution of blood, decreased SVR Neurogenic shock - CORRECT ANSWER Bradycardia (or lack of tachycardia), due to unopposed PS vagal activity, bradypnea, hypotension Anaphylatic shock - CORRECT ANSWER Vasodilation and bronchospasm, 0.3-0.5 mg IM epi, histamine blockers, IVF Limit crystalloids to (volume( in adults - CORRECT ANSWER 1L PRBC:platelet:FFP ratio - CORRECT ANSWER 1:1:1 Universal donor - CORRECT ANSWER O negative, plasma AB negative Give Rh+ blood to - CORRECT ANSWER Males and postmenopausal females 1u PRBC - CORRECT ANSWER Hgb up by 1 mg/dL, Hct up by 3% What does citrate in PRBCs do? - CORRECT ANSWER Binds calcium rendering it inactive, need to replace, pH is 7.1 so causes acidosis Pediatric crystalloid and blood resuscitation - CORRECT ANSWER 20 ml/kg over 5-10 min with 3-way stopcock and 20 mL syringe, blood 10 ml/kg Damage control surgery - CORRECT ANSWER Surgery whose objective is to stop hemorrhage and prevent sepsis without attempting reconstruction or anatomical continuity, 90 MINUTE WINDOW TXA - CORRECT ANSWER Tranexamic acid, prevents clot breakdown, antifibrinolytic TEG and ROTEM - CORRECT ANSWER POC tests to evaluate efficiency of blood clotting, platelet function, clot strength and fibrinolysis REBOA to stop hemorrhage with .... - CORRECT ANSWER Chest, abdomen, pelvis Resuscitation goals - CORRECT ANSWER UO of 0.5 ml/kg/hr in adults, CVP of 2-6, PAOP of 8-12, CI of 2.5-4; normal lactate and base deficit Sepsis continuum - CORRECT ANSWER SIRS (2 or more) - temp, HR > 90, RR > 20 Sepsis - SIRS plus source Severe sepsis - organ dysfunction, lactic acidosis, platelets < 100k, oliguria, RESPONDS TO FLUIDS Septic shock - requires vasopressors to increase BP MODS, organ system signs - CORRECT ANSWER ARDS - infiltrates Renal failure - Cr > 2 Liver failure - Bili > 2 DIC - platelets <100k Decreased fibrinogen and H&H Increased d-dimer, FSP and PT/PTT Prevention of MODS - CORRECT ANSWER Insulin to keep blood glucose < 150, early feeding (24 hours) Frontal impact MOI - CORRECT ANSWER Aortic due to shearing Lateral impact MOI - CORRECT ANSWER Clavicle, ribs, liver, spleen Rear-end MOI - CORRECT ANSWER Highest risk of SCI Penetrating injury organs - CORRECT ANSWER Hollow organs Primary injury prevention - CORRECT ANSWER Actions that change overall background conditions to prevent injury; reduces incidence, prevalence and morbidity Secondary injury prevention - CORRECT ANSWER Actions that decrease severity of injury - doesn't prevent Tertiary injury prevention - CORRECT ANSWER Improve patient outcomes after injury E's of Injury Prevention - CORRECT ANSWER Education, enforcement, engineering, economic Forensics basics - CORRECT ANSWER Paper bags, chain of custody, cut around holes/defects, pain chips on paper folder, gloved hands or rubber-tipped forceps for bullets. Tertiary trauma assessment - CORRECT ANSWER Within 24 hours Blunt cardiac injury with abnormal ECG findings - CORRECT ANSWER Admit and observe for 24 hours Pancreatic injuries - later issues - CORRECT ANSWER Rare but associated with fistulas and sepsis Virchow's triad - CORRECT ANSWER Endothelial injury, venous stasis, hypercoagulability Actions to limit VAP - CORRECT ANSWER HOB elevated to 45 degrees, oral care with chlorhex, inline closed system suction DIC labs - CORRECT ANSWER Decreased platelet count, fibrinogen, H&H. Elevated d-dimer and FSP, long PT/PTT Transfer/trasnport considerations - CORRECT ANSWER Ground is most cost-effective, expedite as soon as you know needs exceed resources, no air splints in rotor-wing, fixed-wing is pressurized Physiatrist - CORRECT ANSWER Physician who specializes in physical medicine and rehabilitation with the focus on restoring function Corneal donation basics - CORRECT ANSWER Up to 24 hours after death, artificial tears, tape lids closed with paper tape, HOB elevated, ice packs Trauma care levels - CORRECT ANSWER 1. Teaching facility, comprehensive care, specialists, research, rehab 2. No research requirement 3. Transfer agreements with 1s and 2s 4. Stabilize then transfer 5. Basic ED that evals, stabilizes and transports Performance improvement - CORRECT ANSWER Primary: in real time, don't know outcome Secondary: retrospective after discharge or death Tertiary: after discharge and secondary performance improvement (M&M) Quaternary: outside agency for independent analysis Performance improvement cycle - CORRECT ANSWER Plan do check act, close the loop TRISS - CORRECT ANSWER RTS, age, MOI, abbreviated injury score (only top 3 are scored) Trauma registry points - CORRECT ANSWER Aggregate data to compare to national standards; demographics, diagnosis, treatment, outcomes; use information to plan injury prevention Evidenced-based practice - CORRECT ANSWER Clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences, not historical practice. Disaster management - mitigation - CORRECT ANSWER Hazards vulnerability assessment to discover risks Disaster management - preparedness - CORRECT ANSWER Mutual aid agreements, extra supplies Disaster management - response - CORRECT ANSWER START/jumpSTART, RPM 30-2-can do. ED nurses role is TRIAGE. Disaster management - recovery - CORRECT ANSWER Replenish supplies and CISM to mitigate impact and restore adaptive functioning of caregivers Chemical or radiation exposure - patient flow - CORRECT ANSWER Opposite of wind direction Autonomy - CORRECT ANSWER Right to make own healthcare decisions Beneficence - CORRECT ANSWER Doing good or causing good to be done; kindly action Non-maleficence - CORRECT ANSWER Duty to do no harm Veracity - CORRECT ANSWER Truthfulness, honesty Justice - CORRECT ANSWER Fair and equal treatment Costs of trauma - CORRECT ANSWER Direct: cost of medical care Indirect: cost of lost productivity EMTALA - CORRECT ANSWER Provides medical screening, chose appropriate transport to higher level of care, stabilize