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TCRN EXAM STUDY GUIDE
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TCRN EXAM STUDY GUIDE
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TCRN EXAM STUDY GUIDEMost common mechanism of injury - answer- Falls
Forms of energy - answer- -mechanical
-gravitational
-thermal
-chemical
Types of trauma - answer- -blunt
-penetrating
-burn
-other
Blunt trauma - answer- accounts most injuries sustained
frontal impact
-aortic & cardiac injury, rib fxs, liver & spleen
-dash board posterior hip fx/dislocation, femur, knee injury
lateral impact
-head/facial, c spine, clavicle, pelvic, liver/spleen
rear end
-low velocity, neck hyperextension/hyperflexn
rollover
-DAI
ejection
-risk of death 4x greater
pedestrian vs car
-tib/fib fx, truncal, head injury
bicycle
-head and abdominal injury from handlebar
falls
-4 stories 50% will die
-calcaneous, pelvis, spine, arm fx
Penetrating Trauma - answer- lower incidence higher mortality
GSW
Stab: low velocity higher direct damage to organs
Burn: thermal or inhalation
Other: Hanging, strangulation , suffocation, drowning
Waddell's Triad - answer- -femoral shaft fx
-intrathoracic and abdominal injury
-contralateral head injury
Newton's three laws of motion - answer- 1. object at rest will stay at rest, object in
motion will stay in motion
,2. Force: F=ma applying force produces acceleration (think seatbelt sign)
3. Action & Rxn: Every action there is an equal and opposite reaction
ABCDE "do your job" Primary Survey - answer- Airway obstruction is major cause of
preventable trauma deaths
Hemorrhage is the most common cause of mortality in trauma
Airway-get definitive airway
Circulation-IV access and IVF
Disability-assess LOC GCS scale
Exposure-get your pt naked! temperature control
-hypothermia=acidosis, coagulopathy, low O2
Hemorrhage Control-STOP THE BLEED replace volume loss, use tourniquet-note
tourniquet time
-<6yo IO access preferred over central line
MTP
-1:1:1 pRBC:plasma:platelet
-pt receiving >10 units pRBC w/in 24 hrs admit
Herniation - answer- Abnormal protrusion of brain tissue through opening where
increased ICP is
1. uncal
2. central (transtentorial)
3. cingulate
4. transcalvarial infratentorial
5. upward cerebellar
6. tonsillar
Secondary Brain Injury - answer- Prevent secondary injury esp. hypoxia & hypotension
Pre hospital: oxygenation, prevent aspiration, field stabilization and triage of GCS
Concussions - answer- An immediate disruption of brain activity that is temporary
Early GCS, PERRL, VS
HA, vertigo, tinnitus, balance, sleep disturbance, and mood change can go on for
months educate pt of s/s
Recc liberal use of head CT esp in anticoag pts
Spinal Column and Cord Injuries - answer- Blunt mechanism
-deceleration MVC falls
-hypo/hyperflexion
-axial load vertical compression
Violence
Penetrating trauma
-missile injury (bullet, knife)
-stabbing
-impalement
,Vertebral anatomy - answer- 33 total vertebrae
7 cervical
C1 majority parasympathetic exit
C2 axis
12 thoracic
5 lumbar
5 sacral (fused)
5 coccyx (fused)
Dermatomes - answer-
Cord Syndromes - answer- Incomplete injury
Anterior
Brown-Sequard
Conus Medullaris
Cauda equine
Anterior Cord Injury - answer- motor function BELOW injury
Brown-Sequard - answer- Hemisection of cord from penetrating injury
Loss of motor on side of injury
Loss of sensation on opposite side
Conus Medullaris - answer- S4-5 exit at L1
May be a fx at L1
Cauda Equina - answer- Lumbar sacral nerve root w/ or w/o fx
Complete Cord Injuries - answer- Quadriplegia/tetraplegia
Paraplegia
Quadriplegia/tetraplegia - answer- Below level of C1-T1
Paraplegia - answer- Below level of injury below T1
ABCDE Spinal Injuries - answer- A-airway! Assume injury C1-C4 definitive airway
Below C4 may need airway
B-RR effort paradoxical movement?
C-fluids, neurogenic shock, poiklothermic
D-Diagnosis Helical CT better MRI best peds; determine loss sensation pain, temp,
pressure, vibration, proprioception, reflexes, bowel/bladder fxn
Exposure associated injuries fxs etc.
ASIA type A - answer- Complete no sensory/motor in sacral roots S4-5A. Complete no
sensory/motor in sacral roots S4-5
, American Spinal Injury Association Impairment Scale - answer- A. Complete no
sensory/motor in sacral roots S4-5
B. Sensory Incomplete-sensory preserved below the neurological level includes sacral
segments AND no fxn preserved more than 3 levels below on either side of body
C. Motor Incomplete-some sacral sparing less than 1/2 muscle groups motor strength
>=3
D. Motor incomplete-preservation below injury. At least 50% muscle groups motor
strength >=3
E. Normal motor and sensory intact
ASIA type B - answer- Sensory Incomplete-sensory preserved below the neurological
level includes sacral segments AND no fxn preserved more than 3 levels below on
either side of body
ASIA type C - answer- Motor Incomplete-some sacral sparing less than 1/2 muscle
groups motor strength >=3
ASIA type D - answer- Motor incomplete-preservation below injury. At least 50% muscle
groups motor strength >=3
ASIA type E - answer- Normal motor and sensory intact
Most likely vertebrae to get injured - answer- C5-6 because it is the greatest point of
flexion
C2 Dens fx - answer- Hypertension injury more frequent in geriatric population
Compression fx - answer- Axial load
Degree of compression affects stability
Thoracic & lumbar spine
Chance fx - answer- Usually L1-2 teardrop fx
May result in paraplegia and SMALL BOWEL INJURY from lap belt compression of
lumbar spine
Burst fx - answer- Fracturing in outward pattern may impinge cord
can have compression & cord compression
SCIWORA - answer- spinal cord injury without radiographic abnormality
most common in peds population
dislocation w/ spontaneous relocation
cord injury evident
imaging negative
Post Traumatic Syringomyelia - answer- may need decompression and laminectomy or
shunting
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