Exam (elaborations)
TCRN PRACTICE QUESTIONS WITH CORRECT ANSWERS
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TCRN PRACTICE QUESTIONS WITH CORRECT ANSWERS
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TCRN QUESTIONS AND ANSWERSMost sscommon ssmechanism ssof ssinjury ss- ssans✔✔Falls
Forms ssof ssenergy ss- ssans✔✔-mechanical
-gravitational
-thermal
-chemical
Types ssof sstrauma ss- ssans✔✔-blunt
-penetrating
-burn
-other
Blunt sstrauma ss- ssans✔✔accounts ssmost ssinjuries sssustained
frontal ssimpact
ss-aortic ss& sscardiac ssinjury, ssrib ssfxs, ssliver ss& ssspleen
ss-dash ssboard ssposterior sship ssfx/dislocation, ssfemur, ssknee ssinjury
lateral ssimpact
ss-head/facial, ssc ssspine, ssclavicle, sspelvic, ssliver/spleen
rear ssend
ss-low ssvelocity, ssneck sshyperextension/hyperflexn ss
rollover
ss-DAI ss
ejection
ss-risk ssof ssdeath ss4x ssgreater
pedestrian ssvs sscar ss
ss-tib/fib ssfx, sstruncal, sshead ssinjury
bicycle
ss-head ssand ssabdominal ssinjury ssfrom sshandlebar
falls
ss-4 ssstories ss50% sswill ssdie
ss-calcaneous, sspelvis, ssspine, ssarm ssfx
Penetrating ssTrauma ss- ssans✔✔lower ssincidence sshigher ssmortality
GSW
Stab: sslow ssvelocity sshigher ssdirect ssdamage ssto ssorgans
Burn: ssthermal ssor ssinhalation
Other: ssHanging, ssstrangulation ss, sssuffocation, ssdrowning
Waddell's ssTriad ss- ssans✔✔-femoral ssshaft ssfx ss
-intrathoracic ssand ssabdominal ssinjury
-contralateral sshead ssinjury
,Newton's ssthree sslaws ssof ssmotion ss- ssans✔✔1. ssobject ssat ssrest sswill ssstay ssat ssrest,
ssobject ssin ssmotion sswill ssstay ssin ssmotion
2. ssForce: ssF=ma ssapplying ssforce ssproduces ssacceleration ss(think ssseatbelt sssign) ss
3. ssAction ss& ssRxn: ssEvery ssaction ssthere ssis ssan ssequal ssand ssopposite ssreaction
ABCDE ss"do ssyour ssjob" ssPrimary ssSurvey ss- ssans✔✔Airway ssobstruction ssis ssmajor
sscause ssof sspreventable sstrauma ssdeaths ss
Hemorrhage ssis ssthe ssmost sscommon sscause ssof ssmortality ssin sstrauma ss
Airway-get ssdefinitive ssairway
Circulation-IV ssaccess ssand ssIVF ss
Disability-assess ssLOC ssGCS ssscale ss
Exposure-get ssyour sspt ssnaked! sstemperature sscontrol
ss-hypothermia=acidosis, sscoagulopathy, sslow ssO2
Hemorrhage ssControl-STOP ssTHE ssBLEED ssreplace ssvolume ssloss, ssuse sstourniquet-
note sstourniquet sstime
ss-<6yo ssIO ssaccess sspreferred ssover sscentral ssline
MTP
ss-1:1:1 sspRBC:plasma:platelet
ss-pt ssreceiving ss>10 ssunits sspRBC ssw/in ss24 sshrs ssadmit
When ssis ssa ssdefinitive ssairway ssneeded? ss- ssans✔✔Edema, sshemorrhage, ssfracture ssto
ssobstruct ssairway ssand ssan ssET/NT sscannot ssbe ssplaced ss
-closed sshead ssinjury ssw/ ssGCS ss<8
-unresponsive ss
-neuromuscular ssparalysis ss
-apnea
-sustained ssseizure ssactivity
-inability ssto ssprotect sslower ssairway ssfrom ssblood/secretion
Breathing ssAssessment ss- ssans✔✔-rate
-depth
-effort
-symmetry
-watch ssfor sstension sspneumothorax!!
Open sspneumothorax ssdressing ss- ssans✔✔3 sssided ssdressing
Confirm ssairway ssplacement ss- ssans✔✔-cords ssvisualized
-chest ssrise ssand ssfall
-auscultate
-CO2 ssdetector
-pulse ssox
-CXR
Adult ssIVF ssbolus ss- ssans✔✔1-2 ssliters ssif ssno sscontraindication
,Pediatric ssIVF ssbolus ss- ssans✔✔20ml/kg
Secondary ssSurvey ss- ssans✔✔a sshead-to-toe ssphysical ssassessment; ssan ssadditional
ssassessment ssof ssa sspatient ssto ssdetermine ssthe ssexistence ssof ssany ssinjuries ssother ssthan
ssthose ssfound ssin ssthe ssprimary sssurvey, sshistory ssor ssscene ssdetail
Cardiac ssOutput ss(L/min) ss- ssans✔✔HR ss(beats/min) ssx ssSV ss(cc/beat)
Shock ssDefinition ss- ssans✔✔State ssin sswhich ssperfusion ssis sscompromised ss@ sscellular
sslevel ssd/t: ss
-insufficient ssoxygen ssdelivery
-increased ssoxygen ssconsumption
-ineffective ssoxygen ssutilization
Hypovolemic ssShock ss- ssans✔✔most sscommon sstype ssshock: sssignificant ssloss
sscirculating ssvolume ssmost sscommon sssource ssacute ssblood ssloss ss(hemorrhage) ss
-AMS ssfirst sssign ssof ssshock
-Tachycardia ss>120 ssvery ssconcerning-one ssof ss1st sssigns
-Cool ssclammy ssskin ssd/t ssvasoconstriction
-prolonged ssCRT ss
-Narrowed sspulse sspressure ss(40-50mm)
-Hypotension
-Decreased ssUO
ss-adult ss0.5mL/kg/hr
ss-child ss1mL/kghr
ss-toddler ss1.5 ssmL/kg/hr
ss-Infant ss2mL/kg/hr
Hemorrhagic ssShock ssGoals ss- ssans✔✔Goal: ssSTOP ssTHE ssBLEED ss& ssdefinitive
sscontrol ssof sshemorrhage ssand ssrestoration ssof ssadequate sscirculating ssvolume
Hemorrhagic ssShock ss- ssans✔✔Look ss@ sschest, ssabdomen, sspelvis
Class ssI ssHemorrhage ss- ssans✔✔up ssto ss15% ssblood ssloss, ssminimal sstachycardia, ssno
ssmeasurable sschanges ssin ssBP, ssHR, ssRR ss
ex. sssomeone sswho ssdonated ssblood
Class ssII ssHemorrhage ss- ssans✔✔15-30%, ssuncomplicated sshemorrhage, ss1-2 ssL ssof
sscrystalloid ss
increased ssHR, ssnarrowed sspulse sspressure
Class ssIII ssHemorrhage ss- ssans✔✔30-40%, sscomplicated ssstate sswhere ssblood
ssreplacement ssessential, ssno sslonger ssable ssto sscompensate ssfor ssvolume ssloss,
sshypotension ssoccurs, ssHR ss>120 ssBPM, ssRR ss30-40, sssevere ssanxiety ssor ssconfusion
, Class ssIV ssHemorrhage ss- ssans✔✔Blood ssloss: ss>40%
Pre-terminal ssevent ss
Aggressive ssmeasures ssnecessary ssactivate ssMTP
BP: ssprofound ssdecrease
HR: ss>140
RR: ss>35
Urine ssoutput: ss<5cc/h
CNS ssstatus: ssobtunded
Capillary ssrefill: sssignificant ssdelay/cold
ABG ssvalues ss- ssans✔✔pH ss7.35-7.45
pCO2 ss39-55
PO2 ss30-55
Base ssexcess ss-3 ssto ss3 ss
Bicarb ss20-28
INR ss- ssans✔✔>1.5=coagulopathy
Male ssTrauma ssPatient ssBlood ssProduct ss- ssans✔✔O ssPositive
Female ssTrauma ssPatient ssBlood ssProduct ss- ssans✔✔O ssNegative
TEG ss- ssans✔✔TEG ssmonitors sswhole ssdynamic ssprocess ssof sshemostasis ssfrom ssclot
ssformation ssto ssclot ssdissolution
pH ss<7.20 sstreatment ss- ssans✔✔Indicates ssmyocardial ssdepression
Fix ssthe ssunderlying ssinjury
The ssLethal ssTriad/Bloody ssViscous ssCycle/Trauma ssTriad ssof ssDeath ss-
ssans✔✔hypothermia, ssacidosis, sscoagulopathy
hypoxia=hypothermia=hypoperfusion=coagulopathy ss(stops ssblood ssclotting)=anaerobic
ssenergy=increased sslactate=acidosis
Permissive ssHypotension ss- ssans✔✔Non ssTBI sspatients: ss80-90 ss
TBI sspatients: ss>90
Evaluating ssOrgan ssPerfusion ssin ssShock ss- ssans✔✔Vigilant ssmonitoring ssof ssurine
ssoutput ssand sscore sstemperature
Obstructive ssShock ss- ssans✔✔Heart ssis ssimpeded ssas ssa ssresult ssof ssobstructed ssvenous
ssfilling ssor ssdirect sscompression ssof ssthe ssheart ss
Ex. sspericardial sstamponade ss(most ssw/ sspenetrating ssinjury), sstension sspneumothorax ss
*Life ssthreatening* ssand ssshould ssbe ssseen sson ssprimary sssurvey ss*
Tension ssPneumothorax ss- ssans✔✔ABSENT ssbreath sssounds
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