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TCAR questions and answers graded A+ 2024/2025
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TCAR questions and answers graded A+ 2024/2025
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TCAR3 questions to ask in trauma - ANS-what was the dose of energy?
-where did it go?
-what injuries are likely?
2 q's to ask in GSW - ANScaliber
type of gun
# of entrance/exit wounds
high/low velocity
1st question to ask in any traumatic injury? - ANSwhat was the dose of energy involved?
(was it high or low?)
what is the caliber of a bullet? - ANSdiameter
aka diameter of a bullet - ANScaliber
what happens to projectiles when they enter the body - ANSprojectiles don't travel in a straight
line
consider temporary cavity wound
what should you consider about tissue a projectile enounters - ANStemporary cavitation
primary goal of GSW surgery - ANSusually damage repair & not bullet removal
-if superficial, it may migrate the surface with time
important thing to remember about retained projectiles - ANSthey 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 - ANSsternum
what attaches the ribs to the sternum - ANScartliage
what breaks thoracic bones - ANSsignificant 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 - ANSribs 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 - ANSunusual 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 - ANSto injure c-spine, you don't need a big energy blow. all it takes
is shaking around.
c spine versus t spine fractures - ANSc-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 - ANSlargely supportive nursing care like pulmonary toilet
CXR and rib fractures - ANSsimple 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 - ANSonce healed, rib fractures form bony callouses and
become more visible on CXR
how to tell a pt has a pneumonia from a CXR - ANSdark spot that is not equal to the opposite
side
consider if a pt has a lower rib fracture - ANSliver & spleen injury
acts like BBQ/marshmellow skewers
how high does the diaphragm rise on inspiration - ANSlevel of 4th ICS
risk of rib fractures - ANScan puncture liver, spleen,, diaphragm
pop lungs
+2 adjacent rib fractures - ANSflail chest
free floating sternum - ANSflail chest
definition of flail chest - ANS+2 adjacent rib fracture
free floating sternum
,why is flail chest a problem - ANSb/c breathing is a mechanical process
paradoxical chest movements - ANSin flail chest
s/s of flail chest - ANSparadoxical chest wall movement
where on the tissue oxygenation cascade is thoracic cage fractures a problem - ANSventilation
parameters to assess ventilation - ANSETCO2, PaCO2, clinical assessment
what are considered "great vessels" - ANS
thorax - ANS
what type of injuries occur when the lungs are subjected to force? - ANSbruise = contusion
tear = lacerations
pop = punctures
inhalation injury
bruise on the lungs - ANSpulmonary contusion
causes of pulmonary contusions - ANShigh speed blunt or penetrating injury
what happens to the lungs in pulmonary contusions - ANSbig 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 -
ANSdiffusion
all contusions over time - ANSall 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 -
ANS70% of pulmonary contusions aren't initial on the initial CXR
what should you monitor when a pt has trauma to the throax - ANSclosely 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 -
ANSanticipate "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 - ANSCXR 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 - ANSpulmonary laceration
problem of pulmonary lacerations - ANSrisk of massive hemothoax b/c those vessels are very
vascular
simple v. tension v. open v. closed. v. hemothorax v. hemopneumothorax - ANS
what is a simple pneumothorax - ANSany 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 - ANSair 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 -
ANSventilation
what happens in penumothorax - ANSlungs are collapsed/deflated
aire enters space between the visceral & parietal
two layers of the lungs - ANSvisceral & parietal
Q - in a pneumothorax, no ligaments attach the lung to the wall. so what holds it up? - ANSA - 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 - ANS
aka chest tube - ANSchest thoacotomy
purpose of using a chest tube in simple pneumothorax - ANSto allow for negative pressure to
reestablish .
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