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TNCC Study Guide Exam 1262 Questions with Verified
Answers
Primary concern when a person cannot stop coughing/clearing their throat following house fire/smoke? - CORRECT ANSWER Airway/Intubate Lab evidence of cellular perfusion - CORRECT ANSWER Base Excess (Less than -6 is BAD) Multiple people are in the ER of different ages who all go to the same church. They all have the same symptoms. What is the most likely cause? - CORRECT ANSWER Biologic Suspected shock type with a spinal cord injury - CORRECT ANSWER Distributive Shock (Includes neurogenic) Patient has GCS of 3, unequal pupils (one sluggish, one blown), and is posturing. What is the cause? - CORRECT ANSWER Herniation Middle Meningeal Artery - CORRECT ANSWER Epidural Hematoma (results from collection of blood that forms between dura mater and skull) Prior to having a concussion (TBI), the patient had a brain injury that was not fully healed. What is the cause? - CORRECT ANSWER 2nd Impact Syndrome Bowel sounds heard in the L chest. What is this a symptom of? - CORRECT ANSWER Ruptured diaphragm Symptoms of __________________: include muffled heart sounds and hypotension - CORRECT ANSWER Pericardiocentesis How should you dress a severed limb? - CORRECT ANSWER Sterile gauze with normal saline THEN put ice on it Amylase level looks at _____________ - CORRECT ANSWER Pancreas
What should you do if your patient has hyphema (collection of blood inside the front part of the eye?) - CORRECT ANSWER Sit HOB up to 30 degrees Principle that people have to take action after suffering a loss in order to decrease severity, seriousness, or painfulness - CORRECT ANSWER Mitigation What organ is most at risk following a gunshot - CORRECT ANSWER Liver 8 year old child with longitudinal thigh lacerations - CORRECT ANSWER Sign of child abuse Bleeding around belly button - CORRECT ANSWER Cullen's Sign What would cause an inaccurate reading from an 02 saturation probe? - CORRECT ANSWER Carboxyhemoglobin (increase FiO2 to 100%) General study of forces and their effects on living tissue and the human body - CORRECT ANSWER Biomechanics Study of energy transfer as it applies to identifying actual or potential injuries - CORRECT ANSWER Kinematics Refers to the separation of tissue resulting from a sound and/or hydraulic wave force- the effect is a crushing pressure wave which creates a temporary cavity, followed by a rapid and violent closing of the cavity. - CORRECT ANSWER Cavitation This rapid motion can lead to crushing, tearing, and shearing forces on tissue - CORRECT ANSWER Cavitation Used in OR; does not provide protection against aspiration and not recommended in patients who have eaten recently. It is a supraglottic airway. - CORRECT ANSWER Laryngeal Mask Airway Single tube retroglottic device inserted into the esophagus and traps the glottis opening between an esophageal cuff and an oropharyngeal cuff. Designed with 2
_______________________: Results in depletion of clotting factors through hemodilution and the impaired ability to produce clotting factors. - CORRECT ANSWER Trauma Triad of Death
- Hypothermia
- Metabolic Acidosis
- Coagulopathy Stages of Shock (3) - CORRECT ANSWER 1. Compensated
- Decompensated vs Progressive
- Irreversible Complete craniofacial separation involving maxilla, zygoma, orbits, and bones of the cranial base. Assessment findings include: massive facial edema, mobility and depression of zygomatic bones, ecchymoses, diplopia, and open bite or malocclusion. - CORRECT ANSWER LeFort III Transverse maxillary bone fracture that occurs above the level of the teeth from the maxilla. Assessment findings include: independent moment of the maxilla from the rest of the face, slight swelling of the maxillary area, lip laceration or fractured teeth, malocclusion. - CORRECT ANSWER LeFort I Pyramidal maxillary bone fracture involving the mid-face area. The apex of the fracture transverses the bridge of the nose. Assessment findings include: massive facial edema, nasal swelling with obvious fracture of the nasal bones, malocclusion, CSF rhinorrhea - CORRECT ANSWER LeFort II Can be caused by blunt trauma. Air escapes from the injured lung into the pleural space, and negative intrapleural pressure is lost resulting in partial or complete collapse of the lung. S & S: dyspnea, tachypnea, decreased/absent breath sounds on injured side, chest pain. Treatment: based on size, symptoms, and stability. Chest tube may be placed to evacuate pleural air and maintain lung expansion - CORRECT ANSWER Pneumothorax Air enters the intrapleural space but cannot escape on expiration. The increasing intrathoracic pressure causes the lung on the injured side to collapse. If pressure is not relieved, the mediastinum can shift toward the uninjured side compressing the heart/great vessels/and opposite lung. S & S: anxiety, severe restlessness,
severe respiratory distress, significantly diminished or absent breath sounds on injured side, hypotension, distended neck/head/upper extremity veins, tracheal deviation, or a shift toward uninjured side. Treatment: Needle thoracentesis and chest tube insertion - CORRECT ANSWER Tension Pneumothorax Collection of blood in pericardial sac. Mechanism of injury is typically penetrating trauma. Compresses the heart and decreases ability of the ventricles to fill causing decreased SV and CO. S & S: hypotension, muffled heart sounds, distended neck veins, tachycardia or PEA, dyspnea, cyanosis, chest pain. Surgical evacuation will be needed. - CORRECT ANSWER Cardiac Tamponade __________________ Shock: Spinal cord injury at T6 or above. Temporary loss of vasomotor tone and sympathetic innervation. Temporary duration usually < hours. S & S: hypotension, bradycardia, loss of ability to sweat below level of injury. - CORRECT ANSWER Neurogenic ______________ Shock: Spinal cord injury at any level. Transient loss of reflex below the level of injury. Variable duration. S & S: flaccidity, loss of reflexes, bowel/bladder dysfunction. - CORRECT ANSWER Spinal Significant muscle damage and cellular destruction releases myoglobin: a muscle protein; into the bloodstream. Classic symptoms: muscle pain/numbness/changes in sensation, muscle weakness/paralysis, dark red/brown urine. - CORRECT ANSWER Rhabdomyolysis What does MIST mnemonic mean? - CORRECT ANSWER M: Mechanism of Injury I: Injuries sustained S: S&S in the field T: Treatment in the field Older adults are harder to intubate due to ______________ ____________ - CORRECT ANSWER cervical arthritis Leading cause of preventable death after injury - CORRECT ANSWER Hemorrhage Room Air = ____% FiO2 - CORRECT ANSWER 21%
Most frequently injured organ from BLUNT trauma - CORRECT ANSWER Spleen Pain Ladder: Step 1: Non-opioids for mild pain Step 2: Weak opioids for mild to moderate pain Step 3: Strong opioids for moderate to severe pain - CORRECT ANSWER 1: Tylenol, Ibuprofen, Ketorolac 2: Codeine 3: Morphine, Fentanyl, Dilaudid Signs of increased compartment syndrome - CORRECT ANSWER Increased pain, feels tight/very painful, but nothing looks wrong Ischemia develops -- Pressure Fasical Development -- Impaired Blood Flow. 6 P's: Pressure, pallor, pulses, paresthesia, paralysis. Extremity goes to level of the ___________!!! NO ______!! - CORRECT ANSWER Compartment Syndrome: Level of heart; NO ice!! Control bleeding with direct pressure, elevate, apply tourniquets. - CORRECT ANSWER Amputation Wrap in saline gauze, put in bag, then put that bag in another bag filled with ice. Label bag. - CORRECT ANSWER Removed limb A ____ and ___ approach is used by all members of the trauma team to provide optimal care for the trauma pt. - CORRECT ANSWER Systematic , Organized Trauma is injury to living tissue caused by ... - CORRECT ANSWER An extrinsic agent A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - CORRECT ANSWER Intentional;unintentional .... is the study of energy transfer as it applies to identifying actual or potential injuries - CORRECT ANSWER Kinematics The general study of forces and their effects - CORRECT ANSWER Biomechanics
How external forces in the environment are transferred to the body - CORRECT ANSWER Mechanism of injury A body at rest will remain at rest, a body in motion will stay in motion - CORRECT ANSWER Newton's first law Force = mass x acceleration - CORRECT ANSWER Newton's second law For every action there is an equal and opposite reaction - CORRECT ANSWER Newton's third law Energy can neither be created nor destroyed but rather I can change form - CORRECT ANSWER Law of conservation of energy Kinect is energy is equal to ... - CORRECT ANSWER 1/2 the mass x by the velocity squared (v^2) Caused by a sudden stop of the body's motion - CORRECT ANSWER Deceleration forces Caused from a sudden and rapid onset of motion ( a Parker car being hit by another vehicle) - CORRECT ANSWER Acceleration forces An external force applied time of impact, ex. Steering wheels or dashboards that collide with or push up into a person. - CORRECT ANSWER Compression force .... is the major cause of preventable death after injury - CORRECT ANSWER Uncontrolled hemorrhage .... is suspected in any patient with multi system trauma. - CORRECT ANSWER Cervical spine injury ... shock is from hemorrhage and is the leading cause of preventable deaths in trauma patients. Can also be caused by plasma loss in ... - CORRECT ANSWER Hypovolemic; burns
What stage of shock: anxiety, restless, confused, norm systolic pressure, rising diastolic pressure, slightly tachycardiac, increased RR and decreased urine output
- CORRECT ANSWER Stage I: compensated What stage of shock:patient is unconscious or intended, normal systolic pressure, narrowing pulse pressure, tachycardia, weak and threads pulses, rapid and shallow respiration, cool and clammy, worsening base excess and increasing Lacoste levels - CORRECT ANSWER Stage II: decompensated or progressive shock What stage of shock?: this will lead to death without rapid intervention, obtunded, stuporous or comatose, marked hypotension and heart failure, bradycardia, decreased and shallow respirations, pale, cool and clammy, organ failure and severe acidosis - CORRECT ANSWER Stage III: irreversible shock ... is a principle that confuses on prevention rather than intervention. - CORRECT ANSWER Damage control resuscitation The components of the neurological system involved with pain transmission include... - CORRECT ANSWER Neurons, neuron synapses and neurotransmitters ... pain is persistent and usually lasts longer than 3 to 6 months. - CORRECT ANSWER Chronic ... describes the concept of under treatment of pain. - CORRECT ANSWER Oligoanalgesia The most reliable and valid tool for pain assessment is ... - CORRECT ANSWER Self- report Causes of oligoanalgesia include... - CORRECT ANSWER Failure to assess initial pain; failure to implement guidelines and protocols; failure to document pain; failure to meet patients expectations The meninges consist of three layers of protective coverings ... - CORRECT ANSWER (PAD) pia matter, arachnoid matter and dura matter
Adequate perfusion of oxygen and supply of nutrients to the brain tissue is dependent on ... and ... - CORRECT ANSWER CPP; CBF ... is defined as the pressure gradient across the brain tissue, or the difference between the pressures of the cerebral artery and venous vessels. - CORRECT ANSWER CPP; CPP = map - icp Normal CPP is ... Acceptable CPP is ... During this auto regulation maintains in a steady state. - CORRECT ANSWER 60 to 100; 50 to 70 ... is a triad of assessment findings; widening pulse pressure, bradycardia, and diminished respiratory effort - CORRECT ANSWER Cushing ( it is an attempt to increase MAP against elevated ICP, ultimately trying to cause a rise in CPP) ... pain originates from skin and musculoskeletal structures (burns) - CORRECT ANSWER Somatic ... pain originates from organs and may lead to referred pain. (Trauma) - CORRECT ANSWER Visceral If injury causes the CPP to fall outside the range of 50 - 160, the brain loses its ability to ... and CBF is directly dependent on ... for perfusion - CORRECT ANSWER Auto regulate ; MAP Normal Co2 ... - CORRECT ANSWER 35- Co2 ... causes dilation of cerebral arterial vasculature and increased blood flood and increased ICP. ... causes constriction and decreased blood flow.! - CORRECT ANSWER Hypercapnia; hypocapnia Signs of impending herniation include ... - CORRECT ANSWER Unilateral or bulge risk pupillary dilation, asymmetric pupillary reactivity or abnormal posturing As ICP increases CPP decreases resulting in ... - CORRECT ANSWER Cerebral ischemia, hypoxemia and lethal secondary insult
that lacerated the .... - CORRECT ANSWER Epidural hematoma ; middle meninges artery This is commonly the type of bleed sustained by athletes who suffer a catastrophic head injury. - CORRECT ANSWER Acute subdue all hematoma .... are frequently associated with minor injury in older adults, patients taking anticoagulation medications and patients with chronic alcohol abuse. - CORRECT ANSWER Chronic subdural Hematoma ... is the shifting of brain tissue with displacement into another compartment as the result of bleeding or edema. - CORRECT ANSWER Herniation GCS scores : I. Mild TBI II. Moderate TBI III. Severe TBI - CORRECT ANSWER 13-15; 9-12; 8 or less ... refers to a condition that occurs when the patient suffers a second milks TBI before recovery from the first - CORRECT ANSWER Second impact syndrome Patients who sustain a mild TBI may develop ..... Typically it will manifest several days or moths after head trauma. - CORRECT ANSWER Postconcussive syndrome A ... fracture is a complete craniofacial separation - CORRECT ANSWER Lefort III Assessment findings with maxillary fractures include - CORRECT ANSWER Facial edema, ecchymoses and diplopoa (lefort III) What are some interventions for the patient with a brain, cranial or macillofacial trauma - CORRECT ANSWER Elevation of patients head of bed by 30 degrees to decrease ICP, position head midline, ICP monitoring device Treatment of corneal abrasion includes - CORRECT ANSWER Topical antibiotics, oral analgesics NO patching , topical anti inflammatory
What are the late signs of breathing compromise? - CORRECT ANSWER - Tracheal deviation
- JVD What are signs of ineffective breathing? - CORRECT ANSWER - AMS
- Cyanosis, especially around the mouth
- Asymmetric expansion of chest wall
- Paradoxical movement of the chest wall during inspiration and expiration
- Use of accessory muscles or abdominal muscles or both or diaphragmatic breathing
- Sucking chest wounds
- Absent or diminished breath sounds
- Administer O2 via NRB or assist ventilations with a bag-mask device, as indicated
- Anticipate definitive airway management to support ventilation. Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? - CORRECT ANSWER A tight-fitting nonrebreather mask at 12-15 lpm. What intervention should be done if a pt presents with effective circulation? - CORRECT ANSWER - Insert 2 large caliber IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate What are signs of ineffective circulation? - CORRECT ANSWER - Tachycardia
- AMS
- Uncontrolled external bleeding
- Pale, cool, moist skin
- Distended or abnormally flattened external jugular veins
- Distant heart sounds What are the interventions for Effective/Ineffective Circulation? - CORRECT ANSWER - Control any uncontrolled external bleeding by:
- Applying direct pressure over bleeding site
- Elevating bleeding extremity
- Applying pressure over arterial pressure points
- Using tourniquet (last resort).
PRETREATMENT:
- Decrease S/E's of intubation PARALYSIS WITH INDUCTION:
- Pt has LOC, then administer neuromuscular blocking agent PROTECTION AND POSITIONING:
- Apply pressure over cricoid cartilage (minimizes likelihood of vomiting and aspiration PLACEMENT WITH PROOF
- Each attempt NOT to exceed 30 seconds, max of 3 attempts. Ventilate pt 30- seconds between attempts.
- After intubation, inflate the cuff
- Confirm tube placement w/exhaled CO2 detector. POSTINTUBATION MANAGEMENT:
- Secure ET tube
- Set ventilator settings
- Obtain Chest x-ray
- Continue to medicate
- Recheck VS and pulse oxtimetry What is a Combitube? - CORRECT ANSWER A dual-lumen, dual-cuff airway that can be placed blindly into the esophagus to establish an airway. If inadvertently placed into trachea, it can be used as a temporary ET tube. There are only two sizes: small adult and larger adult. What is a Laryngeal Mask Airway? - CORRECT ANSWER Looks like an ET tube but is equipped with an inflatable, elliptical, silicone rubber collar at the distal end. It is designed to cover the supraglottic area. ILMA, does not require laryngoscopy and visualization of the chords. What is Needle Cricothyrotomy - CORRECT ANSWER Percutaneous transtracheal ventilation. (temporary) Complications include:
- inadequate ventilation causing hypoxia
- hematoma formation
- esophageal perforation
- aspiration
- thyroid perforation
- subcutaneous emphysema What is Surgical Cricothyrotomy? - CORRECT ANSWER Making an incision in cricothyroid membrane and placing a cuffed endo or trach tube into trachea. This is indicated when other methods of airway management have failed and pt cannot be adequately ventilated and oxygenated. Complications include:
- Aspiration
- Hemorrhage or hematoma formation or both
- Lac to trachea or esophagus
- Creation of a false passage
- Laryngeal stenosis How do you confirm ET Tube/Alternative Airway Placement? - CORRECT ANSWER
- Visualization of the chords
- Using bronchoscope to confirm placement
- Listening to breath sounds over the epigastrum and chest walls while ventilating the pt
- CO2 detector
- Esophageal detection device
- Chest x-ray How do you inspect the chest for adequate ventilation? - CORRECT ANSWER Observe:
- mental status
- RR and pattern
- chest wall symmetry
- any injuries
- patient's skin color (cyanosis?)
- JVD or tracheal deviation? (Tension pneumothorax) What are you looking for when auscultating lung sounds? - CORRECT ANSWER Absence of BS:
- Pneumothorax
Explain Cardiogenic Shock. - CORRECT ANSWER Syndrome that results from ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: MI, Blunt cardiac injury, Mitral valve insufficiency, dysrhythmias, Cardiac Failure Explain Obstructive Shock. - CORRECT ANSWER Results from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes:
- Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume).
- Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium.
- Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Distributive Shock. - CORRECT ANSWER Results from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. What is vascular response? - CORRECT ANSWER As blood volume decreases, peripheral blood vessels vasoconstrict as a result of sympathetic stimulation via inhibition of baroreceptors. Arterioles constrict to increase TPR and BP.
What is renal response? - CORRECT ANSWER Renal ischemia activates release of renin. Kidneys do not receive adequate blood supply, renin is release into circulation. Renin causes angiotensinogen, normal plasma protein, to release angiotensin I. Angiotensin-converting enzyme from the lungs converts into angiotensin II. Angiotensin II causes:
- Vasoconstriction of arterioles and some veins
- Stimulation of sympathetic nervous system
- Retention of water by kidneys
- Stimulation of release of aldosterone from the adrenal cortex (sodium retention hormone) *Decreased urinary output = early sign renal hypoperfusion and an indicator that there's systemic hypoperfusion. Explain adrenal gland response. - CORRECT ANSWER When adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water.
