TCRN EXAM QUESTIONS AND 100% CORRECT ANSWERS
Kehr's sign- Answer Referred left shoulder pain, usually indicates a splenic injury
Base deficit- Answer Base deficit > -6 indicates need for agressive resuscitation and
determination of the etiology
CXR- Answer Most important tool providing useful information in the early minutes. Can
identify major sources of blood loss from injuries in the chest or elevated diaphragm
with displacement of abdominal organs
Tracheobronchial injury - Answer Should be suspected if after chest tube placement a
significant air leak is present
Diagnostic Peritoneal Lavage - Answer Alternative to FAST scan to detect abd bleeding.
A urinary catheter and gastric tube should be in place prior to procedure.
FAST- Focused Assessment with Sonography in Trauma. Used to detect free fluid in
peritoneum or hemoperitoneum. Free fluid appears "black" on the screen. Replaced
DPL when available.
Positive FAST scan- A Hemodynamically unstable trauma patient with a positive fast are
taken directly to the OR for laparotomy
Ultrasound abd exam- Answer Not helpful for the diagnosis of diaphragmatic, intestinal,
and pancreatic injuries. In obese patients, those with ascites and/or subQ emphysema,
the accuracy is diminished.
CT scan- Answer Stable patients from hemodynamic point of view can be taken for CT
, Angiography - Answer Embolization useful in treating patient with unstable pelvic
fractures, liver and splenic hemorrhage. Utilization of hybrid Operating Room suites to
allow for both surgical and interventional radiology methods of treatment
simultaneously.
Diagnostic laparoscopy - Answer Can be used to detect or exclude finding so f
hemoperitoneum, organ injury, intestinal spillage or peritoneal penetration. Most useful
in evaluating possible diaphragmatic injuries, espectially in penetrating
thoracoabdominal injuries on the left site
Diaphragmatic injuries - Answer Usually resultant of penetrating throacoabdominal
injuries on the left side, including 11-12 rib fractures on the left.
Small intestine injuries Answer Result from shearing forces in MVC or direct blows that
crush intestine between force and the vertebrae. Most commonly intra-abd injury in
penetrating trauma. Occurs often w/ spinal injury. Pancreatic/solid organ injury are
predictive of increased risk for hollow viscus injury. Signs of peritonitis develop. Any
blow to the abd/penetrating injury to the lower chest/abd should increase suspicion of
injury
Small intestine injury management- Answer Control bleeding before exploration.
Debridement and closure and ligation of bleeders. Resection for multiple defects.
Observe for wound infection/abscess development
Cause of duodenum injuries- Answer Penetrating trauma most frequent cause. Usually
concomitant mult-organ injuries. Usually found intraoperatively, commonly missed
during exlap. Blunt force injury cause by vetebral compression.
Duodenal injury tx- Diagnosis Identification with CT scan. Often patient presents with
midepigastric or back pain with progressive peritoneal signs 6-24 hrs post injury. Initial
treatment includes primary closure in the operating room, closed drainage system.
Objectives of surgical intervention are to control hemorrhage, debride devitalized tissue
and provide adequate drainage. Non-operative management demands close
observation for expanding or ruptured hematomas causing bleeding or peritoneal
contamination.
Kehr's sign- Answer Referred left shoulder pain, usually indicates a splenic injury
Base deficit- Answer Base deficit > -6 indicates need for agressive resuscitation and
determination of the etiology
CXR- Answer Most important tool providing useful information in the early minutes. Can
identify major sources of blood loss from injuries in the chest or elevated diaphragm
with displacement of abdominal organs
Tracheobronchial injury - Answer Should be suspected if after chest tube placement a
significant air leak is present
Diagnostic Peritoneal Lavage - Answer Alternative to FAST scan to detect abd bleeding.
A urinary catheter and gastric tube should be in place prior to procedure.
FAST- Focused Assessment with Sonography in Trauma. Used to detect free fluid in
peritoneum or hemoperitoneum. Free fluid appears "black" on the screen. Replaced
DPL when available.
Positive FAST scan- A Hemodynamically unstable trauma patient with a positive fast are
taken directly to the OR for laparotomy
Ultrasound abd exam- Answer Not helpful for the diagnosis of diaphragmatic, intestinal,
and pancreatic injuries. In obese patients, those with ascites and/or subQ emphysema,
the accuracy is diminished.
CT scan- Answer Stable patients from hemodynamic point of view can be taken for CT
, Angiography - Answer Embolization useful in treating patient with unstable pelvic
fractures, liver and splenic hemorrhage. Utilization of hybrid Operating Room suites to
allow for both surgical and interventional radiology methods of treatment
simultaneously.
Diagnostic laparoscopy - Answer Can be used to detect or exclude finding so f
hemoperitoneum, organ injury, intestinal spillage or peritoneal penetration. Most useful
in evaluating possible diaphragmatic injuries, espectially in penetrating
thoracoabdominal injuries on the left site
Diaphragmatic injuries - Answer Usually resultant of penetrating throacoabdominal
injuries on the left side, including 11-12 rib fractures on the left.
Small intestine injuries Answer Result from shearing forces in MVC or direct blows that
crush intestine between force and the vertebrae. Most commonly intra-abd injury in
penetrating trauma. Occurs often w/ spinal injury. Pancreatic/solid organ injury are
predictive of increased risk for hollow viscus injury. Signs of peritonitis develop. Any
blow to the abd/penetrating injury to the lower chest/abd should increase suspicion of
injury
Small intestine injury management- Answer Control bleeding before exploration.
Debridement and closure and ligation of bleeders. Resection for multiple defects.
Observe for wound infection/abscess development
Cause of duodenum injuries- Answer Penetrating trauma most frequent cause. Usually
concomitant mult-organ injuries. Usually found intraoperatively, commonly missed
during exlap. Blunt force injury cause by vetebral compression.
Duodenal injury tx- Diagnosis Identification with CT scan. Often patient presents with
midepigastric or back pain with progressive peritoneal signs 6-24 hrs post injury. Initial
treatment includes primary closure in the operating room, closed drainage system.
Objectives of surgical intervention are to control hemorrhage, debride devitalized tissue
and provide adequate drainage. Non-operative management demands close
observation for expanding or ruptured hematomas causing bleeding or peritoneal
contamination.
