TCRN EXAM REVIEW KEY WORDS TO KNOW BEFORE SITTING FOR THE
EXAM 2022 NEW UPDATE
Circumfrential burns - Full-thickness burns result in the formation of an eschar that is tough
and unyielding.
Can cause a burn compartment syndrome, and often requires escharotomy
Shock - Systemic reaction to insult that causes decreased oxygen delivery to the cells
4 Classifications of Shock - 1. Hypovolemic
2. Distributive
3. Cardiogenic
4. Obstruction
Hypovolemic Shock - Low blood volume results in altered perfusion (Ex: Hemorrhage, third
spacing)
Distributive Shock - Severe vasodilation with normal blood volume results in altered perfusion
(Ex: Sepsis, anaphylaxis, neurogenic)
Cardiogenic Shock - Altered cardiac function results in reduced perfusion (Ex: Blunt chest
injury, CHF)
Obstructive Shock - Blockage in the system causes altered perfusion (Ex: PE, high PEEP,
tension pneumothorax)
Alpha Receptors - Activated by sympathetic nervous system, causing:
Vasoconstriction
Glycogenolysis
Diaphoresis
Glycogenolysis - Breakdown of glucose stores in the liver to provide increased circulating
glucose, stimulated by Alpha receptors
Beta 1 Receptors - *Think: 1 heart
Cause increased heart rate and contractility
Beta 2 receptors - *Think: 2 lungs
Cause bronchodilation and increased respiratory rate
RAAS System - Increases resorption of sodium and water in the kidneys to increase vascular
volume, decreasing urine output
3 hr. Sepsis Bundle - Lactic level
Blood cultures before antibiotics
Broad spectrum antibiotics
,30 ml/kg fluid bolus for hypotension
6 hr. Sepsis Bundle - Repeat lactic
Start pressors if fluid bolus ineffective
Gain central access for pressors
Symptoms of Early Shock - Normotensive with NARROWING pulse pressure
Tachycardia
Weak and thready pulse
Tachypnea with DEEP respirations
Normal lactic
Cool and clammy
Anxiety, impending doom
Decreased urine output
Symptoms of Late Shock - Hypotension
Tachycardia
Tachypnea with shallow respirations
Elevated lactic
Cool, clammy, and mottled skin
Confusion, decreased LOC
SUPER decreased to no urine output
Stages of Shock - 1. Early (Compensatory)
2. Late (Decompensated)
3. Irreversible
Irreversible Shock Symptoms - MODS
Severe acidosis
Obtunded
Cardiac arrest
Trauma Triad of Death - Hypothermia
Acidosis
Coagulopathy
Symptoms of Hypothermia - Decreased cardiac output and HR (reduced perfusion)
Vasoconstriction
Depressed CNS
Bleeding due to decreased coagulation
Symptoms of acidosis - Decreased myocardial contractility
Prolonged PTT
Increased risk of dysrhythmias
SIRS
Explain the trauma triad of death - Hypothermia causes coagulopathies which worsen acidosis,
causing cardiac dysfunction and further worsening shock
,What blood product is administered for low fibrinogen levels? - Cryo
What blood product is used to address increased PT/PTT? - FFP
What blood product is used for thrombocytopenia? - Platelets
Where should tourniquets be placed in relation to the injury? - As close to the bleed as possible
to preserve as much limb as possible
Pneumoperitoneum - Air in the peritoneal cavity that is related to a ruptured hollow organ
Displays as abdominal distention
Cullen's sign -
Chance fractures - Lumbar spine fractures caused by hyperflexion over a seat belt
Indications for TXA - Indicated for SBP <90 or HR >110
Major hemorrhage (except in the head)
Indicated <3 hours from injury
Contraindications for TXA - Isolated brain bleeds
Known DVT/PE
Known clotting disorder
Transexamic Acid (TXA) - IV medication that inhibits the formation and binding of
plasmin/plasminogen to prevent degradation of clots
Dose of TXA - 1G in 100 cc in NS or LR given over 10 minutes
REBOA - Resuscitative endovascular balloon occlusion of the aorta
Provides balloon tamponade of the aorta to inhibit blood flow to the lower half of the body to
try and stop hemorrhage
Indications for REBOA - PEA arrest
Hypovolemia with SBP <70 mmHg related to bleeding below the diaphragm (Pelvic, severe
abdominal injuries, etc..)
**VERY invasive measure that should only be used for patients that would otherwise die of
hemorrhage extremely quickly
What is the current recommendation for initial fluid bolus in hypovolemic shock and why? -
500 ml, to maintain BP >90 systolic
Second 500 ml bolus can be administered if first is ineffective
, Because approximately 75% will third space after administration. More than 1L is not
recommended. Blood products are the preferred option.
What should be the ratio of blood product resuscitation in hemorrhagic shock? - 1:1:1
PRBC, FFP, Platelets
How much will 1 unit of PRBC increase the hemoglobin in a patient? - 1 unit= 1 g/dL
What is a "unit" of blood for a pediatric patient? - 10 ml/kg is considered a unit for kids
Pulse pressure - SBP-DBP
TIC (Trauma Induced Coagulopathy) - Coagulopathy cascade initiated by a traumatic insult
2 Stages:
1-Increased coagulopathy related to trauma triad of death, hypercoagulopathy
2- Excessive bleeding due to consumption of clotting factors, can result in DIC
Where are the primary access locations used for intraosseous cannulation? - Sternum, proximal
humerus, proximal tibia
Contraindications to an IO - Fracture, repeated attempts in same location
Average volume of one unit of blood - 250-300 ml
FFP (fresh frozen plasma) - Contains the majority of clotting factors
Frozen to preserve clotting factors that degrade quickly
AB is the universal donor
Cryoprecipitate - Plasma that has been spun a second time to further concentrate clotting
factors
What blood product does not require ABO testing? - Platelets
Permissive hypotension - Hypotension permitted in trauma patients to prevent the breakage of
new clots in high pressure
Better for penetrating trauma than blunt trauma
SBP 70-90 mmHg, MAP of 50
In what patient population is permissive hypotension contraindicated? - Head trauma
Normal CVP - 2-6 mmHg
Normal wedge pressure - 8-10 mmHg
EXAM 2022 NEW UPDATE
Circumfrential burns - Full-thickness burns result in the formation of an eschar that is tough
and unyielding.
Can cause a burn compartment syndrome, and often requires escharotomy
Shock - Systemic reaction to insult that causes decreased oxygen delivery to the cells
4 Classifications of Shock - 1. Hypovolemic
2. Distributive
3. Cardiogenic
4. Obstruction
Hypovolemic Shock - Low blood volume results in altered perfusion (Ex: Hemorrhage, third
spacing)
Distributive Shock - Severe vasodilation with normal blood volume results in altered perfusion
(Ex: Sepsis, anaphylaxis, neurogenic)
Cardiogenic Shock - Altered cardiac function results in reduced perfusion (Ex: Blunt chest
injury, CHF)
Obstructive Shock - Blockage in the system causes altered perfusion (Ex: PE, high PEEP,
tension pneumothorax)
Alpha Receptors - Activated by sympathetic nervous system, causing:
Vasoconstriction
Glycogenolysis
Diaphoresis
Glycogenolysis - Breakdown of glucose stores in the liver to provide increased circulating
glucose, stimulated by Alpha receptors
Beta 1 Receptors - *Think: 1 heart
Cause increased heart rate and contractility
Beta 2 receptors - *Think: 2 lungs
Cause bronchodilation and increased respiratory rate
RAAS System - Increases resorption of sodium and water in the kidneys to increase vascular
volume, decreasing urine output
3 hr. Sepsis Bundle - Lactic level
Blood cultures before antibiotics
Broad spectrum antibiotics
,30 ml/kg fluid bolus for hypotension
6 hr. Sepsis Bundle - Repeat lactic
Start pressors if fluid bolus ineffective
Gain central access for pressors
Symptoms of Early Shock - Normotensive with NARROWING pulse pressure
Tachycardia
Weak and thready pulse
Tachypnea with DEEP respirations
Normal lactic
Cool and clammy
Anxiety, impending doom
Decreased urine output
Symptoms of Late Shock - Hypotension
Tachycardia
Tachypnea with shallow respirations
Elevated lactic
Cool, clammy, and mottled skin
Confusion, decreased LOC
SUPER decreased to no urine output
Stages of Shock - 1. Early (Compensatory)
2. Late (Decompensated)
3. Irreversible
Irreversible Shock Symptoms - MODS
Severe acidosis
Obtunded
Cardiac arrest
Trauma Triad of Death - Hypothermia
Acidosis
Coagulopathy
Symptoms of Hypothermia - Decreased cardiac output and HR (reduced perfusion)
Vasoconstriction
Depressed CNS
Bleeding due to decreased coagulation
Symptoms of acidosis - Decreased myocardial contractility
Prolonged PTT
Increased risk of dysrhythmias
SIRS
Explain the trauma triad of death - Hypothermia causes coagulopathies which worsen acidosis,
causing cardiac dysfunction and further worsening shock
,What blood product is administered for low fibrinogen levels? - Cryo
What blood product is used to address increased PT/PTT? - FFP
What blood product is used for thrombocytopenia? - Platelets
Where should tourniquets be placed in relation to the injury? - As close to the bleed as possible
to preserve as much limb as possible
Pneumoperitoneum - Air in the peritoneal cavity that is related to a ruptured hollow organ
Displays as abdominal distention
Cullen's sign -
Chance fractures - Lumbar spine fractures caused by hyperflexion over a seat belt
Indications for TXA - Indicated for SBP <90 or HR >110
Major hemorrhage (except in the head)
Indicated <3 hours from injury
Contraindications for TXA - Isolated brain bleeds
Known DVT/PE
Known clotting disorder
Transexamic Acid (TXA) - IV medication that inhibits the formation and binding of
plasmin/plasminogen to prevent degradation of clots
Dose of TXA - 1G in 100 cc in NS or LR given over 10 minutes
REBOA - Resuscitative endovascular balloon occlusion of the aorta
Provides balloon tamponade of the aorta to inhibit blood flow to the lower half of the body to
try and stop hemorrhage
Indications for REBOA - PEA arrest
Hypovolemia with SBP <70 mmHg related to bleeding below the diaphragm (Pelvic, severe
abdominal injuries, etc..)
**VERY invasive measure that should only be used for patients that would otherwise die of
hemorrhage extremely quickly
What is the current recommendation for initial fluid bolus in hypovolemic shock and why? -
500 ml, to maintain BP >90 systolic
Second 500 ml bolus can be administered if first is ineffective
, Because approximately 75% will third space after administration. More than 1L is not
recommended. Blood products are the preferred option.
What should be the ratio of blood product resuscitation in hemorrhagic shock? - 1:1:1
PRBC, FFP, Platelets
How much will 1 unit of PRBC increase the hemoglobin in a patient? - 1 unit= 1 g/dL
What is a "unit" of blood for a pediatric patient? - 10 ml/kg is considered a unit for kids
Pulse pressure - SBP-DBP
TIC (Trauma Induced Coagulopathy) - Coagulopathy cascade initiated by a traumatic insult
2 Stages:
1-Increased coagulopathy related to trauma triad of death, hypercoagulopathy
2- Excessive bleeding due to consumption of clotting factors, can result in DIC
Where are the primary access locations used for intraosseous cannulation? - Sternum, proximal
humerus, proximal tibia
Contraindications to an IO - Fracture, repeated attempts in same location
Average volume of one unit of blood - 250-300 ml
FFP (fresh frozen plasma) - Contains the majority of clotting factors
Frozen to preserve clotting factors that degrade quickly
AB is the universal donor
Cryoprecipitate - Plasma that has been spun a second time to further concentrate clotting
factors
What blood product does not require ABO testing? - Platelets
Permissive hypotension - Hypotension permitted in trauma patients to prevent the breakage of
new clots in high pressure
Better for penetrating trauma than blunt trauma
SBP 70-90 mmHg, MAP of 50
In what patient population is permissive hypotension contraindicated? - Head trauma
Normal CVP - 2-6 mmHg
Normal wedge pressure - 8-10 mmHg
