TCRN Top Exam Questions and answers, 100% Accurate, graded A+

TCRN Top Exam Questions and answers, 100% Accurate, graded A+ Kehr's sign - -Referred left shoulder pain, usually indicates a splenic injury Base deficit - -Base deficit more than -6 indicates the need for agressive resuscitation and determination of the etiology CXR - -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 - -Should be suspected if after chest tube placement a significant air leak is present Diagnostic Peritoneal Lavage - -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. Has replaced DPL when available. Positive FAST scan - -Hemodynamically unstable trauma patient with a positive fast are taken directly to the OR for laparotomy Ultrasound abd exam - -Not useful to detect injuries to the diaphragm, intestine and pancreas. In patients with obesity, ascites and/or subQ emphysema the accuracy is reduced. CT scan - -Hemodynamically stable patients may be taken to CT Angiography - -Embolization is useful in treating patient with unstable pelvic fractures, liver and splenic hemorrhage. Use of hybrid OR suites to allow for surgical and interventional radiology methods of treatment simultaneously. Diagnostic laparoscopy - -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 - -Usually resultant of penetrating throacoabdominal injuries on the left side, including 11-12 rib fractures on the left. Small intestine injuries - -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 with 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 Treatment of small intestine injury - -Control bleeding prior to exploration. Debridement and closure and ligation of bleeders. Resection for multiple defects. Observe for wound infection/abscess development Cause of duodenum injuries - -Penetrating trauma most frequent cause. Usually conconcurrent mult-organ injuries. Usually found intraoperatively, commonly missed during exlap. Blunt force injury cause by vetebral compression. Duodenal injury treatment - -Identification with CT scan. Commonly patients have midepigastric or back pain with evolving peritoneal signs 6-24 hrs after injury. Primary closure in OR, closed drainage system. Goals are to control hemorrhage, debride devitalized tissue and provide drainage. Non operative management requires close observation for expanding or ruptured hematomas causing bleeding or peritoneal contamination. Jejunum and ileum injuries - -Jejunum lies in umbilical region, ileum lies in the hypogastric/pelvice regions. Lap belt can cause bowel to be crushed between the vertebrae and a solid object. Incorrect wearing of seatbelt increases chance for injury