1|Page
TCAR Exam Review –Real Post-Test Bank Questions with
Verified A+ Answers (Emergency/Critical Care Nursing)
Trauma Care After Resuscitation
important thing to remember about retained projectiles
they 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
sternum
what attaches the ribs to the sternum
cartliage
what breaks thoracic bones
significant 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
ribs 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
unusual 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
to injure c-spine, you don't need a big energy blow. all it takes is shaking around.
c spine versus t spine fractures
,2|Page
c-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
largely supportive nursing care like pulmonary toilet
CXR and rib fractures
simple 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
once healed, rib fractures form bony callouses and become more visible on CXR
how to tell a pt has a pneumonia from a CXR
dark spot that is not equal to the opposite side
consider if a pt has a lower rib fracture
liver & spleen injury
acts like BBQ/marshmellow skewers
how high does the diaphragm rise on inspiration
level of 4th ICS
risk of rib fractures
can puncture liver, spleen,, diaphragm
pop lungs
+2 adjacent rib fractures
flail chest
free floating sternum
flail chest
definition of flail chest
+2 adjacent rib fracture
free floating sternum
why is flail chest a problem
b/c breathing is a mechanical process
,3|Page
paradoxical chest movements
in flail chest
s/s of flail chest
paradoxical chest wall movement
where on the tissue oxygenation cascade is thoracic cage fractures a problem
ventilation
parameters to assess ventilation
ETCO2, PaCO2, clinical assessment
what are considered "great vessels"
thorax
what type of injuries occur when the lungs are subjected to force?
bruise = contusion
tear = lacerations
pop = punctures
inhalation injury
bruise on the lungs
pulmonary contusion
causes of pulmonary contusions
high speed blunt or penetrating injury
what happens to the lungs in pulmonary contusions
big 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
diffusion
all contusions over time
all 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
, 4|Page
70% of pulmonary contusions aren't initial on the initial CXR
what should you monitor when a pt has trauma to the throax
closely 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
anticipate "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
CXR 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
pulmonary laceration
3 questions to ask in trauma
-what was the dose of energy?
-where did it go?
-what injuries are likely?
2 q's to ask in GSW
caliber
type of gun
# of entrance/exit wounds
high/low velocity
1st question to ask in any traumatic injury?
what was the dose of energy involved?
(was it high or low?)
what is the caliber of a bullet?
diameter
aka diameter of a bullet
TCAR Exam Review –Real Post-Test Bank Questions with
Verified A+ Answers (Emergency/Critical Care Nursing)
Trauma Care After Resuscitation
important thing to remember about retained projectiles
they 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
sternum
what attaches the ribs to the sternum
cartliage
what breaks thoracic bones
significant 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
ribs 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
unusual 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
to injure c-spine, you don't need a big energy blow. all it takes is shaking around.
c spine versus t spine fractures
,2|Page
c-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
largely supportive nursing care like pulmonary toilet
CXR and rib fractures
simple 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
once healed, rib fractures form bony callouses and become more visible on CXR
how to tell a pt has a pneumonia from a CXR
dark spot that is not equal to the opposite side
consider if a pt has a lower rib fracture
liver & spleen injury
acts like BBQ/marshmellow skewers
how high does the diaphragm rise on inspiration
level of 4th ICS
risk of rib fractures
can puncture liver, spleen,, diaphragm
pop lungs
+2 adjacent rib fractures
flail chest
free floating sternum
flail chest
definition of flail chest
+2 adjacent rib fracture
free floating sternum
why is flail chest a problem
b/c breathing is a mechanical process
,3|Page
paradoxical chest movements
in flail chest
s/s of flail chest
paradoxical chest wall movement
where on the tissue oxygenation cascade is thoracic cage fractures a problem
ventilation
parameters to assess ventilation
ETCO2, PaCO2, clinical assessment
what are considered "great vessels"
thorax
what type of injuries occur when the lungs are subjected to force?
bruise = contusion
tear = lacerations
pop = punctures
inhalation injury
bruise on the lungs
pulmonary contusion
causes of pulmonary contusions
high speed blunt or penetrating injury
what happens to the lungs in pulmonary contusions
big 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
diffusion
all contusions over time
all 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
, 4|Page
70% of pulmonary contusions aren't initial on the initial CXR
what should you monitor when a pt has trauma to the throax
closely 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
anticipate "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
CXR 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
pulmonary laceration
3 questions to ask in trauma
-what was the dose of energy?
-where did it go?
-what injuries are likely?
2 q's to ask in GSW
caliber
type of gun
# of entrance/exit wounds
high/low velocity
1st question to ask in any traumatic injury?
what was the dose of energy involved?
(was it high or low?)
what is the caliber of a bullet?
diameter
aka diameter of a bullet
