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TNCC Exam Study Guide: Trauma Assessment and Management, Exams of Nursing

Tncc (trauma nurse core course) notes for the written exam, covering key aspects of trauma patient assessment and management. It includes initial assessment techniques for cranial and thoracic injuries, hypovolemic shock, and specific injury signs and symptoms. The notes detail inspection, palpation, auscultation, and diagnostic procedures, along with interventions for various conditions such as increased intracranial pressure (icp) and ineffective ventilation. This resource is designed to aid trauma nurses in preparing for certification and enhancing their clinical practice, focusing on rapid and effective trauma care strategies. It emphasizes the importance of recognizing critical signs and symptoms to guide appropriate interventions and improve patient outcomes in trauma settings. The document serves as a concise review of essential trauma nursing concepts, useful for both exam preparation and quick reference in clinical practice.

Typology: Exams

2024/2025

Available from 05/15/2025

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TNCC NOTES FOR WRITTEN EXAM LATEST 2024-2025 |TEST
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How would you assess a pt with a cranial injury? - ans(Initial assessment)
INSPECTION:
- Assess airway
- RR, pattern and effort
- Assess pupil size and response to light
- Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation
syndrome
- Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates
- Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome
- Widely dilated pupil occasionally occurs w/direct trauma to globe of eye
- Determine if pt uses eye meds
- Abnormal posturing?
- Inspect craniofacial area for ecchymosis/contusions
- Periorbital ecchymosis
- Mastoid's process ecchymosis
- Blood behind tympanic membrane
- Inspect nose and ears for drainage
- Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of
CSF
- If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring
forms around dark inner ring, drng contains CSF
- Assess extraocular eye movement (Tests cranial nerves, III, IV, VI)
- Performing extraocular eye movements indicates functioning brainstem
- Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle
- Determine LOC with GCS
PALPATION
- Palpate cranial area for:
- Point tenderness
- Depressions or deformities
- Hematomas
- Assess all 4 extremities for:
- Motor function, muscle strength and abnormal motor posturing
- Sensory function
DIAGNOSTIC PROCEDURES
- Lab Studies
PLANNING AND IMPLEMENTATION
- (Initial assessment)
- Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with
subsequent aspiration.
- Administer O2 via NRB
- Assist with early ET intubation
- Administer sedative/neuromuscular blocking agent
- Consider hyperventilation
- PaCO2 above 45
How would you assess a pt with a thoracic injury? - ans(Initial assessment)
Obtain Hx.
PHYSICAL:
Inspection:
- Observe chest wall
- Assess breathing effort and RR
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How would you assess a pt with a cranial injury? - ans(Initial assessment) INSPECTION:

  • Assess airway
  • RR, pattern and effort
  • Assess pupil size and response to light
  • Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome
  • Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates
  • Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome
  • Widely dilated pupil occasionally occurs w/direct trauma to globe of eye
  • Determine if pt uses eye meds
  • Abnormal posturing?
  • Inspect craniofacial area for ecchymosis/contusions
  • Periorbital ecchymosis
  • Mastoid's process ecchymosis
  • Blood behind tympanic membrane
  • Inspect nose and ears for drainage
  • Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF
  • If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF
  • Assess extraocular eye movement (Tests cranial nerves, III, IV, VI)
  • Performing extraocular eye movements indicates functioning brainstem
  • Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle
  • Determine LOC with GCS PALPATION
  • Palpate cranial area for:
  • Point tenderness
  • Depressions or deformities
  • Hematomas
  • Assess all 4 extremities for:
  • Motor function, muscle strength and abnormal motor posturing
  • Sensory function DIAGNOSTIC PROCEDURES
  • Lab Studies PLANNING AND IMPLEMENTATION
  • (Initial assessment)
  • Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration.
  • Administer O2 via NRB
  • Assist with early ET intubation
  • Administer sedative/neuromuscular blocking agent
  • Consider hyperventilation
  • PaCO2 above 45 How would you assess a pt with a thoracic injury? - ans(Initial assessment) Obtain Hx. PHYSICAL: Inspection:
  • Observe chest wall
  • Assess breathing effort and RR

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  • Symmetry
  • Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or pericardial tamponade. Flat = external jugular veins may reflect hypovolemia)
  • Inspect upper abdominal region for injury Percussion:
  • Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax) Palpation:
  • Palpate chest wall, clavicles and neck for:
  • Tenderness
  • Swelling or hematoma
  • Subcutaneous emphysema
  • Note presence of bony crepitus
  • Palpate central and peripheral pulses and compare quality between:
  • Right and left extremities
  • Upper and lower extremities
  • Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension pneumothorax or massive hemothorax)
  • Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate aortic injury). Auscultation:
  • Auscultate compare BP in both UE's and LE's
  • Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS = splinting. Shallow = b/c of pain).
  • Auscultate chest for presence of BS (diaphragmatic rupture)
  • Auscultate Heart sounds (muffled = pericardial tamponade)
  • Auscultate neck vessels for bruits (vascular injury) Diagnostic Procedures:
  • Xrays
  • Arteriography
  • Bronchoscopy and laryngoscopy
  • CT's
  • FAST
  • Labs (cardiac enzymes)
  • ECG, CVP How would you assess someone in hypovolemic shock? - ans(Use Initial Assessment) and then: Inspect:
  • LOC
  • Rate and quality of respirations
  • External bleeding?
  • Skin color and moisture
  • Assess jugular veins and peripheral veins Auscultate:
  • BP
  • Pulse pressure
  • Breath sounds
  • Heart sounds
  • Bowel sounds Percuss:
  • Chest and abdomen Palpate:
  • Central pulse (carotid or femoral)

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  • Increased age What are intracerebral hematoma's and its S/S? - ansOccur deep within brain tissue, may be single or multiple and commonly associated with contusions (frontal & temporal lobes). They result in significant mass effect, leading to increased ICP and neurologic deterioration. S/S:
  • Progressive and often rapid decline in LOC
  • H/A
  • Signs of increasing ICP
  • Pupil abnormalities
  • Contralateral hemiplegia What are neck injury S/S? - ans- Dyspnea
  • Hemoptysis (coughing up blood)
  • Subcutaneous emphysema in neck, face, or suprasternal area
  • Decreased or absent breath sounds
  • Penetrating wounds or impaled objects
  • Pulsatile or expanding hematoma
  • Loss of normal anatomic prominence of the laryngeal region
  • Bruits
  • Active external bleeding
  • Neurologic deficit, such as aphasia or hemiplegia
  • Cranial nerve deficits
  • Facial sensory or motor nerve deficits
  • Dysphonia (hoarseness)
  • Dysphagia (difficulty swallowing) What are S/S of a rib fracture? - ans- Dyspnea
  • Localized pain on movement, palpation, or inspiration
  • Pt assumes position intended to splint chest wall to reduce pain
  • Chest wall ecchymosis or sternal contusion
  • Bony crepitus or deformity What are S/S of a ruptured diaphragm? - ans(Anything below the nipple line and should be evaluated for potential diaphragmatic injury).
  • Dyspnea or orthopnea
  • Dysphagia
  • Abdominal pain
  • Sharp epigastric or chest pain radiating to left shoulder (Kehr's sign)
  • Bowel sounds heard in lower middle chest
  • Decreased breath sounds on injured side What are s/s of chemical burns to the eye? - ansChemical injuries require immediate intervention if it is to be preserved. S/S:
  • Pain
  • Corneal Opacification
  • Coexisting chemical burn and swelling of lids What are S/S of penetrating trauma/open or ruptured globe? - ans- Marked visual impairments
  • Extrusion of intraocular contents
  • Flattened or shallow anterior chamber

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  • Subconjunctival hemorrhage, hyphema
  • Decreased intraocular pressure
  • Restriction of extraocular movements What are S/S with blunt cardiac injury? - ans"Cardiac contusion" or "concussion." Common with MVC or falls from heights.
  • ECG (sinus tach, PVC's, AV blocks)
  • Chest pain
  • Chest wall ecchymosis What are S/S with tracheobronchial injury? - ansBlunt trauma. "Clothesline-type" injuries.
  • Dyspnea, tachypnea
  • Hoarseness
  • Hemoptysis
  • Subcutaneous emphysema in neck, face, or suprasternal area
  • Decreased or absent breath sounds
  • S/S of airway obstruction What are signs of a serious eye injury? - ans- Visual disturbances
  • Pain
  • Redness and ecchymosis of the eye
  • Periorbital ecchymosis
  • Increased intraocular pressure What are signs of ineffective breathing? - ans- 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. What are signs of ineffective circulation? - ans- Tachycardia
  • AMS
  • Uncontrolled external bleeding
  • Pale, cool, moist skin
  • Distended or abnormally flattened external jugular veins
  • Distant heart sounds What are the early signs and symptoms of increased ICP? - ans- Headache
  • N/V
  • Amnesia regarding events around the injury
  • Altered LOC
  • Restlessness, drowsiness, changes in speech, or loss of judgement What are the interventions for Disability? - ans- If assessment indicates a decreased LOC, conduct further investigation during secondary focused assessments
  • If pt is not alert or verbal, continue to monitor for any compromise to ABC's
  • If pt demonstrates signs of herniation or neurologic deterioration, consider hyperventilation.

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  • Stabilize impaled objects
  • Admin analgesic meds What are the nursing interventions for a pt with an ocular injury? - ans- Assess visual acuity & reassess
  • Elevate HOB to minimize intraocular pressure
  • Instruct pt not to bend forward, cough or perform Valsalva maneuver b/c these actions may raise intraocular pressure
  • Assist w/removal of foreign bodies as indicated; stabilize impaled objects
  • Apply cool packs to decrease pain + periorbital swelling
  • Admin medications
  • Instill prescribed topical anesthetic drops for pain
  • Instill NS drops or artificial tears to keep corneas moist. Cover eyelids w/sterile, moist saline dsg to prevent drying and ulceration
  • Antibiotics topically or systemically
  • Admin tetanus prophylactically
  • Use an eye patch to affected eye
  • Patch or shield both eyes to reduce movement + photophobia in pt's w/retinal injuries
  • Patch, shield or cover w/cool pack
  • Do NOT patch injured eye of pt w/suspected open or ruptured globe or impaled object, patch unaffected eye. Use metal or plastic and do not put pressure on the globe.
  • Provide psychosocial support
  • Obtain an ophthalmology consultation
  • Provide d/c instructions:
  • Importance of protective eyewear
  • No driving w/eye patch on
  • Wear sunglasses to prevent tearing, aid photophobia
  • Prepare for admission, OR or transfer What are the Rapid Sequence Intubation Steps? - ansPREPARATION:
  • gather equipment, staffing, etc. PREOXYGENATION:
  • Use 100% O2 (prevent risk of aspiration). 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 30-60 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 are the S/S of a basilar skull fx? - ans- H/A
  • Altered LOC

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  • Periorbital ecchymosis (raccoon eyes), mastoid ecchymosis (Battle's sign), or blood behind tympanic membrane (hemotympanum)
  • Facial nerve (VII) palsy
  • CSF rhinorrhea or otorrhea What are the S/S of a depressed skull fx? - ans- H/A
  • Possible decreased LOC
  • Possible open fx
  • Palpable depression of skull over the fx site What are the S/S of a linear skull fx? - ans- H/A
  • Possible decreased LOC What are the S/S of a pneumothorax? - ans- Dyspnea, tachypnea
  • Tachycardia
  • Hyerresonance (increased echo produced by percussion over the lung field) on the injured side
  • Decreased or absent breath sounds on the injured side
  • Chest pain
  • Open, sucking wound on inspiration (open pneumothorax) What are the S/S of a tension pneumothorax? - ans- Severe respiratory distress
  • Markedly diminished or absent breath sounds on affected side
  • hypotension
  • Distended neck, head and upper extremity veins-may not be clinically appreciated if significant blood loss present
  • Tracheal deviation - shift toward uninjured side (LATE sign)
  • Cyanosis (LATE sign) What are the S/S of flail chest? - ans- Dyspnea
  • Chest wall pain
  • Paradoxical chest wall movement - the flail segment moves in during inspiration and out during expiration. What are the S/S of Hemothorax? - ans- Dyspnea, tachypnea
  • Chest pain
  • Signs of shock
  • Decreased breath sounds on injured side
  • Dullness to percussion on the injured side What are the S/S of orbital fracture (orbital blowout fracture)? - ans- Diplopia (double vision)
  • Loss of vision
  • Altered extraocular eye movements
  • Enophthalmos (displacement of the eye backward into the socket)
  • Subconjunctival hemorrhage or ecchymosis of the eyelid
  • Infraorbital pain or loss of sensation
  • Orbital bony deformity What are the S/S of pericardial tamponade? - ansA collection of blood in pericardial sac. As blood accumulates, it exerts pressure on the heart, inhibiting or compromising ventricular filling.
  • Hyotension
  • Tachycardia or PEA
  • Dyspnea

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What happens to a ruptured diaphragm? - ansPotentially life-threatening, results from forces that penetrate the body. Left hemidiaphragm is more susceptible to injury because the right side is protected by the liver.

  • Herniation of abdominal contents
  • Respiratory compromise b/c impaired lung capacity + displacement of normal tissue.
  • Mediastinal structures may shift to opposite side of injury What intervention should be done if a pt presents with effective circulation? - ans- Insert 2 large caliber IV's
  • Administer warmed isotonic crystalloid solution at an appropriate rate What is a cerebral contusion and its S/S? - ansA common focal brain injury in which brain tissue is bruised and damaged in a local area. Mainly located in frontal and temporal lobes. May cause hemorrhage, infarction, necrosis and edema. Max effects of bleeding & edema peak 18-36 post injury. S/S:
  • Alteration in LOC
  • Behavior, motor or speech deficits
  • Abnormal motor posturing
  • Signs of increased ICP What is a Combitube? - ansA 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 concussion and its signs and symptoms? - ansA temporary change in neurologic function that may occur as a result of minor head trauma. S/S:
  • Transient LOC
  • H/A
  • Confusion and disorientation
  • Dizziness
  • N/V
  • Loss of memory
  • Difficulty with concentration
  • Irritability
  • Fatigue What is a flail chest? - ansA fracture of two or more sites on two or more adjacent ribs, or when rib fractures produce a free-floating sternum. Flail segments may not be clinically evident in the first several hours after injury b/c of muscle spasms that cause splinting. After positive pressure intiated, paradoxical chest wall movement ceases. What is a Laryngeal Mask Airway? - ansLooks 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 a pulmonary contusion? - ansThey occur as a result of direct impact, deceleration or high-velocity bullet wounds. It develops when blood leaks into lung parenchyma, causing edema + hemorrhage. This usually develops overtime and not immediately.

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What is a subdural hematoma and its S/S? - ansA focal brain injury beneath the dura mater that results from acceleration/deceleration. Usually venous, and not necessarily from a fx. Formation may be acute or chronic. Acute pt's hematoma manifest 48 hrs post injury S/S:

  • Altered LOC or steady decline in LOC
  • S/S of increased ICP
  • Hemiparesis or hemiplegia on opposite side of hematoma
  • Unilateral fixed and dilated pupil on same side of hematoma Chronic pt's " " up to 2 wks post injury
  • H/A
  • Progressive decrease in LOC
  • Ataxia
  • Incontinence
  • Sz's What is an epidural hematoma and its S/S? - ansResults when a collection of blood forms between the skull and the dura mater. Bleeding is arterial=blood accumulates rapidly:
  • Compression of underlying brain
  • rapid increase in ICP
  • Decreased CBF
  • Secondary brain injury
  • Usually requires surgical intervention S/S:
  • Transient LOC
  • Lucid period lasting a few minutes to several hours
  • Rapid deterioration in neurologic status
  • Severe H/A
  • Sleepiness
  • Dizziness
  • N/V
  • Hemiparesis or hemiplegia on opposite side of hematoma
  • Unilateral fixed and dilated pupil on same side of hematoma What is assessed and intervened for Expose/Environmental Controls? - ans- Remove clothing
  • Ensure appropriate decontamination if exposed to hazardous material
  • Keep pt warm
  • Keep clothing for evidence What is assessed under the Mnemonic "H"? - ansHISTORY / HEAD-TO-TOE ASSESSMENT
  • MIVT
  • M = Mechanism of injury
  • I = Injuries sustained
  • V = Vital Signs
  • T = Treatment
  • Pt generated information
  • PMH
  • Head-to-toe assessment What is assessed under the Mnemonic "I"? - ansINSPECT POSTERIOR SURFACES

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  • CSF rhinorrhea What is LeFort III fracture and its S/S? - ansComplete craniofacial separation involving maxilla, zygoma and bones of cranial base. This fx is frequently associated w/leakage of CSF and fx mandible. S/S:
  • Massive facial edema
  • Mobility and depression of zygomatic bones
  • Ecchymosis
  • Anesthesia of the cheek
  • Diplopia
  • Open bite or malocclusion
  • CSF rhinorrhea What is Needle Cricothyrotomy - ansPercutaneous transtracheal ventilation. (temporary) Complications include:
  • inadequate ventilation causing hypoxia
  • hematoma formation
  • esophageal perforation
  • aspiration
  • thyroid perforation
  • subcutaneous emphysema What is Newton's First Law? - ansA body at rest will remain at rest. A body in motion will remain in motion until acted on by an outside force. What is Newton's Second Law? - ansForce equals mass multiplied by acceleration of deceleration. What is renal response? - ansRenal 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. What is Surgical Cricothyrotomy? - ansMaking 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

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  • Lac to trachea or esophagus
  • Creation of a false passage
  • Laryngeal stenosis What is the DOPE mnemonic? - ansD - Displaced tube O - Obstruction: Check secretions or pt biting tube P - Pneumothorax: Condition may occur from original trauma or barotrauma from ventilator E - Equipment failure: pt may have become detached from equipment or there's a kink in the tubing What is the first thing assessed under the Secondary Assessment? - ansFULL SET VS / FOCUSED ADJUNCTS / FAMILY PRESENCE
  • ABCDE should be completed
  • Labs, X-rays, CT, Foley,
  • Family Presence What is the Law of Conservation of Energy? - ansEnergy can neither be created nor destroyed. It is only changed from one form to another. What is the Mnemonic for the Initial Assessment? - ansA = Airway with simultaneous cervical spine protection B = Breathing C = Circulation D = Disability (neurologic status) E = Expose/Environmental controls (remove clothing and keep the patient warm) What is the Mnemonic for the Secondary Assessment? - ansF = Full set of VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric tube)/Family presence G = Give comfort measures (verbal reassurance, touch, and pharmacologic and nonpharmacologic management of pain). H = Hx and Head-to-toe assessment I = Inspect posterior surfaces What is the planning and implementation for thoracic injury? - ansp. 142 What is the second thing assessed under the Secondary Assessment? - ansGIVE COMFORT MEASURES
  • Talking to pt
  • Pharmacologic/Nonpharmacologic pain management
  • Observe for physical signs of pain What is vascular response? - ansAs 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 medications are used during intubation? - ansLOAD Mnemonic: L = Lidocaine O = Opioids A = Atropine D = Defasiculating agents What she be done after the Secondary Assessment? - ansReassess:
  • Primary survey,

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CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Explain adrenal gland response. - ansWhen 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. Explain Cardiogenic Shock. - ansSyndrome that results from ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes:

  • MI
  • Blunt cardiac injury
  • Mitral valve insufficiency
  • dysrhythmias
  • Cardiac Failure Explain Distributive Shock. - ansResults 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. Explain Hepatic Response. - ansLiver can store excess glucose as glycogen. As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hypovolemic Shock. - ansMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes:
  • Blood loss
  • Burns, etc.

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Explain Irreversible Shock. - ansShock uncompensated or irreversible stages will cause compromises to most body systems.

  • Inadequate venous return
  • inadequate cardiac filling
  • decreased coronary artery perfusion
  • Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Obstructive Shock. - ansResults 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 Pulmonary Response. - ansTachypnea happens for 2 reasons:
  1. Maintain acid-base balance
  2. Maintain increased supply of oxygen
  • Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli. How do you assess Mnemonic "D"? - ansDISABILITY A = Alert V = Verbal P = Pain U = Unresponsive
  • GCS
  • PERRL?
  • Determine presence of lateralizing signs including:
  • Unilateral deterioration in motor movements or unequal pupils
  • Symptoms that help to locate area of injury in brain How do you confirm ET Tube/Alternative Airway Placement? - ans- 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? - ansObserve:
  • mental status
  • RR and pattern
  • chest wall symmetry
  • any injuries
  • patient's skin color (cyanosis?)