TNCC Trauma Nursing Core Course 7th Edition ENA. Questions and answers. Rated A+.

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Components of SBAR and its purpose - ✔✔S: Situation B: Background A: Assessment R: Recommendation Purpose- to provide framework for communication amount members of the healthcare team p. 7 ... Components of DESC and its purpose - ✔✔D: Describe the specific situation or behavior E: Express your concerns or how the situation makes you feel S: Suggest alternatives and seek agreement C: State consequences in terms of impact on performance goals Purpose- used in conflict management; paraphrasing the other person's comments is an important technique that should be done throughout the DESC script. Following discussion of consequences, team members should work towards consensus. p. 7 Components of CUS and its purpose - ✔✔C: I am Concerned U: I am Uncomfortable S: This is a Safety issue/ I am Stressed Purpose- used to "stop the line" if a team member senses or discovers an essential safety breach p. 7 Define trauma - ✔✔- Trauma is injury to living tissue caused by extrinsic agent - Regardless of MOI, trauma creates stressors that exceed the tissue's or organ's ability to compensate p. 9 Leading cause of death for ages 1. over 65 2. 5 to 24 3. 25 to 64 - ✔✔1. Falls 2. MVCs 3. poisoning p. 9 Explain 3 phases of injury prevention - ✔✔Primary: prevention of the occurrence of the injury Secondary: Reduction in the severity of the injury that has occurred Tertiary: Improvement of outcomes related to the traumatic injury p. 10 Describe the three E's of injury control - ✔✔Engineering: technological interventions such as side impact airbags, automated blind spot alarms, ignition lock devices for those with DUIs. In playgrounds and sports, this involves surface material under playground equipment and athletic safety gear. Another intervention is improved use of smoke alarms in fire prevention Enforcement and legislation: include laws at all jurisdictional levels regarding driving while intoxicated, booster seats, primary seatbelt use, and distracted driving. For sports this includes rules regarding illegal hits, examination after impact, and return-to-play requirements after a head injury Education: these can be community-based initiatives such as public service announcements for improved seatbelt use, education regarding risks of distracted driving, programs to commit to no texting while driving, and promotions for bicycle helmet giveaways with instructions for proper use p. 11 How can the trauma nurse have an impact when it comes to the legislative process? - ✔✔By advocating for stronger laws and more consistent enforcement p. 11 Define kinematics - ✔✔The study of energy transfer as it applies to identifying actual or intentional injuries p. 25 Define biomechanics - ✔✔The general study of forces and their effects p. 25 Define mechanism of injury (MOI) - ✔✔How external energy forces in the environment are transferred to the body p. 25 Newton's First Law of Motion - ✔✔A body at rest will remain at rest, and a body in motion will stay in motion p. 26 Newton's Second Law of Motion - ✔✔Force = Mass X Acceleration p. 26 Newton's Third Law of Motion - ✔✔For every action, there is an equal and opposite reaction p. 26 Law of Conservation of Energy - ✔✔Energy can neither be created nor destroyed, but it can change form p. 26 Describe energy forms - ✔✔- Mechanical (energy transfer from one object to another in the form of motion) - Thermal (energy transfer of heat in environment to the host) - Chemical (heat energy transfer from active chemical substances such as chlorine, drain cleaner, acids, or plants) - Electrical (energy transfer from light socket, power lines, or lightning) - Radiant (energy transfer from blast sound waves, radioactivity such as a nuclear facility, or rays of the sun) p. 26 External energy forces can be exerted on the body by the following forces - ✔✔- Deceleration forces: include those applied in falls and collisions where injuries are caused by sudden stop of the body's motion - Acceleration forces: not as common as deceleration forces and result from a sudden and rapid onset of motion (parked car being hit by a vehicle traveling at a high rate of speed) - Compression force is an external force applied at times of impact, explains include: + Stationary objects such as dashboards or steering wheels, that collide with or push up into a person + Objects in motion such as bullets and stabbing instruments, bats and balls, fists and feet, or heavy falling objects + Blast forces p. 27 The degree to which tissues resist destruction under circumstances of energy transfer depends on... - ✔✔Their proximity to the impact and their structural characteristics p. 27 Structural strengths of tissue are described in what three ways? - ✔✔-Compression -Tensile -Shear p. 27 Compression strength refers to the tissue's ability to: - ✔✔Resist crush force - Compression injuries to organs occur when the organs are crushed from surrounding internal organs or structures such as a seatbelt worn up across the abdomen causing compression of the small bowel or a fracture to the lumbar spine p. 27 Tensile strength describes the tissue's ability to: - ✔✔Resist pulling apart when stretched - Tendons, ligaments, and muscles can tear when they are overstretched (Achilles tendon) p. 27 Shear strength describes the tissue's ability to: - ✔✔Resist a force applied parallel to the tissue - Coup/contrecoup injury, such as a boxer being hit in the head, is an example of this p. 27 Types of injuries include - ✔✔- Blunt trauma - Penetrating trauma - Thermal trauma - Blast trauma p. 28 Lateral impacts (T-bone) are associated with - ✔✔Shear injuries to aorta and other organs, fracture of the side clavicle, lateral pelvic and abdominal injuries, and lateral head and neck injury p. 30 Depending on the motorcycle design and rider positioning, the lower extremities can collide with the handlebars, resulting in... - ✔✔Femur and pelvis fractures and hip dislocations p. 31 Cavitation refers to the... - ✔✔Separation of surrounding tissue resulting from a sound and/or hydraulic wave force. This rapid motion can lead to crushing, tearing, and shearing forces on tissue. The impact of cavitation is dependent on the characterists of the affected tissue. Additional considerations include: - Air-filled organs such as lungs or stomach, are elastic, so this tissue tolerates high-velocity cavitation relatively well compared to other tissues - Solid organs such as the liver, have a greater propensity to shear or tear under the same forces - If those same forces are instead released inside the cranium, bone will resist expansion, augmenting soft tissue crushing, until the tensile strength of the bone is exceeded and an explosive release of pressure results ch. 4, p. 32 The U.S. Department of Defense classifies blast injuries in five levels: - ✔✔- Primary blast injuries: found in those closest to the detonation, with enclosed space detonation resulting in the most lethal impacts. Air-filled organs (tympanic membranes, lungs, stomach, and bowel) are most susceptible to rupture with primary blast injuries. - Secondary injuries: include fragment injuries and generally cause the greatest volume of casualties. They include injuries such as puncture wounds, lacerations, and impaled objects. - Tertiary injuries: include impacts with larger objects propelled by the blast wind resulting in blunt trauma. These cause high energy transfer and can result in pelvic or femur fractures or major thoracic injuries such as aortic and great vessel rupture. - Quaternary injuries: result of heat, flame, gas, and smoke. These injuries include external burns and internal burns from inhaled hot gases. - Quinary injuries are those associated with exposure to hazardous materials from radioactive, biologic, or chemical components of a blast. ch. 4, p. 33 Compression may occur from the effects of chemical substances and can cause.. - ✔✔Edema, restricting or obstructing the airways, oxygenation, and ventilation. This can result from aspiration of liquids or inhalation of powder or noxious gas. ch. 4, p. 33-34 The Haddon Matrix broadened the approach and placed emphasis on countermeasures, such were more effective than changing human behavior. Haddon describes three phases of the injury event: - ✔✔Pre-event, Event, Post-event For each phase of the event, countermeasures for prevention can be applied. They include: The host (human) The agent (motor vehicle) The physical environment (socioeconomic environment) ch. 4, p. 34 Initial assessment - approach to trauma patient care that requires a process to identify and treat or stabilize life-threatening injuries in an efficient and timely manner. It is divided into the following process points: - ✔✔- Preparation and triage - Primary survey (ABCDE) with resuscitation adjuncts (FG) - Reevaluation (consideration of transfer) - Secondary survey (HI) with reevaluation adjuncts - Reevaluation and post resuscitation care - Definitive care of transfer to an appropriate trauma center ch. 5, p. 39 The A-I mnemonic helps the trauma nurse rapidly assess for and intervene in life-threatening injuries and identify all injuries in a systematic manner. - ✔✔A: airway and alertness with simultaneous cervical spinal stabilization B: breathing and ventilation C: circulation and control of hemorrhage D: disability (neurological status) E: exposure and environmental control F: full set of vital signs and family presence G: get resuscitation adjuncts: L - lab studies (ABGs) and obtain specimen for blood type and cross match M - monitor for continuous cardiac rhythm and rate assessment N - naso or orogastric tube consideration O - oxygenation and ventilation analysis: pulse oximetry and end-tidal carbon dioxide (ETCO2) monitoring and capnography P - pain assessment and management H: history and head-to-toe assessment I: inspect posterior surfaces ch. 5, p. 39 When does the approach to trauma care typically begin? - ✔✔With notification that a trauma patient is arriving to ED ch. 5, p. 39 What does 'safe practice' mean? - ✔✔Means taking into consideration the protection of the team, including: - observing universal precautions - donning PPE (gown, gloves, mask) prior to patient's arrival ch. 5, p. 39 What does 'safe care' mean? - ✔✔Means assuring the patient is getting to the right hospital in the right amount of time for the right care. American College of Surgeons Committee on Trauma (ACS-COT) developed trauma triage criteria that serves at the international standard to identify the trauma patient who would benefit from resuscitation and care at the right trauma facility with the appropriate resources. ch. 5, p. 40 During primary survey... - ✔✔Life-threatening conditions are identified and immediately corrected, beginning immediately upon the patient's arrival to the trauma room. ch. 5, p. 40 What is the most major cause of preventable death after injury? - ✔✔Uncontrolled hemorrhage ch. 5, p. 40 Explain the MARCH mnemonic - ✔✔M: MASSIVE HEMORRHAGE A: AIRWAY R: RESPIRATION - decompress suspected pneumo, seal open chest wounds, support ventilation and oxygenation as required C: CIRCULATION - vascular access and admin fluids H: HEAD INJURY/HYPOTHERMIA - prevent or treat hypotension and hypoxia to prevent worsening of traumatic brain injury and prevent or treat hypothermia ch. 5, p. 41-42 While in ED, alignment and protection of the cervical spine can be accomplished by which 2 ways? - ✔✔- Manual stabilization - Immobilization ch. 5, p. 42 Explain the AVPU mnemonic - ✔✔Used to quickly assess patient's level of alertness A- ALERT (If any of the responses below are elicited at this point, the airway may be compromised) V- responds to VERBAL stimuli, airway adjunct may be needed to keep tongue from obstructing airway P - responds to PAIN. U- UNRESPONSIVE. If patient is unresponsive, announce loudly to the team and direct someone to check if the patient has a pulse while assessing if the cause of the problem is the airway. Consider reprioritizing the assessment priority to <C>ABC ch. 5, p. 42 Use the jaw-thrust maneuver to open airway and assess for obstruction when the patient is... - ✔✔Unable to open the mouth, responds only to pain, or is unresponsive. ch. 5, p. 42 Once patient has airway in place, assess for proper placement by... - ✔✔- Presence of adequate rise and fall of the chest with assisted ventilation - Absence of gurgling on auscultation over epigastrium - Bilateral breath sounds present on auscultation - CO2 detector device color change ch. 5, p. 43 If patient's airway is NOT patent: - ✔✔1. Suction airway - Avoid stimulating gag reflex - Use rigid suction device if obstructed by blood, vomitus, or secretions - Remove any foreign bodies carefully with forceps 2. If suctioning does not relieve airway obstruction, tongue may be cause. Insert airway adjunct. - Use jaw-thrust maneuver to open airway while maintaining manual stabilization - A nasopharyngeal airway can be used in patients who are conscious or unconscious - An oropharyngeal airway can be used in patients without gag reflex 3. Consider a definitive airway (ET tube securely placed in trachea with cuff inflated) - The following conditions or situations require a definitively secured airway --apnea -- GCS score < 8 -- severe maxillofacial fractures -- evidence of inhalation injury/facial burns -- laryngeal or tracheal injury or neck hematoma -- high risk of aspiration and patient's inability to protect airway -- compromised or ineffective ventilation -- anticipated of deterioration of neurological status ch. 5, p. 43 What are the late signs that may indicate a tension pneumothorax? - ✔✔JVD and tracheal deviation ch. 5, p. 43 If breathing is absent: - ✔✔- Open airway using jaw-thrust maneuver while maintaining manual cervical spinal stabilization - Insert and oral airway adjunct - Assist ventilations with bag-mask device - Prepare for definitive airway ch. 5, p. 44 If breathing is present: - ✔✔1. Administer O2 at 15L/min via nonrebreather mask -- inability to maintain adequate oxygenation, causes hypoxemia resulting in anaerobic metabolism and acidosis -- Titrate oxygen delivery for stabilized trauma patients to avoid the detrimental physiologic effects of hyperoxia 2. Determine if ventilation is effective -- ETCO2 (end-tidal carbon dioxide) measurement between 35-45 shows effective ventilation. Level above 50 signifies depressed ventilation -- SpO2 of 94% of higher is associated with effective ventilation ch. 5, p. 44 The major assessment parameters that produce important information within seconds of a patient's arrival are... - ✔✔1. Level of consciousness 2. Skin color 3. Pulse ch. 5, p. 44 The assessment of circulation during the primary survey includes... - ✔✔Early evaluation of the possibility of hemorrhage in the abdomen and pelvis in any patient who has sustained blunt trauma. In those cases, an emergent abdominal or pelvic assessment may be preformed to include a focused assessment with sonography for trauma (FAST) examination or a radiograph of the pelvis. ch. 5, p. 44 A rapid, thready pulse may indicate (a. _______), and an irregular pulse may warn of potential (b. _______). - ✔✔a. HYPOVOLEMIA b. CARDIAC DYSFUNCTION ch. 5, p. 45 The standard approach to treating hypotension in trauma patients has been to infuse large volumes of IV fluids. Recent studies now recommend a different approach and note that an elevated BP may dislodge the body's formation of clots and promote further bleeding. In addition, large volumes of fluid lead to... - ✔✔Dilutional coagulopathy which worsens metabolic acidosis and may cause hypothermia [Show More]

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