TNS Review - the radial pulse is present but very weak. The ...

TNS Review

A patient presents with circumferential burns to his forearm. His fingers are dusky and

the radial pulse is present but very weak. The TNS should anticipate:

• Escharotomy through SQ tissue to reestablish tissue perfusion
• Fasciotomy to relieve Volman's contracture
• Arteriogram to define the degree of circulation compromise
• Silvadene ointment and an occlusive, transparent dressing to limit infection -

ANSWER-a. Escharotomy through SQ tissue to reestablish tissue perfusion

In a burn patient, what is the most important indicator for adequate fluid resuscitation?

• CVP
• Hematocrit
• Hourly urine output
• Hourly vital signs - ANSWER-c. Hourly urine output

A 23 y/o traumatic burn patient has developed peripheral edema. What could the TNS attribute this shift of fluid to the interstitial space?

• Congestive heart failure
• Increased permeability of capillaries
• Lymphatic obstruction
• Cor Pulmonale - ANSWER-b. Increased permeability of capillaries

Write out Parkland formula - ANSWER-2-4 ml x Wt in Kg x %TBSA (1/2 over first 8 hours, 1/2 over next 16 hours)

Dry charred areas of thermal burn are characterized as:

• Superficial
• Partial thickness
• Full thickness
• Electrical - ANSWER-c. Full thickness

Dry charred areas of thermal burn are characterized as:

• Superficial
• Partial thickness
• Full thickness
• Electrical - ANSWER-c. Full thickness

In Jackson's thermal wound theory which zone is it with the central area with the most intense heat contact and the most damage?

• Zone of Coagulation 1 / 4

• Zone of Stasis
• Zone of Hyperemia - ANSWER-a. Zone of Coagulation

In Jackson's thermal wound theory which zone is it that extends peripherally from the zone of coagulation is an inflamed area where blood flow decreases?

• Zone of Coagulation
• Zone of Stasis
• Zone of Hyperemia - ANSWER-b. Zone of Stasis

In Jackson's thermal wound theory which zone is it that is the burn perimeter?

• Zone of Coagulation
• Zone of Stasis
• Zone of Hyperemia - ANSWER-c. Zone of Hyperemia

Type of burn that is epidermis only, characterized by blanchable redness, warm (may be moist), local pain (nerve endings exposed to air), heals spontaneously. Example: sunburn

• Superficial
• Partial Thickness
• Full thickness
• Fourth degree - ANSWER-a. Superficial

Type of burn that is epidermis and varying degree of dermal involvement with basement membrane still intact; characterized by blanchable redness, edematous tissue, moist (blisters), extreme local pain, minimal scarring if wound closure happens within 2-3 weeks, grafting indicated with longer closure time.

• Superficial
• Partial Thickness
• Full thickness
• Fourth degree - ANSWER-b. Partial Thickness

Type of burn that destroys both layers of skin including basement membrane; characterized by white, pale, brown, leathery, charring, dry, non-blanchable, NO pain, coagulated dead skin forms tough, leathery eschar. Requires skin grafting.

• Superficial
• Partial Thickness
• Full thickness
• Fourth degree - ANSWER-c. Full thickness

Type of burn that destroys down to muscle and bone, usually requiring excision of tissue and grafting. Seen with electrical and deep chemical burns.

• Superficial
• Partial Thickness
• Full thickness
• Fourth degree - ANSWER-d. Fourth degree
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Indications for escharotomy. - ANSWER-Circumferential burns and loss of distal pulses

You should suspect inhalation injury in a patient with facial burns.True/False - ANSWER-True

Rule of nines:

Entire head Chest Abdomen Each arm Anterior of each leg Posterior of each leg Upper back Lower back and buttocks Perineum - ANSWER-Entire head 9% (Front 4.5%, Back 4.5%) Chest 9% Abdomen 9% Each arm 9% Anterior of each leg 9% Posterior of each leg 9% Upper back 9% Lower back and buttocks 9% Perineum 1%

Potential complications seen in burn patient in ICU. - ANSWER-Hypothermia, hypovolemia, dysrhythmias, ileus, SIRS, infection

Using a bair hugger and warm blankets is classified as:

• Passive rewarming
• Active internal rewarming - ANSWER-a. Passive rewarming

Warmed fluids, humidified O2, and warmed peritoneal lavage are used in:

• Passive rewarming
• Active internal rewarming - ANSWER-b. Active internal rewarming

Danger of rewarming shock. - ANSWER-Inability to correct Vasodilation - acidosis, clinical deterioration, refractory V-fib, increased ICP

Based on the Illinois Trauma Center regulations, the RN completing the Trauma Flow Record must include which component?

• Trauma category classification
• Vital signs q5 minutes
• Pre-hospital care provided
• Serial GCS - ANSWER-a. Trauma category classification
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Documentation of a Trauma Flow Sheet of all Category 1 & 2 trauma patients include all

of the following EXCEPT:

• Trauma category classification with time and place of classification
• Time of arrival of patient to Trauma Center
• Notification of surgical specialty and time of arrival to see patient
• Consent for treatment - ANSWER-d. Consent for treatment

What are the following response times required at a Level 1 Trauma center:

Trauma Surgeon Cardiothoracic Surgeon Orthopedic Surgeon Neurosurgeon in OR

Opthalmologic, oral-dental, ENT - ANSWER-Trauma Surgeon: immediate

Cardiothoracic Surgeon: 30 minutes

Orthopedic Surgeon: 60 minutes

Neurosurgeon in OR: 60 minutes

Opthalmologic, oral-dental, ENT: 60 minutes

A category 1 trauma patient includes:

• Blunt or penetrating trauma with unstable VS
• Hemodynamic compromise (SBP <90 [adult] or SBP <80 [peds]; respiratory

compromise; AMS with GCS <10)

• Anatomical injuries such as penetrating injury of head, neck, torso, or groin; 2 or more

body regions with threat of loss of limb or life; trauma combined with over 20% TBSA burn; amputation or paralysis/sensory deficit above wrist or ankle; flail chest; fracture of

• or more proximal long bones
• ED physician's discretion
• All of the above
• None of the above - ANSWER-e. All of the above

A hypotensive patient with a GSW to the chest arrive at a Level 1 TC. The entire trauma team is activated. The trauma surgeon and anesthesia arrive 30 minutes post-arrival to assess the patient. He notifies the CV surgeon who arrives 15 minutes later and the patient is taken to the OR. What violation occurred based on the IDPH Trauma Center Regulations. - ANSWER-Trauma and anesthesia arrive time.

A patient with a GSW to the chest resulting in a hemothorax and placement of a CT and blood transfusion along with Ancef is being transported to a Level 1 TC from a regional hospital. Who should transport?

• BLS ambulance
• BLS ambulance with EMT-I on board
• ALS ambulance with EMT-P
• ALS ambulance with flight RN - ANSWER-d. ALS ambulance with flight RN

A 10 y/o trauma victim presents unconscious and hypotensive. Multiple attmepts at PIV access are unsuccessful. The TNS next access of choice is:

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