Your FREE TCRN Flashcards 2026 – 200+ Cards

Hypotension + jugular venous distension + muffled heart sounds = cardiac tamponade.

3 (no eye, verbal, or motor response) — there is no score of 0.

15 (eye 4 + verbal 5 + motor 6) — a fully alert, oriented patient.

Eye opening (1–4), verbal response (1–5), best motor response (1–6).

8 or below — usually requires definitive airway protection (intubation).

9–12.

13–15 (includes concussion).

Hypertension with widening pulse pressure + bradycardia + irregular respirations — a LATE sign of raised ICP.

5–15 mmHg.

CPP = MAP − ICP; keep it adequate (about 60–70 mmHg) to prevent secondary ischemia.

Arterial (middle meningeal artery); biconvex/lens-shaped on CT; does NOT cross suture lines.

Brief lucid interval after impact, then rapid deterioration ('talk and die').

Venous (bridging veins); crescent-shaped on CT; crosses suture lines.

Older or anticoagulated adults; slower onset than epidural.

Blood in the sulci/cisterns; 'worst headache of life' with nuchal rigidity.

Primary = mechanical damage at impact (irreversible); secondary = hypoxia/hypotension/edema cascade the nurse can PREVENT.

Head of bed 30°, head midline, normocapnia, normothermia, hypertonic saline/mannitol; avoid hypoxia and hypotension.

Hypoxia and hypotension — preventing both IS the brain-saving intervention.

Raccoon eyes, Battle's sign, CSF rhinorrhea/otorrhea — do NOT place nasal/NG tubes.

Distributive shock after a high SCI: hypotension WITH bradycardia and warm, dry skin from lost sympathetic tone.

Temporary loss of ALL reflexes, motor, and sensation below the injury; gradually resolves.

Neurogenic = hypotension with BRADYcardia and warm skin; hypovolemic = hypotension with TACHYcardia and cool, clammy skin.

Fluids, vasopressors, and atropine for symptomatic bradycardia — but rule out hemorrhage first.

Injuries at or above T6.

Severe hypertension, pounding headache, flushing (often from a full bladder) → SIT the patient up and remove the trigger.

Hemorrhage until proven otherwise.

The airway (blood, edema, broken teeth, Le Fort fractures can obstruct rapidly).

Shield the eye (do NOT apply pressure), keep the patient upright, and avoid further manipulation.

Immediate, copious irrigation.

Never probe or explore the wound; watch for expanding hematoma, bruit, and subcutaneous emphysema.

Missing a deteriorating bleed — trend the GCS; a falling score is the alarm.

Decorticate (flexion toward the core) is less severe than decerebrate (extension); both signal serious brain injury.

Midface fractures (I, II, III) that can cause airway compromise and CSF leak.

Blood in the anterior chamber of the eye after blunt trauma; elevate head, shield, limit activity.

Localizes (5) = purposeful movement toward a stimulus; withdraws (4) = pulls away — localizing is the better response.

A standardized 3–15 score of level of consciousness used to classify and trend TBI severity.

Coup = brain injury at the impact site; contrecoup = injury on the opposite side from rebound.

Widespread shearing of axons from rotational/deceleration forces; severe TBI often with a poor CT-to-coma mismatch.

A blown (fixed, dilated) pupil with rapid neuro decline — a neurosurgical emergency.

A 'halo'/ring sign on gauze or glucose-positive fluid suggests CSF rhinorrhea/otorrhea.

Loss of motor and pain/temperature below the lesion with preserved proprioception; poor prognosis.

Greater motor loss in the UPPER than lower extremities; often hyperextension injury in older adults.

Absent breath sounds + hyperresonance on one side, hypotension, JVD, and LATE tracheal deviation away from the injury.

Immediate needle decompression, then a chest tube — a clinical diagnosis (do not wait for a film).

Three-sided occlusive (flutter-valve) dressing, then a chest tube.

>1,500 mL initial chest-tube output, or ongoing >200 mL/hr — needs a chest tube and surgery.

Usually penetrating chest injury; blood compresses the heart and impairs filling (obstructive shock).

A fall in systolic BP of more than 10 mmHg on inspiration; a sign of cardiac tamponade.

Pericardiocentesis or, in trauma, emergency thoracotomy.

Three or more adjacent ribs each fractured in two or more places → paradoxical chest movement.

The underlying pulmonary contusion, which can worsen over 24–48 hours.

Both: hypotension + JVD. Tension PTX = ABSENT breath sounds + hyperresonance; tamponade = MUFFLED heart sounds, breath sounds intact.

Bruised lung tissue causing hypoxia that can worsen over 24–48 hours; support oxygenation, careful fluids.

High-speed deceleration; widened mediastinum on imaging; most often at the aortic isthmus.

Strict heart-rate and blood-pressure control to limit shear while awaiting repair.

Bedside ultrasound for free fluid in four windows: perihepatic (RUQ), perisplenic (LUQ), pelvic, and pericardial.

Evaluation of the chest for pneumothorax and hemothorax.

Means the operating room — not the CT scanner.

The spleen, followed by the liver.

Referred left shoulder pain from diaphragmatic irritation — a clue to splenic injury/bleeding.

A red flag for underlying bowel, mesenteric, and lumbar-spine injury even if the patient looks well early.

Serial abdominal exams, serial hematocrits, bed rest, and vigilance for a failing nonoperative course.

Grades solid-organ injury severity from I (least) to V (most severe).

Exsanguination into the retroperitoneum.

At the level of the greater trochanters, to reduce pelvic volume and tamponade venous bleeding.

Do not repeatedly rock or 'spring' the pelvis; it can worsen bleeding.

Blood at the meatus, a high-riding prostate, scrotal/perineal bruising → NO urinary catheter until excluded.

Usually left-sided after blunt trauma; bowel sounds in the chest, respiratory distress; needs surgical repair.

Indicates an air leak in the system.

Never clamp a functioning chest tube without an order (risk of tension pneumothorax).

Bleeding behind the peritoneum (kidneys, pelvis, great vessels) that can be occult; suspect with flank/back pain and unexplained shock.

Anticipate massive transfusion and emergent operative source control.

Spinal motion restriction, log-roll for movement and skin checks, image per validated criteria.

Validated criteria used to decide which patients need cervical-spine imaging.

Needle aspiration of pericardial fluid to relieve cardiac tamponade.

An open pneumothorax that draws air through the wound; seal on three sides.

Decreased/absent breath sounds with hyperresonance on the affected side.

Decreased breath sounds with DULLNESS to percussion (blood, not air).

Suspected urethral injury (blood at meatus) contraindicates catheter placement until a retrograde urethrogram.

Blunt cardiac injury causing dysrhythmias and elevated troponin; monitor ECG.

A seat-belt/handlebar mark with delayed peritonitis — easy to miss early.

Pain, Paresthesia, Pallor, Pulselessness, Paralysis, Poikilothermia.

Pain out of proportion to the injury and pain on passive stretch.

Pulselessness and paralysis (ominous).

Emergent fasciotomy.

Do NOT elevate the limb above the heart or apply ice; remove constricting casts/dressings.

24–72 hours after a long-bone/pelvic fracture: hypoxia, neurologic change, and a petechial rash.

Crush injury releasing myoglobin; elevated CK and dark, tea-colored urine; risks AKI.

Aggressive IV fluids; monitor potassium and renal function.

Early antibiotics, tetanus prophylaxis, sterile dressing, and neurovascular checks.

Before AND after splinting/reduction.

Head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%.

$4\,\text{mL}\times \text{kg}\times \%\text{TBSA}$ of lactated Ringer's over 24 h; give half in the first 8 h from the burn, the rest over 16 h.

Urine output about 0.5 mL/kg/hr in adults (1 mL/kg/hr in children).

The airway — intubate EARLY for inhalation injury before edema closes it.

Facial burns, singed nasal hairs, soot in the mouth, hoarseness, stridor.

SpO₂ can be falsely NORMAL; treat with high-flow 100% oxygen.

Constriction; may require escharotomy to restore perfusion/ventilation.

Only partial-thickness and full-thickness burns (not superficial/first-degree).

A more accurate burn TBSA estimate, especially in children (larger head proportion).

Stabilize it in place; do NOT remove it (it may be tamponading a vessel).

Direct pressure, then a tourniquet (note the time applied).

Update based on wound type and immunization history.

Pain out of proportion, crepitus, systemic toxicity — a surgical emergency.

Wrap the part in saline-moistened gauze, seal in a bag, and place on ice (not directly on ice).

Assess neurovascular status; reduce promptly to relieve pressure on vessels and nerves.

Immobilize the joint above and below the injury.

Pain, Pallor, Pulses, Paresthesia, Paralysis (a fracture/limb perfusion check).

Diastolic BP minus compartment pressure; a value of $\le 30$ mmHg supports fasciotomy.

Epidermis only (e.g., sunburn); red, painful, no blisters; NOT counted in TBSA.

Epidermis + dermis; blisters, very painful, moist red base; counted in TBSA.

Through the dermis; dry, leathery, white/charred, often painless; counted in TBSA.

An incision through burn eschar to relieve constriction and restore perfusion/ventilation.

Always record the TIME applied; prolonged use risks ischemia.

Tachycardia — children maintain BP until late, so hypotension is a very late, ominous sign.

Larger head-to-body ratio increases head-injury risk.

Compliant ribs transmit force to organs → significant injury with few external marks.

A length-based tape for weight-based pediatric drug doses and equipment sizing.

Injuries inconsistent with the history or developmental stage — mandatory to report.

Minor mechanisms (a ground-level fall) cause serious injury from reduced reserve and anticoagulation.

They can mask the tachycardia of shock, hiding deterioration.

May be relative hypotension in a chronically hypertensive patient — undertriage is dangerous.

Greatly raised risk of intracranial bleeding even after minor head injury → low CT threshold.

Falls.

Left lateral tilt or manual uterine displacement to relieve aortocaval compression.

Aggressive resuscitation of the mother.

A pregnant patient can lose 30–35% of blood volume before showing shock signs — the fetus is compromised first.

Abdominal pain, vaginal bleeding, uterine tenderness/contractions after abdominal trauma.

Considered within about 4 minutes of maternal cardiac arrest after roughly 20–24 weeks.

Airway, ventilation, imaging, dosing, access, and pressure-injury risk — plan equipment early.

Assume brain injury and image — do not attribute a depressed GCS to alcohol alone.

Confounds the exam, masks pain; anticipate withdrawal during the stay; screen and intervene.

Recognize/report abuse (IPV, child, elder, trafficking), preserve evidence, maintain chain of custody.

Deep tissue and cardiac/muscle damage beneath minimal skin findings; monitor ECG and for rhabdomyolysis.

Brush off dry chemical, then irrigate copiously with water; remove contaminated clothing.

Titrate burn fluids to a urine output of about 1 mL/kg/hr in children.

Unexplained injuries, malnutrition, poor hygiene, or inconsistent caregiver accounts — mandatory to report.

Pre-existing disease (e.g., on anticoagulation, COPD, diabetes) changes injury response and recovery.

Pediatric mass-casualty triage adapted for children's physiology.

Consider Rho(D) immune globulin (RhoGAM) after abdominal trauma to prevent isoimmunization.

If IV access fails quickly, use intraosseous (IO) access for resuscitation.

Screen privately, document objectively, ensure safety, and report per law/policy.

eXsanguinating hemorrhage, Airway with C-spine, Breathing, Circulation with hemorrhage control, Disability, Exposure.

Uncontrolled bleeding kills fastest — control exsanguinating hemorrhage first.

Head-to-toe exam plus an AMPLE history, AFTER the primary survey and life threats are addressed.

Allergies, Medications, Past medical history, Last meal, Events/Environment of the injury.

Blunt transfers energy over a wide area (internal/deceleration injuries); penetrating injures along the object's path.

Ejection, death of another occupant, a fall over ~20 feet, high-speed deceleration.

Up to 15% loss; HR <100, normal BP, normal mentation.

15–30% loss; HR 100–120, narrowing pulse pressure, mild anxiety.

30–40% loss; HR 120–140, frank hypotension, confusion — BP reliably drops here.

Over 40% loss; HR >140, severe hypotension, lethargy, negligible urine — life-threatening.

Tachycardia and a narrowing pulse pressure.

A falling systolic blood pressure (young patients compensate until they crash).

Hypovolemic, obstructive, distributive (neurogenic/septic), and cardiogenic.

Tension pneumothorax, cardiac tamponade, and massive pulmonary embolism.

Direct pressure → tourniquet/hemostatic dressing (limbs) → pelvic binder → operative/angiographic control.

Blood products — NOT large-volume crystalloid (which dilutes clotting factors and cools the patient).

Balanced 1:1:1 — packed red cells : plasma : platelets.

Give early — ideally within 3 hours of injury — to reduce death from bleeding.

Hypothermia + acidosis + coagulopathy — a self-reinforcing cycle that worsens bleeding.

The triad (hypothermia, acidosis, coagulopathy) PLUS hypocalcemia — the BCEN outline's updated term.

Binds calcium → hypocalcemia; replace calcium during massive transfusion.

A lower BP target until surgical control, in selected patients WITHOUT TBI (TBI needs adequate cerebral perfusion).

TACO = transfusion-associated circulatory overload (volume); TRALI = transfusion-related acute lung injury (non-cardiogenic pulmonary edema).

Hemorrhage control + balanced blood products + permissive hypotension + warming, bridging to damage-control surgery.

A repeat head-to-toe exam (often 24 h later) to catch injuries missed during initial resuscitation.

Injury → field care → resuscitation → definitive care → rehabilitation → reintegration (or end-of-life).

Secure the airway and lines before moving; anticipate deterioration and altitude effects in flight.

Prevent immobility complications (VTE, pressure injury, pneumonia) and restore function.

Compassionate care, family presence, support for organ/tissue donation per protocol, and psychosocial/spiritual needs.

Irreversible loss of all brain and brainstem function; a clinical/confirmatory determination that may precede organ donation.

Reassess the primary survey from the top after every intervention and whenever the patient deteriorates.

Refractory hypoxemia with bilateral infiltrates not from cardiac failure; managed with lung-protective ventilation.

Apneic oxygenation and appropriate induction/paralytic medications to avoid hypoxia/hypotension on intubation.

Less than 2 seconds; a delay suggests poor perfusion/shock.

Worsens coagulopathy and acidosis; prevent it with warming during resuscitation (part of the triad/diamond of death).

Neurogenic, septic, and anaphylactic — vasodilation lowers systemic vascular resistance.

Matches injured patients to the appropriate level of trauma center based on physiology, anatomy, and mechanism.

Interfacility = between facilities (EMTALA applies); intrafacility = within a facility (e.g., ED to OR).

Care that recognizes the impact of trauma and avoids re-traumatization, addressing psychosocial needs.

Patient/family education, addressing barriers, and home-readiness/safety for a safe transition of care.

Early clotting dysfunction from tissue injury, shock, and dilution; treated with balanced products and TXA.

Provides the most comprehensive trauma care (full specialty coverage, research, and education).

Centers are designated/verified by level (I = most comprehensive, fewer resources at II–V).

A database of trauma cases used for performance improvement, benchmarking, and research.

Performance Improvement and Patient Safety — audit filters, peer review, and M&M reviews to close care gaps.

A non-punitive environment that encourages error and near-miss reporting to improve safety.

Simple Triage And Rapid Treatment — sorts MCI patients by Respirations, Perfusion, and Mental status.

Red = immediate, Yellow = delayed, Green = minor/walking wounded, Black = expectant/deceased.

Respirations over 30, capillary refill over 2 sec (or no radial pulse), or unable to follow commands.

A patient not breathing after the airway is repositioned (expectant).

Do the most good for the most people — the opposite of everyday one-patient care.

The pediatric version of START triage.

Primary (prevent the event), secondary (reduce severity), tertiary (optimize recovery).

Seat belts, helmets, fall-proofing.

Airbags and restraint systems (reduce injury severity once the event occurs).

Situation, Background, Assessment, Recommendation — a structured handoff/escalation tool.

The duty to screen, stabilize, and appropriately transfer any patient regardless of ability to pay.

Federal law protecting patient health-information privacy.

Document wounds objectively, handle clothing/bullets carefully, and maintain chain of custody.

A documented, unbroken record of who handled evidence and when — required for it to be admissible.

In a life-threatening emergency, consent is presumed for a patient who cannot consent.

Under-triage (missing serious injury) is the dangerous one; systems accept some over-triage to keep it low.

Removing hazardous agents from a patient (often before ED entry) to protect the patient and staff.

Suspected abuse, neglect, and certain injuries (e.g., gunshot wounds) must be reported by law.

Structured post-event support that addresses staff stress and improves future performance.

Integrating best research evidence, clinical expertise, and patient values into trauma care decisions.

A recognized hazard in trauma/emergency care addressed by prevention programs and reporting.

A structured case review of complications and deaths to improve care.

Predefined trauma indicators that flag cases for performance-improvement review.

Injury-prevention education and programs that are part of trauma-center designation.

Documenting safety events/near-misses to drive system improvement in a just culture.