Breathing and Ventilation Assessment - ANSInspect: spontaneous breathing,
symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use,
diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic),
contusions/abrasions/deformities (signs of underlying injury), open pneumothoraces
(sucking chest wound), JVD, tracheal position, signs of inhalation injury
Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space
midclavicular line and bases at the fifth intercostal space anterior axillary line
Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV
pulsations at suprasternal notch or supraclavicular area
Breathing and Ventilation Intervention - ANSBreathing absent: jaw-thrust maneuver,
oral airway adjunct, assist ventilation with bag-mask device, prepare for definitive airway
Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or
higher. If ineffective: assist with bag-mask and determine need for definitive airway
,TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+
C (Primary Survey) - ANSCirculation and Control of Hemorrhage
Cardiogenic Shock - ANSResults from pump failure in the presence of adequate
intravascular volume. There is a lack of cardiac output and end-organ perfusion
secondary to a decrease in myocardial contractility and/or valvular insufficiency.
Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart
failure is a chronic cause.
Blunt cardiac injury may present similar to MI.
Excess of volume administration or increased after load can result in pulmonary edema
and increased myocardial ischemia.
Inotropic support to improve contractility.
Circulation and Control of Hemorrhage Assessment - ANSInspect: Uncontrolled
external bleeding, skin color
Auscultate: Muffled heart sounds - may indicate pericardial tamponade
Palpate: carotid and/or femoral pulses for rate, rhythm, strength
Circulation and Control of Hemorrhage Interventions - ANSControl and treat external
bleeding: apply direct pressure, elevate bleeding extremity, apply pressure over arterial
sites, consider use of a tourniquet.
2 large bore IVs, if unable consider IO, obtain labs and crossmatch.
Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L.
**Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis
and may cause hypothermia. Component therapy, including administering RBC, plasma
and platelets is a balanced approach so that O2 delivery is optimized, acidosis
corrected and coagulopathy prevented.
Classifications of Shock - ANSHypovolemic - decrease in the amount of circulating
blood volume
Obstructive - obstruction in either the vasculature or heart
Cardiogenic - pump failure in the presence of adequate intravascular volume
Distributive - maldistribution of an adequate circulating blood volume (septic,
anaphylactic, neurogenic)
,TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+
Corneal Abrasion - ANSDamage to the corneal epithelium. Easy to evaluate with
fluorescein.
Findings: photophobia, tearing, pain, injected conjunctiva (redness), lid swelling,
irritation
Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,
ophthalmic NSAIDS to decrease swelling, oral analgesics, Ophthalmic f/u in 24 hours.
(Do NOT patch - increases infection)
Corneal Foreign Body - ANSRoutinely metal, plastic or wood.
Findings: photophobia, pain, injected conjunctiva (redness), lid swelling
Corneal Laceration - ANSInvolves one or more layers of the cornea. Visualized with a
slit lamp.
Findings: similar to abrasion, pain out of proportion to findings, decreased vision
Treatment: treat small lacerations similar to an abrasion, larger lacerations need
ophthalmology referral and possible surgery
Cycloplegic agent - ANSCycloplegia is paralysis of the ciliary muscle of the eye,
resulting in a loss of accommodation. Because of the paralysis of the ciliary muscle, the
curvature of the lens can no longer be adjusted to focus on nearby objects.
D (Primary Survey) - ANSDisability (Neurologic Status)
Disability Assessment - ANSAssess GCS on arrival and repeat per policy.
Assess pupils for equality, shape and reactivity (PERRL)
Disability interventions - ANSEvaluate for need for CT. Assume AMS to be the result of
CNS injury until proven otherwise.
Consider ABGs - AMS may be indicator of decreased cerebral perfusion,
hypoventilation or acid-base imbalance.
Consider bedside glucose.
Distributive Shock - ANSOccurs as a result of maldistribution of an adequate circulating
volume with a loss of vascular tone or increased permeability.
Diffuse vasodilation lowers the systemic pressure, creating a relative hypovolemia or
reduction of the mean systemic volume and venous return to the heart or drop in
preload, resulting in distributive shock.
Anaphylactic: release of inflammatory mediators, such as histamine, which contracts
bronchial smooth muscle and increases vascular permeability and vasodilation.
Septic Shock: systemic release of bacterial endotoxins, resulting in an increased
vascular permeability and vasodilation
Neurogenic shock: loss of sympathetic nervous system control of vascular tone, which
produces venous and arterial vasodilation. With the loss of sympathetic nervous system
input in spinal cord injury, unopposed vagal activity may result in decreased cardiac
output through bradycardia.
TREATMENT: increase systemic resistance, controlled volume replacement.
Vasoconstriction and in some cases (neurogenic) Atropine to counteract bradycardia.
E (Primary Survey) - ANSExposure and Environmental Control
Exposure and Environmental Control - ANSCarefully and completely undress the
patient. Inspect for uncontrolled bleeding and note any obvious injuries.
Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentially
lethal combination in the injured patient. Consider: warm blankets, keep ambient
temperature warm, warm IVF, forced air warmers, radiant warming lights.
F (Primary Survey) - ANSFull Set of VS & Family Presence
G (Primary Survey) - ANSGet Resuscitation Adjuncts:
(LMNOP)
L: Labs
M: Monitor cardiac rate and rhythm
N: Naso or orogastric tube consideration
O: Oxygenation - SpO2 and/or etCO2 monitor
P: Pain assessment and management
GCS - ANSGCS
EYES
1: Does not open eyes
2: Opens eyes in response to pain
3: Opens eyes in response to voice
4: Opens eyes spontaneously
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller LAWEXEPRT. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.99. You're not tied to anything after your purchase.
