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TNCC Notes for Written Exam (Latest 2022/2023) Graded A
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TNCC Notes for Written Exam (Latest 2022/2023) Graded A What is kinematics? A branch of mechanics (energy transfer) that refers to motion and does not consider the concepts of force and mass of the object or body. What is Newton's First Law? A body at rest will remain at rest. A body in mot...

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  • June 26, 2022
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  • 2021/2022
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TNCC Notes for Written Exam
Define central or transtentorial herniation. –
CORRECT ANSWER: A downward movement of the cerebral hemispheres with herniation of
the diencephalon and midbrain through the elongated gap of the tentorium.
Define Hemothorax. –
CORRECT ANSWER: Accumulation of blood in the pleural space.
Define Minor Head Trauma. –
CORRECT ANSWER: GCS 13-15
Define Moderate Head Trauma –
CORRECT ANSWER: Postresuscitative state with GCS 9-13.
Define Pneumothorax. –
CORRECT ANSWER: Results when an injury to lung leads to accumulation of air in pleural
space w/subsequent loss of negative intrapleural pressure. Partial or total collapse of lung may
ensue.
An open pneumothorax results from wound through chest wall. Air enters pleural space both
through the wound and trachea.
Define Severe Head Trauma. –
CORRECT ANSWER: Postresuscitative state with GCS score of 8 or less.
Define tension pneumothorax. –
CORRECT ANSWER: Life-threatening injury. Air enters pleural space on inspiration, but air
cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury
causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung.
Venous return impeded, cardiac output falls, hypotension results.


Immediate decompression should be performed. Treatment should not be delayed.
Define uncal herniation. –
CORRECT ANSWER: The uncus (medial aspect of the temporal lobe) is displaced over the
tentorium into the posterior fossa. This herniation is the more common of the two types of
herniation syndromes.
Disruptions of the bony structures of the skull can result in what? –

,CORRECT ANSWER: Displaced or nondisplaced fx's causing CSF leakage b/c of lac to the
dura mater, creating a passage for CSF.


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. –
CORRECT ANSWER: When 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. –
CORRECT ANSWER: Syndrome 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. –
CORRECT ANSWER: Results 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. –
CORRECT ANSWER: Liver 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. –
CORRECT ANSWER: Most 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.
Explain Irreversible Shock. –
CORRECT ANSWER: Shock 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. –
CORRECT ANSWER: Results 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. - CORRECT ANSWER: Tachypnea 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"? - CORRECT ANSWER: DISABILITY
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? - CORRECT ANSWER: -
Visualization of the chords
- Using bronchoscope to confirm placement

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