TNCC test prepa, TNCC Notes for Written Exam, TNCC Notes for Written Exam,
TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+
- ANSPrehospital shock index pg. 85
.. activation: .... are found in the carotid sinus and along the aortic arch, are sensitive to the degree of
stretch in the arterial wall. When the receptors sense a decrease in stretch, they stimulate the
sympathetic nervous system to release Epi, norepi, causing stimulation of cardiac activity and constriction
of blood vessels, which causes a rise in heart rate and diastolic blood pressure - ANSBaroreceptors:
1. A- airway and Alertness with simultaneous cervical spinal stabilization
2. B- breathing and Ventilation
3. circulation and control of hemorrhage
4. D - disability (neurologic status)
5. F - full set of vitals and Family presence
6. G - Get resuscitation adjuncts
L- Lab results (arterial gases, blood type and crossmatch)
M- monitor for continuous cardiac rhythm and rate assessment
N- naso or orogastric tube consideration
O- oxygenation and ventilation analysis: Pulse oxygemetry and end-tidal caron dioxide (ETC02)
monitoring and capnopgraphy
H- History and head to toe assessment
I- Inspect posterior surfaces - ANSABCDEFGHI
1. Apnea
2. GCS 8 or less
3. Maxillary fractures
4. Evidence of inhalation injury (facial burns)
5. Laryngeal or tracheal injury or neck hematoma
6. High risk of aspiration and patients inability to protect the airway
7. Compromised or ineffective ventilation - ANSFollowing conditions might require a definitive airway
1. bony fractures and possible rib fractures, which may impact ventilation
2. palpate for crepitus
3. subcutaneous emphysema which may be a sign for a pneumothorax
4. soft tissue injury - ANSPalpate the chest for
1. Check the presence of adequate rise and fall of the chest with assisted ventilation
2. Absence of gurgling on auscultation over the epigastrium
3. Bilateral breath sounds present on auscultation
4. Presence of carbon dioxide (CO2) verified by a CO2 device or monitor - ANSIf the pt has a definitive
airway in what should you do?
1. Dyspnea
2. Tachycardia
3. Decreased or absent breath sounds on the injured side
4. CP - ANSSimple Pneumo assessment:
1. equal breath sounds bilaterally at the second intercostal space midclavicular line and the bases for fifth
intercostal space at the axillary line - ANSAuscultate the chest for:
1. Get a CT
2. Consider ABG 's if decreased LOC
3. Consider glucose check - ANSD Interventions
1. Hypotension
, TNCC test prepa, TNCC Notes for Written Exam, TNCC Notes for Written Exam,
TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+
2. JVD
3. Muffled heart sounds - ANSBecks Triad:
1. open the airway, use jaw thrust
2. insert an oral airway
3. assist ventilations with a bag mask
4. prepare for definitive airway - ANSIf breathing is absent..
1. pain - hallmark sign, early sign
2. pressure - early sign
3. pallor, pules, paresthesia, paralysis - late sign - ANSSix P's of compartment syndrome:
1. Preparation
2. Preoxygenation
3. Pretreatment
4. Paralysis and Induction
5. Protecting and positioning - v
6. Placement of proof - secure the tube
7. Post intubation - secure ETT Tube, get X-ray for placement - ANSSteps of Rapid Sequence Intubation
1. Preparation and Triage
2. Primary Survery (ABCDE) with resuscitation adjuncts (F,G)
3. Reevaluation (consideration of transfer)
4. Secondary Survey (HI) with reevaluation adjuncts
5. Reevaluation and post resuscitation care
6. Definitive care of transfer to an appropriate trauma nurse - ANSInitial Assessment
1. Suction the airway
2, Use care to avoid stimulating the gag reflex
3. If the airway is obstructed by blood or vomitus secretions, use a rigid suction device
If foreign body is noted, remove it carefully with forceps or another appropriate method - ANSIf Airway is
not patent
1. The tongue obstructing the airway
2. loose or missing teeth
3. foreign objects
4. blood, vomit, or secretions'
5. edema
6. burns or evidence of inhalation injury
Auscultiate or listen for:
1. Obstructive airway sounds such as snoring or gurgling
2. Possible occlusive maxillofacial bony deformity
3. Subcutaneous emphysema - ANSInspect the mouth for:
50 to 150 - ANSMAP Range
500 mL/hr - ANSYou are treating a 27 y/o M in respiratory distress who was involved in a house fire.
Calculating TBSA burned is deferred due to the need for emergent intubation. At what rate should you
begin fluid resuscitation?
A 14 gauge needle that is inserted into the 2nd intercostal space in the midclavicular line on the affected
side over the top of the rib to avoid neuromuscular bundle that runs under the rib.
, TNCC test prepa, TNCC Notes for Written Exam, TNCC Notes for Written Exam,
TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+
Prepare for chest tube placement. - ANSTension pneumo intervention
a 52 y/o diabetic male with a partial thickness burn to the left lower leg - ANSWhich of the following
patients warrants referral to a burn center?
A breath every 5 to 6 seconds: 10-12 ventilations per minute - ANSBag mask ventilation
a pertinent medical hx is crucial - ANSWhich of the following considerations is the most important when
caring for a geriatric trauma pt?
According to newtons law which of these two force is greater: size or force? - ANSNeither. For each force
there is an equal and opposite reaction.
acidosis - ANSWhich of the following is a component of the trauma triad of death?
activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When
Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS
and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP -
ANSChemoreceptors:
advanced age - ANSWhich of the following is most likely to contribute to inadequate oxygenation and
ventilation?
after a physical examination if the pt has no radiologic abnormalities on CT - ANSEMS arrives with the
intoxicated driver of a car involved in a MVC. EMS reports significant damage to the drivers side of the
car. The pt is asking to have the cervical collar removed. When it is appropriate to remove the cervical
collar?
Air cannot escape intrapleural space.. can begin to compress heart. pt will have sever resp distress,
hypotension, JVD. - ANSTension pneumo
any deformities? bleeding? contusions, lacs? skin temp?? place splints on deformities, pulses - ANSHead
to toe assessment: Extremities
any lacs? deformities? blood at the urtheral meatus
palpate pelvis with high pressure over the iliac wings downward and medially - ANSHead to toe
assessment: pelvis and perineum
Aortic Dissection - ANSUnequal extremity pulse strength possibility of..
apply direct pressure to bleeding
elevate extremity
apply pressure over arterial sites
Consider a pelvic binder for pelvic fractures
consider a tourniquet
cannulate two veins with large caliber IV - if unable to gain assess consider IO
, TNCC test prepa, TNCC Notes for Written Exam, TNCC Notes for Written Exam,
TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+
a. obtain labs, type and cross
b. infuse warm isotonic fluids
c. consider balanced resuscitation
d. use rapid infusion device - ANSC Interventions:
apply splint and elevate above the level of the heart - ANSa 37 y/o F has a deformity of the L wrist after a
fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate
intervention?
ask pt to pen his or her mouth - ANSWhile assessing airway the patient is alert and responds to verbal
stimuli you should..
bardycardia and absent motor function below the level of injury - ANSA pt with a complete spinal cord
injury in neurogenic shock will demonstrate hypotension and which other clinical signs?
Before the arrival of the pt - ANSWhen should PPE be placed:
Biomechanics - ANSIs the general study of forces and their effects.
bowel - ANSWhich of the following injuries is LEAST likely to be promptly identified?
brachial pulse - ANSUnder age of 1 where do you find a pulse
Breathing: To assess breathing expose the chest:
1. Inspect for
a. spontaneous breathing
b. symmetrical rise and fall
c. depth, pattern, and rate of respiration
d. signs of difficulty breathing such as accessory muscle use
e. skin color (normal, pale, flushed, cyanotic)
f. contusions, abrasions, deformities (flail chest)
g. open pneumothoraces (sucking chest wounds)
h. JVD
i. signs of inhalation injury (singed nasal hairs, carbonaceous sputum) - ANSB
calcium - ANSif a pt has received multiple transfusions of banked blood preserved with citrate, which
electrolyte is most likely to drop and require supplementation?
can be caused by blunt trauma. air escapes from injured lung to pleural space and negative intrapleural
pressure is lost causing partial or collapsed lung - ANSSimple Pneumothorax
can result from penetrating wound through chest wall causing air to be trapped in to the intrapleural place.
Might hear "sucking"
Tx: nonporous dressing tapes on 3 sided, then Chest tube and would closure surgical repair. - ANSOpen
Pneumo:
Capnography monitors numeric value, as well as continuous waveform, indicating real-time measurement
and trending over time. - ANSQuantitative:
Caused by blood in the intrapleural space/ May also occur from lac to live or spleen combined with injury
to the diaphragm.
