TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+
A (AVPU) - ANSAlert. Will be able to maintain airway once clear.
A (Primary Survey) - ANSAirway and alertness with simultaneous cervical spinal
stabilization.
Airway Assessment - ANSInspect: tongue obstruction, loose/missing teeth, foreign
objects, blood, vomitus, secretions, edema, burns or evidence of inhalation injury
Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor)
Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous
emphysema
Airway Interventions: - ANSSuction
Remove foreign body if noted
Jaw thrust maneuver (maintain cspine)
Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag)
Consider definitive airway
Alertness Assessment - ANSA-Alert
V-Verbal
P-Painful
U-Unresponsive
B (Primary Survey) - ANSBreathing and Ventilation
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
Life-threatening pulmonary injuries requiring immediate intervention: open
pneumothorax, tension pneumothorax, flail chest, hemothorax.
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
Treatment: topical anesthetic, removal of foreign body, ophthalmic ABX, cycloplegics,
oral analgesia
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.
, TNCC 10NTH EDITION EXAM LATEST 2023-2024 COMPLETE 220 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+
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
