TNCC Study Guide Test Questions and Correct Answers

TNCC Study Guide Test Questions and Correct Answers MIST (Prehospital report) - Ans: Mechanism of injury (MOI) Injuries sustained Signs and symptoms in the field Treatment in the field Across-the-room Observation - Ans: First look at the pt If pt has uncontrolled hemorrhage reprioritize ABC to CAB Trauma Nursing Process (TNP) - Ans: Assessment Outcomes/Planning Implementation Evaluation Operational Process Points - Ans: Preparation and triage Primary Survey (ABCDE) w/ resuscitation adjuncts Reevaluation (consider it pt needs transfer) Secondary survey (HI) w/ reevaluation adjuncts Reevaluation and post resuscitation care Definitive care or transfer Primary Survey (ABCDE) - Ans: Airway & Alertness w/ simultaneous cervical spinal stabilization Breathing and ventilation Circulation and Control of Hemorrhage Disability (neuro state) Exposure and Environmental Control Cervical spine stabilization for c-spine injury - Ans: State need for second person to provide manual cervical spinal stabilization (two hands holding the pts head and neck) THEN demonstrate manual opening of airway using jaw-thrust maneuver Jaw-thrust maneuver - Ans: If pt is anything less than A in AVPU airway maybe compromised Always use two people to assess for obstruction if suspected CSI AIRWAY: Inspect mouth for: - Ans: Tongue obstruction Loose or missing teeth Foreign bodies (FB) Blood, emesis, secretions Edema Is there any snoring, gurgling, or stridor? Tip - Ans: After each intervention, reassess pt Patent Airway Interventions - Ans: Always be alert, can be compromised at anytime Look for possible risks that can lead to obstruction: Injury to mouth Active bleeding Blistering of oral mucosa Air is NOT Patent - Ans: 1. Jaw-thrust maneuver (two people) 2. Suction 3. Reassess Airway, if auctioning does not work look at tongue 4. Insert airway adjunct (temporary measure) 5. Consider definitive airway Adjunct Airway - Ans: Nasopharyngeal airway: usually in R nares, measure from tip of pts nose to tip of earlobe, DO NOT USE in pts with facial trauma or suspected basilar skull fx oropharyngeal airway: for unresponsive pt, measure by placing proximal end @ corner of mouth, distal end should reach tip of earlobe Definitive Airways - Ans: Endnote aches Tube (ETT): inserted oral or nasal (NTI), DO NOT use NTI if pt is: apneic, mid-face fx, or pregnancy Surgical airway (cricothyrotomy): needed if pt has larynx fx, oropharyngeal edema, or hemorrhage BREATHING: How to Check Effectiveness - Ans: Is breathing spontaneous? Symmetrical chest rise? Depth, pattern, and rate of resp? Increased WOB? Skin color? Open wounds? Subcutaneous emphysema? Tracheal deviation or JVD? Breath sounds present and equal? Assess ETT - Ans: Always listen to breath sounds after airway placed Look for symmetrical chest rise Listen over epigastrium for bilateral breath sounds Attach CO2 detector, check after 5-6 breaths for color change Look for improvement in skin color Assess ETT position: number at the teeth, secure airway Start mechanical ventilation CIRCULATION: Top three checks - Ans: Inspect for any uncontrolled hemorrhaging Palpate central pulses Inspect skin for: color, temp, and moisture Prehospital IV - Ans: assess IV for patency, place additional large-bore IV Fluids - Ans: Administer warm, isotonic crystalloid w/ blood tubing CONTROL THE RATE: fluid overload can cause pulmonary edema & increase myocardial ischemia DISABILITY: During Disability assessment (AVPU) - Ans: A- the pt is alert and responsive V- the pt responds to verbal stimulation (consider airway adjunct) P- the pt responds only to painful stimulation (consider airway adjunct) U- the pt is unresponsive (announce loudly to team, immediately check pulse, consider CAB) Glasgow Coma Scale (GCS) - Ans: 1 being no response 1-4 score Eye opening: spontaneous, speech, pain, none 1-5 Verbal response: oriented, confused, inappropriate response, incomprehensible, none 1-6 motor response: obeys, localizes pain, w/d from pain, abnormal flexion (decorticate), abnormal extension (decerebrate), none Assess Pupils - Ans: Shape, size, reactivity, and symmetry CT scan - Ans: CT of head and c-spine if neuro compromise need to be ordered EXPOSURE - Ans: Remove all clothing AND inspect for uncontrolled bleeding and injuries ENVIRONMENTAL: Warmth - Ans: Blankets Warm lights Increase room temp Warmed fluids Warmed O2 Resuscitation Adjunts (FG) - Ans: Full set of vitals & Family presence: BP, HR, RR, T Get resuscitation adjuncts FAMILY - Ans: Remember importance of family presence Resuscitation adjuncts (LMNOP) - Ans: Lab studies - ABG, lactic acid, blood type, crossmatch Monitor cardiac (EKG/ECG) Consider NG/OG Oxygenation and ventilation assessment (PaO2 & ETCO2) Pain assessment Nonpharmacologic Interventions - Ans: Apply Ice Reposition pt Padding over bony prominences Consider analgesic meds - Ans: Nonopioid: Tylenol, Motrin, Toradol Opioid: Morphine, fentanyl, dilaudid Reevaluation - Ans: Look for findings from primary assessment that indicate: Uncontrolled internal hemorrhage Emergency surgical interventions Transport to higher level of care Reevaluation Adjuncts - Ans: Additions Labs Rad scans Wound care Splints Traction device Tdap Admin meds Prep for transfer Secondary Survey (H) - Ans: History Head-to-toe assessment HISTORY - Ans: MIST Past medical hx Head-to-Toe Assessment - Ans: Inspect and Palpate head and face Inspect and Palpate neck (removal and/or place c-collar_ Inspect and Palpate chest Auscultate breath AND heart sounds Inspect abd and flank Auscultate bowel sounds Palpate ALL four quadrants of abd Inspect pelvis and perineum Put pressure over iliac crests downward to check for instability Apply pressure to symphysis pubis to check for instability Inspect and Palpate all four extremities for neurovascular status and injury Log roll pt to look at posterior side Inspect and Palpate posterior DO Insert Urinary Catheter if: - Ans: Urinary obstruction or retention Alteration in BP or volume status Accurate I&Os Pt unable to use urinal or bedpan Emergency surgery or major trauma Comfort care for terminally ill DO NOT Insert Urinary Catheter if: - Ans: Blood @ urethral meatus Perineal ecchymosis Scrotal ecchymosis High-riding prostate Suspected pelvic fx American Collage of Surgeon's Criteria for Consideration of Transfer (Level one) - Ans: Carotid or vertebral arterial injury Torn thoracic aorta or great vessel Cardiac rupture Bilateral pulmonary contusion with PaO2; FiO2 ration 200mm Hg Major abdominal vascular injury Grade IV or V liver injury requiring 6 units PRBC in 6 hrs Unstable pelvic fx requiring 6 units PRBCs in 6 hrs Fx or dislocation w/ loss of distal pulse Level one or two trauma care Criteria - Ans: Penetrating injury or open fx of skull GCS 14 or lateralizing neuro signs Spinal cord fx (SCI) or deficit 2 unilateral rib fxs or bilateral rib fxs w/ pulmonary contusion Open long bone fx Significant torso injury w/ advanced comorbidity