TNCC Study Guide
Abrasion - correct answer--A partial or full thickness wound that denudes the skin
-Commonly occurring with falls and bicycle or motorcycle collisions
-Can be mild to severe
-Road burn or abrasions, resulting in a low side crash or laying down a motorcycle--large
surface area
Are vasoconstrictors and vasopressors indicated in hemorrhagic shock? - correct
answer-NO
Avulsion - correct answer--Full thickness wounds caused by a tearing or ripping of skin and
soft tissue
-Wound edges are not well approximated
-Often fingers, scalps, noses and can occur as a result of working with machinery or from
MVCs
-Degloving
Biomechanics - correct answer-The general study of forces and their effects
Contusion - correct answer--A closed wound in which a ruptured blood vessel or capillary
bed hemorrhages into the surrounding tissue
Define an unstable pelvis fracture and list the presenting clinical findings - correct
answer--Unstable pelvic fractures are two or more fractures of the pelvic ring that have
outward rotational displacement
-Shortening on the leg
-Blood at the urinary meatus or hematuria
-Pelvic instability and/or pain
-Unexplained hypotension or evidence of hypovolemic shock
Define and list three types of primary brain injury - correct answer-Primary injuries result
from a direct transfer of energy
-Skull and craniofacial fractures
-Intracranial lesions (contusions or mild TBIs)
-Lacerations, tearing, and shearing injuries and bleeding into the brain (epidural or subdural
hematoma)
Define and provide assessment findings for post concussive syndrome - correct
answer--Manifests several days or months after the head trauma
-Signs and symptoms usually resolve but may persist for long periods of time
-Nausea
-Dizziness and persistent HA
-Memory and judgment impairment, as well as attention deficits
-Insomnia and sleep disturbance
,-Loss of libido
-Anxiety, irritability, depression, and emotional lability
-Noise and light oversensitivity
-Attention or concentration problems
Define anisocoria - correct answer-Unequal pupils (25% population); a benign physiologic
condition
Causes: trauma, uncle herniation, oculomotor nerve (CN III) palsy, medications, and some
nebulizers (ipratropium)
Define damage control surgery and its purpose - correct answer--A shift from rapid definitive
surgery and complete repair to surgery tat is intended to stop the bleeding, restore
normothermia, and treat coagulopathy and acidosis
-In other words, resuscitation from the trauma triad
-Damage control surgery is recommended to last no longer than 90 minutes
-Definitive injury repair is accomplished later during planned or staged operations after the
patient has been further resuscitated, stabilized, and warmed in the ICU
Define hyperoxia and the pulse oximetry parameters used to monitor it - correct
answer-*Hyperoxia:* refers to an excess supply of oxygen in the tissues. Better outcomes
depend on prompt titration of oxygen as indicated by maintaining SpO2 between 94-98%
Define residual limb - correct answer-Part of the body that remains after an amputation--for
instance, the part of the thigh that remains following an above-the-knee amputation is the
residual limb
Define second impact syndrome - correct answer--Refers to a condition that occurs when
the patient suffers a second mild TBI before recovery from the first, it is rare but usually fatal,
especially in pediatric patients
-The second impact causes loss of auto regulation leading to cerebral edema
Define the components of and use for FOUR (Full Outline of UnResponsiveness) Score -
correct answer--The FOUR score ranges from 0 to 16 and provides greater neurologic detail
than the GCS score
-The patient's total score suits from a summative score of 4 components of response that
include:
*Eye Response*
*Motor Response*
*Brainstem Reflexes*
*Respiration*
All components of the FOUR score can be rated in patients with or without an endotracheal
tube
Define the components of capnography - correct answer-
Define the components of cardiac output - correct answer-CO = SV x HR
,-Stroke volume is affected by preload (venous return) and afterload (peripheral vascular
resistance) and contractility (strength of contraction)
Define the components of the Incident Command Structure - correct answer-
Define the five mechanisms of injury in blast trauma - correct answer-1. *Primary:* injuries
are found in those closest to the detonation, with enclosed space detonation resulting in the
most lethal impacts. Air-filled organs (tympanic membranes, lungs, stomach, and bowel) are
most susceptible to rupture with primary blast injuries
2. *Secondary:* fragment injuries and generally cause the greatest volume of casualties.
They can include injuries such as puncture wounds, lacerations, and impaled objects
3. *Tertiary:* include impacts with larger objects propelled by the bast wind resulting in blunt
trauma. These cause high energy transfer and can result in pelvic or femur fractures or
major thoracic injuries such as aortic and great vessel rupture
4. *Quaternary:* result of heat, flame, gas, and smoke. These injuries include external burns
and internal burns from inhale hot gases
5. *Quinary:* those associated with exposure of hazardous materials from radioactive,
biologic, or chemical components of a blast
Define the four categories of disaster triage and the difference between adult and pediatric
definitions - correct answer-
Define the ten types of fractures - correct answer-*1. Open* fracture site is accompanied by
compromised skin integrity near or over the fracture
*2. Closed* skin is intact over or near fracture site
*3. Complete* bony cortex is completely interrupted
*4. Incomplete* bony cortex is not completely interrupted
*5. Comminuted* bone is splintered into fragments
*6. Greenstick* bone bends or is buckled
*7. Impacted* bone is wedged into distal and proximal fracture sites
*8. Displaced* bone fracture sites are not aligned
Define the two classifications of open globe eye injuries - correct answer--Open globe
injuries are classified as either lacerations or ruptures
-These injuries penetrate through the eye wall and are described as a through and through
injury to the cornea, sclera, or both
-Lacerations: can be further categorized as penetrating, intraocular foreign body, or
perforating
Describe an ethical consideration related to trauma care - correct answer-
Describe assessment findings and treatment for corneal abrasions - correct
answer-Assessment findings:
-Photophobia and tearing
-Pain
-Injected conjunctiva or redness of the eye
-Lid swelling
-Complaint of a foreign body sensation in the eye
, Treatment:
-Topical ophthalmic antibiotics (if caused by contact lenses, treat for pseudomonas)
-Cycloplegic opthalmic lent to decrease spasms and pain
-Topical ophthalmic NSAIDs, such as ketorolac or diclofenac, to reduce swelling
-Oral analgesics
-No patching; evidence shows abrasions heal faster if unpatched
-Follow up with an ophthalmologist in 24 hrs
Describe common patterns and severity of injuries int he bariatric trauma patient - correct
answer-
Describe effects of common medications in relation to the older adult trauma patient - correct
answer-
Describe how Newton's Laws of Motion and the Law of Conservation affect energy transfer
in traumatic injury, and give an example - correct answer--1st: weight and speed are
reasonable substitutions for mass and velocity, higher mass and/or higher speed delivers
greater energy
-2nd: an object's velocity changes when it is subjected to an external force; heavier objects
require more force to accelerate (or decelerate) them
-3rd:
-Conservation:
Ex: pot vs. child
-1st: the force of gravity holds the pot on the flat stovetop until energy is transferred to the
pot, such as by a toddler, grabbing the handle.Once the pot is in motion, it will sustain its
motion until interrupted by another force. As the pot strikes the child in the head, the strength
of bone imposes a force of resistance upon impact, thereby changing the directional path of
the pot. The stationary head stays in a fixed position until a volume of energy adequate to
move the head is transferred to it. This concept of movement-energy
transfer-countermovement applies to all mechanical traumas
-2nd: the pot continues to fall at a steady rate unless it is acted on by an outside force (a
hand pushing it out of the way or catching it)
-3rd: the transfer causes a redirection of the pot and movement of the head, as well as
energy absorption causing anatomic changes to the tissue that received the energy transfer
-Conservation: energy is not created, nor it is destroyed at the site where the pot impacts the
head. Instead, energy is transferred from the kinetic (moving) object to the object being
impacted
Describe how the respiratory system is affected by the level of spinal cord injury - correct
answer--Injury to the cord at *C3 to C5* can cause loss of phrenic nerve function, resulting in
a paralyzed diaphragm and inability to breathe
-*Hypoventilation:* injury to the spinal cord between *T1 and T11* may result in the loss of
intercostal muscles and decrease respiratory effort
-Loss of innervation from *T7 to T12* may result in loss of the use of abdominal muscles for
support of breathing
