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TNCC EXAM BUNDLE SET 2023
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TNCC, Tncc, TNCC Written Exam, TNCC Written Exam, TNCC class, TNCC/TCRN
Primary concern when a person cannot stop coughing/clearing their throat following house fire/smoke? Airway/Intubate Lab evidence of cellular perfu... [Show More] sion Base Excess (Less than -6 is BAD) Multiple people are in the ER of different ages who all go to the same church. They all have the same symptoms. What is the most likely cause? Biologic Suspected shock type with a spinal cord injury Distributive Shock (Includes neurogenic) Patient has GCS of 3, unequal pupils (one sluggish, one blown), and is posturing. What is the cause? Herniation Middle Meningeal Artery Epidural Hematoma (results from collection of blood that forms between dura mater and skull) Prior to having a concussion (TBI), the patient had a brain injury that was not fully healed. What is the cause? 2nd Impact Syndrome Bowel sounds heard in the L chest. What is this a symptom of? Ruptured diaphragm Symptoms of __________________: include muffled heart sounds and hypotension Pericardiocentesis How should you dress a severed limb? Sterile gauze with normal saline THEN put ice on it Amylase level looks at _____________ Pancreas What should you do if your patient has hyphema (collection of blood inside the front part of the eye?) Sit HOB up to 30 degrees Principle that people have to take action after suffering a loss in order to decrease severity, seriousness, or painfulness Mitigation What organ is most at risk following a gunshot Liver 8 year old child with longitudinal thigh lacerations Sign of child abuse Bleeding around belly button Cullen's Sign [Show Less]
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TNCC Exam 8th edition study Questions and Answers 2023
1.What is the effect of hypothermia on the oxyhemoglobin dissociation curve Hemoglobin does not readily release oxygen for use by the tissues A shift to t... [Show More] he left occurs in an environment of low metabolic demand (hypothermia, hypocapnia, alkalosis), increasing hemoglobin's affinity for oxygen. EMS arrives with the intoxicated driver of a car involved in a motor vehicle crash. EMS reports significant damage to the driver's side of the car. The patient is asking to have the cervical collar removed. When it is appropriate to remove the cervical collar? After a physical examination if the patient has no radiologic abnormalities on CT A CT is recommended for spinal clearance in an impaired patient. The nurse is caring for a 120 kg male brought in after a warehouse fire and is calculating the patient's fluid resuscitation needs. He has painful red blistering to the entire surface of both upper extremities and superficial burns to the anterior chest. Using the modified Lund and Browder chart to calculate the total body surface area burned, how much IV fluid would be administered in the first 8 hours? 2280 mL Both upper arms = 8%, both lower arms = 6%, and both hands = 5%, yielding 19 2 120 = 4560 mL. Half of the total is equal to 2280 mL. Superficial burns are not included in the TBSA calculation for fluid resuscitation. Which of the following is an expected finding in a patient with a tube thoracostomy connected to a chest drainage system Fluctuation in the water seal chamber Fluctuation in the water seal chamber indicates the tube is placed correctly in the pleural space. .A 35-year-old male presents with facial trauma after being struck in the face with a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is suspected? Globe rupture A teardrop-shaped pupil suggests a globe rupture. .A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? Bradycardia and absent motor function below the level of injury Patients with a complete spinal cord injury will have absent motor function below the level of the lesion. They become hypotensive and bradycardic due to loss of autonomic nervous system function. Which of the following patients warrants referral to a burn center? A 52-year-old diabetic male with a partial-thickness burn to the left lower leg This patient has a 7% TBSA burn with a preexisting medical history that could complicate management, prolong recovery, or affect mortality. You are caring for a patient who was involved in a motor vehicle crash and is 32 weeks pregnant. Findings of your secondary survey include abdominal pain on palpation, fundal height at the costal margin, and some dark bloody show. Varying accelerations and decelerations are noted on cardiotocography. These findings are most consistent with which of the following? Placental abruption The findings of abdominal pain, elevated fundal height, dark bloody show, and fetal distress are most consistent with placental abruption. A 20-year-old male presents to the ED complaining of severe lower abdominal pain after landing hard on the bicycle cross bars while performing an aerial BMX maneuver. Secondary assessment reveals lower abdominal tenderness and scrotal ecchymosis. Which of the following orders would the nurse question? Straight catheter for urine sample Insertion of a urinary catheter is contraindicated if urethral transection is suspected. Signs and symptoms of urethral injury include blood at the meatus, perineal ecchymosis, scrotal ecchymosis, and a high-riding or non-palpable prostate. Which of the following occurs during the third impact of a motor vehicle crash? The aorta is torn at its attachment with the ligamentum arteriosum This occurs during the third impact. All of these are considered a critical communication point in trauma care EXCEPT which of the following? Defusings A defusing is part of critical incident stress management but is not considered a critical communication point in trauma care. Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? MARCH The MARCH mnemonic stands for massive hemorrhage, airway, respiration, circulation, and head injury/hypothermia. The MARCH mnemonic recognizes uncontrolled hemorrhage as the major cause of preventable death after injury. You are treating a 27-year-old male in respiratory distress who was involved in a house fire. Calculating total body surface area (TBSA) burned is deferred due to the need for emergent intubation. At what rate should you begin fluid resuscitation? 500 mL/hour Prior to calculating TBSA, this is the recommended starting point for fluid resuscitation for patients 14 years of age and older A 49-year-old restrained driver involved in a motor vehicle collision presents to the trauma center complaining of abdominal, pelvic, and bilateral lower extremity pain. Vital signs are stable. The nurse can anticipate all of these after a negative FAST exam EXCEPT which of the following? Diagnostic peritoneal lavage Diagnostic peritoneal lavage is indicated for hemodynamically unstable patients or if FAST and CT are not available. An elderly patient with a history of anticoagulant use presents after a fall at home today. She denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. What is the most likely cause of her symptoms? Subdural hematoma Subdural hematomas are characterized by nausea, vomiting, headache, changes in level of consciousness, ipsilateral dilated, nonreactive pupil, and unilateral weakness or hemiparesis. These typically occur after a fall or assault. Tearing of the bridging veins is most frequently associated with which brain injury? Subdural hematoma Subdural hematomas are usually caused by tearing of the bridging veins and associated with direct injury to the underlying brain tissue. .During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. What priority nursing intervention should be performed next? Insert an oropharyngeal airway if there is no gag reflex Snoring respirations may indicate airway obstruction from the tongue. Insert an airway adjunct to alleviate obstruction by the tongue. Oropharyngeal airways can be used in patients without a gag reflex. What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation? Pulse oximetry and capnography Pulse oximetry measures the percentage of hemoglobin saturated with oxygen. Capnography measures the amount of carbon dioxide exhaled. Carbon dioxide is the end-product of ventilation and a reflection of metabolism and pulmonary function. Which of the following is NOT considered a benefit of debriefings? Identifying individuals who made mistakes during the traumatic event Debriefings are not used to single out individuals who made mistakes. Debriefings are used to provide an opportunity to review performance and identify areas for improvement with a sharing of individual responses. Which of the following is NOT considered goal-directed therapy for cardiogenic shock? Pericardiocentesis A pericardial tamponade is a form of obstructive, not cardiogenic, shock. A patient is brought to the emergency department of a rural hospital following a high-speed motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, which of the following is the priority intervention? Initiate transfer to a trauma center Early consideration for transfer to a trauma center is essential to ensure optimal outcomes. The most reassuring finding for a male patient with hip pain after a fall is which of the following? Pelvic stability Uncontrolled hemorrhage is the major cause of preventable death after injury. Unstable pelvic fractures increase the volume of the pelvic cavity and can be life-threatening due to blood loss. EMS brings a patient from a motor vehicle crash. Vital signs are BP 90/49 mm Hg, heart rate 48 beats/minute, respiratory rate 12 breaths/minute, temperature 97.2°F (36.2° C). The patient exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the following types of spinal cord injury? Complete Incontinence, priapism, and hypotension with bradycardia are manifestations of a complete spinal cord injury. What physiologic change in the elderly population increases the risk of traumatic injury? Decreased subcutaneous fat Decreased subcutaneous fat and thinning of the skin increases the risk of injuries from soft tissue trauma and increases the risk of hypothermia If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? Calcium Hypocalcemia is a concern with massive transfusion because citrate is added to banked blood to prevent coagulation. Citrate chelates (binds with) calcium, rendering it inactive. Which of the following is a possible complication of positive-pressure ventilation? Worsening pneumothorax Positive-pressure ventilation can lead to increased air in the chest cavity without a route of escape, worsening a pneumothorax and possibly leading to a tension pneumothorax. An intubated and sedated patient in the emergency department has multiple extremity injuries with the potential for causing compartment syndrome. What is the most reliable indication of compartment syndrome in a patient who is unconscious? Pressure Pressure can be assessed in the limb by palpation or direct measurement. The compartment or limb will feel tight or tense upon palpation. The skin may also appear taut and shiny. A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital providers placed a nonporous dressing over the chest wound and taped it on three sides. He is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis and decreasing blood pressure. Which of the following is the MOST appropriate immediate intervention? Dressing removal This is the fastest effective intervention for this decompensating patient. A nonporous dressing taped on three sides is temporary and has variable effectiveness. If signs and symptoms of tension pneumothorax develop after the application of the dressing Which of the following is a component of the trauma triad of death? Acidosis The three components of the trauma triad of death are acidosis, hypothermia and coagulopathy. When is the tertiary survey completed for a trauma patient? Within 24 hours of the trauma The tertiary survey consists of a complete examination performed following the primary and secondary surveys and within 24 hours after trauma to identify any injuries missed during the initial assessment. A 36-year-old female has a deformity of the left wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention? Apply a splint and elevate the extremity above the level of the heart Splinting the injured extremity stabilizes the extremity and reduces further injury. Elevation above the level of the heart promotes venous return and may reduce swelling. [Show Less]
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TNCC Questions and Answers 2023
C What are the primary benefits of a team approach to trauma care it provides a systemic approach to care and organizes care A In the primary surve... [Show More] y AVPU is performed to determine if the patient can: Protect their aiway B WHich may lead to unreliable pulse ox reading carboxyhemoglobin A The systemic inflammatory response is a normal part of the body's response to shock from traumatic injury. what best describes this response it is activated by tissue hypoxia and sends neutrophils to injury site A what is an early assessment finding to increased ICP in pt with a brain injury vomiting A an unrestrained driver was involved in a frontal collision without airbag deployment. he is hypotensive and tachycardic with shallow respirations, distended JVD and muffled heart tones the nurse prepare for what pericardiocentesis D An unrestrained driver is brought into the emergency department following a frontal impact MVC. she is pale, anxious, and c/o SOB. what is the potential injury Lumbar fx B pt to ER after being pinned to brick retaining wall. knwoing crushing injuries can result to significant damage to muslces the priority asessment for trauma nruse is for myoglobinemia nd renal failure A the nurse is preparing to cleanse an extensive abrasion contaminated with dirt and gravel. which of the following intervention is indicated us copious amounts of NS A when providing care for the pedicatric pt with burns the post resuscitation care, how are fluids delivered parkland formula with maintainence fluidss B thinning skin and diminished autonomic response in older adult can have what effect on primary assessment compromised thermoregulation A in mass casualty "doing the greatest good for the greatest number of people refers to a situation where there may be more patients than resources C effective pain management in hte pt iwth rib fxwill promote what cough with ability to clear secretions Bduring the primary survery which of the following has the greatest priority cervical spine injury D restrained driver is involved in a severe head on MVC and presnts with a seatbelt mark along the neck and upper chest area. bilateral decreased breath sounds, hemoptysis and diffuse sub q emphysemato the neck and upper chest area tracheobronchial injury B a pt involved in an MVC develops asymmetric pupillary reactivity, bilateral pupillary dilation and abnormal motor posturing. what does the nurse suspect as the most likely cause herniation syndrome B which of the following hemodynamic support strategies is the prioririty intervention for a pt with traumatic pulmonary contusion judicios use of IV fluids B the unrestrained fron seat passenger in a MVC develops echymosis around umbillicus. this assessment finding is most commonly associated with: bleeding in the peritoneal cavity D elevated comaprtment pressure can be the result of hemorrhage from within the muscle A prego trauma pt develops tachy, hypotension, a rigide board like uterus, and dark, red vaginal bleeding. she reports constant back pain which is increasing. the most likely cause of s/s is placental abruption A for a ptwho has undergone recent bariatric surgery, flouroscopy is recommended to place NG tube A identification of vulnerabilities is an example of what phase of disaster management mitigation A which of the following structures would be hte most affected by teh concept of caviation Liver B the most common cause of shock in the trauma pt is loss of circ volume B a pt with injury to the middle meningeal artery is at risk for which of the following epidural hematoma C what organ might be injured in left lower rib fx spleen D pt with amputation of an index finger with a knife. amputaiton is brought in with pt. it is wrapped in sterile gauze with saline and sealed in a plastic bag. the next step amputation care is place the bag on ice D which physiological change in airway of an odler adult pt places the pt at risk for difficult intubation cervical arthritis Cthe term worried well when refering to disaster preparedness planning refers to: individuals hwo think they have been affected by the event but are asymptomatic C which of the following would be priority intervention for a pt with multiple rib fractures and chest wall instability follwoing a mvc collision assist with endotracheal intubation A a 22 yr old was struck by a vehicle while crossing the street, sustaining multiple fx she is alert and answering qestions and crying what is the best method for initial pain assessment for this pt self report scale D which of the following diagnostic intervention is most appropriate for the unstable pt with a suspectedinternal hemorrhage focused assessment with sonography for trauma C an adult pt involved in a brush fire arrives to the er. upon initial assessment in the er the most concerning finding is hoarse voice and repeatedly decides to clear throat. C a college student presents to the er stating afterarriving at a party , she awoke in a dorm rom. she didnt recognize with no memory of the previous evening the trauma nurse prepare for what exam. sexual assult [Show Less]
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TNCC Practice Exam with Rationale Questions Answered 100% Correct
What is the key to a high performing trauma team? effective communication rationale: skilled communication, cooperation, and coordination are the corne... [Show More] rstones of high-performance teams and high-quality trauma care When obtaining a history for an injured patient, understanding the kinematic concepts associated with the mechanism of injury and energy transfer can initially assist the trauma provider in: evaluating and anticipating the types of injuries that may be present rationale: mechanism of injury and energy transfer can assist the provider in evaluating and anticipating damage the major preventable cause of death in the trauma patient is: uncontrolled hemorrhage rationale: uncontrolled hemorrhage is the major cause of preventable death after injury, so assessment to identify uncontrolled hemorrhage is key to the initial assessment process the across-the-room observation step in the initial assessment provides the opportunity to reprioritize circulation before airway or breathing rationale: the across-the-room observation is done at the beginning of the primary survey to rapidly assess the need to reprioritize circulation before airway or breathing. This is done if uncontrolled external hemorrhage is identified. Which of the following accurately describes ventilation prinicples associated with a bag-mask device? ventilate at a rate of 10-12 breaths/minute rationale: if ventilation is ineffective, assist ventilation at 10-12 breaths/minute or one every 5-6 seconds Which of the following is the best measure of the adequacy of cellular perfusion and helps to predict the outcome of resuscitation? base deficit rationale: base deficit serves as an endpoint measurement of the adequacy of cellular perfusion and when used in conjunction with serum lactate helps predict the success of resuciation What is the safe pharmacological alternative to opioids for rib fracture pain management in the anticoagulated patient? intercostal nerve blocks rationale: continuous intercostal nerve blocks use long-acting anesthetics and can provide safe and effective pain management for the anticoagulated patient. In a patient with severe traumatic brain injury, hypocapnia causes: cerebral vasoconstriction rationale: hypocapnia, or low levels of carbon dioxide, will cause vasoconstriction, especially in the cerebra; vasculature A patient with a knife injury to the neck has an intact airway and is hemodynamically stable. He complains of difficulty swallowing and speaking. Further assessment is indicated next for which of the following? damage to spinal cord rationale: penetrating neck trauma may include concurrent injuries to the spinal cord, airway, or vascular neck structures. With an intact airway and hemodynamic stability, the other common concurrent injury is to the spinal cord What is the appropriate technique for palpating the pelvis for stability? apply gentle pressure over the iliac downward and medially rationale: to assess for pelvic instability, gentle pressure is applied over the iliac crests downward and medially a patient with a spinal cord injury at C5 is being cared for in the emergency department while awaiting transport to a trauma center. which of the following represents the highest priority for ongoing assessment and management? maintain adequate respiratory status rationale: spinal cord injuries at C3 to C5 can cause the loss of phrenic nerve function, resulting in a paralyzed diaphragm and inability to breathe Based on proper bleeding control techniques, what is the first step to stop the bleeding of a penetrating injury to the lower extremity? initiate direct pressure rationale: the first step in controlling any bleeding is direct pressure. if that is not adequate, the application of a tourniquet may be needed treatment for frostbite includes: administer tissue plasminogen activator rationale: with frostbite, thrombus formation is a risk. tissue plasminogen or nonsteroidal anti-inflammatory medication can be administered. The tissue plasminogen activator has been effective in maintaining perfusion and decreasing the need for amputation when administered within 24 hours of rewarming A 30-week pregnant trauma patient's vital signs include a blood pressure of 94/62 mm Hg and a heart rate of 108 beats/minute. Fetal heart tones are 124 beats/minute. The emergency nurse interprets the patient's hemodynamic findings as an indication of which of the following? normal vital signs in pregnancy rationale: in pregnancy, the resting heart rate increases by 10 to 20 bpm and a small decrease in systolic blood pressure and a larger decrease in diastolic blood pressure due to a decrease in peripheral resistance. Normal fetal rate is between 120 and 160 bpm While performing an assessment on a 13-month old involved in a motor vehicle collision, the nurse identifies which of the following findings from the patient as a potential sign of mental status change? cooperation with the assessment rationale: an alert older infant or toddler will recognize his or her caregiver, be cautious of strangers, and may not respond to commands, which is a normal response What is the best position for maintaining an open airway in the bariatric patient? reverse trendelenburg rationale: the reverse trendelenburg position will benefit both airway maintenance and work of breathing in the bariatric patient. The nurse is obtaining for a patient who presents following sexual assault. The history is completed using which of the following techniques? use direct quotes to record information rationale: history includes a detailed description of the incident that is objective, using direct quotes A trauma nurse cared for a child with devasting burns 2 weeks ago. She called in sick for a couple of days and is now back working on the team. Which of the following behaviors would indicate this nurse is coping well? she is talking about taking the emergency nursing certification examination rationale: this is an indication she is taking positive steps to advance her own practice, a sign of resilience Following a bomb explosion, fragmentation injuries from the bomb or objects in the enviroment are examples of which phase of injury? secondary rationale: the secondary phase of a blast results from flying debris, projectiles, and bomb fragments causing lacerations or penetrating injuries [Show Less]
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TNCC test prepA, TNCC Notes for Written Exam, TNCC Notes for Written Exam,
Expedite transfer to the closest trauma center A 56 y/o M pt involved in a motor vehicle crash is brought to the ED of a rural critical access facility. H... [Show More] e complains of neck pain, SOB, and diffuse abd pain. His GCS is 15. His VS: BP 98/71, HR 125, RR 26, SpO2 94% on high-flow O2 via NRB mask. Which of the following is the priority intervention for this patient? a pertinent medical hx is crucial Which of the following considerations is the most important when caring for a geriatric trauma pt? Mitigation Following a review of recent drills and a real disaster event, a hospital has identified deficiencies and is taking steps to minimize the impact of a future disaster . Which phase of the disaster life cycle does this describe? Multiple requests for water EMS brings a pt who fell while riding his bicycle. Using the American College of Surgeobs screening guidelines, which assessment finding would prompt the RN to prepare the pt for a radiologic spine clearance? hemoglobin does not readily release O2 for use by the tissues What is the effect of hypothermia on the oxyhemoglobin dissociation curve? acidosis Which of the following is a component of the trauma triad of death? Complete EMS brings a pt from MVC. VS: BP 90/49, HR 48, RR 12, temp 97.2F (36.2 C). The pt exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the following types of spinal cord injury? flucuation in the water seal chamber Which of the following is an expected finding in a pt with a tube thoracstomy connected to a chest drainage system? insert an oropharyngeal airway if there is no gag reflex During the primary survey of an unconscious pt with multi-system trauma, the nurse notes snoring respirations. What priority nursing interventions should be preformed next? globe rupture A 35 y/o M presents with facial trauma after being struck in the face with a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is suspected? compensated A trauma pt is restless and repeatedly asking "where am i?" VS upon arrival: BP 110/60, HR96, RR 24. Her skin is cool and dry. Current VS are BP 104/84, HR 108, RR 28. The pt is demonstrating s/sx of which stage of shock? ventilate with a bag mask device An unresponsive trauma pt has an oropharygeal airway in place, shallow and labored respirations, and dusky skin. The trauma team has administered medications for drug-assisted intubation and attempted intubation but was unsuccessful. What is the most appropriate immediate next step? within 24 hrs of trauma When is the tertiary survey completed fora trauma pt? pressure An intubated and sedated pt in the ED has multiple extremity injuries with the potential for causing compartment syndrome. What is the most reliable indication of compartment syndrome in a patient who is unconscious? worsening pneumothorax Which of the following is possible complication of positive-pressure ventilation? pelvic stability the most reassuring finding for a male pt with hip pain after a fall is which of the following? narrowed Which of the following pulse pressures indicate early hypovolemic shock? dysrhythmias Patients with a crush injury should be monitored for which of the following conditions? subdural hematoma Tearing of the bridging veins is most frequently associated with which brain injury? straight cath for urine sample A 20 y/o M presents to the ED complaining of severe lower abd pain after landing hard on the bicycle cross bars while preforming an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the RN question? placental abruption You are caring for a pt who was involved in a MVC and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal ht at the costal margin, and some dark bloody show. Varying accelerations and decelerations are noted on cariocgraphy. These findings are most consistent with which of the following? it can worsen cord damage from an unstable spinal injury Which of the following is true about the log-roll? defusings All of these are considered a critical communication point in trauma care EXCEPT which of the following? pulse oximetry and capnography What bedside monitoring parameters are used to assess for adequacy of O2 and effectiveness of ventilation? padding the upper back while stabilizing the cervical spine Caregivers carry in a 2 y/o into the ED who fell out of a second-story window. The pt is awake and crying with increased work of breathing and pale skin. Which of the following interventions has the highest priority? bowel Which of the following injuries is LEAST likely to be promptly identified? Initiate transfer to a trauma center A pt is brought to the ED of a rural hospital following a high-speed MVC. When significant abd and pelvic injuries are noted in the primary survey, which of the following is the priority interventions? bardycardia and absent motor function below the level of injury A pt with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? apply splint and elevate above the level of the heart a 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? the aorta is torn at its attachment with the ligamentum arteriosum which of the following occurs during the third impact of a motor vehicle crash? Report your suspicion of maltreatment in accordance with local regulations a 5 y/o child presents to the ED with bruises to the upper arm and buttocks in various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities found based on the pediatric assessment triangle or primary survey. Which of the following is the priority survey. Which of the following is the priority nursing intervention? [Show Less]
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TNCC Exam 8th edition study Questions and Answers Scored A+
All of these are considered a critical communication point in trauma care EXCEPT which of the following? Defusings A defusing is part of critical incident... [Show More] stress management but is not considered a critical communication point in trauma care. .During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. What priority nursing intervention should be performed next? Insert an oropharyngeal airway if there is no gag reflex Snoring respirations may indicate airway obstruction from the tongue. Insert an airway adjunct to alleviate obstruction by the tongue. Oropharyngeal airways can be used in patients without a gag reflex. Which of the following is NOT considered a benefit of debriefings? Identifying individuals who made mistakes during the traumatic event Debriefings are not used to single out individuals who made mistakes. Debriefings are used to provide an opportunity to review performance and identify areas for improvement with a sharing of individual responses. What physiologic change in the elderly population increases the risk of traumatic injury? Decreased subcutaneous fat Decreased subcutaneous fat and thinning of the skin increases the risk of injuries from soft tissue trauma and increases the risk of hypothermia An intubated and sedated patient in the emergency department has multiple extremity injuries with the potential for causing compartment syndrome. What is the most reliable indication of compartment syndrome in a patient who is unconscious? Pressure Pressure can be assessed in the limb by palpation or direct measurement. The compartment or limb will feel tight or tense upon palpation. The skin may also appear taut and shiny. When is the tertiary survey completed for a trauma patient? Within 24 hours of the trauma The tertiary survey consists of a complete examination performed following the primary and secondary surveys and within 24 hours after trauma to identify any injuries missed during the initial assessment. A patient with a lower extremity fracture complains of severe pain and tightness in his calf, minimally relieved by pain medications. Which of the following is the priority nursing intervention? Elevating the extremity to the level of the heart Elevating the extremity higher than the heart can reduce circulation and tissue perfusion if compartment syndrome is suspected. A toddler who fell off a trampoline is making eye contact with the family and is consolable. There is no increased work of breathing and the skin color is pink. The nurse asks the patient to open his mouth, but the patient does not respond to commands. The nurse recognizes this as an expected finding due to which of the following conditions? Developmental stage An alert or older infant or toddler will recognize his or her caregiver but be cautious of strangers and my not respond to commands This is normal. There has been a mass casualty incident a block from the hospital. The hospital is receiving dozens of patients. A truck arrives with an unresponsive patient in the back with obvious chest and abdominal trauma. Agonal respirations do not improve with airway positioning. Using the START triage algorithm, you would triage tag this patient as which of the following? Black This patient is unlikely to survive given the severity of their injuries and is triaged as expectant. Resources should be reserved for individuals considered to be more salvageable. The nurse is assessing a patient with a fractured forearm that was splinted three hours ago. Which symptom is of most concern as a late sign of an evolving complication? Weak radial pulse A weak radial pulse is evidence of an actual compromise in circulation. Which of the following is a late sign of increased intracranial pressure? Decreased respiratory effort Other late signs of increased intracranial pressure include dilated, nonreactive pupils, unresponsiveness, abnormal motor posturing, and the Cushing response. [Show Less]
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TNCC Notes for Written Exam Questions and Answers 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 bo... [Show More] dy. What is Newton's First Law? A body at rest will remain at rest. A body in motion will remain in motion until acted on by an outside force. What is the Law of Conservation of Energy? Energy can neither be created nor destroyed. It is only changed from one form to another. What is Newton's Second Law? Force equals mass multiplied by acceleration of deceleration. What is kinetic energy (KE)? KE equals 1/2 the mass (M) multiplied by the velocity squared. What is the Mnemonic for the Initial Assessment? A = Airway with simultaneous cervical spine protection B = Breathing C = Circulation D = Disability (neurologic status) E = Expose/Environmental controls (remove clothing and keep the patient warm) What is the Mnemonic for the Secondary Assessment? F = Full set of VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric tube)/Family presence G = Give comfort measures (verbal reassurance, touch, and pharmacologic and nonpharmacologic management of pain). H = Hx and Head-to-toe assessment I = Inspect posterior surfaces Where do you listen to auscultate breath sounds? Auscultate the lungs bilaterally at the second intercostal space midclavicular line and at the fifth intercostal space at the anterior axillary line. What are the late signs of breathing compromise? - Tracheal deviation - JVD What are signs of ineffective breathing? - AMS - Cyanosis, especially around the mouth - Asymmetric expansion of chest wall - Paradoxical movement of the chest wall during inspiration and expiration - Use of accessory muscles or abdominal muscles or both or diaphragmatic breathing - Sucking chest wounds - Absent or diminished breath sounds - Administer O2 via NRB or assist ventilations with a bag-mask device, as indicated - Anticipate definitive airway management to support ventilation. Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? A tight-fitting nonrebreather mask at 12-15 lpm. What intervention should be done if a pt presents with effective circulation? - Insert 2 large caliber IV's - Administer warmed isotonic crystalloid solution at an appropriate rate What are signs of ineffective circulation? - Tachycardia - AMS - Uncontrolled external bleeding - Pale, cool, moist skin - Distended or abnormally flattened external jugular veins - Distant heart sounds What are the interventions for Effective/Ineffective Circulation? - Control any uncontrolled external bleeding by: - Applying direct pressure over bleeding site - Elevating bleeding extremity - Applying pressure over arterial pressure points - Using tourniquet (last resort). - Cannulate 2 large-caliber IV's and initiate infusions of an isotonic crystalloid solution - Use warmed solution - Use pressure bags to increase speed of IVF infusion - Use blood administration tubing for possible administration of blood - Use rapid infusion device based on protocol - Use NS 0.9% in same tubing as blood product - IV = surgical cut-down, central line, or both. - Blood sample to determine ABO and Rh group - IO in sternum, legs, arms or pelvis - Administer blood products - PASG (without interfering with fluid resuscitation) How do you assess Mnemonic "D"? 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 What are the interventions for Disability? - If assessment indicates a decreased LOC, conduct further investigation during secondary focused assessments - If pt is not alert or verbal, continue to monitor for any compromise to ABC's - If pt demonstrates signs of herniation or neurologic deterioration, consider hyperventilation. What is assessed and intervened for Expose/Environmental Controls? - Remove clothing - Ensure appropriate decontamination if exposed to hazardous material - Keep pt warm - Keep clothing for evidence What is the first thing assessed under the Secondary Assessment? FULL SET VS / FOCUSED ADJUNCTS / FAMILY PRESENCE - ABCDE should be completed - Labs, X-rays, CT, Foley, - Family Presence What is the second thing assessed under the Secondary Assessment? GIVE COMFORT MEASURES - Talking to pt - Pharmacologic/Nonpharmacologic pain management - Observe for physical signs of pain What is assessed under the Mnemonic "H"? HISTORY / HEAD-TO-TOE ASSESSMENT - MIVT - M = Mechanism of injury - I = Injuries sustained - V = Vital Signs - T = Treatment - Pt generated information - PMH - Head-to-toe assessment What is assessed under the Mnemonic "I"? INSPECT POSTERIOR SURFACES - While maintaining C-spine, logroll pt with assistance to inspect back, flanks, buttocks and posterior thighs. - Palpate vertebral column for deformity and areas of tenderness - Assess rectum for presence/absence of tone, presence of blood What she be done after the Secondary Assessment? Reassess: - Primary survey, - VS - Pain - Any injuries What are factors that contribute to ineffective ventilation? - AMS - LOC - Neurologic injury - Spinal Cord Injury - Intracranial Injury - Blunt trauma - Pain caused by rib fractures - Penetrating Trauma - Preexisting hx of respiratory diseases - Increased age What medications are used during intubation? LOAD Mnemonic: L = Lidocaine O = Opioids A = Atropine D = Defasiculating agents What are the Rapid Sequence Intubation Steps? PREPARATION: - gather equipment, staffing, etc. PREOXYGENATION: - Use 100% O2 (prevent risk of aspiration). PRETREATMENT: - Decrease S/E's of intubation PARALYSIS WITH INDUCTION: - Pt has LOC, then administer neuromuscular blocking agent PROTECTION AND POSITIONING: - Apply pressure over cricoid cartilage (minimizes likelihood of vomiting and aspiration PLACEMENT WITH PROOF - Each attempt NOT to exceed 30 seconds, max of 3 attempts. Ventilate pt 30-60 seconds between attempts. - After intubation, inflate the cuff - Confirm tube placement w/exhaled CO2 detector. POSTINTUBATION MANAGEMENT: - Secure ET tube - Set ventilator settings - Obtain Chest x-ray - Continue to medicate - Recheck VS and pulse oxtimetry What is a Combitube? A dual-lumen, dual-cuff airway that can be placed blindly into the esophagus to establish an airway. If inadvertently placed into trachea, it can be used as a temporary ET tube. There are only two sizes: small adult and larger adult. What is a Laryngeal Mask Airway? Looks like an ET tube but is equipped with an inflatable, elliptical, silicone rubber collar at the distal end. It is designed to cover the supraglottic area. ILMA, does not require laryngoscopy and visualization of the chords. What is Needle Cricothyrotomy Percutaneous transtracheal ventilation. (temporary) Complications include: - inadequate ventilation causing hypoxia - hematoma formation - esophageal perforation - aspiration - thyroid perforation - subcutaneous emphysema What is Surgical Cricothyrotomy? Making an incision in cricothyroid membrane and placing a cuffed endo or trach tube into trachea. This is indicated when other methods of airway management have failed and pt cannot be adequately ventilated and oxygenated. Complications include: - Aspiration - Hemorrhage or hematoma formation or both - Lac to trachea or esophagus - Creation of a false passage - Laryngeal stenosis How do you confirm ET Tube/Alternative Airway Placement? - Visualization of the chords - Using bronchoscope to confirm placement - Listening to breath sounds over the epigastrum and chest walls while ventilating the pt - CO2 detector - Esophageal detection device - Chest x-ray How do you inspect the chest for adequate ventilation? Observe: - mental status - RR and pattern - chest wall symmetry - any injuries - patient's skin color (cyanosis?) - JVD or tracheal deviation? (Tension pneumothorax) What are you looking for when auscultating lung sounds? Absence of BS: - Pneumothorax - Hemothorax - Airway Obstruction Diminished BS: - Splinting or shallow BS may be a result of pain What are you looking for when percussing the chest? Dullness: - hemothorax Hyperresonance - Pneumothorax [Show Less]
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TNCC Test prep 8th Edition Questions and Answers 100% correct
Expedite transfer to the closest trauma center A 56 y/o M involved in a MVC is brought to the ED. He complains of neck pain, SOB, and diffuse abdominal pa... [Show More] in. His GCS is 15, VS: BP 98/71, HR 125, RR 26, SpO2 94% on high-flow O2 via NRB mask. Which is the priority intervention for this patient? a pertinent medical hx is crucial Which of the following considerations is the most important when caring for a geriatric trauma pt? Mitigation Following a review of recent drills and a real disaster event, a hospital has identified deficiencies and is taking steps to minimize the impact of a future disaster . Which phase of the disaster life cycle does this describe? smell of alcohol on breath EMS brings a pt who fell while riding his bicycle. Using the American College of Surgeobs screening guidelines, which assessment finding would prompt the RN to prepare the pt for a radiologic spine clearance? hemoglobin does not readily release O2 for use by the tissues What is the effect of hypothermia on the oxyhemoglobin dissociation curve? acidosis Which of the following is a component of the trauma triad of death? Complete EMS brings a pt from MVC. VS: BP 90/49, HR 48, RR 12, temp 97.2F (36.2 C). The pt exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the following types of spinal cord injury? flucuation in the water seal chamber Which of the following is an expected finding in a pt with a tube thoracstomy connected to a chest drainage system? insert an oropharyngeal airway if there is no gag reflex During the primary survey of an unconscious pt with multi-system trauma, the nurse notes snoring respirations. What priority nursing interventions should be preformed next? globe rupture A 35 y/o M presents with facial trauma after being struck in the face with a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is suspected? compensated A trauma pt is restless and repeatedly asking "where am i?" VS upon arrival: BP 110/60, HR96, RR 24. Her skin is cool and dry. Current VS are BP 104/84, HR 108, RR 28. The pt is demonstrating s/sx of which stage of shock? ventilate with a bag mask device An unresponsive trauma pt has an oropharygeal airway in place, shallow and labored respirations, and dusky skin. The trauma team has administered medications for drug-assisted intubation and attempted intubation but was unsuccessful. What is the most appropriate immediate next step? within 24 hrs of trauma When is the tertiary survey completed fora trauma pt? pressure An intubated and sedated pt in the ED has multiple extremity injuries with the potential for causing compartment syndrome. What is the most reliable indication of compartment syndrome in a patient who is unconscious? worsening pneumothorax Which of the following is possible complication of positive-pressure ventilation? pelvic stability the most reassuring finding for a male pt with hip pain after a fall is which of the following? narrowed Which of the following pulse pressures indicate early hypovolemic shock? dysrhythmias Patients with a crush injury should be monitored for which of the following conditions? subdural hematoma Tearing of the bridging veins is most frequently associated with which brain injury? straight cath for urine sample A 20 y/o M presents to the ED complaining of severe lower abd pain after landing hard on the bicycle cross bars while preforming an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the RN question? placental abruption You are caring for a pt who was involved in a MVC and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal ht at the costal margin, and some dark bloody show. Varying accelerations and decelerations are noted on cariocgraphy. These findings are most consistent with which of the following? it can worsen cord damage from an unstable spinal injury Which of the following is true about the log-roll? defusings All of these are considered a critical communication point in trauma care EXCEPT which of the following? pulse oximetry and capnography What bedside monitoring parameters are used to assess for adequacy of O2 and effectiveness of ventilation? padding the upper back while stabilizing the cervical spine Caregivers carry in a 2 y/o into the ED who fell out of a second-story window. The pt is awake and crying with increased work of breathing and pale skin. Which of the following interventions has the highest priority? bowel (Hollow organ injury signs and symptoms may be subtle and delayed but are associated with a high mortality rate if not identified.) Which of the following injuries is LEAST likely to be promptly identified? Initiate transfer to a trauma center A pt is brought to the ED of a rural hospital following a high-speed MVC. When significant abd and pelvic injuries are noted in the primary survey, which of the following is the priority interventions? bardycardia and absent motor function below the level of injury A pt with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? apply splint and elevate above the level of the heart a 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? the aorta is torn at its attachment with the ligamentum arteriosum which of the following occurs during the third impact of a motor vehicle crash? Report your suspicion of maltreatment in accordance with local regulations a 5 y/o child presents to the ED with bruises to the upper arm and buttocks in various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities found based on the pediatric assessment triangle or primary survey. Which of the following is the priority survey. Which of the following is the priority nursing intervention? to guage end-organ perfusion and tissue hypoxia Why is a measure of serum lactate obtained in the initial assessment of a trauma patient? elevating the extremity to the level of the heart A pt with a lower extremity fracture complains of severe pain and tightness in his calf, minimally by pain medications. Which of the following is the priority nursing intervention? velocity What factor contributes most to the kinetic energy of a body in motion? subdural hematoma An elderly patient with a history of anticoagulant use presents after a fall at home today. She denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. What is the most likely cause of her symptoms? fat embolism a pt has been in the ED for several hrs waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and complaining of leg pain. His wife reported that he suddenly became anxious and confused. Upon reassessment, the pt is restless with respiratory distress and petechiae to his neck. The pt is exhibiting s/sx most commonly associated with which of the following conditions? decreased respiratory effort (Early signs of increased intracranial pressure include headache, nausea, vomiting, amnesia, and behavioral changes (impaired judgment, restlessness, drowsiness). Which of the following is a late sign of increased intracranial pressure? serial FAST exams a 49 y/o restrained driver involved in a MVC presents to the trauma center complaining of abd, pelvic, and bilateral lower extremity pain. VS are stable. The nurse can anticipate all of these after a negative FAST exam EXCEPT which of the following? pericardiocentesis Which of the following is NOT considered goal-directed therapy for cardiogenic shock? endotracheal tube The trauma nurse knows that placing a bariatric patient in a ramped position providers better visualization during the insertion of which device? hypotension that worsens w/ inspiration which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? calcium (Hypocalcemia is a concern with massive transfusion because citrate is added to banked blood to prevent coagulation. Citrate chelates/binds with calcium, rendering it inactive.) if a pt has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? identifying individuals who made mistakes during the traumatic event Which of the following is NOT considered a benefit of debriefings? 500 mL/hr You 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? advanced age Which of the following is most likely to contribute to inadequate oxygenation and ventilation? a 52 y/o diabetic male with a partial thickness burn to the left lower leg Which of the following patients warrants referral to a burn center? dressing removal (This is the fastest effective intervention for this decompensating patient. A nonporous dressing taped on three sides is temporary and has variable effectiveness. If signs and symptoms of tension pneumothorax develop after the application of the dressing) A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital providers placed a nonporous dressing over the chest wound and taped it on three sides. he is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis and decreasing blood pressure. Which of the following is the MOST appropriate immediate intervention? after a physical examination if the pt has no radiologic abnormalities on CT EMS 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? MARCH (The MARCH mnemonic stands for massive hemorrhage, airway, respiration, circulation, and head injury/hypothermia. The MARCH mnemonic recognizes uncontrolled hemorrhage as the major cause of preventable death after injury.) Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? [Show Less]
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TNCC Written Exam Questions and Answers 2023
What is the best measure of the adequacy of cellular perfusion and helps predict the outcome of resuscitation? Base deficit used in conjunction with serum... [Show More] lactate Will hypocapnia cause vasoconstriction or vasodilation, especially in the cerebral vasculature? Vasoconstriction What results from tissue hypo perfusion and oxygen deficit? Metabolic acidosis What type of shock results in generalized vasodilation? Neurogenic shock Spinal cord injuries at C3-C5 causes loss of what nerves function, resulting in what? Phrenic nerve; paralyzed diaphragm and inability to breath Extremity elevation AT the level of the heart is beneficial for what type of injury? Compartment Syndrome What is a high risk of frostbite? Thrombus formation What two medications can be administered to maintain perfusion after a frostbite injury along with rewarming? Tissue plasminogen activator or non steroidal anti-inflammatory medication (NSAIDS) An rise in diastolic blood pressures is a sign of increasing what? Peripheral resistance What position will benefit the airway and work of breathing for the bariatric patient? Reverse Trendelenburg Which phase of a blast results from flying debris, projectiles, and bomb fragments causing lacerations or penetrating injuries? Secondary Phase What phase of a blast results from any explosion-related illness or injury including hyperglycemia, hypertension, angina, asthma, COPD, or sepsis? Quaternary Phase What phase of a blast results from individuals being thrown by the blast and impacting walls, ground, or any hard object? Tertiary Phase What phase of a blast results from impact of the over and under pressurization wave with body surfaces. Injuries include blast lung, tympanic membrane rupture, abdominal hemorrhage, globe rupture, and mild traumatic brain injury? Primary Phase Signs of what include muscle pain or weakness, dark red or brown urine, general weakness or malaise, and elevated creatinine kinase levels? Rhabdomyolosis Signs of what include anxiety, pleuritic chest pain, dyspnea, hypoxemia, hemoptysis, cough, orthopnea, adventitious lung sounds, decreased lung sounds, jugular vein distention, or hypotension? Pulmonary Embolus Signs of what include headache, nausea and vomiting, amnesia, behavioral changes, altered level of consciousness? Increased intracranial pressure Signs of what include asymmetric pupillary reactivity, unilateral dilation, widening pulse pressure, abnormal motor posturing, bradycardia, and decreased respiratory effort? Late signs of increased ICP with Herniation Syndrome What is caused by the tear of the bridging veins or middle meningeal artery? Subdural and Epidural Hematoma Affect concentration, memory, sleep, mode, and libido. Causes headaches, dizziness and nausea. Postconcussive Syndrome/ Mild Traumatic Brain Injury Signs and symptoms similar to early signs of increased ICP but do not worsen. Postconcussive Syndrome/ Mild Traumatic Brain Injury Cerebral Perfusion Pressure = ______-______ MAP - ICP What is the range for CO2 to maximize perfusion? 35-45 Does hypoventilation cause dilation or constriction? Increase or decrease ICP? Dilation and increase in ICP due to high CO2 Hyperventilation cause dilation or constriction? Constriction d/t low CO2 Pupils with pressure on cranial nerve Fixed and dilated Pupils with opiates vs stimulants small; large Pupils with anticholinergics such as atropine, ipratropium, and scopolamine large Sluggish reaction of pupils is an early sign of what? Increasing ICP Glasgow Coma Score with Mild, Moderate, and Severe TBI Mild = 13-15 Moderate = 9-12 Severe = 3-8 Goal value for ICP <15 Goal value for Cerebral Perfusion Pressure (CPP) >60 Le Fort Fracture Fracture of the maxilla What decrease ICP by decreasing cellular edema? Osmotic diuretics (such as 3% saline and mannitol) Becks Triad is a sign of what? And includes what three symptoms? Cardiac Tamponade; 1. Hypotension 2. JVD 3. Muffled heart sounds What is pulsus paradoxus? And what is it a sign of? Drop in blood pressure with inspiration, sign of cardiac tamponade Tachycarida, weak pulses, hypotension, cool periphery, delayed cap refill, anxiety and agitation are signs of what type of shock? Seen with what? Obstructive Shock; Cardiac Tamponade Persistent blood loss following chest tube insertion is a sign of what? Hemothorax Ipsilateral diminished breath sounds and chest movement is a sign of what? Hemothorax Tearing chest/back pain, unequal blood pressure and pulses are a sign of what? Caused by a high mechanism of injury. Thoracic Aortic Disruption Dysrhythmia, ischemic changes, and persistent unexplained tachycardia are signs of what? Myocardial contusion from Blunt Cardiac Injury Decreased/absent breath sounds ipsilaterally, JVD, hypotension, and tracheal deviation to the contralateral side (late sign) is seen with what? Can lead to what? Tension Pneumothorax; PEA Hemoptysis, ineffective cough, crackles in affected lung, hypoxia/hypercapnia, and alveolar opacities are signs of what? Pulmonary Contusion Paradoxical chest wall movement, bony crepitus, rib segment depressed with inhalation and elevated with exhalation are signs of what? Flail Chest (caused by chest wall injury) Open wound on chest wall resulting in sucking sound, decreased breath sounds, chest movement, and hyper-resonance ipsilaterally, subcutaneous emphysema, and tachycardia are signs of what? Open Pneumothorax Hear bowel sounds in chest and Kehr's sign seen with what? Traumatic Diaphragmatic Tear Referred pain down the left shoulder; indicative of a ruptured spleen. Kehr's Sign Diaphragmatic Tears are seen with what types of injuries? Penetrating injuries between T4-T12, or rapid deceleration causing severe blunt trauma to the torso. Incision with blood clot, edges approximated with suture closer, and results in a fine scar. This is __________ Intention. Primary Irregular large wound with blood clot, no closure, granulation tissue fills in the wound, results in large scar. This is ________ Intention. Secondary Contaminated wound, granulation tissue, delayed closure with suture. This is _______ Intention. Tertiary [Show Less]
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TNCC EXAM QUESTIONS AND ANSWERS 2023
1. Preparation and Triage 2. Primary Survery (ABCDE) with resuscitation adjuncts (F,G) 3. Reevaluation (consideration of transfer) 4. Secondary Survey (... [Show More] HI) with reevaluation adjuncts 5. Reevaluation and post resuscitation care 6. Definitive care of transfer to an appropriate trauma nurse Initial Assessment 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 ABCDEFGHI Before the arrival of the pt When should PPE be placed: Pt is at hospital in the right amount of time, right care, right trauma facility, right resources Safe Care: Uncontrolled Hemorrhage Major cause of preventable death: reorganize care to C-ABC If uncontrolled hemorrhage .. Used at the beginning of the initial assessment 1. A Alert. If the pt is alert he or she will be able to maintain his or her airway once it is clear. 2. V responds to verbal stimuli responds to pain. If the patient needs verbal stimulation to respond, an airway adjunct may be needed to keep the tongue from obstructing the airway. 3. P responds to pain. If the pt. responds only to pain, he or she may not be able to maintain his or her airway adjunct may need to be placed while further assessment is made to determine the need for intubation. 4. U Unresponsive. If the pt. is unresponsive, announce it loudly to the team and direct someone to chk in the pt is pulseless while assessing if the cause of the problem is the airway. Airway and AVPU: ask pt to pen his or her mouth While assessing airway the patient is alert and responds to verbal stimuli you should.. jaw thrust maneuver to open airway and assess for obstruction. If pt has a suspected csi, the jaw thrust procedure should be done by two providers. One provider can maintain c-spine and the other can perform the jaw thrust maneuver. While assessing airway pt is unable to open mouth, responds only to pain, or is unresponsive you should.. 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 Inspect the mouth 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 If the pt has a definitive airway in what should you do? 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 If Airway is not patent 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 Following conditions might require a definitive airway 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) B tracheal deviation and jvd Late signs of tension pneumo: 1. equal breath sounds bilaterally at the second intercostal space midclavicular line and the bases for fifth intercostal space at the axillary line Auscultate the chest for: 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 Palpate the chest for 1. open the airway, use jaw thrust 2. insert an oral airway 3. assist ventilations with a bag mask 4. prepare for definitive airway If breathing is absent.. trauma its need early supplemental oxygen, start with 15 mL O2 and titrate oxygen delivery. Oxygen on trauma patients Circulation and Control of Hemorrhage Inspect first for any uncontrolled bleeding Skin color palpate for central pulses - carotid and femoral - rate, rhythm, and strength Skin temp: cool, diaphoretic, or warm and dry C 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 a. obtain labs, type and cross b. infuse warm isotonic fluids c. consider balanced resuscitation d. use rapid infusion device C Interventions: Disability - Neurologic Status 1. Assess pupils for equality, shape, and reactivity (PERRL) 2. Assess GCS (eye opening, verbal response, and motor response) D 1. Get a CT 2. Consider ABG 's if decreased LOC 3. Consider glucose check D Interventions Exposure and Environmental Control Remove all clothes and assess for any obvious injuries and uncontrolled bleeding E IF clothing is needed for evidence preserve in paper bag. Maintain body temp - cover the pt, turn up heat in room, administer warm fluids E Interventions: Full set of vitals and family presence F Get Resuscitation Adjuncts L - Labs (maybe a lactic acid), a b g 's, blood type M - monitors N - naso or oro gastric tubes O Oxygen and ETC02 monitors P - pain assessment and management G Reevaluation and Consider the need to Transfer Final step in primary survey H,I Secondary Survery History and Head to toe MIST - prehospital report MOI Injuries sustained S s/s in the field T treatment in the field if patients family present get a better hx on them H Sample is part of history S symptoms associated with injury A allergies and tetanus status M meds currently on including anticoagulant therapy P past medical hx L last oral intake E Events and environment factors related to the injury SAMPLE [Show Less]
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