Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

2024 TNCC test prepa, TNCC Notes for Written Exam, TNCC Notes for Written Exam, TNCC Prep,, Exams of Nursing

2024 TNCC test prepa, TNCC Notes for Written Exam, TNCC Notes for Written Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Gra

Typology: Exams

2024/2025

Available from 10/16/2024

samuel-waweru-1
samuel-waweru-1 🇬🇧

421 documents

1 / 55

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
2024 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
pf3
pf4
pf5
pf8
pf9
pfa
pfd
pfe
pff
pf12
pf13
pf14
pf15
pf16
pf17
pf18
pf19
pf1a
pf1b
pf1c
pf1d
pf1e
pf1f
pf20
pf21
pf22
pf23
pf24
pf25
pf26
pf27
pf28
pf29
pf2a
pf2b
pf2c
pf2d
pf2e
pf2f
pf30
pf31
pf32
pf33
pf34
pf35
pf36
pf37

Partial preview of the text

Download 2024 TNCC test prepa, TNCC Notes for Written Exam, TNCC Notes for Written Exam, TNCC Prep, and more Exams Nursing in PDF only on Docsity!

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
  7. Apnea
  8. GCS 8 or less
  9. Maxillary fractures
  10. Evidence of inhalation injury (facial burns)
  11. Laryngeal or tracheal injury or neck hematoma
  12. High risk of aspiration and patients inability to protect the airway
  13. Compromised or ineffective ventilation - ANSFollowing conditions might require a definitive airway
  14. bony fractures and possible rib fractures, which may impact ventilation
  15. palpate for crepitus
  16. subcutaneous emphysema which may be a sign for a pneumothorax
  17. soft tissue injury - ANSPalpate the chest for
  18. Check the presence of adequate rise and fall of the chest with assisted ventilation
  19. Absence of gurgling on auscultation over the epigastrium
  20. Bilateral breath sounds present on auscultation
  21. Presence of carbon dioxide (CO2) verified by a CO2 device or monitor - ANSIf the pt has a definitive airway in what should you do?
  22. Dyspnea
  23. Tachycardia
  24. Decreased or absent breath sounds on the injured side
  25. CP - ANSSimple Pneumo assessment:
  26. 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:
  27. Get a CT
  28. Consider ABG 's if decreased LOC
  29. Consider glucose check - ANSD Interventions
  30. Hypotension

Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+

2. JVD

  1. Muffled heart sounds - ANSBecks Triad:
  2. open the airway, use jaw thrust
  3. insert an oral airway
  4. assist ventilations with a bag mask
  5. prepare for definitive airway - ANSIf breathing is absent..
  6. pain - hallmark sign, early sign
  7. pressure - early sign
  8. pallor, pules, paresthesia, paralysis - late sign - ANSSix P's of compartment syndrome:
  9. Preparation
  10. Preoxygenation
  11. Pretreatment
  12. Paralysis and Induction
  13. Protecting and positioning - v
  14. Placement of proof - secure the tube
  15. Post intubation - secure ETT Tube, get X-ray for placement - ANSSteps of Rapid Sequence Intubation
  16. Preparation and Triage
  17. Primary Survery (ABCDE) with resuscitation adjuncts (F,G)
  18. Reevaluation (consideration of transfer)
  19. Secondary Survey (HI) with reevaluation adjuncts
  20. Reevaluation and post resuscitation care
  21. Definitive care of transfer to an appropriate trauma nurse - ANSInitial Assessment
  22. Suction the airway 2, Use care to avoid stimulating the gag reflex
  23. 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
  24. The tongue obstructing the airway
  25. loose or missing teeth
  26. foreign objects
  27. blood, vomit, or secretions'
  28. edema
  29. burns or evidence of inhalation injury Auscultiate or listen for:
  30. Obstructive airway sounds such as snoring or gurgling
  31. Possible occlusive maxillofacial bony deformity
  32. 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.

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.

Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+

Ensure two large bore IVS are placed. Prepare for thoracentesis and chest tube insertion. If open thoracotomy is done chest tube is deferred. - ANSHemothorax: 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 - ANSC Colorimetric CO2 detectors provide info about the presence or absence of CO2. A chemically treated indicator strip changes color revealing the presence or absence of exhaled CO2 - ANSQualitative compensated - ANSA 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? Complete - ANSEMS 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? D displaced tube O obstructed or kinked P pneumothorax E equipment failure , such as becoming detached from the equipment or loss of capnopgrahy - ANSDOPE Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define Cushing's triad - ANSBradycardia, progressive hypertension (widening pulse pressure), and decreased respiratory effort Define Hemothorax. - ANSAccumulation of blood in the pleural space. Define Hemothorax. - ANSAccumulation of blood in the pleural space. Define Minor Head Trauma. - ANSGCS 13- Define Minor Head Trauma. - ANSGCS 13- Define Moderate Head Trauma - ANSPostresuscitative state with GCS 9-13. Define Moderate Head Trauma - ANSPostresuscitative state with GCS 9-13. Define Pneumothorax. - ANSResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total collapse of lung may ensue.

Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+

defusings - ANSAll of these are considered a critical communication point in trauma care EXCEPT which of the following? Describe common patterns and severity of injuries in the bariatric trauma patient. - ANS Describe effects of common medications in relation to the older adult trauma patient. - ANS Describe one fat embolism syndrome is most likely to occur in its characteristics - ANSWith longform fractures. Tachycardia, Thrombocytopenia, and petechiae rash. Describe specific injuries associated with interpersonal violence and abuse. - ANS Describe steps to maintain the forensic chain of custody. - ANS Describe techniques to improve the intubation process for the bariatric trauma patient. - ANS Describe the 3 types of external forces of energy transfer in the context of trauma. - ANSDeceleration: Force from a sudden stop in the body's motion Acceleration: Force from a sudden onset in the body's motion Compression: Force from being crushed between objects Describe the 3 types of Internal forces of energy transfer in the context of trauma. - ANSCompression: The ability of the tissue to resist crush injury or force Tension: The ability to resist being pulled apart when stretched Shear: The ability to resist a force applied parallel to the tissue Describe the activities and associated factors related to low-energy trauma in the older adult. - ANS Describe the characteristics of cardiogenic shock - ANSCardiogenic shock results from pump failure in the presence of adequate intravascular volume. Lack of cardiac output and an organ perfusion occurs secondary to a decrease in myocardial contractility and or valvular insufficiency. This can happen with blunt cardiac trauma or an MI. Symptoms can include low blood pressure increase heart rate and respiratory rate chest pain shortness of breath dysrhythmias increase troponin and pale cool moist skin Describe the characteristics of distributive shock. - ANSDistributive shock occurs as a result of Mel distribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. This can occur with spinal cord injuries, sepsis, or anaphylaxis. Symptoms include low blood pressure heart rate respiratory rate preload and afterload, spinal tenderness, difficulty breathing, warm pink and dry skin with a cool core temperature. Describe the characteristics of hypovolemic shock - ANSHypovolemia is caused by a decrease in the amount of circulating volume usually caused by massive bleeding, but also can be from vomiting and diarrhea. Characteristics include low blood pressure and preload, increase heart rate respiratory rate and afterload, with contractility unchanged. Signs include obvious bleeding, weak peripheral pulses, pale cool and moist skin, distended abdomen, pelvic fracture, or bruise swollen and deformed extremities especially long bones. Describe the characteristics of obstructive shock - ANSObstructive shock is it mechanical problem that results from hypoperfusion of the tissue due to an obstruction in either the vasculature or the heart resulting in decreased cardiac output. Some causes include a tension pneumothorax, cardiac tamponade,

Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+

or venous air embolism on the right side of the heart during systole in the pulmonary artery.Signs include anxiety, muffled heart sounds, JVD, hypertension, chest pain, difficulty breathing, or pulses paradoxes. Describe the fluid resuscitation of an older adult patient related to fluid overload, when to administer red blood cells, and the use of anticoagulant medication. - ANS Describe the four types of spinal cord injury - ANSCentral cord injury results in greater weakness distally, anterior injury includes motor loss or weakness below the cord level of injury yet sensory is intact, Brown- Sequard (hemicord) is weak on one side with sensory deficit on opposite side, posterior cord syndrome although rare is when the patient is unable to use sense vibration in proprioception Describe the measurement of an NPA - ANSMeasure from the tip of the patient's nose to the tip of the patients earlobe. Describe the pathophysiologic changes of the systems of the bariatric patient and the effects on trauma resuscitation efforts. - ANS Describe the three impacts in the motor vehicle impact sequence - ANS1. First Impact: Vehicle hits another object

  1. Second Impact: Occupant hits the interior of the vehicle
  2. Third Impact: Organcs hit other internal structures Describe the types of abuse and the associated signs of each. - ANS Describe the usefulness of the Haddon Matrix in prevention and reduction of injury - ANSLooks at 3 phases of the event: Pre-event, event, and post-event. Looks at 4 factors involved in the event: The host (patient), the agent (cause), the physical evironment, and the socioeconomic environment. Countermeasures can be applied at each phase to help reduce injury. Differentiate between the three impacts of motor vehicle impact sequence. - ANSThe first impact occurs when the vehicle collided with another object. The second impact occurs after the initial impact when the occupant continues to move in the original direction of travel until they collide with the interior of the vehicle or meet resistance. The third impact occurs when internal structures collide within the body cavity. Differentiate family and intimate partner violence from community violence. - ANS Disability - Neurologic Status
  3. Assess pupils for equality, shape, and reactivity (PERRL)
  4. Assess GCS (eye opening, verbal response, and motor response) - ANSD Discuss the use and insertion of nasogastric tubes in the bariatric patient. - ANS Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF.

Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+

Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes:

  • MI
  • Blunt cardiac injury
  • Mitral valve insufficiency
  • dysrhythmias
  • Cardiac Failure Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes:
  • MI
  • Blunt cardiac injury
  • Mitral valve insufficiency
  • dysrhythmias
  • Cardiac Failure Explain Distributive Shock. - ANSResults from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Distributive Shock. - ANSResults from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Hepatic Response. - ANSLiver can store excess glucose as glycogen.

Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+

As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hepatic Response. - ANSLiver can store excess glucose as glycogen. As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes:

  • Blood loss
  • Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes:
  • Blood loss
  • Burns, etc. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages will cause compromises to most body systems.
  • Inadequate venous return
  • inadequate cardiac filling
  • decreased coronary artery perfusion
  • Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages will cause compromises to most body systems.
  • Inadequate venous return
  • inadequate cardiac filling
  • decreased coronary artery perfusion
  • Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes:
  • Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume).
  • Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium.

Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+

N - naso or oro gastric tubes O Oxygen and ETC02 monitors P - pain assessment and management - ANSG globe rupture - ANSA 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? H,I - ANSSecondary Survery hemoglobin does not readily release O2 for use by the tissues - ANSWhat is the effect of hypothermia on the oxyhemoglobin dissociation curve? 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 - ANSH How do you assess Mnemonic "D"? - ANSDISABILITY 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 How do you assess Mnemonic "D"? - ANSDISABILITY 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 How do you confirm ET Tube/Alternative Airway Placement? - ANS- 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 confirm ET Tube/Alternative Airway Placement? - ANS- 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

Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+

  • Esophageal detection device
  • Chest x-ray How do you inspect the chest for adequate ventilation? - ANSObserve:
  • mental status
  • RR and pattern
  • chest wall symmetry
  • any injuries
  • patient's skin color (cyanosis?)
  • JVD or tracheal deviation? (Tension pneumothorax) How do you inspect the chest for adequate ventilation? - ANSObserve:
  • mental status
  • RR and pattern
  • chest wall symmetry
  • any injuries
  • patient's skin color (cyanosis?)
  • JVD or tracheal deviation? (Tension pneumothorax) How would you assess a patient with ocular, maxillofacial and neck trauma? - ANS(Initial assessment) HISTORY
  • MOI?
  • Acceleration/Deceleration?
  • What was it caused by?
  • Pt restrained? Airbags deployed? Etc.
  • What are the pt's complaints?
  • Pt normally wear glasses or contacts?
  • Pt have hx of eye problems?
  • Pt ever have eye surgery?
  • Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION:
  • Inspect eye, orbits, face and neck
  • Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas
  • Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents
  • Determine whether lid lac's
  • Assess pupil's (PERRL)
  • Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome
  • Bilateral fixed and pinpoint pupils = pontine lesion or drugs
  • Mildly dilated pupil w/sluggish response may early sign of herniation syndrome
  • Widely dilated pupil occasionally occurs w/direct trauma to globe of eye
  • Assess for consensual response
  • Assess redness, eye watering, blepharospasm
  • Assess extraocular movement, except when an open globe injury is known or suspected.
  • Limitation range of ocular motion may indicate orbital rim fx w/entrapment or paralysis of cranial nerve or ocular muscle
  • Perform visual acuity exam
  • Use Snellen or handheld chart. Check uninjured eye first
  • Assess for blurred or double vision with injured eye and then with both eyes open
  • Inspect for rhinorrhea or otorrhea
  • If drng present, may indicate CSF leak

Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+

How would you assess a pt with a cranial injury? - ANS(Initial assessment) INSPECTION:

  • Assess airway
  • RR, pattern and effort
  • Assess pupil size and response to light
  • Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome
  • Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates
  • Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome
  • Widely dilated pupil occasionally occurs w/direct trauma to globe of eye
  • Determine if pt uses eye meds
  • Abnormal posturing?
  • Inspect craniofacial area for ecchymosis/contusions
  • Periorbital ecchymosis
  • Mastoid's process ecchymosis
  • Blood behind tympanic membrane
  • Inspect nose and ears for drainage
  • Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF
  • If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF
  • Assess extraocular eye movement (Tests cranial nerves, III, IV, VI)
  • Performing extraocular eye movements indicates functioning brainstem
  • Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle
  • Determine LOC with GCS PALPATION
  • Palpate cranial area for:
  • Point tenderness
  • Depressions or deformities
  • Hematomas
  • Assess all 4 extremities for:
  • Motor function, muscle strength and abnormal motor posturing
  • Sensory function DIAGNOSTIC PROCEDURES
  • Lab Studies PLANNING AND IMPLEMENTATION
  • (Initial assessment)
  • Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration.
  • Administer O2 via NRB
  • Assist with early ET intubation
  • Administer sedative/neuromuscular blocking agent
  • Consider hyperventilation
  • PaCO2 above 45 How would you assess a pt with a cranial injury? - ANS(Initial assessment) INSPECTION:
  • Assess airway
  • RR, pattern and effort
  • Assess pupil size and response to light
  • Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome

Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+

  • Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates
  • Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome
  • Widely dilated pupil occasionally occurs w/direct trauma to globe of eye
  • Determine if pt uses eye meds
  • Abnormal posturing?
  • Inspect craniofacial area for ecchymosis/contusions
  • Periorbital ecchymosis
  • Mastoid's process ecchymosis
  • Blood behind tympanic membrane
  • Inspect nose and ears for drainage
  • Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF
  • If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF
  • Assess extraocular eye movement (Tests cranial nerves, III, IV, VI)
  • Performing extraocular eye movements indicates functioning brainstem
  • Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle
  • Determine LOC with GCS PALPATION
  • Palpate cranial area for:
  • Point tenderness
  • Depressions or deformities
  • Hematomas
  • Assess all 4 extremities for:
  • Motor function, muscle strength and abnormal motor posturing
  • Sensory function DIAGNOSTIC PROCEDURES
  • Lab Studies PLANNING AND IMPLEMENTATION
  • (Initial assessment)
  • Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration.
  • Administer O2 via NRB
  • Assist with early ET intubation
  • Administer sedative/neuromuscular blocking agent
  • Consider hyperventilation
  • PaCO2 above 45 How would you assess a pt with a thoracic injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection:
  • Observe chest wall
  • Assess breathing effort and RR
  • Symmetry
  • Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or pericardial tamponade. Flat = external jugular veins may reflect hypovolemia)
  • Inspect upper abdominal region for injury Percussion:
  • Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax) Palpation:
  • Palpate chest wall, clavicles and neck for:
  • Tenderness

Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+

  • Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS = splinting. Shallow = b/c of pain).
  • Auscultate chest for presence of BS (diaphragmatic rupture)
  • Auscultate Heart sounds (muffled = pericardial tamponade)
  • Auscultate neck vessels for bruits (vascular injury) Diagnostic Procedures:
  • Xrays
  • Arteriography
  • Bronchoscopy and laryngoscopy
  • CT's
  • FAST
  • Labs (cardiac enzymes)
  • ECG, CVP How would you assess someone in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect:
  • LOC
  • Rate and quality of respirations
  • External bleeding?
  • Skin color and moisture
  • Assess jugular veins and peripheral veins Auscultate:
  • BP
  • Pulse pressure
  • Breath sounds
  • Heart sounds
  • Bowel sounds Percuss:
  • Chest and abdomen Palpate:
  • Central pulse (carotid or femoral)
  • Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse
  • Palpate peripheral pulses
  • Palpate skin temp and moisture Diagnostic Procedures:
  • Xrays and other studies
  • Labs Planning and Implementation
  • Oxygen
  • IV's with warmed replacement fluids
  • Control external bleeding with direct pressure
  • Elevate LE's
  • NGT
  • Foley
  • Monitor and pulse oximeter
  • Monitor for development of coagulopathies
  • Surgery? How would you assess someone in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect:
  • LOC
  • Rate and quality of respirations
  • External bleeding?

Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Graded A+

  • Skin color and moisture
  • Assess jugular veins and peripheral veins Auscultate:
  • BP
  • Pulse pressure
  • Breath sounds
  • Heart sounds
  • Bowel sounds Percuss:
  • Chest and abdomen Palpate:
  • Central pulse (carotid or femoral)
  • Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse
  • Palpate peripheral pulses
  • Palpate skin temp and moisture Diagnostic Procedures:
  • Xrays and other studies
  • Labs Planning and Implementation
  • Oxygen
  • IV's with warmed replacement fluids
  • Control external bleeding with direct pressure
  • Elevate LE's
  • NGT
  • Foley
  • Monitor and pulse oximeter
  • Monitor for development of coagulopathies
  • Surgery? ICP is a reflection of what three volumes? What happens when one increases? - ANS1. Brain
  1. CSF
  2. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO dilates cerebral blood vessels = increase blood volume and ICP. ICP is a reflection of what three volumes? What happens when one increases? - ANS1. Brain
  3. CSF
  4. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful.