TNCC Trauma Nursing Core Course 11th
Edition ENA Test Bank |Graded A+ pass
Nonoperative management is standard of care in hemodynamically stable patient. Observed with serial
abdominal exams.
Findings of contrast extravasation may be embolized by IR.
For surgical patients - fluid resuscitation is essential. Risks of surgery include disruption of the natural
tamponade process due to the evacuation of large amounts of blood resulting in hypovolemia.
Hypovolemic Shock - ansCaused by a decrease in the amount of circulating blood volume.
In trauma typically results from hemorrhage, but can result in a precipitous loss of volume, ie vomiting or
diarrhea.
Burn trauma can result in hypovolemic shock from damage to the cell membranes leading to plasma and
protein leakage. of body water, results in inadequate perfusion.
Hyperventilation can cause increased intrathoracic pressure resulting in compression of the heart and
decreased cardiac output.
Initial Assessment - ans1. Preparation and Triage
2. Primary Survey
3. Reevaluation
4. Secondary Survey
5. Reevaluation Adjuncts
6. Reevaluation and Post Resuscitation Care
7. Definitive Care or Transport
Intraocular Foreign Body - ans*TRUE EMERGENCY AND EARLY INTERVENTION IS ESSENTIAL.
Findings: compromised visual acuity, misshapen pupils, pain
Treatment: elevate HOB, ophthalmology, immobilize foreign body, patch UNAFFECTED eye to limit
concomitant eye movement, globe closure ASAP, systemic and ophthalmic ABX, analgesics.
Postop infection, retinal detachment and vision loss are common complications.
lid injury - ans
Liver - ansLargest solid organ of the body. RUQ, 6th to 10th ribs. Encased by Glisson capsule with blood
vessels, lymphatics and nerves. Filters 1.7L of blood per minute.
The liver filters out toxins, takes the nutrients and returns the blood to the heart via the hepatic veins.
Hepatocyte cells are capable of regeneration allowing the liver to repair its own tissue.
Functions: Store and metabolize lipids, transport nutrients, produce glucose and bilirubin, convert
ammonia to urea, secrete electrolytes, lipids, lecithin, cholesterol and bile. Metabolizes vitamin K and
produces thrombin and fibrinogen (all necessary for clotting).
Obstructive Shock - ansResults from hypo perfusion of the tissue due to an obstruction in either the
vasculature or heart.
,TNCC Trauma Nursing Core Course 11th
Edition ENA Test Bank |Graded A+ pass
Tension pneumothorax - increased thoracic pressure leads to displacement of the vena cava, obstruction
to atrial filling, decreased preload and decreased cardiac output.
Cardiac tamponade - impedes diastolic expansion and filling leads to decreased preload, strokes volume
and cardiac output and ultimately end organ perfusion.
P (AVPU) - ansPainful. Responds only to painful stimuli.
(Airway adjunct may be needed while determining need for intubation)
Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identify potentially life-threatening
injuries such as pneumothorax or pelvic fracture with uncontrolled internal hemorrhage. Can also confirm
placement of ET tubes, chest tubes and gastric tubes.
Consider need for transfer.
shock - ansInadequate tissue perfusion.
Spleen - ansEncapsulated organ LUQ level of 9th-11th ribs and curves around a portion of the stomach.
Minimal elasticity and flexibility - most frequent injured organ in blunt trauma.
Secondary lymph organ that filters and cleanses the blood. Removes old RBCs and holds a reserve of
blood. It recycles iron. It removes antibody-coated bacteria. Supplies lymphocytes to stimulate an immune
response to blood borne microorganisms. Stores 200-300ml of blood and leads to hemodynamic instability
quickly if damaged.
Splenic Injuries - ansIn blunt trauma the spleen may lacerate from increased abdominal pressure.
Graded I-V, I = minor trauma
Assessment findings: signs of trauma LUQ, abdominal distention, asymmetry, abnormal contour,
tenderness, guarding, rigidity, pain left shoulder when supine.
CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption, intraparenchymal hematoma or
subcapsular hematoma. Contrast blush or extravasation - hyperdense area that represent traumatic
disruption. Active extravasation implies ongoing bleeding.
Nonoperative management is preferred if hemodynamically stable, stable H/H x 12-24 hours, minimal
transfusion requirements (<2units), grade I or II without blush, age <55, alert able to assist in assessment
of abdomen.
Surgical options: total splenectomy for severe injury, for less severe - direct pressure packing,
embolization, splenorrhaphy (suturing spleen), partial removal.
Asplenic patients have difficulty destroying encapsulated bacteria - Streptococcus pneumonia, Neisseria
meningitides and Haemophilus influenza. At risk for pneumococcal sepsis. Need annual flu shot and q5yr
meningococcal and pneumococcal vaccines.
U (AVPU) - ansUnresponsive. Does not respond to any stimuli.
V (AVPU) - ansVerbal. Needs verbal stimuli to respond.
(Airway adjunct may be needed to prevent tongue obstruction)
A (AVPU) - ansAlert. Will be able to maintain airway once clear.
,TNCC Trauma Nursing Core Course 11th
Edition ENA Test Bank |Graded A+ pass
A (Primary Survey) - ansAirway and alertness with simultaneous cervical spinal stabilization.
Airway Assessment - ansInspect: tongue obstruction, loose/missing teeth, foreign objects, blood, vomitus,
secretions, edema, burns or evidence of inhalation injury
Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor)
Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphysema
Airway Interventions: - ansSuction
Remove foreign body if noted
Jaw thrust maneuver (maintain cspine)
Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag)
Consider definitive airway
Alertness Assessment - ansA-Alert
V-Verbal
P-Painful
U-Unresponsive
B (Primary Survey) - ansBreathing and Ventilation
Breathing and Ventilation Assessment - ansInspect: spontaneous breathing, symmetrical rise and fall,
depth/pattern/rate of respirations, accessory muscle use, diaphragmatic breathing, skin color (normal,
pale, flushed, cyanotic), contusions/abrasions/deformities (signs of underlying injury), open
pneumothoraces (sucking chest wound), JVD, tracheal position, signs of inhalation injury
Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space midclavicular line
and bases at the fifth intercostal space anterior axillary line
Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV pulsations at
suprasternal notch or supraclavicular area
Life-threatening pulmonary injuries requiring immediate intervention: open pneumothorax, tension
pneumothorax, flail chest, hemothorax.
Breathing and Ventilation Intervention - ansBreathing absent: jaw-thrust maneuver, oral airway adjunct,
assist ventilation with bag-mask device, prepare for definitive airway
Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or higher. If ineffective:
assist with bag-mask and determine need for definitive airway
C (Primary Survey) - ansCirculation and Control of Hemorrhage
Cardiogenic Shock - ansResults from pump failure in the presence of adequate intravascular volume.
There is a lack of cardiac output and end-organ perfusion secondary to a decrease in myocardial
contractility and/or valvular insufficiency.
Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic
cause.
Blunt cardiac injury may present similar to MI.
, TNCC Trauma Nursing Core Course 11th
Edition ENA Test Bank |Graded A+ pass
Excess of volume administration or increased after load can result in pulmonary edema and increased
myocardial ischemia.
Inotropic support to improve contractility.
Circulation and Control of Hemorrhage Assessment - ansInspect: Uncontrolled external bleeding, skin
color
Auscultate: Muffled heart sounds - may indicate pericardial tamponade
Palpate: carotid and/or femoral pulses for rate, rhythm, strength
Circulation and Control of Hemorrhage Interventions - ansControl and treat external bleeding: apply direct
pressure, elevate bleeding extremity, apply pressure over arterial sites, consider use of a tourniquet.
2 large bore IVs, if unable consider IO, obtain labs and crossmatch.
Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L.
**Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis and may cause
hypothermia. Component therapy, including administering RBC, plasma and platelets is a balanced
approach so that O2 delivery is optimized, acidosis corrected and coagulopathy prevented.
Classifications of Shock - ansHypovolemic - decrease in the amount of circulating blood volume
Obstructive - obstruction in either the vasculature or heart
Cardiogenic - pump failure in the presence of adequate intravascular volume
Distributive - maldistribution of an adequate circulating blood volume (septic, anaphylactic, neurogenic)
Corneal Abrasion - ansDamage to the corneal epithelium. Easy to evaluate with fluorescein.
Findings: photophobia, tearing, pain, injected conjunctiva (redness), lid swelling, irritation
Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain, ophthalmic NSAIDS to
decrease swelling, oral analgesics, Ophthalmic f/u in 24 hours.
(Do NOT patch - increases infection)
Corneal Foreign Body - ansRoutinely metal, plastic or wood.
Findings: photophobia, pain, injected conjunctiva (redness), lid swelling
Treatment: topical anesthetic, removal of foreign body, ophthalmic ABX, cycloplegics, oral analgesia
Corneal Laceration - ansInvolves one or more layers of the cornea. Visualized with a slit lamp.
Findings: similar to abrasion, pain out of proportion to findings, decreased vision
Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral
and possible surgery
Edition ENA Test Bank |Graded A+ pass
Nonoperative management is standard of care in hemodynamically stable patient. Observed with serial
abdominal exams.
Findings of contrast extravasation may be embolized by IR.
For surgical patients - fluid resuscitation is essential. Risks of surgery include disruption of the natural
tamponade process due to the evacuation of large amounts of blood resulting in hypovolemia.
Hypovolemic Shock - ansCaused by a decrease in the amount of circulating blood volume.
In trauma typically results from hemorrhage, but can result in a precipitous loss of volume, ie vomiting or
diarrhea.
Burn trauma can result in hypovolemic shock from damage to the cell membranes leading to plasma and
protein leakage. of body water, results in inadequate perfusion.
Hyperventilation can cause increased intrathoracic pressure resulting in compression of the heart and
decreased cardiac output.
Initial Assessment - ans1. Preparation and Triage
2. Primary Survey
3. Reevaluation
4. Secondary Survey
5. Reevaluation Adjuncts
6. Reevaluation and Post Resuscitation Care
7. Definitive Care or Transport
Intraocular Foreign Body - ans*TRUE EMERGENCY AND EARLY INTERVENTION IS ESSENTIAL.
Findings: compromised visual acuity, misshapen pupils, pain
Treatment: elevate HOB, ophthalmology, immobilize foreign body, patch UNAFFECTED eye to limit
concomitant eye movement, globe closure ASAP, systemic and ophthalmic ABX, analgesics.
Postop infection, retinal detachment and vision loss are common complications.
lid injury - ans
Liver - ansLargest solid organ of the body. RUQ, 6th to 10th ribs. Encased by Glisson capsule with blood
vessels, lymphatics and nerves. Filters 1.7L of blood per minute.
The liver filters out toxins, takes the nutrients and returns the blood to the heart via the hepatic veins.
Hepatocyte cells are capable of regeneration allowing the liver to repair its own tissue.
Functions: Store and metabolize lipids, transport nutrients, produce glucose and bilirubin, convert
ammonia to urea, secrete electrolytes, lipids, lecithin, cholesterol and bile. Metabolizes vitamin K and
produces thrombin and fibrinogen (all necessary for clotting).
Obstructive Shock - ansResults from hypo perfusion of the tissue due to an obstruction in either the
vasculature or heart.
,TNCC Trauma Nursing Core Course 11th
Edition ENA Test Bank |Graded A+ pass
Tension pneumothorax - increased thoracic pressure leads to displacement of the vena cava, obstruction
to atrial filling, decreased preload and decreased cardiac output.
Cardiac tamponade - impedes diastolic expansion and filling leads to decreased preload, strokes volume
and cardiac output and ultimately end organ perfusion.
P (AVPU) - ansPainful. Responds only to painful stimuli.
(Airway adjunct may be needed while determining need for intubation)
Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identify potentially life-threatening
injuries such as pneumothorax or pelvic fracture with uncontrolled internal hemorrhage. Can also confirm
placement of ET tubes, chest tubes and gastric tubes.
Consider need for transfer.
shock - ansInadequate tissue perfusion.
Spleen - ansEncapsulated organ LUQ level of 9th-11th ribs and curves around a portion of the stomach.
Minimal elasticity and flexibility - most frequent injured organ in blunt trauma.
Secondary lymph organ that filters and cleanses the blood. Removes old RBCs and holds a reserve of
blood. It recycles iron. It removes antibody-coated bacteria. Supplies lymphocytes to stimulate an immune
response to blood borne microorganisms. Stores 200-300ml of blood and leads to hemodynamic instability
quickly if damaged.
Splenic Injuries - ansIn blunt trauma the spleen may lacerate from increased abdominal pressure.
Graded I-V, I = minor trauma
Assessment findings: signs of trauma LUQ, abdominal distention, asymmetry, abnormal contour,
tenderness, guarding, rigidity, pain left shoulder when supine.
CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption, intraparenchymal hematoma or
subcapsular hematoma. Contrast blush or extravasation - hyperdense area that represent traumatic
disruption. Active extravasation implies ongoing bleeding.
Nonoperative management is preferred if hemodynamically stable, stable H/H x 12-24 hours, minimal
transfusion requirements (<2units), grade I or II without blush, age <55, alert able to assist in assessment
of abdomen.
Surgical options: total splenectomy for severe injury, for less severe - direct pressure packing,
embolization, splenorrhaphy (suturing spleen), partial removal.
Asplenic patients have difficulty destroying encapsulated bacteria - Streptococcus pneumonia, Neisseria
meningitides and Haemophilus influenza. At risk for pneumococcal sepsis. Need annual flu shot and q5yr
meningococcal and pneumococcal vaccines.
U (AVPU) - ansUnresponsive. Does not respond to any stimuli.
V (AVPU) - ansVerbal. Needs verbal stimuli to respond.
(Airway adjunct may be needed to prevent tongue obstruction)
A (AVPU) - ansAlert. Will be able to maintain airway once clear.
,TNCC Trauma Nursing Core Course 11th
Edition ENA Test Bank |Graded A+ pass
A (Primary Survey) - ansAirway and alertness with simultaneous cervical spinal stabilization.
Airway Assessment - ansInspect: tongue obstruction, loose/missing teeth, foreign objects, blood, vomitus,
secretions, edema, burns or evidence of inhalation injury
Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor)
Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphysema
Airway Interventions: - ansSuction
Remove foreign body if noted
Jaw thrust maneuver (maintain cspine)
Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag)
Consider definitive airway
Alertness Assessment - ansA-Alert
V-Verbal
P-Painful
U-Unresponsive
B (Primary Survey) - ansBreathing and Ventilation
Breathing and Ventilation Assessment - ansInspect: spontaneous breathing, symmetrical rise and fall,
depth/pattern/rate of respirations, accessory muscle use, diaphragmatic breathing, skin color (normal,
pale, flushed, cyanotic), contusions/abrasions/deformities (signs of underlying injury), open
pneumothoraces (sucking chest wound), JVD, tracheal position, signs of inhalation injury
Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space midclavicular line
and bases at the fifth intercostal space anterior axillary line
Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV pulsations at
suprasternal notch or supraclavicular area
Life-threatening pulmonary injuries requiring immediate intervention: open pneumothorax, tension
pneumothorax, flail chest, hemothorax.
Breathing and Ventilation Intervention - ansBreathing absent: jaw-thrust maneuver, oral airway adjunct,
assist ventilation with bag-mask device, prepare for definitive airway
Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or higher. If ineffective:
assist with bag-mask and determine need for definitive airway
C (Primary Survey) - ansCirculation and Control of Hemorrhage
Cardiogenic Shock - ansResults from pump failure in the presence of adequate intravascular volume.
There is a lack of cardiac output and end-organ perfusion secondary to a decrease in myocardial
contractility and/or valvular insufficiency.
Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic
cause.
Blunt cardiac injury may present similar to MI.
, TNCC Trauma Nursing Core Course 11th
Edition ENA Test Bank |Graded A+ pass
Excess of volume administration or increased after load can result in pulmonary edema and increased
myocardial ischemia.
Inotropic support to improve contractility.
Circulation and Control of Hemorrhage Assessment - ansInspect: Uncontrolled external bleeding, skin
color
Auscultate: Muffled heart sounds - may indicate pericardial tamponade
Palpate: carotid and/or femoral pulses for rate, rhythm, strength
Circulation and Control of Hemorrhage Interventions - ansControl and treat external bleeding: apply direct
pressure, elevate bleeding extremity, apply pressure over arterial sites, consider use of a tourniquet.
2 large bore IVs, if unable consider IO, obtain labs and crossmatch.
Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L.
**Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis and may cause
hypothermia. Component therapy, including administering RBC, plasma and platelets is a balanced
approach so that O2 delivery is optimized, acidosis corrected and coagulopathy prevented.
Classifications of Shock - ansHypovolemic - decrease in the amount of circulating blood volume
Obstructive - obstruction in either the vasculature or heart
Cardiogenic - pump failure in the presence of adequate intravascular volume
Distributive - maldistribution of an adequate circulating blood volume (septic, anaphylactic, neurogenic)
Corneal Abrasion - ansDamage to the corneal epithelium. Easy to evaluate with fluorescein.
Findings: photophobia, tearing, pain, injected conjunctiva (redness), lid swelling, irritation
Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain, ophthalmic NSAIDS to
decrease swelling, oral analgesics, Ophthalmic f/u in 24 hours.
(Do NOT patch - increases infection)
Corneal Foreign Body - ansRoutinely metal, plastic or wood.
Findings: photophobia, pain, injected conjunctiva (redness), lid swelling
Treatment: topical anesthetic, removal of foreign body, ophthalmic ABX, cycloplegics, oral analgesia
Corneal Laceration - ansInvolves one or more layers of the cornea. Visualized with a slit lamp.
Findings: similar to abrasion, pain out of proportion to findings, decreased vision
Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral
and possible surgery
