TNCC EXAM
1. Preparation and Triage
2. Primary Survery (ABCDE) with resuscitation adjuncts (F,G)
3. Reevaluation (consideration of transfer)
4. Secondary Survey (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
1. Preparation and Triage
2. Primary Survery (ABCDE) with resuscitation adjuncts (F,G)
3. Reevaluation (consideration of transfer)
4. Secondary Survey (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
