TNCC 9th Edition Practice Questions And Answers 2023

TNCC 9th Edition Practice Questions And Answers MARCH mneumonic - CORRECT ANSWER-Massive Hemorrhage: Control with combat gauze, celox gauze, or chito gauze; replacement of blood loss with whole blood or 1:1:1 ratio of plasma, RBC, and platelets to achieve SBP of 80-90mmHg. Airway: Establish and maintain patent airway Respiration: Decompress suspected tension pneumothorax, seal open chest wounds, and support ventilation and oxygenation as required. Circulation: Provide vascular access (IV/IO) and administer fluids as required to treat shock Head injury/Hypothermia: Prevent or treat hypotension and hypoxia to prevent worsening of TBI and prevent or treat hypothermia. AVPU - CORRECT ANSWER-Assessing Alertness A: Alert and oriented V: Responds to verbal stimuli P: Responds only to painful stimuli U: Unresponsive LACE - CORRECT ANSWER-Soft Tissue Injuries L: Lacerations A: Abrasions, Avulsions C: Contusions E: Edema, Ecchymosis Urinary Catheter Contraindications - CORRECT ANSWER-if urethral transsection is suspected: -blood at the urethral meatus -perineal ecchymosis -scrotal ecchymosis -high-riding or nonpalpable prostate Breathing Intervention Reassessment - CORRECT ANSWER-1. Attach CO2 detector 2. Listen over epigastrum 3. Bilateral breath sounds at midaxillary and midclavicular lines 4. Color change after 6 breaths 5. Monitor skin color; get xr Troubleshooting Ventilator Alarms - CORRECT ANSWER-D: Displaced Tube O: Obstructed or Kinked Tube P: Pneumothorax E: Equipment failure, such as the patient becoming detached from the equipment or loss of capnography Seven P's of RSI - CORRECT ANSWER--Preparation: ensure you have all necessary equipment and personnel. Verify IV sites -Preoxygenation: high flow oxygen for minimum of 3 minutes. Position is HOB elevated to 20 degrees. For spinal precautions, reverse Trendelenburg at 30 degrees. -Pre-intubation optimization: Lidocaine (may reduce risk of rise in ICP during intubation) or Fentanyl (mitigates sympathetic response increased HR and BP during intubation) administration -Paralysis with induction -Protection: after neuromuscular blocking agent is administered, protect the airway from aspiration by avoiding BVM, which can result in regurgitation and aspiration. -Placement with proof: inflate ETT cuff, secure, use ETCO2 for confirmation -Post-intubation management: secure tube and note measurement; xr. Inductions Agents for RSI - CORRECT ANSWER-Etomidate Ketamine Midazolam Propofol Paralysis Agents for RSI - CORRECT ANSWER-Succinylcholine Rocuronium Vecuronium Cerebral Perfusion Pressure (CPP) - CORRECT ANSWER-Normal: 60-100 mm Hg Acceptable: 50-70 mm Hg Hypercarbia - CORRECT ANSWER-PaCO2 45 mmHg Excess of Co2 in the blood, indicated by an elevated PaCO2 as determined by blood gas analysis Intracranial Pressure (ICP) - CORRECT ANSWER-0-15mmHg The pressure of the CSF in the subarachnoid space Mean Arterial Pressure (MAP) - CORRECT ANSWER-50-150mmHg The average blood pressure in a single cardiac cycle, roughly calculated as the SBP + 2 x the DBP/3 Avoid hypoxemia in the patient with head trauma - CORRECT ANSWER-A single episode of hypoxemia (PaO2 60mmHg) can be detrimental to the patient's outcome. Maintain pulse ox at 95% or greater and obtain ABG measurement asap for patient with severe TBI. Maintain ETCO2 between 35-45 mmHg Manage ICP in the patient with head trauma - CORRECT ANSWER-An ICP sustained at greater than 22 mmHg and unresponsive to treatment is associated with poor outcomes Increased ICP Assessment Findings - CORRECT ANSWER-Early: Headache; n/v; amnesia; behavior changes (restlessness, impaired judgement; drowsiness); altered level of consciousness (hyperarousability and hypoarousability) Late: Dilated, nonreactive pupils; unresponsive to verbal or painful stimuli; abnormal motor posturing (flexion, extension, flaccidity); Cushing response: Widening pulse pressure, reflex bradycardia, and decreased respiratory effort. Corneal Injury - CORRECT ANSWER-Assessment Findings: Photophobia, pain, eye redness, lid swelling, FB sensation Treatment: Topical anesthesia, topical ophthalmic NSAID, no eye patch, remove FB, may need topical abx for laceration. Follow up: with ophthalmologist in 24-48 hours; ophthalmology consultation for deep and large FB Orbital Fracture - CORRECT ANSWER-Assessment Findings: Periorbital ecchymosis, facial swelling, double vision, enophthalmos (posterior displacement of eyeball within orbit, ptosis. Treatment: Nasal decongestant, ice packs to the orbit for 48 hours, oral abx Follow up: May require surgery, ophthalmology. Avoid blowing nose, sneezing, and Valsalva maneuver Retrobulbar hematoma - CORRECT ANSWER-Assessment Findings: Severe pain, decreased vision or loss of vision, reduced eye movement, double vision, IOP 40mmHg Treatment: Administer medications to decrease IOP, emergency decompression via lateral canthotomy Follow up: Emergent consultation with ophthalmology Globe Rupture - CORRECT ANSWER-Assessment Findings: Irregular or teardropshaped pupils, periorbital ecchymosis, decreased visual acuity and EOM, severe subconjunctival hemorrhage, deep eye pain, nausea Treatment: Avoid any pressure on the globe, apply a rigid shielf to protect the affected eye, consider tetanus vaccine, keep patient NPO, assess and treat pain, administer antiemetics to decrease risk of n/v, elevate the HOB to decrease IOP, avoid ophthalmic drops or medications, administer systemic abx Follow up: Emergency consultation with ophthalmology; prepare pt for CT scan and OR Ocular Burns - CORRECT ANSWER-Assessment Findings: Swelling of the sclera, conjunctival irritation, corneal clouding (may be indicative of severe burn, pain Treatment: Determine baseline pH of the eye, topical anesthesia, immediate copious irrigation until the pH returns to normal range (7.4) which may require 2L of irrigating solution, visual acuity reassessment