TNCC Study Guide
What roles are vital to a trauma team? - answer 1. Patient
2. Team leader
3. Core team
4. Contingency and support services
What are the characteristics of an effective team? - answer 1. Clear roles and
responsibilities
2. Shared mental model
3. Optimize resources
4. Strong team leadership
5. Engage in regular discipline of feedback
6. Strong sense of collective trust and confidence
7. Create mechanisms to cooperate and coordinate
8. Manage and optimize performance outcomes
9. Interdependent and adaptive
What are the key foundations to successful teamwork in the care of the trauma patient?
- answer 1. Communication
2. Cooperation
3. Coordination
What tools can be used to promote communication within a team member? What are
the benefits of each? - answer 1. *SBAR:* Situation, Background, Assessment,
Recommendations-To provide a framework for communication among members of the
healthcare team
2. *DESC:* Describe the specific situation or behavior, Express your concerns or how
the situation makes you feel, Suggest alternatives and seek agreement, state
Consequences in terms of impact on performance goals-Used in conflict management,
paraphrasing the other person's comments is an important technique that should be
done throughout the DESC support
3. *CUS:* I am Concerned, I am Uncomfortable, This is a Safety issue/I am Stressed-
Used to "stop the line" if a team member senses or discovers an essential safety breach
Kinematics - answer The study of energy transfer as it applies to identifying actual or
potential injuries
Biomechanics - answer The general study of forces and their effects
,Mechanism of Injury - answer How external energy forces in the environment are
transferred to the body
Newton's First Law of Motion - answer A body rest will remain at rest, and a body in
motion will stay in motion
Newton's Second Law of Motion - answer Force = mass x acceleration
Newton's Third Law of Motion - answer For every action, there is an equal and
opposite reaction
Law of Conservation of Energy - answer Energy can neither be created nor
destroyed, but can change form
Describe how Newton's Laws of Motion and the Law of Conservation affect energy
transfer in traumatic injury, and give an example - answer -1st: weight and speed are
reasonable substitutions for mass and velocity, higher mass and/or higher speed
delivers greater energy
-2nd: an object's velocity changes when it is subjected to an external force; heavier
objects require more force to accelerate (or decelerate) them
-3rd:
-Conservation:
Ex: pot vs. child
-1st: the force of gravity holds the pot on the flat stovetop until energy is transferred to
the pot, such as by a toddler, grabbing the handle.Once the pot is in motion, it will
sustain its motion until interrupted by another force. As the pot strikes the child in the
head, the strength of bone imposes a force of resistance upon impact, thereby changing
the directional path of the pot. The stationary head stays in a fixed position until a
volume of energy adequate to move the head is transferred to it. This concept of
movement-energy transfer-countermovement applies to all mechanical traumas
-2nd: the pot continues to fall at a steady rate unless it is acted on by an outside force (a
hand pushing it out of the way or catching it)
-3rd: the transfer causes a redirection of the pot and movement of the head, as well as
energy absorption causing anatomic changes to the tissue that received the energy
transfer
-Conservation: energy is not created, nor it is destroyed at the site where the pot
impacts the head. Instead, energy is transferred from the kinetic (moving) object to the
object being impacted
What are the five forms in which energy exist? - answer 1. *Mechanical:* energy
transfer form one object to another in the form of motion
2. *Thermal:* energy transfer of heat in the environment to the host
3. *Chemical:* heat energy transfer from active chemical substances, chlorine, drain
cleaner, acids, or plants
4. *Electrical:* energy transfer from light socket, power lines, or lightning
,5. *Radiant:* energy transfer from blast sound waves, radioactivity such as a nuclear
facility, or rays of the sun
Differentiate between internal and external forces of energy transfer in the context of
trauma - answer *External forces:*
-Can be exerted on the body by deceleration, acceleration, compression forces
-Deceleration forces include those applied in falls and collisions where injuries are
cause by a sudden stop in the body's motion
-Acceleration forces are not as common as deceleration forces and result from a
sudden and rapid onset of motion, like a parked car that is hit y vehicle traveling at the
high rate of speed
-Compression force is an external force applied at time of impact, like stationary
objects-dashboards or steering wheels that collide with or push up into a person.
Objects in motion-bullets, stabbing, bats, balls, fists and feet, or heavy falling objects
-Blast forces
*Internal forces:*
-Stress describes the internal force that resists the applied external force
-Stress is exerted on the body as tissues and organs change their dimensions
-Body tissues respond differently to energy impact, and the capacity to withstand energy
transfer is based on the characteristics, combined with biomechanics and MOIs
-The strength of bone varies and can be augmented by adjacent muscle systems
-Solid organs tolerated pressure-wave energy better than air-filled organs
-Air-filled organs can often resist shear forces better than solid organs
How do internal forces protect the body from injury? - answer -*Compression
strength:* ability of tissue to resist crush injury or force
-*Tensile strength:* ability to resist being pulled apart when stretched
-*Shear strength:* ability to resist a force applied parallel to the tissue
The various strengths of tissue, especially bone, can be augmented or diminished by
the pre-event circumstances. The muscle density surrounding bone absorbs energy of
compressing and shearing forces. Tensile strength is augmented by the strength of
opposing muscles. The tissue most proximal to the point of impact is affected by the
maximum amount of energy from the object striking the tissue, or maximal energy. As
energy transverses tissue, it is absorbed by cells. As a result of this cellular energy
absorption, the net energy available for transfer is attenuated over distance
-If the flat bottom of the pot fell squarely on top of the toddler's head, the tissue would
be strained primarily by the transfer of compressive energy-soft tissue flattens, and
depending on the amount of energy transfer present, tissues may rupture, the
microvasculature may rupture resulting in a hematoma, or skin may rupture resulting in
laceration, or bone may be crushed resulting in fracture
-If the pot struck the toddler on the side of the head in a glancing manner, the skin may
experience tensile or stretching strain more than compression strain. Skin
, characteristically stretches; however, if the energy transfer is sufficient to exceed skin's
tensile strength, a laceration is likely to result
List the four main types of traumatic injury and give an example of each - answer 1.
*Blunt trauma:* falls, MVA, vehicle vs. pedestrian collisions, assaults
2. *Penetrating trauma:* gunshots, cavitation
3. *Thermal trauma:* burns
4. *Blast trauma:* explosions
Differentiate between deceleration and acceleration forces - answer *Deceleration
forces:* occurs as energy that is dispersed from the moving object. For example, a body
sliding across pavement transfers energy to the pavement through friction
*Acceleration forces:* the sample principles used to describe deceleration forces apply
to acceleration forces. For example, as energy is slowly transferred to the stationary
pieces of gravel, the gravel accelerates while the body and internal organs continue to
travel as a single entity
What environmental and pathophysiologic factors are considered when the mechanism
of injury is a fall? - answer Consider the old adult who becomes dizzy and falls from
a standing position. The energy transfer begins as the patient begins to fall through the
air. When the patient falls to the ground, the impact of the ground or floor causes energy
to transfer and injuries related to the following:
1. The point of impact on the patient's body (head, hip, outstretched arm) determines
the major point of energy transfer and underlying injuries or tissues impacted
2. The type of surface that is hit (tile floor, grassy yard, carpeted floor) and the extent
that surface can absorb the energy affects injuries. Carpet and grass can help to absorb
energy, but tile does not
3. The tissue's ability to resist also affects potential injuries, bone is less flexible than
soft tissue. Air-filled organs may rupture; solid organs may fracture
4. If a person is pushed or accidentally knocked down, acceleration increases, causes
additional transfer of energy, and results in a greater impact on deceleration
Describe the three impacts in the motor vehicle impact sequence - answer 1. The
first impact occurs when the vehicle hits another object such asa tree. The occupants
experience a relative acceleration as the vehicle stops over the distance of the crushing
metal, but they have not begun to absorb the energy if the abrupt vehicle stop
2. The second impact occurs when the vehicle occupant collides with the interior of the
vehicle, yet the internal organs continue in motion. After the initial impact, the occupant
continues to move in the original direction of travel until they collide with the interior of
the vehicle or meet the resistance of a seatbelt or airbag
3. The third impact occurs when internal structures collide within the body cavity. The
organs meet the resistance of the structures that encapsulate them and/or are town
loose and continue in motion until they meet the resistance of another structure
Define the five mechanisms of injury in blast trauma - answer 1. *Primary:* injuries
are found in those closest to the detonation, with enclosed space detonation resulting in
What roles are vital to a trauma team? - answer 1. Patient
2. Team leader
3. Core team
4. Contingency and support services
What are the characteristics of an effective team? - answer 1. Clear roles and
responsibilities
2. Shared mental model
3. Optimize resources
4. Strong team leadership
5. Engage in regular discipline of feedback
6. Strong sense of collective trust and confidence
7. Create mechanisms to cooperate and coordinate
8. Manage and optimize performance outcomes
9. Interdependent and adaptive
What are the key foundations to successful teamwork in the care of the trauma patient?
- answer 1. Communication
2. Cooperation
3. Coordination
What tools can be used to promote communication within a team member? What are
the benefits of each? - answer 1. *SBAR:* Situation, Background, Assessment,
Recommendations-To provide a framework for communication among members of the
healthcare team
2. *DESC:* Describe the specific situation or behavior, Express your concerns or how
the situation makes you feel, Suggest alternatives and seek agreement, state
Consequences in terms of impact on performance goals-Used in conflict management,
paraphrasing the other person's comments is an important technique that should be
done throughout the DESC support
3. *CUS:* I am Concerned, I am Uncomfortable, This is a Safety issue/I am Stressed-
Used to "stop the line" if a team member senses or discovers an essential safety breach
Kinematics - answer The study of energy transfer as it applies to identifying actual or
potential injuries
Biomechanics - answer The general study of forces and their effects
,Mechanism of Injury - answer How external energy forces in the environment are
transferred to the body
Newton's First Law of Motion - answer A body rest will remain at rest, and a body in
motion will stay in motion
Newton's Second Law of Motion - answer Force = mass x acceleration
Newton's Third Law of Motion - answer For every action, there is an equal and
opposite reaction
Law of Conservation of Energy - answer Energy can neither be created nor
destroyed, but can change form
Describe how Newton's Laws of Motion and the Law of Conservation affect energy
transfer in traumatic injury, and give an example - answer -1st: weight and speed are
reasonable substitutions for mass and velocity, higher mass and/or higher speed
delivers greater energy
-2nd: an object's velocity changes when it is subjected to an external force; heavier
objects require more force to accelerate (or decelerate) them
-3rd:
-Conservation:
Ex: pot vs. child
-1st: the force of gravity holds the pot on the flat stovetop until energy is transferred to
the pot, such as by a toddler, grabbing the handle.Once the pot is in motion, it will
sustain its motion until interrupted by another force. As the pot strikes the child in the
head, the strength of bone imposes a force of resistance upon impact, thereby changing
the directional path of the pot. The stationary head stays in a fixed position until a
volume of energy adequate to move the head is transferred to it. This concept of
movement-energy transfer-countermovement applies to all mechanical traumas
-2nd: the pot continues to fall at a steady rate unless it is acted on by an outside force (a
hand pushing it out of the way or catching it)
-3rd: the transfer causes a redirection of the pot and movement of the head, as well as
energy absorption causing anatomic changes to the tissue that received the energy
transfer
-Conservation: energy is not created, nor it is destroyed at the site where the pot
impacts the head. Instead, energy is transferred from the kinetic (moving) object to the
object being impacted
What are the five forms in which energy exist? - answer 1. *Mechanical:* energy
transfer form one object to another in the form of motion
2. *Thermal:* energy transfer of heat in the environment to the host
3. *Chemical:* heat energy transfer from active chemical substances, chlorine, drain
cleaner, acids, or plants
4. *Electrical:* energy transfer from light socket, power lines, or lightning
,5. *Radiant:* energy transfer from blast sound waves, radioactivity such as a nuclear
facility, or rays of the sun
Differentiate between internal and external forces of energy transfer in the context of
trauma - answer *External forces:*
-Can be exerted on the body by deceleration, acceleration, compression forces
-Deceleration forces include those applied in falls and collisions where injuries are
cause by a sudden stop in the body's motion
-Acceleration forces are not as common as deceleration forces and result from a
sudden and rapid onset of motion, like a parked car that is hit y vehicle traveling at the
high rate of speed
-Compression force is an external force applied at time of impact, like stationary
objects-dashboards or steering wheels that collide with or push up into a person.
Objects in motion-bullets, stabbing, bats, balls, fists and feet, or heavy falling objects
-Blast forces
*Internal forces:*
-Stress describes the internal force that resists the applied external force
-Stress is exerted on the body as tissues and organs change their dimensions
-Body tissues respond differently to energy impact, and the capacity to withstand energy
transfer is based on the characteristics, combined with biomechanics and MOIs
-The strength of bone varies and can be augmented by adjacent muscle systems
-Solid organs tolerated pressure-wave energy better than air-filled organs
-Air-filled organs can often resist shear forces better than solid organs
How do internal forces protect the body from injury? - answer -*Compression
strength:* ability of tissue to resist crush injury or force
-*Tensile strength:* ability to resist being pulled apart when stretched
-*Shear strength:* ability to resist a force applied parallel to the tissue
The various strengths of tissue, especially bone, can be augmented or diminished by
the pre-event circumstances. The muscle density surrounding bone absorbs energy of
compressing and shearing forces. Tensile strength is augmented by the strength of
opposing muscles. The tissue most proximal to the point of impact is affected by the
maximum amount of energy from the object striking the tissue, or maximal energy. As
energy transverses tissue, it is absorbed by cells. As a result of this cellular energy
absorption, the net energy available for transfer is attenuated over distance
-If the flat bottom of the pot fell squarely on top of the toddler's head, the tissue would
be strained primarily by the transfer of compressive energy-soft tissue flattens, and
depending on the amount of energy transfer present, tissues may rupture, the
microvasculature may rupture resulting in a hematoma, or skin may rupture resulting in
laceration, or bone may be crushed resulting in fracture
-If the pot struck the toddler on the side of the head in a glancing manner, the skin may
experience tensile or stretching strain more than compression strain. Skin
, characteristically stretches; however, if the energy transfer is sufficient to exceed skin's
tensile strength, a laceration is likely to result
List the four main types of traumatic injury and give an example of each - answer 1.
*Blunt trauma:* falls, MVA, vehicle vs. pedestrian collisions, assaults
2. *Penetrating trauma:* gunshots, cavitation
3. *Thermal trauma:* burns
4. *Blast trauma:* explosions
Differentiate between deceleration and acceleration forces - answer *Deceleration
forces:* occurs as energy that is dispersed from the moving object. For example, a body
sliding across pavement transfers energy to the pavement through friction
*Acceleration forces:* the sample principles used to describe deceleration forces apply
to acceleration forces. For example, as energy is slowly transferred to the stationary
pieces of gravel, the gravel accelerates while the body and internal organs continue to
travel as a single entity
What environmental and pathophysiologic factors are considered when the mechanism
of injury is a fall? - answer Consider the old adult who becomes dizzy and falls from
a standing position. The energy transfer begins as the patient begins to fall through the
air. When the patient falls to the ground, the impact of the ground or floor causes energy
to transfer and injuries related to the following:
1. The point of impact on the patient's body (head, hip, outstretched arm) determines
the major point of energy transfer and underlying injuries or tissues impacted
2. The type of surface that is hit (tile floor, grassy yard, carpeted floor) and the extent
that surface can absorb the energy affects injuries. Carpet and grass can help to absorb
energy, but tile does not
3. The tissue's ability to resist also affects potential injuries, bone is less flexible than
soft tissue. Air-filled organs may rupture; solid organs may fracture
4. If a person is pushed or accidentally knocked down, acceleration increases, causes
additional transfer of energy, and results in a greater impact on deceleration
Describe the three impacts in the motor vehicle impact sequence - answer 1. The
first impact occurs when the vehicle hits another object such asa tree. The occupants
experience a relative acceleration as the vehicle stops over the distance of the crushing
metal, but they have not begun to absorb the energy if the abrupt vehicle stop
2. The second impact occurs when the vehicle occupant collides with the interior of the
vehicle, yet the internal organs continue in motion. After the initial impact, the occupant
continues to move in the original direction of travel until they collide with the interior of
the vehicle or meet the resistance of a seatbelt or airbag
3. The third impact occurs when internal structures collide within the body cavity. The
organs meet the resistance of the structures that encapsulate them and/or are town
loose and continue in motion until they meet the resistance of another structure
Define the five mechanisms of injury in blast trauma - answer 1. *Primary:* injuries
are found in those closest to the detonation, with enclosed space detonation resulting in
