TNCC Study Guide
What roles are vital to a trauma team? - ans1. Patient
2. Team leader
3. Core team
4. Contingency and support services
What are the characteristics of an effective team? - ans1. 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? -
ans1. Communication
2. Cooperation
3. Coordination
What tools can be used to promote communication within a team member? What are the
benefits of each? - ans1. *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 - ansThe study of energy transfer as it applies to identifying actual or potential
injuries
Biomechanics - ansThe general study of forces and their effects
Mechanism of Injury - ansHow external energy forces in the environment are transferred to
the body
Newton's First Law of Motion - ansA body rest will remain at rest, and a body in motion will
stay in motion
Newton's Second Law of Motion - ansForce = mass x acceleration
,Newton's Third Law of Motion - ansFor every action, there is an equal and opposite reaction
Law of Conservation of Energy - ansEnergy 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 - ans-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? - ans1. *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 -
ans*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? - ans-*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 - ans1. *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 - ans*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? - ansConsider 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
What roles are vital to a trauma team? - ans1. Patient
2. Team leader
3. Core team
4. Contingency and support services
What are the characteristics of an effective team? - ans1. 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? -
ans1. Communication
2. Cooperation
3. Coordination
What tools can be used to promote communication within a team member? What are the
benefits of each? - ans1. *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 - ansThe study of energy transfer as it applies to identifying actual or potential
injuries
Biomechanics - ansThe general study of forces and their effects
Mechanism of Injury - ansHow external energy forces in the environment are transferred to
the body
Newton's First Law of Motion - ansA body rest will remain at rest, and a body in motion will
stay in motion
Newton's Second Law of Motion - ansForce = mass x acceleration
,Newton's Third Law of Motion - ansFor every action, there is an equal and opposite reaction
Law of Conservation of Energy - ansEnergy 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 - ans-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? - ans1. *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 -
ans*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? - ans-*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 - ans1. *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 - ans*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? - ansConsider 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
