TNCC LATEST EDITION (2024): QUESTIONS AND ANSWERS

TNCC LATEST EDITION (2024): QUESTIONS AND ANSWERS Caregivers carry a 2-year-old into the emergency department who fell out of a second-story window. The patient is awake and crying with increased work of breathing and pale skin. Which of the following interventions has the highest priority? - ANSWER Padding the upper back while stabilizing the cervical spine You are treating a 27-year old male in respiratory distress who was involved in a house fire. Calculating total body surface area (TBSA) burned is deferred due to the need for emergent intubation. A what rate should you begin fluid resusitation? - ANSWER 500 ml/hour Which of the following is a component of the trauma triad of death? - ANSWER acidosis Patients with a crush injury should be monitored for which of the following conditions? - ANSWER dysrhythmias What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation? - ANSWER Pulse oximetry and capnography The most reassuring finding for a male patient with hip pain after a fall is which of the following? - ANSWER Pelvic stability The best measure of the adequacy of cellular perfusion and helps to predict the outcome of resuscitation - ANSWER Base deficit Examples of primary blast injuries - ANSWER Blast lung, ruptured tympanic membrane, TBI, abdominal hemorrhage Examples of secondary blast injuries - ANSWER Wounds from debris and bomb fragments Examples of tertiary blast injuries - ANSWER Blunt or penetrating trauma from the body being thrown by the blast Examples of quaternary blast injuries - ANSWER Injuries or illness related to explosion: burns, toxic injury from chemicals Examples of quinary blast injuries - ANSWER Injuries associated with exposure to hazardous materials from the components of the blast Questions to ask for airway assessment (need 4) - ANSWER Is the tongue obstructing? Are there any foreign objects? Is there any edema? Are there loose or missing teeth? Is there snoring, gurgling, or stridor? Is there bony deformity? Is there blood, vomit, or secretions? Questions to ask during breathing assessment. (Need 4) - ANSWER Is there symmetrical chest rise? Is there spontaneous breathing? Is there tracheal deviation or JVD? What is their skin color? Are there open wounds or deformities in the chest? What's the depth, pattern, and rate of respirations? Is there increased work of breathing? Are breath sounds present and equal? 3 ways to assess ETT placement - ANSWER 1. Apply end tidal, assess CO2 after 5-6 breaths 2. Assess for symmetrical chest wall rise and fall 3. Auscultation over the epigastrium for gurgling and bilateral breath sounds. What do you document after placing an ETT? - ANSWER ETT placement at teeth or gums Situations that require a definitive airway - ANSWER GCS 8 or less Apnea Inhalation injury Increased risk of aspiration Anticipate decreased neuro status Severe maxo fractures Laryngeal/tracheal injury Where do you listen for breath sounds? - ANSWER 2nd intercostal space at midclavicular line and 5th intercostal space at anterior axillary line King airway - ANSWER A multidimensional esophageal airway that traps the glottis opening between an esophageal cuff and an oropharyngeal cuff 3 things to assess for circulation - ANSWER Palpate central pulse Assess (again) for external hemorrhage Inspect and palpate skin for color, temp, and moisture. When do you establish IV access? - ANSWER Right after the circulatory assessment At what point to you evaluate need for transfer or definitive care? - ANSWER After the primary survey How do you palpate the iliac crests? - ANSWER Downward and medially The 3 components of the pediatric assessment triangle - ANSWER Skin circulation, work of breathing, general appearance What type of fluids should you give kids with normal blood glucose? - ANSWER Fluids with dextrose to prevent hypoglycemia How much fluid do you give a kid? - ANSWER 20mL/kg What assessment finding gives concern for severe brain injury? - ANSWER Bulging fontanels Parkland formula - ANSWER 3mL x the weight in kg x % TBSA = the fluid to go over 24 hours How do you give the fluid over 24 hours in parkland formula? - ANSWER First half over 8 hours and second half over 16 hours Normal baseline FHR - ANSWER 120-160 What does Kleihaver-Betke test for? - ANSWER Tests for fetal RBCs I. Maternal circulation, which is abnormal and could indicate fetomaternal hemorrhage has occurred Symptoms of abruptly placentae - ANSWER Dark red bleeding, sudden sharp abdominal pain, "board-like" uterus, increased FHR Symptoms of uterine rupture - ANSWER Sudden sharp abdominal or suprapibic pain, asymmetry of uterus, decreased FHR What degree to you tilt the supine pregnant patient to prevent supine hypotension? - ANSWER 15 degrees 3 parts of the trauma triad of death - ANSWER Hypothermia, coagulopathy, metabolic acidosise Examples of obstructive shock - ANSWER Tension pneumo, cardiac tamponade, pulmonary artery embolism Symptoms of stage 1 of shock - ANSWER Change in neuro status, increased DBP, decreased UO, tachycardia Symptoms of stage 2 of shock - ANSWER Declining neuro status, tachycardia, narrow pulse pressure, weak thready pulse, cool skin, abnormal base deficit, increased lactate symptoms of epidural hematoma - ANSWER Transient LOC with a lucid period, HA, N/V, rapidly declining neuro status For what reasons would you not give mannitol? - ANSWER An active bleed or hypotension What is Beck triad for cardiac tamponade? - ANSWER Hypotension, distended neck veins, muffled heart sounds Solid abdominal organs and what are they prone to? - ANSWER Liver, spleen, gallbladder, pancreas, prone to lacerations Hollow abdominal organs and what are they prone to - ANSWER Stomach, bowels, uterus, bladder, prone to rupture Big symptom of splenic injury - ANSWER Left shoulder pain Where do you secure a pelvic binder? - ANSWER At the level of the greater trochanter and symphysis pubis What is Turners sign? - ANSWER Ecchymosis over the flank at the 11th and 12th ribs, in renal injury What organs do you ultrasound in a FAST exam? - ANSWER Bladder, liver, spleen What kind of dressing do you apply to an open pneumo? - ANSWER Nonporous dressing (petroleum gauze or plastic wrap) and tape on 3 sides The trauma nurse knows that placing a bariatric patient in a "ramped position" provides better visualization during the insertion of which device? - ANSWER endotracheal tube Tearing of the bridging veins is most frequently associated with which brain injury? - ANSWER subdural hematoma A patient is found lying on the floor after falling 13 hours ago. Which of the following laboratory values is expected with a musculoskeletal complication associated with this presentation? - ANSWER Elevated creatine kinase A patient is brought to the emergency department of a rural hospital following a high-speed motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, which of the following is the priority intervention? - ANSWER Initiate transfer to a trauma center