TNCC - Trauma Nursing Core Course
A (AVPU) - ANSWER✅✅✅Alert. Will be able to maintain airway once clear.
A (Primary Survey) - ANSWER✅✅✅Airway and alertness with simultaneous cervical spinal
stabilization.
Airway Assessment - ANSWER✅✅✅Inspect: tongue obstruction, loose/missing teeth, foreign
objects, blood, vomitus, secretions, edema, burns or evidence of inhalation injury
Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor)
Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphysema
Airway Interventions: - ANSWER✅✅✅Suction
Remove foreign body if noted
Jaw thrust maneuver (maintain cspine)
Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag)
Consider definitive airway
Alertness Assessment - ANSWER✅✅✅A-Alert
V-Verbal
P-Painful
U-Unresponsive
B (Primary Survey) - ANSWER✅✅✅Breathing and Ventilation
Breathing and Ventilation Assessment - ANSWER✅✅✅Inspect: spontaneous breathing, symmetrical
rise and fall, depth/pattern/rate of respirations, accessory muscle use, diaphragmatic breathing, skin
color (normal, pale, flushed, cyanotic), contusions/abrasions/deformities (signs of underlying injury),
open pneumothoraces (sucking chest wound), JVD, tracheal position, signs of inhalation injury
TNCC - Trauma Nursing Core Course
, TNCC - Trauma Nursing Core Course
Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space midclavicular line
and bases at the fifth intercostal space anterior axillary line
Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV pulsations at
suprasternal notch or supraclavicular area
Life-threatening pulmonary injuries requiring immediate intervention: open pneumothorax, tension
pneumothorax, flail chest, hemothorax.
Breathing and Ventilation Intervention - ANSWER✅✅✅Breathing absent: jaw-thrust maneuver, oral
airway adjunct, assist ventilation with bag-mask device, prepare for definitive airway
Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or higher. If
ineffective: assist with bag-mask and determine need for definitive airway
C (Primary Survey) - ANSWER✅✅✅Circulation and Control of Hemorrhage
Cardiogenic Shock - ANSWER✅✅✅Results from pump failure in the presence of adequate
intravascular volume. There is a lack of cardiac output and end-organ perfusion secondary to a decrease
in myocardial contractility and/or valvular insufficiency.
Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic
cause.
Blunt cardiac injury may present similar to MI.
Excess of volume administration or increased after load can result in pulmonary edema and increased
myocardial ischemia.
Inotropic support to improve contractility.
TNCC - Trauma Nursing Core Course
A (AVPU) - ANSWER✅✅✅Alert. Will be able to maintain airway once clear.
A (Primary Survey) - ANSWER✅✅✅Airway and alertness with simultaneous cervical spinal
stabilization.
Airway Assessment - ANSWER✅✅✅Inspect: tongue obstruction, loose/missing teeth, foreign
objects, blood, vomitus, secretions, edema, burns or evidence of inhalation injury
Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor)
Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphysema
Airway Interventions: - ANSWER✅✅✅Suction
Remove foreign body if noted
Jaw thrust maneuver (maintain cspine)
Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag)
Consider definitive airway
Alertness Assessment - ANSWER✅✅✅A-Alert
V-Verbal
P-Painful
U-Unresponsive
B (Primary Survey) - ANSWER✅✅✅Breathing and Ventilation
Breathing and Ventilation Assessment - ANSWER✅✅✅Inspect: spontaneous breathing, symmetrical
rise and fall, depth/pattern/rate of respirations, accessory muscle use, diaphragmatic breathing, skin
color (normal, pale, flushed, cyanotic), contusions/abrasions/deformities (signs of underlying injury),
open pneumothoraces (sucking chest wound), JVD, tracheal position, signs of inhalation injury
TNCC - Trauma Nursing Core Course
, TNCC - Trauma Nursing Core Course
Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space midclavicular line
and bases at the fifth intercostal space anterior axillary line
Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV pulsations at
suprasternal notch or supraclavicular area
Life-threatening pulmonary injuries requiring immediate intervention: open pneumothorax, tension
pneumothorax, flail chest, hemothorax.
Breathing and Ventilation Intervention - ANSWER✅✅✅Breathing absent: jaw-thrust maneuver, oral
airway adjunct, assist ventilation with bag-mask device, prepare for definitive airway
Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or higher. If
ineffective: assist with bag-mask and determine need for definitive airway
C (Primary Survey) - ANSWER✅✅✅Circulation and Control of Hemorrhage
Cardiogenic Shock - ANSWER✅✅✅Results from pump failure in the presence of adequate
intravascular volume. There is a lack of cardiac output and end-organ perfusion secondary to a decrease
in myocardial contractility and/or valvular insufficiency.
Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic
cause.
Blunt cardiac injury may present similar to MI.
Excess of volume administration or increased after load can result in pulmonary edema and increased
myocardial ischemia.
Inotropic support to improve contractility.
TNCC - Trauma Nursing Core Course
