TNCC WRITTEN EXAM QUESTIONS AND
ANSWERS
What6are6the6late6signs6of6breathing6compromise?6-6ans---6Tracheal6deviation
6-6JVD
What6are6signs6of6ineffective6breathing?6-6ans---6AMS
6-6Cyanosis,6especially6around6the6mouth
6-6Asymmetric6expansion6of6chest6wall
6-6Paradoxical6movement6of6the6chest6wall6during6inspiration6and6expiration
6-6Use6of6accessory6muscles6or6abdominal6muscles6or6both6or6diaphragmatic6breathing
6-6Sucking6chest6wounds6
6-6Absent6or6diminished6breath6sounds
6-6Administer6O26via6NRB6or6assist6ventilations6with6a6bag-mask6device,6as6indicated
6-6Anticipate6definitive6airway6management6to6support6ventilation.
Upon6initial6assessment,6what6type6of6oxygen6should6be6used6for6a6pt6breathing6effective
ly?6-6ans--A6tight-fitting6nonrebreather6mask6at612-156lpm.
What6intervention6should6be6done6if6a6pt6presents6with6effective6circulation?6-6ans---
6Insert626large6caliber6IV's
6-6Administer6warmed6isotonic6crystalloid6solution6at6an6appropriate 6rate
What6are6signs6of6ineffective6circulation?6-6ans---6Tachycardia
6-6AMS
6-6Uncontrolled6external6bleeding
6-6Pale,6cool,6moist6skin
6-6Distended6or6abnormally6flattened6external6jugular6veins
6-6Distant6heart6sounds
What6are6the6interventions6for6Effective/Ineffective6Circulation?6-6ans---
6Control6any6uncontrolled6external6bleeding6by:
6-6Applying6direct6pressure6over6bleeding6site
6-6Elevating6bleeding6extremity
6-6Applying6pressure6over6arterial6pressure6points
6-6Using6tourniquet6(last6resort).
6-6Cannulate626large-caliber6IV's6and6initiate6infusions6of6an6isotonic6crystalloid6solution
6-6Use6warmed6solution
, - Use6pressure6bags6to6increase6speed6of6IVF6infusion
6 6
6-6Use6blood6administration6tubing6for6possible6administration6of6blood
6-6Use6rapid6infusion6device6based6on6protocol
6-6Use6NS60.9%6in6same6tubing6as6blood6product
6-6IV6=6surgical6cut-down,6central6line,6or6both.
6-6Blood6sample6to6determine6ABO6and6Rh6group
6-6IO6in6sternum,6legs,6arms6or6pelvis
6-6Administer6blood6products
6-6PASG6(without6interfering6with6fluid6resuscitation)
What6are6factors6that6contribute6to6ineffective6ventilation?6-6ans---6AMS
6-6LOC
6-6Neurologic6injury
6-6Spinal6Cord6Injury
6-6Intracranial6Injury
6-6Blunt6trauma
6-6Pain6caused6by6rib6fractures
6-6Penetrating6Trauma
6-6Preexisting6hx6of6respiratory6diseases
6-6Increased6age
What6medications6are6used6during6intubation?6-6ans--LOAD6Mnemonic:
6L6=6Lidocaine
6O6=6Opioids
6A6=6Atropine
6D6=6Defasiculating6agents
What6are6the6Rapid6Sequence6Intubation6Steps?6-6ans--PREPARATION:6
6-6gather6equipment,6staffing,6etc.
PREOXYGENATION:6
6-6Use6100%6O26(prevent6risk6of6aspiration).
PRETREATMENT:6
6-6Decrease6S/E's6of6intubation
PARALYSIS6WITH6INDUCTION:6
6-6Pt6has6LOC,6then6administer6neuromuscular6blocking6agent
PROTECTION6AND6POSITIONING:6
6-6Apply6pressure6over6cricoid6cartilage6(minimizes6likelihood6of6vomiting6and6aspiration
PLACEMENT6WITH6PROOF
6-6Each6attempt6NOT6to6exceed6306seconds,6max6of636attempts.6Ventilate6pt630-
606seconds6between6attempts.
6-6After6intubation,6inflate6the6cuff
6-6Confirm6tube6placement6w/exhaled6CO26detector.
POSTINTUBATION6MANAGEMENT:
6-6Secure6ET6tube
6-6Set6ventilator6settings
6-6Obtain6Chest6x-ray
, - Continue6to6medicate
6 6
6-6Recheck6VS6and6pulse6oxtimetry
What6is6a6Combitube?6-6ans--A6dual-lumen,6dual-
cuff6airway6that6can6be6placed6blindly6into6the6esophagus6to6establish6an6airway.6If6inadv
ertently6placed6into6trachea,6it6can6be6used6as6a6temporary6ET6tube.6There6are6only6two6
sizes:6small6adult6and6larger6adult.
What6is6a6Laryngeal6Mask6Airway?6-6ans--
Looks6like6an6ET6tube6but6is6equipped6with6an6inflatable,6elliptical,6silicone6rubber6collar6
at6the6distal6end.6It6is6designed6to6cover6the6supraglottic6area.6
ILMA,6does6not6require6laryngoscopy6and6visualization6of6the6chords.
What6is6Needle6Cricothyrotomy6-6ans--
Percutaneous6transtracheal6ventilation.6(temporary)
Complications6include:6
6-6inadequate6ventilation6causing6hypoxia
6-6hematoma6formation
6-6esophageal6perforation
6-6aspiration
6-6thyroid6perforation
6-6subcutaneous6emphysema
What6is6Surgical6Cricothyrotomy?6-6ans--
Making6an6incision6in6cricothyroid6membrane6and6placing6a6cuffed6endo6or6trach6tube6int
o6trachea.6This6is6indicated6when6other6methods6of6airway6management6have6failed6and6
pt6cannot6be6adequately6ventilated6and6oxygenated.6
Complications6include:
6-6Aspiration
6-6Hemorrhage6or6hematoma6formation6or6both
6-6Lac6to6trachea6or6esophagus
6-6Creation6of6a6false6passage
6-6Laryngeal6stenosis
How6do6you6confirm6ET6Tube/Alternative6Airway6Placement?6-6ans---
6Visualization6of6the6chords
6-6Using6bronchoscope6to6confirm6placement
6-
6Listening6to6breath6sounds6over6the6epigastrum6and6chest6walls6while6ventilating6the6pt
6-6CO26detector
6-6Esophageal6detection6device
6-6Chest6x-ray
ANSWERS
What6are6the6late6signs6of6breathing6compromise?6-6ans---6Tracheal6deviation
6-6JVD
What6are6signs6of6ineffective6breathing?6-6ans---6AMS
6-6Cyanosis,6especially6around6the6mouth
6-6Asymmetric6expansion6of6chest6wall
6-6Paradoxical6movement6of6the6chest6wall6during6inspiration6and6expiration
6-6Use6of6accessory6muscles6or6abdominal6muscles6or6both6or6diaphragmatic6breathing
6-6Sucking6chest6wounds6
6-6Absent6or6diminished6breath6sounds
6-6Administer6O26via6NRB6or6assist6ventilations6with6a6bag-mask6device,6as6indicated
6-6Anticipate6definitive6airway6management6to6support6ventilation.
Upon6initial6assessment,6what6type6of6oxygen6should6be6used6for6a6pt6breathing6effective
ly?6-6ans--A6tight-fitting6nonrebreather6mask6at612-156lpm.
What6intervention6should6be6done6if6a6pt6presents6with6effective6circulation?6-6ans---
6Insert626large6caliber6IV's
6-6Administer6warmed6isotonic6crystalloid6solution6at6an6appropriate 6rate
What6are6signs6of6ineffective6circulation?6-6ans---6Tachycardia
6-6AMS
6-6Uncontrolled6external6bleeding
6-6Pale,6cool,6moist6skin
6-6Distended6or6abnormally6flattened6external6jugular6veins
6-6Distant6heart6sounds
What6are6the6interventions6for6Effective/Ineffective6Circulation?6-6ans---
6Control6any6uncontrolled6external6bleeding6by:
6-6Applying6direct6pressure6over6bleeding6site
6-6Elevating6bleeding6extremity
6-6Applying6pressure6over6arterial6pressure6points
6-6Using6tourniquet6(last6resort).
6-6Cannulate626large-caliber6IV's6and6initiate6infusions6of6an6isotonic6crystalloid6solution
6-6Use6warmed6solution
, - Use6pressure6bags6to6increase6speed6of6IVF6infusion
6 6
6-6Use6blood6administration6tubing6for6possible6administration6of6blood
6-6Use6rapid6infusion6device6based6on6protocol
6-6Use6NS60.9%6in6same6tubing6as6blood6product
6-6IV6=6surgical6cut-down,6central6line,6or6both.
6-6Blood6sample6to6determine6ABO6and6Rh6group
6-6IO6in6sternum,6legs,6arms6or6pelvis
6-6Administer6blood6products
6-6PASG6(without6interfering6with6fluid6resuscitation)
What6are6factors6that6contribute6to6ineffective6ventilation?6-6ans---6AMS
6-6LOC
6-6Neurologic6injury
6-6Spinal6Cord6Injury
6-6Intracranial6Injury
6-6Blunt6trauma
6-6Pain6caused6by6rib6fractures
6-6Penetrating6Trauma
6-6Preexisting6hx6of6respiratory6diseases
6-6Increased6age
What6medications6are6used6during6intubation?6-6ans--LOAD6Mnemonic:
6L6=6Lidocaine
6O6=6Opioids
6A6=6Atropine
6D6=6Defasiculating6agents
What6are6the6Rapid6Sequence6Intubation6Steps?6-6ans--PREPARATION:6
6-6gather6equipment,6staffing,6etc.
PREOXYGENATION:6
6-6Use6100%6O26(prevent6risk6of6aspiration).
PRETREATMENT:6
6-6Decrease6S/E's6of6intubation
PARALYSIS6WITH6INDUCTION:6
6-6Pt6has6LOC,6then6administer6neuromuscular6blocking6agent
PROTECTION6AND6POSITIONING:6
6-6Apply6pressure6over6cricoid6cartilage6(minimizes6likelihood6of6vomiting6and6aspiration
PLACEMENT6WITH6PROOF
6-6Each6attempt6NOT6to6exceed6306seconds,6max6of636attempts.6Ventilate6pt630-
606seconds6between6attempts.
6-6After6intubation,6inflate6the6cuff
6-6Confirm6tube6placement6w/exhaled6CO26detector.
POSTINTUBATION6MANAGEMENT:
6-6Secure6ET6tube
6-6Set6ventilator6settings
6-6Obtain6Chest6x-ray
, - Continue6to6medicate
6 6
6-6Recheck6VS6and6pulse6oxtimetry
What6is6a6Combitube?6-6ans--A6dual-lumen,6dual-
cuff6airway6that6can6be6placed6blindly6into6the6esophagus6to6establish6an6airway.6If6inadv
ertently6placed6into6trachea,6it6can6be6used6as6a6temporary6ET6tube.6There6are6only6two6
sizes:6small6adult6and6larger6adult.
What6is6a6Laryngeal6Mask6Airway?6-6ans--
Looks6like6an6ET6tube6but6is6equipped6with6an6inflatable,6elliptical,6silicone6rubber6collar6
at6the6distal6end.6It6is6designed6to6cover6the6supraglottic6area.6
ILMA,6does6not6require6laryngoscopy6and6visualization6of6the6chords.
What6is6Needle6Cricothyrotomy6-6ans--
Percutaneous6transtracheal6ventilation.6(temporary)
Complications6include:6
6-6inadequate6ventilation6causing6hypoxia
6-6hematoma6formation
6-6esophageal6perforation
6-6aspiration
6-6thyroid6perforation
6-6subcutaneous6emphysema
What6is6Surgical6Cricothyrotomy?6-6ans--
Making6an6incision6in6cricothyroid6membrane6and6placing6a6cuffed6endo6or6trach6tube6int
o6trachea.6This6is6indicated6when6other6methods6of6airway6management6have6failed6and6
pt6cannot6be6adequately6ventilated6and6oxygenated.6
Complications6include:
6-6Aspiration
6-6Hemorrhage6or6hematoma6formation6or6both
6-6Lac6to6trachea6or6esophagus
6-6Creation6of6a6false6passage
6-6Laryngeal6stenosis
How6do6you6confirm6ET6Tube/Alternative6Airway6Placement?6-6ans---
6Visualization6of6the6chords
6-6Using6bronchoscope6to6confirm6placement
6-
6Listening6to6breath6sounds6over6the6epigastrum6and6chest6walls6while6ventilating6the6pt
6-6CO26detector
6-6Esophageal6detection6device
6-6Chest6x-ray
