Tcnn Study Guide Latest 2025
Initial Assessment
● Preparation And Triage
○ Use Universal Precautions And Don Ppe
○ Consider Any Possible Patient Exposure To Hazardous Material That Puts The Trauma
Team At Risk ○ Safe Practice, Safe Care
○ Ensure Resuscitation Equipment Is Readily Available
● Across The Room Observation To Identify Any Uncontrolled External Hemorrhage
○ Need To Reprioritize To Circulation And Control Of Hemorrhage
○ Uncontrolled Hemorrhage Is The Major Cause Of Preventable Death In Trauma Patients
● Primary Survey - Inspect, Auscultate, Palpate
○ A: Airway And Alertness With Cervical Spine Stabilization
■ Avpu (Alert/Verbal Stimuli/Painful Stimuli/Unresponsive)
■ Jaw-Thrust Maneuver To Open The Airway And Assess For Obstruction
● Tongue Obstruction
● Loose Teeth, Foreign Objects
● Blood, Vomitus, Secretions
● Edema
■ Listen For Obstructive Airway Sounds (Snoring, Gurgling, Stridor)
■ Feel For Subcutaneous Emphysema Or Deformities
■ Definitive Airway Devices = Et Tube
● Assess For Proper Placement (Etco2, Bilat Breath Sounds, Absence Of Gurgling Over The
Epigastrium)
■ Suction The Airway If Needed, Then Reassess
○ B: Breathing And Ventilation
■ Are They Breathing? How Well Are They Breathing? How Long Can They Keep It Up?
■ Spontaneous Breathing? Symmetrical Rise And Fall?
■ Depth, Pattern, And Rate
■ Skin Color
■ Breath Sounds
■ Palpate Bony Structures For Possible Rib Fractures, Subcutaneous Emphysema, Soft Tissue
Injury
■ Open The Airway If Needed
● Use Oral Airway Adjunct, Assist Ventilations, Then Prepare For Definitive Airway
○ C: Circulation And Control Of Hemorrhage
■ Any Signs Of Uncontrolled External Bleeding?
● Apply Direct Pressure Or Use A Tourniquet ■ Skin Color, Temp, And Moisture?
■ Listen To Heart And Lung Sounds
■ Palpate Central Pulses For Rate, Rhythm, And Strength
■ 2 Large-Bore Ivs
● Io If Needed
, ■ Initiate Warmed Isotonic Crystalloid Solution Infusion At A Controlled Rate
● Consider Balanced Resuscitation Needs
● Rapid Infusion Protocols
■ Component Therapy = Replacing Patient Loss By Administering Rbcs, Plasma, And Platelets =
Balanced Approach
● Suggested For Fluid Resuscitation Instead Of Standard Approach (Large Volumes Of
Iv Fluids)
○ D: Disability (Neuro Status)
■ Gcs (Not Accurate If Patient Is Intubated) And Trends
● Eye Opening
• 4 Spontaneous
• 3 To Speech
• 2 To Pain
, • 1 None
● Verbal Response
• 5 Oriented
• 4 Confused Conversation
• 3 Inappropriate Words
• 2 Incomprehensive Words
• 1 None
● Motor Response
•6 Obeys Commands
• 5 Localizes Pain
• 4 Withdrawal (Normal Flexion)
• 3 Abnormal Flexion (Decorticate)
• 2 Extension (Decerebrate)
• 1 None
■ Assess Pupils
■ Need For Ct Of Head And Cervical Spine?
○ E: Exposure & Environment
■ Remove All Clothing
■ Inspect For Any Uncontrolled Bleeding Or Any Obvious Injuries
■ Keep The Patient Warm
● Blankets, Fluids, Room Temp, O2
● Aggressive Measures Are To Be Taken To Prevent Loss Of Body Heat
■ Hypothermia + Coagulopathy + Acidosis = Trauma Triad Of Death
● Decreased Coagulopathy:
• Trauma Induced
• Resuscitation Related
● Increased Acidosis
• Reduced Ph
• Elevated Lactate Level
• Excessive Fluids (Can Lead To Dic)
● Hypothermia, Decreased Heart Performance
• Exposure
• Excessive Bleeding
• Worsens Acidosis
● ** Avoiding Excess Fluids, Initiating Hemostatic Resuscitation, Keep Pt Warm
○ F: Full Set Of Vs And Family Presence
■ Monitor Effectiveness Of Resuscitation Efforts And Trend Vs
■ Facilitate Family Presence As Soon As A Member Of The Trauma Team Is Available To Act As A
Liaison To The Family
, ○ G: Get Resuscitation Adjuncts (Get Stuff!)
■ L: Labs (Abgs, Type And Screen, Lactic Acid)
● Lactic Acid Is An Excellent Reflection Of Tissue Perfusion
● Base Deficit Of -6 Is Associated With Poor Outcomes
■ M: Monitor Cardiac Rhythm
■ N: Naso Or Orogastric Tube
■ O: Oxygenation And Ventilation = Pulse Ox And Etco2
● Spo2 > 95%
● Etco2 Norm = 35-45 Mmhg
■ P: Pain
● Assess For Pain Using Appropriate Pain Scale
● Give Nonpharmacologic Comfort Measures ○ Repositioning, Ice Therapy, Padding, Etc.
● Order Appropriate Analgesic Medication
● Reevaluation For Signs Of Internal Uncontrolled Hemorrhage And Consider The Need For Patient Transfer
○ Portable Radiograph
○ Initiate Steps For Transfer To Another Facility
● Secondary Survey
○ H: History And Head To Toe Assessment
■ History From Emts, Patient, Family
■ Mist = Moi, Injuries, S/S, Tx
■ Sample = Symptoms, Allergies, Meds, Pmh, Last Oral Intake, Events/Environmental
■ Head
● Eyes, Ears, Nose
■ Neck & Cervical Spine
● Tracheal Deviation = Late Sign Of Tension Pneumothorax
■ Chest
● Assess Heart, Lungs, And Bones
● Work Of Breathing
■ Abdomen & Flanks
● Presence Or Absence Of Bowel Sounds
■ Pelvis/Perineum
● Palpate Instability Of Pelvis (Gentle Pressure Over The Iliac Wings Downward And
Medially And Over The Symphysis Pubis)
● Assess Any Contraindications For Foley Catheter
○ Insertion Of Foley Is No Longer Part Of Primary Assessment Due To High Risk Of
Cauti
■ Inspect And Palpate All Four Extremities
● Neurological Status, Color/Temp/Moisture, Sensation, Pulses, Etc.
○ I: Inspect Posterior Surfaces
■ Team Assist With Log Rolling The Patient
■ Rectal Examination
○ Re Evaluation Of Adjuncts
Initial Assessment
● Preparation And Triage
○ Use Universal Precautions And Don Ppe
○ Consider Any Possible Patient Exposure To Hazardous Material That Puts The Trauma
Team At Risk ○ Safe Practice, Safe Care
○ Ensure Resuscitation Equipment Is Readily Available
● Across The Room Observation To Identify Any Uncontrolled External Hemorrhage
○ Need To Reprioritize To Circulation And Control Of Hemorrhage
○ Uncontrolled Hemorrhage Is The Major Cause Of Preventable Death In Trauma Patients
● Primary Survey - Inspect, Auscultate, Palpate
○ A: Airway And Alertness With Cervical Spine Stabilization
■ Avpu (Alert/Verbal Stimuli/Painful Stimuli/Unresponsive)
■ Jaw-Thrust Maneuver To Open The Airway And Assess For Obstruction
● Tongue Obstruction
● Loose Teeth, Foreign Objects
● Blood, Vomitus, Secretions
● Edema
■ Listen For Obstructive Airway Sounds (Snoring, Gurgling, Stridor)
■ Feel For Subcutaneous Emphysema Or Deformities
■ Definitive Airway Devices = Et Tube
● Assess For Proper Placement (Etco2, Bilat Breath Sounds, Absence Of Gurgling Over The
Epigastrium)
■ Suction The Airway If Needed, Then Reassess
○ B: Breathing And Ventilation
■ Are They Breathing? How Well Are They Breathing? How Long Can They Keep It Up?
■ Spontaneous Breathing? Symmetrical Rise And Fall?
■ Depth, Pattern, And Rate
■ Skin Color
■ Breath Sounds
■ Palpate Bony Structures For Possible Rib Fractures, Subcutaneous Emphysema, Soft Tissue
Injury
■ Open The Airway If Needed
● Use Oral Airway Adjunct, Assist Ventilations, Then Prepare For Definitive Airway
○ C: Circulation And Control Of Hemorrhage
■ Any Signs Of Uncontrolled External Bleeding?
● Apply Direct Pressure Or Use A Tourniquet ■ Skin Color, Temp, And Moisture?
■ Listen To Heart And Lung Sounds
■ Palpate Central Pulses For Rate, Rhythm, And Strength
■ 2 Large-Bore Ivs
● Io If Needed
, ■ Initiate Warmed Isotonic Crystalloid Solution Infusion At A Controlled Rate
● Consider Balanced Resuscitation Needs
● Rapid Infusion Protocols
■ Component Therapy = Replacing Patient Loss By Administering Rbcs, Plasma, And Platelets =
Balanced Approach
● Suggested For Fluid Resuscitation Instead Of Standard Approach (Large Volumes Of
Iv Fluids)
○ D: Disability (Neuro Status)
■ Gcs (Not Accurate If Patient Is Intubated) And Trends
● Eye Opening
• 4 Spontaneous
• 3 To Speech
• 2 To Pain
, • 1 None
● Verbal Response
• 5 Oriented
• 4 Confused Conversation
• 3 Inappropriate Words
• 2 Incomprehensive Words
• 1 None
● Motor Response
•6 Obeys Commands
• 5 Localizes Pain
• 4 Withdrawal (Normal Flexion)
• 3 Abnormal Flexion (Decorticate)
• 2 Extension (Decerebrate)
• 1 None
■ Assess Pupils
■ Need For Ct Of Head And Cervical Spine?
○ E: Exposure & Environment
■ Remove All Clothing
■ Inspect For Any Uncontrolled Bleeding Or Any Obvious Injuries
■ Keep The Patient Warm
● Blankets, Fluids, Room Temp, O2
● Aggressive Measures Are To Be Taken To Prevent Loss Of Body Heat
■ Hypothermia + Coagulopathy + Acidosis = Trauma Triad Of Death
● Decreased Coagulopathy:
• Trauma Induced
• Resuscitation Related
● Increased Acidosis
• Reduced Ph
• Elevated Lactate Level
• Excessive Fluids (Can Lead To Dic)
● Hypothermia, Decreased Heart Performance
• Exposure
• Excessive Bleeding
• Worsens Acidosis
● ** Avoiding Excess Fluids, Initiating Hemostatic Resuscitation, Keep Pt Warm
○ F: Full Set Of Vs And Family Presence
■ Monitor Effectiveness Of Resuscitation Efforts And Trend Vs
■ Facilitate Family Presence As Soon As A Member Of The Trauma Team Is Available To Act As A
Liaison To The Family
, ○ G: Get Resuscitation Adjuncts (Get Stuff!)
■ L: Labs (Abgs, Type And Screen, Lactic Acid)
● Lactic Acid Is An Excellent Reflection Of Tissue Perfusion
● Base Deficit Of -6 Is Associated With Poor Outcomes
■ M: Monitor Cardiac Rhythm
■ N: Naso Or Orogastric Tube
■ O: Oxygenation And Ventilation = Pulse Ox And Etco2
● Spo2 > 95%
● Etco2 Norm = 35-45 Mmhg
■ P: Pain
● Assess For Pain Using Appropriate Pain Scale
● Give Nonpharmacologic Comfort Measures ○ Repositioning, Ice Therapy, Padding, Etc.
● Order Appropriate Analgesic Medication
● Reevaluation For Signs Of Internal Uncontrolled Hemorrhage And Consider The Need For Patient Transfer
○ Portable Radiograph
○ Initiate Steps For Transfer To Another Facility
● Secondary Survey
○ H: History And Head To Toe Assessment
■ History From Emts, Patient, Family
■ Mist = Moi, Injuries, S/S, Tx
■ Sample = Symptoms, Allergies, Meds, Pmh, Last Oral Intake, Events/Environmental
■ Head
● Eyes, Ears, Nose
■ Neck & Cervical Spine
● Tracheal Deviation = Late Sign Of Tension Pneumothorax
■ Chest
● Assess Heart, Lungs, And Bones
● Work Of Breathing
■ Abdomen & Flanks
● Presence Or Absence Of Bowel Sounds
■ Pelvis/Perineum
● Palpate Instability Of Pelvis (Gentle Pressure Over The Iliac Wings Downward And
Medially And Over The Symphysis Pubis)
● Assess Any Contraindications For Foley Catheter
○ Insertion Of Foley Is No Longer Part Of Primary Assessment Due To High Risk Of
Cauti
■ Inspect And Palpate All Four Extremities
● Neurological Status, Color/Temp/Moisture, Sensation, Pulses, Etc.
○ I: Inspect Posterior Surfaces
■ Team Assist With Log Rolling The Patient
■ Rectal Examination
○ Re Evaluation Of Adjuncts
