TNCC NOTES FOR WRITTEN EXAM LATEST 2024-2025|TEST
BANK|100% COMPLETE verified A+
Define central or transtentorial herniation. - ansA downward movement of the cerebral
hemispheres with herniation of the diencephalon and midbrain through the elongated
gap of the tentorium.
Define Hemothorax. - ansAccumulation of blood in the pleural space.
Define Minor Head Trauma. - ansGCS 13-15
Define Moderate Head Trauma - ansPostresuscitative state with GCS 9-13.
Define Pneumothorax. - ansResults when an injury to lung leads to accumulation of air
in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total
collapse of lung may ensue.
An open pneumothorax results from wound through chest wall. Air enters pleural space
both through the wound and trachea.
Define Severe Head Trauma. - ansPostresuscitative state with GCS score of 8 or less.
Define tension pneumothorax. - ansLife-threatening injury. Air enters pleural space on
inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses
lung on side of injury causing a mediastinal shift that compresses the heart, great
vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls,
hypotension results.
Immediate decompression should be performed. Treatment should not be delayed.
Define uncal herniation. - ansThe uncus (medial aspect of the temporal lobe) is
displaced over the tentorium into the posterior fossa. This herniation is the more
common of the two types of herniation syndromes.
Disruptions of the bony structures of the skull can result in what? - ansDisplaced or
nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage
for CSF.
CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for
invading bacteria.
Also: meningitis or encephalitis or brain abscess
Explain adrenal gland response. - ansWhen adrenal glands are stimulated by SNS,
release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will
increase.
,TNCC NOTES FOR WRITTEN EXAM LATEST 2024-2025|TEST
BANK|100% COMPLETE verified A+
Epi stimulates receptors in heart to increase force of cardiac contraction (positive
inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and
tissue perfusion.
Shock stimulates hypothalamus to release corticotropin-releasing hormone that
stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol.
Effect of cortisol release is elevation in blood sugar and increased insulin resistance and
gluconeogenesis, hepatic process to produce more sugar.
Cortisol also causes renal retention of water and sodium, a compensatory mechanism
to conserve body water.
Explain Cardiogenic Shock. - ansSyndrome that results from ineffective perfusion
caused by ineffective perfusion caused by inadequate contractility of cardiac muscle.
Some causes:
- MI
- Blunt cardiac injury
- Mitral valve insufficiency
- dysrhythmias
- Cardiac Failure
Explain Distributive Shock. - ansResults from disruption in SNS control of the tone of
blood vessels, which leads to vasodilation and maldistribution of blood volume and flow.
(Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord
in cervical or upper thoracic region.
Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement
in complete cord injuries; reflexes return with resolution of spinal shock.
Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory
mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion
abnormalities.
Explain Hepatic Response. - ansLiver can store excess glucose as glycogen.
As shock progresses, glycogenolysis is activated by epi to break down glycogen into
glucose.
, TNCC NOTES FOR WRITTEN EXAM LATEST 2024-2025|TEST
BANK|100% COMPLETE verified A+
In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to
other vital areas.
Explain Hypovolemic Shock. - ansMost common to affect a trauma pt cause by
hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may
result from significant loss of whole blood because of hemorrhage or from loss of
semipermeable integrity of cellular membrane leading to leakage of plasma and protein
from intravascular space to the interstitial space (as in a burn).
Some causes:
- Blood loss
- Burns, etc.
Explain Irreversible Shock. - ansShock uncompensated or irreversible stages will cause
compromises to most body systems.
- Inadequate venous return
- inadequate cardiac filling
- decreased coronary artery perfusion
- Membranes of lysosomes breakdown within cells and release digestive enzymes that
cause intracellular damage.
Explain Obstructive Shock. - ansResults from inadequate circulating blood volume
because of an obstruction or compression of great veins, aorta, pulmonary arteries, or
heart itself.
Some causes:
- Cardiac tamponade (may compress the heart during diastole to such and extent that
atria cannot adequately fill, leading to decreased stroke volume).
- Tension pneumothorax may lead to inadequate stroke volume by displacing inferior
vena cava and obstructing venous return to right atrium.
- Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction
to right ventricular outflow during systole, with resulting obstructive shock
Explain Pulmonary Response. - ansTachypnea happens for 2 reasons:
1. Maintain acid-base balance
2. Maintain increased supply of oxygen
* Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to
increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments
oxygen supply to maximize oxygen delivery to alveoli.
How do you assess Mnemonic "D"? - ansDISABILITY
BANK|100% COMPLETE verified A+
Define central or transtentorial herniation. - ansA downward movement of the cerebral
hemispheres with herniation of the diencephalon and midbrain through the elongated
gap of the tentorium.
Define Hemothorax. - ansAccumulation of blood in the pleural space.
Define Minor Head Trauma. - ansGCS 13-15
Define Moderate Head Trauma - ansPostresuscitative state with GCS 9-13.
Define Pneumothorax. - ansResults when an injury to lung leads to accumulation of air
in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total
collapse of lung may ensue.
An open pneumothorax results from wound through chest wall. Air enters pleural space
both through the wound and trachea.
Define Severe Head Trauma. - ansPostresuscitative state with GCS score of 8 or less.
Define tension pneumothorax. - ansLife-threatening injury. Air enters pleural space on
inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses
lung on side of injury causing a mediastinal shift that compresses the heart, great
vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls,
hypotension results.
Immediate decompression should be performed. Treatment should not be delayed.
Define uncal herniation. - ansThe uncus (medial aspect of the temporal lobe) is
displaced over the tentorium into the posterior fossa. This herniation is the more
common of the two types of herniation syndromes.
Disruptions of the bony structures of the skull can result in what? - ansDisplaced or
nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage
for CSF.
CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for
invading bacteria.
Also: meningitis or encephalitis or brain abscess
Explain adrenal gland response. - ansWhen adrenal glands are stimulated by SNS,
release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will
increase.
,TNCC NOTES FOR WRITTEN EXAM LATEST 2024-2025|TEST
BANK|100% COMPLETE verified A+
Epi stimulates receptors in heart to increase force of cardiac contraction (positive
inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and
tissue perfusion.
Shock stimulates hypothalamus to release corticotropin-releasing hormone that
stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol.
Effect of cortisol release is elevation in blood sugar and increased insulin resistance and
gluconeogenesis, hepatic process to produce more sugar.
Cortisol also causes renal retention of water and sodium, a compensatory mechanism
to conserve body water.
Explain Cardiogenic Shock. - ansSyndrome that results from ineffective perfusion
caused by ineffective perfusion caused by inadequate contractility of cardiac muscle.
Some causes:
- MI
- Blunt cardiac injury
- Mitral valve insufficiency
- dysrhythmias
- Cardiac Failure
Explain Distributive Shock. - ansResults from disruption in SNS control of the tone of
blood vessels, which leads to vasodilation and maldistribution of blood volume and flow.
(Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord
in cervical or upper thoracic region.
Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement
in complete cord injuries; reflexes return with resolution of spinal shock.
Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory
mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion
abnormalities.
Explain Hepatic Response. - ansLiver can store excess glucose as glycogen.
As shock progresses, glycogenolysis is activated by epi to break down glycogen into
glucose.
, TNCC NOTES FOR WRITTEN EXAM LATEST 2024-2025|TEST
BANK|100% COMPLETE verified A+
In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to
other vital areas.
Explain Hypovolemic Shock. - ansMost common to affect a trauma pt cause by
hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may
result from significant loss of whole blood because of hemorrhage or from loss of
semipermeable integrity of cellular membrane leading to leakage of plasma and protein
from intravascular space to the interstitial space (as in a burn).
Some causes:
- Blood loss
- Burns, etc.
Explain Irreversible Shock. - ansShock uncompensated or irreversible stages will cause
compromises to most body systems.
- Inadequate venous return
- inadequate cardiac filling
- decreased coronary artery perfusion
- Membranes of lysosomes breakdown within cells and release digestive enzymes that
cause intracellular damage.
Explain Obstructive Shock. - ansResults from inadequate circulating blood volume
because of an obstruction or compression of great veins, aorta, pulmonary arteries, or
heart itself.
Some causes:
- Cardiac tamponade (may compress the heart during diastole to such and extent that
atria cannot adequately fill, leading to decreased stroke volume).
- Tension pneumothorax may lead to inadequate stroke volume by displacing inferior
vena cava and obstructing venous return to right atrium.
- Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction
to right ventricular outflow during systole, with resulting obstructive shock
Explain Pulmonary Response. - ansTachypnea happens for 2 reasons:
1. Maintain acid-base balance
2. Maintain increased supply of oxygen
* Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to
increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments
oxygen supply to maximize oxygen delivery to alveoli.
How do you assess Mnemonic "D"? - ansDISABILITY
