TNCC Notes for Written Exam latest 2023-2024
What are the S/S of a pneumothorax? - ans- Dyspnea, tachypnea
- Tachycardia
- Hyerresonance (increased echo produced by percussion over the lung field) on the injured side
- Decreased or absent breath sounds on the injured side
- Chest pain
- Open, sucking wound on inspiration (open pneumothorax)
What are the S/S of a tension pneumothorax? - ans- Severe respiratory distress
- Markedly diminished or absent breath sounds on affected side
- hypotension
- Distended neck, head and upper extremity veins-may not be clinically appreciated if significant blood
loss present
- Tracheal deviation - shift toward uninjured side (LATE sign)
- Cyanosis (LATE sign)
What are the S/S of flail chest? - ans- Dyspnea
- Chest wall pain
- Paradoxical chest wall movement - the flail segment moves in during inspiration and out during
expiration.
What are the S/S of Hemothorax? - ans- Dyspnea, tachypnea
- Chest pain
- Signs of shock
- Decreased breath sounds on injured side
- Dullness to percussion on the injured side
What are the S/S of orbital fracture (orbital blowout fracture)? - ans- Diplopia (double vision)
- Loss of vision
- Altered extraocular eye movements
- Enophthalmos (displacement of the eye backward into the socket)
- Subconjunctival hemorrhage or ecchymosis of the eyelid
- Infraorbital pain or loss of sensation
- Orbital bony deformity
What are the S/S of pericardial tamponade? - ansA collection of blood in pericardial sac. As blood
accumulates, it exerts pressure on the heart, inhibiting or compromising ventricular filling.
- Hyotension
- Tachycardia or PEA
- Dyspnea
- Cyanosis
- Beck's Triad (hypotension, distended neck veins + muffled heart sounds)
- Progressive decreased voltage of conduction complexes on ECG
What are the S/S of pulmonary contusion? - ans- Dyspnea
- Ineffective cough
- Hemoptysis
- Hypoxia
- Chest pain
- Chest wall contusion or abrasions
What are the signs and symptoms of postconcussive syndrome? - ans- Persistent H/A
- Dizziness
- Nausea
,TNCC Notes for Written Exam latest 2023-2024
- Memory impairment
- Attention deficit
- Irritability
- Insomnia
- Impaired judgement
- Loss of libido
- Anxiety
- Depression
What are the two types of herniation that occurs with ICP? - ans1. Uncal herniation
2. Central or transtentorial herniation
What are you looking for when auscultating lung sounds? - ansAbsence of BS:
- Pneumothorax
- Hemothorax
- Airway Obstruction
Diminished BS:
- Splinting or shallow BS may be a result of pain
What are you looking for when palpating the chest wall, clavicles and neck? - ans- Tenderness
- Swelling
- subcutaneous emphysema
- step-off deformities
= These may indicate: esophageal, pleural, tracheal or bronchial injuries.
Palpate trachea above suprasternal notch. Tracheal deviation may indicate a tension pneumothorax or
massive hemothorax.
What are you looking for when percussing the chest? - ansDullness:
- hemothorax
Hyperresonance
- Pneumothorax
What could a flail chest be associated with? - ans- Ineffective ventilation
- Pulmonary contusion
- Lacerated lung parenchyma
What happens to a ruptured diaphragm? - ansPotentially life-threatening, results from forces that
penetrate the body. Left hemidiaphragm is more susceptible to injury because the right side is protected
by the liver.
- Herniation of abdominal contents
- Respiratory compromise b/c impaired lung capacity + displacement of normal tissue.
- Mediastinal structures may shift to opposite side of injury
What intervention should be done if a pt presents with effective circulation? - ans- Insert 2 large caliber
IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate
What is a cerebral contusion and its S/S? - ansA common focal brain injury in which brain tissue is bruised
and damaged in a local area. Mainly located in frontal and temporal lobes. May cause hemorrhage,
infarction, necrosis and edema. Max effects of bleeding & edema peak 18-36 post injury.
S/S:
- Alteration in LOC
- Behavior, motor or speech deficits
- Abnormal motor posturing
- Signs of increased ICP
, TNCC Notes for Written Exam latest 2023-2024
What is a Combitube? - ansA dual-lumen, dual-cuff airway that can be placed blindly into the esophagus to
establish an airway. If inadvertently placed into trachea, it can be used as a temporary ET tube. There are
only two sizes: small adult and larger adult.
What is a concussion and its signs and symptoms? - ansA temporary change in neurologic function that
may occur as a result of minor head trauma.
S/S:
- Transient LOC
- H/A
- Confusion and disorientation
- Dizziness
- N/V
- Loss of memory
- Difficulty with concentration
- Irritability
- Fatigue
What is a flail chest? - ansA fracture of two or more sites on two or more adjacent ribs, or when rib
fractures produce a free-floating sternum.
Flail segments may not be clinically evident in the first several hours after injury b/c of muscle spasms
that cause splinting. After positive pressure intiated, paradoxical chest wall movement ceases.
What is a Laryngeal Mask Airway? - ansLooks like an ET tube but is equipped with an inflatable, elliptical,
silicone rubber collar at the distal end. It is designed to cover the supraglottic area.
ILMA, does not require laryngoscopy and visualization of the chords.
What is a pulmonary contusion? - ansThey occur as a result of direct impact, deceleration or high-velocity
bullet wounds. It develops when blood leaks into lung parenchyma, causing edema + hemorrhage. This
usually develops overtime and not immediately.
What is a subdural hematoma and its S/S? - ansA focal brain injury beneath the dura mater that results
from acceleration/deceleration. Usually venous, and not necessarily from a fx. Formation may be acute or
chronic.
Acute pt's hematoma manifest 48 hrs post injury
S/S:
- Altered LOC or steady decline in LOC
- S/S of increased ICP
- Hemiparesis or hemiplegia on opposite side of hematoma
- Unilateral fixed and dilated pupil on same side of hematoma
Chronic pt's " " up to 2 wks post injury
- H/A
- Progressive decrease in LOC
- Ataxia
- Incontinence
- Sz's
What is an epidural hematoma and its S/S? - ansResults when a collection of blood forms between the
skull and the dura mater. Bleeding is arterial=blood accumulates rapidly:
- Compression of underlying brain
- rapid increase in ICP
What are the S/S of a pneumothorax? - ans- Dyspnea, tachypnea
- Tachycardia
- Hyerresonance (increased echo produced by percussion over the lung field) on the injured side
- Decreased or absent breath sounds on the injured side
- Chest pain
- Open, sucking wound on inspiration (open pneumothorax)
What are the S/S of a tension pneumothorax? - ans- Severe respiratory distress
- Markedly diminished or absent breath sounds on affected side
- hypotension
- Distended neck, head and upper extremity veins-may not be clinically appreciated if significant blood
loss present
- Tracheal deviation - shift toward uninjured side (LATE sign)
- Cyanosis (LATE sign)
What are the S/S of flail chest? - ans- Dyspnea
- Chest wall pain
- Paradoxical chest wall movement - the flail segment moves in during inspiration and out during
expiration.
What are the S/S of Hemothorax? - ans- Dyspnea, tachypnea
- Chest pain
- Signs of shock
- Decreased breath sounds on injured side
- Dullness to percussion on the injured side
What are the S/S of orbital fracture (orbital blowout fracture)? - ans- Diplopia (double vision)
- Loss of vision
- Altered extraocular eye movements
- Enophthalmos (displacement of the eye backward into the socket)
- Subconjunctival hemorrhage or ecchymosis of the eyelid
- Infraorbital pain or loss of sensation
- Orbital bony deformity
What are the S/S of pericardial tamponade? - ansA collection of blood in pericardial sac. As blood
accumulates, it exerts pressure on the heart, inhibiting or compromising ventricular filling.
- Hyotension
- Tachycardia or PEA
- Dyspnea
- Cyanosis
- Beck's Triad (hypotension, distended neck veins + muffled heart sounds)
- Progressive decreased voltage of conduction complexes on ECG
What are the S/S of pulmonary contusion? - ans- Dyspnea
- Ineffective cough
- Hemoptysis
- Hypoxia
- Chest pain
- Chest wall contusion or abrasions
What are the signs and symptoms of postconcussive syndrome? - ans- Persistent H/A
- Dizziness
- Nausea
,TNCC Notes for Written Exam latest 2023-2024
- Memory impairment
- Attention deficit
- Irritability
- Insomnia
- Impaired judgement
- Loss of libido
- Anxiety
- Depression
What are the two types of herniation that occurs with ICP? - ans1. Uncal herniation
2. Central or transtentorial herniation
What are you looking for when auscultating lung sounds? - ansAbsence of BS:
- Pneumothorax
- Hemothorax
- Airway Obstruction
Diminished BS:
- Splinting or shallow BS may be a result of pain
What are you looking for when palpating the chest wall, clavicles and neck? - ans- Tenderness
- Swelling
- subcutaneous emphysema
- step-off deformities
= These may indicate: esophageal, pleural, tracheal or bronchial injuries.
Palpate trachea above suprasternal notch. Tracheal deviation may indicate a tension pneumothorax or
massive hemothorax.
What are you looking for when percussing the chest? - ansDullness:
- hemothorax
Hyperresonance
- Pneumothorax
What could a flail chest be associated with? - ans- Ineffective ventilation
- Pulmonary contusion
- Lacerated lung parenchyma
What happens to a ruptured diaphragm? - ansPotentially life-threatening, results from forces that
penetrate the body. Left hemidiaphragm is more susceptible to injury because the right side is protected
by the liver.
- Herniation of abdominal contents
- Respiratory compromise b/c impaired lung capacity + displacement of normal tissue.
- Mediastinal structures may shift to opposite side of injury
What intervention should be done if a pt presents with effective circulation? - ans- Insert 2 large caliber
IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate
What is a cerebral contusion and its S/S? - ansA common focal brain injury in which brain tissue is bruised
and damaged in a local area. Mainly located in frontal and temporal lobes. May cause hemorrhage,
infarction, necrosis and edema. Max effects of bleeding & edema peak 18-36 post injury.
S/S:
- Alteration in LOC
- Behavior, motor or speech deficits
- Abnormal motor posturing
- Signs of increased ICP
, TNCC Notes for Written Exam latest 2023-2024
What is a Combitube? - ansA dual-lumen, dual-cuff airway that can be placed blindly into the esophagus to
establish an airway. If inadvertently placed into trachea, it can be used as a temporary ET tube. There are
only two sizes: small adult and larger adult.
What is a concussion and its signs and symptoms? - ansA temporary change in neurologic function that
may occur as a result of minor head trauma.
S/S:
- Transient LOC
- H/A
- Confusion and disorientation
- Dizziness
- N/V
- Loss of memory
- Difficulty with concentration
- Irritability
- Fatigue
What is a flail chest? - ansA fracture of two or more sites on two or more adjacent ribs, or when rib
fractures produce a free-floating sternum.
Flail segments may not be clinically evident in the first several hours after injury b/c of muscle spasms
that cause splinting. After positive pressure intiated, paradoxical chest wall movement ceases.
What is a Laryngeal Mask Airway? - ansLooks like an ET tube but is equipped with an inflatable, elliptical,
silicone rubber collar at the distal end. It is designed to cover the supraglottic area.
ILMA, does not require laryngoscopy and visualization of the chords.
What is a pulmonary contusion? - ansThey occur as a result of direct impact, deceleration or high-velocity
bullet wounds. It develops when blood leaks into lung parenchyma, causing edema + hemorrhage. This
usually develops overtime and not immediately.
What is a subdural hematoma and its S/S? - ansA focal brain injury beneath the dura mater that results
from acceleration/deceleration. Usually venous, and not necessarily from a fx. Formation may be acute or
chronic.
Acute pt's hematoma manifest 48 hrs post injury
S/S:
- Altered LOC or steady decline in LOC
- S/S of increased ICP
- Hemiparesis or hemiplegia on opposite side of hematoma
- Unilateral fixed and dilated pupil on same side of hematoma
Chronic pt's " " up to 2 wks post injury
- H/A
- Progressive decrease in LOC
- Ataxia
- Incontinence
- Sz's
What is an epidural hematoma and its S/S? - ansResults when a collection of blood forms between the
skull and the dura mater. Bleeding is arterial=blood accumulates rapidly:
- Compression of underlying brain
- rapid increase in ICP
