TNCC NOTES FOR WRITTEN EXAM LATEST 2025 |TEST
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How would you assess a pt with a thoracic injury? - ans(Initial assessment)
Obtain Hx.
PHYSICAL:
Inspection:
- Observe chest wall
- Assess breathing effort and RR
- Symmetry
- Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or
pericardial tamponade. Flat = external jugular veins may reflect hypovolemia)
- Inspect upper abdominal region for injury
Percussion:
- Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax)
Palpation:
- Palpate chest wall, clavicles and neck for:
- Tenderness
- Swelling or hematoma
- Subcutaneous emphysema
- Note presence of bony crepitus
- Palpate central and peripheral pulses and compare quality between:
- Right and left extremities
- Upper and lower extremities
- Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension
pneumothorax or massive hemothorax)
- Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate
aortic injury).
Auscultation:
- Auscultate compare BP in both UE's and LE's
- Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS =
splinting. Shallow = b/c of pain).
- Auscultate chest for presence of BS (diaphragmatic rupture)
- Auscultate Heart sounds (muffled = pericardial tamponade)
- Auscultate neck vessels for bruits (vascular injury)
Diagnostic Procedures:
- Xrays
- Arteriography
- Bronchoscopy and laryngoscopy
- CT's
- FAST
- Labs (cardiac enzymes)
- ECG, CVP
How would you assess someone in hypovolemic shock? - ans(Use Initial Assessment) and then:
Inspect:
- LOC
- Rate and quality of respirations
- External bleeding?
- Skin color and moisture
- Assess jugular veins and peripheral veins
Auscultate:
- BP
- Pulse pressure
- Breath sounds
- Heart sounds
,TNCC NOTES FOR WRITTEN EXAM LATEST 2025 |TEST
BANK|100% COMPLETE verified pass
- Bowel sounds
Percuss:
- Chest and abdomen
Palpate:
- Central pulse (carotid or femoral)
- Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse
- Palpate peripheral pulses
- Palpate skin temp and moisture
Diagnostic Procedures:
- Xrays and other studies
- Labs
Planning and Implementation
- Oxygen
- IV's with warmed replacement fluids
- Control external bleeding with direct pressure
- Elevate LE's
- NGT
- Foley
- Monitor and pulse oximeter
- Monitor for development of coagulopathies
- Surgery?
ICP is a reflection of what three volumes? What happens when one increases? - ans1. Brain
2. CSF
3. Blood within the nonexpansible cranial vault
As volume of one increases, the volume of another decreases to maintain ICP within normal range.
As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary
insult. Hypotensive pt w/marginally elevated ICP can be harmful.
Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead
to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates
cerebral blood vessels = increase blood volume and ICP.
Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? - ansA tight-
fitting nonrebreather mask at 12-15 lpm.
What are aortic injuries S/S? - ans- Hypotension
- Decreased LOC
- Hypertension in UE's
- Decreased quality (amplitude) of femoral pulses compared to UE pulses
- Loud systolic murmur in parascapular region
- Chest pain
- Chest wall ecchymosis
- Widened mediastinum on chest xray
- Paraplegia
What are factors that contribute to ineffective ventilation? - ans- AMS
- LOC
- Neurologic injury
- Spinal Cord Injury
- Intracranial Injury
, TNCC NOTES FOR WRITTEN EXAM LATEST 2025 |TEST
BANK|100% COMPLETE verified pass
- Blunt trauma
- Pain caused by rib fractures
- Penetrating Trauma
- Preexisting hx of respiratory diseases
- Increased age
What are intracerebral hematoma's and its S/S? - ansOccur deep within brain tissue, may be single or
multiple and commonly associated with contusions (frontal & temporal lobes). They result in significant
mass effect, leading to increased ICP and neurologic deterioration.
S/S:
- Progressive and often rapid decline in LOC
- H/A
- Signs of increasing ICP
- Pupil abnormalities
- Contralateral hemiplegia
What are neck injury S/S? - ans- Dyspnea
- Hemoptysis (coughing up blood)
- Subcutaneous emphysema in neck, face, or suprasternal area
- Decreased or absent breath sounds
- Penetrating wounds or impaled objects
- Pulsatile or expanding hematoma
- Loss of normal anatomic prominence of the laryngeal region
- Bruits
- Active external bleeding
- Neurologic deficit, such as aphasia or hemiplegia
- Cranial nerve deficits
- Facial sensory or motor nerve deficits
- Dysphonia (hoarseness)
- Dysphagia (difficulty swallowing)
What are S/S of a rib fracture? - ans- Dyspnea
- Localized pain on movement, palpation, or inspiration
- Pt assumes position intended to splint chest wall to reduce pain
- Chest wall ecchymosis or sternal contusion
- Bony crepitus or deformity
What are S/S of a ruptured diaphragm? - ans(Anything below the nipple line and should be evaluated for
potential diaphragmatic injury).
- Dyspnea or orthopnea
- Dysphagia
- Abdominal pain
- Sharp epigastric or chest pain radiating to left shoulder (Kehr's sign)
- Bowel sounds heard in lower middle chest
- Decreased breath sounds on injured side
What are s/s of chemical burns to the eye? - ansChemical injuries require immediate intervention if it is to
be preserved.
S/S:
- Pain
- Corneal Opacification
- Coexisting chemical burn and swelling of lids
BANK|100% COMPLETE verified pass
How would you assess a pt with a thoracic injury? - ans(Initial assessment)
Obtain Hx.
PHYSICAL:
Inspection:
- Observe chest wall
- Assess breathing effort and RR
- Symmetry
- Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or
pericardial tamponade. Flat = external jugular veins may reflect hypovolemia)
- Inspect upper abdominal region for injury
Percussion:
- Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax)
Palpation:
- Palpate chest wall, clavicles and neck for:
- Tenderness
- Swelling or hematoma
- Subcutaneous emphysema
- Note presence of bony crepitus
- Palpate central and peripheral pulses and compare quality between:
- Right and left extremities
- Upper and lower extremities
- Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension
pneumothorax or massive hemothorax)
- Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate
aortic injury).
Auscultation:
- Auscultate compare BP in both UE's and LE's
- Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS =
splinting. Shallow = b/c of pain).
- Auscultate chest for presence of BS (diaphragmatic rupture)
- Auscultate Heart sounds (muffled = pericardial tamponade)
- Auscultate neck vessels for bruits (vascular injury)
Diagnostic Procedures:
- Xrays
- Arteriography
- Bronchoscopy and laryngoscopy
- CT's
- FAST
- Labs (cardiac enzymes)
- ECG, CVP
How would you assess someone in hypovolemic shock? - ans(Use Initial Assessment) and then:
Inspect:
- LOC
- Rate and quality of respirations
- External bleeding?
- Skin color and moisture
- Assess jugular veins and peripheral veins
Auscultate:
- BP
- Pulse pressure
- Breath sounds
- Heart sounds
,TNCC NOTES FOR WRITTEN EXAM LATEST 2025 |TEST
BANK|100% COMPLETE verified pass
- Bowel sounds
Percuss:
- Chest and abdomen
Palpate:
- Central pulse (carotid or femoral)
- Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse
- Palpate peripheral pulses
- Palpate skin temp and moisture
Diagnostic Procedures:
- Xrays and other studies
- Labs
Planning and Implementation
- Oxygen
- IV's with warmed replacement fluids
- Control external bleeding with direct pressure
- Elevate LE's
- NGT
- Foley
- Monitor and pulse oximeter
- Monitor for development of coagulopathies
- Surgery?
ICP is a reflection of what three volumes? What happens when one increases? - ans1. Brain
2. CSF
3. Blood within the nonexpansible cranial vault
As volume of one increases, the volume of another decreases to maintain ICP within normal range.
As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary
insult. Hypotensive pt w/marginally elevated ICP can be harmful.
Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead
to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates
cerebral blood vessels = increase blood volume and ICP.
Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? - ansA tight-
fitting nonrebreather mask at 12-15 lpm.
What are aortic injuries S/S? - ans- Hypotension
- Decreased LOC
- Hypertension in UE's
- Decreased quality (amplitude) of femoral pulses compared to UE pulses
- Loud systolic murmur in parascapular region
- Chest pain
- Chest wall ecchymosis
- Widened mediastinum on chest xray
- Paraplegia
What are factors that contribute to ineffective ventilation? - ans- AMS
- LOC
- Neurologic injury
- Spinal Cord Injury
- Intracranial Injury
, TNCC NOTES FOR WRITTEN EXAM LATEST 2025 |TEST
BANK|100% COMPLETE verified pass
- Blunt trauma
- Pain caused by rib fractures
- Penetrating Trauma
- Preexisting hx of respiratory diseases
- Increased age
What are intracerebral hematoma's and its S/S? - ansOccur deep within brain tissue, may be single or
multiple and commonly associated with contusions (frontal & temporal lobes). They result in significant
mass effect, leading to increased ICP and neurologic deterioration.
S/S:
- Progressive and often rapid decline in LOC
- H/A
- Signs of increasing ICP
- Pupil abnormalities
- Contralateral hemiplegia
What are neck injury S/S? - ans- Dyspnea
- Hemoptysis (coughing up blood)
- Subcutaneous emphysema in neck, face, or suprasternal area
- Decreased or absent breath sounds
- Penetrating wounds or impaled objects
- Pulsatile or expanding hematoma
- Loss of normal anatomic prominence of the laryngeal region
- Bruits
- Active external bleeding
- Neurologic deficit, such as aphasia or hemiplegia
- Cranial nerve deficits
- Facial sensory or motor nerve deficits
- Dysphonia (hoarseness)
- Dysphagia (difficulty swallowing)
What are S/S of a rib fracture? - ans- Dyspnea
- Localized pain on movement, palpation, or inspiration
- Pt assumes position intended to splint chest wall to reduce pain
- Chest wall ecchymosis or sternal contusion
- Bony crepitus or deformity
What are S/S of a ruptured diaphragm? - ans(Anything below the nipple line and should be evaluated for
potential diaphragmatic injury).
- Dyspnea or orthopnea
- Dysphagia
- Abdominal pain
- Sharp epigastric or chest pain radiating to left shoulder (Kehr's sign)
- Bowel sounds heard in lower middle chest
- Decreased breath sounds on injured side
What are s/s of chemical burns to the eye? - ansChemical injuries require immediate intervention if it is to
be preserved.
S/S:
- Pain
- Corneal Opacification
- Coexisting chemical burn and swelling of lids
