TNCC EVALUATION EXAMS 2025/2026 QUESTION AND
SOLUTIONS RANKED A+
✔✔Examples of blast trauma - ✔✔- Overpressure
- Dynamic pressure
✔✔What is overpressure? - ✔✔Sudden change in atmospheric pressure caused by
blast; can cause crushing forces
✔✔What is dynamic pressure? - ✔✔Directional, similar to a gust of wind. Can carry with
it fragments and debris that are displaced by explosion.
*Can carry fragment and debris at velocities exceeding those in high-velocity firearms
✔✔Primary MOI in blast trauma - ✔✔Found in those closest to detonation; air filled
organs most susceptible to rupture
✔✔Secondary MOI in blast trauma - ✔✔Results from flying debris and bomb fragments;
causes most casualties
✔✔Tertiary MOI in blast trauma - ✔✔Results from individuals being thrown by the blast
wind; high-energy transfer can result in major thoracic injuries or pelvic/femur fractures
✔✔Quaternary MOI in blast trauma - ✔✔Result from heat, flame, gas, and smoke
✔✔Quinary MOI in blast trauma - ✔✔Result from radioactive, biological, or chemical
elements present in explosion
✔✔Describe the usefulness of the Haddon Matrix in prevention and reduction of injury. -
✔✔Places emphasis on countermeasures instead of changing human behaviors
✔✔Initial Assessment - ✔✔- Preparation and triage
- Across the room observation to identify any uncontrolled external hemorrhage
- Primary survey
~ A: Airway and Alertness with simultaneous cervical spinal stabilization
~ B: Breathing and Ventilation
~ C: Circulation and Control of hemorrhage
~ D: Disability (neurological status)
~ E: Exposure and Environmental control
- Resuscitation adjuncts
~ F: Full set of vitals and Family presence
~ G: Get resuscitation adjuncts
- L: Labs and obtain blood for type & xmatch
- M: Monitor for continuous cardiac rhythm and rate assessment
- N: Naso- or orogastric tube consideration
, - O: Oxygenation and ventilation analysis: pulse oximetry and end-tidal CO2 monitoring
or capnography
- P: Pain assessment and management
- Re-evaluation (consideration of transfer)
- Secondary survey with re-evaluation adjuncts
~ H: History and Head-to-toe assessment
~ I: Inspect posterior surfaces
- Re-evaluation and post resuscitation care
- Definitive care or transfer to an appropriate trauma center
✔✔Why is there repeated emphasis on assessment for hemorrhage throughout the
initial assessment? - ✔✔Uncontrolled hemorrhage is the major cause of preventable
death after injury
✔✔When is cervical spinal injury (CSI) suspected? - ✔✔In any patient with multi system
trauma, until pt has GCS of 15 and has CSI has been ruled out by physician or
radiography
*Can be stabilized manually or with semi-rigid cervical collar
✔✔Which tool can be used to rapidly assess the LOC during the A - Airway and
Alertness step? Why is it important to determine alertness along with airway? What are
the components of this tool? - ✔✔A - Alert
V - Verbal stimuli; if verbal stimuli needed to respond, an airway adjunct may be needed
to keep to keep tongue from obstructing airway
P - Responds to pain; if pt responds only to pain, may need airway adjunct while
determining need for intubation
U - Unresponsive; announce loudly to team; get someone to check for pulse while you
assess airway
Uses LOC to determine need for airway
Airway may be compromised with V,P, or U
✔✔What to inspect for when checking airway: - ✔✔- Tongue obstructing airway
- Loose or missing teeth
- Foreign objects
- Blood, vomitus, or secretions
- Edema
- Burns or evidence of inhalation injury
✔✔What to auscultate for when assessing airway: - ✔✔Obstructive airway sounds
(snoring, gurgling, stridor)
, ✔✔What to palpate for when assessing airway: - ✔✔- Possible occlusive maxillofacial
body deformity
- SQ emphysema
✔✔How do you check for proper placement of definitive airway (endotracheal
intubation)? - ✔✔- Adequate rise and fall of chest
- Absence of gurgling on auscultation over epigastrium
- BBS present
- Presence of CO2 verified by CO2 detector device or monitor
✔✔Which method of opening airway is recommended for use in trauma? - ✔✔Jaw-
thrust maneuver
*Performed by two people when needing to stabilize cervical spine
✔✔What conditions or situations require definitely secure airway? - ✔✔- Apnea
- GCS score of 8 or less
- Severe maxillofacial fractures
- Evidence of inhalation injury (facial burns)
- Laryngeal or tracheal injury or neck hematoma
- High risk of aspiration and patients inability to protect airway
- Compromised or ineffective ventilation
- Anticipation of deterioration of neuro status that may result in inability to maintain or
protect airway
*Ventilate with bag-mask at 15 L until airway can be established
✔✔Breathing and Ventilation: Assessment - ✔✔Inspect for:
- Spontaneous breathing
- Symmetrical rise and fall of chest
- Depth, pattern, and rate
- Signs of respiratory difficulty (use of accessory muscles or diaphragmatic breathing)
- Skin color
- Contusion, abrasions, deformities hat suggest underlying injury
- Open pneumothorax (open chest wound)
- JVD and position of trachea
- Signs of inhalation injury
Auscultation for:
- Presence, quality, and equality if breath sounds bilaterally at second intercostal space,
midclavicular line and bases at fifth intercostal space at anterior axillary line
Palpate for:
- Bony structures and possible rib fractures
- SQ edema
SOLUTIONS RANKED A+
✔✔Examples of blast trauma - ✔✔- Overpressure
- Dynamic pressure
✔✔What is overpressure? - ✔✔Sudden change in atmospheric pressure caused by
blast; can cause crushing forces
✔✔What is dynamic pressure? - ✔✔Directional, similar to a gust of wind. Can carry with
it fragments and debris that are displaced by explosion.
*Can carry fragment and debris at velocities exceeding those in high-velocity firearms
✔✔Primary MOI in blast trauma - ✔✔Found in those closest to detonation; air filled
organs most susceptible to rupture
✔✔Secondary MOI in blast trauma - ✔✔Results from flying debris and bomb fragments;
causes most casualties
✔✔Tertiary MOI in blast trauma - ✔✔Results from individuals being thrown by the blast
wind; high-energy transfer can result in major thoracic injuries or pelvic/femur fractures
✔✔Quaternary MOI in blast trauma - ✔✔Result from heat, flame, gas, and smoke
✔✔Quinary MOI in blast trauma - ✔✔Result from radioactive, biological, or chemical
elements present in explosion
✔✔Describe the usefulness of the Haddon Matrix in prevention and reduction of injury. -
✔✔Places emphasis on countermeasures instead of changing human behaviors
✔✔Initial Assessment - ✔✔- Preparation and triage
- Across the room observation to identify any uncontrolled external hemorrhage
- Primary survey
~ A: Airway and Alertness with simultaneous cervical spinal stabilization
~ B: Breathing and Ventilation
~ C: Circulation and Control of hemorrhage
~ D: Disability (neurological status)
~ E: Exposure and Environmental control
- Resuscitation adjuncts
~ F: Full set of vitals and Family presence
~ G: Get resuscitation adjuncts
- L: Labs and obtain blood for type & xmatch
- M: Monitor for continuous cardiac rhythm and rate assessment
- N: Naso- or orogastric tube consideration
, - O: Oxygenation and ventilation analysis: pulse oximetry and end-tidal CO2 monitoring
or capnography
- P: Pain assessment and management
- Re-evaluation (consideration of transfer)
- Secondary survey with re-evaluation adjuncts
~ H: History and Head-to-toe assessment
~ I: Inspect posterior surfaces
- Re-evaluation and post resuscitation care
- Definitive care or transfer to an appropriate trauma center
✔✔Why is there repeated emphasis on assessment for hemorrhage throughout the
initial assessment? - ✔✔Uncontrolled hemorrhage is the major cause of preventable
death after injury
✔✔When is cervical spinal injury (CSI) suspected? - ✔✔In any patient with multi system
trauma, until pt has GCS of 15 and has CSI has been ruled out by physician or
radiography
*Can be stabilized manually or with semi-rigid cervical collar
✔✔Which tool can be used to rapidly assess the LOC during the A - Airway and
Alertness step? Why is it important to determine alertness along with airway? What are
the components of this tool? - ✔✔A - Alert
V - Verbal stimuli; if verbal stimuli needed to respond, an airway adjunct may be needed
to keep to keep tongue from obstructing airway
P - Responds to pain; if pt responds only to pain, may need airway adjunct while
determining need for intubation
U - Unresponsive; announce loudly to team; get someone to check for pulse while you
assess airway
Uses LOC to determine need for airway
Airway may be compromised with V,P, or U
✔✔What to inspect for when checking airway: - ✔✔- Tongue obstructing airway
- Loose or missing teeth
- Foreign objects
- Blood, vomitus, or secretions
- Edema
- Burns or evidence of inhalation injury
✔✔What to auscultate for when assessing airway: - ✔✔Obstructive airway sounds
(snoring, gurgling, stridor)
, ✔✔What to palpate for when assessing airway: - ✔✔- Possible occlusive maxillofacial
body deformity
- SQ emphysema
✔✔How do you check for proper placement of definitive airway (endotracheal
intubation)? - ✔✔- Adequate rise and fall of chest
- Absence of gurgling on auscultation over epigastrium
- BBS present
- Presence of CO2 verified by CO2 detector device or monitor
✔✔Which method of opening airway is recommended for use in trauma? - ✔✔Jaw-
thrust maneuver
*Performed by two people when needing to stabilize cervical spine
✔✔What conditions or situations require definitely secure airway? - ✔✔- Apnea
- GCS score of 8 or less
- Severe maxillofacial fractures
- Evidence of inhalation injury (facial burns)
- Laryngeal or tracheal injury or neck hematoma
- High risk of aspiration and patients inability to protect airway
- Compromised or ineffective ventilation
- Anticipation of deterioration of neuro status that may result in inability to maintain or
protect airway
*Ventilate with bag-mask at 15 L until airway can be established
✔✔Breathing and Ventilation: Assessment - ✔✔Inspect for:
- Spontaneous breathing
- Symmetrical rise and fall of chest
- Depth, pattern, and rate
- Signs of respiratory difficulty (use of accessory muscles or diaphragmatic breathing)
- Skin color
- Contusion, abrasions, deformities hat suggest underlying injury
- Open pneumothorax (open chest wound)
- JVD and position of trachea
- Signs of inhalation injury
Auscultation for:
- Presence, quality, and equality if breath sounds bilaterally at second intercostal space,
midclavicular line and bases at fifth intercostal space at anterior axillary line
Palpate for:
- Bony structures and possible rib fractures
- SQ edema
