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.
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.
, TNCC NOTES FOR WRITTEN EXAM LATEST 2024-2025|TEST
BANK|100% COMPLETE verified A+
Explain Hepatic Response. - ansLiver can store excess glucose as glycogen.
As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose.
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
A = Alert
V = Verbal
P = Pain
U = Unresponsive
- GCS
- PERRL?
- Determine presence of lateralizing signs including:
- Unilateral deterioration in motor movements or unequal pupils
- Symptoms that help to locate area of injury in brain
How do you confirm ET Tube/Alternative Airway Placement? - ans- Visualization of the chords
- Using bronchoscope to confirm placement
- Listening to breath sounds over the epigastrum and chest walls while ventilating the pt
- CO2 detector
- Esophageal detection device
- Chest x-ray
How do you inspect the chest for adequate ventilation? - ansObserve:
- mental status
- RR and pattern
- chest wall symmetry
- any injuries
- patient's skin color (cyanosis?)
- JVD or tracheal deviation? (Tension pneumothorax)
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.
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.
, TNCC NOTES FOR WRITTEN EXAM LATEST 2024-2025|TEST
BANK|100% COMPLETE verified A+
Explain Hepatic Response. - ansLiver can store excess glucose as glycogen.
As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose.
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
A = Alert
V = Verbal
P = Pain
U = Unresponsive
- GCS
- PERRL?
- Determine presence of lateralizing signs including:
- Unilateral deterioration in motor movements or unequal pupils
- Symptoms that help to locate area of injury in brain
How do you confirm ET Tube/Alternative Airway Placement? - ans- Visualization of the chords
- Using bronchoscope to confirm placement
- Listening to breath sounds over the epigastrum and chest walls while ventilating the pt
- CO2 detector
- Esophageal detection device
- Chest x-ray
How do you inspect the chest for adequate ventilation? - ansObserve:
- mental status
- RR and pattern
- chest wall symmetry
- any injuries
- patient's skin color (cyanosis?)
- JVD or tracheal deviation? (Tension pneumothorax)
