QUESTION AND ANSWER FOR TNCC EXAM

QUESTION AND ANSWER FOR TNCC EXAM 1. Preparation and Triage 2. Primary Survery (ABCDE) with resuscitation adjuncts (F,G) 3. Reevaluation (consideration of transfer) 4. Secondary Survey (HI) with reevaluation adjuncts 5. Reevaluation and post resuscitation care 6. Definitive care of transfer to an appropriate trauma nurse - CORRECT ANSWERInitial Assessment 1. A- airway and Alertness with simultaneous cervical spinal stabilization 2. B- breathing and Ventilation 3. circulation and control of hemorrhage 4. D - disability (neurologic status) 5. F - full set of vitals and Family presence 6. G - Get resuscitation adjuncts L- Lab results (arterial gases, blood type and crossmatch) M- monitor for continuous cardiac rhythm and rate assessment N- naso or orogastric tube consideration O- oxygenation and ventilation analysis: Pulse oxygemetry and end-tidal caron dioxide (ETC02) monitoring and capnopgraphy H- History and head to toe assessment I- Inspect posterior surfaces - CORRECT ANSWER-ABCDEFGHI Before the arrival of the pt - CORRECT ANSWER-When should PPE be placed: Pt is at hospital in the right amount of time, right care, right trauma facility, right resources - CORRECT ANSWER-Safe Care: Uncontrolled Hemorrhage - CORRECT ANSWER-Major cause of preventable death: reorganize care to C-ABC - CORRECT ANSWER-If uncontrolled hemorrhage .. Used at the beginning of the initial assessment 1. A Alert. If the pt is alert he or she will be able to maintain his or her airway once it is clear. 2. V responds to verbal stimuli responds to pain. If the patient needs verbal stimulation to respond, an airway adjunct may be needed to keep the tongue from obstructing the airway. 3. P responds to pain. If the pt. responds only to pain, he or she may not be able to maintain his or her airway adjunct may need to be placed while further assessment is made to determine the need for intubation. 4. U Unresponsive. If the pt. is unresponsive, announce it loudly to the team and direct someone to chk in the pt is pulseless while assessing if the cause of the problem is the airway. - CORRECT ANSWER-Airway and AVPU: ask pt to pen his or her mouth - CORRECT ANSWER-While assessing airway the patient is alert and responds to verbal stimuli you should.. jaw thrust maneuver to open airway and assess for obstruction. If pt has a suspected csi, the jaw thrust procedure should be done by two providers. One provider can maintain c-spine and the other can perform the jaw thrust maneuver. - CORRECT ANSWER-While assessing airway pt is unable to open mouth, responds only to pain, or is unresponsive you should.. 1. The tongue obstructing the airway 2. loose or missing teeth 3. foreign objects 4. blood, vomit, or secretions' 5. edema 6. burns or evidence of inhalation injury Auscultiate or listen for: 1. Obstructive airway sounds such as snoring or gurgling 2. Possible occlusive maxillofacial bony deformity 3. Subcutaneous emphysema - CORRECT ANSWER-Inspect the mouth for: 1. Check the presence of adequate rise and fall of the chest with assisted ventilation 2. Absence of gurgling on auscultation over the epigastrium 3. Bilateral breath sounds present on auscultation 4. Presence of carbon dioxide (CO2) verified by a CO2 device or monitor - CORRECT ANSWER-If the pt has a definitive airway in what should you do? 1. Suction the airway 2, Use care to avoid stimulating the gag reflex 3. If the airway is obstructed by blood or vomitus secretions, use a rigid suction device If foreign body is noted, remove it carefully with forceps or another appropriate method - CORRECT ANSWER-If Airway is not patent 1. Apnea 2. GCS 8 or less 3. Maxillary fractures 4. Evidence of inhalation injury (facial burns) 5. Laryngeal or tracheal injury or neck hematoma 6. High risk of aspiration and patients inability to protect the airway 7. Compromised or ineffective ventilation - CORRECT ANSWER-Following conditions might require a definitive airway Breathing: To assess breathing expose the chest: 1. Inspect for a. spontaneous breathing b. symmetrical rise and fall c. depth, pattern, and rate of respiration d. signs of difficulty breathing such as accessory muscle use e. skin color (normal, pale, flushed, cyanotic) f. contusions, abrasions, deformities (flail chest) g. open pneumothoraces (sucking chest wounds) h. JVD i. signs of inhalation injury (singed nasal hairs, carbonaceous sputum) - CORRECT ANSWER-B tracheal deviation and jvd - CORRECT ANSWER-Late signs of tension pneumo: 1. equal breath sounds bilaterally at the second intercostal space midclavicular line and the bases for fifth intercostal space at the axillary line - CORRECT ANSWER-Auscultate the chest for: 1. bony fractures and possible rib fractures, which may impact ventilation 2. palpate for crepitus 3. subcutaneous emphysema which may be a sign for a pneumothorax 4. soft tissue injury - CORRECT ANSWER-Palpate the chest for 1. open the airway, use jaw thrust 2. insert an oral airway 3. assist ventilations with a bag mask 4. prepare for definitive airway - CORRECT ANSWER-If breathing is absent.. trauma its need early supplemental oxygen, start with 15 mL O2 and titrate oxygen delivery. - CORRECT ANSWER-Oxygen on trauma patients Circulation and Control of Hemorrhage Inspect first for any uncontrolled bleeding Skin color palpate for central pulses - carotid and femoral - rate, rhythm, and strength Skin temp: cool, diaphoretic, or warm and dry - CORRECT ANSWER-C apply direct pressure to bleeding elevate extremity apply pressure over arterial sites Consider a pelvic binder for pelvic fractures consider a tourniquet cannulate two veins with large caliber IV - if unable to gain assess consider IO a. obtain labs, type and cross b. infuse warm isotonic fluids c. consider balanced resuscitation d. use rapid infusion device - CORRECT ANSWER-C Interventions: Disability - Neurologic Status 1. Assess pupils for equality, shape, and reactivity (PERRL) 2. Assess GCS (eye opening, verbal response, and motor response) - CORRECT ANSWER-D 1. Get a CT 2. Consider ABG 's if decreased LOC 3. Consider glucose check - CORRECT ANSWER-D Interventions Exposure and Environmental Control Remove all clothes and assess for any obvious injuries and uncontrolled bleeding - CORRECT ANSWER-E IF clothing is needed for evidence preserve in paper bag. Maintain body temp - cover the pt, turn up heat in room, administer warm fluids - CORRECT ANSWER-E Interventions: Full set of vitals and family presence - CORRECT ANSWER-F Get Resuscitation Adjuncts L - Labs (maybe a lactic acid), a b g 's, blood type M - monitors N - naso or oro gastric tubes O Oxygen and ETC02 monitors P - pain assessment and management - CORRECT ANSWER-G Reevaluation and Consider the need to Transfer - CORRECT ANSWER-Final step in primary survey H,I - CORRECT ANSWER-Secondary Survery