TNCC Clinical exam questions with
correct answers
KE - Answer-Speed increases energy by the square of the velocity and can influence
the extent of injury. However, the action of stopping must also be considered. Speed
increases the risk of injury, but energy transfer occurs during the "stop," when energy is
exerted and applied to the tissues upon impact. (pp. 12)
Blunt Trauma - Answer-Because blunt trauma may often appear less obvious, with
minimal to no outward signs of injury as compared to other mechanisms or types of
injuries, it's severity may be dismissed initially, resulting with in delayed treatment and
increased complications. (pp. 13)
Rollover Collisions w/ Ejection - Answer-Ejection from the vehicle significantly increases
the probability of fatal injury (pp. 16)
Velocity and KE are positively correlated with destruction - Answer-KE increases with
velocity. Therefore, although velocity is relative, it is the projectile's KE that causes
damage by transferring energy to the tissue (pp.18)
Cavitation - Answer-Cavitation can also be seen when an unrestrained driver hits a
steering wheel. As the chest pushes inward from the resistance of the steering wheel, a
temporary cavity is created (pp.19)
Explosion - Answer-The explosion that occurs in an enclosed space has an increase in
pressure relative to the explosion that occurs in an open environment. The increased
pressure compounds the blast effects, and potentially increases internal and external
injury severity. (pp. 21)
AVPU - Answer-A: alert and oriented
V: responds to verbal stimuli
P: responds only to painful stimuli
U: unresponsive
Dysthymias - Answer-Such as premature ventricular contractions, a-fib, or ST segment
changes may indicate blunt cardiac trauma
PEA-pulseless electrical activity - Answer-May point to cardiac tamponade, tension
pneumothorax, or profound hypovolemia
Why NG or OG tube? - Answer-To optimize inflation of the lungs and prevent vomiting
and/or aspiration. This is considered routine care for an intimated pt to minimize
aspiration risk (pp. 35)
,Check carboxyhemoglobin - Answer-For pts who are victims of combustion events, the
O1 (monoxide) binds to hemoglobin but is not absolve for cellular use. Therefore a pt
could have 100% SPO2 but may have hypoxia
diplopia - Answer-Significant finding that can indicate entrapment of cranial nerves III,
IV, & VI (oculomotor, trochlear, abducens)
CSF - Answer-Will be 2/3 the glucose
Monitoring Urinary Output - Answer-Urinary output reflects end organ perfusion and is
considered a sensitive indicator of the patients volume status
(Pp. 49)
LACE-soft tissue iniuries - Answer-L: lacerations
A: abrasions and avulsions
C: contusions
E: edema and ecchymosis
Valproic Acid - Answer-VAP- has been shown to cause reversible acetylation of proteins
( which creates an anti-inflammatory and pro survival phenotype) thereby decreasing
the organ damage seen as the result of hemorrhage, poly trauma, and ischemia-
reproduction injury
Shock BP Note - Answer-As diastolic pressure rises, systemic and peripheral vascular
resistance (afterload) increases. A narrowing pulse pressure may be one of the first
concrete measurements signaling that the patients circulatory status is compromised
and the body is trying to compensate.
Prepare and triage - AnswerI will need to activate the triage team
I will need to prepare the trauma room - this may not include and is not limited to
1) fluid warmer
2) peds equipment
3) bariatric equipment
4) difficult airway
5) IV equipment
I will need to don PPE and consider the potential need for decontamination or other
safety threats to the trauma team
Across-the-room Observation - AnswerI will assess for obvious uncontrolled external
hemorrhage
Yes= "c" I will control bleeding and assess circulation
If pt is compromised then I will
, 1)initiate IV fluid and blood replacement before returning to "A"
Note: with multi. Members available , airway/breathing can be assessed but does NOT
take priority over circulation
Primary survey (Alertness and airway with simultaneous c-Spine stabilization) -
Answer**** I will assess pts LOC using AVPU
If c-spine is suspected then I will need a 2nd person to provide manual c-spine
stabilization AND demonstrate manual opening of the airway using the Jaw thrust
maneuver
If pt is alert- it is ok to ask pt to open mouth to asses airway
I will demonstrate and describe techniques to determine patent of airway using
(insp/ausc/palp)
(Name 4)
1. Is the tongue obstructing?
2. Are there missing or loose teeth
3. Is there foreign objects?
4. Is there any blood,vomit,secretions
5. Is there edema
6. Is there snoring, gurgling, or stridor
7. Is there any bony deformity
Techniques may include and not limited to (4)
1. Suctioning airway
2. Removing loose teeth or foreign objects
3. Insert an oral or nasopharyngeal airway
4. Indicate the need for intubation
REASSESS PT
Note: clear speech in an alert patient may indicate an open and maintainable airway.
Primary survey (Breathing and Ventilation) - AnswerI will demonstrate and describe
techniques for determining effective breathing using (insp/ausc/palp) (name 4)
1. Spontaneous breathing
2. Symmetrical chest rise and fall
3. Depth/pattern/rate of respirations
4. Is there inc work of breathing
5. Skin color
6.open wounds or deformities
correct answers
KE - Answer-Speed increases energy by the square of the velocity and can influence
the extent of injury. However, the action of stopping must also be considered. Speed
increases the risk of injury, but energy transfer occurs during the "stop," when energy is
exerted and applied to the tissues upon impact. (pp. 12)
Blunt Trauma - Answer-Because blunt trauma may often appear less obvious, with
minimal to no outward signs of injury as compared to other mechanisms or types of
injuries, it's severity may be dismissed initially, resulting with in delayed treatment and
increased complications. (pp. 13)
Rollover Collisions w/ Ejection - Answer-Ejection from the vehicle significantly increases
the probability of fatal injury (pp. 16)
Velocity and KE are positively correlated with destruction - Answer-KE increases with
velocity. Therefore, although velocity is relative, it is the projectile's KE that causes
damage by transferring energy to the tissue (pp.18)
Cavitation - Answer-Cavitation can also be seen when an unrestrained driver hits a
steering wheel. As the chest pushes inward from the resistance of the steering wheel, a
temporary cavity is created (pp.19)
Explosion - Answer-The explosion that occurs in an enclosed space has an increase in
pressure relative to the explosion that occurs in an open environment. The increased
pressure compounds the blast effects, and potentially increases internal and external
injury severity. (pp. 21)
AVPU - Answer-A: alert and oriented
V: responds to verbal stimuli
P: responds only to painful stimuli
U: unresponsive
Dysthymias - Answer-Such as premature ventricular contractions, a-fib, or ST segment
changes may indicate blunt cardiac trauma
PEA-pulseless electrical activity - Answer-May point to cardiac tamponade, tension
pneumothorax, or profound hypovolemia
Why NG or OG tube? - Answer-To optimize inflation of the lungs and prevent vomiting
and/or aspiration. This is considered routine care for an intimated pt to minimize
aspiration risk (pp. 35)
,Check carboxyhemoglobin - Answer-For pts who are victims of combustion events, the
O1 (monoxide) binds to hemoglobin but is not absolve for cellular use. Therefore a pt
could have 100% SPO2 but may have hypoxia
diplopia - Answer-Significant finding that can indicate entrapment of cranial nerves III,
IV, & VI (oculomotor, trochlear, abducens)
CSF - Answer-Will be 2/3 the glucose
Monitoring Urinary Output - Answer-Urinary output reflects end organ perfusion and is
considered a sensitive indicator of the patients volume status
(Pp. 49)
LACE-soft tissue iniuries - Answer-L: lacerations
A: abrasions and avulsions
C: contusions
E: edema and ecchymosis
Valproic Acid - Answer-VAP- has been shown to cause reversible acetylation of proteins
( which creates an anti-inflammatory and pro survival phenotype) thereby decreasing
the organ damage seen as the result of hemorrhage, poly trauma, and ischemia-
reproduction injury
Shock BP Note - Answer-As diastolic pressure rises, systemic and peripheral vascular
resistance (afterload) increases. A narrowing pulse pressure may be one of the first
concrete measurements signaling that the patients circulatory status is compromised
and the body is trying to compensate.
Prepare and triage - AnswerI will need to activate the triage team
I will need to prepare the trauma room - this may not include and is not limited to
1) fluid warmer
2) peds equipment
3) bariatric equipment
4) difficult airway
5) IV equipment
I will need to don PPE and consider the potential need for decontamination or other
safety threats to the trauma team
Across-the-room Observation - AnswerI will assess for obvious uncontrolled external
hemorrhage
Yes= "c" I will control bleeding and assess circulation
If pt is compromised then I will
, 1)initiate IV fluid and blood replacement before returning to "A"
Note: with multi. Members available , airway/breathing can be assessed but does NOT
take priority over circulation
Primary survey (Alertness and airway with simultaneous c-Spine stabilization) -
Answer**** I will assess pts LOC using AVPU
If c-spine is suspected then I will need a 2nd person to provide manual c-spine
stabilization AND demonstrate manual opening of the airway using the Jaw thrust
maneuver
If pt is alert- it is ok to ask pt to open mouth to asses airway
I will demonstrate and describe techniques to determine patent of airway using
(insp/ausc/palp)
(Name 4)
1. Is the tongue obstructing?
2. Are there missing or loose teeth
3. Is there foreign objects?
4. Is there any blood,vomit,secretions
5. Is there edema
6. Is there snoring, gurgling, or stridor
7. Is there any bony deformity
Techniques may include and not limited to (4)
1. Suctioning airway
2. Removing loose teeth or foreign objects
3. Insert an oral or nasopharyngeal airway
4. Indicate the need for intubation
REASSESS PT
Note: clear speech in an alert patient may indicate an open and maintainable airway.
Primary survey (Breathing and Ventilation) - AnswerI will demonstrate and describe
techniques for determining effective breathing using (insp/ausc/palp) (name 4)
1. Spontaneous breathing
2. Symmetrical chest rise and fall
3. Depth/pattern/rate of respirations
4. Is there inc work of breathing
5. Skin color
6.open wounds or deformities
