TNCC EXAM 2024
Epidemiology: Unintentional injury is a leading cause of death across all age groups in the US -
ANS • 65+ falls are the leading cause of injury-related deaths
• 25-64: poisoning is the leading cause of death
• 5-24: MVC leading cause of death
• TBI: more for males, 0-4 highest rate of death
Injury prevention: 3 E's - ANS • Engineering: technological interventions (airbags, alarms,
safety gear)
• Enforcement and legislation: laws and regulations
• Education: community based initiatives, public service announcements
Kinematics - ANS study of energy transfer as it applies to identifying actual or potential injuries
Major cause of death 1-44 - ANS Trauma: major cause of death for people ages 1-44 years
Biomechanics - ANS study of forces and their effects on living tissue and the human body
Mechanism of injury (MOI) - ANS how injuries occur as a result of energy from environment
transferred to the body
Newton's 1st law of motion: - ANS a body at rest will remain at rest, a body in motion will
remain in motion
Newton's 2nd law of motion: - ANS Force=Mass x Acceleration
Newton's 3rd law of motion: - ANS for every action there is an equal and opposite reaction
Law of conservation of energy: - ANS energy can neither be created nor destroyed, but it can
change form
Types of injuries: - ANS • Blunt trauma: broad energy impact across a large surface area: falls,
MVC, assaults
• Penetrating trauma: energy that results in impalement: guns, stab wounds,
• Thermal trauma: burns
• Blast trauma: rapid release of blast energy in chemical, physical, radioactive exposures
• Occlusive/obtrusive: drowning, handing, strangulation,
Motor vehicle impact sequence: - ANS • 1st impact: car hit object
• 2nd: impact person hits inside of car
,• 3rd: impact organs hit inside of body- organs can be ripped from ligaments (aorta) and hit
internal structures
Pedestrian vs Vehicle: - ANS Waddell triad: lower initial hit (leg), chest injury when landing on
car (thorax), upper body injury when bounced off and landing on the ground (head and arms)
Triage: - ANS sorting pt's based on their need for treatment and the resources available. Based
on:
• MOI (head on collision, fall more than 20ft for adult)
• Physiologic criteria (vs)
• Anatomic criteria (flail chest, fractured pelvis)
• Special considerations (age, special needs)
1. Prehospital report - ANS MIST (MOI, injury, s/s, treatment)
2. Preparation and triage: - ANS Safe practice, safe care
a. Activate trauma team
b. Right equipment, room ready
c. PPE
d. Consider any potential hazmat situation
3. Across the room observations - ANS C-AB: As pt is brought in rapid assess of stability and id
of uncontrolled bleeding
IF BLEEDING: CIRCULATION BEFORE AIRWAY! CONTROL THE BLEED THEN MOVE TO
AIRWAY
4. Primary survey: A-B-C-D-E-F-G (LMNOP) - ANS life-threatening conditions or identified and
immediately corrected
a. Alertness: AVPU W/ c-spine stabilization
AIRWAY ASSISTANCE W/ JAW THRUST W/C-SPINE CONTROL→ BVM if need assistance
and/or difficult airway
Look for: teeth/tongue/foreign bodies, blood/vomit/secretions, edema, burns (suction→
REASSESS)
Listen for: snoring, gurgling, stridor (OPA→REASSESS→ET→REASSESS)
Feel for: facial deformities, subcutaneous emphysema
ROBI: Reopen, OPA, BVM, Intubation→ reassess
*If ETT in place assess placement:
1. Adequate chest rise and fall w/ BVM
2. No epigastric gurgling
3. Bilateral breath sounds heard
4 CO2 detector gold
Interventions:
1. Suction
, 2. Jaw thrust w/manual stabilization
3. Naso/oropharyngeal airway
4. Definitive airway (ETT)→ REASSESS
b. Breathing and ventilation: Expose chest. Inadequate oxygenation causes hypoxia causing
acidosis
Look for: spontaneous breathing, symmetrical rise and fall, depth/pattern/rate of respirations,
use of accessory muscles, skin color, abrasions/bruising/deformities, sucking chest wounds,
JVD and tracheal deviation=s/s pneumothorax
Listen for breath sounds
Feel for fractures, subcutaneous emphysema
Interventions:
1. No breathing:
Jaw-Thrust
OPA
BMV
Prepare for definitive airway→ REASSESS
2. Breathing present:
Oxygen 15 L via NRB
*check capnography (35-45) & pulse ox above 94% If NOT= BVM give 10-12 breaths a min/ 1 q
6 seconds→? ETT? →REASSESS
c. Circulation and control of hemorrhage
Look for: Bleeding, skin color
Listen for: Muffled heart tones (tamponade)
Feel for: skin temp/moisture, Pulses (central)→ABSENT=CPR, RAPID/THREADY→
HYPOVOLEMIA
Interventions:
1.Control bleeding= direct pressure
2. Elevate bleeding extremity, ? tourniquet
3. Get 2- IV/IO, T&S
4. Warm IVF w/blood tubing 1-2L, give blood→ REASSESS
d. Disability/neurological status:
Look for: Pupi
5. Reevaluation: - ANS xrays? transfer, sx? FAST? Emergency interventions?
6. Secondary survey: H-I - ANS a. History/MIST: MOI→ Injuries sustained→ Signs and
symptoms in the field→ Treatment received in the field
SAMPLE history: Symptoms, Allergies, Medications, PMH, Last oral intake, Events leading to
injury
Head-to-toe: LOOK AND LISTEN AND FEEL
1. Head: LOOK AND FEEL FOR lacerations, symmetry, depressions
Epidemiology: Unintentional injury is a leading cause of death across all age groups in the US -
ANS • 65+ falls are the leading cause of injury-related deaths
• 25-64: poisoning is the leading cause of death
• 5-24: MVC leading cause of death
• TBI: more for males, 0-4 highest rate of death
Injury prevention: 3 E's - ANS • Engineering: technological interventions (airbags, alarms,
safety gear)
• Enforcement and legislation: laws and regulations
• Education: community based initiatives, public service announcements
Kinematics - ANS study of energy transfer as it applies to identifying actual or potential injuries
Major cause of death 1-44 - ANS Trauma: major cause of death for people ages 1-44 years
Biomechanics - ANS study of forces and their effects on living tissue and the human body
Mechanism of injury (MOI) - ANS how injuries occur as a result of energy from environment
transferred to the body
Newton's 1st law of motion: - ANS a body at rest will remain at rest, a body in motion will
remain in motion
Newton's 2nd law of motion: - ANS Force=Mass x Acceleration
Newton's 3rd law of motion: - ANS for every action there is an equal and opposite reaction
Law of conservation of energy: - ANS energy can neither be created nor destroyed, but it can
change form
Types of injuries: - ANS • Blunt trauma: broad energy impact across a large surface area: falls,
MVC, assaults
• Penetrating trauma: energy that results in impalement: guns, stab wounds,
• Thermal trauma: burns
• Blast trauma: rapid release of blast energy in chemical, physical, radioactive exposures
• Occlusive/obtrusive: drowning, handing, strangulation,
Motor vehicle impact sequence: - ANS • 1st impact: car hit object
• 2nd: impact person hits inside of car
,• 3rd: impact organs hit inside of body- organs can be ripped from ligaments (aorta) and hit
internal structures
Pedestrian vs Vehicle: - ANS Waddell triad: lower initial hit (leg), chest injury when landing on
car (thorax), upper body injury when bounced off and landing on the ground (head and arms)
Triage: - ANS sorting pt's based on their need for treatment and the resources available. Based
on:
• MOI (head on collision, fall more than 20ft for adult)
• Physiologic criteria (vs)
• Anatomic criteria (flail chest, fractured pelvis)
• Special considerations (age, special needs)
1. Prehospital report - ANS MIST (MOI, injury, s/s, treatment)
2. Preparation and triage: - ANS Safe practice, safe care
a. Activate trauma team
b. Right equipment, room ready
c. PPE
d. Consider any potential hazmat situation
3. Across the room observations - ANS C-AB: As pt is brought in rapid assess of stability and id
of uncontrolled bleeding
IF BLEEDING: CIRCULATION BEFORE AIRWAY! CONTROL THE BLEED THEN MOVE TO
AIRWAY
4. Primary survey: A-B-C-D-E-F-G (LMNOP) - ANS life-threatening conditions or identified and
immediately corrected
a. Alertness: AVPU W/ c-spine stabilization
AIRWAY ASSISTANCE W/ JAW THRUST W/C-SPINE CONTROL→ BVM if need assistance
and/or difficult airway
Look for: teeth/tongue/foreign bodies, blood/vomit/secretions, edema, burns (suction→
REASSESS)
Listen for: snoring, gurgling, stridor (OPA→REASSESS→ET→REASSESS)
Feel for: facial deformities, subcutaneous emphysema
ROBI: Reopen, OPA, BVM, Intubation→ reassess
*If ETT in place assess placement:
1. Adequate chest rise and fall w/ BVM
2. No epigastric gurgling
3. Bilateral breath sounds heard
4 CO2 detector gold
Interventions:
1. Suction
, 2. Jaw thrust w/manual stabilization
3. Naso/oropharyngeal airway
4. Definitive airway (ETT)→ REASSESS
b. Breathing and ventilation: Expose chest. Inadequate oxygenation causes hypoxia causing
acidosis
Look for: spontaneous breathing, symmetrical rise and fall, depth/pattern/rate of respirations,
use of accessory muscles, skin color, abrasions/bruising/deformities, sucking chest wounds,
JVD and tracheal deviation=s/s pneumothorax
Listen for breath sounds
Feel for fractures, subcutaneous emphysema
Interventions:
1. No breathing:
Jaw-Thrust
OPA
BMV
Prepare for definitive airway→ REASSESS
2. Breathing present:
Oxygen 15 L via NRB
*check capnography (35-45) & pulse ox above 94% If NOT= BVM give 10-12 breaths a min/ 1 q
6 seconds→? ETT? →REASSESS
c. Circulation and control of hemorrhage
Look for: Bleeding, skin color
Listen for: Muffled heart tones (tamponade)
Feel for: skin temp/moisture, Pulses (central)→ABSENT=CPR, RAPID/THREADY→
HYPOVOLEMIA
Interventions:
1.Control bleeding= direct pressure
2. Elevate bleeding extremity, ? tourniquet
3. Get 2- IV/IO, T&S
4. Warm IVF w/blood tubing 1-2L, give blood→ REASSESS
d. Disability/neurological status:
Look for: Pupi
5. Reevaluation: - ANS xrays? transfer, sx? FAST? Emergency interventions?
6. Secondary survey: H-I - ANS a. History/MIST: MOI→ Injuries sustained→ Signs and
symptoms in the field→ Treatment received in the field
SAMPLE history: Symptoms, Allergies, Medications, PMH, Last oral intake, Events leading to
injury
Head-to-toe: LOOK AND LISTEN AND FEEL
1. Head: LOOK AND FEEL FOR lacerations, symmetry, depressions
