TNCC Final Exam Questions And Answers Verified
100% Correct
What medications are used during intubation?
LOAD Mnemonic:
L = Lidocaine
O = Opioids
A = Atropine
D = Defasiculating agents
What are the Rapid Sequence Intubation Steps?
PREPARATION:
- gather equipment, staffing, etc.
PREOXYGENATION:
- Use 100% O2 (prevent risk of aspiration).
PRETREATMENT:
- Decrease S/E's of intubation PARALYSIS WITH INDUCTION:
- Pt has LOC, then administer neuromuscular blocking agent PROTECTION AND POSITIONING:
- Apply pressure over cricoid cartilage (minimizes likelihood of vomiting and aspiration
PLACEMENT WITH PROOF
- Each attempt NOT to exceed 30 seconds, max of 3 attempts. Ventilate pt 30-60 seconds
between attempts.
- After intubation, inflate the cuff
- Confirm tube placement w/exhaled CO2 detector.
POSTINTUBATION MANAGEMENT:
- Secure ET tube
- Set ventilator settings
- Obtain Chest x-ray
- Continue to medicate
- Recheck VS and pulse oxtimetry
What is a Combitube?
A dual-lumen, dual-cuff airway that can be placed blindly into the esophagus to establish an
airway. If inadvertently placed into trachea, it can be used as a temporary ET tube. There are
only two sizes: small adult and larger adult.
What is a Laryngeal Mask Airway?
Looks like an ET tube but is equipped with an inflatable, elliptical, silicone rubber collar at the
distal end. It is designed to cover the supraglottic area.
,ILMA, does not require laryngoscopy and visualization of the chords.
What is Needle Cricothyrotomy
Percutaneous transtracheal ventilation. (temporary)
Complications include:
- inadequate ventilation causing hypoxia
- hematoma formation
- esophageal perforation
- aspiration
- thyroid perforation
- subcutaneous emphysema
What is Surgical Cricothyrotomy?
Making an incision in cricothyroid membrane and placing a cuffed endo or trach tube into
trachea. This is indicated when other methods of airway management have failed and pt
cannot be adequately ventilated and oxygenated.
Complications include:
- Aspiration
- Hemorrhage or hematoma formation or both
- Lac to trachea or esophagus
- Creation of a false passage
- Laryngeal stenosis
How do you confirm ET Tube/Alternative Airway Placement?
- 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?
Observe:
- mental status
- RR and pattern
- chest wall symmetry
- any injuries
- patient's skin color (cyanosis?)
, - JVD or tracheal deviation? (Tension pneumothorax) What are you looking for when
auscultating lung sounds?
Absence of BS:
- Pneumothorax
- Hemothorax
- Airway Obstruction Diminished BS:
- Splinting or shallow BS may be a result of pain What are you looking for when percussing the
chest?
Dullness:
- hemothorax
Hyperresonanc
e-
Pneumothorax
What are you looking for when palpating the chest wall, clavicles and neck?
- Tenderness
- Swelling
- subcutaneous emphysema
- step-off deformities
= These may indicate: esophageal, pleural, tracheal or bronchial injuries.
Palpate trachea above suprasternal notch. Tracheal deviation may indicate a tension
pneumothorax or massive hemothorax.
What is the DOPE mnemonic?
D - Displaced tube
O - Obstruction: Check secretions or pt biting tube
P - Pneumothorax: Condition may occur from original trauma or barotrauma from
ventilator E - Equipment failure: pt may have become detached from equipment or
there's a kink in the tubing
Explain Hypovolemic Shock.
Most 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.
100% Correct
What medications are used during intubation?
LOAD Mnemonic:
L = Lidocaine
O = Opioids
A = Atropine
D = Defasiculating agents
What are the Rapid Sequence Intubation Steps?
PREPARATION:
- gather equipment, staffing, etc.
PREOXYGENATION:
- Use 100% O2 (prevent risk of aspiration).
PRETREATMENT:
- Decrease S/E's of intubation PARALYSIS WITH INDUCTION:
- Pt has LOC, then administer neuromuscular blocking agent PROTECTION AND POSITIONING:
- Apply pressure over cricoid cartilage (minimizes likelihood of vomiting and aspiration
PLACEMENT WITH PROOF
- Each attempt NOT to exceed 30 seconds, max of 3 attempts. Ventilate pt 30-60 seconds
between attempts.
- After intubation, inflate the cuff
- Confirm tube placement w/exhaled CO2 detector.
POSTINTUBATION MANAGEMENT:
- Secure ET tube
- Set ventilator settings
- Obtain Chest x-ray
- Continue to medicate
- Recheck VS and pulse oxtimetry
What is a Combitube?
A dual-lumen, dual-cuff airway that can be placed blindly into the esophagus to establish an
airway. If inadvertently placed into trachea, it can be used as a temporary ET tube. There are
only two sizes: small adult and larger adult.
What is a Laryngeal Mask Airway?
Looks like an ET tube but is equipped with an inflatable, elliptical, silicone rubber collar at the
distal end. It is designed to cover the supraglottic area.
,ILMA, does not require laryngoscopy and visualization of the chords.
What is Needle Cricothyrotomy
Percutaneous transtracheal ventilation. (temporary)
Complications include:
- inadequate ventilation causing hypoxia
- hematoma formation
- esophageal perforation
- aspiration
- thyroid perforation
- subcutaneous emphysema
What is Surgical Cricothyrotomy?
Making an incision in cricothyroid membrane and placing a cuffed endo or trach tube into
trachea. This is indicated when other methods of airway management have failed and pt
cannot be adequately ventilated and oxygenated.
Complications include:
- Aspiration
- Hemorrhage or hematoma formation or both
- Lac to trachea or esophagus
- Creation of a false passage
- Laryngeal stenosis
How do you confirm ET Tube/Alternative Airway Placement?
- 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?
Observe:
- mental status
- RR and pattern
- chest wall symmetry
- any injuries
- patient's skin color (cyanosis?)
, - JVD or tracheal deviation? (Tension pneumothorax) What are you looking for when
auscultating lung sounds?
Absence of BS:
- Pneumothorax
- Hemothorax
- Airway Obstruction Diminished BS:
- Splinting or shallow BS may be a result of pain What are you looking for when percussing the
chest?
Dullness:
- hemothorax
Hyperresonanc
e-
Pneumothorax
What are you looking for when palpating the chest wall, clavicles and neck?
- Tenderness
- Swelling
- subcutaneous emphysema
- step-off deformities
= These may indicate: esophageal, pleural, tracheal or bronchial injuries.
Palpate trachea above suprasternal notch. Tracheal deviation may indicate a tension
pneumothorax or massive hemothorax.
What is the DOPE mnemonic?
D - Displaced tube
O - Obstruction: Check secretions or pt biting tube
P - Pneumothorax: Condition may occur from original trauma or barotrauma from
ventilator E - Equipment failure: pt may have become detached from equipment or
there's a kink in the tubing
Explain Hypovolemic Shock.
Most 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.
