TNCC Study Guide

Initial Assessment ● Preparation and Triage ○ Use universal precautions and don PPE ○ Consider any possible patient exposure to hazardous material that puts the trauma team at risk ○ Safe practice, safe care ○ Ensure resuscitation equipment is readily available ● Across the room observation to identify any uncontrolled external hemorrhage ○ Need to reprioritize to Circulation and Control of Hemorrhage ○ Uncontrolled hemorrhage is the major cause of preventable death in trauma patients ● Primary Survey - Inspect, Auscultate, Palpate ○ A: Airway and alertness with cervical spine stabilization ■ AVPU (Alert/verbal stimuli/painful stimuli/unresponsive) ■ Jaw-thrust maneuver to open the airway and assess for obstruction ● Tongue obstruction ● Loose teeth, foreign objects ● Blood, vomitus, secretions ● Edema ■ Listen for obstructive airway sounds (snoring, gurgling, stridor) ■ Feel for subcutaneous emphysema or deformities ■ Definitive Airway devices = ET tube ● Assess for proper placement (ETCO2, bilat breath sounds, absence of gurgling over the epigastrium) ■ Suction the airway if needed, then reassess ○ B: Breathing and ventilation ■ Are they breathing? How well are they breathing? How long can they keep it up? ■ Spontaneous breathing? Symmetrical rise and fall? ■ Depth, pattern, and rate ■ Skin color ■ Breath sounds ■ Palpate bony structures for possible rib fractures, subcutaneous emphysema, soft tissue injury ■ Open the airway if needed ● Use oral airway adjunct, assist ventilations, then prepare for definitive airway ○ C: Circulation and Control of Hemorrhage ■ Any signs of uncontrolled external bleeding? ● Apply direct pressure or use a tourniquet ■ Skin color, temp, and moisture? ■ Listen to heart and lung sounds ■ Palpate central pulses for rate, rhythm, and strength ■ 2 large-bore IVs ● IO if needed ■ Initiate Warmed isotonic crystalloid solution infusion at a controlled rate ● Consider balanced resuscitation needs ● Rapid infusion protocols ■ Component Therapy = replacing patient loss by administering RBCs, plasma, and platelets = balanced approach ● Suggested for fluid resuscitation instead of standard approach (large volumes of IV fluids) ○ D: Disability (Neuro status) ■ GCS (not accurate if patient is intubated) and trends ■ Assess pupils ■ Need for CT of head and cervical spine? ○ E: Exposure & Environment ■ Remove all clothing ■ Inspect for any uncontrolled bleeding or any obvious injuries ■ Keep the patient warm ● Blankets, fluids, room temp, O2 ● Aggressive measures are to be taken to prevent loss of body heat ● Hypothermia + hypotension + acidosis = TRAUMA TRIAD OF DEATH ○ F: Full set of VS and Family presence ■ Monitor ef ectiveness of resuscitation ef orts and trend VS December 2017; TNCC 7th Edition ■ Facilitate family presence as soon as a member of the trauma team is available to act as a liaison to the family ○ G: Get Resuscitation Adjuncts (Get Stuff!) ■ L: Labs (ABGs, Type and Screen, Lactic Acid) ● Lactic acid is an excellent reflection of tissue perfusion ● Base deficit of -6 is associated with poor outcomes ■ M: Monitor cardiac Rhythm ■ N: Naso or Orogastric tube ■ O: Oxygenation and Ventilation = Pulse ox and ETCO2 ● SpO2 95% ● ETCO2 norm = 35-45 mmHg ■ P: Pain ● Assess for pain using appropriate pain scale ● Give nonpharmacologic comfort measures ○ Repositioning, ice therapy, padding, etc. ● Order appropriate analgesic medication ● Reevaluation for signs of internal uncontrolled hemorrhage and consider the need for patient transfer ○ Portable radiograph ○ Initiate steps for transfer to another facility ● Secondary Survey