TNCC 8th Edition GRADED A
MARCH mneumonic - ✔✔Massive Hemorrhage: Control with combat gauze, celox gauze, or chito
gauze; replacement of blood loss with whole blood or 1:1:1 ratio of plasma, RBC, and platelets to
achieve SBP of 80-90mmHg.
Airway: Establish and maintain patent airway
Respiration: Decompress suspected tension pneumothorax, seal open chest wounds, and support
ventilation and oxygenation as required.
Circulation: Provide vascular access (IV/IO) and administer fluids as required to treat shock
Head injury/Hypothermia: Prevent or treat hypotension and hypoxia to prevent worsening of TBI and
prevent or treat hypothermia.
AVPU - ✔✔Assessing Alertness
A: Alert and oriented
V: Responds to verbal stimuli
P: Responds only to painful stimuli
U: Unresponsive
LACE - ✔✔Soft Tissue Injuries
L: Lacerations
A: Abrasions, Avulsions
C: Contusions
E: Edema, Ecchymosis
Urinary Catheter Contraindications - ✔✔if urethral transsection is suspected:
-blood at the urethral meatus
-perineal ecchymosis
-scrotal ecchymosis
-high-riding or nonpalpable prostate
Breathing Intervention Reassessment - ✔✔1. Attach CO2 detector
2. Listen over epigastrum
, 3. Bilateral breath sounds at midaxillary and midclavicular lines
4. Color change after 6 breaths
5. Monitor skin color; get xr
Troubleshooting Ventilator Alarms - ✔✔D: Displaced Tube
O: Obstructed or Kinked Tube
P: Pneumothorax
E: Equipment failure, such as the patient becoming detached from the equipment or loss of
capnography
Seven P's of RSI - ✔✔-Preparation: ensure you have all necessary equipment and personnel. Verify IV
sites
-Preoxygenation: high flow oxygen for minimum of 3 minutes. Position is HOB elevated to 20
degrees. For spinal precautions, reverse Trendelenburg at 30 degrees.
-Pre-intubation optimization: Lidocaine (may reduce risk of rise in ICP during intubation) or Fentanyl
(mitigates sympathetic response increased HR and BP during intubation) administration
-Paralysis with induction
-Protection: after neuromuscular blocking agent is administered, protect the airway from aspiration
by avoiding BVM, which can result in regurgitation and aspiration.
-Placement with proof: inflate ETT cuff, secure, use ETCO2 for confirmation
-Post-intubation management: secure tube and note measurement; xr.
Inductions Agents for RSI - ✔✔Etomidate
Ketamine
Midazolam
Propofol
Paralysis Agents for RSI - ✔✔Succinylcholine
Rocuronium
Vecuronium
Cerebral Perfusion Pressure (CPP) - ✔✔Normal: 60-100 mm Hg
MARCH mneumonic - ✔✔Massive Hemorrhage: Control with combat gauze, celox gauze, or chito
gauze; replacement of blood loss with whole blood or 1:1:1 ratio of plasma, RBC, and platelets to
achieve SBP of 80-90mmHg.
Airway: Establish and maintain patent airway
Respiration: Decompress suspected tension pneumothorax, seal open chest wounds, and support
ventilation and oxygenation as required.
Circulation: Provide vascular access (IV/IO) and administer fluids as required to treat shock
Head injury/Hypothermia: Prevent or treat hypotension and hypoxia to prevent worsening of TBI and
prevent or treat hypothermia.
AVPU - ✔✔Assessing Alertness
A: Alert and oriented
V: Responds to verbal stimuli
P: Responds only to painful stimuli
U: Unresponsive
LACE - ✔✔Soft Tissue Injuries
L: Lacerations
A: Abrasions, Avulsions
C: Contusions
E: Edema, Ecchymosis
Urinary Catheter Contraindications - ✔✔if urethral transsection is suspected:
-blood at the urethral meatus
-perineal ecchymosis
-scrotal ecchymosis
-high-riding or nonpalpable prostate
Breathing Intervention Reassessment - ✔✔1. Attach CO2 detector
2. Listen over epigastrum
, 3. Bilateral breath sounds at midaxillary and midclavicular lines
4. Color change after 6 breaths
5. Monitor skin color; get xr
Troubleshooting Ventilator Alarms - ✔✔D: Displaced Tube
O: Obstructed or Kinked Tube
P: Pneumothorax
E: Equipment failure, such as the patient becoming detached from the equipment or loss of
capnography
Seven P's of RSI - ✔✔-Preparation: ensure you have all necessary equipment and personnel. Verify IV
sites
-Preoxygenation: high flow oxygen for minimum of 3 minutes. Position is HOB elevated to 20
degrees. For spinal precautions, reverse Trendelenburg at 30 degrees.
-Pre-intubation optimization: Lidocaine (may reduce risk of rise in ICP during intubation) or Fentanyl
(mitigates sympathetic response increased HR and BP during intubation) administration
-Paralysis with induction
-Protection: after neuromuscular blocking agent is administered, protect the airway from aspiration
by avoiding BVM, which can result in regurgitation and aspiration.
-Placement with proof: inflate ETT cuff, secure, use ETCO2 for confirmation
-Post-intubation management: secure tube and note measurement; xr.
Inductions Agents for RSI - ✔✔Etomidate
Ketamine
Midazolam
Propofol
Paralysis Agents for RSI - ✔✔Succinylcholine
Rocuronium
Vecuronium
Cerebral Perfusion Pressure (CPP) - ✔✔Normal: 60-100 mm Hg
