TNCC10TH EDITION Questions and
Answers Graded Latest Versions Top
Rated A+
What is the leading cause of preventable death for the trauma patient in the prehospital environment?
a. Airway compromise
b. Ineffective ventilation
c. Secondary head injury
d. Uncontrolled external hemorrhage - ansd. Uncontrolled external hemorrhage
Which of the following accurately describes ventilation principles associated with use of a bag-mask
device for an adult?
a. Compress the bag-mask device at a rate of one breath every 6 seconds.
b. Delivers 100% oxygen.
c. Squeeze the bag-mask device completely for each breath.
d. Maintain the oxygen saturation levels between 92% and 94%. - ansa. Compress the bag-mask
device at a rate of one breath every 6 seconds.
Which of the following is considered a cornerstone of a high-performance trauma team?
a. Individual goals
b. Use of TeamSTEPPS
c. Identification of a single decision maker
d. Effective communication - ansd. Effective communication
While performing an assessment on a 13-month-old involved in a motor vehicle collision, the nurse
identifies which of the following findings from the patient as a sign of possible altered mental status?
a. Sunken fontanel
b. Crying, but consolable
c. Spontaneous movement of arms and legs
d. Cooperation with the assessment - ansd. Cooperation with the assessment A (AVPU) -
ansAlert. Will be able to maintain airway once clear.
A (Primary Survey) - ansAirway and alertness with simultaneous cervical spinal stabilization.
Airway Assessment - ansInspect: tongue obstruction, loose/missing teeth, foreign objects, blood,
vomitus, secretions, edema, burns or evidence of inhalation injury
Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor)
Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphysema
Airway Interventions: - ansSuction Remove foreign body if noted
Jaw thrust maneuver (maintain cspine)
Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag) Consider definitive airway
Alertness Assessment - ansA-Alert V-Verbal
P-Painful
U-Unresponsive
B (Primary Survey) - ansBreathing and Ventilation
Breathing and Ventilation Assessment - ansInspect: spontaneous breathing, symmetrical rise and fall,
,depth/pattern/rate of respirations, accessory muscle use, diaphragmatic breathing, skin color (normal,
pale, flushed, cyanotic), contusions/abrasions/deformities (signs of underlying injury), open
pneumothoraces (sucking chest wound), JVD, tracheal position, signs of inhalation injury
Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space midclavicular line
and bases at the fifth intercostal space anterior axillary line
Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV pulsations at
suprasternal notch or supraclavicular area
Life-threatening pulmonary injuries requiring immediate intervention: open pneumothorax, tension
pneumothorax, flail chest, hemothorax.
Breathing and Ventilation Intervention - ansBreathing absent: jaw-thrust maneuver, oral airway adjunct,
assist ventilation with bag-mask device, prepare for definitive airway
Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or higher. If
ineffective: assist with bag-mask and determine need for definitive airway
C (Primary Survey) - ansCirculation and Control of Hemorrhage
Cardiogenic Shock - ansResults from pump failure in the presence of adequate intravascular volume.
There is a lack of cardiac output and end-organ perfusion secondary to a decrease in myocardial
contractility and/or valvular insufficiency.
Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic
cause.
Blunt cardiac injury may present similar to MI.
Excess of volume administration or increased after load can result in pulmonary edema and increased
myocardial ischemia.
Inotropic support to improve contractility.
Circulation and Control of Hemorrhage Assessment - ansInspect: Uncontrolled external bleeding, skin
color
Auscultate: Muffled heart sounds - may indicate pericardial tamponade
Palpate: carotid and/or femoral pulses for rate, rhythm, strength
Circulation and Control of Hemorrhage Interventions - ansControl and treat external bleeding: apply
direct pressure, elevate bleeding extremity, apply pressure over arterial sites, consider use of a
tourniquet.
2 large bore IVs, if unable consider IO, obtain labs and crossmatch.
Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L.
**Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis and may
cause hypothermia. Component therapy, including administering RBC, plasma and platelets is a
balanced approach so that O2 delivery is optimized, acidosis corrected and coagulopathy prevented.
Classifications of Shock - ansHypovolemic - decrease in the amount of circulating blood volume
Obstructive - obstruction in either the vasculature or heart
Cardiogenic - pump failure in the presence of adequate intravascular volume
,Distributive - maldistribution of an adequate circulating blood volume (septic, anaphylactic, neurogenic)
Corneal Abrasion - ansDamage to the corneal epithelium. Easy to evaluate with fluorescein.
Findings: photophobia, tearing, pain, injected conjunctiva (redness), lid swelling, irritation
Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain, ophthalmic NSAIDS to
decrease swelling, oral analgesics, Ophthalmic f/u in 24 hours. (Do NOT patch - increases infection)
Corneal Foreign Body - ansRoutinely metal, plastic or wood.
Findings: photophobia, pain, injected conjunctiva (redness), lid swelling
Treatment: topical anesthetic, removal of foreign body, ophthalmic ABX, cycloplegics, oral analgesia
Corneal Laceration - ansInvolves one or more layers of the cornea. Visualized with a slit lamp.
Findings: similar to abrasion, pain out of proportion to findings, decreased vision
Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral
and possible surgery
Cycloplegic agent - ansCycloplegia is paralysis of the ciliary muscle of the eye, resulting in a loss of
accommodation. Because of the paralysis of the ciliary muscle, the curvature of the lens can no longer
be adjusted to focus on nearby objects.
D (Primary Survey) - ansDisability (Neurologic Status)
Disability Assessment - ansAssess GCS on arrival and repeat per policy.
Assess pupils for equality, shape and reactivity (PERRL)
Disability interventions - ansEvaluate for need for CT. Assume AMS to be the result of CNS injury until
proven otherwise.
Consider ABGs - AMS may be indicator of decreased cerebral perfusion, hypoventilation or acid-base
imbalance.
Consider bedside glucose.
Distributive Shock - ansOccurs as a result of maldistribution of an adequate circulating volume with a
loss of vascular tone or increased permeability.
Diffuse vasodilation lowers the systemic pressure, creating a relative hypovolemia or reduction of the
mean systemic volume and venous return to the heart or drop in preload, resulting in distributive shock.
Anaphylactic: release of inflammatory mediators, such as histamine, which contracts bronchial smooth
muscle and increases vascular permeability and vasodilation.
Septic Shock: systemic release of bacterial endotoxins, resulting in an increased vascular permeability
and vasodilation
Neurogenic shock: loss of sympathetic nervous system control of vascular tone, which produces
venous and arterial vasodilation. With the loss of sympathetic nervous system input in spinal cord
injury, unopposed vagal activity may result in decreased cardiac output through bradycardia.
TREATMENT: increase systemic resistance, controlled volume replacement. Vasoconstriction and in
some cases (neurogenic) Atropine to counteract bradycardia.
E (Primary Survey) - ansExposure and Environmental Control
Exposure and Environmental Control - ansCarefully and completely undress the patient. Inspect for
uncontrolled bleeding and note any obvious injuries.
, Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentially lethal
combination in the injured patient. Consider: warm blankets, keep ambient temperature warm, warm
IVF, forced air warmers, radiant warming lights.
F (Primary Survey) - ansFull Set of VS & Family Presence
G (Primary Survey) - ansGet Resuscitation Adjuncts: (LMNOP)
L: Labs
M: Monitor cardiac rate and rhythm
N: Naso or orogastric tube consideration
O: Oxygenation - SpO2 and/or etCO2 monitor P: Pain assessment and management
GCS - ansGCS
EYES
1: Does not open eyes
2: Opens eyes in response to pain 3: Opens eyes in response to voice 4: Opens eyes spontaneously
VERBAL
1. Makes no sounds
2. Makes sounds
3. Words
4. Confused, disoriented
5. Oriented, converses normally
MOTOR
1. Makes no movements
2. Extension to painful stimuli (decerebrate)
3. Abnormal flexion to painful stimuli (decorticate)
4. Withdrawal to painful stimuli
5. Localizes painful stimuli
6. Obeys commands
H (Secondary Survey) - ansHistory Prehospital Report (MIST)
M: MOI
I: Injuries sustained
S: Signs and symptoms in the field T: Treatment in field
Patient History (SAMPLE): S: Symptoms
A: Allergies and tetanus status M: Medications
P: Past medical history L: Last oral intake
E: Events and Environmental factors related to injury.
H: Head and Face
Head to Toe Assessment (secondary survey) - ansSOFT TISSUE:
Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled objects.
Palpate: areas of tenderness, step-offs, crepitus
BONY DEFORMITIES:
Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter
Palpate: depressions, angulations, tenderness
Answers Graded Latest Versions Top
Rated A+
What is the leading cause of preventable death for the trauma patient in the prehospital environment?
a. Airway compromise
b. Ineffective ventilation
c. Secondary head injury
d. Uncontrolled external hemorrhage - ansd. Uncontrolled external hemorrhage
Which of the following accurately describes ventilation principles associated with use of a bag-mask
device for an adult?
a. Compress the bag-mask device at a rate of one breath every 6 seconds.
b. Delivers 100% oxygen.
c. Squeeze the bag-mask device completely for each breath.
d. Maintain the oxygen saturation levels between 92% and 94%. - ansa. Compress the bag-mask
device at a rate of one breath every 6 seconds.
Which of the following is considered a cornerstone of a high-performance trauma team?
a. Individual goals
b. Use of TeamSTEPPS
c. Identification of a single decision maker
d. Effective communication - ansd. Effective communication
While performing an assessment on a 13-month-old involved in a motor vehicle collision, the nurse
identifies which of the following findings from the patient as a sign of possible altered mental status?
a. Sunken fontanel
b. Crying, but consolable
c. Spontaneous movement of arms and legs
d. Cooperation with the assessment - ansd. Cooperation with the assessment A (AVPU) -
ansAlert. Will be able to maintain airway once clear.
A (Primary Survey) - ansAirway and alertness with simultaneous cervical spinal stabilization.
Airway Assessment - ansInspect: tongue obstruction, loose/missing teeth, foreign objects, blood,
vomitus, secretions, edema, burns or evidence of inhalation injury
Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor)
Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphysema
Airway Interventions: - ansSuction Remove foreign body if noted
Jaw thrust maneuver (maintain cspine)
Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag) Consider definitive airway
Alertness Assessment - ansA-Alert V-Verbal
P-Painful
U-Unresponsive
B (Primary Survey) - ansBreathing and Ventilation
Breathing and Ventilation Assessment - ansInspect: spontaneous breathing, symmetrical rise and fall,
,depth/pattern/rate of respirations, accessory muscle use, diaphragmatic breathing, skin color (normal,
pale, flushed, cyanotic), contusions/abrasions/deformities (signs of underlying injury), open
pneumothoraces (sucking chest wound), JVD, tracheal position, signs of inhalation injury
Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space midclavicular line
and bases at the fifth intercostal space anterior axillary line
Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV pulsations at
suprasternal notch or supraclavicular area
Life-threatening pulmonary injuries requiring immediate intervention: open pneumothorax, tension
pneumothorax, flail chest, hemothorax.
Breathing and Ventilation Intervention - ansBreathing absent: jaw-thrust maneuver, oral airway adjunct,
assist ventilation with bag-mask device, prepare for definitive airway
Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or higher. If
ineffective: assist with bag-mask and determine need for definitive airway
C (Primary Survey) - ansCirculation and Control of Hemorrhage
Cardiogenic Shock - ansResults from pump failure in the presence of adequate intravascular volume.
There is a lack of cardiac output and end-organ perfusion secondary to a decrease in myocardial
contractility and/or valvular insufficiency.
Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic
cause.
Blunt cardiac injury may present similar to MI.
Excess of volume administration or increased after load can result in pulmonary edema and increased
myocardial ischemia.
Inotropic support to improve contractility.
Circulation and Control of Hemorrhage Assessment - ansInspect: Uncontrolled external bleeding, skin
color
Auscultate: Muffled heart sounds - may indicate pericardial tamponade
Palpate: carotid and/or femoral pulses for rate, rhythm, strength
Circulation and Control of Hemorrhage Interventions - ansControl and treat external bleeding: apply
direct pressure, elevate bleeding extremity, apply pressure over arterial sites, consider use of a
tourniquet.
2 large bore IVs, if unable consider IO, obtain labs and crossmatch.
Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L.
**Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis and may
cause hypothermia. Component therapy, including administering RBC, plasma and platelets is a
balanced approach so that O2 delivery is optimized, acidosis corrected and coagulopathy prevented.
Classifications of Shock - ansHypovolemic - decrease in the amount of circulating blood volume
Obstructive - obstruction in either the vasculature or heart
Cardiogenic - pump failure in the presence of adequate intravascular volume
,Distributive - maldistribution of an adequate circulating blood volume (septic, anaphylactic, neurogenic)
Corneal Abrasion - ansDamage to the corneal epithelium. Easy to evaluate with fluorescein.
Findings: photophobia, tearing, pain, injected conjunctiva (redness), lid swelling, irritation
Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain, ophthalmic NSAIDS to
decrease swelling, oral analgesics, Ophthalmic f/u in 24 hours. (Do NOT patch - increases infection)
Corneal Foreign Body - ansRoutinely metal, plastic or wood.
Findings: photophobia, pain, injected conjunctiva (redness), lid swelling
Treatment: topical anesthetic, removal of foreign body, ophthalmic ABX, cycloplegics, oral analgesia
Corneal Laceration - ansInvolves one or more layers of the cornea. Visualized with a slit lamp.
Findings: similar to abrasion, pain out of proportion to findings, decreased vision
Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral
and possible surgery
Cycloplegic agent - ansCycloplegia is paralysis of the ciliary muscle of the eye, resulting in a loss of
accommodation. Because of the paralysis of the ciliary muscle, the curvature of the lens can no longer
be adjusted to focus on nearby objects.
D (Primary Survey) - ansDisability (Neurologic Status)
Disability Assessment - ansAssess GCS on arrival and repeat per policy.
Assess pupils for equality, shape and reactivity (PERRL)
Disability interventions - ansEvaluate for need for CT. Assume AMS to be the result of CNS injury until
proven otherwise.
Consider ABGs - AMS may be indicator of decreased cerebral perfusion, hypoventilation or acid-base
imbalance.
Consider bedside glucose.
Distributive Shock - ansOccurs as a result of maldistribution of an adequate circulating volume with a
loss of vascular tone or increased permeability.
Diffuse vasodilation lowers the systemic pressure, creating a relative hypovolemia or reduction of the
mean systemic volume and venous return to the heart or drop in preload, resulting in distributive shock.
Anaphylactic: release of inflammatory mediators, such as histamine, which contracts bronchial smooth
muscle and increases vascular permeability and vasodilation.
Septic Shock: systemic release of bacterial endotoxins, resulting in an increased vascular permeability
and vasodilation
Neurogenic shock: loss of sympathetic nervous system control of vascular tone, which produces
venous and arterial vasodilation. With the loss of sympathetic nervous system input in spinal cord
injury, unopposed vagal activity may result in decreased cardiac output through bradycardia.
TREATMENT: increase systemic resistance, controlled volume replacement. Vasoconstriction and in
some cases (neurogenic) Atropine to counteract bradycardia.
E (Primary Survey) - ansExposure and Environmental Control
Exposure and Environmental Control - ansCarefully and completely undress the patient. Inspect for
uncontrolled bleeding and note any obvious injuries.
, Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentially lethal
combination in the injured patient. Consider: warm blankets, keep ambient temperature warm, warm
IVF, forced air warmers, radiant warming lights.
F (Primary Survey) - ansFull Set of VS & Family Presence
G (Primary Survey) - ansGet Resuscitation Adjuncts: (LMNOP)
L: Labs
M: Monitor cardiac rate and rhythm
N: Naso or orogastric tube consideration
O: Oxygenation - SpO2 and/or etCO2 monitor P: Pain assessment and management
GCS - ansGCS
EYES
1: Does not open eyes
2: Opens eyes in response to pain 3: Opens eyes in response to voice 4: Opens eyes spontaneously
VERBAL
1. Makes no sounds
2. Makes sounds
3. Words
4. Confused, disoriented
5. Oriented, converses normally
MOTOR
1. Makes no movements
2. Extension to painful stimuli (decerebrate)
3. Abnormal flexion to painful stimuli (decorticate)
4. Withdrawal to painful stimuli
5. Localizes painful stimuli
6. Obeys commands
H (Secondary Survey) - ansHistory Prehospital Report (MIST)
M: MOI
I: Injuries sustained
S: Signs and symptoms in the field T: Treatment in field
Patient History (SAMPLE): S: Symptoms
A: Allergies and tetanus status M: Medications
P: Past medical history L: Last oral intake
E: Events and Environmental factors related to injury.
H: Head and Face
Head to Toe Assessment (secondary survey) - ansSOFT TISSUE:
Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled objects.
Palpate: areas of tenderness, step-offs, crepitus
BONY DEFORMITIES:
Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter
Palpate: depressions, angulations, tenderness
