TNCC - Trauma Nursing Core Course

TNCC - Trauma Nursing Core Course
A (AVPU) - correct answers--Alert. Will be able to maintain airway once clear.

A (Primary Survey) - correct answers--
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Airway and alertness with simultaneous cervical spinal stabilization.
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Airway Assessment - correct answers--
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Inspect: tongue obstruction, loose/missing teeth, foreign objects, blood, vomitus, secretion
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s, edema, burns or evidence of inhalation injury
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Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor)
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Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphy
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sema

Airway Interventions: - correct answers--Suction
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Remove foreign body if noted2 2 2 2


Jaw thrust maneuver (maintain cspine)
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Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag) 2 2 2 2 2 2 2 2


Consider definitive airway 2 2




Alertness Assessment - correct answers--A-Alert
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V-Verbal
P-Painful
U-Unresponsive

B (Primary Survey) - correct answers--Breathing and Ventilation
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Breathing and Ventilation Assessment - correct answers--
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Inspect: spontaneous breathing, symmetrical rise and fall, depth/pattern/rate of respiration
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s, accessory muscle use, diaphragmatic breathing, skin color (normal, pale, flushed, cyan
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otic), contusions/abrasions/deformities (signs of underlying injury), open pneumothoraces
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2(sucking chest wound), JVD, tracheal position, signs of inhalation injury
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Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space mid
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clavicular line and bases at the fifth intercostal space anterior axillary line
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Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV puls
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ations at suprasternal notch or supraclavicular area
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Life-
threatening pulmonary injuries requiring immediate intervention: open pneumothorax, ten
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sion pneumothorax, flail chest, hemothorax.
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, Breathing and Ventilation Intervention - correct answers--Breathing absent: jaw-
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thrust maneuver, oral airway adjunct, assist ventilation with bag-
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mask device, prepare for definitive airway
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Breathing present: NRB. Determine if ventilation effective: etCO2 35-
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45, SpO2 94% or higher. If ineffective: assist with bag-
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mask and determine need for definitive airway
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C (Primary Survey) - correct answers--Circulation and Control of Hemorrhage
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Cardiogenic Shock - correct answers-- 2 2 2 2


Results from pump failure in the presence of adequate intravascular volume. There is a lac
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k of cardiac output and end-
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organ perfusion secondary to a decrease in myocardial contractility and/or valvular insuffic
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iency. 2




Acute causes - 2 2


myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic ca
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use. 2




Blunt cardiac injury may present similar to MI.
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Excess of volume administration or increased after load can result in pulmonary edema an
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d increased myocardial ischemia.
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Inotropic support to improve contractility. 2 2 2 2




Circulation and Control of Hemorrhage Assessment - correct answers--
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Inspect: Uncontrolled external bleeding, skin color
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Auscultate: Muffled heart sounds - may indicate pericardial tamponade
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Palpate: carotid and/or femoral pulses for rate, rhythm, strength
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Circulation and Control of Hemorrhage Interventions - correct answers--
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Control and treat external bleeding: apply direct pressure, elevate bleeding extremity, appl
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y pressure over arterial sites, consider use of a tourniquet.
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2 large bore IVs, if unable consider IO, obtain labs and crossmatch.
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Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L.
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**Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis a
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nd may cause hypothermia. Component therapy, including administering RBC, plasma an
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