TNCC Flashcards
MIST
- Mechanisms of Injury
- Injuries sustained
- Signs and symptoms in the field
- Treatment in the field
Across-the-room Observation
Observe for uncontrolled hemorrhage and consider reprioritizing to C- A-B-C
Primary Survey Goal
Id life threatening situations and rapidly intervene. Includes ABCDE
A
Airway and Alertness with simultaneous cervical and spinal stabilization
B
Breathing and ventilation
C
Circulation and Control of Hemorrhage
D
Disability (neurological status)
E
Exposure and Environmental Control
Order of TNP
- Prehospital Report
- Across-the-room observation
- Primary Survey
- Resucitation Adjuncts to Primary Survey (FG)
- Reevaluation
- Secondary Survey (HI)
- Reevaluation Adjuncts to the Secondary Survey
- Definitive Care or Transfer
Resuscitation Adjuncts (F&G)
F- Full set of vital signs and family presence
G- Get recuscitation adjuncts (LMNOP)
LMNOP
L-labs
M-monitor continuous cardiac rate and rhythm
N- Naso or orogastric tube
O- oxygenation and ventilation (pulse ox and capnography)
P - pain assessment and management
Reevaluation
Reevaluate for presence of hemorrhage or any primary findings that raise suspicion
Secondary Survey (HI)
H - History - from prehospital (MIST), from pt or family and/or PMH
I- Inspection (Head-to-toe)
Reevaluation Adjunct to the Secondary Survey
diagnostic studies and interventions that supplement the clinical assessment, confirm findings or rule out others.
Reevaluatin and Post Resuscitation Care
evaluated for response to and effectiveness of interventions. Reevaluation of primary survey, vitals, pain and all injuries.
Definitive care of transfer
Consideration given to decide if transfer to trauma center is needed.
Preparation and Triage
Test
- Activate the trauma team
- Prepare the trauma room (rapid infuser and trauma equipment)
- Don PPE
Across-the-Room Observation
Test
Assess for uncontrolled external hemorrhage
Airway and Alertness with Simultaneous Cervical Spinal Stabilization
(Test)
- Assess LOC using AVPU
- State need for 2nd person to provide cervical stabilization. and manually opens airway using jaw-thrust maneuver
- Check airway (tongue obstruction, loose or missing teeth, foreign objects, blood, vomit, secretions, edema, snoring, gurgling or stridor?)
- Place temporary airway (OPA or NPA)
- State need for definitive airway
- Reassess temporary airway after insertion.
Breathing and Ventilation
Test
- Assess breathing effectiveness (spontaneous breathing, symmetrical chest rise, depth, pattern, rate, effort, skin color, tracheal deviation, JVD, breath sounds present, open wounds, subq emphysema?)
- State need for assisted ventilation
Incubated using RSI now what?
Test
- Assess ET placement ( 1. attach CO2 detector, 2.observe for rise and fall or chest, 3. auscultate over epigastrium and then 4. bilateral breath sounds, 5. After 5 or 6 breaths observe CO2 detector for presence of CO2, 6. assess for improvement in skin color)
- Assess ET position by noting the number at the teeth (or lips) and SECURE ETT.
- State need to continue ventilation or begin mechanical ventilation.
Circulation and Control of Hemorrhage
Test
- Assess adequacy of circulation ID ALL 3! 1. Inspect for hemorrhage, 2. palpate central pulse, 3. inspect and palate skin for color, temp and moisture.
- Assess patency of prehospital IV
- Place 2nd large caliber IV
- Adminiater warmed, isotonic crystalloid (with blood tubing and AT A CONTROLLED RATE if not actively hemorrhaging)
Disability
Test
- Asses GCS (eye opening, verbal, motor response)
- Assess pupils
- state need for CT of head and cervical spine
Exposure and Environmental Control
test
- remove all clothing and inspect for uncontrolled bleeding and obvious injuries
- keep patient warm (blankets, warming lights, increase room temp, warmed fluids, warmed O2)
Resucitation Adjuncts
test
- Obtain a full set of vitals
- Facilitate family presence
- Get resuscitation adjuncts (labs t+s, ABG etc, attach to cardiac monitor, consider NG or OG, Oximetry and Capnography, Assess Pain (using appropriate scale), Give nonpharmacologic measure ice, repositions, padding over bony prominences, States need to consider order for analgesia)
Secondary Survey
test
History - obtain pertinent history from MIST, PMH from pt or family.
Head to Toe
-Inspect and palpate head and face
- I&P neck. remove and replace cervical collar
-I&P chest
- Auscultate breath sounds and heart sounds
- Inspect abdomen AND flanks
-Auscultates bowl sounds
- Palpate abdomen
- Inspect pelvis and perineum
- Apply pressure on iliac crest downward and medially
- apply pressure on symphysis pubis
- assess placement of urinary catheters.
- I&P all extremities and neurovascular status
Posterior Surfaces
test
- state need to maintain manual cervical and spinal stabilization to turn pt
- I&P posterior surfaces
- Consider removal of spine board
Reevaluation Adjuncts
test
- ID all simulated injuries
- What reevaulation adjuncts will you expect? (IE tests)
- Reevaluate primary assessment, vital signs, pain, injuries and effectiveness of interventions
- Definitive care (consider transfer to trauma center or admission depending oon results of testing. Surgery may also be considered)
