TNCC

Question 1

MIST

Answer 1

• Mechanisms of Injury
• Injuries sustained
• Signs and symptoms in the field
• Treatment in the field

Question 2

Across-the-room Observation

Answer 2

Observe for uncontrolled hemorrhage and consider reprioritizing to C- A-B-C

Question 3

Primary Survey Goal

Answer 3

Id life threatening situations and rapidly intervene. Includes ABCDE

Question 4

A

Answer 4

Airway and Alertness with simultaneous cervical and spinal stabilization

Question 5

B

Answer 5

Breathing and ventilation

Question 6

C

Answer 6

Circulation and Control of Hemorrhage

Question 7

D

Answer 7

Disability (neurological status)

Question 8

E

Answer 8

Exposure and Environmental Control

Question 9

Order of TNP

Answer 9

1. Prehospital Report
2. Across-the-room observation
3. Primary Survey
4. Resucitation Adjuncts to Primary Survey (FG)
5. Reevaluation
6. Secondary Survey (HI)
7. Reevaluation Adjuncts to the Secondary Survey
8. Definitive Care or Transfer

Question 10

Resuscitation Adjuncts (F&G)

Answer 10

F- Full set of vital signs and family presence

G- Get recuscitation adjuncts (LMNOP)

Question 11

LMNOP

Answer 11

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

Question 12

Reevaluation

Answer 12

Reevaluate for presence of hemorrhage or any primary findings that raise suspicion

Question 13

Secondary Survey (HI)

Answer 13

H - History - from prehospital (MIST), from pt or family and/or PMH
I- Inspection (Head-to-toe)

Question 14

Reevaluation Adjunct to the Secondary Survey

Answer 14

diagnostic studies and interventions that supplement the clinical assessment, confirm findings or rule out others.

Question 15

Reevaluatin and Post Resuscitation Care

Answer 15

evaluated for response to and effectiveness of interventions. Reevaluation of primary survey, vitals, pain and all injuries.

Question 16

Definitive care of transfer

Answer 16

Consideration given to decide if transfer to trauma center is needed.

Question 17

Preparation and Triage

Test

Answer 17

1. Activate the trauma team
2. Prepare the trauma room (rapid infuser and trauma equipment)
3. Don PPE

Question 18

Across-the-Room Observation

Test

Answer 18

Assess for uncontrolled external hemorrhage

Question 19

Airway and Alertness with Simultaneous Cervical Spinal Stabilization
(Test)

Answer 19

1. Assess LOC using AVPU
2. State need for 2nd person to provide cervical stabilization. and manually opens airway using jaw-thrust maneuver
3. Check airway (tongue obstruction, loose or missing teeth, foreign objects, blood, vomit, secretions, edema, snoring, gurgling or stridor?)
4. Place temporary airway (OPA or NPA)
5. State need for definitive airway
6. Reassess temporary airway after insertion.

Question 20

Breathing and Ventilation

Test

Answer 20

1. Assess breathing effectiveness (spontaneous breathing, symmetrical chest rise, depth, pattern, rate, effort, skin color, tracheal deviation, JVD, breath sounds present, open wounds, subq emphysema?)
2. State need for assisted ventilation

Question 21

Incubated using RSI now what?

Test

Answer 21

• 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.

Question 22

Circulation and Control of Hemorrhage

Test

Answer 22

• 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)

Question 23

Disability

Test

Answer 23

• Asses GCS (eye opening, verbal, motor response)
• Assess pupils
• state need for CT of head and cervical spine

Question 24

Exposure and Environmental Control

test

Answer 24

• remove all clothing and inspect for uncontrolled bleeding and obvious injuries
• keep patient warm (blankets, warming lights, increase room temp, warmed fluids, warmed O2)

Question 25

Resucitation Adjuncts

test

Answer 25

• 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)

Question 26

Secondary Survey

test

Answer 26

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

Question 27

Posterior Surfaces

test

Answer 27

• state need to maintain manual cervical and spinal stabilization to turn pt
• I&P posterior surfaces
• Consider removal of spine board

Question 28

Reevaluation Adjuncts

test

Answer 28

• 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)