TNCC Flashcards
MARCH Acronym
M - Massive hemorrhage A - Airway R - Respiration C - Circulation H - Head injury/Hypothermia
AVPU Scale
A: Alert and oriented
V: Responds to verbal stimuli
P: Responds only to painful stimuli
U: Unresponsive
FAST Exam
Focused Assessment with Sonography
hollow organs
gall bladder, stomach small/large bowel, worried about ruputre
Solid organs
liver spleen kidneys and pancreas
hemorrhage is the major concern; potential for rapid deterioration and death
Hollow organs
gall bladder, stomach small/large bowel, worried about rupture
Hollow organs
gall bladder, stomach small/large bowel, worried about rupture
Hollow organs
gall bladder, stomach small/large bowel, worried about rupture
Four phases of emergency management
- Mitigation
- Preparedness
- Response
- Recovery
Four phases of emergency management
- Mitigation
- Preparedness
- Response
- Recovery
Level I
Tertiary acre facility
Commonly a university affiliated
the most common preventable cause of death in trauma pt
hemorrhagic shock
the most common preventable cause of death in trauma pt
hemorrhagic shock
in this stage there is widespread tissue hypoxia and anaerobic metabolism
decompensated stage of shock (stage II)
pg 72-75
this management strategy allows a lower bp to avoid popping clot
permissive hypotension
pg 80
this stage is manifested by a restless pt with tachypnea, bounding pulses…
compensated shock stage I
pg 72-75
supine hypotension in a pregnant pt due to compression of the great vessels
aortocaval (vena cava) compression syndrome
pg 294
the most common preventable cause of death in trauma pt
Hemorrhagic shock
hypothermia, coagulopathy and metabolic acidosis
Trauma Triad of Death
victims disrobe, wash with soap and water and dry with towel in this process
decontamination
In this stage of shock there is:
- Widespread tissue hypoxia
- Anaerobic metabolism
- Peripheral pooling of blood
- Stage of impaired issue perfusion
Decompensated stage of shock (stage II)
pg 72-75
this management strategy allows a lower bp to avoid popping clot
Permissive hypotension
pg 80
This stage of shock is manifested by a restless pt with tachypnea, bounding pulses, and pale diaphoretic skin.
Compensated shock (stage I) pg 72-75
presence of rectal tone and perineal sensation in spinal shock
sacral sparing
pg 173
cervical arthritis, cerebral atrophy, gait instability
Physiologic changes in the geriatric pt
victims disrobe, wash with soap and water and dry with towel in this process
Decontamination
Vertical shear, lateral compression, and anterio-posterior compression
The 3 patterns of pelvic fractures
pg155
picture
Decloving injury
presence of rectal tone and perineal sensation in spinal shock
Sacral sparing
pg 173
Rib Fx with paradoxical chest wall movement
flail chest
Tear shaped pupil, loss of vision, sclera and corneal damage
Ruptured globe injury
the clinical findings in this triad
- bradycardia
- widening pulse pressure
- diminished respiratory effort
Cushings triad
pg 96
a rare eye injury where bleeding causes bleeding behind the globe
Retrobulbar hematoma
pg13
Rib Fx with paradoxical chest wall movement
Flail chest
direct force is transmitted along the length of the vertebral column
Axial loading
pg 170
the presence of a spinal cord injury in a child despite negative imaging
spinal cord injury with radiographic imag..
an injury at or above this level of the spine result in resp compromise
C5
pg 167
the presence of a spinal cord injury in a child despite negative imaging
Spinal cord injury with radiographic abnormality (SCIWORA)
an injury at or above this level of the spine result in resp compromise
C-5
pg 167
Diaphramatic irritation
Kehrs sign
pg149
Diaphramatic irritation
Kehrs sign
pg149
In this type of blast injury, pulmonary barotrauma and tympanic membrane rupture can occur
Primary blast injury
This type of energy increases four times when velocity is doubled
Kinetic energy
The trajectory of a driver thrown through the windshield
“up and over” pathway
In this impact the internal organs collide within the body cavity
The third impact
Muffled heart sounds, hypotension, and JVD
Symptoms of pericardial tamponade
Shortness of breath and bowel sounds heard in the lower chest
Symptoms of ruptured diaphram
150-200mL fluid necessary, does not evaluate the retroperitoneal space, and operator dependent
Limitations of the FAST exam
Stages of Shock
- Compensated Shock
- Decompensated Shock
- Irreversible Shock
Types of Shock
- Hypovolemic
- Obstructive Shock
- Cardiogenic Shock
- Distributive Shock
Hypovolemic Shock
Etiology/Pathology:
Hemorrhage / Whole-blood loss
Burns / Plasmas loss, fluid shifts`
Obstructive Shock
Etiology / Pathology:
- Cardiac tamponade / Compression of heart w/obstruction to atrial filling
- Tension pneumothorax / Mediastinal shift w/obstruction to atrial filling
- Tension hemothorax /combination of compression of the heart and mediastinal shift
Cardiogenic Shock
Etiology / Pathology:
- Myocardial infarction / loss of cardiac contractility
- Dysrhythmias / Reduced CO
- Blunt cardiac trauma / Loss of cardiac contractility and dysrhythmias
Distributive Shock
Etiology/Pathology:
- Spinal Cord Injury (Neurogenic shock) / loss of vaso -motor tone due to decreases in sympathetic control
- Sepsis / mediated by sstemic inflammatory resonse syndrome with hypotension and perfusion abnormalities
- Anaphylaxis / vasodilation of vessels due to immune reaction to allergens (release of histamine)
Cerbral Perfusion Pressure (CPP)
60-100 mmHg
Mean Arterial Pressure (MAP)
50-150 mmHg
Intracranial Pressure (ICP)
Normal is 0-15 mmHg
Effects of CO2 on Vasculature?
High CO2 (hypoventilation) = thin dilated vessels Low CO2 (hyperventilation) = thickened narrow vessels
Effects of CO2 on Vasculature?
High CO2 (hypoventilation) = thin dilated vessels Low CO2 (hyperventilation) = thickened narrow vessels
Increased in sympathetic discharge
Fluid conservation by kidneys
To maintain BP and CO
Compensated Shock (Stage I)
Cellular hypoxia
Severe metabolic acidosis
Multisystem failure
Irreversible Shock (Stage III)
