TNCC Assessment Deck Flashcards
Prep for passing TNCC exam and practical
Primary Assessment consists of what steps?
ABCDE
Secondary Assessment consists of what steps?
FGHI
ABCDE stands for -
Airway, Breathing, Circulation, Disability (Neuro); Expose/ Environment
FGHI stands for -
Full V/S/Five Interventions/Family presence; Give Comfort; History/Head to Toe; Inspect Posterior (stable neck)
A step assessments
(Pre - A = Site Survey, establish unresponsiveness, then activate EMS)
Vocalizations, tongue/teeth/object obstructions; bleeding/vomit/secretions; edema
A step interventions
Spinal stabilization, airway via chin lift or jaw thrust; suction; oral or nasal airway insertion; ET intubation; needle cricothyrotomy (If in hosp, CXR and capnography to confirm tube plcmt.) (Nasal in Right nostril)
B step assessments
spont breathing; chest rise/fall; skin color; resp rate/depth; soft tissue/chest wall integrity; accessory resp mm usage; bilat breath sounds; JVD; tracheal position
B step interventions
O2; BVM ventilation; needle thoracentesis; chest tube; 3 sided occlusive dsg
C step assessments
Pule rate and quality; skin color/temp/moisture; external bleeding; cap refill
C step interventions
Direct P over bleeding; 2 Lg bore IVs (14G); warms LR or NS; infuse rapidly with blood tubing; blood sample for type; blood infusions; antishock garment; pericardiocentesis; thoracotomy (in ED only); CPR/ACLS/AED; surgery
D step assessments
LOC via AVPU; PERL; GCS (3-15, impt for brain injury tx plan): Lateralizing signs
D step interventions
Investigate causes; hyperventilation prn if signs of herniation; CONSIDER TRANSPORT HERE
AVPU meaning
Alert, Verbal, Pain, Unresponsive
E Step
Remove clothing; keep warm with blankets or lights
F Step
Complete set V/S; Get hx from family and involve them in care at least by presence; consider 5 Interventions
5 Interventions
Cardiac monitor; Pulse Ox; Foley (if not C/I); G tube; Labs (also CO2 monitor; Rad; CT; DPL/FAST, tox screen, lactate, consults, prep for disposition)
G steps
Comfort - verbal reassurances; touch, pain meds; Assess pain - Verb/nonverbal, numeric, word, of visual scale
H step regions
HISTORY - MIVT, pt and fam input, PMHx
Head and Face; Neck; Chest; Abd and Flanks; Pelvis & Perineum; Extremities
H Step - Head
Inspect for wounds; ecchymosis; deformity; entrapment; pupils again; palpate for tenderness, crepitus, deformity
H Step Neck
Remove ant C collar to I&P neck. (Other member holds neck during eval); I for wounds, bruises, swelling, JVD; palp for deformity, tenderness, crepitus, subQ emphysema, trach deviation
H Step Chest
Breathing rate/depth; deformity/bruises/wounds; paradoxical mvt; access mm use; auscultate breath sounds
H Step Abd
wounds/deformit/bruising; bowel sounds FIRST; then palp 4 quads - guarding, rigidity, masses, and femoral pulses
H Step Pelvis
As above, plus priapism, blood at urethra; anal tone; pelvis integrity
H Step Extremities
as above - wounds, bruises, deformity, pulses, temp, sensation, movement, crepitus
I Step
Log roll pt with C spine stabilized; ck for all above (anal tone here if not done above.)
FINALLY NEED TO INVESTIGATE RESPONSES AND REDO ASSMT AND TX PRN
MIVT
Mechanism of Injury; Injuries Sustained, Vital Signs; Treatment given so far (used to report to hospital/EMS staff at handoff)
Phases of Nsg Process
Assmt; Dx; Outcome ID; Develop Plan; Implement Plan/Interventions; Eval and Monitor
ALL trauma pts should receive -
oxygen, nonrebreather mask, 12-15 LPM
Contraindications to urinary catherization -
blood at meatus; blood in scrotum, displaced prostate on rectal exam, suspected ant pelvic fx
NG tube inserted primarily to -
decrease distention and nausea/vomiting, which would stim vagus nerve and cause bradycardia
Highest priority lab test is –
blood typing
Also in the H step with Head To Toe is –
History, including report to ED staff, but also inform from family, prior responders
Pretreatment meds for Rapid Sequence Intubation of patients
LOAD (“LOAD the Airway”) - Lidocaine (Head Inj pts), Opioids, Atropine (Peds), and Defasciculating agents (decrease laryngospasms which could increase ICP)
AVPU is for ______ rating and stands for _______.
Disability (Neuro)
Alert, Verbal, Pain, Unresponsive
MIVT IS FOR ___ and stands for ____.
Reporting Hx to hospital staff.
Mech of injury
Injuries sustained
Vital signs
Treatments done so far
AMPLE-T is for ____ and stands for ______.
Hand off Report anywhere
Age and Allergies Medications incl immunizations Past medical hx Last meal and menstruation ETOH/drugs and Event details of problem/injury Tetanus status
FOCA is for ___ and stands for ____.
Chest tube functional eval (“FOCAs on the Chest”)
Fluctuation of water in seal chamber
Output seen
Color of drainage (as expected)
Air leaks
Formula for IV fluid need in burns, first 24 hr need
= Wt in Kg x TBSA x 2-4ml
Rule of 9s TBSA burned - adult
18% each leg, torso front, torso back
9% each arm, head
1% groin
Rule of 9s TBSA burned - child
18% front torso, back torso, head
14% each leg
9% each arm
Glasgow Coma Scale (GCS) range, best and worst
3-15, 15 is best, response scale so more is better
GCS categories (3)
Best EYE opening
Best VERBAL response
Best MOTOR response
GCS rating scales - EYE
4 - opens SPONTaneously, no stim
3 - response to VOICE
2 - PAIN
1 - no response
GCS rating scales - VERBAL
5 - oriented fully PPT 4 - confused speech 3 - Conf, inappropriate, comprehensible 2 - incomprehensible, sounds only 1 - no response
GCS rating scales - MOTOR
6 - obeys commands to move 5 - localizes painful stimuli 4 - withdraws from pain stimuli 3 - flexion posturing 2 - extension posturing 1 - no mvmt or posturing
Location and Indication for Needle Thoracentesis
2nd ICS, midclavicular line on side with decreased/absent breath sounds and contralat to tracheal shift
Tension Pneumothorax
Technique for Needle Thoracentesis
Insert 10-14G IV catheter needle (3-6cm long) above rib #3 until sound of air escaping. Remove needle but leave catheter in place.
DOPE is for ___ and stands for ___.
Troubleshooting ventilators “(DOPE the VENT”)
Displaced tube
Obstruction (secretions or patient biting tube)
Pneumothorax
Equipment failure (kinked tube, tube came apart)
Shock is defined as ___.
Inadequate perfusion of tissues which lead to the physio responses in attempt to increase O2 delivery/perfusion.
Types of shock and definitions
Hypovolemic - due to loss of blood volume from loss of blood or fluid as with burns. MOST COMMON TYPE
Cardiogenic - due to inadequate contraction - VT, VF, MI
Obstructive - tamponade here b/c heart is fine but external obstruction to fn. Also tension pneumo or embolism
Distributive - loss of vasomotor tone. Neurogenic and septic here. Since vol nl treat with vasoconstrictor NOT IV!
Oxygen is usually administered at a rate of ___ via ____.
12-15 LPM; non-rebreather mask
Ideal IV fluid choice and initial bolus amount
LR best; NS second best
1-2L bolus
If unsure of blood type, universal donor, ______, can be given.
O Neg
Urinary output that indicates good fluid resuscitation/ renal perfusion
1 ml/ kg/ hr
Sign of good fluid restoration and oxygenation of tissues is when the base deficit ____
Increases numerically. 2 or above is mild problem and -15 is severe problem. An increasing DEFICIT is bad sign, but a more positive number is good. (Makes sense b/c deficit is a negative/loss concept so less neg is less deficit!)
Minor vs mod vs severe head trauma GCS
Minor = 13-15
Mod = 9-13
Severe = 8 or less
(just remember Mod is 9-13)
Epidural vs Subdural Hematomas DDx
Epidural - due to artery so rapid onset, transient loss of consciousness and rapid decline, requires surgery. Classic is LOC immed, then fine, then rapid decline.
Subdural - venous cause so slower, gradual, progressive deterioration
Uses, benefits, and downsides of hyperventilating a patient
If hi ICP not resolving, can try hyperventilation.
Hi CO2 causes vasodilation which leads to inc ICP, so hypervent to blow off CO2 reverses the process
Since it causes vasoconstriction tho it increases ischemia problems like thrombotic strokes
6 Ps of Compartment Syndromes
Pain - especially on simple passive ROM Pallor and coolness Pulses decreased Paresthesia Paralysis or motor weakness Pressure - fullness/tightness in limb with swelling
MOI for DC vs AC shock burns
DC current shocks and throws patient.
AC current shocks but causes tetany so patient holds onto current making shock burn worse than by DC
What amount of burn requires IV fluid resuscitation?
More than 20% TBSA
Once fluid need calculated with 2-4 ml x %TBSA x wt in Kg, what is done with the number?
One half of the volume is given over the first 8 hrs since onset of burn
The next half goes in over the next 16 hrs
The calculated fluid amt is the need for the first 24hrs immediately at burn time!
Disaster Triage Categories and Color of Tags
Emergent (RED), life threatening ER type tx
Urgent (YELLOW), major probs, take about 30-60 min
Non-Urgent (GREEN), walking wounded/self treat
Expectant (BLACK), dead or dying, massive full thickness burns
IDME Triage System
Immediate, Delayed, Minimal, Expectant
Stages of Grieving
Denial, Anger, Bargaining, Depression, Acceptance
EMTALA stands for ___ and was enacted in ____ as part of _____ which stands for ____ and came out in ___
Emergency Medical Tx and Labor Act; 1986; Consolidated Omnibus Budget Reconciliation Act; 1985
At end of initial primary and secondary assessments and txs, what is reassessed?
Primary assessment
Vital signs
Pain
All indentified injuries
8 Mandatory steps we MUST do in Primary Assmt, IN ORDER
Assess Airway and Open appropriately Assess Breathing (3 or more ways) Ck Central Pulse Inspect for bleeding Start 2 Lg IVs AVPU Remove Clothes Keep warm with blankets, lights, room temp
5 Mandatory steps in Secondary Assmts, in any order
Assess pain
Maintain spine stability when log-rollling
Identify all injuries sustained
Identify 5 additional interventions or tests
Reeval Primary, vitals, pain, and conditions found
Additional Tests avail
plain films, CT, MRI, FAST, ABGs, EKG, Blood Type/Screen/Cross; GCS
Additional Interventions
Psych support, Pain control, tetatus prophylaxis, ADMIT/SURGERY/TRANSFER!
7Ps of Rapid Seq Intubation
Prep, Preoxygenate, Pretx, Paralysis, Protection/Positioning, Placement (and PROOF), Postintubation Mgmt
Ways to confirm trach airway placement
CXR (best), CO2 monitor (second best), epigastric then lung auscultation with repositioning prn
Tetanus is an intervention because __
Lots of trauma involves the ground, so assume all wounds are infected
Vascular response in shock is ______
vasoconstriction
