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TNCC Study Cards > TNCC Assessment Deck > Flashcards

TNCC Assessment Deck Flashcards

Prep for passing TNCC exam and practical

1
Q

Primary Assessment consists of what steps?

A

ABCDE

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2
Q

Secondary Assessment consists of what steps?

A

FGHI

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3
Q

ABCDE stands for -

A

Airway, Breathing, Circulation, Disability (Neuro); Expose/ Environment

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4
Q

FGHI stands for -

A

Full V/S/Five Interventions/Family presence; Give Comfort; History/Head to Toe; Inspect Posterior (stable neck)

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5
Q

A step assessments

A

(Pre - A = Site Survey, establish unresponsiveness, then activate EMS)
Vocalizations, tongue/teeth/object obstructions; bleeding/vomit/secretions; edema

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6
Q

A step interventions

A

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)

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7
Q

B step assessments

A

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

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8
Q

B step interventions

A

O2; BVM ventilation; needle thoracentesis; chest tube; 3 sided occlusive dsg

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9
Q

C step assessments

A

Pule rate and quality; skin color/temp/moisture; external bleeding; cap refill

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10
Q

C step interventions

A

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

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11
Q

D step assessments

A

LOC via AVPU; PERL; GCS (3-15, impt for brain injury tx plan): Lateralizing signs

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12
Q

D step interventions

A

Investigate causes; hyperventilation prn if signs of herniation; CONSIDER TRANSPORT HERE

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13
Q

AVPU meaning

A

Alert, Verbal, Pain, Unresponsive

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14
Q

E Step

A

Remove clothing; keep warm with blankets or lights

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15
Q

F Step

A

Complete set V/S; Get hx from family and involve them in care at least by presence; consider 5 Interventions

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16
Q

5 Interventions

A

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)

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17
Q

G steps

A

Comfort - verbal reassurances; touch, pain meds; Assess pain - Verb/nonverbal, numeric, word, of visual scale

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18
Q

H step regions

A

HISTORY - MIVT, pt and fam input, PMHx

Head and Face; Neck; Chest; Abd and Flanks; Pelvis & Perineum; Extremities

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19
Q

H Step - Head

A

Inspect for wounds; ecchymosis; deformity; entrapment; pupils again; palpate for tenderness, crepitus, deformity

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20
Q

H Step Neck

A

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

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21
Q

H Step Chest

A

Breathing rate/depth; deformity/bruises/wounds; paradoxical mvt; access mm use; auscultate breath sounds

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22
Q

H Step Abd

A

wounds/deformit/bruising; bowel sounds FIRST; then palp 4 quads - guarding, rigidity, masses, and femoral pulses

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23
Q

H Step Pelvis

A

As above, plus priapism, blood at urethra; anal tone; pelvis integrity

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24
Q

H Step Extremities

A

as above - wounds, bruises, deformity, pulses, temp, sensation, movement, crepitus

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25
Q

I Step

A

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

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26
Q

MIVT

A

Mechanism of Injury; Injuries Sustained, Vital Signs; Treatment given so far (used to report to hospital/EMS staff at handoff)

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27
Q

Phases of Nsg Process

A

Assmt; Dx; Outcome ID; Develop Plan; Implement Plan/Interventions; Eval and Monitor

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28
Q

ALL trauma pts should receive -

A

oxygen, nonrebreather mask, 12-15 LPM

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29
Q

Contraindications to urinary catherization -

A

blood at meatus; blood in scrotum, displaced prostate on rectal exam, suspected ant pelvic fx

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30
Q

NG tube inserted primarily to -

A

decrease distention and nausea/vomiting, which would stim vagus nerve and cause bradycardia

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31
Q

Highest priority lab test is –

A

blood typing

32
Q

Also in the H step with Head To Toe is –

A

History, including report to ED staff, but also inform from family, prior responders

33
Q

Pretreatment meds for Rapid Sequence Intubation of patients

A

LOAD (“LOAD the Airway”) - Lidocaine (Head Inj pts), Opioids, Atropine (Peds), and Defasciculating agents (decrease laryngospasms which could increase ICP)

34
Q

AVPU is for ______ rating and stands for _______.

A

Disability (Neuro)

Alert, Verbal, Pain, Unresponsive

35
Q

MIVT IS FOR ___ and stands for ____.

A

Reporting Hx to hospital staff.

Mech of injury
Injuries sustained
Vital signs
Treatments done so far

36
Q

AMPLE-T is for ____ and stands for ______.

A

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
37
Q

FOCA is for ___ and stands for ____.

A

Chest tube functional eval (“FOCAs on the Chest”)

Fluctuation of water in seal chamber
Output seen
Color of drainage (as expected)
Air leaks

38
Q

Formula for IV fluid need in burns, first 24 hr need

A

= Wt in Kg x TBSA x 2-4ml

39
Q

Rule of 9s TBSA burned - adult

A

18% each leg, torso front, torso back
9% each arm, head
1% groin

40
Q

Rule of 9s TBSA burned - child

A

18% front torso, back torso, head
14% each leg
9% each arm

41
Q

Glasgow Coma Scale (GCS) range, best and worst

A

3-15, 15 is best, response scale so more is better

42
Q

GCS categories (3)

A

Best EYE opening
Best VERBAL response
Best MOTOR response

43
Q

GCS rating scales - EYE

A

4 - opens SPONTaneously, no stim
3 - response to VOICE
2 - PAIN
1 - no response

44
Q

GCS rating scales - VERBAL

A 
5 - oriented fully PPT
4 - confused speech
3 - Conf, inappropriate, comprehensible
2 - incomprehensible, sounds only
1 - no response
45
Q

GCS rating scales - MOTOR

A 
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
46
Q

Location and Indication for Needle Thoracentesis

A

2nd ICS, midclavicular line on side with decreased/absent breath sounds and contralat to tracheal shift
Tension Pneumothorax

47
Q

Technique for Needle Thoracentesis

A

Insert 10-14G IV catheter needle (3-6cm long) above rib #3 until sound of air escaping. Remove needle but leave catheter in place.

48
Q

DOPE is for ___ and stands for ___.

A

Troubleshooting ventilators “(DOPE the VENT”)
Displaced tube
Obstruction (secretions or patient biting tube)
Pneumothorax
Equipment failure (kinked tube, tube came apart)

49
Q

Shock is defined as ___.

A

Inadequate perfusion of tissues which lead to the physio responses in attempt to increase O2 delivery/perfusion.

50
Q

Types of shock and definitions

A

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!

51
Q

Oxygen is usually administered at a rate of ___ via ____.

A

12-15 LPM; non-rebreather mask

52
Q

Ideal IV fluid choice and initial bolus amount

A

LR best; NS second best

1-2L bolus

53
Q

If unsure of blood type, universal donor, ______, can be given.

A

O Neg

54
Q

Urinary output that indicates good fluid resuscitation/ renal perfusion

A

1 ml/ kg/ hr

55
Q

Sign of good fluid restoration and oxygenation of tissues is when the base deficit ____

A

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!)

56
Q

Minor vs mod vs severe head trauma GCS

A

Minor = 13-15
Mod = 9-13
Severe = 8 or less
(just remember Mod is 9-13)

57
Q

Epidural vs Subdural Hematomas DDx

A

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

58
Q

Uses, benefits, and downsides of hyperventilating a patient

A

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

59
Q

6 Ps of Compartment Syndromes

A 
Pain - especially on simple passive ROM
Pallor and coolness
Pulses decreased
Paresthesia
Paralysis or motor weakness
Pressure - fullness/tightness in limb with swelling
60
Q

MOI for DC vs AC shock burns

A

DC current shocks and throws patient.

AC current shocks but causes tetany so patient holds onto current making shock burn worse than by DC

61
Q

What amount of burn requires IV fluid resuscitation?

A

More than 20% TBSA

62
Q

Once fluid need calculated with 2-4 ml x %TBSA x wt in Kg, what is done with the number?

A

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!

63
Q

Disaster Triage Categories and Color of Tags

A

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

64
Q

IDME Triage System

A

Immediate, Delayed, Minimal, Expectant

65
Q

Stages of Grieving

A

Denial, Anger, Bargaining, Depression, Acceptance

66
Q

EMTALA stands for ___ and was enacted in ____ as part of _____ which stands for ____ and came out in ___

A

Emergency Medical Tx and Labor Act; 1986; Consolidated Omnibus Budget Reconciliation Act; 1985

67
Q

At end of initial primary and secondary assessments and txs, what is reassessed?

A

Primary assessment
Vital signs
Pain
All indentified injuries

68
Q

8 Mandatory steps we MUST do in Primary Assmt, IN ORDER

A 
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
69
Q

5 Mandatory steps in Secondary Assmts, in any order

A

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

70
Q

Additional Tests avail

A

plain films, CT, MRI, FAST, ABGs, EKG, Blood Type/Screen/Cross; GCS

71
Q

Additional Interventions

A

Psych support, Pain control, tetatus prophylaxis, ADMIT/SURGERY/TRANSFER!

72
Q

7Ps of Rapid Seq Intubation

A

Prep, Preoxygenate, Pretx, Paralysis, Protection/Positioning, Placement (and PROOF), Postintubation Mgmt

73
Q

Ways to confirm trach airway placement

A

CXR (best), CO2 monitor (second best), epigastric then lung auscultation with repositioning prn

74
Q

Tetanus is an intervention because __

A

Lots of trauma involves the ground, so assume all wounds are infected

75
Q

Vascular response in shock is ______

A

vasoconstriction

TNCC Study Cards (1 decks)

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