TNCC checkoff

Question 1

After receiving the call in report from EMS about a trauma patient, what are the first 3 things you will do before the patient arrives to the ED?

Answer 1

1) Alert the trauma team
2) Prep the trauma room for possible necessary equipment (i.e. IV fluid warmer, intubation and IV kits, pediatric or bariatric kit, etc)
3) Don PPE

Question 2

The EMS is strolling into the ER with the patient, what is the first thing you do?

Answer 2

Across the room observation; assess for external hemorrhage that would reprioritize ABC to CAB

Question 3

Define what you look for when assessing for A: Alertness and Airway

Answer 3

• AVPU (Alert, Verbal, Pain, Unresponsive)
• If pt not alert: While someone else is maintaining C-Spine, jaw thrust to assess for foreign objects, missing teeth, tongue, edema, any blood/vomit/secretions, bony deformity, and if pt is snoring, gurling, or has stridor.
• If pt is alert, ask the pt to open their mouth to assess their airway

Question 4

What are some possible interventions if there is an airway obstruction?

Answer 4

• suction secretions
• remove any foreign objects or loose teeth
• insert NPA or OPA (only OPA in unconscious pts w/o gag reflex)
• indicate need for intubation
• *REASSESS any interventions applied

Question 5

If you apply any interventions to correct for a problem with the airway, what are you going to do before moving on to assessingB: Breathing and Ventilation?

Answer 5

REASSESS your patient!

Question 6

Define what you look for when assessing for B: Breathing and Ventilation?

Answer 6

• Inspect skin for color, spontaneous breathing, depth/pattern/RR, symmetrical chest rise and fall, increased work of breathing, open wounds or deformities, tracheal deviation, or JVD
• auscultate breath sounds: are they both present and equal?
• palpate for subQ emphysema

Question 7

Name some interventions for correcting problems with breathing.

Answer 7

• Apply O2
• Bag-mask ventilation
• Indicate need for intubation
• Indicate need for needle decompression (tension pneumo)
• Indicate need for chest tube
• *REASSESS after any interventions applied

Question 8

Immediately after intubation, what things do you need to do?

Answer 8

• attach a CO2 device (after 5-6 breaths, assess for evidence of exhaled CO2)
• observe for rise and fall of chest with ventilations
• auscultate over the epigastrum for gurgling, and then auscultate for bilateral breath sounds
• document where ETT is positioned at teeth, secure ETT, and attach it to the ventilator

Question 9

Define what you look for when assessing for C: Circulation and Control of Hemorrhage

Answer 9

Mneumonic: PSH (as in the sound psshhhhhh)

• pulse (central)
• skin: color, temp, moisture
• hemorrhage

Question 10

Name some interventions for correcting problems with circulation

Answer 10

• control uncontrolled hemorrhage
• CPR/ACLS
• assess patency of IV, obtain 2 IV sites, and initiate (warm) isotonic IVF (either rapid bolus or steady continuous
• consider blood products
• apply pelvic binder
• *REASSESS any interventions implemented

Question 11

Define what you look for when assessing for D: Disability

Answer 11

Disability aka Neuro

• GCS
• pupils
• is CT head needed?
• assess BG

Question 12

What do you assess for E: Exposure and Environment Control?

Answer 12

• strip patient down to assess for any uncontrolled external hemorrhage or obvious injuries
• provide warmth via blankets, warming lights, increase room temp, warmed IVF, warmed O2

Question 13

What do you assess for F?

Answer 13

Full set of VS

Family Presence

Question 14

What do you assess for G?

Answer 14

G: get all monitoring devices
L: labs
M: monitor (Cardiac/EKG)
N: NG/OG
O: O2 (ability to wean down O2?) and attach to capnography if still needed
P: Pain assessment

Question 15

Name some nonpharmacologic pain interventions

Answer 15

ice to swollen areas
repositioning
padding bony prominences

Question 16

What do you assess for H?

Answer 16

History: PMH and prehospital report

Head to Toe Assessment

Question 17

Briefly describe the Head to Toe assessment

Answer 17

• Inspect and Palpate face and head
• Inspect and Palpate neck while someone maintains C-spine
• Inspect, Auscultate, and Palpate chest, then abd and flanks
• Inspect and palpate hips, apply pressure to iliac crests medially and downward
• Inspect perineum for discharge and apply pressure to symphysis pubis; urinary catheter insertion needed or contraindicated?
• Inspects and palpates all extremities and checks for neurovascular status
• IF NO spinal or pelvic injury, log roll pt to inspect posterior and to remove back board

Question 18

If spinal cord or pelvic injury is suspected in a trauma patient, how do you remove the backboard since log rolling the pt is contraindicated?

Answer 18

use the 6+ person lift technique

Question 19

What do you assess for I?

Answer 19

Identify all injuries and name interventions needed (i.e. CT/xray, consults, psychosocial support, abx, pain/sedation meds, social services, law enforcement, labs, wound care, splinting, tetanus

Question 20

What is J?

Answer 20

Just keep reevaluating VIPP
V: VS
I: identified injuries and effectiveness of interventions
P: primary assessment 
P: pain

Question 21

What is K?

Answer 21

Keep or transfer patient