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TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

• ANSPrehospital shock index pg. 85 .. activation: .... are found in the carotid sinus and along the aortic arch, are sensitive to the degree of stretch in the arterial wall. When the receptors sense a decrease in stretch, they stimulate the sympathetic nervous system to release Epi, norepi, causing stimulation of cardiac activity and constriction of blood vessels, which causes a rise in heart rate and diastolic blood pressure - ANSBaroreceptors:

1. A- airway and Alertness with simultaneous cervical spinal stabilization
2. B- breathing and Ventilation
3. circulation and control of hemorrhage
4. D - disability (neurologic status)
5. F - full set of vitals and Family presence
6. G - Get resuscitation adjuncts L- Lab results (arterial gases, blood type and crossmatch) M- monitor for continuous cardiac rhythm and rate assessment N- naso or orogastric tube consideration O- oxygenation and ventilation analysis: Pulse oxygemetry and end-tidal caron dioxide (ETC02) monitoring and capnopgraphy H- History and head to toe assessment I- Inspect posterior surfaces - ANSABCDEFGHI
7. Apnea
8. GCS 8 or less
9. Maxillary fractures
10. Evidence of inhalation injury (facial burns)
11. Laryngeal or tracheal injury or neck hematoma
12. High risk of aspiration and patients inability to protect the airway
13. Compromised or ineffective ventilation - ANSFollowing conditions might require a definitive airway
14. bony fractures and possible rib fractures, which may impact ventilation
15. palpate for crepitus
16. subcutaneous emphysema which may be a sign for a pneumothorax
17. soft tissue injury - ANSPalpate the chest for
18. Check the presence of adequate rise and fall of the chest with assisted ventilation
19. Absence of gurgling on auscultation over the epigastrium
20. Bilateral breath sounds present on auscultation
21. Presence of carbon dioxide (CO2) verified by a CO2 device or monitor - ANSIf the pt has a definitive airway in what should you do?
22. Dyspnea
23. Tachycardia
24. Decreased or absent breath sounds on the injured side
25. CP - ANSSimple Pneumo assessment:
26. equal breath sounds bilaterally at the second intercostal space midclavicular line and the bases for fifth intercostal space at the axillary line - ANSAuscultate the chest for:
27. Get a CT
28. Consider ABG 's if decreased LOC
29. Consider glucose check - ANSD Interventions
30. Hypotension

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

2. JVD

3. Muffled heart sounds - ANSBecks Triad:
4. open the airway, use jaw thrust
5. insert an oral airway
6. assist ventilations with a bag mask
7. prepare for definitive airway - ANSIf breathing is absent..
8. pain - hallmark sign, early sign
9. pressure - early sign
10. pallor, pules, paresthesia, paralysis - late sign - ANSSix P's of compartment syndrome:
11. Preparation
12. Preoxygenation
13. Pretreatment
14. Paralysis and Induction
15. Protecting and positioning - v
16. Placement of proof - secure the tube
17. Post intubation - secure ETT Tube, get X-ray for placement - ANSSteps of Rapid Sequence Intubation
18. Preparation and Triage
19. Primary Survery (ABCDE) with resuscitation adjuncts (F,G)
20. Reevaluation (consideration of transfer)
21. Secondary Survey (HI) with reevaluation adjuncts
22. Reevaluation and post resuscitation care
23. Definitive care of transfer to an appropriate trauma nurse - ANSInitial Assessment
24. Suction the airway 2, Use care to avoid stimulating the gag reflex
25. If the airway is obstructed by blood or vomitus secretions, use a rigid suction device If foreign body is noted, remove it carefully with forceps or another appropriate method - ANSIf Airway is not patent
26. The tongue obstructing the airway
27. loose or missing teeth
28. foreign objects
29. blood, vomit, or secretions'
30. edema
31. burns or evidence of inhalation injury Auscultiate or listen for:
32. Obstructive airway sounds such as snoring or gurgling
33. Possible occlusive maxillofacial bony deformity
34. Subcutaneous emphysema - ANSInspect the mouth for: 50 to 150 - ANSMAP Range 500 mL/hr - ANSYou are treating a 27 y/o M in respiratory distress who was involved in a house fire. Calculating TBSA burned is deferred due to the need for emergent intubation. At what rate should you begin fluid resuscitation? A 14 gauge needle that is inserted into the 2nd intercostal space in the midclavicular line on the affected side over the top of the rib to avoid neuromuscular bundle that runs under the rib.

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

Prepare for chest tube placement. - ANSTension pneumo intervention a 52 y/o diabetic male with a partial thickness burn to the left lower leg - ANSWhich of the following patients warrants referral to a burn center? A breath every 5 to 6 seconds: 10-12 ventilations per minute - ANSBag mask ventilation a pertinent medical hx is crucial - ANSWhich of the following considerations is the most important when caring for a geriatric trauma pt? According to newtons law which of these two force is greater: size or force? - ANSNeither. For each force there is an equal and opposite reaction. acidosis - ANSWhich of the following is a component of the trauma triad of death? activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP - ANSChemoreceptors: advanced age - ANSWhich of the following is most likely to contribute to inadequate oxygenation and ventilation? after a physical examination if the pt has no radiologic abnormalities on CT - ANSEMS arrives with the intoxicated driver of a car involved in a MVC. EMS reports significant damage to the drivers side of the car. The pt is asking to have the cervical collar removed. When it is appropriate to remove the cervical collar? Air cannot escape intrapleural space.. can begin to compress heart. pt will have sever resp distress, hypotension, JVD. - ANSTension pneumo any deformities? bleeding? contusions, lacs? skin temp?? place splints on deformities, pulses - ANSHead to toe assessment: Extremities any lacs? deformities? blood at the urtheral meatus palpate pelvis with high pressure over the iliac wings downward and medially - ANSHead to toe assessment: pelvis and perineum Aortic Dissection - ANSUnequal extremity pulse strength possibility of.. apply direct pressure to bleeding elevate extremity apply pressure over arterial sites Consider a pelvic binder for pelvic fractures consider a tourniquet cannulate two veins with large caliber IV - if unable to gain assess consider IO

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

a. obtain labs, type and cross b. infuse warm isotonic fluids c. consider balanced resuscitation d. use rapid infusion device - ANSC Interventions: apply splint and elevate above the level of the heart - ANSa 37 y/o F has a deformity of the L wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention? ask pt to pen his or her mouth - ANSWhile assessing airway the patient is alert and responds to verbal stimuli you should.. bardycardia and absent motor function below the level of injury - ANSA pt with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? Before the arrival of the pt - ANSWhen should PPE be placed: Biomechanics - ANSIs the general study of forces and their effects. bowel - ANSWhich of the following injuries is LEAST likely to be promptly identified? brachial pulse - ANSUnder age of 1 where do you find a pulse Breathing: To assess breathing expose the chest:

1. Inspect for a. spontaneous breathing b. symmetrical rise and fall c. depth, pattern, and rate of respiration d. signs of difficulty breathing such as accessory muscle use e. skin color (normal, pale, flushed, cyanotic) f. contusions, abrasions, deformities (flail chest) g. open pneumothoraces (sucking chest wounds) h. JVD i. signs of inhalation injury (singed nasal hairs, carbonaceous sputum) - ANSB calcium - ANSif a pt has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? can be caused by blunt trauma. air escapes from injured lung to pleural space and negative intrapleural pressure is lost causing partial or collapsed lung - ANSSimple Pneumothorax can result from penetrating wound through chest wall causing air to be trapped in to the intrapleural place. Might hear "sucking" Tx: nonporous dressing tapes on 3 sided, then Chest tube and would closure surgical repair. - ANSOpen Pneumo: Capnography monitors numeric value, as well as continuous waveform, indicating real-time measurement and trending over time. - ANSQuantitative: Caused by blood in the intrapleural space/ May also occur from lac to live or spleen combined with injury to the diaphragm.

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

Ensure two large bore IVS are placed. Prepare for thoracentesis and chest tube insertion. If open thoracotomy is done chest tube is deferred. - ANSHemothorax: Circulation and Control of Hemorrhage Inspect first for any uncontrolled bleeding Skin color palpate for central pulses - carotid and femoral - rate, rhythm, and strength Skin temp: cool, diaphoretic, or warm and dry - ANSC Colorimetric CO2 detectors provide info about the presence or absence of CO2. A chemically treated indicator strip changes color revealing the presence or absence of exhaled CO2 - ANSQualitative compensated - ANSA trauma pt is restless and repeatedly asking "where am i?" VS upon arrival: BP 110/60, HR96, RR 24. Her skin is cool and dry. Current VS are BP 104/84, HR 108, RR 28. The pt is demonstrating s/sx of which stage of shock? Complete - ANSEMS brings a pt from MVC. VS: BP 90/49, HR 48, RR 12, temp 97.2F (36.2 C). The pt exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the following types of spinal cord injury? D displaced tube O obstructed or kinked P pneumothorax E equipment failure , such as becoming detached from the equipment or loss of capnopgrahy - ANSDOPE Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define central or transtentorial herniation. - ANSA downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Define Cushing's triad - ANSBradycardia, progressive hypertension (widening pulse pressure), and decreased respiratory effort Define Hemothorax. - ANSAccumulation of blood in the pleural space. Define Hemothorax. - ANSAccumulation of blood in the pleural space. Define Minor Head Trauma. - ANSGCS 13- 15 Define Minor Head Trauma. - ANSGCS 13- 15 Define Moderate Head Trauma - ANSPostresuscitative state with GCS 9-13. Define Moderate Head Trauma - ANSPostresuscitative state with GCS 9-13. Define Pneumothorax. - ANSResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total collapse of lung may ensue.

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

An open pneumothorax results from wound through chest wall. Air enters pleural space both through the wound and trachea. Define Pneumothorax. - ANSResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total collapse of lung may ensue. An open pneumothorax results from wound through chest wall. Air enters pleural space both through the wound and trachea. Define Severe Head Trauma. - ANSPostresuscitative state with GCS score of 8 or less. Define Severe Head Trauma. - ANSPostresuscitative state with GCS score of 8 or less. Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define the characteristics of neurogenic shock - ANSDistributive shock with a T6 or higher injury results and vasodilation, bradycardia, flushed warm dry skin. Risk for temperature instability. Nursing interventions include maintaining warmth and spinal stabilization. Define the characteristics of spinal shock - ANSTransient loss of function can include loss of reflexes and muscle tone below the level of industry with possible vascular response. Define the five mechanisms of injury in blast trauma. - ANS1. Primary: Found in patients who were closest to the blast. Injuries are most commonly associated with air-filled organs

2. Secondary: Include fragment injuries, puncture wounds, lacerations, and impaled objects. Generally, these cause the most casualties
3. Tertiary: Result from the patient being blown into a large object. Injuries include pelvic or femur fractures an thoracic injuries.
4. Quaternary: Result from heat, flame, gas, and smoke and cause burn injuries.
5. Quinary: Injuries associated with radioactive, biological or chemical elements that may be present in the explosion. Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more common of the two types of herniation syndromes. Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more common of the two types of herniation syndromes.

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

defusings - ANSAll of these are considered a critical communication point in trauma care EXCEPT which of the following? Describe common patterns and severity of injuries in the bariatric trauma patient. - ANS Describe effects of common medications in relation to the older adult trauma patient. - ANS Describe one fat embolism syndrome is most likely to occur in its characteristics - ANSWith longform fractures. Tachycardia, Thrombocytopenia, and petechiae rash. Describe specific injuries associated with interpersonal violence and abuse. - ANS Describe steps to maintain the forensic chain of custody. - ANS Describe techniques to improve the intubation process for the bariatric trauma patient. - ANS Describe the 3 types of external forces of energy transfer in the context of trauma. - ANSDeceleration: Force from a sudden stop in the body's motion Acceleration: Force from a sudden onset in the body's motion Compression: Force from being crushed between objects Describe the 3 types of Internal forces of energy transfer in the context of trauma. - ANSCompression: The ability of the tissue to resist crush injury or force Tension: The ability to resist being pulled apart when stretched Shear: The ability to resist a force applied parallel to the tissue Describe the activities and associated factors related to low-energy trauma in the older adult. - ANS Describe the characteristics of cardiogenic shock - ANSCardiogenic shock results from pump failure in the presence of adequate intravascular volume. Lack of cardiac output and an organ perfusion occurs secondary to a decrease in myocardial contractility and or valvular insufficiency. This can happen with blunt cardiac trauma or an MI. Symptoms can include low blood pressure increase heart rate and respiratory rate chest pain shortness of breath dysrhythmias increase troponin and pale cool moist skin Describe the characteristics of distributive shock. - ANSDistributive shock occurs as a result of Mel distribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. This can occur with spinal cord injuries, sepsis, or anaphylaxis. Symptoms include low blood pressure heart rate respiratory rate preload and afterload, spinal tenderness, difficulty breathing, warm pink and dry skin with a cool core temperature. Describe the characteristics of hypovolemic shock - ANSHypovolemia is caused by a decrease in the amount of circulating volume usually caused by massive bleeding, but also can be from vomiting and diarrhea. Characteristics include low blood pressure and preload, increase heart rate respiratory rate and afterload, with contractility unchanged. Signs include obvious bleeding, weak peripheral pulses, pale cool and moist skin, distended abdomen, pelvic fracture, or bruise swollen and deformed extremities especially long bones. Describe the characteristics of obstructive shock - ANSObstructive shock is it mechanical problem that results from hypoperfusion of the tissue due to an obstruction in either the vasculature or the heart resulting in decreased cardiac output. Some causes include a tension pneumothorax, cardiac tamponade,

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

or venous air embolism on the right side of the heart during systole in the pulmonary artery.Signs include anxiety, muffled heart sounds, JVD, hypertension, chest pain, difficulty breathing, or pulses paradoxes. Describe the fluid resuscitation of an older adult patient related to fluid overload, when to administer red blood cells, and the use of anticoagulant medication. - ANS Describe the four types of spinal cord injury - ANSCentral cord injury results in greater weakness distally, anterior injury includes motor loss or weakness below the cord level of injury yet sensory is intact, Brown- Sequard (hemicord) is weak on one side with sensory deficit on opposite side, posterior cord syndrome although rare is when the patient is unable to use sense vibration in proprioception Describe the measurement of an NPA - ANSMeasure from the tip of the patient's nose to the tip of the patients earlobe. Describe the pathophysiologic changes of the systems of the bariatric patient and the effects on trauma resuscitation efforts. - ANS Describe the three impacts in the motor vehicle impact sequence - ANS1. First Impact: Vehicle hits another object

2. Second Impact: Occupant hits the interior of the vehicle
3. Third Impact: Organcs hit other internal structures Describe the types of abuse and the associated signs of each. - ANS Describe the usefulness of the Haddon Matrix in prevention and reduction of injury - ANSLooks at 3 phases of the event: Pre-event, event, and post-event. Looks at 4 factors involved in the event: The host (patient), the agent (cause), the physical evironment, and the socioeconomic environment. Countermeasures can be applied at each phase to help reduce injury. Differentiate between the three impacts of motor vehicle impact sequence. - ANSThe first impact occurs when the vehicle collided with another object. The second impact occurs after the initial impact when the occupant continues to move in the original direction of travel until they collide with the interior of the vehicle or meet resistance. The third impact occurs when internal structures collide within the body cavity. Differentiate family and intimate partner violence from community violence. - ANS Disability - Neurologic Status
4. Assess pupils for equality, shape, and reactivity (PERRL)
5. Assess GCS (eye opening, verbal response, and motor response) - ANSD Discuss the use and insertion of nasogastric tubes in the bariatric patient. - ANS Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Disruptions of the bony structures of the skull can result in what? - ANSDisplaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF.

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess don't forget flanks!!! inspect of lacs, puncture wounds, contusions, auscultate then palpate: bowel sounds? any rigidity, guarding? begin with light palpation start to palpate with side that does not hurt maybe do a fast scan? - ANSHead to toe assessment: Abdomen dressing removal - ANSA patient arrives with a large open chest wound after being assaulted with a machete. Prehospital providers placed a nonporous dressing over the chest wound and taped it on three sides. he is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis and decreasing blood pressure. Which of the following is the MOST appropriate immediate intervention? dysrhythmias - ANSPatients with a crush injury should be monitored for which of the following conditions? elevating the extremity to the level of the heart - ANSA pt with a lower extremity fracture complains of severe pain and tightness in his calf, minimally by pain medications. Which of the following is the priority nursing intervention? endotracheal tube - ANSThe trauma nurse knows that placing a bariatric patient in a ramped position providers better visualization during the insertion of which device? Expedite transfer to the closest trauma center - ANSA 56 y/o M pt involved in a motor vehicle crash is brought to the ED of a rural critical access facility. He complains of neck pain, SOB, and diffuse abd pain. His GCS is 15. His VS: BP 98/71, HR 125, RR 26, SpO2 94% on high-flow O2 via NRB mask. Which of the following is the priority intervention for this patient? Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase.

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes:

• MI
• Blunt cardiac injury
• Mitral valve insufficiency
• dysrhythmias
• Cardiac Failure Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes:
• MI
• Blunt cardiac injury
• Mitral valve insufficiency
• dysrhythmias
• Cardiac Failure Explain Distributive Shock. - ANSResults from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Distributive Shock. - ANSResults from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Hepatic Response. - ANSLiver can store excess glucose as glycogen.

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hepatic Response. - ANSLiver can store excess glucose as glycogen. As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes:

• Blood loss
• Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes:
• Blood loss
• Burns, etc. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages will cause compromises to most body systems.
• Inadequate venous return
• inadequate cardiac filling
• decreased coronary artery perfusion
• Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages will cause compromises to most body systems.
• Inadequate venous return
• inadequate cardiac filling
• decreased coronary artery perfusion
• Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes:
• Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume).
• Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium.

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

• Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes:
• Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume).
• Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium.
• Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Pulmonary Response. - ANSTachypnea happens for 2 reasons:

1. Maintain acid-base balance
2. Maintain increased supply of oxygen

• Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli. Explain Pulmonary Response. - ANSTachypnea happens for 2 reasons:

1. Maintain acid-base balance
2. Maintain increased supply of oxygen

• Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli. Exposure and Environmental Control Remove all clothes and assess for any obvious injuries and uncontrolled bleeding - ANSE fat embolism - ANSa pt has been in the ED for several hrs waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and complaining of leg pain. His wife reported that he suddenly became anxious and confused. Upon reassessment, the pt is restless with respiratory distress and petechiae to his neck. The pt is exhibiting s/sx most commonly associated with which of the following conditions? Flail chest - ANSParadoxical chest wall movement flucuation in the water seal chamber - ANSWhich of the following is an expected finding in a pt with a tube thoracstomy connected to a chest drainage system? from hemorrhage is leading cause. Hypovolemia is caused by decrease in the amount of circulating volume. Goal is to replace volume. - ANSHypovolemic Shock Full set of vitals and family presence - ANSF Get Resuscitation Adjuncts L - Labs (maybe a lactic acid), a b g 's, blood type M - monitors

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

N - naso or oro gastric tubes O Oxygen and ETC02 monitors P - pain assessment and management - ANSG globe rupture - ANSA 35 y/o M presents with facial trauma after being struck in the face with a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is suspected? H,I - ANSSecondary Survery hemoglobin does not readily release O2 for use by the tissues - ANSWhat is the effect of hypothermia on the oxyhemoglobin dissociation curve? History and Head to toe MIST - prehospital report MOI Injuries sustained S s/s in the field T treatment in the field if patients family present get a better hx on them - ANSH How do you assess Mnemonic "D"? - ANSDISABILITY A = Alert V = Verbal P = Pain U = Unresponsive

• GCS
• PERRL?
• Determine presence of lateralizing signs including:
• Unilateral deterioration in motor movements or unequal pupils
• Symptoms that help to locate area of injury in brain How do you assess Mnemonic "D"? - ANSDISABILITY A = Alert V = Verbal P = Pain U = Unresponsive
• GCS
• PERRL?
• Determine presence of lateralizing signs including:
• Unilateral deterioration in motor movements or unequal pupils
• Symptoms that help to locate area of injury in brain How do you confirm ET Tube/Alternative Airway Placement? - ANS- Visualization of the chords
• Using bronchoscope to confirm placement
• Listening to breath sounds over the epigastrum and chest walls while ventilating the pt
• CO2 detector
• Esophageal detection device
• Chest x-ray How do you confirm ET Tube/Alternative Airway Placement? - ANS- Visualization of the chords
• Using bronchoscope to confirm placement
• Listening to breath sounds over the epigastrum and chest walls while ventilating the pt
• CO2 detector

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

• Esophageal detection device
• Chest x-ray How do you inspect the chest for adequate ventilation? - ANSObserve:
• mental status
• RR and pattern
• chest wall symmetry
• any injuries
• patient's skin color (cyanosis?)
• JVD or tracheal deviation? (Tension pneumothorax) How do you inspect the chest for adequate ventilation? - ANSObserve:
• mental status
• RR and pattern
• chest wall symmetry
• any injuries
• patient's skin color (cyanosis?)
• JVD or tracheal deviation? (Tension pneumothorax) How would you assess a patient with ocular, maxillofacial and neck trauma? - ANS(Initial assessment) HISTORY
• MOI?
• Acceleration/Deceleration?
• What was it caused by?
• Pt restrained? Airbags deployed? Etc.
• What are the pt's complaints?
• Pt normally wear glasses or contacts?
• Pt have hx of eye problems?
• Pt ever have eye surgery?
• Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION:
• Inspect eye, orbits, face and neck
• Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas
• Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents
• Determine whether lid lac's
• Assess pupil's (PERRL)
• Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome
• Bilateral fixed and pinpoint pupils = pontine lesion or drugs
• Mildly dilated pupil w/sluggish response may early sign of herniation syndrome
• Widely dilated pupil occasionally occurs w/direct trauma to globe of eye
• Assess for consensual response
• Assess redness, eye watering, blepharospasm
• Assess extraocular movement, except when an open globe injury is known or suspected.
• Limitation range of ocular motion may indicate orbital rim fx w/entrapment or paralysis of cranial nerve or ocular muscle
• Perform visual acuity exam
• Use Snellen or handheld chart. Check uninjured eye first
• Assess for blurred or double vision with injured eye and then with both eyes open
• Inspect for rhinorrhea or otorrhea
• If drng present, may indicate CSF leak

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• Observe for impaled objects
• Assess occlusion of mandible and maxilla
• Malocclusion or inability to open + close mouth is highly indicative of maxillary or mandibular fx
• Observe for uncontrolled bleeding PALPATION
• Palpate periorbital area, face and neck for:
• Tenderness
• Edema
• Step-off de How would you assess a patient with ocular, maxillofacial and neck trauma? - ANS(Initial assessment) HISTORY
• MOI?
• Acceleration/Deceleration?
• What was it caused by?
• Pt restrained? Airbags deployed? Etc.
• What are the pt's complaints?
• Pt normally wear glasses or contacts?
• Pt have hx of eye problems?
• Pt ever have eye surgery?
• Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION:
• Inspect eye, orbits, face and neck
• Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas
• Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents
• Determine whether lid lac's
• Assess pupil's (PERRL)
• Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome
• Bilateral fixed and pinpoint pupils = pontine lesion or drugs
• Mildly dilated pupil w/sluggish response may early sign of herniation syndrome
• Widely dilated pupil occasionally occurs w/direct trauma to globe of eye
• Assess for consensual response
• Assess redness, eye watering, blepharospasm
• Assess extraocular movement, except when an open globe injury is known or suspected.
• Limitation range of ocular motion may indicate orbital rim fx w/entrapment or paralysis of cranial nerve or ocular muscle
• Perform visual acuity exam
• Use Snellen or handheld chart. Check uninjured eye first
• Assess for blurred or double vision with injured eye and then with both eyes open
• Inspect for rhinorrhea or otorrhea
• If drng present, may indicate CSF leak
• Observe for impaled objects
• Assess occlusion of mandible and maxilla
• Malocclusion or inability to open + close mouth is highly indicative of maxillary or mandibular fx
• Observe for uncontrolled bleeding PALPATION
• Palpate periorbital area, face and neck for:
• Tenderness
• Edema
• Step-off de

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

How would you assess a pt with a cranial injury? - ANS(Initial assessment) INSPECTION:

• Assess airway
• RR, pattern and effort
• Assess pupil size and response to light
• Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome
• Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates
• Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome
• Widely dilated pupil occasionally occurs w/direct trauma to globe of eye
• Determine if pt uses eye meds
• Abnormal posturing?
• Inspect craniofacial area for ecchymosis/contusions
• Periorbital ecchymosis
• Mastoid's process ecchymosis
• Blood behind tympanic membrane
• Inspect nose and ears for drainage
• Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF
• If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF
• Assess extraocular eye movement (Tests cranial nerves, III, IV, VI)
• Performing extraocular eye movements indicates functioning brainstem
• Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle
• Determine LOC with GCS PALPATION
• Palpate cranial area for:
• Point tenderness
• Depressions or deformities
• Hematomas
• Assess all 4 extremities for:
• Motor function, muscle strength and abnormal motor posturing
• Sensory function DIAGNOSTIC PROCEDURES
• Lab Studies PLANNING AND IMPLEMENTATION
• (Initial assessment)
• Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration.
• Administer O2 via NRB
• Assist with early ET intubation
• Administer sedative/neuromuscular blocking agent
• Consider hyperventilation
• PaCO2 above 45 How would you assess a pt with a cranial injury? - ANS(Initial assessment) INSPECTION:
• Assess airway
• RR, pattern and effort
• Assess pupil size and response to light
• Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

• Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates
• Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome
• Widely dilated pupil occasionally occurs w/direct trauma to globe of eye
• Determine if pt uses eye meds
• Abnormal posturing?
• Inspect craniofacial area for ecchymosis/contusions
• Periorbital ecchymosis
• Mastoid's process ecchymosis
• Blood behind tympanic membrane
• Inspect nose and ears for drainage
• Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF
• If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF
• Assess extraocular eye movement (Tests cranial nerves, III, IV, VI)
• Performing extraocular eye movements indicates functioning brainstem
• Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle
• Determine LOC with GCS PALPATION
• Palpate cranial area for:
• Point tenderness
• Depressions or deformities
• Hematomas
• Assess all 4 extremities for:
• Motor function, muscle strength and abnormal motor posturing
• Sensory function DIAGNOSTIC PROCEDURES
• Lab Studies PLANNING AND IMPLEMENTATION
• (Initial assessment)
• Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration.
• Administer O2 via NRB
• Assist with early ET intubation
• Administer sedative/neuromuscular blocking agent
• Consider hyperventilation
• PaCO2 above 45 How would you assess a pt with a thoracic injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection:
• Observe chest wall
• Assess breathing effort and RR
• Symmetry
• Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or pericardial tamponade. Flat = external jugular veins may reflect hypovolemia)
• Inspect upper abdominal region for injury Percussion:
• Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax) Palpation:
• Palpate chest wall, clavicles and neck for:
• Tenderness

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• Swelling or hematoma
• Subcutaneous emphysema
• Note presence of bony crepitus
• Palpate central and peripheral pulses and compare quality between:
• Right and left extremities
• Upper and lower extremities
• Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension pneumothorax or massive hemothorax)
• Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate aortic injury). Auscultation:
• Auscultate compare BP in both UE's and LE's
• Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS = splinting. Shallow = b/c of pain).
• Auscultate chest for presence of BS (diaphragmatic rupture)
• Auscultate Heart sounds (muffled = pericardial tamponade)
• Auscultate neck vessels for bruits (vascular injury) Diagnostic Procedures:
• Xrays
• Arteriography
• Bronchoscopy and laryngoscopy
• CT's
• FAST
• Labs (cardiac enzymes)
• ECG, CVP How would you assess a pt with a thoracic injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection:
• Observe chest wall
• Assess breathing effort and RR
• Symmetry
• Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or pericardial tamponade. Flat = external jugular veins may reflect hypovolemia)
• Inspect upper abdominal region for injury Percussion:
• Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax) Palpation:
• Palpate chest wall, clavicles and neck for:
• Tenderness
• Swelling or hematoma
• Subcutaneous emphysema
• Note presence of bony crepitus
• Palpate central and peripheral pulses and compare quality between:
• Right and left extremities
• Upper and lower extremities
• Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension pneumothorax or massive hemothorax)
• Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate aortic injury). Auscultation:
• Auscultate compare BP in both UE's and LE's

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

• Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS = splinting. Shallow = b/c of pain).
• Auscultate chest for presence of BS (diaphragmatic rupture)
• Auscultate Heart sounds (muffled = pericardial tamponade)
• Auscultate neck vessels for bruits (vascular injury) Diagnostic Procedures:
• Xrays
• Arteriography
• Bronchoscopy and laryngoscopy
• CT's
• FAST
• Labs (cardiac enzymes)
• ECG, CVP How would you assess someone in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect:
• LOC
• Rate and quality of respirations
• External bleeding?
• Skin color and moisture
• Assess jugular veins and peripheral veins Auscultate:
• BP
• Pulse pressure
• Breath sounds
• Heart sounds
• Bowel sounds Percuss:
• Chest and abdomen Palpate:
• Central pulse (carotid or femoral)
• Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse
• Palpate peripheral pulses
• Palpate skin temp and moisture Diagnostic Procedures:
• Xrays and other studies
• Labs Planning and Implementation
• Oxygen
• IV's with warmed replacement fluids
• Control external bleeding with direct pressure
• Elevate LE's
• NGT
• Foley
• Monitor and pulse oximeter
• Monitor for development of coagulopathies
• Surgery? How would you assess someone in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect:
• LOC
• Rate and quality of respirations
• External bleeding?

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

• Skin color and moisture
• Assess jugular veins and peripheral veins Auscultate:
• BP
• Pulse pressure
• Breath sounds
• Heart sounds
• Bowel sounds Percuss:
• Chest and abdomen Palpate:
• Central pulse (carotid or femoral)
• Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse
• Palpate peripheral pulses
• Palpate skin temp and moisture Diagnostic Procedures:
• Xrays and other studies
• Labs Planning and Implementation
• Oxygen
• IV's with warmed replacement fluids
• Control external bleeding with direct pressure
• Elevate LE's
• NGT
• Foley
• Monitor and pulse oximeter
• Monitor for development of coagulopathies
• Surgery? ICP is a reflection of what three volumes? What happens when one increases? - ANS1. Brain

2. CSF
3. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO dilates cerebral blood vessels = increase blood volume and ICP. ICP is a reflection of what three volumes? What happens when one increases? - ANS1. Brain
4. CSF
5. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful.

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. identifying individuals who made mistakes during the traumatic event - ANSWhich of the following is NOT considered a benefit of debriefings? IF clothing is needed for evidence preserve in paper bag. Maintain body temp - cover the pt, turn up heat in room, administer warm fluids - ANSE Interventions: immobilize cervical spine, tenderness, tracheal deviation - ANSHead to toe assessment: Neck and cervical spine in massive transfusion protocol... responsible for dissolving clots - ANSTXA increased work of breathing? - ANSwhich of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? Initiate transfer to a trauma center - ANSA pt is brought to the ED of a rural hospital following a high- speed MVC. When significant abd and pelvic injuries are noted in the primary survey, which of the following is the priority interventions? insert an oropharyngeal airway if there is no gag reflex - ANSDuring the primary survey of an unconscious pt with multi-system trauma, the nurse notes snoring respirations. What priority nursing interventions should be preformed next? inspect for lacs, abrasions, asymmetry of facial expressions palate for depressions and tenderness look at ears for drainage - ANSHead to toe assessment: Head and face inspect posterior surfaces blogroll with at least 3 people. maintain c spine take out backboard Rectal tone per MD - ANSI inspect, auscultate, palpate any spontaneous breathing, rate, depth, and degree of effort, use of accessory muscles lacs, contusions, auscilate lung sounds and heart sounds - ANSHead to toe assessment: Chest it can worsen cord damage from an unstable spinal injury - ANSWhich of the following is true about the log-roll?

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jaw thrust maneuver to open airway and assess for obstruction. If pt has a suspected csi, the jaw thrust procedure should be done by two providers. One provider can maintain c-spine and the other can perform the jaw thrust maneuver. - ANSWhile assessing airway pt is unable to open mouth, responds only to pain, or is unresponsive you should.. Kinematics - ANSIs the study of energy transfer as it applies to identifying actual or potential injuries. labs, wound care, tetanus, administer meds, prepare for transfer - ANSSecondary Reval Adjuncts Law of Conservation of Energy - ANSMatter is neither created nor destroyed (but may change form) List common injuries from falls in the older adult population. - ANS List the basic components of evidence collection. - ANS List the four main types of traumatic injury and give an example of each - ANSBlunt: The result of a broad energy impact across a large surface area. Penetrating: The List the populations at higher risk for interpersonal violence. - ANS MARCH - ANSWhich of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? Measurement of an OPA - ANSPlace the proximal end or flange of the airway adjunct at the corner of the mouth to the tip of the mandibular angle. Mechanism of Injury - ANSIs how external forces are transferred to the body, resulting in injury Mitigation - ANSFollowing a review of recent drills and a real disaster event, a hospital has identified deficiencies and is taking steps to minimize the impact of a future disaster. Which phase of the disaster life cycle does this describe? Multiple requests for water - ANSEMS brings a pt who fell while riding his bicycle. Using the American College of Surgeobs screening guidelines, which assessment finding would prompt the RN to prepare the pt for a radiologic spine clearance? Name the three ways to confirm ETT placement - ANSPlacement of a CO2 monitoring device, Assessing for equal chest rise and fall, and listening at the epigastrium and four lung fields for equal breath sounds. narrowed - ANSWhich of the following pulse pressures indicate early hypovolemic shock? nausea and vomiting - ANSWhich of the following is a late sign of increased intracranial pressure? Needle pericardiocentesis, but it is a temp solution. Requires surgical evaluation. (Ultrasound guided) - ANSCardiac Tamponade Intervention: Newton's First Law of Motion - ANSan object in motion will remain in motion unless acted upon by another force Newton's Second Law of Motion - ANSThe acceleration of an object depends on the mass of the object and the amount of force applied.

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

Newton's Third Law of Motion - ANSFor every action there is an equal and opposite reaction occurs as a result of maldistribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. Ex: Anaphylactic - release of antihistamines Septic Shock - systemic release of bacterial endotoxins, resulting in increased vascular permeability and vasodilation. Neurogenic shock - spinal cord injury results of loss in sympathetic nervous system control of vascular tone. Goal: Volume replacement and vasoconstriction - ANSDistributive Shock padding the upper back while stabilizing the cervical spine - ANSCaregivers carry in a 2 y/o into the ED who fell out of a second-story window. The pt is awake and crying with increased work of breathing and pale skin. Which of the following interventions has the highest priority? Pediatric Assessment Triangle

1. General appearance - muscle tone, interactiveness, consoloability, poor or gaze, speech or cry
2. Work of breathing - inadequate or excessive, accessory muscle use, retractions, tripod position, abnormal upper airway sounds
3. Circulation of the skin - color, mottling or central or peripheral cyanosis, diaphoresis - ANSPAT pelvic stability - ANSthe most reassuring finding for a male pt with hip pain after a fall is which of the following? pericardiocentesis - ANSWhich of the following is NOT considered goal-directed therapy for cardiogenic shock? placental abruption - ANSYou are caring for a pt who was involved in a MVC and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal ht at the costal margin, and some dark bloody show. Varying accelerations and decelerations are noted on cariocgraphy. These findings are most consistent with which of the following? pressure - ANSAn intubated and sedated pt in the ED has multiple extremity injuries with the potential for causing compartment syndrome. What is the most reliable indication of compartment syndrome in a patient who is unconscious? Pt is at hospital in the right amount of time, right care, right trauma facility, right resources - ANSSafe Care: pulse oximetry and capnography - ANSWhat bedside monitoring parameters are used to assess for adequacy of O2 and effectiveness of ventilation? Reevaluation and Consider the need to Transfer - ANSFinal step in primary survey reorganize care to C-ABC - ANSIf uncontrolled hemorrhage .. Report your suspicion of maltreatment in accordance with local regulations - ANSa 5 y/o child presents to the ED with bruises to the upper arm and buttocks in various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities found based on the pediatric assessment triangle or primary survey. Which of the following is the priority survey. Which of the following is the priority nursing intervention?

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

results from hypo perfusion to the tissue due to an obstruction in either vasculature or heart. Goal is to relieve obstruction and improve perfusion. Ex: tension pneumo or cardiac tamponade are two classic examples that may result from trauma. - ANSObstructive Shock Results from pump failure in the presence of adequate intravascular volume. There is a lack of cardiac output and end organ perfusion secondary to a decrease in myocardial contractility and/or valvular insufficiency. Ex: MI's or dysrhythmia are common causes - ANSCariogenic Shock Review the age-related anatomic and physiologic change of the older adult in relation to the components of the initial assessment. - ANS Sample is part of history S symptoms associated with injury A allergies and tetanus status M meds currently on including anticoagulant therapy P past medical hx L last oral intake E Events and environment factors related to the injury - ANSSAMPLE serial FAST exams - ANSa 49 y/o restrained driver involved in a MVC presents to the trauma center complaining of abd, pelvic, and bilateral lower extremity pain. VS are stable. The nurse can anticipate all of these after a negative FAST exam EXCEPT which of the following? stabilized vital signs, improved mental status, improved urine output - ANSWhat are indicators of increased perfusion? straight cath for urine sample - ANSA 20 y/o M presents to the ED complaining of severe lower abd pain after landing hard on the bicycle cross bars while preforming an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the RN question? Stroke Volume X HR - ANSCardiac Output = subdural hematoma - ANSAn elderly patient with a history of anticoagulant use presents after a fall at home today. She denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. What is the most likely cause of her symptoms? subdural hematoma - ANSTearing of the bridging veins is most frequently associated with which brain injury? the aorta is torn at its attachment with the ligamentum arteriosum - ANSwhich of the following occurs during the third impact of a motor vehicle crash? the decrease coagulopathy .. you will you bleed more - ANSThe colder you are the more acidic you are.. to guage end-organ perfusion and tissue hypoxia - ANSWhy is a measure of serum lactate obtained in the initial assessment of a trauma patient?

TNCC Prep, TNCC EXAM, TNCC 10th Edition Graded A+

tracheal deviation and jvd - ANSLate signs of tension pneumo: trauma its need early supplemental oxygen, start with 15 mL O2 and titrate oxygen delivery. - ANSOxygen on trauma patients True or false: NPAs and OPAs are definitive airways. - ANSFalse. When placing one of these? One should consider the potential need for a definitive airway. Tx is based on size, presence of sx, and stability. For those are aysmpomatic and stable. Observation with or without oxygen. Larger pneumo who are unstable or likely to deteriorate a chest tube is placed. - ANSSimple pneumo interventions: Uncontrolled Hemorrhage - ANSMajor cause of preventable death: Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? - ANSA tight- fitting nonrebreather mask at 12-15 lpm. Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? - ANSA tight- fitting nonrebreather mask at 12-15 lpm. Used at the beginning of the initial assessment

1. A Alert. If the pt is alert he or she will be able to maintain his or her airway once it is clear.
2. V responds to verbal stimuli responds to pain. If the patient needs verbal stimulation to respond, an airway adjunct may be needed to keep the tongue from obstructing the airway.
3. P responds to pain. If the pt. responds only to pain, he or she may not be able to maintain his or her airway adjunct may need to be placed while further assessment is made to determine the need for intubation.
4. U Unresponsive. If the pt. is unresponsive, announce it loudly to the team and direct someone to chk in the pt is pulseless while assessing if the cause of the problem is the airway. - ANSAirway and AVPU: velocity - ANSWhat factor contributes most to the kinetic energy of a body in motion? ventilate with a bag mask device - ANSAn unresponsive trauma pt has an oropharygeal airway in place, shallow and labored respirations, and dusky skin. The trauma team has administered medications for drug-assisted intubation and attempted intubation but was unsuccessful. What is the most appropriate immediate next step? Vital signs Interventions Primary survey Pain - ANSPost resuscitation care parameters that are continuously evaluated: What 4 environmental and pathophysiologic factors are considered when the mechanism of injury is a fall? - ANS What are aortic injuries S/S? - ANS- Hypotension
   • Decreased LOC
   • Hypertension in UE's
   • Decreased quality (amplitude) of femoral pulses compared to UE pulses
   • Loud systolic murmur in parascapular region
   • Chest pain