TNCC Written Exam – Exam Questions With 100%Correct Answers (Distinction)
TNCC Written Exam – Exam Questions With 100%
Correct Answers (Distinction)
What are the late signs of breathing compromise? Correct ans --
Tracheal deviation
- JVD
What are signs of ineffective breathing? Correct ans - - AMS
- Cyanosis, especially around the mouth
- Asymmetric expansion of chest wall
- Paradoxical movement of the chest wall during inspiration and expiration
- Use of accessory muscles or abdominal muscles or both or diaphragmatic
breathing
- Sucking chest wounds
- Absent or diminished breath sounds
- Administer O2 via NRB or assist ventilations with a bag-mask device, as
indicated
- Anticipate definitive airway management to support ventilation.
Upon initial assessment, what type of oxygen should be used for a pt
breathing effectively? Correct ans - A tight-fitting nonrebreather mask
at 12-15 lpm.
What intervention should be done if a pt presents with effective circulation?
Correct ans - - Insert 2 large caliber IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate
What are signs of ineffective circulation? Correct ans - - Tachycardia
- AMS
- Uncontrolled external bleeding
- Pale, cool, moist skin
- Distended or abnormally flattened external jugular veins
- Distant heart sounds
What are the interventions for Effective/Ineffective Circulation? Correct
ans - - Control any uncontrolled external bleeding by:
- Applying direct pressure over bleeding site
- Elevating bleeding extremity
- Applying pressure over arterial pressure points
- Using tourniquet (last resort).
- Cannulate 2 large-caliber IV's and initiate infusions of an isotonic
crystalloid solution
- Use warmed solution
- Use pressure bags to increase speed of IVF infusion
- Use blood administration tubing for possible administration of blood
, TNCC Written Exam – Exam Questions With 100%Correct Answers (Distinction)
- Use rapid infusion device based on protocol
- Use NS 0.9% in same tubing as blood product
- IV = surgical cut-down, central line, or both.
- Blood sample to determine ABO and Rh group
- IO in sternum, legs, arms or pelvis
- Administer blood products
- PASG (without interfering with fluid resuscitation)
What are factors that contribute to ineffective ventilation? Correct ans
- - AMS
- LOC
- Neurologic injury
- Spinal Cord Injury
- Intracranial Injury
- Blunt trauma
- Pain caused by rib fractures
- Penetrating Trauma
- Preexisting hx of respiratory diseases
- Increased age
What medications are used during intubation? Correct ans - LOAD
Mnemonic:
L = Lidocaine
O = Opioids
A = Atropine
D = Defasiculating agents
What are the Rapid Sequence Intubation Steps? Correct ans -
PREPARATION:
- gather equipment, staffing, etc.
PREOXYGENATION:
- Use 100% O2 (prevent risk of aspiration).
PRETREATMENT:
- Decrease S/E's of intubation
PARALYSIS WITH INDUCTION:
- Pt has LOC, then administer neuromuscular blocking agent
PROTECTION AND POSITIONING:
- Apply pressure over cricoid cartilage (minimizes likelihood of vomiting and
aspiration
PLACEMENT WITH PROOF
- Each attempt NOT to exceed 30 seconds, max of 3 attempts. Ventilate pt
30-60 seconds between attempts.
- After intubation, inflate the cuff
- Confirm tube placement w/exhaled CO2 detector.
POSTINTUBATION MANAGEMENT:
- Secure ET tube
, TNCC Written Exam – Exam Questions With 100%Correct Answers (Distinction)
- Set ventilator settings
- Obtain Chest x-ray
- Continue to medicate
- Recheck VS and pulse oxtimetry
What is a Combitube? Correct ans - A dual-lumen, dual-cuff airway
that can be placed blindly into the esophagus to establish an airway. If
inadvertently placed into trachea, it can be used as a temporary ET tube.
There are only two sizes: small adult and larger adult.
What is a Laryngeal Mask Airway? Correct ans - Looks like an ET tube
but is equipped with an inflatable, elliptical, silicone rubber collar at the
distal end. It is designed to cover the supraglottic area.
ILMA, does not require laryngoscopy and visualization of the chords.
What is Needle Cricothyrotomy Correct ans - Percutaneous
transtracheal ventilation. (temporary)
Complications include:
- inadequate ventilation causing hypoxia
- hematoma formation
- esophageal perforation
- aspiration
- thyroid perforation
- subcutaneous emphysema
What is Surgical Cricothyrotomy? Correct ans - Making an incision in
cricothyroid membrane and placing a cuffed endo or trach tube into trachea.
This is indicated when other methods of airway management have failed and
pt cannot be adequately ventilated and oxygenated.
Complications include:
- Aspiration
- Hemorrhage or hematoma formation or both
- Lac to trachea or esophagus
- Creation of a false passage
- Laryngeal stenosis
How do you confirm ET Tube/Alternative Airway Placement? Correct 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
TNCC Written Exam – Exam Questions With 100%
Correct Answers (Distinction)
What are the late signs of breathing compromise? Correct ans --
Tracheal deviation
- JVD
What are signs of ineffective breathing? Correct ans - - AMS
- Cyanosis, especially around the mouth
- Asymmetric expansion of chest wall
- Paradoxical movement of the chest wall during inspiration and expiration
- Use of accessory muscles or abdominal muscles or both or diaphragmatic
breathing
- Sucking chest wounds
- Absent or diminished breath sounds
- Administer O2 via NRB or assist ventilations with a bag-mask device, as
indicated
- Anticipate definitive airway management to support ventilation.
Upon initial assessment, what type of oxygen should be used for a pt
breathing effectively? Correct ans - A tight-fitting nonrebreather mask
at 12-15 lpm.
What intervention should be done if a pt presents with effective circulation?
Correct ans - - Insert 2 large caliber IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate
What are signs of ineffective circulation? Correct ans - - Tachycardia
- AMS
- Uncontrolled external bleeding
- Pale, cool, moist skin
- Distended or abnormally flattened external jugular veins
- Distant heart sounds
What are the interventions for Effective/Ineffective Circulation? Correct
ans - - Control any uncontrolled external bleeding by:
- Applying direct pressure over bleeding site
- Elevating bleeding extremity
- Applying pressure over arterial pressure points
- Using tourniquet (last resort).
- Cannulate 2 large-caliber IV's and initiate infusions of an isotonic
crystalloid solution
- Use warmed solution
- Use pressure bags to increase speed of IVF infusion
- Use blood administration tubing for possible administration of blood
, TNCC Written Exam – Exam Questions With 100%Correct Answers (Distinction)
- Use rapid infusion device based on protocol
- Use NS 0.9% in same tubing as blood product
- IV = surgical cut-down, central line, or both.
- Blood sample to determine ABO and Rh group
- IO in sternum, legs, arms or pelvis
- Administer blood products
- PASG (without interfering with fluid resuscitation)
What are factors that contribute to ineffective ventilation? Correct ans
- - AMS
- LOC
- Neurologic injury
- Spinal Cord Injury
- Intracranial Injury
- Blunt trauma
- Pain caused by rib fractures
- Penetrating Trauma
- Preexisting hx of respiratory diseases
- Increased age
What medications are used during intubation? Correct ans - LOAD
Mnemonic:
L = Lidocaine
O = Opioids
A = Atropine
D = Defasiculating agents
What are the Rapid Sequence Intubation Steps? Correct ans -
PREPARATION:
- gather equipment, staffing, etc.
PREOXYGENATION:
- Use 100% O2 (prevent risk of aspiration).
PRETREATMENT:
- Decrease S/E's of intubation
PARALYSIS WITH INDUCTION:
- Pt has LOC, then administer neuromuscular blocking agent
PROTECTION AND POSITIONING:
- Apply pressure over cricoid cartilage (minimizes likelihood of vomiting and
aspiration
PLACEMENT WITH PROOF
- Each attempt NOT to exceed 30 seconds, max of 3 attempts. Ventilate pt
30-60 seconds between attempts.
- After intubation, inflate the cuff
- Confirm tube placement w/exhaled CO2 detector.
POSTINTUBATION MANAGEMENT:
- Secure ET tube
, TNCC Written Exam – Exam Questions With 100%Correct Answers (Distinction)
- Set ventilator settings
- Obtain Chest x-ray
- Continue to medicate
- Recheck VS and pulse oxtimetry
What is a Combitube? Correct ans - A dual-lumen, dual-cuff airway
that can be placed blindly into the esophagus to establish an airway. If
inadvertently placed into trachea, it can be used as a temporary ET tube.
There are only two sizes: small adult and larger adult.
What is a Laryngeal Mask Airway? Correct ans - Looks like an ET tube
but is equipped with an inflatable, elliptical, silicone rubber collar at the
distal end. It is designed to cover the supraglottic area.
ILMA, does not require laryngoscopy and visualization of the chords.
What is Needle Cricothyrotomy Correct ans - Percutaneous
transtracheal ventilation. (temporary)
Complications include:
- inadequate ventilation causing hypoxia
- hematoma formation
- esophageal perforation
- aspiration
- thyroid perforation
- subcutaneous emphysema
What is Surgical Cricothyrotomy? Correct ans - Making an incision in
cricothyroid membrane and placing a cuffed endo or trach tube into trachea.
This is indicated when other methods of airway management have failed and
pt cannot be adequately ventilated and oxygenated.
Complications include:
- Aspiration
- Hemorrhage or hematoma formation or both
- Lac to trachea or esophagus
- Creation of a false passage
- Laryngeal stenosis
How do you confirm ET Tube/Alternative Airway Placement? Correct 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
