1|Page
*TNCC CARDIAC REVIEW**
**COMPREHENSIVE STUDY GUIDE FOR TRAUMA
NURSING CORE COURSE**
**CARDIAC INJURIES • DYSRHYTHMIAS IN TRAUMA
• RESUSCITATION • TNCC ALGORITHMS**
**HIGH-YIELD CONTENT FOR FIRST-TIME PASS**
**ENA 9TH EDITION ALIGNED • 2026–2027**
TABLE OF CONTENTS
| Section | Topic | Page |
|---------|-------|------|
| 1 | Cardiac Anatomy & Physiology Review for Trauma | 2 |
| 2 | Blunt Cardiac Injury (BCI) | 4 |
| 3 | Pericardial Tamponade | 6 |
| 4 | Tension Pneumothorax (Cardiovascular Collapse) | 8 |
| 5 | Hemorrhagic Shock & Cardiovascular Response | 10 |
| 6 | Dysrhythmias in Trauma | 12 |
| 7 | TNCC Algorithms (ABCDE with Cardiac Focus) | 14 |
| 8 | Resuscitation Pharmacology for Cardiac Trauma | 16 |
| 9 | ECG Interpretation for Trauma Nurses | 18 |
| 10 | Practice Questions (100 Multiple Choice) | 20 |
,2|Page
# SECTION 1: CARDIAC ANATOMY & PHYSIOLOGY REVIEW
FOR TRAUMA
## Key Cardiac Structures Relevant to Trauma
| Structure | Location | Trauma Relevance |
|-----------|----------|------------------|
| **Myocardium** | Heart muscle | Blunt cardiac injury → contusion,
dysrhythmia, failure |
| **Pericardium** | Fibrous sac around heart | Hemopericardium →
tamponade |
| **Coronary arteries** | Epicardial surface | Dissection or thrombosis
from blunt trauma |
| **Valves** | Between chambers | Traumatic regurgitation (rare, high
mortality) |
| **Great vessels (aorta, SVC, IVC, pulmonary artery)** | Above heart |
Deceleration injury → aortic transection |
## Cardiac Output in Trauma
> **CO = HR × SV**
| Component | Effect in Trauma |
,3|Page
|-----------|------------------|
| **HR** | Increases in shock (compensatory tachycardia) except
neurogenic shock (bradycardia) |
| **SV** | Decreases in hypovolemia (reduced preload), tension
pneumothorax (reduced filling), tamponade (restricted filling), and
myocardial contusion (reduced contractility) |
## Shock States Affecting Cardiac Function (TNCC Key Points)
| Shock Type | Cardiac Output | Heart Rate | SVR |
|------------|---------------|------------|-----|
| Hypovolemic | ↓↓ | ↑↑ | ↑ |
| Cardiogenic | ↓↓ | ↑ (or ↓ if severe) | ↑↑ |
| Obstructive (tamponade, tension pneumo) | ↓↓ | ↑ | ↑ |
| Neurogenic | ↓ | ↓ | ↓↓ |
| Distributive (sepsis) | ↑ | ↑↑ | ↓ |
---
# SECTION 2: BLUNT CARDIAC INJURY (BCI)
## Definition
, 4|Page
- Contusion (bruising) of the heart muscle due to blunt chest trauma
(steering wheel, fall, assault)
## Mechanism
- Sudden compression of the heart between sternum and spine
- Most common **right ventricle** (anterior position)
## Clinical Presentation
| Mild BCI | Severe BCI |
|----------|-------------|
| Chest pain (often attributed to chest wall injury) | Hypotension
(cardiogenic shock) |
| Tachycardia out of proportion to injury | New-onset dysrhythmias (AF,
VF, VT, heart block) |
| Elevated troponin | Heart failure (JVD, crackles) |
| ECG changes (non-specific ST/T wave) | Sudden death |
## Diagnostic Workup (TNCC Recommended)
| Test | Finding | Sensitivity |
|------|---------|-------------|
*TNCC CARDIAC REVIEW**
**COMPREHENSIVE STUDY GUIDE FOR TRAUMA
NURSING CORE COURSE**
**CARDIAC INJURIES • DYSRHYTHMIAS IN TRAUMA
• RESUSCITATION • TNCC ALGORITHMS**
**HIGH-YIELD CONTENT FOR FIRST-TIME PASS**
**ENA 9TH EDITION ALIGNED • 2026–2027**
TABLE OF CONTENTS
| Section | Topic | Page |
|---------|-------|------|
| 1 | Cardiac Anatomy & Physiology Review for Trauma | 2 |
| 2 | Blunt Cardiac Injury (BCI) | 4 |
| 3 | Pericardial Tamponade | 6 |
| 4 | Tension Pneumothorax (Cardiovascular Collapse) | 8 |
| 5 | Hemorrhagic Shock & Cardiovascular Response | 10 |
| 6 | Dysrhythmias in Trauma | 12 |
| 7 | TNCC Algorithms (ABCDE with Cardiac Focus) | 14 |
| 8 | Resuscitation Pharmacology for Cardiac Trauma | 16 |
| 9 | ECG Interpretation for Trauma Nurses | 18 |
| 10 | Practice Questions (100 Multiple Choice) | 20 |
,2|Page
# SECTION 1: CARDIAC ANATOMY & PHYSIOLOGY REVIEW
FOR TRAUMA
## Key Cardiac Structures Relevant to Trauma
| Structure | Location | Trauma Relevance |
|-----------|----------|------------------|
| **Myocardium** | Heart muscle | Blunt cardiac injury → contusion,
dysrhythmia, failure |
| **Pericardium** | Fibrous sac around heart | Hemopericardium →
tamponade |
| **Coronary arteries** | Epicardial surface | Dissection or thrombosis
from blunt trauma |
| **Valves** | Between chambers | Traumatic regurgitation (rare, high
mortality) |
| **Great vessels (aorta, SVC, IVC, pulmonary artery)** | Above heart |
Deceleration injury → aortic transection |
## Cardiac Output in Trauma
> **CO = HR × SV**
| Component | Effect in Trauma |
,3|Page
|-----------|------------------|
| **HR** | Increases in shock (compensatory tachycardia) except
neurogenic shock (bradycardia) |
| **SV** | Decreases in hypovolemia (reduced preload), tension
pneumothorax (reduced filling), tamponade (restricted filling), and
myocardial contusion (reduced contractility) |
## Shock States Affecting Cardiac Function (TNCC Key Points)
| Shock Type | Cardiac Output | Heart Rate | SVR |
|------------|---------------|------------|-----|
| Hypovolemic | ↓↓ | ↑↑ | ↑ |
| Cardiogenic | ↓↓ | ↑ (or ↓ if severe) | ↑↑ |
| Obstructive (tamponade, tension pneumo) | ↓↓ | ↑ | ↑ |
| Neurogenic | ↓ | ↓ | ↓↓ |
| Distributive (sepsis) | ↑ | ↑↑ | ↓ |
---
# SECTION 2: BLUNT CARDIAC INJURY (BCI)
## Definition
, 4|Page
- Contusion (bruising) of the heart muscle due to blunt chest trauma
(steering wheel, fall, assault)
## Mechanism
- Sudden compression of the heart between sternum and spine
- Most common **right ventricle** (anterior position)
## Clinical Presentation
| Mild BCI | Severe BCI |
|----------|-------------|
| Chest pain (often attributed to chest wall injury) | Hypotension
(cardiogenic shock) |
| Tachycardia out of proportion to injury | New-onset dysrhythmias (AF,
VF, VT, heart block) |
| Elevated troponin | Heart failure (JVD, crackles) |
| ECG changes (non-specific ST/T wave) | Sudden death |
## Diagnostic Workup (TNCC Recommended)
| Test | Finding | Sensitivity |
|------|---------|-------------|
