TNCC Notes for Written Exam
What is kinematics? - answer A branch of mechanics (energy transfer) that refers to
motion and does not consider the concepts of force and mass of the object or body.
What is Newton's First Law? - answer A body at rest will remain at rest. A body in
motion will remain in motion until acted on by an outside force.
What is the Law of Conservation of Energy? - answer Energy can neither be created
nor destroyed. It is only changed from one form to another.
What is Newton's Second Law? - answer Force equals mass multiplied by acceleration
of deceleration.
What is kinetic energy (KE)? - answer KE equals 1/2 the mass (M) multiplied by the
velocity squared.
What is the Mnemonic for the Initial Assessment? - answer A = Airway with
simultaneous cervical spine protection
B = Breathing
C = Circulation
D = Disability (neurologic status)
E = Expose/Environmental controls (remove clothing and keep the patient warm)
What is the Mnemonic for the Secondary Assessment? - answer F = Full set of
VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric
tube)/Family presence
G = Give comfort measures (verbal reassurance, touch, and pharmacologic and
nonpharmacologic management of pain).
H = Hx and Head-to-toe assessment
I = Inspect posterior surfaces
Where do you listen to auscultate breath sounds? - answer Auscultate the lungs
bilaterally at the second intercostal space midclavicular line and at the fifth intercostal
space at the anterior axillary line.
What are the late signs of breathing compromise? - answer - Tracheal deviation
- JVD
What are signs of ineffective breathing? - answer - 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.
,TNCC Notes for Written Exam
Upon initial assessment, what type of oxygen should be used for a pt breathing
effectively? - answer A tight-fitting nonrebreather mask at 12-15 lpm.
What intervention should be done if a pt presents with effective circulation? - answer -
Insert 2 large caliber IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate
What are signs of ineffective circulation? - answer - 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? - answer - 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
- 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)
How do you assess Mnemonic "D"? - answer DISABILITY
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
What are the interventions for Disability? - answer - If assessment indicates a
decreased LOC, conduct further investigation during secondary focused assessments
, TNCC Notes for Written Exam
- If pt is not alert or verbal, continue to monitor for any compromise to ABC's
- If pt demonstrates signs of herniation or neurologic deterioration, consider
hyperventilation.
What is assessed and intervened for Expose/Environmental Controls? - answer -
Remove clothing
- Ensure appropriate decontamination if exposed to hazardous material
- Keep pt warm
- Keep clothing for evidence
What is the first thing assessed under the Secondary Assessment? - answer FULL SET
VS / FOCUSED ADJUNCTS / FAMILY PRESENCE
- ABCDE should be completed
- Labs, X-rays, CT, Foley,
- Family Presence
What is the second thing assessed under the Secondary Assessment? - answer GIVE
COMFORT MEASURES
- Talking to pt
- Pharmacologic/Nonpharmacologic pain management
- Observe for physical signs of pain
What is assessed under the Mnemonic "H"? - answer HISTORY / HEAD-TO-TOE
ASSESSMENT
- MIVT
- M = Mechanism of injury
- I = Injuries sustained
- V = Vital Signs
- T = Treatment
- Pt generated information
- PMH
- Head-to-toe assessment
What is assessed under the Mnemonic "I"? - answer INSPECT POSTERIOR
SURFACES
- While maintaining C-spine, logroll pt with assistance to inspect back, flanks, buttocks
and posterior thighs.
- Palpate vertebral column for deformity and areas of tenderness
- Assess rectum for presence/absence of tone, presence of blood
What she be done after the Secondary Assessment? - answer Reassess:
- Primary survey,
- VS
- Pain
- Any injuries
What is kinematics? - answer A branch of mechanics (energy transfer) that refers to
motion and does not consider the concepts of force and mass of the object or body.
What is Newton's First Law? - answer A body at rest will remain at rest. A body in
motion will remain in motion until acted on by an outside force.
What is the Law of Conservation of Energy? - answer Energy can neither be created
nor destroyed. It is only changed from one form to another.
What is Newton's Second Law? - answer Force equals mass multiplied by acceleration
of deceleration.
What is kinetic energy (KE)? - answer KE equals 1/2 the mass (M) multiplied by the
velocity squared.
What is the Mnemonic for the Initial Assessment? - answer A = Airway with
simultaneous cervical spine protection
B = Breathing
C = Circulation
D = Disability (neurologic status)
E = Expose/Environmental controls (remove clothing and keep the patient warm)
What is the Mnemonic for the Secondary Assessment? - answer F = Full set of
VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric
tube)/Family presence
G = Give comfort measures (verbal reassurance, touch, and pharmacologic and
nonpharmacologic management of pain).
H = Hx and Head-to-toe assessment
I = Inspect posterior surfaces
Where do you listen to auscultate breath sounds? - answer Auscultate the lungs
bilaterally at the second intercostal space midclavicular line and at the fifth intercostal
space at the anterior axillary line.
What are the late signs of breathing compromise? - answer - Tracheal deviation
- JVD
What are signs of ineffective breathing? - answer - 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.
,TNCC Notes for Written Exam
Upon initial assessment, what type of oxygen should be used for a pt breathing
effectively? - answer A tight-fitting nonrebreather mask at 12-15 lpm.
What intervention should be done if a pt presents with effective circulation? - answer -
Insert 2 large caliber IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate
What are signs of ineffective circulation? - answer - 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? - answer - 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
- 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)
How do you assess Mnemonic "D"? - answer DISABILITY
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
What are the interventions for Disability? - answer - If assessment indicates a
decreased LOC, conduct further investigation during secondary focused assessments
, TNCC Notes for Written Exam
- If pt is not alert or verbal, continue to monitor for any compromise to ABC's
- If pt demonstrates signs of herniation or neurologic deterioration, consider
hyperventilation.
What is assessed and intervened for Expose/Environmental Controls? - answer -
Remove clothing
- Ensure appropriate decontamination if exposed to hazardous material
- Keep pt warm
- Keep clothing for evidence
What is the first thing assessed under the Secondary Assessment? - answer FULL SET
VS / FOCUSED ADJUNCTS / FAMILY PRESENCE
- ABCDE should be completed
- Labs, X-rays, CT, Foley,
- Family Presence
What is the second thing assessed under the Secondary Assessment? - answer GIVE
COMFORT MEASURES
- Talking to pt
- Pharmacologic/Nonpharmacologic pain management
- Observe for physical signs of pain
What is assessed under the Mnemonic "H"? - answer HISTORY / HEAD-TO-TOE
ASSESSMENT
- MIVT
- M = Mechanism of injury
- I = Injuries sustained
- V = Vital Signs
- T = Treatment
- Pt generated information
- PMH
- Head-to-toe assessment
What is assessed under the Mnemonic "I"? - answer INSPECT POSTERIOR
SURFACES
- While maintaining C-spine, logroll pt with assistance to inspect back, flanks, buttocks
and posterior thighs.
- Palpate vertebral column for deformity and areas of tenderness
- Assess rectum for presence/absence of tone, presence of blood
What she be done after the Secondary Assessment? - answer Reassess:
- Primary survey,
- VS
- Pain
- Any injuries
