TNCC Day One

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TNCC Day One

 Initial Assessment
o Preparation and triage
o Primary Survey
 Resuscitation adjuncts (F, G)
o Reevaluation
o Secondary Survey (H, I)
 Reevaluation adjuncts
o Reevaluation and post resuscitation care
o Definitive care or transport
 A-I Mnemonic
o A- AVPU--airway and alertness with C spine
o B- breathing and ventilation (rate)
o C- circulation and control of hemorrhage
o D- disability (neuro status)
o E- exposure and environmental control
o F- full set of vital signs and family presence
o G- get resuscitation adjuncts (LMNOP- labs, monitor (ekg), OG
tube, pain)
o H- history and head to toe
o I- inspect posterior surfaces
 Prep and Triage
o Safe practice
 PPE
 Hazardous exposure
o Safe care
 Right care- if gunshot wound to chest, get chest tube
 Right trauma facility- EMS decides this
 Right time- is patient stable enough to transfer

,  Right resources
 Across-the-room- Observation
o Uncontrolled hemorrhage is a major cause of preventable death
after injury
o On arrival, determine the need to reorder ABC to <C> ABC
o Look for uncontrolled EXTERNAL hemorrhage
 Look before you start
 Look during letter C and E
 Also look when doing head-to-toe assessment/roll
o First priority is to treat the greatest threat!
 A- airway and alertness
o Cervical spinal immobilization
o Manual stabilization
o Spine board primarily a transportation device
o First thing we ask, “Is the patient alert and can the patient
speak?”
 Alert
 Verbal
 Pain
 Unresponsive
o Can the patient open and protect the airway?
o If patient is unable to open airway
 Manually open airway using jaw-thrust
 Two person procedure
o Inspect for:
 Tongue obstructing, loose teeth, foreign objects, blood,
vomitus, secretions, edema, burns
o Auscultate for:
 Obstructive airway sounds- snoring or stridor
o Palpate for:
 Bony deformity
o If a definitive airway is in place, assess for placement and
continue assessment (and assess for co2 detector)


2

, o Patent airway?
o Not patent?
 Suction
 Remove debris
 Airway adjunct
 Definitive airway
 B- breathing and ventilation
o Inspect for:
 Spontaneous breathing
 Symmetrical rise and fall of the chest
 Depth, pattern, and rate of respirations
 Signs of respiratory difficulty
 Skin color (breathing problems or circulatory problems)
 Wounds, contusions, abrasions, or deformities
o Auscultate for
 Breath sounds
 Presence
 Quality
 Comparison
o Palpate for:
 Bony structures
 Subcutaneous emphysema
 Soft tissue injury (bony structures sub q air)
o If breathing is absent:
 Open the airway
 Jaw thrust with second person
 Insert an airway adjunct
 Assist ventilations with bag mask device
 Prepare for definitive airway
o If breathing is present:
 Administer oxygen
 Nonrebreather mask at 15L
 Avoid hyperoxia- patient just needs to be above 94%



3

,  Determine ventilation effectiveness
 Use end-tidal CO2 monitoring (best way to monitor
ventilation in the quickest way)
 If ventilation is ineffective:
 Assist ventilations with bag mask
 10-12 breaths per min
 C- circulation and control of hemorrhage
o Hemorrhage: leading cause of preventable death after injury
o Continued assessments and high index of suspicion during:
 Across the room observation
 Primary survey at C
 Reevaluation directly following the primary survey
 Reevaluation following the second survey
o Inspect for:
 Uncontrolled EXTERNAL hemorrhage- first step put direct
pressure, then tourniquet
 Skin color
 Palpate for:
 Presence of central pulse
 Skin temp and moisture
 Pulses absent
 Initiate basic life support
 Assess for cause related to injury
o Uncontrolled INTENRAL hemorrhage- we can’t
do much about it but we can take them to a
trauma surgeon.
 If pulses are present, is circulation effective?
 Inspect for external hemorrhage, sin color
 Palpate for central pulses, rate and rhythm, temp,
and moisture
 If circulation is ineffective:
 Assess for signs of uncontrolled internal hemorrhage




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