TNCC WRITTEN EXAM 2022
24 Hour Burn Fluid Calculation - ANS Dosage x Kg x % - ml in first 24 hours
-More than 20% of their TBSA burned require:
*Adults: 2-4 ml of crystalloid solution x kg x %
*Peds: 3-4 ml of crystalloid solution x kg x %
*Infants: fluid with 5% dextrose at a maintenance rate in addition to the Peds rate protocol
(1/2 the amount should be infused in first 8 hours)
Define central or transtentorial herniation. - ANS A downward movement of the cerebral hemispheres
with herniation of the diencephalon and midbrain through the elongated gap of the tentorium.
Define Hemothorax. - ANS Accumulation of blood in the pleural space.
Define Minor Head Trauma. - ANS GCS 13-15
Define Moderate Head Trauma - ANS Postresuscitative state with GCS 9-13.
Define Pneumothorax. - ANS Results 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. - ANS Postresuscitative state with GCS score of 8 or less.
Define tension pneumothorax. - ANS Life-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 uncal herniation. - ANS The 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 WRITTEN EXAM 2022
Disruptions of the bony structures of the skull can result in what? - ANS Displaced 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
Explain adrenal gland response. - ANS When 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 Cardiogenic Shock. - ANS Syndrome that results from ineffective perfusion caused by inadequate
contractility of cardiac muscle. Some causes: MI, Blunt cardiac injury, Mitral valve insufficiency,
dysrhythmias, Cardiac Failure
Explain Distributive Shock. - ANS Results 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.
,TNCC WRITTEN EXAM 2022
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. - ANS Liver 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. - ANS Most 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. - ANS Shock 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. - ANS Results from inadequate circulating blood volume because of an
obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself.
Some causes:
, TNCC WRITTEN EXAM 2022
- 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. - ANS Tachypnea 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.
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 inspect the chest for adequate ventilation? - ANS Observe:
- mental status
- RR and pattern
- chest wall symmetry
- any injuries
- patient's skin color (cyanosis?)
- JVD or tracheal deviation? (Tension pneumothorax)
24 Hour Burn Fluid Calculation - ANS Dosage x Kg x % - ml in first 24 hours
-More than 20% of their TBSA burned require:
*Adults: 2-4 ml of crystalloid solution x kg x %
*Peds: 3-4 ml of crystalloid solution x kg x %
*Infants: fluid with 5% dextrose at a maintenance rate in addition to the Peds rate protocol
(1/2 the amount should be infused in first 8 hours)
Define central or transtentorial herniation. - ANS A downward movement of the cerebral hemispheres
with herniation of the diencephalon and midbrain through the elongated gap of the tentorium.
Define Hemothorax. - ANS Accumulation of blood in the pleural space.
Define Minor Head Trauma. - ANS GCS 13-15
Define Moderate Head Trauma - ANS Postresuscitative state with GCS 9-13.
Define Pneumothorax. - ANS Results 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. - ANS Postresuscitative state with GCS score of 8 or less.
Define tension pneumothorax. - ANS Life-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 uncal herniation. - ANS The 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 WRITTEN EXAM 2022
Disruptions of the bony structures of the skull can result in what? - ANS Displaced 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
Explain adrenal gland response. - ANS When 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 Cardiogenic Shock. - ANS Syndrome that results from ineffective perfusion caused by inadequate
contractility of cardiac muscle. Some causes: MI, Blunt cardiac injury, Mitral valve insufficiency,
dysrhythmias, Cardiac Failure
Explain Distributive Shock. - ANS Results 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.
,TNCC WRITTEN EXAM 2022
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. - ANS Liver 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. - ANS Most 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. - ANS Shock 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. - ANS Results from inadequate circulating blood volume because of an
obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself.
Some causes:
, TNCC WRITTEN EXAM 2022
- 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. - ANS Tachypnea 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.
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 inspect the chest for adequate ventilation? - ANS Observe:
- mental status
- RR and pattern
- chest wall symmetry
- any injuries
- patient's skin color (cyanosis?)
- JVD or tracheal deviation? (Tension pneumothorax)
