TNCC Notes for Written Exam
What is kinematics? - ansA 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? - ansA 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? - ansEnergy can neither be created nor
destroyed. It is only changed from one form to another.
What is Newton's Second Law? - ansForce equals mass multiplied by acceleration of
deceleration.
What is kinetic energy (KE)? - ansKE equals 1/2 the mass (M) multiplied by the velocity
squared.
What is the Mnemonic for the Initial Assessment? - ansA = 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? - ansF = 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? - ansAuscultate 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? - ans- Tracheal deviation
- JVD
What are signs of ineffective breathing? - 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? -
ansA tight-fitting nonrebreather mask at 12-15 lpm.
What intervention should be done if a pt presents with effective circulation? - ans- Insert 2
large caliber IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate
What are signs of ineffective circulation? - 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? - 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
- 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"? - ansDISABILITY
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? - ans- If assessment indicates a decreased LOC,
conduct further investigation during secondary focused assessments
- 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? - ans- 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? - ansFULL 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? - ansGIVE COMFORT
MEASURES
- Talking to pt
- Pharmacologic/Nonpharmacologic pain management
- Observe for physical signs of pain
What is assessed under the Mnemonic "H"? - ansHISTORY / 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"? - ansINSPECT 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? - ansReassess:
- Primary survey,
- VS
- Pain
- Any injuries
What are factors that contribute to ineffective ventilation? - 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 is kinematics? - ansA 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? - ansA 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? - ansEnergy can neither be created nor
destroyed. It is only changed from one form to another.
What is Newton's Second Law? - ansForce equals mass multiplied by acceleration of
deceleration.
What is kinetic energy (KE)? - ansKE equals 1/2 the mass (M) multiplied by the velocity
squared.
What is the Mnemonic for the Initial Assessment? - ansA = 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? - ansF = 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? - ansAuscultate 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? - ans- Tracheal deviation
- JVD
What are signs of ineffective breathing? - 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? -
ansA tight-fitting nonrebreather mask at 12-15 lpm.
What intervention should be done if a pt presents with effective circulation? - ans- Insert 2
large caliber IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate
What are signs of ineffective circulation? - 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? - 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
- 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"? - ansDISABILITY
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? - ans- If assessment indicates a decreased LOC,
conduct further investigation during secondary focused assessments
- 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? - ans- 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? - ansFULL 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? - ansGIVE COMFORT
MEASURES
- Talking to pt
- Pharmacologic/Nonpharmacologic pain management
- Observe for physical signs of pain
What is assessed under the Mnemonic "H"? - ansHISTORY / 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"? - ansINSPECT 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? - ansReassess:
- Primary survey,
- VS
- Pain
- Any injuries
What are factors that contribute to ineffective ventilation? - 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
