TNCC Trauma Nursing Core Course 7th
Edition ENA
Components of SBAR and its purpose - ansS: Situation
B: Background
A: Assessment
R: Recommendation
Purpose- to provide framework for communication amount members of the healthcare team
p. 7
Components of DESC and its purpose - ansD: Describe the specific situation or behavior
E: Express your concerns or how the situation makes you feel
S: Suggest alternatives and seek agreement
C: State consequences in terms of impact on performance goals
Purpose- used in conflict management; paraphrasing the other person's comments is an
important technique that should be done throughout the DESC script. Following discussion of
consequences, team members should work towards consensus.
p. 7
Components of CUS and its purpose - ansC: I am Concerned
U: I am Uncomfortable
S: This is a Safety issue/ I am Stressed
Purpose- used to "stop the line" if a team member senses or discovers an essential safety
breach
p. 7
Define trauma - ans- Trauma is injury to living tissue caused by extrinsic agent
- Regardless of MOI, trauma creates stressors that exceed the tissue's or organ's ability to
compensate
p. 9
Leading cause of death for ages
1. over 65
2. 5 to 24
3. 25 to 64 - ans1. Falls
2. MVCs
3. poisoning
p. 9
Explain 3 phases of injury prevention - ansPrimary: prevention of the occurrence of the injury
Secondary: Reduction in the severity of the injury that has occurred
Tertiary: Improvement of outcomes related to the traumatic injury
,p. 10
Describe the three E's of injury control - ansEngineering: technological interventions such as
side impact airbags, automated blind spot alarms, ignition lock devices for those with DUIs.
In playgrounds and sports, this involves surface material under playground equipment and
athletic safety gear. Another intervention is improved use of smoke alarms in fire prevention
Enforcement and legislation: include laws at all jurisdictional levels regarding driving while
intoxicated, booster seats, primary seatbelt use, and distracted driving. For sports this
includes rules regarding illegal hits, examination after impact, and return-to-play
requirements after a head injury
Education: these can be community-based initiatives such as public service announcements
for improved seatbelt use, education regarding risks of distracted driving, programs to
commit to no texting while driving, and promotions for bicycle helmet giveaways with
instructions for proper use
p. 11
How can the trauma nurse have an impact when it comes to the legislative process? - ansBy
advocating for stronger laws and more consistent enforcement
p. 11
Define kinematics - ansThe study of energy transfer as it applies to identifying actual or
intentional injuries
p. 25
Define biomechanics - ansThe general study of forces and their effects
p. 25
Define mechanism of injury (MOI) - ansHow external energy forces in the environment are
transferred to the body
p. 25
Newton's First Law of Motion - ansA body at rest will remain at rest, and a body in motion
will stay in motion
p. 26
Newton's Second Law of Motion - ansForce = Mass X Acceleration
p. 26
Newton's Third Law of Motion - ansFor every action, there is an equal and opposite reaction
,p. 26
Law of Conservation of Energy - ansEnergy can neither be created nor destroyed, but it can
change form
p. 26
Describe energy forms - ans- Mechanical (energy transfer from one object to another in the
form of motion)
- Thermal (energy transfer of heat in environment to the host)
- Chemical (heat energy transfer from active chemical substances such as chlorine, drain
cleaner, acids, or plants)
- Electrical (energy transfer from light socket, power lines, or lightning)
- Radiant (energy transfer from blast sound waves, radioactivity such as a nuclear facility, or
rays of the sun)
p. 26
External energy forces can be exerted on the body by the following forces - ans- Deceleration
forces: include those applied in falls and collisions where injuries are caused by sudden stop
of the body's motion
- Acceleration forces: not as common as deceleration forces and result from a sudden and
rapid onset of motion (parked car being hit by a vehicle traveling at a high rate of speed)
- Compression force is an external force applied at times of impact, explains include:
+ Stationary objects such as dashboards or steering wheels, that collide with or push up into a
person
+ Objects in motion such as bullets and stabbing instruments, bats and balls, fists and feet, or
heavy falling objects
+ Blast forces
p. 27
The degree to which tissues resist destruction under circumstances of energy transfer depends
on... - ansTheir proximity to the impact and their structural characteristics
p. 27
Structural strengths of tissue are described in what three ways? - ans-Compression
-Tensile
-Shear
p. 27
Compression strength refers to the tissue's ability to: - ansResist crush force
- Compression injuries to organs occur when the organs are crushed from surrounding
internal organs or structures such as a seatbelt worn up across the abdomen causing
compression of the small bowel or a fracture to the lumbar spine
p. 27
, Tensile strength describes the tissue's ability to: - ansResist pulling apart when stretched
- Tendons, ligaments, and muscles can tear when they are overstretched (Achilles tendon)
p. 27
Shear strength describes the tissue's ability to: - ansResist a force applied parallel to the tissue
- Coup/contrecoup injury, such as a boxer being hit in the head, is an example of this
p. 27
Types of injuries include - ans- Blunt trauma
- Penetrating trauma
- Thermal trauma
- Blast trauma
p. 28
Lateral impacts (T-bone) are associated with - ansShear injuries to aorta and other organs,
fracture of the side clavicle, lateral pelvic and abdominal injuries, and lateral head and neck
injury
p. 30
Depending on the motorcycle design and rider positioning, the lower extremities can collide
with the handlebars, resulting in... - ansFemur and pelvis fractures and hip dislocations
p. 31
Cavitation refers to the... - ansSeparation of surrounding tissue resulting from a sound and/or
hydraulic wave force. This rapid motion can lead to crushing, tearing, and shearing forces on
tissue. The impact of cavitation is dependent on the characterists of the affected tissue.
Additional considerations include:
- Air-filled organs such as lungs or stomach, are elastic, so this tissue tolerates high-velocity
cavitation relatively well compared to other tissues
- Solid organs such as the liver, have a greater propensity to shear or tear under the same
forces
- If those same forces are instead released inside the cranium, bone will resist expansion,
augmenting soft tissue crushing, until the tensile strength of the bone is exceeded and an
explosive release of pressure results
ch. 4, p. 32
The U.S. Department of Defense classifies blast injuries in five levels: - ans- Primary blast
injuries: found in those closest to the detonation, with enclosed space detonation resulting in
the most lethal impacts. Air-filled organs (tympanic membranes, lungs, stomach, and bowel)
are most susceptible to rupture with primary blast injuries.
- Secondary injuries: include fragment injuries and generally cause the greatest volume of
casualties. They include injuries such as puncture wounds, lacerations, and impaled objects.
Edition ENA
Components of SBAR and its purpose - ansS: Situation
B: Background
A: Assessment
R: Recommendation
Purpose- to provide framework for communication amount members of the healthcare team
p. 7
Components of DESC and its purpose - ansD: Describe the specific situation or behavior
E: Express your concerns or how the situation makes you feel
S: Suggest alternatives and seek agreement
C: State consequences in terms of impact on performance goals
Purpose- used in conflict management; paraphrasing the other person's comments is an
important technique that should be done throughout the DESC script. Following discussion of
consequences, team members should work towards consensus.
p. 7
Components of CUS and its purpose - ansC: I am Concerned
U: I am Uncomfortable
S: This is a Safety issue/ I am Stressed
Purpose- used to "stop the line" if a team member senses or discovers an essential safety
breach
p. 7
Define trauma - ans- Trauma is injury to living tissue caused by extrinsic agent
- Regardless of MOI, trauma creates stressors that exceed the tissue's or organ's ability to
compensate
p. 9
Leading cause of death for ages
1. over 65
2. 5 to 24
3. 25 to 64 - ans1. Falls
2. MVCs
3. poisoning
p. 9
Explain 3 phases of injury prevention - ansPrimary: prevention of the occurrence of the injury
Secondary: Reduction in the severity of the injury that has occurred
Tertiary: Improvement of outcomes related to the traumatic injury
,p. 10
Describe the three E's of injury control - ansEngineering: technological interventions such as
side impact airbags, automated blind spot alarms, ignition lock devices for those with DUIs.
In playgrounds and sports, this involves surface material under playground equipment and
athletic safety gear. Another intervention is improved use of smoke alarms in fire prevention
Enforcement and legislation: include laws at all jurisdictional levels regarding driving while
intoxicated, booster seats, primary seatbelt use, and distracted driving. For sports this
includes rules regarding illegal hits, examination after impact, and return-to-play
requirements after a head injury
Education: these can be community-based initiatives such as public service announcements
for improved seatbelt use, education regarding risks of distracted driving, programs to
commit to no texting while driving, and promotions for bicycle helmet giveaways with
instructions for proper use
p. 11
How can the trauma nurse have an impact when it comes to the legislative process? - ansBy
advocating for stronger laws and more consistent enforcement
p. 11
Define kinematics - ansThe study of energy transfer as it applies to identifying actual or
intentional injuries
p. 25
Define biomechanics - ansThe general study of forces and their effects
p. 25
Define mechanism of injury (MOI) - ansHow external energy forces in the environment are
transferred to the body
p. 25
Newton's First Law of Motion - ansA body at rest will remain at rest, and a body in motion
will stay in motion
p. 26
Newton's Second Law of Motion - ansForce = Mass X Acceleration
p. 26
Newton's Third Law of Motion - ansFor every action, there is an equal and opposite reaction
,p. 26
Law of Conservation of Energy - ansEnergy can neither be created nor destroyed, but it can
change form
p. 26
Describe energy forms - ans- Mechanical (energy transfer from one object to another in the
form of motion)
- Thermal (energy transfer of heat in environment to the host)
- Chemical (heat energy transfer from active chemical substances such as chlorine, drain
cleaner, acids, or plants)
- Electrical (energy transfer from light socket, power lines, or lightning)
- Radiant (energy transfer from blast sound waves, radioactivity such as a nuclear facility, or
rays of the sun)
p. 26
External energy forces can be exerted on the body by the following forces - ans- Deceleration
forces: include those applied in falls and collisions where injuries are caused by sudden stop
of the body's motion
- Acceleration forces: not as common as deceleration forces and result from a sudden and
rapid onset of motion (parked car being hit by a vehicle traveling at a high rate of speed)
- Compression force is an external force applied at times of impact, explains include:
+ Stationary objects such as dashboards or steering wheels, that collide with or push up into a
person
+ Objects in motion such as bullets and stabbing instruments, bats and balls, fists and feet, or
heavy falling objects
+ Blast forces
p. 27
The degree to which tissues resist destruction under circumstances of energy transfer depends
on... - ansTheir proximity to the impact and their structural characteristics
p. 27
Structural strengths of tissue are described in what three ways? - ans-Compression
-Tensile
-Shear
p. 27
Compression strength refers to the tissue's ability to: - ansResist crush force
- Compression injuries to organs occur when the organs are crushed from surrounding
internal organs or structures such as a seatbelt worn up across the abdomen causing
compression of the small bowel or a fracture to the lumbar spine
p. 27
, Tensile strength describes the tissue's ability to: - ansResist pulling apart when stretched
- Tendons, ligaments, and muscles can tear when they are overstretched (Achilles tendon)
p. 27
Shear strength describes the tissue's ability to: - ansResist a force applied parallel to the tissue
- Coup/contrecoup injury, such as a boxer being hit in the head, is an example of this
p. 27
Types of injuries include - ans- Blunt trauma
- Penetrating trauma
- Thermal trauma
- Blast trauma
p. 28
Lateral impacts (T-bone) are associated with - ansShear injuries to aorta and other organs,
fracture of the side clavicle, lateral pelvic and abdominal injuries, and lateral head and neck
injury
p. 30
Depending on the motorcycle design and rider positioning, the lower extremities can collide
with the handlebars, resulting in... - ansFemur and pelvis fractures and hip dislocations
p. 31
Cavitation refers to the... - ansSeparation of surrounding tissue resulting from a sound and/or
hydraulic wave force. This rapid motion can lead to crushing, tearing, and shearing forces on
tissue. The impact of cavitation is dependent on the characterists of the affected tissue.
Additional considerations include:
- Air-filled organs such as lungs or stomach, are elastic, so this tissue tolerates high-velocity
cavitation relatively well compared to other tissues
- Solid organs such as the liver, have a greater propensity to shear or tear under the same
forces
- If those same forces are instead released inside the cranium, bone will resist expansion,
augmenting soft tissue crushing, until the tensile strength of the bone is exceeded and an
explosive release of pressure results
ch. 4, p. 32
The U.S. Department of Defense classifies blast injuries in five levels: - ans- Primary blast
injuries: found in those closest to the detonation, with enclosed space detonation resulting in
the most lethal impacts. Air-filled organs (tympanic membranes, lungs, stomach, and bowel)
are most susceptible to rupture with primary blast injuries.
- Secondary injuries: include fragment injuries and generally cause the greatest volume of
casualties. They include injuries such as puncture wounds, lacerations, and impaled objects.
