TNCC 8th Edition
MARCH mneumonic - ansMassive Hemorrhage: Control with combat gauze, celox gauze, or
chito gauze; replacement of blood loss with whole blood or 1:1:1 ratio of plasma, RBC, and
platelets to achieve SBP of 80-90mmHg.
Airway: Establish and maintain patent airway
Respiration: Decompress suspected tension pneumothorax, seal open chest wounds, and
support ventilation and oxygenation as required.
Circulation: Provide vascular access (IV/IO) and administer fluids as required to treat shock
Head injury/Hypothermia: Prevent or treat hypotension and hypoxia to prevent worsening of
TBI and prevent or treat hypothermia.
AVPU - ansAssessing Alertness
A: Alert and oriented
V: Responds to verbal stimuli
P: Responds only to painful stimuli
U: Unresponsive
LACE - ansSoft Tissue Injuries
L: Lacerations
A: Abrasions, Avulsions
C: Contusions
E: Edema, Ecchymosis
Urinary Catheter Contraindications - ansif urethral transsection is suspected:
-blood at the urethral meatus
-perineal ecchymosis
-scrotal ecchymosis
-high-riding or nonpalpable prostate
Breathing Intervention Reassessment - ans1. Attach CO2 detector
2. Listen over epigastrum
3. Bilateral breath sounds at midaxillary and midclavicular lines
4. Color change after 6 breaths
5. Monitor skin color; get xr
Troubleshooting Ventilator Alarms - ansD: Displaced Tube
O: Obstructed or Kinked Tube
P: Pneumothorax
E: Equipment failure, such as the patient becoming detached from the equipment or loss of
capnography
Seven P's of RSI - ans-Preparation: ensure you have all necessary equipment and personnel.
Verify IV sites
-Preoxygenation: high flow oxygen for minimum of 3 minutes. Position is HOB elevated to
20 degrees. For spinal precautions, reverse Trendelenburg at 30 degrees.
, -Pre-intubation optimization: Lidocaine (may reduce risk of rise in ICP during intubation) or
Fentanyl (mitigates sympathetic response increased HR and BP during intubation)
administration
-Paralysis with induction
-Protection: after neuromuscular blocking agent is administered, protect the airway from
aspiration by avoiding BVM, which can result in regurgitation and aspiration.
-Placement with proof: inflate ETT cuff, secure, use ETCO2 for confirmation
-Post-intubation management: secure tube and note measurement; xr.
Inductions Agents for RSI - ansEtomidate
Ketamine
Midazolam
Propofol
Paralysis Agents for RSI - ansSuccinylcholine
Rocuronium
Vecuronium
Cerebral Perfusion Pressure (CPP) - ansNormal: 60-100 mm Hg
Acceptable: 50-70 mm Hg
Hypercarbia - ansPaCO2 > 45 mmHg
Excess of Co2 in the blood, indicated by an elevated PaCO2 as determined by blood gas
analysis
Intracranial Pressure (ICP) - ans0-15mmHg
The pressure of the CSF in the subarachnoid space
Mean Arterial Pressure (MAP) - ans50-150mmHg
The average blood pressure in a single cardiac cycle, roughly calculated as the SBP + 2 x the
DBP/3
Avoid hypoxemia in the patient with head trauma - ansA single episode of hypoxemia (PaO2
<60mmHg) can be detrimental to the patient's outcome. Maintain pulse ox at 95% or greater
and obtain ABG measurement asap for patient with severe TBI.
Maintain ETCO2 between 35-45 mmHg
Manage ICP in the patient with head trauma - ansAn ICP sustained at greater than 22 mmHg
and unresponsive to treatment is associated with poor outcomes
Increased ICP Assessment Findings - ansEarly: Headache; n/v; amnesia; behavior changes
(restlessness, impaired judgement; drowsiness); altered level of consciousness
(hyperarousability and hypoarousability)
Late: Dilated, nonreactive pupils; unresponsive to verbal or painful stimuli; abnormal motor
posturing (flexion, extension, flaccidity); Cushing response: Widening pulse pressure, reflex
bradycardia, and decreased respiratory effort.
Corneal Injury - ansAssessment Findings: Photophobia, pain, eye redness, lid swelling, FB
sensation
MARCH mneumonic - ansMassive Hemorrhage: Control with combat gauze, celox gauze, or
chito gauze; replacement of blood loss with whole blood or 1:1:1 ratio of plasma, RBC, and
platelets to achieve SBP of 80-90mmHg.
Airway: Establish and maintain patent airway
Respiration: Decompress suspected tension pneumothorax, seal open chest wounds, and
support ventilation and oxygenation as required.
Circulation: Provide vascular access (IV/IO) and administer fluids as required to treat shock
Head injury/Hypothermia: Prevent or treat hypotension and hypoxia to prevent worsening of
TBI and prevent or treat hypothermia.
AVPU - ansAssessing Alertness
A: Alert and oriented
V: Responds to verbal stimuli
P: Responds only to painful stimuli
U: Unresponsive
LACE - ansSoft Tissue Injuries
L: Lacerations
A: Abrasions, Avulsions
C: Contusions
E: Edema, Ecchymosis
Urinary Catheter Contraindications - ansif urethral transsection is suspected:
-blood at the urethral meatus
-perineal ecchymosis
-scrotal ecchymosis
-high-riding or nonpalpable prostate
Breathing Intervention Reassessment - ans1. Attach CO2 detector
2. Listen over epigastrum
3. Bilateral breath sounds at midaxillary and midclavicular lines
4. Color change after 6 breaths
5. Monitor skin color; get xr
Troubleshooting Ventilator Alarms - ansD: Displaced Tube
O: Obstructed or Kinked Tube
P: Pneumothorax
E: Equipment failure, such as the patient becoming detached from the equipment or loss of
capnography
Seven P's of RSI - ans-Preparation: ensure you have all necessary equipment and personnel.
Verify IV sites
-Preoxygenation: high flow oxygen for minimum of 3 minutes. Position is HOB elevated to
20 degrees. For spinal precautions, reverse Trendelenburg at 30 degrees.
, -Pre-intubation optimization: Lidocaine (may reduce risk of rise in ICP during intubation) or
Fentanyl (mitigates sympathetic response increased HR and BP during intubation)
administration
-Paralysis with induction
-Protection: after neuromuscular blocking agent is administered, protect the airway from
aspiration by avoiding BVM, which can result in regurgitation and aspiration.
-Placement with proof: inflate ETT cuff, secure, use ETCO2 for confirmation
-Post-intubation management: secure tube and note measurement; xr.
Inductions Agents for RSI - ansEtomidate
Ketamine
Midazolam
Propofol
Paralysis Agents for RSI - ansSuccinylcholine
Rocuronium
Vecuronium
Cerebral Perfusion Pressure (CPP) - ansNormal: 60-100 mm Hg
Acceptable: 50-70 mm Hg
Hypercarbia - ansPaCO2 > 45 mmHg
Excess of Co2 in the blood, indicated by an elevated PaCO2 as determined by blood gas
analysis
Intracranial Pressure (ICP) - ans0-15mmHg
The pressure of the CSF in the subarachnoid space
Mean Arterial Pressure (MAP) - ans50-150mmHg
The average blood pressure in a single cardiac cycle, roughly calculated as the SBP + 2 x the
DBP/3
Avoid hypoxemia in the patient with head trauma - ansA single episode of hypoxemia (PaO2
<60mmHg) can be detrimental to the patient's outcome. Maintain pulse ox at 95% or greater
and obtain ABG measurement asap for patient with severe TBI.
Maintain ETCO2 between 35-45 mmHg
Manage ICP in the patient with head trauma - ansAn ICP sustained at greater than 22 mmHg
and unresponsive to treatment is associated with poor outcomes
Increased ICP Assessment Findings - ansEarly: Headache; n/v; amnesia; behavior changes
(restlessness, impaired judgement; drowsiness); altered level of consciousness
(hyperarousability and hypoarousability)
Late: Dilated, nonreactive pupils; unresponsive to verbal or painful stimuli; abnormal motor
posturing (flexion, extension, flaccidity); Cushing response: Widening pulse pressure, reflex
bradycardia, and decreased respiratory effort.
Corneal Injury - ansAssessment Findings: Photophobia, pain, eye redness, lid swelling, FB
sensation
