TNCC
Energy forces: Tension - ansforces stretch by pulling at opposite ends.
Example: Tensile strength describes the tissues ability to resist pulling apart when stretched.
Tendons, ligaments, and muscles can tear when they are overstretched (Achilles tendon)
Energy Forces: Compression - ansCompression forces crush by squeezing together.
Example: Injuries to organs occur when the organs are crushed from surrounding internal
organs or structures such as a seat belt worn up across the abdomen, causing compression of
the small bowel or a fracture to the lumbar spine.
Energy Forces: Bending - ansLoading about an axis. Bending causes compression on the side
the person is bending toward and tension to the opposite side.
Example: A force moves from a straight form to a curved form, such as bending forward
from a standing position.
Energy Forces: Shearing - ansDamage by tearing or bending by exerting force at different
parts in opposite directions at the same time.
Example: Describes the tissues ability to resist a force applied parallel to the tissue. An aortic
aneurysm is an example: As the aorta is stretched beyond its capacity, the vessel is torn away
from the attachment.
Energy Forces: Torsion - ansForces twist ends in opposite directions
Twisting motion depends on the body's ability to resist applied torque. (A golfers spine
twisting when swinging a golf club)
Initial Assessment A- J mnemonic - ansHelps the trauma nurse rapidly assess for and
intervene in life threatening injuries and identify all injuries in a systematic manner; it is the
basis for the trauma nursing process.
A-J Initial assessment steps - ansA: Across the room assessment for uncontrolled
hemorrhage, Airway and Alertness with simultaneous cervical spinal stabilization
B: Breathing and ventilation
C: Circulation and Control of Hemorrhage
D: Disability (Neurological status)
E: Exposure and Environmental control
F: Full set of vital signs and Family Presence
G: Get monitoring devices and give comfort using mnemonic (LMNOP)
L: laboratory studies (including arterial blood gases {ABGs} and serum lactate and obtain a
specimen for blood type and cross match
, M: Monitor for continuous cardiac rhythm and rate assessment
N: Nasogastric or orogastric tube consideration
O: Oxygenation and ventilation analysis: consider weaning oxygen based on pulse oximetry,
end-tidal carbon dioxide (ETCO2) monitoring or capnography for intubated or sedated
patients
P: Pain assessment and management
H: History and Head to toe assessment
I: Inspect posterior surfaces
J: Just keep reevaluating - A,B,C,D,E,F,G,H and I
Safe Care - ansAssuring the patient gets to the right hospital in the right amount of time for
the right care.
The right time has been long referred to as the "golden hour" however, patients presenting
with some serious injuries will not survive an hour without definitive treatment. Timely
effective and efficient interventions facilitate improved outcomes for trauma patients.
Optimal outcomes result when time in the field is minimized and care is focused on airway
maintenance, control of hemorrhage, and spinal motion restriction when necessary.
Across the room observation - ansThe primary survey begins immediately upon the patient's
arrival to the trauma room. Across the room observation is completed as the patient is
brought into the room.
This evaluation can allow for a rapid determination of the patient's overall physiologic
stability and the identification of any uncontrolled external hemorrhage.
The main goal during the primary survey is to immediately identify all life threatening
conditions that can cause death within the first few minutes of presentation. These conditions
must be treated upon discovery and as such are identified and immediately corrected.
The trauma nurse chooses the appropriate examination elements of inspection, auscultation,
and palpation for assessment.
Uncontrolled hemorrhage - ansThe major cause of preventable death after injury. If
uncontrolled external hemorrhage is noted during the across the room observation or as the
patient is being transferred to the trauma room stretcher, in some environments, and under
some circumstances, the priorities may be reordered to C, ABC. The use of a "bleeding
control bundle" can decrease trauma morbidity and mortality.
The MARCH mnemonic - ansMassive hemorrhage: control life threatening bleeding with the
use of tourniquets; combat Gauzze, Celox Gauze, or Chito Gauze, and replacement of blood
loss with whole blood or a 1:1:1 ratio of plasma, red blood cells, and platelets to achieve a
systolic blood pressure of 80 to 90 mm Hg as soon as possible.
Airway: Establish and maintain a patent airway.
Energy forces: Tension - ansforces stretch by pulling at opposite ends.
Example: Tensile strength describes the tissues ability to resist pulling apart when stretched.
Tendons, ligaments, and muscles can tear when they are overstretched (Achilles tendon)
Energy Forces: Compression - ansCompression forces crush by squeezing together.
Example: Injuries to organs occur when the organs are crushed from surrounding internal
organs or structures such as a seat belt worn up across the abdomen, causing compression of
the small bowel or a fracture to the lumbar spine.
Energy Forces: Bending - ansLoading about an axis. Bending causes compression on the side
the person is bending toward and tension to the opposite side.
Example: A force moves from a straight form to a curved form, such as bending forward
from a standing position.
Energy Forces: Shearing - ansDamage by tearing or bending by exerting force at different
parts in opposite directions at the same time.
Example: Describes the tissues ability to resist a force applied parallel to the tissue. An aortic
aneurysm is an example: As the aorta is stretched beyond its capacity, the vessel is torn away
from the attachment.
Energy Forces: Torsion - ansForces twist ends in opposite directions
Twisting motion depends on the body's ability to resist applied torque. (A golfers spine
twisting when swinging a golf club)
Initial Assessment A- J mnemonic - ansHelps the trauma nurse rapidly assess for and
intervene in life threatening injuries and identify all injuries in a systematic manner; it is the
basis for the trauma nursing process.
A-J Initial assessment steps - ansA: Across the room assessment for uncontrolled
hemorrhage, Airway and Alertness with simultaneous cervical spinal stabilization
B: Breathing and ventilation
C: Circulation and Control of Hemorrhage
D: Disability (Neurological status)
E: Exposure and Environmental control
F: Full set of vital signs and Family Presence
G: Get monitoring devices and give comfort using mnemonic (LMNOP)
L: laboratory studies (including arterial blood gases {ABGs} and serum lactate and obtain a
specimen for blood type and cross match
, M: Monitor for continuous cardiac rhythm and rate assessment
N: Nasogastric or orogastric tube consideration
O: Oxygenation and ventilation analysis: consider weaning oxygen based on pulse oximetry,
end-tidal carbon dioxide (ETCO2) monitoring or capnography for intubated or sedated
patients
P: Pain assessment and management
H: History and Head to toe assessment
I: Inspect posterior surfaces
J: Just keep reevaluating - A,B,C,D,E,F,G,H and I
Safe Care - ansAssuring the patient gets to the right hospital in the right amount of time for
the right care.
The right time has been long referred to as the "golden hour" however, patients presenting
with some serious injuries will not survive an hour without definitive treatment. Timely
effective and efficient interventions facilitate improved outcomes for trauma patients.
Optimal outcomes result when time in the field is minimized and care is focused on airway
maintenance, control of hemorrhage, and spinal motion restriction when necessary.
Across the room observation - ansThe primary survey begins immediately upon the patient's
arrival to the trauma room. Across the room observation is completed as the patient is
brought into the room.
This evaluation can allow for a rapid determination of the patient's overall physiologic
stability and the identification of any uncontrolled external hemorrhage.
The main goal during the primary survey is to immediately identify all life threatening
conditions that can cause death within the first few minutes of presentation. These conditions
must be treated upon discovery and as such are identified and immediately corrected.
The trauma nurse chooses the appropriate examination elements of inspection, auscultation,
and palpation for assessment.
Uncontrolled hemorrhage - ansThe major cause of preventable death after injury. If
uncontrolled external hemorrhage is noted during the across the room observation or as the
patient is being transferred to the trauma room stretcher, in some environments, and under
some circumstances, the priorities may be reordered to C, ABC. The use of a "bleeding
control bundle" can decrease trauma morbidity and mortality.
The MARCH mnemonic - ansMassive hemorrhage: control life threatening bleeding with the
use of tourniquets; combat Gauzze, Celox Gauze, or Chito Gauze, and replacement of blood
loss with whole blood or a 1:1:1 ratio of plasma, red blood cells, and platelets to achieve a
systolic blood pressure of 80 to 90 mm Hg as soon as possible.
Airway: Establish and maintain a patent airway.
