TNCC exam 2016,Question with Complete Solutions,
Updated 2024
Epidemiology: Unintentional injury is a leading cause of death across all age groups in the US
• 65+ falls are the leading cause of injury-related deaths
• 25-64: poisoning is the leading cause of death
• 5-24: MVC leading cause of death
• TBI: more for males, 0-4 highest rate of death
Injury prevention: 3 E's
• Engineering: technological interventions (airbags, alarms, safety gear)
• Enforcement and legislation: laws and regulations
• Education: community based initiatives, public service announcements
Kinematics
study of energy transfer as it applies to identifying actual or potential injuries
Major cause of death 1-44
Trauma: major cause of death for people ages 1-44 years
Biomechanics
study of forces and their effects on living tissue and the human body
Mechanism of injury (MOI)
how injuries occur as a result of energy from environment transferred to the body
Newton's 1st law of motion:
a body at rest will remain at rest, a body in motion will remain in motion
Newton's 2nd law of motion:
Force=Mass x Acceleration
Newton's 3rd law of motion:
for every action there is an equal and opposite reaction
Law of conservation of energy:
energy can neither be created nor destroyed, but it can change form
Types of injuries:
• Blunt trauma: broad energy impact across a large surface area: falls, MVC, assaults
• Penetrating trauma: energy that results in impalement: guns, stab wounds,
,• Thermal trauma: burns
• Blast trauma: rapid release of blast energy in chemical, physical, radioactive exposures
• Occlusive/obtrusive: drowning, handing, strangulation,
Motor vehicle impact sequence:
• 1st impact: car hit object
• 2nd: impact person hits inside of car
• 3rd: impact organs hit inside of body- organs can be ripped from ligaments (aorta) and hit internal
structures
Pedestrian vs Vehicle:
Waddell triad: lower initial hit (leg), chest injury when landing on car (thorax), upper body injury when
bounced off and landing on the ground (head and arms)
Triage:
sorting pt's based on their need for treatment and the resources available. Based on:
• MOI (head on collision, fall more than 20ft for adult)
• Physiologic criteria (vs)
• Anatomic critera (flail chest, fractured pelvis)
• Special considerations (age, special needs)
1. Prehospital report
MIST (MOI, injury, s/s, treatment)
2. Preparation and triage:
Safe practice, safe care
a. Activate trauma team
b. Right equipment, room ready
c. PPE
d. Consider any potential haz mat situation
3. Across the room observations
C-AB: As pt is brought in rapid assess of stability and id of uncontrolled bleeding
IF BLEEDING: CIRCULATION BEFORE AIRWAY! CONTROLL THE BLEED THEN MOVE TO AIRWAY
4. Primary survey: A-B-C-D-E-F-G (LMNOP)
life-threatening conditions or identified and immediately corrected
a. Alertness: AVPU W/ c-spine stabilization
AIRWAY ASSISTANCE W/ JAW THRUST W/C-SPINE CONTROL→ BVM if need assistance and/or difficult
airway
Look for: teeth/tongue/foreign bodies, blood/vomit/secretions, edema, burns (suction→ REASSESS)
Listen for: snoring, gurgling, stridor (OPA→REASSESS→ET→REASSESS)
Feel for: facial deformities, subcutaneous emphysema
, ROBI: Reopen, OPA, BVM, Intubation→ reassess
*If ETT in place assess placement:
1. Adequate chest rise and fall w/ BVM
2. No epigastric gurgling
3. Bilateral breath sounds heard
4 CO2 detector gold
Interventions:
1. Suction
2. Jaw thrust w/manual stabilization
3. Naso/oraopharyngeal airway
4. Definitive airway (ETT)→ REASSESS
b. Breathing and ventilation: Expose chest. Inadequate oxygenation causes hypoxemia causing acidosis
Look for: spontaneous breathing, symmetrical rise and fall, depth/pattern/rate of respirations, use of
accessory muscles, skin color, abrasions/bruising/deformities, sucking chest wounds, JVD and tracheal
deviation=s/s pneumothorax
Listen for breath sounds
Feel for fractures, subcutaneous emphysema
Interventions:
1. No breathing:
Jaw-Thrust
OPA
BMV
Prepare for definitive airway→ REASSESS
2. Breathing present:
Oxygen 15 L via NRB
*check capnography (35-45) & pulse ox above 94% If NOT= BVM give 10-12 breaths a min/ 1 q 6
seconds→? ETT? →REASSESS
c. Circulation and control of hemorrhage
Look for: Bleeding, skin color
Listen for: Muffled heart tones (tamponade)
Feel for: skin temp/moisture, Pulses (central)→ABSENT=CPR, RAPID/THREADY→ HYPOVOLEMIA
Interventions:
1.Control bleeding= direct pressure
2. Elevate bleeding extremity, ? tourniquet
3. Get 2- IV/IO, T&S
4. Warm IVF w/blood tubing 1-2L, give blood→ REASSESS
d. Disability/neurological status:
Look for: Pupils PEARRL, GCS 3-15 (less than 8=intubate)
1. Eye: spontaneous 4, to verbal 3, to pain 2, none 1
2. Verbal: orientated 5, confused but able to answer ? 4, inappropriate 3, incomprehensible 2, none 1
3. Motor: obeys commands 6, purposeful to pain stim 5, withdraws from pain 4, decorticate (flexion in
Updated 2024
Epidemiology: Unintentional injury is a leading cause of death across all age groups in the US
• 65+ falls are the leading cause of injury-related deaths
• 25-64: poisoning is the leading cause of death
• 5-24: MVC leading cause of death
• TBI: more for males, 0-4 highest rate of death
Injury prevention: 3 E's
• Engineering: technological interventions (airbags, alarms, safety gear)
• Enforcement and legislation: laws and regulations
• Education: community based initiatives, public service announcements
Kinematics
study of energy transfer as it applies to identifying actual or potential injuries
Major cause of death 1-44
Trauma: major cause of death for people ages 1-44 years
Biomechanics
study of forces and their effects on living tissue and the human body
Mechanism of injury (MOI)
how injuries occur as a result of energy from environment transferred to the body
Newton's 1st law of motion:
a body at rest will remain at rest, a body in motion will remain in motion
Newton's 2nd law of motion:
Force=Mass x Acceleration
Newton's 3rd law of motion:
for every action there is an equal and opposite reaction
Law of conservation of energy:
energy can neither be created nor destroyed, but it can change form
Types of injuries:
• Blunt trauma: broad energy impact across a large surface area: falls, MVC, assaults
• Penetrating trauma: energy that results in impalement: guns, stab wounds,
,• Thermal trauma: burns
• Blast trauma: rapid release of blast energy in chemical, physical, radioactive exposures
• Occlusive/obtrusive: drowning, handing, strangulation,
Motor vehicle impact sequence:
• 1st impact: car hit object
• 2nd: impact person hits inside of car
• 3rd: impact organs hit inside of body- organs can be ripped from ligaments (aorta) and hit internal
structures
Pedestrian vs Vehicle:
Waddell triad: lower initial hit (leg), chest injury when landing on car (thorax), upper body injury when
bounced off and landing on the ground (head and arms)
Triage:
sorting pt's based on their need for treatment and the resources available. Based on:
• MOI (head on collision, fall more than 20ft for adult)
• Physiologic criteria (vs)
• Anatomic critera (flail chest, fractured pelvis)
• Special considerations (age, special needs)
1. Prehospital report
MIST (MOI, injury, s/s, treatment)
2. Preparation and triage:
Safe practice, safe care
a. Activate trauma team
b. Right equipment, room ready
c. PPE
d. Consider any potential haz mat situation
3. Across the room observations
C-AB: As pt is brought in rapid assess of stability and id of uncontrolled bleeding
IF BLEEDING: CIRCULATION BEFORE AIRWAY! CONTROLL THE BLEED THEN MOVE TO AIRWAY
4. Primary survey: A-B-C-D-E-F-G (LMNOP)
life-threatening conditions or identified and immediately corrected
a. Alertness: AVPU W/ c-spine stabilization
AIRWAY ASSISTANCE W/ JAW THRUST W/C-SPINE CONTROL→ BVM if need assistance and/or difficult
airway
Look for: teeth/tongue/foreign bodies, blood/vomit/secretions, edema, burns (suction→ REASSESS)
Listen for: snoring, gurgling, stridor (OPA→REASSESS→ET→REASSESS)
Feel for: facial deformities, subcutaneous emphysema
, ROBI: Reopen, OPA, BVM, Intubation→ reassess
*If ETT in place assess placement:
1. Adequate chest rise and fall w/ BVM
2. No epigastric gurgling
3. Bilateral breath sounds heard
4 CO2 detector gold
Interventions:
1. Suction
2. Jaw thrust w/manual stabilization
3. Naso/oraopharyngeal airway
4. Definitive airway (ETT)→ REASSESS
b. Breathing and ventilation: Expose chest. Inadequate oxygenation causes hypoxemia causing acidosis
Look for: spontaneous breathing, symmetrical rise and fall, depth/pattern/rate of respirations, use of
accessory muscles, skin color, abrasions/bruising/deformities, sucking chest wounds, JVD and tracheal
deviation=s/s pneumothorax
Listen for breath sounds
Feel for fractures, subcutaneous emphysema
Interventions:
1. No breathing:
Jaw-Thrust
OPA
BMV
Prepare for definitive airway→ REASSESS
2. Breathing present:
Oxygen 15 L via NRB
*check capnography (35-45) & pulse ox above 94% If NOT= BVM give 10-12 breaths a min/ 1 q 6
seconds→? ETT? →REASSESS
c. Circulation and control of hemorrhage
Look for: Bleeding, skin color
Listen for: Muffled heart tones (tamponade)
Feel for: skin temp/moisture, Pulses (central)→ABSENT=CPR, RAPID/THREADY→ HYPOVOLEMIA
Interventions:
1.Control bleeding= direct pressure
2. Elevate bleeding extremity, ? tourniquet
3. Get 2- IV/IO, T&S
4. Warm IVF w/blood tubing 1-2L, give blood→ REASSESS
d. Disability/neurological status:
Look for: Pupils PEARRL, GCS 3-15 (less than 8=intubate)
1. Eye: spontaneous 4, to verbal 3, to pain 2, none 1
2. Verbal: orientated 5, confused but able to answer ? 4, inappropriate 3, incomprehensible 2, none 1
3. Motor: obeys commands 6, purposeful to pain stim 5, withdraws from pain 4, decorticate (flexion in
