TNCC 8th Edition
What are the greatest risks for transport? - (ANSWER)Loss of airway patency, displaced obstructive tubes
lines or catheters, dislodge splinting devices, need to replace or reinforce dressings, deterioration in
patient status change in vital signs or level of consciousness, injury to the patient and/or team members
According to newtons law which of these two force is greater: size or force? - (ANSWER)Neither. For each
force there is an equal and opposite reaction.
What is the relationship between mass and velocity to kinetic energy? - (ANSWER)Kinetic energy is equal
to 1/2 the mass multiplied the square of its velocity therefore when mass is doubled so is the net energy,
however, when velocity is doubled energy is quadrupled.
What is tension? - (ANSWER)stretching force by pulling at opposite ends
What is compression? - (ANSWER)Crushing by squeezing together
What is bending? - (ANSWER)Loading about an axis. Bending causes compression on the side the person
is bending toward intention to the opposite side
What is shearing? - (ANSWER)Damage by tearing or bending by exerting faucet different parts in
opposite directions at the same time.
What is torsion? - (ANSWER)Torsion forces twist ends in opposite directions.
What is combined loading? - (ANSWER)Any combination of tension compression torsion bending and/or
shear.
What are the four types of trauma related injuries? - (ANSWER)Blunt, penetrating, thermal, or blast.
,What are contributing factors to injuries related to blunt traumas? - (ANSWER)The point of impact on
the patient's body, the type of surface that is hit, the tissues ability to resist (bone versus soft tissue, air-
filled versus solid organs), and the trajectory of force.
What are the seven patterns of pathway injuries related to motor vehicle accidents? - (ANSWER)Up and
over, down and under, lateral, rotational, rear, roll over, and ejection.
Differentiate between the three impacts of motor vehicle impact sequence. - (ANSWER)The first impact
occurs when the vehicle collided with another object. The second impact occurs after the initial impact
when the occupant continues to move in the original direction of travel until they collide with the
interior of the vehicle or meet resistance. The third impact occurs when internal structures collide within
the body cavity.
What are the three factors that contribute to the damage caused by penetrating trauma's? -
(ANSWER)The point of impact, the velocity and speed of impact, and the proximity to the object.
What causes the primary effects of blast traumas? - (ANSWER)The direct blast effects. Types of injuries
include last long, tympanic membrane rupture and middle ear damage, abdominal hemorrhage and
perforation, global rupture, mild Trumatic brain injury.
What causes the secondary effects of blast traumas? - (ANSWER)Projectiles propelled by the explosion.
Injuries include penetrating or blunt injuries or I penetration.
What causes the tertiary effects of blast traumas? - (ANSWER)Results from individuals being thrown by
the blast wind. Injuries include hole or partial body translocation from being thrown against a hard
service: blunt or penetrating trauma's, fractures, traumatic amputations.
What causes quarternary effects of blast traumas? - (ANSWER)All explosion related injuries, illnesses, or
diseases not due to the first three mechanisms. Injuries include external and internal burns, crush
injuries, closed and open brain injuries, asthmatic or breathing problems from dust smoke or toxic
fumes, angina, or hyper glycemia and hypertension.
,What causes quinary effects of blasts traumas? - (ANSWER)Those associated with exposure to hazardous
materials from radioactive, biologic, or chemical components of a blast. Injuries include a variety of
health effects depending on agent.
What are the three processes that transfer oxygen from the air to the lungs and blood stream -
(ANSWER)Ventilation: the active mechanical movement of air into and out of the lungs; diffusion: the
passive movement of gases from an area of higher concentration to an area of lower concentration; and
perfusion: the movement of blood to and from the lungs as a delivery medium of oxygen to the entire
body.
When would you use a nasopharyngeal airway versus an oral pharyngeal airway? -
(ANSWER)Nasopharyngeal airways is contraindicated in patients with facial trauma or a suspected
basilar skull fracture. Oral pharyngeal airways is used in unresponsive patients unable to maintain their
airway, without a gag reflex as a temporary measure to facilitate ventilation with a bag mask device or
spontaneous ventilation until the patient can be intubated.
Describe the measurement of an NPA - (ANSWER)Measure from the tip of the patient's nose to the tip of
the patients earlobe.
Measurement of an OPA - (ANSWER)Place the proximal end or flange of the airway adjunct at the corner
of the mouth to the tip of the mandibular angle.
True or false: NPAs and OPAs are definitive airways. - (ANSWER)False. When placing one of these? One
should consider the potential need for a definitive airway.
Name the three ways to confirm ETT placement - (ANSWER)Placement of a CO2 monitoring device,
Assessing for equal chest rise and fall, and listening at the epigastrium and four lung fields for equal
breath sounds.
When capnography measurement reads greater than 45MMHG, the nurse should consider increasing or
decreasing the ventilation rate? - (ANSWER)Increasing the ventilation rate. Doing so would allow the
patient to blow off retained CO2.
, When capnography measurement reads less than 35MMHG, the nurse should consider increasing or
decreasing the ventilation rate? - (ANSWER)Decreasing the ventilation rate. By doing so, the nurse allows
the patient to retain CO2.
What are the three stages of shock - (ANSWER)Compensated, decompensated or progressive, and
irreversible.
What are the signs of compensated shock? - (ANSWER)Anxiety, confusion, restlessness, increased
respiratory rate, narrowing pulse pressure were diastolic increases yet systolic remains unchanged,
tachycardia with bounding pulses, and decreased urinary output
What are the signs and symptoms of decompensated shock? - (ANSWER)Decreased level of
consciousness, hypertension, narrow pulse pressure, tachycardia with weak pulses, tachypnea, skin that
is cool clammy and cyanotic, base access outside the normal range, and serum lactate levels greater than
two to 4MMOL/L.
What are the signs and symptoms of irreversible shock? - (ANSWER)Obtunded stuporous or comatose
state, marked hypertension and heart failure, bradycardia with possible dysrhythmias, decreased and
shallow respiratory rate, pale cool and clammy skin, kidney liver and other organ failure, severe acidosis,
elevated lactic acid levels, worsening base access on ABGs, coagulopathies with petechiae purpura or
bleeding.
What are the four types of shock? - (ANSWER)Hypovolemic, Cardiogenic, Obstructive, & Distributive
What is the trauma triad of death? - (ANSWER)hypothermia, acidosis, coagulopathy
Describe the characteristics of obstructive shock - (ANSWER)Obstructive shock is it mechanical problem
that results from hypoperfusion of the tissue due to an obstruction in either the vasculature or the heart
resulting in decreased cardiac output. Some causes include a tension pneumothorax, cardiac
tamponade, or venous air embolism on the right side of the heart during systole in the pulmonary
artery.Signs include anxiety, muffled heart sounds, JVD, hypertension, chest pain, difficulty breathing, or
pulses paradoxes.
Describe the characteristics of cardiogenic shock - (ANSWER)Cardiogenic shock results from pump failure
in the presence of adequate intravascular volume. Lack of cardiac output and an organ perfusion occurs
What are the greatest risks for transport? - (ANSWER)Loss of airway patency, displaced obstructive tubes
lines or catheters, dislodge splinting devices, need to replace or reinforce dressings, deterioration in
patient status change in vital signs or level of consciousness, injury to the patient and/or team members
According to newtons law which of these two force is greater: size or force? - (ANSWER)Neither. For each
force there is an equal and opposite reaction.
What is the relationship between mass and velocity to kinetic energy? - (ANSWER)Kinetic energy is equal
to 1/2 the mass multiplied the square of its velocity therefore when mass is doubled so is the net energy,
however, when velocity is doubled energy is quadrupled.
What is tension? - (ANSWER)stretching force by pulling at opposite ends
What is compression? - (ANSWER)Crushing by squeezing together
What is bending? - (ANSWER)Loading about an axis. Bending causes compression on the side the person
is bending toward intention to the opposite side
What is shearing? - (ANSWER)Damage by tearing or bending by exerting faucet different parts in
opposite directions at the same time.
What is torsion? - (ANSWER)Torsion forces twist ends in opposite directions.
What is combined loading? - (ANSWER)Any combination of tension compression torsion bending and/or
shear.
What are the four types of trauma related injuries? - (ANSWER)Blunt, penetrating, thermal, or blast.
,What are contributing factors to injuries related to blunt traumas? - (ANSWER)The point of impact on
the patient's body, the type of surface that is hit, the tissues ability to resist (bone versus soft tissue, air-
filled versus solid organs), and the trajectory of force.
What are the seven patterns of pathway injuries related to motor vehicle accidents? - (ANSWER)Up and
over, down and under, lateral, rotational, rear, roll over, and ejection.
Differentiate between the three impacts of motor vehicle impact sequence. - (ANSWER)The first impact
occurs when the vehicle collided with another object. The second impact occurs after the initial impact
when the occupant continues to move in the original direction of travel until they collide with the
interior of the vehicle or meet resistance. The third impact occurs when internal structures collide within
the body cavity.
What are the three factors that contribute to the damage caused by penetrating trauma's? -
(ANSWER)The point of impact, the velocity and speed of impact, and the proximity to the object.
What causes the primary effects of blast traumas? - (ANSWER)The direct blast effects. Types of injuries
include last long, tympanic membrane rupture and middle ear damage, abdominal hemorrhage and
perforation, global rupture, mild Trumatic brain injury.
What causes the secondary effects of blast traumas? - (ANSWER)Projectiles propelled by the explosion.
Injuries include penetrating or blunt injuries or I penetration.
What causes the tertiary effects of blast traumas? - (ANSWER)Results from individuals being thrown by
the blast wind. Injuries include hole or partial body translocation from being thrown against a hard
service: blunt or penetrating trauma's, fractures, traumatic amputations.
What causes quarternary effects of blast traumas? - (ANSWER)All explosion related injuries, illnesses, or
diseases not due to the first three mechanisms. Injuries include external and internal burns, crush
injuries, closed and open brain injuries, asthmatic or breathing problems from dust smoke or toxic
fumes, angina, or hyper glycemia and hypertension.
,What causes quinary effects of blasts traumas? - (ANSWER)Those associated with exposure to hazardous
materials from radioactive, biologic, or chemical components of a blast. Injuries include a variety of
health effects depending on agent.
What are the three processes that transfer oxygen from the air to the lungs and blood stream -
(ANSWER)Ventilation: the active mechanical movement of air into and out of the lungs; diffusion: the
passive movement of gases from an area of higher concentration to an area of lower concentration; and
perfusion: the movement of blood to and from the lungs as a delivery medium of oxygen to the entire
body.
When would you use a nasopharyngeal airway versus an oral pharyngeal airway? -
(ANSWER)Nasopharyngeal airways is contraindicated in patients with facial trauma or a suspected
basilar skull fracture. Oral pharyngeal airways is used in unresponsive patients unable to maintain their
airway, without a gag reflex as a temporary measure to facilitate ventilation with a bag mask device or
spontaneous ventilation until the patient can be intubated.
Describe the measurement of an NPA - (ANSWER)Measure from the tip of the patient's nose to the tip of
the patients earlobe.
Measurement of an OPA - (ANSWER)Place the proximal end or flange of the airway adjunct at the corner
of the mouth to the tip of the mandibular angle.
True or false: NPAs and OPAs are definitive airways. - (ANSWER)False. When placing one of these? One
should consider the potential need for a definitive airway.
Name the three ways to confirm ETT placement - (ANSWER)Placement of a CO2 monitoring device,
Assessing for equal chest rise and fall, and listening at the epigastrium and four lung fields for equal
breath sounds.
When capnography measurement reads greater than 45MMHG, the nurse should consider increasing or
decreasing the ventilation rate? - (ANSWER)Increasing the ventilation rate. Doing so would allow the
patient to blow off retained CO2.
, When capnography measurement reads less than 35MMHG, the nurse should consider increasing or
decreasing the ventilation rate? - (ANSWER)Decreasing the ventilation rate. By doing so, the nurse allows
the patient to retain CO2.
What are the three stages of shock - (ANSWER)Compensated, decompensated or progressive, and
irreversible.
What are the signs of compensated shock? - (ANSWER)Anxiety, confusion, restlessness, increased
respiratory rate, narrowing pulse pressure were diastolic increases yet systolic remains unchanged,
tachycardia with bounding pulses, and decreased urinary output
What are the signs and symptoms of decompensated shock? - (ANSWER)Decreased level of
consciousness, hypertension, narrow pulse pressure, tachycardia with weak pulses, tachypnea, skin that
is cool clammy and cyanotic, base access outside the normal range, and serum lactate levels greater than
two to 4MMOL/L.
What are the signs and symptoms of irreversible shock? - (ANSWER)Obtunded stuporous or comatose
state, marked hypertension and heart failure, bradycardia with possible dysrhythmias, decreased and
shallow respiratory rate, pale cool and clammy skin, kidney liver and other organ failure, severe acidosis,
elevated lactic acid levels, worsening base access on ABGs, coagulopathies with petechiae purpura or
bleeding.
What are the four types of shock? - (ANSWER)Hypovolemic, Cardiogenic, Obstructive, & Distributive
What is the trauma triad of death? - (ANSWER)hypothermia, acidosis, coagulopathy
Describe the characteristics of obstructive shock - (ANSWER)Obstructive shock is it mechanical problem
that results from hypoperfusion of the tissue due to an obstruction in either the vasculature or the heart
resulting in decreased cardiac output. Some causes include a tension pneumothorax, cardiac
tamponade, or venous air embolism on the right side of the heart during systole in the pulmonary
artery.Signs include anxiety, muffled heart sounds, JVD, hypertension, chest pain, difficulty breathing, or
pulses paradoxes.
Describe the characteristics of cardiogenic shock - (ANSWER)Cardiogenic shock results from pump failure
in the presence of adequate intravascular volume. Lack of cardiac output and an organ perfusion occurs
