TNCC 9th Edition – Questions and Answers Graded A+ 100% (SOLVED 2023/2024)
VERBAL
1. Makes no sounds
2. Makes sounds
3. Words
4. Confused, disoriented
5. Oriented, converses normally
MOTOR
1. Makes no movements
2. Extension to painful stimuli (decerebrate)
3. Abnormal flexion to painful stimuli (decorticate)
4. Withdrawal to painful stimuli
5. Localizes painful stimuli
6. Obeys commands
H (Secondary Survey) - ansHistory
Prehospital Report (MIST)
M: MOI
I: Injuries sustained
S: Signs and symptoms in the field
,TNCC 9th Edition – Questions and Answers Graded A+ 100% (SOLVED 2023/2024)
T: Treatment in field
Patient History (SAMPLE):
S: Symptoms
A: Allergies and tetanus status M:
Medications
P: Past medical history L:
Last oral intake
E: Events and Environmental factors related to injury.
H: Head and Face
Head to Toe Assessment (secondary survey) - ansSOFT TISSUE:
Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled
objects.
Palpate: areas of tenderness, step-offs, crepitus
BONY DEFORMITIES:
Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter
Palpate: depressions, angulations, tenderness
Hepatic Injuries - ansIn blunt trauma the liver may lacerate from increased abdominal
pressure.
Hematoma - bleeding contained within the capsule
Laceration - the capsule is disrupted
Findings: Cullen sign (ecchymosis around the umbilicus or RUQ), tenderness, guarding or
rigidity RUQ, 9-12 rib FXs, elevated LFT
Graded I-VI, I = minor trauma
Nonoperative management is standard of care in hemodynamically stable patient. Observed
with serial abdominal exams.
Findings of contrast extravasation may be embolized by IR.
For surgical patients - fluid resuscitation is essential. Risks of surgery include disruption of the
natural tamponade process due to the evacuation of large amounts of blood resulting in
hypovolemia.
,TNCC 9th Edition – Questions and Answers Graded A+ 100% (SOLVED 2023/2024)
Hypovolemic Shock - ansCaused by a decrease in the amount of circulating blood volume.
In trauma typically results from hemorrhage, but can result in a precipitous loss of volume, ie
vomiting or diarrhea.
Burn trauma can result in hypovolemic shock from damage to the cell membranes leading to
plasma and protein leakage. of body water, results in inadequate perfusion.
Hyperventilation can cause increased intrathoracic pressure resulting in compression of the
heart and decreased cardiac output.
Initial Assessment - ans1. Preparation and Triage
2. Primary Survey
3. Reevaluation
4. Secondary Survey
5. Reevaluation Adjuncts
6. Reevaluation and Post Resuscitation Care
7. Definitive Care or Transport
Intraocular Foreign Body - ans*TRUE EMERGENCY AND EARLY INTERVENTION IS ESSENTIAL.
Findings: compromised visual acuity, misshapen pupils, pain
Treatment: elevate HOB, ophthalmology, immobilize foreign body, patch UNAFFECTED eye to
limit concomitant eye movement, globe closure ASAP, systemic and ophthalmic ABX,
analgesics.
Postop infection, retinal detachment and vision loss are common complications.
lid injury - ans
Liver - ansLargest solid organ of the body. RUQ, 6th to 10th ribs. Encased by Glisson capsule
with blood vessels, lymphatics and nerves. Filters 1.7L of blood per minute.
The liver filters out toxins, takes the nutrients and returns the blood to the heart via the
hepatic veins.
Hepatocyte cells are capable of regeneration allowing the liver to repair its own tissue.
Functions: Store and metabolize lipids, transport nutrients, produce glucose and bilirubin,
convert ammonia to urea, secrete electrolytes, lipids, lecithin, cholesterol and bile.
Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary for clotting).
, TNCC 9th Edition – Questions and Answers Graded A+ 100% (SOLVED 2023/2024)
Obstructive Shock - ansResults from hypo perfusion of the tissue due to an obstruction in
either the vasculature or heart.
Tension pneumothorax - increased thoracic pressure leads to displacement of the vena cava,
obstruction to atrial filling, decreased preload and decreased cardiac output.
Cardiac tamponade - impedes diastolic expansion and filling leads to decreased preload,
strokes volume and cardiac output and ultimately end organ perfusion.
P (AVPU) - ansPainful. Responds only to painful stimuli.
(Airway adjunct may be needed while determining need for intubation)
Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identify potentially life-
threatening injuries such as pneumothorax or pelvic fracture with uncontrolled internal
hemorrhage. Can also confirm placement of ET tubes, chest tubes and gastric tubes.
Consider need for transfer.
shock - ansInadequate tissue perfusion.
Spleen - ansEncapsulated organ LUQ level of 9th-11th ribs and curves around a portion of the
stomach. Minimal elasticity and flexibility - most frequent injured organ in blunt trauma.
Secondary lymph organ that filters and cleanses the blood. Removes old RBCs and holds a
reserve of blood. It recycles iron. It removes antibody-coated bacteria. Supplies lymphocytes
to stimulate an immune response to blood borne microorganisms. Stores 200-300ml of blood
and leads to hemodynamic instability quickly if damaged.
Splenic Injuries - ansIn blunt trauma the spleen may lacerate from increased abdominal
pressure.
Graded I-V, I = minor trauma
Assessment findings: signs of trauma LUQ, abdominal distention, asymmetry, abnormal
contour, tenderness, guarding, rigidity, pain left shoulder when supine.
CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption, intraparenchymal
hematoma or subcapsular hematoma. Contrast blush or extravasation
- hyperdense area that represent traumatic disruption. Active extravasation implies ongoing
bleeding.
VERBAL
1. Makes no sounds
2. Makes sounds
3. Words
4. Confused, disoriented
5. Oriented, converses normally
MOTOR
1. Makes no movements
2. Extension to painful stimuli (decerebrate)
3. Abnormal flexion to painful stimuli (decorticate)
4. Withdrawal to painful stimuli
5. Localizes painful stimuli
6. Obeys commands
H (Secondary Survey) - ansHistory
Prehospital Report (MIST)
M: MOI
I: Injuries sustained
S: Signs and symptoms in the field
,TNCC 9th Edition – Questions and Answers Graded A+ 100% (SOLVED 2023/2024)
T: Treatment in field
Patient History (SAMPLE):
S: Symptoms
A: Allergies and tetanus status M:
Medications
P: Past medical history L:
Last oral intake
E: Events and Environmental factors related to injury.
H: Head and Face
Head to Toe Assessment (secondary survey) - ansSOFT TISSUE:
Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled
objects.
Palpate: areas of tenderness, step-offs, crepitus
BONY DEFORMITIES:
Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter
Palpate: depressions, angulations, tenderness
Hepatic Injuries - ansIn blunt trauma the liver may lacerate from increased abdominal
pressure.
Hematoma - bleeding contained within the capsule
Laceration - the capsule is disrupted
Findings: Cullen sign (ecchymosis around the umbilicus or RUQ), tenderness, guarding or
rigidity RUQ, 9-12 rib FXs, elevated LFT
Graded I-VI, I = minor trauma
Nonoperative management is standard of care in hemodynamically stable patient. Observed
with serial abdominal exams.
Findings of contrast extravasation may be embolized by IR.
For surgical patients - fluid resuscitation is essential. Risks of surgery include disruption of the
natural tamponade process due to the evacuation of large amounts of blood resulting in
hypovolemia.
,TNCC 9th Edition – Questions and Answers Graded A+ 100% (SOLVED 2023/2024)
Hypovolemic Shock - ansCaused by a decrease in the amount of circulating blood volume.
In trauma typically results from hemorrhage, but can result in a precipitous loss of volume, ie
vomiting or diarrhea.
Burn trauma can result in hypovolemic shock from damage to the cell membranes leading to
plasma and protein leakage. of body water, results in inadequate perfusion.
Hyperventilation can cause increased intrathoracic pressure resulting in compression of the
heart and decreased cardiac output.
Initial Assessment - ans1. Preparation and Triage
2. Primary Survey
3. Reevaluation
4. Secondary Survey
5. Reevaluation Adjuncts
6. Reevaluation and Post Resuscitation Care
7. Definitive Care or Transport
Intraocular Foreign Body - ans*TRUE EMERGENCY AND EARLY INTERVENTION IS ESSENTIAL.
Findings: compromised visual acuity, misshapen pupils, pain
Treatment: elevate HOB, ophthalmology, immobilize foreign body, patch UNAFFECTED eye to
limit concomitant eye movement, globe closure ASAP, systemic and ophthalmic ABX,
analgesics.
Postop infection, retinal detachment and vision loss are common complications.
lid injury - ans
Liver - ansLargest solid organ of the body. RUQ, 6th to 10th ribs. Encased by Glisson capsule
with blood vessels, lymphatics and nerves. Filters 1.7L of blood per minute.
The liver filters out toxins, takes the nutrients and returns the blood to the heart via the
hepatic veins.
Hepatocyte cells are capable of regeneration allowing the liver to repair its own tissue.
Functions: Store and metabolize lipids, transport nutrients, produce glucose and bilirubin,
convert ammonia to urea, secrete electrolytes, lipids, lecithin, cholesterol and bile.
Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary for clotting).
, TNCC 9th Edition – Questions and Answers Graded A+ 100% (SOLVED 2023/2024)
Obstructive Shock - ansResults from hypo perfusion of the tissue due to an obstruction in
either the vasculature or heart.
Tension pneumothorax - increased thoracic pressure leads to displacement of the vena cava,
obstruction to atrial filling, decreased preload and decreased cardiac output.
Cardiac tamponade - impedes diastolic expansion and filling leads to decreased preload,
strokes volume and cardiac output and ultimately end organ perfusion.
P (AVPU) - ansPainful. Responds only to painful stimuli.
(Airway adjunct may be needed while determining need for intubation)
Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identify potentially life-
threatening injuries such as pneumothorax or pelvic fracture with uncontrolled internal
hemorrhage. Can also confirm placement of ET tubes, chest tubes and gastric tubes.
Consider need for transfer.
shock - ansInadequate tissue perfusion.
Spleen - ansEncapsulated organ LUQ level of 9th-11th ribs and curves around a portion of the
stomach. Minimal elasticity and flexibility - most frequent injured organ in blunt trauma.
Secondary lymph organ that filters and cleanses the blood. Removes old RBCs and holds a
reserve of blood. It recycles iron. It removes antibody-coated bacteria. Supplies lymphocytes
to stimulate an immune response to blood borne microorganisms. Stores 200-300ml of blood
and leads to hemodynamic instability quickly if damaged.
Splenic Injuries - ansIn blunt trauma the spleen may lacerate from increased abdominal
pressure.
Graded I-V, I = minor trauma
Assessment findings: signs of trauma LUQ, abdominal distention, asymmetry, abnormal
contour, tenderness, guarding, rigidity, pain left shoulder when supine.
CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption, intraparenchymal
hematoma or subcapsular hematoma. Contrast blush or extravasation
- hyperdense area that represent traumatic disruption. Active extravasation implies ongoing
bleeding.
