Tncc

Front 1

AIRWAY with C-Spine

Back 1

1) Vocalization
2) Tongue obstructing airway
3) Loose teeth/foreign objects
4) Blood, vomit or other secretions
5) Edema

Front 2

AIRWAY INTERVENTIONS

Back 2

1) Position the patient
2) Jaw thrust or chin lift
3) Remove any foreign objects
4) Suction blood, vomit or secretions
5) Insert OPA or NPA
6) ET intubation
7) Needle or surgical cricothyrotomy

Front 3

BREATHING

Back 3

1) Spontaneous breathing
2) Equal rise and fall of chest
3) Rate and pattern of breathing
4) Use of accessory muscles and/or diaphragmatic breathing
5) Skin color
6) Integrity of the soft tissue and bony structures of the chest wall
7) Bilateral breath sounds
8) JVD and tracheal deviation-late signs of breathing compromise

Front 4

BREATHING INTERVENTIONS

Back 4

1) Supplemental oxygen
2) Bag mask ventilation
3) Needle thoracentesis/decompression
4) Chest tube
5) Nonporous dressing taped on three sides

Front 5

INNEFECTIVE BREATHING SIGNS

Back 5

1) Altered mental status
2) Cyanosis, especially around mouth
3) Assymetric expansion f the chest wall, paradoxical movement of chest wall
4) Use of accessory or abdominal muscles or diaphragmatic breathing
5) Sucking chest wounds
6) Absent or diminished breath sounds-administer O2 via nonrebreather and assist ventilations
7) Anticipate definitive airway-ET tube

Front 6

IF BREATHING ABSENT

Back 6

1) Ventilate patient
2) Definitive airway
3) Assess for life threatening injuries that may compromise breathing

Front 7

INJURIES THAT MAY COMPROMISE BREATHING

Back 7

1) Tension pneumo-Tx with needle thoracentesis
2) Open pneumo-Tx by covering open chest wound
3) Flail chest with pulmonary contusion
4) Hemothorax-Tx with chest tube

Front 8

CIRCULATION

Back 8

1) PALPATE A CENTRAL PULSE for rate and quality
2) Inspect the skin for color, temperature, and moisture
3) Check capillary refill
4) Look for uncontrolled bleeding

Front 9

CIRCULATION INTERVENTIONS

Back 9

1) Direct pressure over uncontrolled bleeding sites
2) 2 large bore IV's with warmed isotonic crystalloid solution
3) Infuse fluid rapidly with blood tubing
4) Blood sample for typing
5) Blood administration
6) Pericardiocentesis
7) Emergency Thoracotomy
8) Surgery
9) CPR and ACLS

Front 10

INNEFFECTIVE CIRCULATION SIGNS

Back 10

1) Tachycardia
2) Altered mental status (agitated, confused, decreased arousability)
3) Uncontrolled external bleeding
4) Distended or abnormally flattened external jugular veins
5) Distant heart sounds

Front 11

DISABILITY

Back 11

1) Neuro checks
2) AVPU
3) GCS-Eye, verbal, and motor response. <9/15 is severe
4) Access pupils
5) Laterilization

Front 12

DISABILITY INTERVENTIONS

Back 12

1) Perform further investigation
2) Hyperventilate, if indicated- only if exhibiting signs of herniation or neurologic deteriation that are nonresponsive to other measures and mannitol.

Front 13

EXPOSE PATIENT/ENVIRONMENTAL CONTROL

Back 13

1) Remove clothing carefully to avoid provider injury and to avoid destroying evidence
2) Ensure appropriate decontamination (if applicable)
3) Keep patient warm-blankets, warming lights, increase ambient temperature
4) Save clothing as evidence
5) Consider the need for a transfer

Front 14

FAMILY PRESENCE, FULL SET OF VITALS, FOCUSED ADJUNCTS

Back 14

PLUGM
1) Pulse oximetry
2) Labs
3) Urinary Catheter
4) Gastric Tube
5) Monitor cardiac rate and rhythm

Front 15

GIVE COMFORT

Back 15

Pain management: pain medicine, therapeutic touch, positioning, apply heat or cold, distraction, humor, relaxation exercises, verbal reassurance

Front 16

HEAD TO TOE, HISTORY

Back 16

History: MIVT=mechanism of injury, injuries sustained, vitals, treatment recieved, PMH, patient generated info

Head to toe

Front 17

INSPECT POSTERIOR SURFACES

Back 17

Logroll and protect cervical spine when inspecting back. Support extremities with injuries. Palpate the vertebral column and all posterior surfaces. Assess rectum for blood.

Front 18

HEAD TO TOE- GENERAL APPEARANCE

Back 18

1) Body position, posture, guarding, and position of limbs.
2) Unusual odors such as gas, alcohol, chemicals, vomit, urine, feces.

Front 19

HEAD TO TOE- HEAD AND FACE

Back 19

1) Soft tissue injuries-wounds, crackling associated with subQ emphysema, palpate for tenderness
2) Bony deformities
3) Asymmetry of facial expressions
4) Eyes- ask how many fingers, raccoon eyes, edema
5) PERRLA
6) 6 cardinal fields of gaze
7) Ears- Battle's sign (ecchymosis behind ear-late sign of head injury), drainage (don't pack)
8) Nose- drainage (don't pack), position of nasal septum

Front 20

HEAD TO TOE- NECK

Back 20

1) Remove anterior portion of the rigid cervical collar to inspect and palpate the neck
2) Another team member must hold the head while collar is being removed and replaced
3) Inspect for wounds, ecchymosis, deformities, and distended neck veins, position of trachea
4) Palpate for tenderness, note bony crepitus, deformity, subQ emphysema and tracheal position

Front 21

HEAD TO TOE- CHEST

Back 21

1) Inspection-rate, depth, wounds, deformities, ecchymosis, use of accessory muscles, paradoxical movement
2) Auscultation- heart AND lung sounds
3) Palpate for tenderness, note bony crepitus, subQ emphysema and deformity

Front 22

HEAD TO TOE- ABD AND FLANKS

Back 22

1) Inspect-wounds, distention, ecchymosis and scars
2) Auscultate for bowel sounds
3) Palpate all four quads for tenderness, rigidity, guarding, masses, and femoral pulses

Front 23

HEAD TO TOE- PELVIS/PERINEUM

Back 23

1) Inspect for wound, deformities, ecchymosis, priapism, blood and urinary meatus or perineal area
2) Palpate the pelvis and anal sphincter tone
3) Assess pain, urge and abiltiy to void

Front 24

HEAD TO TOE- EXTREMITIES

Back 24

1) Inspect for ecchymosis, movement motor function-ROM scale 0-5, 5 is Full ROM, wounds, deformities and splints
2) Palpate for pulses, skin temp, sensation, tenderness, deformities and note bony crepitus

Front 25

HEAD TO TOE- POSTERIOR SURFACES

Back 25

1) Maintain C-spine protection and support injured extremities while the patient is logrolled
2) Inspect the posterior surfaces for wounds, deformities and ecchymosis
3) Palpate the posterior surfaces for tenderness and deformities
4) Palpate anal sphincter tone if not previously done

Front 26

SECONDARY FOCUSED ADJUNCTS

Back 26

1) Labs
2) X-rays
3) Angiography
4) PASG-pneumatic antishock garment

Front 27

GENERAL DIAGNOSTIC STUDIES

Back 27

1) Type, screen, crossmatch
2) H&H
3) BAC
4) Serum Lactate-to identify sepsis
5) Serum pregnancy
6) Kleihauer-Betke-detects transplacental hemorrhage
7) ABG's

Front 28

GENERAL INTERVENTIONS

Back 28

1) Operative intervention
2) Admission or transfer
3) GCS and Revised Trauma Score
4) Psychosocial support of family
5) Pain control-medication and nonpharmalogical
6) Other meds: Tetanus, Abx, neuromuscular blockers, sedation

Front 29

HEAD AND FACE DIAGNOSTIC STUDIES

Back 29

1) X-rays
2) CT scan
3) MRI
4) Angiography

Front 30

HEAD AND FACE INTERVENTIONS

Back 30

1) Position patient
2) Medications, as prescribed
3) Intracranial pressure monitoring
4) Suctioning

Front 31

NECK DIAGNOSTIC STUDIES

Back 31

1) X-rays
2) CT scan
3) MRI
4) Angiography

Front 32

NECK INTERVENTIONS

Back 32

1) Spinal protection with vertebral column immobilization
2) Steroids, per institutional protocols

Front 33

CHEST DIAGNOSTIC STUDIES

Back 33

1) X-rays
2) CT scan
3) MRI
4) Arteriography or aortography
5) FAST- Focused assessment sonography for trauma
6) Bronchoscopy
7) Esophagoscopy
8) EKG
9) Hemodynamic monitoring

Front 34

CHEST INTERVENTIONS

Back 34

1) Chest tube
2) Autotransfusion
3) Needle thoracentesis/decompressoin
4) Pericardiocentesis
6) Prepare for thoracotomy

Front 35

ABDOMEN AND FLANK DIAGNOSTIC STUDIES

Back 35

1) X-rays
2) CT scan
3) MRI
4) FAST
5) IVP- Intravenous pyelogram
6) DPL- Diagnostic peritoneal lavage
7) Cystogram or urethrogram
8) Angiography

Front 36

ABDOMEN AND FLANK INTERVENTIONS

Back 36

1) Urinary catheter
2) Gastric tube
3) Consider pelvic antishock garment for intraabdominal or pelvic bleeding

Front 37

PELVIS AND PERINEUM DIAGNOSTIC STUDIES

Back 37

1) X-rays
2) CT scan
3) MRI
4) FAST

Front 38

PELVIS AND PERINEUM INTERVENTIONS

Back 38

1) Urinary catheter
2) Pneumatic antishock garment for splinting
3) External pelvic stabilization device

Front 39

EXTREMITIES DIAGNOSTIC STUDIES

Back 39

1) X-rays
2) CT scan
3) MRI
4) Measurement of compartment pressures

Front 40

EXTREMITIES INTERVENTIONS

Back 40

1) Immobilization/ traction devices
2) Elevation
3) Ice

Front 41

POSTERIOR SURFACE DIAGNOSTIC STUDIES

Back 41

1) X-rays
2) CT scan
3) MRI

Front 42

POSTERIOR SURFACE INTERVENTIONS

Back 42

1) Spinal protection with vertebral column immobilization

Front 43

SURFACE TRAUMA INTERVENTIONS

Back 43

1) Irrigation
2) Wound care
3) Ice
4) Care for amputated parts
5) Tetanus prophylaxis
6) Antibiotics

Front 44

PRIMARY ASSESSMENT

Back 44

A, B, C, D, E

Front 45

SECONDARY ASSESSMENT

Back 45

F, G, H, I