Mixed Deck — All TNCC Topics Flashcards

Is there a safe pharmaceutical substitute for opioids in the treatment of rib fracture pain in patients who are anticoagulated?

Answer: blocks of intercostal nerves For patients who are anticoagulated, continuous intercostal nerve blocks can offer safe and efficient pain management since they employ long-acting anesthetics.

For anticoagulated patients with rib fractures, intercostal nerve blocks offer a safe and effective pain management alternative to systemic opioids. These blocks provide targeted pain relief by directly anesthetizing the affected nerves with long-acting anesthetics, minimizing systemic side effects and reducing the risk of bleeding complications associated with other invasive procedures.

During the primary survey of a trauma patient, which assessment is completed first after an initial 'across-the-room' observation identifies no uncontrolled external hemorrhage?

Answer: Airway and alertness with cervical spine stabilization

The TNCC systematic approach to the primary survey follows the ABCDE mnemonic. If the 'across-the-room' observation reveals no catastrophic external hemorrhage (), the next step is to assess Airway and Alertness while maintaining cervical spine stabilization. [3, 10, 14]

Electrical burns are often more severe than they appear externally because:

Answer: Current travels through the body causing extensive internal tissue destruction along its path

Electrical burns cause extensive internal tissue destruction along the current path through the body, while external entry and exit wounds may appear deceptively small.

What is the preferred route for opioid analgesic administration during the acute phase of major burn injury?

Answer: Intravenous administration

IV administration is essential in burn patients because impaired peripheral circulation makes subcutaneous and intramuscular routes unreliable for medication absorption.

A 34-year-old male arrives after a motorcycle crash with a deformed left femur, a heart rate of 130 beats/min, blood pressure of 88/52 mmHg, and cool, clammy skin. After initiating two large-bore IVs, which fluid is most appropriate for initial resuscitation of this patient in suspected hemorrhagic shock?

Answer: Lactated Ringer's solution

Lactated Ringer's is an isotonic crystalloid solution that is the preferred initial fluid for resuscitation in hemorrhagic shock according to TNCC guidelines. It most closely resembles the body's plasma composition and helps to buffer the metabolic acidosis often seen in shock states. While 0.9% NaCl is also an isotonic crystalloid, large volumes can lead to hyperchloremic metabolic acidosis. D5W is hypotonic and not suitable for volume resuscitation. Colloids like Hetastarch are generally not recommended for initial resuscitation due to potential adverse effects on coagulation and renal function.

A patient with a tracheostomy from a previous surgery presents with trauma and respiratory distress. The first step in airway management is:

Answer: Suction the tracheostomy tube and assess patency

Suctioning and assessing patency of the existing tracheostomy tube is the first step, as obstruction by blood, secretions, or a mucus plug is the most common cause of respiratory distress in tracheostomy patients.

You are the triage nurse in the emergency department during a mass casualty incident (MCI). A victim is able to walk to the designated 'green' area. According to the Simple Triage and Rapid Treatment (START) method, what is the next immediate action for this patient?

Answer: Assign them to the 'minor' (green) category and have them await further instruction.

In the START triage system, any victim who is able to walk is categorized as 'minor' or 'green'. These individuals are considered the 'walking wounded' and are the lowest priority for immediate individual assessment, allowing responders to focus on more critically injured patients. [17, 18]

During a mass casualty incident, the trauma nurse's FIRST priority upon arriving at the scene is:

Answer: Establishing a triage area and beginning triage

The first priority in an MCI is to establish a triage area and begin rapidly triaging patients to categorize the scope of injuries and direct limited resources appropriately.

Which splinting principle is MOST important when immobilizing a fractured extremity?

Answer: Splint the joint above and below the fracture site

Proper splinting requires immobilizing the joint above and the joint below the fracture site to prevent movement at the fracture and reduce pain, bleeding, and further injury.

A key difference between the adult START triage system and the pediatric JumpSTART system is the management of an apneic patient. What intervention is performed in the JumpSTART algorithm for an apneic child that is NOT performed for an adult?

Answer: Assessing for a peripheral pulse and, if present, delivering five rescue breaths.

The JumpSTART algorithm accounts for the fact that children are more likely to experience respiratory arrest before cardiac arrest. If an apneic child has a palpable pulse after the airway is opened, the rescuer should deliver five rescue breaths. If breathing resumes, the child is tagged RED (Immediate). This intervention is unique to the pediatric algorithm.

A patient with blunt chest trauma from a steering wheel impact is noted to have a segment of their right chest wall that retracts inward during inspiration and bulges outward during expiration. This physical finding is the most definitive sign of which injury?

Answer: Flail chest

Flail chest is defined by fractures of three or more adjacent ribs in two or more places, creating a free-floating segment. This segment moves independently and opposite to the rest of the chest wall during respiration, a sign known as paradoxical motion, which is the hallmark clinical finding of the injury. [11, 12, 17, 18]

The secondary survey in trauma assessment is best described as:

Answer: A head-to-toe physical examination performed after life threats are addressed

The secondary survey is a systematic head-to-toe physical examination performed after the primary survey is complete and all immediately life-threatening conditions have been identified and treated.

A trauma patient in hemorrhagic shock has received 4 units of PRBCs and remains hypotensive with a heart rate of 140. The next priority in the massive transfusion protocol is:

Answer: Continue balanced transfusion with plasma and platelets in a 1:1:1 ratio with PRBCs

Current evidence supports a balanced 1:1:1 ratio of PRBCs to plasma to platelets during massive transfusion to address both oxygen-carrying capacity and coagulopathy simultaneously.

Which of the following is the PRIMARY patient- and family-centered rationale for facilitating Family Presence During Resuscitation (FPDR) when deemed appropriate?

Answer: To help family members understand the severity of the situation and begin the coping and grieving process.

The primary rationale for FPDR is to support the psychosocial needs of the family. Being present helps them comprehend the gravity of the injuries, see that everything possible is being done, and facilitates grieving and closure, which are critical aspects of family-centered care. While other options might be secondary outcomes, they are not the main therapeutic goal.

During the resuscitation of a patient with hemorrhagic shock, a balanced approach using a 1:1:1 ratio of blood products is often initiated. This ratio refers to the administration of:

Answer: 1 unit of packed red blood cells, 1 unit of fresh frozen plasma, and 1 unit of platelets.

Balanced resuscitation, often guided by a massive transfusion protocol (MTP), advocates for a 1:1:1 ratio of packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets. This approach aims to mimic whole blood to more effectively treat the coagulopathy associated with massive hemorrhage by replacing not just oxygen-carrying capacity (RBCs) but also clotting factors (FFP) and platelets.

Which clinical finding is most specific for esophageal perforation following penetrating neck or chest trauma?

Answer: Mediastinal air on chest X-ray (pneumomediastinum)

Pneumomediastinum (air in the mediastinum) visible on chest X-ray is the most specific radiographic finding for esophageal perforation, as swallowed air and gas-producing bacteria escape into the mediastinal space.

A 78-year-old female presents after a fall, complaining of right-sided chest pain. An x-ray reveals fractures of the 7th and 8th ribs. Her oxygen saturation is 95% on room air, and her respiratory rate is 22 breaths/min with shallow breaths. What is the primary focus of management for this geriatric patient?

Answer: Adequate pain management to promote effective ventilation.

In geriatric patients, rib fractures carry a high risk of mortality and morbidity, primarily due to respiratory complications like pneumonia and atelectasis. These complications arise from shallow breathing (splinting) due to pain. Therefore, aggressive and effective pain control is the cornerstone of management to allow for deep breathing, coughing, and adequate lung expansion, thereby preventing these complications.

In the management of hemorrhagic shock, which class of hemorrhage is characterized by blood loss of 750-1,500 mL with tachycardia but normal blood pressure?

Answer: Class II

Class II hemorrhage involves 750-1,500 mL (15-30%) blood loss, presenting with tachycardia, tachypnea, and narrowed pulse pressure, but systolic blood pressure typically remains normal.

What method is employed to get the history of a patient who comes in after being sexually assaulted?

Answer: When documenting information, utilize direct quotes.

When obtaining a history from a patient who has experienced sexual assault, it is crucial to document their statements using direct quotes. This practice ensures accuracy, preserves the patient's own words, and avoids misinterpretation or bias, which is vital for both legal proceedings and medical care.

When decontaminating a patient with tar or asphalt burns, the recommended technique is:

Answer: Application of a lipophilic agent such as petroleum jelly to dissolve and gently remove the tar

Tar and asphalt are lipophilic and adhere firmly to tissue; applying petroleum-based products dissolves the material for safe removal without causing additional mechanical trauma.