TNCC

Terms in this set (73)

Biomechanics
Is the general study of forces & their effects
Kinematics
Is the study of energy transfer as it applies to ID'ing actual or potential injuries
Mechanism of Injury (MOI)
Is how external forces are transferred to the body, resulting in injury
Newton's 1st Law of Motion
A body @ rest, stays @ rest unless acted on by an outside force
Newton's Second Law
The acceleration of a body is parallel & directly proportional to the net force acting on the body, is in the direction of the net force, & is inversely proportional to the body's mass
Force equals mass times acceleration
(It takes more force to move a heavy object vs a light object)
Newton's Third Law
For every action there is an equal and opposite reaction
Law of conservation of energy
Energy cannot be created or destroyed
When mass is doubled
Energy is doubled as well
When velocity is doubled
Energy is quadrupled
Mechanical energy
The direct impact of an object, such as in a car collision or a pot to the head
Thermal energy
The transfer of heat energy, such as a burn from a liquid or hot object like a pot
Chemical energy
Heat energy from active chemical substances, such as household cleaners or acids
Electrical energy
Energy transferred from light sockets, power cord, or lightning
Radiant energy
Energy transferred from my blast, sound waves, radio activity, are the common sunburn
External Energy Forces
Deceleration
These include forces the current for my sudden stop in the bodies motion
External Energy Forces
Acceleration
These forces are not as common, and result from a sudden and rapid onset of motion. Think of whiplash when you are rear ended
External Energy Forces
Compression
This occurs when a person is crushed by or between objects, such as between a dashboard and a car seat
Internal forces
Compression
The ability of the tissue to resist crush injury or force
Internal Forces
Tension
The ability to resist being pulled apart when stretched
Internal forces
Shearing
The ability to resist a force applied parallel to the tissue
Blunt trauma
The result of a broad energy impact across a large surface area
Penetrating trauma
Energy that results in impalement at the point of impact. Injury potential affected by the velocity of the object
Motor vehicle collisions result in three distinct impacts: 1st impact
Vehicle hits another object
Motor vehicle collisions result in three distinct impacts: 2nd impact
Occupant hits the interior of the vehicle
Motor vehicle collisions result in three distinct impacts: 3rd impact
Organs hit other internal structures
Cavitation
A separation of tissue as the result of a sound or hydraulic way force. This is unique to high velocity penetrating trauma, including blast in injury and gunshot wounds
Cavitation: types of injuries
crushing, tearing, & shearing injuries
Cavitation: effects of internal structures
Solid organ, such as the liver are more likely to tear or sheer under these forces, where as the air-filled organs, such as the lungs can tolerate them more due to their elasticity
Blast trauma: overpressure
This is the sudden change in atmospheric pressure caused by the blast. This can impact a person via crush forces
Blast trauma: dynamic pressure
This includes the impact of explosive fragments and environmental to debris that are displaced by the explosion
Blast trauma injuries: primary
Found in patients who were closest to the blessed. Injuries are most commonly associated with air filled organs
Blast trauma injuries: secondary
Include fragment injuries, puncture wounds, lacerations, and impaled object. Generally, these cause the most casualties
Blast trauma injuries: tertiary
Results from the patient being blown into a large object. Injuries include public or femur fractures and thoracic injuries
Blast trauma injuries: quaternary
Results from heat, flame, gas, and smoke and cause burn injuries
Blast trauma injuries: quinary
"The dirty bomb": injuries associated with radioactive, biological or chemical elements that may be present in the explosion
Prepare
•Activate team
•Equipment: rapid infuser, chest tube set up, intubation set up, etc
•Don PPE
PRIMARY
Across the room survey
Assess for obvious uncontrolled external hemorrhage
A
AVPU
Assess LOC using AVPU
A
CSPINE
2nd person, maintain cspine, manual jaw thrust maneuver
A
Inspection, Auscultation, Palpation
•Foreign objects?
•Blood, emesis, or other secretions?
•Loose or missing teeth?
•Snoring, gurgling or stridor?
A
OPA/NPA?
If needed, state necessity of OPA
State need for intubation
A
OPA
Reassess airway after insertion
B/V
Inspection, Auscultation, Palpation
•Is there spontaneous breathing?
•Depth, pattern & rate of respirations?
•Symmetrical chest rise?
•Breath sounds present & = ?
B/V
O2/BVM
State need for ventilation w/BVM or provide supplemental O2
B/V
Effectiveness?
If not, intubate
B/V
Post ETT
•Attach CO2 detector
•Listen over epigastrium
•Listen to lung fields while visualizing chest rise & fall
•Note skin color change
•After 5-6 breathes, check CO2 detector
•Call XR
ETT continued
•Secure ETT
•Document position @ the lip
•Place on vent
C
Assess: Inspection, Auscultation, Palpate
•Inspect for uncontrolled bleeding
•Palpate a central pulse
•*Inspect & palpate skin for color, temp, & moisture
C
Is there bleeding?
STOP BLEEDING, get FAST
C
IV
•Check patency of medic line
•Start 2nd large bore IV
C
IVF/Blood
•Infuse warmed crystalloid solution @ a controlled rate using blood tubing
D (Neuro)
GCS
D (Neuro)
Pupils?
PEARRL vs sluggish/pinpoint etc
D
Based on GCS & pupils....
Might need a stat head & cervical spine CT
E (environmental)
•Trauma naked & assess for uncontrolled bleeding or obvious injuries
•Cover w/warm blanket
F/F
Full set of vital signs
F/F
Get family @ bedside
Get:
LMNOP
L:
Labs: type & screen, ABG, lactate
M:
Monitor; place pt on 5 lead
N:
NGT vs OGT
O:
•Pulse ox
•Capnography
P:
•Pain
-Nonpharmacologic; reposition
-Pharmacological; obtain order for an appropriate dose of analgesia
H/H
SAMPLE
S: s/s
A: allergies
M: Meds
P: PMH
L: last oral intake
E: events leading up
Head-to-Toe
Head
Inspect & palpate head & face
Head-to-Toe
Neck
Inspect & palpate neck; maintain CSPINE while removing collar & replace
Head-to-Toe
Chest
•Inspect & palpate chest
•Auscultate breath & heart sounds
Head-to-Toe
Abd
• inspect abd & flanks
• auscultate bowel sounds
• palpate all 4 quadrants
Head-to-Toe
Pelvis
•Inspect pelvis & perineum
•Apply gentle pressure over iliac crest downward & medially
•apply gentle pressure on symphysis pubis
•Foley?
Head-to-Toe
Extremities
Inspect & palpate all extremities for neurovascular status & status
Inspect posterior
Log roll, Inspect & palpate posterior, remove backboard
Post-Resuscitation Care
•Re-evaluate primary assessment
•Re-evaluate VS
•Re-evaluate for pain
•Re-evaluate interventions for effectiveness
Disposition:
ICU
OR
Transfer
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