TNCC

Terms in this set (73)

Is the general study of forces & their effects

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

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

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

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

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

•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

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?

If needed, state necessity of OPA
State need for intubation

Reassess airway after insertion

B/V
Inspection, Auscultation, Palpation

•Is there spontaneous breathing?
•Depth, pattern & rate of respirations?
•Symmetrical chest rise?
•Breath sounds present & = ?

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

•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

•Check patency of medic line
•Start 2nd large bore IV

•Infuse warmed crystalloid solution @ a controlled rate using blood tubing

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

Full set of vital signs

Get family @ bedside

Labs: type & screen, ABG, lactate

Monitor; place pt on 5 lead

•Pulse ox
•Capnography

•Pain
-Nonpharmacologic; reposition
-Pharmacological; obtain order for an appropriate dose of analgesia

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

ICU
OR
Transfer

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