TNCC Study Guide | Trauma Nursing Core Course Review

Initial Assessment

1. Preparation & Triage

• Follow universal precautions and wear PPE before patient interaction.
• Assess for potential hazardous material exposure that may endanger the trauma team.
• Ensure resuscitation equipment is readily available for immediate intervention.

2. Across-the-Room Observation

• Identify any uncontrolled external hemorrhage.
• Prioritize Circulation & Hemorrhage Control if active bleeding is present.
• Recognize that uncontrolled hemorrhage is the leading cause of preventable trauma deaths.

Primary Survey: Systematic Assessment

A: Airway & Alertness with C-Spine Stabilization

• Use the AVPU scale (Alert, Verbal, Pain, Unresponsive) to assess responsiveness.
• Open the airway using the jaw-thrust maneuver if a spinal injury is suspected.
• Evaluate for:
  • Obstructions (tongue, foreign objects, blood, secretions).
  • Abnormal sounds (snoring, gurgling, stridor).
  • Signs of trauma (swelling, deformities, subcutaneous emphysema).
• Ensure proper endotracheal tube (ETT) placement:
  • Confirm with end-tidal CO₂ (ETCO₂) monitoring.
  • Check bilateral breath sounds and absence of gurgling in the epigastrium.
• Suction airway if needed, then reassess.

B: Breathing & Ventilation

• Assess:
  • Presence & quality of breathing (spontaneous vs. assisted).
  • Symmetrical chest rise and lung sounds.
  • Depth, pattern, and rate of respiration.
  • Skin color, oxygenation status.
• Palpate for rib fractures, subcutaneous emphysema, and soft tissue injury.
• Provide airway adjuncts or ventilatory support as needed.

C: Circulation & Hemorrhage Control

• Uncontrolled external bleeding → Apply direct pressure or a tourniquet.
• Assess skin color, temperature, and moisture for shock signs.
• Palpate central pulses for rate, rhythm, and strength.
• Establish two large-bore IVs or intraosseous (IO) access if needed.
• Initiate warmed isotonic crystalloid infusion, considering balanced resuscitation protocols.
• Use component therapy (RBCs, plasma, platelets) for effective resuscitation instead of large-volume IV fluids.

D: Disability (Neurological Assessment)

• Perform a Glasgow Coma Scale (GCS) assessment (not reliable if the patient is intubated).
• Assess pupil size, reactivity, and neurological trends.
• Determine the need for CT imaging of the head and cervical spine.

E: Exposure & Environmental Control

• Remove all clothing to inspect for injuries.
• Control bleeding and identify hidden wounds.
• Prevent hypothermia using:
  • Warm blankets and IV fluids.
  • Maintaining room temperature and oxygen warming.
• Remember: Hypothermia + Hypotension + Acidosis = Trauma Triad of Death.

F: Full Set of Vital Signs & Family Presence

• Monitor vital signs to assess resuscitation effectiveness.
• Consider allowing family presence during resuscitation when appropriate.