TNCC Review Notes TNCC: Trauma Nursing Core Course     A = Airway - Check for:  Tongue obstruction  Teeth  Vocalization  Blood/vomit in airway  Edema - If obstruction Suction…then reassess - Maintain C-spine precautions - Prepare for intubation  Once intubated assess tube placement by auscultating over epigastrum first then over lung fields  Secure endotracheal tube B = Breathing - Is it spontaneous? - Accessory muscle use? - Rate and Pattern? - Skin color - Check for bilateral breath sounds  If breath sounds are not bilateral consider: tube placement/tension pneumothorax  If there is JVD (jugular vein distention) or tracheal deviation perform needle thoracentisis…..  Insert large bore needle into the 2nd intercostal space at the midclavicular line…..prepare for chest tube insertion. C = Circulation - Palpate central pulses (carotid/femoral) - Check color/temperature/moisture of skin - Check prehospital IV’s for patency - Start 2nd large bore IV.  Obtain basic labs.  Begin infusion of warmed fluid bolus - Check for obvious signs of external bleeding  If obvious signs of external bleeding  Control bleeding D = Disability - Check AVPU  Alert?  Verbal?  Responsive to Pain?  Unresponsive? - Check pupils. Are they PERRL?  Equal  Round  Reactive to  Light 1 TNCC Review Notes       E = Expose the patient - Remove all clothes - Examine patient for obvious injuries/ble ...
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