TNCC Ninth Edition: Trauma Assessment and Clinical Decisions Study Guide

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A report describes a motorcyclist with facial bleeding and an open leg injury. Before arrival, the team prepares suction, airway equipment, hemorrhage supplies and warming measures, then assigns assessment and intervention roles while awaiting direct findings.

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A patient arrives with rapidly pooling blood from a thigh wound and can answer questions. One nurse immediately controls the bleeding while another assesses airway and breathing, rather than obtaining a complete medication history first.

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A patient initially answers clearly after facial trauma, then develops gurgling and repeatedly spits blood. The nurse reassesses airway patency, readies suction and calls for airway assistance while a colleague maintains cervical stabilization.

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A patient receiving oxygen has a satisfactory saturation but becomes drowsy with shallow breaths and poor chest rise. The nurse identifies possible ventilatory failure, summons support and incorporates capnography into reassessment instead of simply increasing oxygen delivery.

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A patient with altered mental status receives airway, breathing and circulation assessment before the disability assessment includes glucose. After stabilization, history and detailed examination proceed; suspected pelvic injury prompts a coordinated plan for posterior assessment instead of a routine turn.

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After an intervention for respiratory compromise, the patient remains distressed. The nurse immediately compares chest movement, air entry and perfusion with earlier findings, reports the absent improvement and helps reassess the working diagnosis.

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A wet patient arrives after a collision outdoors. The team removes soaked clothing, examines covered surfaces in sequence and replaces coverings as each area is assessed, while monitoring temperature and using available warming equipment.

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A patient has persistent instability and findings concerning for internal bleeding at a facility without definitive surgical capability. The team starts transfer coordination while continuing resuscitation, rather than waiting to complete a nonessential detailed study.

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Firm direct pressure has not controlled a deep forearm wound, and blood continues to pool rapidly. A trained clinician applies an appropriate tourniquet above the wound, verifies bleeding cessation and communicates the application time.

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A patient has a deep bleeding groin wound where a standard limb tourniquet cannot be positioned effectively. A trained nurse uses appropriate packing and sustained pressure while the team prepares further hemorrhage management.

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A metal fragment protrudes from a worker's thigh with bleeding around its edges. The nurse supports the object, applies pressure around it and monitors perfusion while arranging definitive assessment rather than removing it at the bedside.

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After a high-energy collision, a patient has an acceptable pressure but increasing restlessness, cool skin and a rising pulse. The nurse escalates concern for occult hemorrhage and repeats perfusion assessment instead of waiting for hypotension.

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A patient's pressure improves during resuscitation, but lactate remains elevated and extremities stay cool. The nurse reports the discordant findings and supports reassessment for ongoing hypoperfusion rather than declaring resuscitation complete from pressure alone.

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A bleeding patient is undergoing repeated examinations in a cool treatment room. The nurse coordinates efficient exposure, replaces coverings, removes wet materials and checks temperature while the team continues hemorrhage control and resuscitation.

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A patient's pulse and pressure briefly improve, then pressure falls again while abdominal distension increases. The nurse reports the transient response and renewed findings promptly, supporting urgent reassessment for ongoing hemorrhage and definitive treatment.

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A hypotensive patient develops worsening respiratory distress and nearly absent breath sounds on one side after chest trauma. The nurse urgently reports the combined findings rather than assuming the blood pressure change reflects abdominal bleeding alone.

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A patient opens eyes to sound, speaks confusedly and obeys a request to lift a hand. The nurse records E3, V4 and M6, giving a total of 13 while preserving the component findings.

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During an indicated standardized assessment, one patient reaches toward the examiner's hand at the neck, while another rapidly pulls the arm away without targeting the stimulus. The nurse distinguishes localization from normal flexion rather than assigning both the same score.

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An intubated patient opens eyes to sound and obeys commands. The nurse documents eye and motor findings with the verbal component not testable because of the tube, rather than treating inability to speak as observed verbal failure.

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A patient initially follows commands after a fall but later becomes harder to arouse and develops a new pupil asymmetry. The nurse reports the change urgently and repeats physiologic assessment rather than waiting for the next scheduled observation.

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A head-injured patient becomes less responsive while oxygen saturation and blood pressure fall. The nurse immediately supports airway and circulation assessment and reports both abnormalities, recognizing that systemic deterioration can compound the brain injury.

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During assisted ventilation of a head-injured patient, a teammate begins delivering rapid breaths despite adequate chest rise. The nurse calls attention to ventilation rate and monitoring, supporting controlled ventilation instead of assuming more breaths protect the brain.

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After chest trauma, a patient develops severe breathlessness, markedly reduced right-sided air entry and falling pressure. The nurse identifies a possible tension process and urgently mobilizes the team for clinical assessment and immediate treatment.

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A patient with a penetrating neck wound develops an enlarging hematoma and breathing difficulty. The nurse immediately mobilizes airway and surgical support rather than arranging routine CT first.

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A patient with a bubbling drain is ready for transfer to imaging. A teammate suggests clamping the tube for convenience. The nurse clarifies the risk of trapped air and maintains drainage according to the prescribed system.

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A child struck across the chest has no rib fracture identified but develops increasing respiratory effort and reduced oxygenation. The nurse continues evaluation for internal chest injury instead of treating the normal bony findings as clearance.

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After chest trauma, a patient has respiratory distress and a segment moving opposite to the surrounding chest. The nurse reports the movement pattern alongside air entry and perfusion, supporting assessment for flail chest.

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A patient has worsening abdominal pain after a collision despite a negative FAST. The nurse reports the persistent findings and supports further evaluation rather than using the ultrasound result to dismiss the possibility of significant injury.

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Two patients have abdominal tenderness after collisions. One maintains perfusion and can undergo further imaging; the other becomes hypotensive during assessment. The nurse recognizes that the same imaging sequence is inappropriate for both and communicates the deterioration.

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Several hours after blunt abdominal trauma, a patient develops increasing pain and new guarding despite initially equivocal findings. The nurse reports the evolution promptly and supports urgent reassessment for bowel injury rather than relying on the first examination.

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A restrained passenger has a transverse abdominal bruise and mild pain after a collision. The nurse highlights the injury pattern during handoff and ensures planned serial assessment rather than describing the bruise as an isolated skin injury.

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CT shows nonspecific findings and the patient has mild lower abdominal tenderness. The nurse records the initial examination carefully, follows the observation plan and reports spreading tenderness and a rising pulse as a meaningful change.

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After a diving injury, an alert patient reports neck pain and tingling in both hands but can move the legs. The nurse limits unnecessary movement, supports stabilization and promptly reports the neurologic symptoms.

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A patient with possible cervical injury vomits and cannot clear the airway. The team coordinates airway clearance and necessary positioning with spinal support, instead of leaving the patient supine with obstructing material to avoid all movement.

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A patient initially reports normal sensation in both feet. After a change in symptoms, the nurse identifies new unilateral numbness, compares it with the documented baseline and urgently communicates the difference while maintaining spinal precautions.

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Following a tibial fracture, a patient develops escalating calf pain and marked pain when the toes are passively moved. The nurse recognizes a possible compartment process and requests urgent evaluation despite the presence of a foot pulse.

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After a knee injury, one foot becomes pale and its pulse is absent compared with the other side. The nurse immediately reports threatened perfusion and prepares for urgent treatment.

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An adult has dry red skin on one shoulder and a separate moist blistered forearm burn. The nurse distinguishes the superficial shoulder area from the partial-thickness forearm when documenting depth and estimating relevant burn area.

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A patient describes little pain in a small dry, leathery hand burn surrounded by painful blistered skin. The nurse recognizes possible mixed depth and seeks specialist consultation rather than interpreting the quiet center as healing skin.

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An adult has partial-thickness burns over the entire anterior trunk and the entire left arm. The estimate is 18 plus 9, or 27 percent TBSA, with no additional area counted for separate superficial redness.

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A patient has blistered partial-thickness burns on the chest and dry superficial erythema across the back. The nurse includes the involved chest area in relevant TBSA and separately documents the superficial back injury without adding it.

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A confirmed deep partial-thickness burn over finger joints warrants immediate consultation with consideration for transfer despite small TBSA. A small burn of uncertain depth still warrants consultation to clarify depth and management.

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A child after trauma has an acceptable pressure but cool hands, prolonged capillary refill and less interaction with a parent. The nurse escalates concern for shock and repeats perfusion assessment rather than waiting for the pressure to fall.

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For a worked estimate, an infant weighs 5 kg and the selected chart value is 80 mL/kg. Estimated blood volume is 400 mL; an observed 40 mL loss represents 10 percent of that estimate.

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A child with airway contamination becomes less responsive while chest movement weakens. The nurse prepares immediate airway and ventilation support rather than waiting for visible cyanosis.

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A child initially breathes rapidly with marked effort, then becomes drowsy with slower shallow breaths. The nurse identifies a worsening pattern and summons immediate respiratory support instead of documenting the lower rate as an improvement.

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An older adult falls and strikes the head. A relative reports a blood thinner but cannot name it. The nurse prioritizes identifying the actual drug and last dose while the team continues examination and appropriate head-injury evaluation.

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A caregiver says the patient normally recognizes family and follows simple requests despite dementia. After a fall, the patient does neither. The nurse reports a clear acute change rather than recording confusion as the usual baseline.

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An older adult taking an anticoagulant falls from standing, strikes the head and reports feeling fine. The nurse communicates the head impact and medication exposure and supports appropriate evaluation despite the absence of a high-speed mechanism.

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At a mass-casualty scene, some patients walk to a designated area, others wave, and several remain motionless. The triage clinician uses those groups to determine assessment order, beginning with motionless patients rather than treating walking status as a final category.

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A responder controls major external bleeding with immediately available equipment, reassesses the casualty and continues triage. Another child who is not breathing receives airway opening with consideration of two rescue breaths before the breathing decision is repeated.

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A severely injured patient is initially categorized as expectant when transport and treatment resources are overwhelmed. Additional capability later arrives, so the team reassesses survival potential and treatment priority rather than assuming the original category can never change.

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A patient initially assigned delayed status develops worsening respiratory distress while awaiting transport. The responder repeats individual assessment and updates priority based on the new physiology instead of preserving the original category to maintain queue order.

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A team leader requests equipment from a named nurse. The nurse repeats the device and size; the leader corrects a size discrepancy, hears the revised repetition and confirms it before use.

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A handoff reports head impact, usual cognition, current responses and the family's uncertain blood-thinner report, then identifies medication verification as an outstanding task.

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A stable patient withdraws from an examination near a painful surgical scar. The clinician explains the injury concern, agrees to proceed in short steps and asks the patient to signal when a pause is needed.

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A patient asks to be called Maya and uses she pronouns, while the registration record shows another name. The nurse uses Maya in conversation, clarifies identifiers through the usual process and communicates the patient's stated form of address.

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A transgender patient has lower abdominal pain after trauma. The clinician explains why current reproductive anatomy and relevant prior surgery may affect evaluation, then obtains the necessary history without inferring anatomy from the patient's name or gender.

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A stable patient becomes anxious about an examination near a prior surgical site. The clinician explains the injury-related purpose, discusses how to proceed and limits exposure, allowing necessary assessment while giving the patient meaningful choices.

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A patient provides a surgical history relevant to abdominal evaluation but asks that accompanying visitors not hear it. The nurse communicates the clinically necessary information privately to the treating team while respecting the patient's requested form of address.