Question about TNCC

[WelshMedic]

Hi all,

Not sure if I'm in the right place here, but here goes:

Does anybody know if the current TNCC doctrine still includes 2 large bore needles and lots of IV fluids or are have they moved onto permissive hypotension? I ask it because it's a current discussion on a Dutch EMS forum, apparently they still advocate lots of fluids there. I said I would ask here, talk about international co-operation!

Thanks in advance for the help!

WM

[Kiwiology]

This is an issue I am quite interested in however is large and complex and gets people very flustered (preaching to the converted much? lol )

We classify shock as being from "uncontrolled bleeding" meaning if "profoundly shocked" you get just enough fluid to perfuse the brain and generate a radial pulse or shock as being from "other sources" which means you get fluid until you are no longer "poorly perfused".

I'm talking about hypovolaemic shock here not distributive (e.g. anaphylaxis or neurogenic) or cardiogenic. People who are Super Crook^TM from anaphylaxis (as an example) are going to recieve lots of fluid and adrenaline until they are not Super Crook^TM whereas some old bloke with cardiogenic shock is going to get very small (250ml) boluses of fluid provided there are no significant crackles in his chest and he doesn't develop any.

As for fluid in hypovolaemia - Fiona Moore from the LAS said it best - cold salty water neither clots nor carries oxygen.

The days of shoving two massive drainpipe drips into people and infusing litre after litre of crystalliod until they bleed clear are long dead; anybody who still practices like that should be banned or castrated or some shit

Edited October 28, 2011 by kiwimedic

[tcripp]

I'm not sure what the TNCC doctrine is (please elaborate, I'd like to read up), but I can tell you what I remember learning in school. Establishing two large bore IVs in a trauma is indicated...whether or not you apply fluids or a lock.

THEN, you determine fluid administration based on the needs of your patient.

And, permissive hypotension is also maintained somewhere between 70 and 90 SBP, based on your protocols.

Toni

[WelshMedic]

Hi Toni,

TNCC is the Trauma Nursing Core Course. This is the nursing equivalent of the PHTLS and ATLS. The question arose because a young colleague from the ER has just completed the course and there they were very anti permissive hypotension. Everybody got 2 large bore IV's and lots of fluid.

Carl.

[tcripp]

Carl,

Looks like they have an outdated revised textbook? My first (and only) google even speaks to permissive hypotension which references TNCC.

http://www.nursingcenter.com/prodev/ce_article.asp?tid=1070098#P75

tlc