By American College of Surgeons

The ATLS® application used to be built to coach medical professionals one secure, trustworthy procedure for assessing and in the beginning dealing with the trauma sufferer. The direction teaches an equipped strategy for review and administration of heavily injured sufferers and gives a starting place of universal wisdom for all contributors of the trauma workforce. The emphasis is at the severe "first hour" of care, targeting preliminary evaluate, lifesaving intervention, reevaluation, stabilization, and, while wanted, move to a trauma heart. This ebook was once written to be used in ATLS® scholar classes and is up-to-date nearly each 4 years.

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PRIMARY SURVEY PITFALLS Differentiating between ventilation problems and airway compromise can be difficult: ■■ Patients who have profound dyspnea and tachypnea appear as though their primary problem is related to an inadequate airway. However, if the ventilation problem is caused by a pneumothorax or tension pneumothorax, intubation with vigorous bag-mask ventilation can rapidly lead to further deterioration of the patient. ■■ When intubation and ventilation are necessary in an unconscious patient, the procedure itself can unmask or aggravate a pneumothorax, and the patient’s chest must be reevaluated.

Monitoring of urinary output is best accomplished by the insertion of ­12 CHAPTER 1 n Initial Assessment and Management properly, be attached to appropriate suction, and be functional. Blood in the gastric aspirate can be indicative of oropharyngeal (swallowed) blood, traumatic insertion, or actual injury to the upper digestive tract. If the cribriform plate is known to be fractured or a fracture is suspected, the gastric tube should be inserted orally to prevent intracranial passage. In this situation, any nasopharyngeal instrumentation is potentially dangerous.

World Health Organization. Violence and Injury Prevention and Disability (VIP). html. Accessed January 9, 2008. 34. World Health Organization. World Report on Road Traffic Injury Prevention. Geneva: World Health Organization. 35. World Health Organization (WHO). Injuries and violence: the facts. Geneva, Switzerland: WHO; 2010. 36. World Health Organization (WHO). The global burden of disease: 2004 update. Geneva, Switzerland: WHO; 2008. Contents Foreword Preface Acknowledgements Course Overview CHAPTER 1 Initial Assessment and Management Preparation Triage Primary Survey Resuscitation Adjuncts to Primary Survey and Resuscitation Consider Need for Patient Transfer Secondary Survey Adjuncts to the Secondary Survey Reevaluation Definitive Care Disaster Records and Legal Considerations Teamwork CHAPTER SUMMARY BIBLIOGRAPHY vii ix xv xxiii 2 4 6 6 10 11 13 13 18 19 19 20 20 20 22 22  SKILL STATION I: Initial Assessment and Management 23 Skill I-A: Primary Survey Resuscitation Skill I-B: Secondary Survey and Management Skill I-C: Patient Reevaluation Skill I-D: Transfer to Definitive Care Skill I-E: After-Action Review 24 25 28 28 28 CHAPTER 2 Airway and Ventilatory Management Airway Ventilation Airway Management Management of Oxygenation Management of Ventilation CHAPTER SUMMARY BIBLIOGRAPHY 30 32 34 34 46 46 47 48  SKILL STATION II: Airway and Ventilatory Management 50 Scenarios Skill II-A: Oropharyngeal Airway insertion Skill II-B: Nasopharyngeal Airway Insertion Skill II-C: Bag-Mask Ventilation: Two Person Technique Skill II-D: Adult Orotracheal Intubation 51 51 52 52 52 Skill II-E: Laryngeal Mask Airway (LMA) and Intubating LMA (ILMA) Insertion Skill II-F: Laryngeal Tube Airway (LTA) Insertion Skill II-G: Infant Endotracheal Intubation Skill II-H: Pulse Oximetry Monitoring Skill II-I: Carbon Dioxide Detection  SKILL STATION III: Cricothyroidotomy Skill III-A: Needle Cricothyroidotomy Skill III-B: Surgical Cricothyroidotomy CHAPTER 3 Shock Shock Pathophysiology Initial Patient Assessment Hemorrhagic Shock Initial Management of Hemorrhagic Shock Evaluation of Fluid Resuscitation and Organ Perfusion Therapeutic Decisions Based on Response to Initial Fluid Resuscitation Blood Replacement Special Considerations Reassessing Patient Response and Avoiding Complications CHAPTER SUMMARY BIBLIOGRAPHY 53 55 55 56 57 58 59 60 62 64 65 68 70 73 73 74 76 77 79 80  SKILL STATION IV: Shock Assessment and Management 82 Scenarios Skill IV-A: Peripheral Venous Access Skill IV-B: Femoral Venipuncture: Seldinger Technique Skill IV-C: Subclavian Venipuncture: Infraclavicular Approach Skill IV-D: Internal Jugular Venipuncture: Middle or Central Route Skill IV-E: Intraosseous Puncture/Infusion: Proximal Tibial Route Skill IV-F: Identification and Management of Pelvic Fractures: Application of Pelvic Binder 83 85 85 87 88 88 90  SKILL STATION V: Venous Cutdown (Optional Station) 92 Skill V-A: Venous Cutdown 93 xxxi ­xxxii CONTENTS CHAPTER 4 Thoracic Trauma Primary Survey: Life-Threatening Injuries Resuscitative Thoracotomy Secondary Survey: Potentially Life-Threatening Injuries Other Manifestations of Chest Injuries CHAPTER SUMMARY BIBLIOGRAPHY 94 96 102 103 108 110 111  SKILL STATION VI: X-Ray Identification of Thoracic Injuries 113 Scenarios Skill VI-A: Process for Initial Review of Chest X-Rays 114 114  SKILL STATION VII: Chest Trauma Management 118 Skill VII-A: Needle Thoracentesis Skill VII-B: Chest Tube Insertion Skill VII-C: Pericardiocentesis (Optional) CHAPTER 5 Abdominal and Pelvic Trauma Anatomy of the Abdomen Mechanism of Injury Assessment Indications for Laparotomy in Adults Specific Diagnoses CHAPTER SUMMARY BIBLIOGRAPHY 119 119 120 122 124 125 127 134 134 138 139  SKILL STATION VIII: Focused Assessment Sonography in Trauma (FAST) 141 Scenarios Skill VIII: Focused Assessment Sonography in Trauma (FAST) 142 142  SKILL STATION IX: Diagnostic Peritoneal Lavage (Optional) Skill IX-A: Diagnosistic Peritoneal Lavage– Open Technique Skill IX-B: Diagnositic Pertioneal Lavage– Closed Technique CHAPTER 6 Head Trauma Anatomy Review Physiology Classifications of Head Injuries Management of Minor Brain Injury (GCS Score 13–15) Management of Moderate Brain Injury (GCS Score 9–12) 145 146 146 148 150 153 155 158 160 Management of Severe Brain Injury (GCS Score 3–8) Medical Therapies for Brain Injury Surgical Management Prognosis Brain Death CHAPTER SUMMARY BIBLIOGRAPHY 161 163 165 167 167 168 168  SKILL STATION X: Head and Neck Trauma: Assessment and Management 170 Scenarios Skill X-A: Primary Survey Skill X-B: Secondary Survey and Management Skill X-C: Evaluation of CT Scans of the Head Skill X-D: Helmet Removal 171 171 171 172 173 CHAPTER 7 Spine and Spinal Cord Trauma Anatomy and Physiology Classifications of Spinal Cord Injuries Specific Types of Spinal Injuries X-Ray Evaluation General Management CHAPTER SUMMARY BIBLIOGRAPHY 174 176 180 182 185 187 192 192  SKILL STATION XI: X-Ray Identification of Spine Injuries 194 Scenarios Skill XI-A: Cervical Spine X-Ray Assessment Skill XI-B: Atlanto-Occipital Joint Assessment Skill XI-C: Thoracic and Lumbar X-Ray Assessment Skill XI-D: Review Spine X-Rays 195 195 197 198 198  SKILL STATION XII: Spinal Cord Injury Assessment and Management 199 Scenarios Skill XII-A: Primary Survey and Resuscitation– Assessing Spine Injuries Skill XII-B: Secondary Survey–Neurologic Assessment Skill XII-C: Examination for Level of Spinal Cord Injury Skill XII-D: Treatment Principles for Patients with Spinal Cord Injuries Skill XII-E: Principles of Spine Immobilization and Logrolling 200 201 201 202 202 203 CONTENTS xxxiii CHAPTER 8 Musculoskeletal Trauma Primary Survey and Resuscitation Adjuncts to Primary Survery Secondary Survey Life-Threatening Injuries Other Extremity Injuries Principles of Immobilization Pain Control Associated Injuries Occult Skeletal Injuries CHAPTER SUMMARY BIBLIOGRAPHY 206 208 208 209 213 218 219 220 220 221 222 222  SKILL STATION XIII: Musculoskeletal Trauma: Assessment and Management 224 Scenarios Skill XIII-A: Physical Examination Skill XIII-B: Principles of Extremity Immobilization Skill XIII-C: Realigning a Deformed Extremity Skill XIII-D: Application of a Traction Splint Skill XIII-E: Compartment Syndrome: Assessment and Management Skill XIII-F: Identification of Arterial Injury 225 225 227 227 228 CHAPTER 9 Thermal Injuries Immediate Lifesaving Measures for Burn Injuries Assessment of Patients with Burns Primary Survey and Resuscitation of Patients with Burns Circulation—Burn Shock Resuscitation Secondary Survey and Related Adjuncts Chemical Burns Electrical Burns Patient Transfer Cold injury: Local Tissue Effects Cold Injury: Systemic Hypothermia CHAPTER SUMMARY BIBLIOGRAPHY CHAPTER 10 Pediatric Trauma Types and Patterns of Injury Unique Characteristics of Pediatric Patients Airway: Evaluation and Management Breathing: Evaluation and Management Circulation and Shock: Evaluation and Management Cardiopulmonary Resuscitation Chest Trauma Abdominal Trauma Head Trauma 229 229 230 232 233 235 236 237 239 240 240 241 242 243 244 246 247 248 250 255 256 260 260 260 263 Spinal Cord Injury Musculosketal Trauma Child Maltreatment CHAPTER SUMMARY BIBLIOGRAPHY CHAPTER 11 Geriatric Trauma 264 265 266 268 268 272 Types and Patterns of Injuries Airway Breathing and Ventilation Circulation Disability: Brain and Spinal Cord Injury Exposure and Environment Other Systems Special Circumstances CHAPTER SUMMARY BIBLIOGRAPHY 273 275 275 276 277 278 279 280 282 283 CHAPTER 12 Trauma in Pregnancy and Intimate Partner Violence 286 Anatomic and Physiologic Alterations of Pregnancy 288 Mechanisms of Injury 291 Severity of Injury 291 Assessment and Treatment 292 Perimortem Cesarean Section 294 Intimate Partner Violence 294 CHAPTER SUMMARY 295 BIBLIOGRAPHY 296 CHAPTER 13 Transfer to Definitive Care Determining the Need for Patient Transfer Transfer Responsibilities Transfer Protocols Modes of Transportation Transfer Data CHAPTER SUMMARY BIBLIOGRAPHY APPENDICES 298 300 302 303 303 306 307 307 309 Appendix A: Ocular Trauma (Optional Lecture) Appendix B: Hypothermia and Heat Injuries Appendix C: Austere and Armed Conflict Environments (Optional Lecture) Appendix D: Disaster Management and Emergency Preparedness (Optional Lecture) Appendix E: Triage Scenarios 321 INDEX 355 311 317 325 339 Advanced Trauma Life Support ATLS ® STUDENT COURSE MANUAL ® 1 Initial Assessment and Management Outline Introduction Preparation • Prehospital Phase • Hospital Phase Triage • Multiple Casualties • Mass Casualties The primary survey should be repeated frequently to identify any deterioration in the patient’s status that indicates the need for additional intervention.

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