Advanced Trauma Life Support ATLS Student Course Manual 2018

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MECHANISM OF INJURY 85 bladder, iliac vessels, and female internal reproductive organs. Significant blood loss can occur from injuries to organs within the pelvis and/or directly from the bony pelvis. MechANism of Injury Consideration of the mechanism of injury facilitates the early identification of potential injuries, directs which diagnostic studies may be necessary for evaluation, and identifies the potential need for patient transfer. Common injuries from blunt and penetrating trauma are described in this section. A BLUNT A direct blow, such as contact with the lower rim of a steering wheel, bicycle or motorcycle handlebars, or an intruded door in a motor vehicle crash, can cause compression and crushing injuries to abdominopelvic viscera and pelvic bones. Such forces deform solid and hollow organs and can cause rupture with secondary hemorrhage and contamination by visceral contents, leading to associated peritonitis. Shearing injuries are a form of crush injury that can result when a restraint device is worn inappropriately (n FIGURE 5-2A). Patients injured in motor vehicle crashes and who fall from significant heights may sustain deceleration injuries, in which there is a differential movement of fixed and mobile parts of the body. Examples include lacerations of the liver and spleen, both movable organs that are fixed at the sites of their supporting ligaments. Bucket handle injuries to the small bowel are also examples of deceleration injuries (n FIGURE 5-2B). In patients who sustain blunt trauma, the organs most frequently injured are the spleen (40% to 55%), liver (35% to 45%), and small bowel (5% to 10%). Additionally, there is a 15% incidence of retroperitoneal hematoma in patients who undergo laparotomy for blunt trauma. Although restraint devices reduce the incidence of many more major injuries, they are associated with specific patterns of injury, as shown in n TABLE 5-1. Air-bag deployment does not preclude abdominal injury. PENETRATING Stab wounds and low-energy gunshot wounds cause tissue damage by lacerating and tearing. High-energy gunshot wounds transfer more kinetic energy, causing B n FIGURE 5-2 Lap Belt and Bucket Handle Injuries. A. Injuries may be more likely when a restraint device is not in the optimal position. B. Small bowel “bucket handle” injury. increased damage surrounding the track of the missile due to temporary cavitation. Stab wounds traverse adjacent abdominal structures and most commonly involve the liver (40%), small bowel (30%), diaphragm (20%), and colon (15%) (n FIGURE 5-3). Gunshot wounds can cause additional intra-abdominal injuries based on the trajectory, cavitation effect, and possible bullet fragmentation. Gunshot wounds most commonly injure the small bowel (50%), colon (40%), liver (30%), and abdominal vascular structures (25%). The type of weapon, the muzzle velocity, and type of ammunition are important determinants of degree of tissue injury. In the case of shotguns, the distance between the shotgun and the patient determines the severity of injuries incurred. Blast Blast injury from explosive devices occurs through several mechanisms, including penetrating fragment n BACK TO TABLE OF CONTENTS
86 CHAPTER 5 n Abdominal and Pelvic <strong>Trauma</strong> table 5-1 injuries associated with restraint devices RESTRAINT DEVICE Lap Seat Belt • Compression • Hyperflexion Shoulder Harness • Sliding under the seat belt (“submarining”) • Compression Air Bag • Contact • Contact/deceleration • Flexion (unrestrained) • Hyperextension (unrestrained) INJURY • Tear or avulsion of bowel mesentery (bucket handle) • Rupture of small bowel or colon • Thrombosis of iliac artery or abdominal aorta • Chance fracture of lumbar vertebrae • Pancreatic or duodenal injury • Rupture of upper abdominal viscera • Intimal tear or thrombosis in innominate, carotid, subclavian, or vertebral arteries • Fracture or dislocation of cervical spine • Rib fractures • Pulmonary contusion • Face and eye abrasions • Cardiac Injuries • Spine fractures wounds and blunt injuries from the patient being thrown or struck by projectiles. The treating doctor must consider the possibility of combined penetrating and blunt mechanisms in these patients. Patients close to the source of the explosion can incur additional injuries to the tympanic membranes, lungs, and bowel related to blast overpressure. These injuries may have delayed presentation. The potential for overpressure injury following an explosion should not distract the clinician from a systematic approach to identifying and treating blunt and penetrating injuries. Pitfall Missed abdominal injury prevention • Understand the role that mechanism of injury plays in abdominal injury. Do not underestimate the extent of energy delivered to the abdomen in blunt trauma. • Recognize that small, lowenergy wounds (e.g., stab and fragment wounds) can cause visceral and/or vascular injuries. • Perform frequent abdominal reevaluation, as a single examination does not completely eliminate the presence of injury. • High-energy projectiles can produce injuries tangential to the path of the missile. • Missile trajectories can be altered by tumbling or creation of a secondary path after striking bone or fragmenting. This can result in remote injuries (compared with cutaneous wounds). Assessment and Management n FIGURE 5-3 Stab wounds most commonly injure the liver, small bowel, diaphragm, and colon. In hypotensive patients, the goal is to rapidly identify an abdominal or pelvic injury and determine whether it is the cause of hypotension. The patient history, physical exam, and supplemental diagnostic tools n BACK TO TABLE OF CONTENTS
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TENTH EDITION ATLS ® Advanced Trau
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Chair of Committee on Trauma: Ronal
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FOREWORD My first exposure to Advan
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viii PREFACE MyATLS Mobile Applicat
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x PREFACE Gary A. Vercruysse, MD, F
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xii PREFACE Jacqueline Bustraan, MS
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ACKNOWLEDGMENTS It is clear that ma
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xvii ACKNOWLEDGMENTS Bertil Bouillo
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xix ACKNOWLEDGMENTS Oscar Guillamon
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xxi ACKNOWLEDGMENTS Mahesh Misra, M
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xxiii ACKNOWLEDGMENTS James Vosswin
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xxv ACKNOWLEDGMENTS James A. Geilin
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xxvii ACKNOWLEDGMENTS Tone Slåke R
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xxx COURSE OVERVIEW m. Protection o
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xxxii COURSE OVERVIEW Atls and Trau
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xxxiv COURSE OVERVIEW a systematize
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xxxvi COURSE OVERVIEW 69. Switzerla
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xxxviii COURSE OVERVIEW United Stat
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xl COURSE OVERVIEW 67. Hendrickson
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xlii COURSE OVERVIEW 122. Palusci V
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BRIEF CONTENTS Foreword Preface Ack
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xlviii DETAILED CONTENTS Teamwork 5
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l DETAILED CONTENTS Introduction 21
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1 INITIAL ASSESSMENT AND MANAGEMENT
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4 CHAPTER 1 n Initial Assessment an
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10 CHAPTER 1 n Initial Assessment a
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2 AIRWAY AND VENTILATORY MANAGEMENT
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24 CHAPTER 2 n Airway and Ventilato
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Page 95 and 96: 3 SHOCK The first step in the initi
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Page 115 and 116: 4 THORACIC TRAUMA Thoracic injury i
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Page 135 and 136: ABDOMINAL AND 5 PELVIC TRAUMA When
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Page 155 and 156: 6 HEAD TRAUMA The primary goal of t
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Page 182 and 183: CHAPTER 7 Outline Objectives iNtrod
Page 184 and 185: ANATOMY AND PHYSIOLOGY 131 B A n FI
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DOCUMENTATION OF SPINAL CORD INJURI
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SPECIFIC TYPES OF SPINAL INJURIES 1
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RADIOGRAPHIC EVALUATION 139 Penetra
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GENERAL MANAGEMENT 141 When the low
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GENERAL MANAGEMENT 143 them to the
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BIBLIOGRAPHY 145 Bibliography 1. Bi
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8 MUSCULOSKELETAL TRAUMA Injuries t
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150 CHAPTER 8 n Musculoskeletal Tra
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9 THERMAL INJURIES The most signifi
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170 CHAPTER 9 n Thermal Injuries Th
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172 CHAPTER 9 n Thermal Injuries Ch
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174 CHAPTER 9 n Thermal Injuries Pi
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176 CHAPTER 9 n Thermal Injuries th
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178 CHAPTER 9 n Thermal Injuries ju
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180 CHAPTER 9 n Thermal Injuries Im
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182 CHAPTER 9 n Thermal Injuries lo
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184 CHAPTER 9 n Thermal Injuries 4.
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10 PEDIATRIC TRAUMA Injury remains
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188 CHAPTER 10 n Pediatric Trauma I
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190 CHAPTER 10 n Pediatric Trauma c
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192 CHAPTER 10 n Pediatric Trauma A
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194 CHAPTER 10 n Pediatric Trauma b
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196 CHAPTER 10 n Pediatric Trauma b
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198 CHAPTER 10 n Pediatric Trauma t
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200 CHAPTER 10 n Pediatric Trauma f
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202 CHAPTER 10 n Pediatric Trauma t
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204 CHAPTER 10 n Pediatric Trauma G
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206 CHAPTER 10 n Pediatric Trauma C
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208 CHAPTER 10 n Pediatric Trauma
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210 CHAPTER 10 n Pediatric Trauma 1
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212 CHAPTER 10 n Pediatric Trauma 6
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CHAPTER 11 Outline Objectives iNtro
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PRIMARY SURVEY WITH RESUSCITATION 2
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PRIMARY SURVEY WITH RESUSCITATION 2
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SPECIFIC INJURIES 221 table 11-6 ph
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BIBLIOGRAPHY 223 comprise only 12%
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12 TRAUMA IN PREGNANCY AND INTIMATE
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228 CHAPTER 12 n Trauma in Pregnanc
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240 CHAPTER 13 n Transfer to Defini
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Appendix A OCULAR TRAUMA OBJECTIVES
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259 APPENDIX A n Ocular Trauma In c
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261 APPENDIX A n Ocular Trauma to t
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Appendix B HYPOTHERMIA AND HEAT INJ
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267 APPENDIX B n Hypothermia and He
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Appendix C TRAUMA CARE IN MASS-CASU
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277 APPENDIX C n Trauma Care in Mas
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Appendix D DISASTER PREPAREDNESS AN
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291 APPENDIX D n Disaster Preparedn
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Pitfall Inadequate security Failed
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Appendix E ATLS AND TRAUMA TEAM RES
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305 APPENDIX E n ATLS and Trauma Te
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Appendix F TRIAGE SCENARIOS OBJECTI
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319 APPENDIX F n Triage Scenarios T
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333 APPENDIX F n Triage Scenarios 4
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Skill Station A AIRWAY Part 1: Basi
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339 APPENDIX G n Skills One-Person
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341 APPENDIX G n Skills STEP 5. Con
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343 APPENDIX G n Skills STEP 13. Co
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346 APPENDIX G n Skills STEP 1. D
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Skill Station C CIRCULATION LEARNIN
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351 APPENDIX G n Skills manual trac
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353 APPENDIX G n Skills STEP 3. Aft
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355 APPENDIX G n Skills STEP 2. If
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358 APPENDIX G n Skills A. Note fac
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360 APPENDIX G n Skills •• Flex
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362 APPENDIX G n Skills Utilization
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366 APPENDIX G n Skills n FIGURE G-
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368 APPENDIX G n Skills less than 1
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372 APPENDIX G n Skills G. Inspect
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374 APPENDIX G n Skills in the inju
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378 INDEX LTA for, 31-32, 32f Malla
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380 INDEX atlanto-occipital disloca
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382 INDEX Frostbite, 181-183, 182f
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384 INDEX Kussmaul’s sign, 69 Lac
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386 INDEX PEA. See Pulseless electr
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388 INDEX for musculoskeletal traum
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390 INDEX Tibial fractures, 163 Tou
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TRAUMA SCORES Correct triage is ess
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394 TRAUMA SCORES on Field Triage,
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396 INJURY PREVENTION Safety Admini
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398 INJURY PREVENTION providers to
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BIOMECHANICS OF INJURY Injuries occ
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402 BIOMECHANICS OF INJURY Ejection
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404 BIOMECHANICS OF INJURY •• A
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406 BIOMECHANICS OF INJURY in a 30-
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408 TETANUS IMMUNIZATION •• Wou
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410 TETANUS IMMUNIZATION Summary Gu
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SAMPLE TRAUMA FLOW SHEET Page 1 of
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414 SAMPLE TRAUMA FLOW SHEET Page 3
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420 SAMPLE TRAUMA FLOW SHEET Some h
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Advanced Trauma Life Support ATLS Student Course Manual 2018

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