Advanced Trauma Life Support ATLS Student Course Manual 2018

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CHAPTER 6 Outline Objectives iNtroduction Anatomy Review • Scalp • Skull • Meninges • Brain • Ventricular System • Intracranial Compartments Physiology Review • Intracranial Pressure • Monro–Kellie Doctrine • Cerebral Blood Flow Classifications of Head Injuries • Severity of Injury • Morphology Evidence-bAsed Treatment Guidelines • Management of Mild Brain Injury (GCS Score 13–15) • Management of Moderate Brain Injury (GCS Score 9–12) • Management of Severe Brain Injury (GCS Score 3–8) Primary Survey and Resuscitation • Airway and Breathing • Circulation • Neurological Examination • Anesthetic, Analgesics, and Sedatives SecondARy Survey Diagnostic Procedures Medical TheRApies for Brain Injury • Intravenous Fluids • Correction of Anticoagulation • Hyperventilation • Mannitol • Hypertonic Saline • Barbiturates • Anticonvulsants Surgical Management • Scalp Wounds • Depressed Skull Fractures • Intracranial Mass Lesions • Penetrating Brain Injuries Prognosis bRAin Death Teamwork Chapter Summary BibliogRAphy OBJECTIVES After reading this chapter and comprehending the knowledge components of the <strong>ATLS</strong> provider course, you will be able to: 1. Describe basic intracranial anatomy and the physiological principles of intracranial pressure, the Monro–Kellie Doctrine, and cerebral blood flow. 2. Describe the primary survey and resuscitation of patients with head and brain injuries. 3. Describe the components of a focused neurological examination. 4. Explain the role of adequate resuscitation in limiting secondary brain injury. 5. Identify the considerations for patient transfer, admission, consultation, and discharge of patients with head injuries. n BACK TO TABLE OF CONTENTS 103
104 CHAPTER 6 n Head <strong>Trauma</strong> Head injuries are among the most common types of trauma encountered in emergency departments (EDs). Many patients with severe brain injuries die before reaching a hospital; in fact, nearly 90% of prehospital trauma-related deaths involve brain injury. Approximately 75% of patients with brain injuries who receive medical attention can be categorized as having mild injuries, 15% as moderate, and 10% as severe. Most recent United States data estimate 1,700,000 traumatic brain injuries (TBIs) occur annually, including 275,000 hospitalizations and 52,000 deaths. TBI survivors are often left with neuropsychological impairments that result in disabilities affecting work and social activity. Every year, an estimated 80,000 to 90,000 people in the United States experience long-term disability from brain injury. In one average European country (Denmark), approximately 300 individuals per million inhabitants suffer moderate to severe head injuries annually, and more than one-third of these individuals require brain injury rehabilitation. Given these statistics, it is clear that even a small reduction in the mortality and morbidity resulting from brain injury can have a major impact on public health. The primary goal of treatment for patients with suspected TBI is to prevent secondary brain injury. The most important ways to limit secondary brain damage and thereby improve a patient’s outcome are to ensure adequate oxygenation and maintain blood pressure at a level that is sufficient to perfuse the brain. After managing the ABCDEs, patients who are determined by clinical examination to have head trauma and require care at a trauma center should be transferred without delay. If neurosurgical capabilities exist, it is critical to identify any mass lesion that requires surgical evacuation, and this objective is best achieved by rapidly obtaining a computed tomographic (CT) scan of the head. CT scanning should not delay patient transfer to a trauma center that is capable of immediate and definitive neurosurgical intervention. Triage for a patient with brain injury depends on how severe the injury is and what facilities are available within a particular community. For facilities without neurosurgical coverage, ensure that pre-arranged transfer agreements with higher-level care facilities are in place. Consult with a neurosurgeon early in the course of treatment. n BOX 6-1 lists key information to communicate when consulting a neurosurgeon about a patient with TBI. A review of cranial anatomy includes the scalp, skull, meninges, brain, ventricular system, and intracranial compartments (n FIGURE 6-1). Scalp Because of the scalp’s generous blood supply, scalp lacerations can result in major blood loss, hemorrhagic shock, and even death. Patients who are subject to long transport times are at particular risk for these complications. Skull Anatomy Review The base of the skull is irregular, and its surface can contribute to injury as the brain moves within the skull during the acceleration and deceleration that occurs during the traumatic event. The anterior fossa houses the frontal lobes, the middle fossa houses the temporal lobes, and the posterior fossa contains the lower brainstem and cerebellum. Meninges The meninges cover the brain and consist of three layers: the dura mater, arachnoid mater, and pia mater (n FIGURE 6-2). The dura mater is a tough, box 6-1 neurosurgical consultation for patients with tbi When consulting a neurosurgeon about a patient with TBI, communicate the following information: • Patient age • Mechanism and time of injury • Patient’s respiratory and cardiovascular status (particularly blood pressure and oxygen saturation) • Results of the neurological examination, including the GCS score (particularly the motor response), pupil size, and reaction to light • Presence of any focal neurological deficits • Presence of suspected abnormal neuromuscular status • Presence and type of associated injuries • Results of diagnostic studies, particularly CT scan (if available) • Treatment of hypotension or hypoxia • Use of anticoagulants 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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3 SHOCK The first step in the initi
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44 CHAPTER 3 n Shock The first step
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46 CHAPTER 3 n Shock Recognition of
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48 CHAPTER 3 n Shock However, the a
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50 CHAPTER 3 n Shock Class II Hemor
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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
Page 137 and 138: 84 CHAPTER 5 n Abdominal and Pelvic
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Page 155: 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
Page 186 and 187: RIGHT INTERNATIONAL STANDARDS FOR N
Page 188 and 189: DOCUMENTATION OF SPINAL CORD INJURI
Page 190 and 191: SPECIFIC TYPES OF SPINAL INJURIES 1
Page 192 and 193: RADIOGRAPHIC EVALUATION 139 Penetra
Page 194 and 195: GENERAL MANAGEMENT 141 When the low
Page 196 and 197: GENERAL MANAGEMENT 143 them to the
Page 198 and 199: BIBLIOGRAPHY 145 Bibliography 1. Bi
Page 201 and 202: 8 MUSCULOSKELETAL TRAUMA Injuries t
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154 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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