Advanced Trauma Life Support ATLS Student Course Manual 2018

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ACKNOWLEDGMENTS It is clear that many people are responsible for development of the Tenth Edition, but the outstanding staff in the ATLS Program Office deserves special mention. Their dedication and hard work not only produced the new edition while ensuring that each one is better than the last but also facilitates its use in hundreds of courses around the world each year. Monique Drago, MA, EdD Trauma Education Programs Manager The American College of Surgeons Chicago, Illinois United States Ryan Hieronymus, MBA, PMP Trauma Education Projects Manager The American College of Surgeons Chicago, Illinois United States Pascale Leblanc Trauma Education Projects Manager The American College of Surgeons Chicago, Illinois United States Kathryn Strong Program Manager, Trauma Education Programs (LMS) The American College of Surgeons Chicago, Illinois United States Autumn Zarlengo Program Manager, Trauma Education Programs (CME/CE) The American College of Surgeons Chicago, Illinois United States Emily Ladislas Program Coordinator, Trauma Education Programs (CME/CE) The American College of Surgeons Chicago, Illinois United States Marlena Libman Trauma Education Program Coordinator The American College of Surgeons Chicago, Illinois United States Freddie Scruggs Trauma Education Program Coordinator The American College of Surgeons Chicago, Illinois United States Germaine Suiza Program Coordinator, Trauma Education Programs (LMS) The American College of Surgeons Chicago, Illinois United States Contributors While developing this revision, we received a great deal of assistance from many individuals—whether they were reviewing information at meetings, submitting images, or evaluating research. ATLS thanks the following contributors for their time and effort in development of the Tenth Edition. Wesam Abuznadah, MD, MEd, FRCS(C), FACS, RPVI Assistant Professor, Consultant Vascular and Endovascular Surgery; Associate Dean, Academic and Student Affairs, College of Medicine King Saud Bin Abdulaziz University for Health Sciences Jeddah Saudi Arabia Joe Acker, EMT-P, MPH Executive Director, Birmingham Regional EMS System University of Alabama at Birmingham Birmingham, Alabama United States xv
xvi ACKNOWLEDGMENTS Suresh Agarwal, MD, FACS Professor of Surgery University of Wisconsin Madison, Wisconsin United States Jameel Ali, MD, MMedEd, FRCSC, FACS Professor of Surgery University of Toronto Toronto, Ontario Canada Hayley Allan, BA(hons), Dip Ed, MEd, MRes National Educator, ATLS UK The Royal College of Surgeons of England London England Saud Al Turki, MD, FACS Ministry of National Guard Health Affairs, King Abdulaziz Medical City King Saud Bin Abdulaziz University for Health Sciences Riyadh Kingdom of Saudi Arabia Mary Asselstine, RN Sunnybrook Health Sciences Centre Toronto, Ontario Canada Mahmood Ayyaz, MBBS, FCPS, FRCS, FACS Professor of Surgery, Services Institute of Medical Sciences; Councillor and Director, National Residency Programme; National Course Director, ATLS Pakistan Services Hospital College of Physicians and Surgeons Pakistan Lehore Pakistan Mark Bagnall, BMedSc(Hons), MBChB(Hons), MSc, PhD, MRCS(Eng) Specialist Registrar in General Surgery; General Surgery Representative ATLS UK Steering Group United Kingdom Andrew Baker, MBChB, FRCS(Orth), FCS(Orth), SA Senior Consultant Entabeni Hospital Durban South Africa Ryan Bales, RN ATLS Coordinator CNIII Trauma Program Sacramento, California United States Raphael Bonvin, MD, MME Head of Educational Unit Faculty of Biology and Medicine Lausanne Switzerland Bertil Bouillon, MD Professor and Chairman Department of Trauma and Orthopaedic Surgery University of Witten/Herdecke, Cologne Merheim Medical Center Cologne Germany Mark W. Bowyer, MD, FACS ATLS Board Member Germany Col. (Ret.) Ben Eiseman Professor of Surgery; Chief, Trauma and Combat Surgery; Surgical Director of Simulation Department of Surgery The Uniformed Services University; Walter Reed National Military Medical Center Bethesda, Maryland United States Mary-Margaret Brandt, MD, MHSA, FACS Trauma Director St. Joseph Mercy Health System Ann Arbor, Michigan United States Frank Branicki, MB, BS, DM, FRCS, FRCS(Glasg), FRACS, FCSHK, FHKAM, FCSECSA, FACS Professor and Chair, Department of Surgery United Arab Emirates University Al Ain United Arab Emirates Susan Briggs, MD, MPH, FACS Director, International Trauma and Disaster Institute Massachusetts General Hospital Boston, Massachusetts United States George Brighton, MBBS, BSc Honors, MSc, PGCE Med Ed. Clinical Entrepreneur Fellow NHS England Royal Devon and Exeter NHS Foundation Trust Exeter England
Page 1 and 2: TENTH EDITION ATLS ® Advanced Trau
Page 3 and 4: Chair of Committee on Trauma: Ronal
Page 6: FOREWORD My first exposure to Advan
Page 9 and 10: viii PREFACE MyATLS Mobile Applicat
Page 11 and 12: x PREFACE Gary A. Vercruysse, MD, F
Page 13 and 14: xii PREFACE Jacqueline Bustraan, MS
Page 18 and 19: xvii ACKNOWLEDGMENTS Bertil Bouillo
Page 20 and 21: xix ACKNOWLEDGMENTS Oscar Guillamon
Page 22 and 23: xxi ACKNOWLEDGMENTS Mahesh Misra, M
Page 24 and 25: xxiii ACKNOWLEDGMENTS James Vosswin
Page 26 and 27: xxv ACKNOWLEDGMENTS James A. Geilin
Page 28: xxvii ACKNOWLEDGMENTS Tone Slåke R
Page 31 and 32: xxx COURSE OVERVIEW m. Protection o
Page 33 and 34: xxxii COURSE OVERVIEW Atls and Trau
Page 35 and 36: xxxiv COURSE OVERVIEW a systematize
Page 37 and 38: xxxvi COURSE OVERVIEW 69. Switzerla
Page 39 and 40: xxxviii COURSE OVERVIEW United Stat
Page 41 and 42: xl COURSE OVERVIEW 67. Hendrickson
Page 43 and 44: xlii COURSE OVERVIEW 122. Palusci V
Page 46: BRIEF CONTENTS Foreword Preface Ack
Page 49 and 50: xlviii DETAILED CONTENTS Teamwork 5
Page 51: l DETAILED CONTENTS Introduction 21
Page 55 and 56: 1 INITIAL ASSESSMENT AND MANAGEMENT
Page 57 and 58: 4 CHAPTER 1 n Initial Assessment an
Page 63 and 64: 10 CHAPTER 1 n Initial Assessment a
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12 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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52 CHAPTER 3 n Shock hypothermia, a
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54 CHAPTER 3 n Shock replacement du
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56 CHAPTER 3 n Shock aggregation an
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58 CHAPTER 3 n Shock Presence of Pa
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60 CHAPTER 3 n Shock rate can be ac
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4 THORACIC TRAUMA Thoracic injury i
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64 CHAPTER 4 n Thoracic Trauma Thor
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66 CHAPTER 4 n Thoracic Trauma shoc
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68 CHAPTER 4 n Thoracic Trauma comp
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70 CHAPTER 4 n Thoracic Trauma Norm
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72 CHAPTER 4 n Thoracic Trauma Seco
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74 CHAPTER 4 n Thoracic Trauma A B
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76 CHAPTER 4 n Thoracic Trauma Spec
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78 CHAPTER 4 n Thoracic Trauma temp
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80 CHAPTER 4 n Thoracic Trauma 18.
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ABDOMINAL AND 5 PELVIC TRAUMA When
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84 CHAPTER 5 n Abdominal and Pelvic
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100 CHAPTER 5 n Abdominal and Pelvi
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6 HEAD TRAUMA The primary goal of t
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104 CHAPTER 6 n Head Trauma Head in
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106 CHAPTER 6 n Head Trauma fibrous
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108 CHAPTER 6 n Head Trauma n FIGUR
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110 CHAPTER 6 n Head Trauma table 6
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112 CHAPTER 6 n Head Trauma covery.
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120 CHAPTER 6 n Head Trauma necessa
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122 CHAPTER 6 n Head Trauma Use 0.2
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124 CHAPTER 6 n Head Trauma not rea
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126 CHAPTER 6 n Head Trauma 18. Mar
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CHAPTER 7 Outline Objectives iNtrod
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ANATOMY AND PHYSIOLOGY 131 B A n FI
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RIGHT INTERNATIONAL STANDARDS FOR N
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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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