Advanced Trauma Life Support ATLS Student Course Manual 2018

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MEDICAL THERAPIES FOR BRAIN INJURY 121 anti-platelet therapy. After obtaining the international normalized ratio (INR), clinicians should promptly obtain a CT of these patients when indicated. Rapid normalization of anticoagulation is generally required (n TABLE 6-6). Hyperventilation In most patients, normocarbia is preferred. Hyperventilation acts by reducing PaCO 2 and causing cerebral vasoconstriction. Aggressive and prolonged hyperventilation can result in cerebral ischemia in the already injured brain by causing severe cerebral vasoconstriction and thus impaired cerebral perfusion. This risk is particularly high if the PaCO 2 is allowed to fall below 30 mm Hg (4.0 kPa). Hypercarbia (PCO 2 > 45 mm Hg) will promote vasodilation and increase intracranial pressure, and should therefore be avoided. Prophylactic hyperventilation (pCO2 < 25 mm Hg) is not recommended (IIB). Use hyperventilation only in moderation and for as limited a period as possible. In general, it is preferable to keep the PaCO2 at approximately 35 mm Hg (4.7 kPa), the low end of the normal range (35 mm Hg to 45 mm Hg). Brief periods of hyperventilation (PaCO2 of 25 to 30 mm Hg [3.3 to 4.7 kPa]) may be necessary to manage acute neurological deterioration while other treatments are initiated. Hyperventilation will lower ICP in a deteriorating patient with expanding intracranial hematoma until doctors can perform emergent craniotomy. Mannitol Mannitol (Osmitrol) is used to reduce elevated ICP. The most common preparation is a 20% solution (20 g of mannitol per 100 ml of solution). Do not give mannitol to patients with hypotension, because mannitol does not lower ICP in patients with hypovolemia and is a potent osmotic diuretic. This effect can further exacerbate hypotension and cerebral ischemia. Acute neurological deterioration— such as when a patient under observation develops a dilated pupil, has hemiparesis, or loses consciousness—is a strong indication for administering mannitol in a euvolemic patient. In this case, give the patient a bolus of mannitol (1 g/ kg) rapidly (over 5 minutes) and transport her or him immediately to the CT scanner—or directly to the operating room, if a causative surgical lesion is already identified. If surgical services are not available, transfer the patient for definitive care. table 6-6 anticoagulation reversal ANTICOAGULANT TREATMENT COMMENTS Antiplatelets (e.g., aspirin, plavix) Platelets May need to repeat; consider desmopressin acetate (Deamino-Delta-D-Arginine Vasopressin) Coumadin (warfarin) FFP, Vitamin K, prothrombin complex concentrate (Kcentra), Factor VIIa Normalize INR; avoid fluid overload in elderly patients and patients who sustained cardiac injury Heparin Protamine sulfate Monitor PTT Low molecular weight heparin, e.g., Lovenox (enoxaparin) Protamine sulfate N/A Direct thrombin inhibitors dabigatran etexilate (Pradaxa) idarucizumab (Praxbind) May benefit from prothrombin complex concentrate (e.g., Kcentra) Xarelto (rivaroxaban) N/A May benefit from prothrombin complex concentrate (e.g., Kcentra) FFP: Fresh frozen plasma; INR: International Normalized Ratio; PTT: Partial thromboplastin time. n BACK TO TABLE OF CONTENTS
122 CHAPTER 6 n Head <strong>Trauma</strong> Use 0.25–1 g/kg to control elevated ICP ; arterial hypotension (systolic blood pressure
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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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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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Page 133 and 134: 80 CHAPTER 4 n Thoracic Trauma 18.
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 and 156: 6 HEAD TRAUMA The primary goal of t
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Page 161 and 162: 108 CHAPTER 6 n Head Trauma n FIGUR
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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
Page 203 and 204: 150 CHAPTER 8 n Musculoskeletal Tra
Page 221 and 222: 9 THERMAL INJURIES The most signifi
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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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