Advanced Trauma Life Support ATLS Student Course Manual 2018

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LIMB-THREATENING INJURIES 157 necessary. The patient should be adequately resuscitated and, if possible, hemodynamically normal. Wounds may then be operatively debrided, fractures stabilized, and distal pulses confirmed. Tetanus prophylaxis should be administered. (See Tetanus Immunization.) Pitfall prevention n FIGURE 8-6 Example of an open fracture. Open fractures and joint injuries are prone to problems with infection, healing, and function. Failure to give timely antibiotics to patients with open fractures • Recognize that infection is a significant risk in patients with open fractures. • Administer weight-based doses of appropriate antibiotics as soon as an open fracture is suspected. the same limb segment as an associated fracture. At no time should the wound be probed. Documentation of the open wound begins during the prehospital phase with the initial description of the injury and any treatment rendered at the scene. If an open wound exists over or near a joint, it should be assumed that the injury connects with or enters the joint. The presence of an open joint injury may be identified using CT. The presence of intraarticular gas on a CT of the affected extremity is highly sensitive and specific for identifying open joint injury. If CT is not available, consider insertion of saline or dye into the joint to determine whether the joint cavity communicates with the wound. If an open joint is suspected, request consultation by an orthopedic surgeon, as surgical exploration and debridement may be indicated. Management Management decisions should be based on a complete history of the incident and assessment of the injury. Treat all patients with open fractures as soon as possible with intravenous antibiotics using weight-based dosing. First-generation cephalosporins are necessary for all patients with open fractures (n TABLE 8-2). Delay of antibiotic administration beyond three hours is related to an increased risk of infection. Remove gross contamination and particulates from the wound as soon as possible, and cover it with a moist sterile dressing. Apply appropriate immobilization after accurately describing the wound and determining any associated soft-tissue, circulatory, and neurologic involvement. Prompt surgical consultation is Vascular Injuries In patients who manifest vascular insufficiency associated with a history of blunt, crushing, twisting, or penetrating injury or dislocation to an extremity, clinicians should strongly suspect a vascular injury. Assessment The limb may initially appear viable because extremities often have some collateral circulation that provides adequate flow. Non-occlusive vascular injury, such as an intimal tear, can cause coolness and prolonged capillary refill in the distal part of the extremity, as well as diminished peripheral pulses and an abnormal ankle/brachial index. Alternatively, the distal extremity may have complete disruption of flow and be cold, pale, and pulseless. Management It is crucial to promptly recognize and emergently treat an acutely avascular extremity. Early operative revascularization is required to restore arterial flow to an ischemic extremity. Muscle necrosis begins when there is a lack of arterial blood flow for more than 6 hours. Nerves may be even more sensitive to an anoxic environment. If there is an associated fracture deformity, correct it by gently pulling the limb out to length, realigning the fracture, and splinting the injured extremity. This maneuver often restores blood flow to an ischemic extremity when the artery is kinked by shortening and deformity at the fracture site. n BACK TO TABLE OF CONTENTS
158 CHAPTER 8 n Musculoskeletal <strong>Trauma</strong> table 8-2 intravenous antibiotic weight-based dosing guidelines OPEN FRACTURES FIRST-GENERATION CEPHALOSPORINS (GRAM-POSITIVE COVERAGE) CEFAZOLIN IF ANAPHYLACTIC PENICILLIN ALLERGY (INSTEAD OF FIRST- GENERATION CEPHALOSPORIN) CLINDAMYCIN AMINOGLYCOCIDE (GRAM-NEGATIVE COVERAGE) GENTAMICIN PIPERACILLIN/ TAZOBACTAM (BROAD-SPECTRUM GRAM-POSITIVE AND NEGATIVE COVERAGE) Wound
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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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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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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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Page 221 and 222: 9 THERMAL INJURIES The most signifi
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Page 239 and 240: 10 PEDIATRIC TRAUMA Injury remains
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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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