Advanced Trauma Life Support ATLS Student Course Manual 2018

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OTHER EXTREMITY INJURIES 161 Other Extremity Injuries Other significant extremity injuries include contusions and lacerations, joint injuries, and fractures. Contusions and Lacerations Assess simple contusions and/or lacerations to rule out possible vascular and/or neurologic injuries. In general, lacerations require debridement and closure. If a laceration extends below the fascial level, it may require operative intervention to more completely debride the wound and assess for damage to underlying structures. Contusions are usually recognized by pain, localized swelling, and tenderness. If the patient is seen early, contusions are treated by limiting function of the injured part and applying cold packs. Crushing and internal degloving injuries can be subtle and must be suspected based on the mechanism of injury. With crush injury, devascularization and table 8-3 peripheral nerve assessment of upper extremities NERVE MOTOR SENSATION INJURY Ulnar Index and little finger abduction Little finger Elbow injury Median distal Thenar contraction with opposition Distal tip of index finger Wrist fracture or dislocation Median, anterior interosseous Index tip flexion None Supracondylar fracture of humerus (children) Musculocutaneous Elbow flexion Radial forearm Anterior shoulder dislocation Radial Thumb, finger metocarpophalangeal extension First dorsal web space Distal humeral shaft, anterior shoulder dislocation Axillary Deltoid Lateral shoulder Anterior shoulder dislocation, proximal humerus fracture table 8-4 peripheral nerve assessment of lower extremities NERVE MOTOR SENSATION INJURY Femoral Knee extension Anterior knee Pubic rami fractures Obturator Hip adduction Medial thigh Obturator ring fractures Posterior tibial Toe flexion Sole of foot Knee dislocation Superficial peroneal Ankle eversion Lateral dorsum of foot Fibular neck fracture, knee dislocation Deep peroneal Ankle/toe dorsiflexion Dorsal first to second web space Fibular neck fracture, compartment syndrome Sciatic nerve Ankle dorsiflexion or plantar flexion Foot Posterior hip dislocation Superior gluteal Hip abduction Upper buttocks Acetabular fracture Inferior gluteal Gluteus maximus hip extension Lower buttocks Acetabular fracture n BACK TO TABLE OF CONTENTS
162 CHAPTER 8 n Musculoskeletal <strong>Trauma</strong> necrosis of muscle can occur. Soft-tissue avulsion can shear the skin from the deep fascia, allowing for the significant accumulation of blood in the resulting cavity (i.e., Morel-Lavallée lesion). Alternatively, the skin may be sheared from its blood supply and undergo necrosis over a few days. This area may have overlying abrasions or bruised skin, which are clues to a more severe degree of muscle damage and potential compartment or crush syndromes. These soft-tissue injuries are best evaluated by knowing the mechanism of injury and by palpating the specific component involved. Consider obtaining surgical consultation, as drainage or debridement may be indicated. The risk of tetanus is increased with wounds that are more than 6 hours old, contused or abraded, more than 1 cm in depth, from high-velocity missiles, due to burns or cold, and significantly contaminated, particularly wounds with denervated or ischemic tissue (See Tetanus Immunization.) Joint and Ligament Injuries When a joint has sustained significant ligamentous injury but is not dislocated, the injury is not usually limb-threatening. However, prompt diagnosis and treatment are important to optimize limb function. Assessment With joint injuries, the patient usually reports abnormal stress to the joint, for example, impact to the anterior tibia that subluxed the knee posteriorly, impact to the lateral aspect of the leg that resulted in a valgus strain to the knee, or a fall onto an outstretched arm that caused hyperextension of the elbow. Physical examination reveals tenderness throughout the affected joint. A hemarthrosis is usually present unless the joint capsule is disrupted and the bleeding diffuses into the soft tissues. Passive ligamentous testing of the affected joint reveals instability. X-ray examination is usually negative, although some small avulsion fractures from ligamentous insertions or origins may be present radiographically. curred and placed the limb at risk for neurovascular injury. Surgical consultation is usually required for joint stabilization. Fractures Fractures are defined as a break in the continuity of the bone cortex. They may be associated with abnormal motion, soft-tissue injury, bony crepitus, and pain. A fracture can be open or closed. Assessment Examination of the extremity typically demonstrates pain, swelling, deformity, tenderness, crepitus, and abnormal motion at the fracture site. Evaluation for crepitus and abnormal motion is painful and may increase soft-tissue damage. These maneuvers are seldom necessary to make the diagnosis and must not be done routinely or repetitively. Be sure to periodically reassess the neurovascular status of a fractured limb, particularly if a splint is in place. X-ray films taken at right angles to one another confirm the history and physical examination findings of fracture (n FIGURE 8-9). Depending on the patient’s hemodynamic status, x-ray examination may need to be delayed until the patient is stabilized. To exclude occult dislocation and concomitant injury, x-ray films must include the joints above and below the suspected fracture site. Management Immobilize joint injuries, and serially reassess the vascular and neurologic status of the limb distal to the injury. Knee dislocations frequently return to near anatomic position and may not be obvious at presentation. In a patient with a multiligament knee injury, a dislocation may have oc- A n FIGURE 8-9 X-ray films taken at right angles to one another confirm the history and physical examination findings of fracture. A. AP view of the distal femur. B. Lateral view of the distal femur. Satisfactory x-rays of an injured long bone should include two orthogonal views, and the entire bone should be visualized. Thus the images alone would be inadequate. B 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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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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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
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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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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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