Advanced Trauma Life Support ATLS Student Course Manual 2018

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CHAPTER 10 Outline Objectives iNtroduction Types and PatteRNs of Injury uNique ChARActeristics of Pediatric Patients • Size, Shape, and Surface Area • Skeleton • Psychological Status • Long-Term Effects of Injury • Equipment Airway • Anatomy • Management Breathing • Breathing and Ventilation • Needle and Tube Thoracostomy Circulation and Shock • Recognition of Circulatory Compromise • Determination of Weight and Circulating Blood Volume • Venous Access • Fluid Resuscitation and Blood Replacement • Urine Output • Thermoregulation Cardiopulmonary Resuscitation Abdominal Trauma • Assessment • Diagnostic Adjuncts • Nonoperative Management • Specific Visceral Injuries Head Trauma • Assessment • Management Spinal Cord Injury • Anatomical Differences • Radiological Considerations Musculoskeletal Trauma • History • Blood Loss • Special Considerations of the Immature Skeleton • Fracture Splinting Child Maltreatment pRevention Teamwork Chapter Summary BibliogRAphy Chest Trauma OBJECTIVES After reading this chapter and comprehending the knowledge components of the ATLS provider course, you will be able to: 1. Identify the unique characteristics of children as trauma patients, including common types and patterns of injuries, the anatomic and physiologic differences from adults, and the long-term effects of injury. 2. Describe the primary management of trauma in children, including related issues unique to pediatric patients, the anatomic and physiologic differences that affect resuscitation, and the different equipment needs when compared with adult trauma patients. 3. Identify the injury patterns associated with child maltreatment, and describe the factors that lead to suspicion of child maltreatment. 4. List the ABCDEs of injury prevention. n BACK TO TABLE OF CONTENTS 187
188 CHAPTER 10 n Pediatric Trauma Injury remains the most common cause of death and disability in childhood. Each year, more than 10 million children—nearly 1 of every 6 children—in the United States require emergency department care for the treatment of injuries. Each year, more than 10,000 children in the United States die from serious injury. Injury morbidity and mortality surpass all major diseases in children and young adults, making trauma the most serious public health and healthcare problem in this population. Globally, road traffic accidents are the leading cause of adolescent deaths. Failure to secure a compromised airway, support breathing, and recognize and respond to intra-abdominal and intracranial hemorrhage are the leading causes of unsuccessful resuscitation in pediatric patients with severe trauma. Therefore, by applying ATLS principles to the care of injured children, trauma team members can significantly affect ultimate survival and longterm outcomes. Types and PatteRNs of Injury Injuries associated with motor vehicles are the most common cause of death in children of all ages, whether they are occupants, pedestrians, or cyclists. Deaths due to drowning, house fires, homicides, and falls follow in descending order. Child maltreatment accounts for the great majority of homicides in infants (i.e., children younger than 12 months of age), whereas firearm injuries account for most of the homicides in children (over age 1) and adolescents. Falls account for the majority of all pediatric injuries, but infrequently result in death. Blunt mechanisms of injury and children’s unique physical characteristics result in multisystem injury being the rule rather than the exception. Clinicians should presume, therefore, that multiple organ systems may be injured until proven otherwise. n TABLE 10-1 outlines common mechanisms of injury and associated patterns of injury in pediatric patients. The condition of the majority of injured children will not deteriorate during treatment, and most injured children have no hemodynamic abnormalities. Nevertheless, the condition of some children with multisystem injuries will rapidly deteriorate, and serious complications will develop. Therefore, early transfer of pediatric patients to a facility capable of treating children with multisystem injuries is optimal. The Field Triage Decision Scheme (see Figure 1-2 in Chapter 1) and Pediatric Trauma Score n TABLE 10-2 are both useful tools for the early identification of pediatric patients with multisystem injuries. table 10-1 common mechanisms of injury and associated patterns of injury in pediatric patients MECHANISM OF INJURY Pedestrian struck by motor vehicle Occupant in motor vehicle collision Fall from a height Fall from a bicycle COMMON PATTERNS OF INJURY • Low speed: Lower-extremity fractures • High speed: Multiple trauma, head and neck injuries, lowerextremity fractures • Unrestrained: Multiple trauma, head and neck injuries, scalp and facial lacerations • Restrained: Chest and abdominal injuries, lower spine fractures • Low: Upper-extremity fractures • Medium: Head and neck injuries, upper- and lower-extremity fractures • High: Multiple trauma, head and neck injuries, upper- and lowerextremity fractures • Without helmet: Head and neck lacerations, scalp and facial lacerations, upper-extremity fractures • With helmet: Upper-extremity fractures • Striking handlebar: Internal abdominal injuries Unique ChARActeristics of Pediatric Patients The priorities for assessing and managing pediatric trauma patients are the same as for adults. However, the unique anatomic and physiologic characteristics of this population combine with the common mechanisms of injury to produce distinct injury patterns. For example, most serious pediatric trauma is blunt trauma that involves the brain. As a result, apnea, hypoventilation, and hypoxia occur five times more often than hypovolemia with hypotension in children who have sustained trauma. Therefore, treatment protocols for pediatric trauma patients emphasize aggressive management of the airway and breathing. 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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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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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: 10 PEDIATRIC TRAUMA Injury remains
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Page 268 and 269: CHAPTER 11 Outline Objectives iNtro
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238 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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