Advanced Trauma Life Support ATLS Student Course Manual 2018

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UNIQUE CHARACTERISTICS OF PEDIATRIC PATIENTS 189 table 10-2 pediatric trauma score ASSESSMENT COMPONENT SCORE +2 +1 -1 Weight >20 kg (>44 lb) 10–20 kg (22–44 lb)
190 CHAPTER 10 n Pediatric Trauma child are more likely to establish a good rapport, which facilitates a comprehensive assessment of the child’s psychological and physical injuries. The presence of parents or other caregivers during evaluation and treatment, including resuscitation, may assist clinicians by minimizing the injured child’s natural fears and anxieties. Long-Term Effects of Injury A major consideration in treating injured children is the effect of that injury on their subsequent growth and development. Unlike adults, children must recover from the traumatic event and then continue the normal process of growth and development. The potential physiologic and psychological effects of injury on this process can be significant, particularly in cases involving long-term function, growth deformity, or subsequent abnormal development. Children who sustain even a minor injury may have prolonged disability in cerebral function, psychological adjustment, or organ system function. Some evidence suggests that as many as 60% of children who sustain severe multisystem trauma have residual personality changes at one year after hospital discharge, and 50% show cognitive and physical handicaps. Social, affective, and learning disabilities are present in one-half of seriously injured children. In addition, childhood injuries have a significant impact on the family—personality and emotional disturbances are found in two-thirds of uninjured siblings. Frequently, a child’s injuries impose a strain on the parents’ personal relationship, including possible financial and employment hardships. Trauma may affect not only the child’s survival but also the quality of the child’s life for years to come. Bony and solid visceral injuries are cases in point: Injuries through growth centers can cause growth abnormalities of the injured bone. If the injured bone is a femur, a leg length discrepancy may result, causing a lifelong disability in running and walking. If the fracture is through the growth center of one or more thoracic vertebra, the result may be scoliosis, kyphosis, or even gibbus deformity. Another example is massive disruption of a child’s spleen, which may require a splenectomy and predisposes the child to a lifelong risk of overwhelming postsplenectomy sepsis and death. Ionizing radiation, used commonly in evaluation of injured patients may increase the risk of certain malignancies and should be used if the information needed cannot obtained by other means, the information gained will change the clinical management of the patient, obtaining the studies will not delay the transfer of patients who require higher levels of care, and studies are obtained using the lowest possible radiation doses. Nevertheless, the long-term quality of life for children who have sustained trauma is surprisingly positive, even though in many cases they will experience lifelong physical challenges. Most patients report a good to excellent quality of life and find gainful employment as adults, an outcome justifying aggressive resuscitation attempts even for pediatric patients whose initial physiologic status might suggest otherwise. Equipment Successful assessment and treatment of injured children depends on immediately available equipment of the appropriate size (n TABLE 10-3; also see Pediatric Equipment on MyATLS mobile app). A length-based resuscitation tape, such as the Broselow® Pediatric Emergency Tape, is an ideal adjunct for rapidly determining weight based on length for appropriate fluid volumes, drug doses, and equipment size. By measuring the child’s height, clinicians can readily determine his or her ’estimated weight. One side of the tape provides drugs and their recommended doses for pediatric patients based on weight, and the other side identifies equipment needs for pediatric patients based on length (n FIGURE 10-1). Clinicians should be familiar with length-based resuscitation tapes and their uses. Pitfall Incorrect doses of fluids or medications are administered Hypothermia rapidly develops Airway prevention • Recognize the need for weight-based dosing, and use a resuscitation tape to estimate weight from length. • Recognize the significance of a high body surface area in children, and keep the environment warm and the child covered. The “A” of the ABCDEs of initial assessment is the same in the child as for adults. Establishing a patent airway to provide adequate tissue oxygenation is the first objective. The inability to establish and/or maintain a patent airway with the associated lack of oxygenation and ventilation is the most common 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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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
Page 223 and 224: 170 CHAPTER 9 n Thermal Injuries Th
Page 225 and 226: 172 CHAPTER 9 n Thermal Injuries Ch
Page 227 and 228: 174 CHAPTER 9 n Thermal Injuries Pi
Page 229 and 230: 176 CHAPTER 9 n Thermal Injuries th
Page 231 and 232: 178 CHAPTER 9 n Thermal Injuries ju
Page 233 and 234: 180 CHAPTER 9 n Thermal Injuries Im
Page 235 and 236: 182 CHAPTER 9 n Thermal Injuries lo
Page 237 and 238: 184 CHAPTER 9 n Thermal Injuries 4.
Page 239 and 240: 10 PEDIATRIC TRAUMA Injury remains
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Page 245 and 246: 192 CHAPTER 10 n Pediatric Trauma A
Page 247 and 248: 194 CHAPTER 10 n Pediatric Trauma b
Page 249 and 250: 196 CHAPTER 10 n Pediatric Trauma b
Page 251 and 252: 198 CHAPTER 10 n Pediatric Trauma t
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Page 257 and 258: 204 CHAPTER 10 n Pediatric Trauma G
Page 259 and 260: 206 CHAPTER 10 n Pediatric Trauma C
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Page 263 and 264: 210 CHAPTER 10 n Pediatric Trauma 1
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Page 268 and 269: CHAPTER 11 Outline Objectives iNtro
Page 270 and 271: PRIMARY SURVEY WITH RESUSCITATION 2
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Page 274 and 275: SPECIFIC INJURIES 221 table 11-6 ph
Page 276 and 277: BIBLIOGRAPHY 223 comprise only 12%
Page 279 and 280: 12 TRAUMA IN PREGNANCY AND INTIMATE
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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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