Advanced Trauma Life Support ATLS Student Course Manual 2018

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BIBLIOGRAPHY 223 comprise only 12% of the overall population; but strikingly, they account for nearly 30% of deaths due to trauma. Without question, advancing age contributes to increased morbidity and mortality. Preexisting medical diseases may accompany the aging physiology. A patient-centered approach to care should include early discussion with the patient and family regarding goals of care and treatment decisions. In the trauma setting, it is important to have early and open dialogue to encourage communication. Many patients have already discussed their wishes regarding life-sustaining therapies before the acute event occurs. Early consultation with palliative care services may be helpful in determining limitations in care, as well as effective palliative approaches to ease the patient’s symptoms. TeamWORK •• Trauma teams are increasingly managing trauma in the elderly population. •• Because of preexisting medical conditions and the potential complications of anticoagulant and antiplatelet drug therapy, successful management of geriatric trauma remains challenging. A trauma team with an understanding of the unique anatomical and physiological changes related to aging can have a positive impact on patient outcome. •• Early activation of the trauma team may be required for elderly patients who do not meet traditional criteria for activation. A simple injury, such as an open tibia fracture, in a frail elderly person may quickly become life-threatening. •• The effect of cardiac drugs, such as beta blockers, may blunt the typical physiological response to hemorrhage, making interpretation of traditional vital signs difficult. The team member responsible for managing circulation must ensure that the team leader is made aware of even minor changes in physiological parameters, and he or she should assess for perfusion status to promptly identify and manage catastrophic hemorrhage. •• The outcomes for elderly trauma patients are often poor. The team leader must consider patients’ advanced directives and recognize the patient's goals of care. Often, members of the team provide opinions or suggestions that may be helpful in caring for patients in these difficult situations. Chapter Summary 1. Older adults are the fastest growing segment of the population. Trauma providers will see an increasing number of elderly injured. 2. The elderly patient presents unique challenges for the trauma team. The influence of changes in anatomy and physiology, as well as the impact of pre-existing medical conditions, will influence outcomes. 3. Common mechanisms of injury include falls, motor vehicle crashes, burns, and penetrating injuries. 4. The primary survey sequence and resuscitation are the same as for younger adults; however, the unique anatomy and physiology of older patients will influence timing, magnitude, and end-points. 5. Common injuries in the elderly include rib fractures, traumatic brain injury, and pelvic fractures. Understanding the impact of aging and the influences on pitfalls seen with these injuries will result in better outcomes. 6. The impact of medications, elderly maltreatment, and understanding the goals of care are unique features of trauma care of the elderly patient. Early identification will influence care and outcomes. Bibliography 1. American College of Surgeons, Committee on Trauma, National Trauma Data Bank (NTDB). http://www.facs.org/trauma/ntdb. Accessed May 12, 2016. 2. Braver ER, Trempel RE. Are older drivers actually at higher risk of involvement in collisions resulting in deaths or nonfatal injuries among their passengers and other road users? Inj Prev 2004;10:27–29. 3. Bulger EM, Arenson MA, Mock CN, et al. Rib fractures in the elderly. J Trauma 2000;48: 1040–1046. 4. Li C, Friedman B, Conwell Y, et al. Validity of the Patient Health Questionnaire-2 (PHQ-2) in n BACK TO TABLE OF CONTENTS
224 CHAPTER 11 n Geriatric Trauma identifying major depression in older people. J Am Geriatr Soc 2007 April;55(4):596–602. 5. Milzman DP, Rothenhaus TC. Resuscitation of the geriatric patient. Emerg Med Clin of NA. 1996; 14:233–244. 6. Min L, Burruss S, Morley E, et al. A simple clinical risk nomogram to predict mortality-associated geriatric complications in severely injured geriatric patients J Trauma 74(4):1125–1132. Copyright © 2013 Lippincott Williams & Wilkins. 7. Oyetunji TA, Chang DC, et al. Redefining hypotension in the elderly: normotension is not reassuring. Arch Surg. 2011 Jul ;146(7):865-9. 8. Romanowski KS, Barsun A, Pamlieri TL, et al. Frailty score on admission predicts outcomes in elderly burn injury. J Burn Care Res 2015;36:1–6. 9. Stevens JA. Fatalities and injuries from falls among older adults—United States 1993–2003 and 2001–2005. MMWR Morb Mortal Wkly Rep 2006; 55:1221–1224. 10. Sussman M, DiRusso SM, Sullivan T, et al. Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity. J Trauma 2002; 53:219–224. 11. United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Ageing. 12. United States Census: http://www.census.gov/ prod/1/pop/p25-1130.pdf . Accessed June 2016. 13. Yelon JA. Geriatric trauma. In Moore EE, Feliciano DV, and Mattox K, eds. Trauma 7th ed. McGraw Hill, 2012. 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
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RADIOGRAPHIC EVALUATION 139 Penetra
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GENERAL MANAGEMENT 141 When the low
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GENERAL MANAGEMENT 143 them to the
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BIBLIOGRAPHY 145 Bibliography 1. Bi
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8 MUSCULOSKELETAL TRAUMA Injuries t
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150 CHAPTER 8 n Musculoskeletal Tra
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9 THERMAL INJURIES The most signifi
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170 CHAPTER 9 n Thermal Injuries Th
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Page 239 and 240: 10 PEDIATRIC TRAUMA Injury remains
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Page 268 and 269: CHAPTER 11 Outline Objectives iNtro
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Page 310 and 311: Appendix A OCULAR TRAUMA OBJECTIVES
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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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