Advanced Trauma Life Support ATLS Student Course Manual 2018

More documents

Recommendations

Info

INTIMATE PARTNER VIOLENCE 235 Because vaginal bleeding in the third trimester may indicate disruption of the placenta and impending death of the fetus, a vaginal examination is vital. However, repeated vaginal examinations should be avoided. The decision regarding an emergency cesarean section should be made in consultation with an obstetrician. CT scans can be used for pregnant trauma patients if there is significant concern for intra-abdominal injury. An abdomen/pelvis CT scan radiation dose approaches 25 mGy, and fetal radiation doses less than 50 mGy are not associated with fetal anomalies or higher risk for fetal loss. Admission to the hospital is mandatory for pregnant patients with vaginal bleeding, uterine irritability, abdominal tenderness, pain or cramping, evidence of hypovolemia, changes in or absence of fetal heart tones, and/or leakage of amniotic fluid. Care should be provided at a facility with appropriate fetal and maternal monitoring and treatment capabilities. The fetus may be in jeopardy, even with apparently minor maternal injury. Definitive Care Obtain obstetrical consultation whenever specific uterine problems exist or are suspected. With extensive placental separation or amniotic fluid embolization, widespread intravascular clotting may develop, causing depletion of fibrinogen, other clotting factors, and platelets. This consumptive coagulopathy can emerge rapidly. In the presence of life-threatening amniotic fluid embolism and/or disseminated intravascular coagulation, immediately perform uterine evacuation and replace platelets, fibrinogen, and other clotting factors, if necessary. As little as 0.01 mL of Rh-positive blood will sensitize 70% of Rh-negative patients. Although a positive Kleihauer-Betke test (a maternal blood smear allowing detection of fetal RBCs in the maternal circulation) indicates fetomaternal hemorrhage, a negative test does not exclude minor degrees of fetomaternal hemorrhage that are capable of isoimmunizing the Rh-negative mother. All pregnant Rh-negative trauma patients Pitfall Failure to recognize the need for Rh immunoglobulin therapy in an Rhnegative mother prevention • Administer Rh immunoglobulin therapy to all injured Rh-negative mothers unless the injury is remote from the uterus (e.g., isolated distal extremity). should receive Rh immunoglobulin therapy unless the injury is remote from the uterus (e.g., isolated distal extremity injury). Immunoglobulin therapy should be instituted within 72 hours of injury. n TABLE 12-4 summarizes care of injured pregnant patients. Perimortem Cesarean Section Limited data exists to support perimortem cesarean section in pregnant trauma patients who experience hypovolemic cardiac arrest. Remember, fetal distress can be present when the mother has no hemodynamic abnormalities, and progressive maternal instability compromises fetal survival. At the time of maternal hypovolemic cardiac arrest, the fetus already has suffered prolonged hypoxia. For other causes of maternal cardiac arrest, perimortem cesarean section occasionally may be successful if performed within 4 to 5 minutes of the arrest. Intimate Partner Violence Intimate partner violence is a major cause of injury to women during cohabitation, marriage, and pregnancy, regardless of ethnic background, cultural influences, or socioeconomic status. Seventeen percent of injured pregnant patients experience trauma inflicted by another person, and 60% of these patients experience repeated episodes of intimate partner violence. According to estimates from the U.S. Department of Justice, 2 million to 4 million incidents of intimate partner violence occur per year, and almost one-half of all women over their lifetimes are physically and/or psychologically abused in some manner. Worldwide, 10% to 69% of women report having been assaulted by an intimate partner. Document and report any suspicion of intimate partner violence. These attacks, which represent an increasing number of ED visits, can result in death and disability. Although most victims of intimate partner violence are women, men make up approximately 40% of all reported cases in the United States. Indicators that suggest the presence of intimate partner violence include: •• Injuries inconsistent with the stated history •• Diminished self-image, depression, and/or suicide attempts n BACK TO TABLE OF CONTENTS
236 CHAPTER 12 n <strong>Trauma</strong> in Pregnancy and Intimate Partner Violence table 12-4 trauma in the obstetrical patient: a bedside tool VITAL SIGNS Position Hypotension treatment and prophylaxis > 20 weeks, left lateral decubitus. Hypotension See “Treatments,” below. IV fluids Transfusion Hypertension Criteria: ≥140 systolic, >90 diastolic Treat: >160 systolic, >110 diastolic Fetal Uterine Monitoring >20 weeks; initiate as soon as possible. If unable to offer OB intervention, stabilize and arrange prompt transfer. Vaginal Bleeding Treat hypotension as above, OB consultation, Rh negative gets RhIG. LAB (IN ADDITION TO USUAL TRAUMA STUDIES) CBC Low hematocrit Type screen Kleihauer-Betke Rh-negative Coagulation Profile INR, PTT, fibrin degradation, fibrinogen, i-Coombs DIAGNOSTIC IMAGING • Order for the same general indications as for nonpregnant patients. • Coordinate with radiologist and consider ultrasound to replace x-ray when possible. • Shield abdomen, pelvis, and neck when possible. TREATMENTS (MEDICATIONS LISTED ARE COMMONLY RECOMMENDED) IV Fluids Patients require larger fluid requirements when hypotensive; avoid dextrose (D5) loads. Oxygen To avoid fetal hypoxia, administer high-concentration oxygen. Intubation and rapid sequence induction Indications for procedures are generally similar to nonpregnancy. Analgesia Use as needed, and inform OB of doses and times if fetal delivery is anticipated. Antiemetics metoclopramide 5–10 mg IV or IM ondansetron 4–8 mg IV Antibiotics Ceftriaxone 1 g IV (if penicillin allergy) clindamycin 600 mg IV Transfusion CMV antibody—neg leukocyte—reduced Continued n BACK TO TABLE OF CONTENTS
Page 1 and 2:
TENTH EDITION ATLS ® Advanced Trau
Page 3 and 4:
Chair of Committee on Trauma: Ronal
Page 6:
FOREWORD My first exposure to Advan
Page 9 and 10:
viii PREFACE MyATLS Mobile Applicat
Page 11 and 12:
x PREFACE Gary A. Vercruysse, MD, F
Page 13 and 14:
xii PREFACE Jacqueline Bustraan, MS
Page 16 and 17:
ACKNOWLEDGMENTS It is clear that ma
Page 18 and 19:
xvii ACKNOWLEDGMENTS Bertil Bouillo
Page 20 and 21:
xix ACKNOWLEDGMENTS Oscar Guillamon
Page 22 and 23:
xxi ACKNOWLEDGMENTS Mahesh Misra, M
Page 24 and 25:
xxiii ACKNOWLEDGMENTS James Vosswin
Page 26 and 27:
xxv ACKNOWLEDGMENTS James A. Geilin
Page 28:
xxvii ACKNOWLEDGMENTS Tone Slåke R
Page 31 and 32:
xxx COURSE OVERVIEW m. Protection o
Page 33 and 34:
xxxii COURSE OVERVIEW Atls and Trau
Page 35 and 36:
xxxiv COURSE OVERVIEW a systematize
Page 37 and 38:
xxxvi COURSE OVERVIEW 69. Switzerla
Page 39 and 40:
xxxviii COURSE OVERVIEW United Stat
Page 41 and 42:
xl COURSE OVERVIEW 67. Hendrickson
Page 43 and 44:
xlii COURSE OVERVIEW 122. Palusci V
Page 46:
BRIEF CONTENTS Foreword Preface Ack
Page 49 and 50:
xlviii DETAILED CONTENTS Teamwork 5
Page 51:
l DETAILED CONTENTS Introduction 21
Page 55 and 56:
1 INITIAL ASSESSMENT AND MANAGEMENT
Page 57 and 58:
4 CHAPTER 1 n Initial Assessment an
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
10 CHAPTER 1 n Initial Assessment a
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
2 AIRWAY AND VENTILATORY MANAGEMENT
Page 77 and 78:
24 CHAPTER 2 n Airway and Ventilato
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
3 SHOCK The first step in the initi
Page 97 and 98:
44 CHAPTER 3 n Shock The first step
Page 99 and 100:
46 CHAPTER 3 n Shock Recognition of
Page 101 and 102:
48 CHAPTER 3 n Shock However, the a
Page 103 and 104:
50 CHAPTER 3 n Shock Class II Hemor
Page 105 and 106:
52 CHAPTER 3 n Shock hypothermia, a
Page 107 and 108:
54 CHAPTER 3 n Shock replacement du
Page 109 and 110:
56 CHAPTER 3 n Shock aggregation an
Page 111 and 112:
58 CHAPTER 3 n Shock Presence of Pa
Page 113 and 114:
60 CHAPTER 3 n Shock rate can be ac
Page 115 and 116:
4 THORACIC TRAUMA Thoracic injury i
Page 117 and 118:
64 CHAPTER 4 n Thoracic Trauma Thor
Page 119 and 120:
66 CHAPTER 4 n Thoracic Trauma shoc
Page 121 and 122:
68 CHAPTER 4 n Thoracic Trauma comp
Page 123 and 124:
70 CHAPTER 4 n Thoracic Trauma Norm
Page 125 and 126:
72 CHAPTER 4 n Thoracic Trauma Seco
Page 127 and 128:
74 CHAPTER 4 n Thoracic Trauma A B
Page 129 and 130:
76 CHAPTER 4 n Thoracic Trauma Spec
Page 131 and 132:
78 CHAPTER 4 n Thoracic Trauma temp
Page 133 and 134:
80 CHAPTER 4 n Thoracic Trauma 18.
Page 135 and 136:
ABDOMINAL AND 5 PELVIC TRAUMA When
Page 137 and 138:
84 CHAPTER 5 n Abdominal and Pelvic
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
100 CHAPTER 5 n Abdominal and Pelvi
Page 155 and 156:
6 HEAD TRAUMA The primary goal of t
Page 157 and 158:
104 CHAPTER 6 n Head Trauma Head in
Page 159 and 160:
106 CHAPTER 6 n Head Trauma fibrous
Page 161 and 162:
108 CHAPTER 6 n Head Trauma n FIGUR
Page 163 and 164:
110 CHAPTER 6 n Head Trauma table 6
Page 165 and 166:
112 CHAPTER 6 n Head Trauma covery.
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
120 CHAPTER 6 n Head Trauma necessa
Page 175 and 176:
122 CHAPTER 6 n Head Trauma Use 0.2
Page 177 and 178:
124 CHAPTER 6 n Head Trauma not rea
Page 179:
126 CHAPTER 6 n Head Trauma 18. Mar
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
Page 203 and 204:
150 CHAPTER 8 n Musculoskeletal Tra
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220:
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
Page 241 and 242: 188 CHAPTER 10 n Pediatric Trauma I
Page 243 and 244: 190 CHAPTER 10 n Pediatric Trauma c
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
Page 253 and 254: 200 CHAPTER 10 n Pediatric Trauma f
Page 255 and 256: 202 CHAPTER 10 n Pediatric Trauma t
Page 257 and 258: 204 CHAPTER 10 n Pediatric Trauma G
Page 259 and 260: 206 CHAPTER 10 n Pediatric Trauma C
Page 261 and 262: 208 CHAPTER 10 n Pediatric Trauma
Page 263 and 264: 210 CHAPTER 10 n Pediatric Trauma 1
Page 265: 212 CHAPTER 10 n Pediatric Trauma 6
Page 268 and 269: CHAPTER 11 Outline Objectives iNtro
Page 270 and 271: PRIMARY SURVEY WITH RESUSCITATION 2
Page 272 and 273: PRIMARY SURVEY WITH RESUSCITATION 2
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
Page 281 and 282: 228 CHAPTER 12 n Trauma in Pregnanc
Page 287: 234 CHAPTER 12 n Trauma in Pregnanc
Page 293 and 294: 240 CHAPTER 13 n Transfer to Defini
Page 305: 252 CHAPTER 13 n Transfer to Defini
Page 310 and 311: Appendix A OCULAR TRAUMA OBJECTIVES
Page 312 and 313: 259 APPENDIX A n Ocular Trauma In c
Page 314 and 315: 261 APPENDIX A n Ocular Trauma to t
Page 318 and 319: Appendix B HYPOTHERMIA AND HEAT INJ
Page 320 and 321: 267 APPENDIX B n Hypothermia and He
Page 328 and 329: Appendix C TRAUMA CARE IN MASS-CASU
Page 330 and 331: 277 APPENDIX C n Trauma Care in Mas
Page 338 and 339:
285 APPENDIX C n Trauma Care in Mas
Page 342 and 343:
Appendix D DISASTER PREPAREDNESS AN
Page 344 and 345:
291 APPENDIX D n Disaster Preparedn
Page 346 and 347:
Page 348 and 349:
Page 350 and 351:
Page 352 and 353:
Pitfall Inadequate security Failed
Page 356 and 357:
Appendix E ATLS AND TRAUMA TEAM RES
Page 358 and 359:
305 APPENDIX E n ATLS and Trauma Te
Page 360 and 361:
Page 362 and 363:
Page 364 and 365:
Page 366 and 367:
Page 370 and 371:
Appendix F TRIAGE SCENARIOS OBJECTI
Page 372 and 373:
319 APPENDIX F n Triage Scenarios T
Page 374 and 375:
Page 376 and 377:
Page 378 and 379:
Page 380 and 381:
Page 382 and 383:
Page 384 and 385:
Page 386:
333 APPENDIX F n Triage Scenarios 4
Page 390 and 391:
Skill Station A AIRWAY Part 1: Basi
Page 392 and 393:
339 APPENDIX G n Skills One-Person
Page 394 and 395:
341 APPENDIX G n Skills STEP 5. Con
Page 396:
343 APPENDIX G n Skills STEP 13. Co
Page 399 and 400:
346 APPENDIX G n Skills STEP 1. D
Page 402 and 403:
Skill Station C CIRCULATION LEARNIN
Page 404 and 405:
351 APPENDIX G n Skills manual trac
Page 406 and 407:
353 APPENDIX G n Skills STEP 3. Aft
Page 408:
355 APPENDIX G n Skills STEP 2. If
Page 411 and 412:
358 APPENDIX G n Skills A. Note fac
Page 413 and 414:
360 APPENDIX G n Skills •• Flex
Page 415:
362 APPENDIX G n Skills Utilization
Page 419 and 420:
366 APPENDIX G n Skills n FIGURE G-
Page 421:
368 APPENDIX G n Skills less than 1
Page 425 and 426:
372 APPENDIX G n Skills G. Inspect
Page 427:
374 APPENDIX G n Skills in the inju
Page 431 and 432:
378 INDEX LTA for, 31-32, 32f Malla
Page 433 and 434:
380 INDEX atlanto-occipital disloca
Page 435 and 436:
382 INDEX Frostbite, 181-183, 182f
Page 437 and 438:
384 INDEX Kussmaul’s sign, 69 Lac
Page 439 and 440:
386 INDEX PEA. See Pulseless electr
Page 441 and 442:
388 INDEX for musculoskeletal traum
Page 443 and 444:
390 INDEX Tibial fractures, 163 Tou
Page 445 and 446:
TRAUMA SCORES Correct triage is ess
Page 447 and 448:
394 TRAUMA SCORES on Field Triage,
Page 449 and 450:
396 INJURY PREVENTION Safety Admini
Page 451 and 452:
398 INJURY PREVENTION providers to
Page 453 and 454:
BIOMECHANICS OF INJURY Injuries occ
Page 455 and 456:
402 BIOMECHANICS OF INJURY Ejection
Page 457 and 458:
404 BIOMECHANICS OF INJURY •• A
Page 459 and 460:
406 BIOMECHANICS OF INJURY in a 30-
Page 461 and 462:
408 TETANUS IMMUNIZATION •• Wou
Page 463 and 464:
410 TETANUS IMMUNIZATION Summary Gu
Page 465 and 466:
SAMPLE TRAUMA FLOW SHEET Page 1 of
Page 467 and 468:
414 SAMPLE TRAUMA FLOW SHEET Page 3
Page 469 and 470:
Page 471 and 472:
Page 473 and 474:
420 SAMPLE TRAUMA FLOW SHEET Some h
show all

Advanced Trauma Life Support ATLS Student Course Manual 2018

Create successful ePaper yourself

Delete template?

Save as template?