Advanced Trauma Life Support ATLS Student Course Manual 2018

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TEAMWORK 237 table 12-4 trauma in the obstetrical patient: a bedside tool (continued) TREATMENTS (MEDICATIONS LISTED ARE COMMONLY RECOMMENDED) Rh-negative RhIG 1 ampule (300 g) IM Tetanus Td safe BP >160 s, >110 d Hypertension labetalol 10–20 mg IV bolus Seizures Eclamptic magnesium sulfate 4–6 Gm IV load over 15–20 minutes Non-eclamptic lorazepam 1–2 mg/min IV CPR ACLS >20 wks Patient should be in left lateral decubitus position. If no return of spontaneously circulation after 4 minutes of CPR, consider cesarean delivery of viable fetus. DISPOSITION Admission and Monitoring 4 hours fetal monitoring of potentially viable fetus Discharge Prompt follow up with OB Adapted with permission from the American College of Emergency Physicians. Clinical and Practice Management Resources. Trauma in the Obstetric Patient: A Bedside Tool, http://www.acep.org. Accessed May 16, 2016. box 12-1 assessment of immediate safety screening questions 1. Are you in immediate danger? 2. Is your partner at the health facility now? 3. Do you want to (or have to) go home with your partner? 4. Do you have somewhere safe to go? 5. Have there been threats of direct abuse of the children (if s/he has children)? 6. Are you afraid your life may be in danger? 7. Has the violence gotten worse or is it getting scarier? Is it happening more often? 8. Has your partner used weapons, alcohol, or drugs? 9. Has your partner ever held you or your children against your will? 10. Does your partner ever watch you closely, follow you or stalk you? 11. Has your partner ever threatened to kill you, him/herself or your children? Reprinted with permission from Family Violence Prevention Fund, San Francisco, CA. Copyright 2002. •• Self-abuse and/or self-blame for injuries •• Frequent ED or doctor’s office visits •• Symptoms suggestive of substance abuse •• Isolated injuries to the gravid abdomen •• Partner insists on being present for interview and examination and monopolizes discussion These indicators raise suspicion about the potential for intimate partner violence and should serve to initiate further investigation. The screening questions in n BOX 12-1, when asked in a nonjudgmental manner and without the patient’s partner being present, can identify many victims of intimate partner violence. Suspected cases of intimate partner violence should be handled through local social service agencies or the state health and human services department. TeamWORK •• The team leader should remind the team of the major anatomical and physiological changes associated with pregnancy that may affect evaluation of the pregnant injured patient. n BACK TO TABLE OF CONTENTS
238 CHAPTER 12 n Trauma in Pregnancy and Intimate Partner Violence •• The team must remember that, although there are two patients, the team’s primary mission is to ensure optimal resuscitation of the mother. •• The team leader should notify the on-call obstetrician and the obstetrics unit of the impending arrival of an injured pregnant patient as soon as possible while continuing to direct the overall resuscitation. •• The team must maintain an appropriately high index of suspicion for the presence of intimate partner violence, carefully documenting all injuries. Chapter Summary 1. Important and predictable anatomical and physiological changes occur during pregnancy and can influence the assessment and treatment of injured pregnant patients. Attention also must be directed toward the fetus, the second patient of this unique duo, after its environment is stabilized. A qualified surgeon and an obstetrician should be consulted early in the evaluation of pregnant trauma patients. If obstetric services are not available, consider early transfer to a trauma center with obstetrical services. agree with edit. 2. The abdominal wall, uterine myometrium, and amniotic fluid act as buffers to direct fetal injury from blunt trauma. As the gravid uterus increases in size, other abdominal viscera are relatively protected from penetrating injury, whereas the likelihood of uterine injury increases. 3. Appropriate volume resuscitation should be given to correct and prevent maternal and fetal hypovolemic shock. Assess and resuscitate the mother first, and then assess the fetus before conducting a secondary survey of the mother. 4. A search should be made for conditions unique to the injured pregnant patient, such as blunt or penetrating uterine trauma, abruptio placentae, amniotic fluid embolism, isoimmunization, and premature rupture of membranes. 5. Minor degrees of fetomaternal hemorrhage are capable of sensitizing the Rh-negative mother. All pregnant Rh-negative trauma patients should receive Rh immunoglobulin therapy unless the injury is remote from the uterus. 6. Presence of indicators that suggest intimate partner violence should serve to initiate further investigation and protection of the victim. Additional Resources ConceRNing Intimate pARtner Violence National Coalition Against Domestic Violence, PO Box 18749, Denver, CO 80218-0749; 303-839-1852 https://www.ted.com/talks/leslie_morgan_steiner _why_domestic_violence_victims_don_t_leave http://phpa.dhmh.maryland.gov/mch/Pages/IPV.aspx http://www.cdc.gov/violenceprevention/intimate partnerviolence/ http://www.cdc.gov/violenceprevention/pdf/ipv -nisvs-factsheet-v5-a.pdf Bibliography 1. ACEP Clinical Policies Committee and Clinical Policies Subcommittee on Early Pregnancy. American College of Emergency Physicians. Clinical policy: critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy. Ann Emerg Med 2003;41:122–133. 2. Adler G, Duchinski T, Jasinska A, et al. Fibrinogen fractions in the third trimester of pregnancy and in puerperium. Thromb Res 2000;97:405–410. 3. American College of Emergency Physicians. Clinical and Practice Management Resources. Trauma in the Obstetric Patient: A Bedside Tool. http://www.acep.org. Accessed May 16, 2016. 4. American College of Radiology. Practice Parameter. http://www.acr.org/~/media/ 9e2ed55531fc4b4fa53ef3b6d3b25df8.pdf. Accessed May 17, 2016. 5. Berry MJ, McMurray RG, Katz VL. Pulmonary and ventilatory responses to pregnancy, immersion, and exercise. J Appl Physiol 1989;66(2):857–862. 6. Chames MC, Perlman MD. Trauma during pregnancy: outcomes and clinical 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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172 CHAPTER 9 n Thermal Injuries Ch
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174 CHAPTER 9 n Thermal Injuries Pi
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176 CHAPTER 9 n Thermal Injuries th
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178 CHAPTER 9 n Thermal Injuries ju
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180 CHAPTER 9 n Thermal Injuries Im
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182 CHAPTER 9 n Thermal Injuries lo
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184 CHAPTER 9 n Thermal Injuries 4.
Page 239 and 240: 10 PEDIATRIC TRAUMA Injury remains
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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
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Page 310 and 311: Appendix A OCULAR TRAUMA OBJECTIVES
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Page 318 and 319: Appendix B HYPOTHERMIA AND HEAT INJ
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Page 328 and 329: Appendix C TRAUMA CARE IN MASS-CASU
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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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