Advanced Trauma Life Support ATLS Student Course Manual 2018

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CHAPTER 13 Outline Objectives iNtroduction Determining the Need for Patient Transfer • Transfer Factors • Timeliness of Transfer Treatment before Transfer tRANsfer Responsibilities • Referring Doctor • Receiving Doctor tRANsfer Protocols • Information from Referring Doctor • Information to Transferring Personnel • Documentation • Treatment during Transport Transfer Data Teamwork Chapter Summary BibliogRAphy Modes of Transportation OBJECTIVES After reading this chapter and comprehending the knowledge components of the ATLS provider course, you will be able to: 1. Identify injured patients who require transfer from a local receiving hospital to a facility capable of providing the necessary level of trauma care. 2. Describe the responsibilities of the referring and receiving doctors during the process of timely transfer to a higher level of care, to include physicianto-physician communication, documentation, and determination of mode of transport. 3. Identify patients who require further timely imaging and/or stabilization before transfer. 4. Recognize the need to provide ongoing care during transfer to ensure the patient arrives at the receiving hospital in the best possible condition. n BACK TO TABLE OF CONTENTS 241
242 CHAPTER 13 n Transfer to Definitive Care The Advanced Trauma Life Support® course is designed to train clinicians to be proficient in assessing, stabilizing, and preparing trauma patients for definitive care. Definitive trauma care, whether support and monitoring in an intensive care unit (ICU), admission to an unmonitored unit, or operative intervention, requires the presence and active involvement of a team of providers with the skills and knowledge to manage the injuries sustained by the trauma patient. If definitive care cannot be provided at a local hospital, transfer the patient to the closest appropriate hospital that has the resources and capabilities to care for the patient. Ideally, this facility should be a verified trauma center at a level that is appropriate to the patient’s needs. The decision to transfer a patient to another facility depends on the patient’s injuries and the local resources. Decisions about which patients need to be transferred and when and how the transfer will occur are based on medical judgment. Evidence supports the view that trauma outcome is enhanced if critically injured patients are treated in trauma centers. See ACS COT Resources for Optimal Care of the Injured Patient; Guidelines for Trauma System Development and Trauma Center Verification Processes and Standards. The major principle of trauma management is to do no further harm. Indeed, the level of care of trauma patients should consistently improve with each step, from the scene of the incident to the facility that offers the patient necessary and proper definitive treatment. Determining the Need for pAtient Transfer The vast majority of patients receive their total care in a local hospital, and movement beyond that point is not necessary. It is essential that clinicians assess their own capabilities and limitations, as well as those of their institution, to allow for early differentiation between patients who may be safely cared for in the local hospital and those who require transfer for definitive care. hemodynamic abnormalities may be less obvious. Therefore, diligence in recognizing the need for early transfer is critical. To assist clinicians in determining which patients require care at a higher-level facility, the ACS Committee on Trauma recommends using certain physiological indices, injury mechanisms and patterns, and historical information. These factors also help clinicians decide which stable patients might benefit from transfer. Suggested guidelines for interhospital transfer when a patient’s needs exceed available resources are outlined in n TABLE 13-1. It is important to note that these guidelines are flexible and must take into account local circumstances. Certain clinical measurements of physiologic status are useful in determining the need for transfer to an institution that provides a higher level of care. Patients who exhibit evidence of shock, significant physiologic deterioration, or progressive deterioration in neurologic status require the highest level of care and will likely benefit from timely transfer (n FIGURE 13-1). Stable patients with blunt abdominal trauma and documented liver or spleen injuries may be candidates for nonoperative management, requiring the immediate availability of an operating room and a qualified surgical team. A general or trauma surgeon should supervise nonoperative management, regardless of the patient’s age. If the facility is not prepared for urgent operative intervention, these patients should be transferred to a trauma center. Patients with specific injuries, combinations of injuries (particularly those involving the brain), and/or a history indicating high-energy-transfer injury may be at risk for death and are candidates for early transfer to a trauma center. Elderly patients should be considered for transfer for less severe injuries (e.g., multiple rib fractures and patients on anticoagula- Transfer Factors Patients who require prompt transfer can be identified on the basis of physiologic measurements, specific identifiable injuries, and mechanism of injury. Patients with severe head injury (GCS score of 8 or less) and hypotension are easily recognized and warrant urgent transfer. However, the need to transfer patients with multiple injuries without obvious n FIGURE 13-1 Trauma teams rapidly assess patients to determine the need for transfer to a higher level of care. 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.
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10 PEDIATRIC TRAUMA Injury remains
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188 CHAPTER 10 n Pediatric Trauma I
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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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Page 342 and 343: 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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