Advanced Trauma Life Support ATLS Student Course Manual 2018

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283 APPENDIX C n Trauma Care in Mass-Casualty, Austere, and Operational Environments •• What protective equipment is needed to prevent hypothermia, eye injury, and ear/ hearing injury during transport? Implementation of ATLS-OE ATLS-OE is currently offered for all new military medical officer accessions, through the Defense Medical Readiness Training Institute and the Uniformed Service University, and will soon be made available to all military ATLS programs. Improving Survival from Active Shooter and IntentioNAl Mass-cAsualty Events From 2000 to 2013, there were 160 active shooter events with 1,043 casualties and 486 deaths in the United States. Similarly, during the period from 1983 to 2002, there were more than 36,000 explosive incidents in the United States with 6,000 injuries and nearly 700 deaths. Most concerning is that the incidence of active shooter events has risen in recent years, and the extreme lethality of these events cannot be ignored. The Hartford Consensus With these events in mind, in the aftermath of the tragic shootings at Sandy Hook Elementary School in Connecticut in 2012 and the Boston Marathon bombing in 2013, the Joint Committee to Develop a National Policy to Increase Survival from Active Shooter and Intentional Mass Casualty Events was established by the American College of Surgeons in collaboration with leaders from the various federal institutions including the National Security Council; U.S. military and federal law enforcement agencies; police, fire and emergency medical organizations; and several key healthcare organizations. The committee’s efforts have been a national call to action to address survivability of these events and to train first responders and the lay public in the control of hemorrhage. The committee’s recommendations are referred to as the Hartford Consensus, and currently consist of four reports: •• Hartford Consensus I: Improving Survival from Active Shooter Events (June 1, 2013) •• Hartford Consensus II: Active Shooter and Intentional Mass-Casualty Events (September 1, 2013) •• The Hartford Consensus III: Implementation of Bleeding Control (July 1, 2015) •• The Hartford Consensus IV: A Call for Increased National Resilience March 1, 2016 Given the high volatility of an active shooter event, the most important initial step is threat suppression by law enforcement personnel. However, the immediate priorities of rapid extremity hemorrhage control by trained first responders and expeditious transport of those with potentially noncompressible internal hemorrhage must be considered. Critical events in an integrated response to an active shooter event are represented by the acronym THREAT: •• Threat suppression •• Hemorrhage control •• Rapid Extrication •• Assessment by medical providers •• Transport to definitive care Using lessons learned from the military’s experience with TCCC, early external hemorrhage control must be the responsibility of the earliest person on scene, and law enforcement personnel should be trained and equipped to control bleeding with tourniquets and hemostatic agents. Similarly, EMS and fire personnel must shift operational tactics and develop new paradigms of emergency management coordination to push forward in support of rapid casualty evacuation. Stop the Bleed Campaign In response to these recommendations, the White House launched the “Stop the Bleed” initiative in October 2015, with the goal to provide bystanders of emergency situations with the tools and knowledge to stop lifethreatening bleeding. In a public health mandate similar to the widespread teaching of cardiopulmonary resuscitation (CPR) and the Heimlich maneuver, the lay public should be trained in immediate bleeding control, or “buddy aid.” Appropriate bleeding control equipment (gloves, tourniquets, hemostatic dressings) should be readily available to all emergency personnel and in publicly accessible “hemorrhage control kits” that are as readily accessible and as identifiable as automatic external defibrillators. Lastly, the training alone is not n BACK TO TABLE OF CONTENTS
284 APPENDIX C n Trauma Care in Mass-Casualty, Austere, and Operational Environments n FIGURE C-2 The Stop the Bleed Campaign empowers the lay responder to act. 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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190 CHAPTER 10 n Pediatric Trauma c
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192 CHAPTER 10 n Pediatric Trauma A
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194 CHAPTER 10 n Pediatric Trauma b
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196 CHAPTER 10 n Pediatric Trauma b
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198 CHAPTER 10 n Pediatric Trauma t
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200 CHAPTER 10 n Pediatric Trauma f
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202 CHAPTER 10 n Pediatric Trauma t
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204 CHAPTER 10 n Pediatric Trauma G
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206 CHAPTER 10 n Pediatric Trauma C
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208 CHAPTER 10 n Pediatric Trauma
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210 CHAPTER 10 n Pediatric Trauma 1
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212 CHAPTER 10 n Pediatric Trauma 6
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CHAPTER 11 Outline Objectives iNtro
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PRIMARY SURVEY WITH RESUSCITATION 2
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PRIMARY SURVEY WITH RESUSCITATION 2
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SPECIFIC INJURIES 221 table 11-6 ph
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BIBLIOGRAPHY 223 comprise only 12%
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12 TRAUMA IN PREGNANCY AND INTIMATE
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228 CHAPTER 12 n Trauma in Pregnanc
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230 CHAPTER 12 n Trauma in Pregnanc
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Page 293 and 294: 240 CHAPTER 13 n Transfer to Defini
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Page 310 and 311: Appendix A OCULAR TRAUMA OBJECTIVES
Page 312 and 313: 259 APPENDIX A n Ocular Trauma In c
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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 342 and 343: Appendix D DISASTER PREPAREDNESS AN
Page 344 and 345: 291 APPENDIX D n Disaster Preparedn
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 370 and 371: Appendix F TRIAGE SCENARIOS OBJECTI
Page 372 and 373: 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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