Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX D n Disaster Preparedness and Response
••
Gross decontamination consists of removing
the patient’s clothing and jewelry and, if
possible, irrigating the patient’s entire body
with water. Casualties may be rinsed off with
water hoses and sprays. This type of decontamination
is often used in mass-casualty events.
••
Full decontamination (ambulatory or nonambulatory)
is more time-consuming and
expensive. Many hospitals use portable
decontamination tents for this purpose.
Pitfall
Contamination of facility,
leading to quarantine
prevention
• Identify patients
that require
decontamination.
• Decontaminate patients
that require it before
admission to the facility.
• Ensure that
providers performing
decontamination are
properly trained and
wearing appropriate
PPE for the agent
involved.
• Assign security personnel
to protect entrances
to prevent
unintended admission of
contaminated patients.
people and are a particular challenge for trauma team
members. These devices are sometimes packed with
projectiles that result in multiple penetrating injuries.
The blast wind is capable of tossing the victim into
stationary objects. Blast injuries thereby involve
both blunt and penetrating trauma. Lastly, structural
collapse can result in crush injuries, significant
debris inducing airway and breathing problems, and
fire which can result in thermal injury. Knowledge
of ATLS guidelines for managing traumatic injuries
is essential for providers in treatment of such
complex injuries.
Mechanisms of blast injury include:
••
Primary Blast Injury—Injuries that result
from the direct effects of the blast wave and
affect mainly gas-containing organs: the
gastrointestinal tract, the lung, and the
middle ear.
••
Secondary Blast Injury—Injuries resulting from
patients being struck by objects and debris that
have been accelerated by the explosion. IEDs
and other explosive devices are often packed
with screws, bolts, or other sharp objects.
••
Tertiary Blast Injury—Injuries resulting from
the victims being thrown by the high winds
produced by the blast waves.
••
Quaternary Blast Injury—All other injuries
caused by explosives such as burns, crush
injuries, and toxic inhalations (carbon
monoxide, dust, hot gases).
Specific Injury Types
The following are descriptions of the key features,
special considerations, and treatment guidelines for
blast, chemical, and radioactive injuries and illnesses.
Blast Injuries
Blast injuries are multisystem life-threatening
injuries that are caused by explosions. The blast wave
is a supersonic overpressure shock wave created
by high-order explosives. This wave can produce
injury at air fluid interfaces so potentially can result
in lung and gastrointestinal injury. Improvised
explosive devices (IEDs) are homemade bombs and/
or destructive devices designed to kill or incapacitate
Prognostic factors that affect mortality and morbidity
include victim orientation to the blast, magnitude of
the blast, environment of the blast (outdoor vs. indoor
vs. underwater), structural collapse, triage accuracy,
and available medical resources.
Chemical Injuries and Illnesses
There are several special considerations in the care
of chemical injuries and illnesses, whether nerve
agents, asphyxiant agents, pulmonary agents, or
vesicant agents.
Nerve agents (e.g., Tabun [GA], Sarin [GB], Soman
[GD], and VX) enter the body either percutaneously
(through the skin) or by inhalation (through the
lungs). They affect the cholinergic nervous system,
both the muscarinic system (smooth muscles and
exocrine glands) and nicotinic system (skeletal
muscles, pre-ganglionic nerves, adrenal medulla).
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