Advanced Trauma Life Support ATLS Student Course Manual 2018

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Appendix E ATLS AND TRAUMA TEAM RESOURCE MANAGEMENT OBJECTIVES 1. Describe the configuration of a trauma team. 2. Identify the team leader’s roles and responsibilities. 3. Discuss the qualities of effective leadership. 6. Describe best communication practices among team members. 7. Describe areas of potential conflict within a trauma team and general principles for managing conflict. 4. List the roles and responsibilities of team members. 5. Describe how a team can work effectively to deliver ATLS. Despite advances in trauma care, primary threats to patient safety have been attributed to teamwork failures and communication breakdown. In the dynamic and unique emergency department (ED) environment, complex trauma care requires strong interprofessional teamwork and resource management. Success requires not only individual competence in Advanced Trauma Life Support (ATLS®) but also a wellcoordinated ATLS® trauma team. This appendix describes team resource management principles intended to make best use of available personnel, resources, and information. Team resource management is a set of strategies and plans for making the best use of available resources, information, equipment, and people. Historically ATLS® has concentrated on the best-practice assessment and management skills for an individual physician managing victims of major trauma. In fact, teams often provide trauma care; therefore, teamwork is a fundamental part of ATLS® provision. To function well as part of a team, an individual must be familiar with all the individual steps required to attain the best possible outcome. This appendix demonstrates how a clinician trained in ATLS® techniques can function with others to deliver excellent team care with a common goal. In today’s healthcare world, many teams have little chance to prepare or practice together; however, knowledge of team resource management gives every member of the trauma team ways to optimize team performance. This appendix also addresses how the ATLS® model fits comfortably with trauma team resource management, describes the qualities of an effective team leader, suggests ways to integrate trauma team members into new teams, and describes effective communication in this setting. For the purposes of this appendix, “leader” in an ATLS context is understood to represent the person managing, leading, or taking the dominant or directive role in resuscitating a victim of major trauma. Trauma Team ConfiguRAtion Trauma teams ideally are composed of a group of people who have no other commitment than to receive trauma patients. However in most institutions this is not possible, so teams need to be flexible and adapt to the resources available. A trauma team should at minimum consist of: •• Team leader (senior doctor experienced in trauma management) n BACK TO TABLE OF CONTENTS 303
304 APPENDIX E n ATLS and Trauma Team Resource Management •• Airway manager (provider skilled in airway management), referred to as Doctor A •• Airway assistant •• Second provider, referred to as Doctor B •• Two nurses, referred to as Assistant A and Assistant B Additional staff should include, where possible: •• A scribe/coordinator •• Transporters/technicians/nursing assistants •• Radiology support •• Specialist (e.g., neurosurgeon, orthopedic surgeon, vascular surgeon) The team should have access to other areas of the hospital, including the CT scanner, angiography suite, operating rooms, and intensive care facilities. Composition of the team and backup resources vary from country to country and among institutions. However, the team composition and standard operating procedures — including protocols for transfer to other facilities — should always be agreed upon and in place in advance of receiving patients. CHARActeRISTICS OF A SUCCESSFUL Atls® TEAM A successful and effective trauma team requires a good leader with experience not just in managing clinical cases but also in leading and directing the team. Trauma team leaders may not necessarily be the most senior clinicians available. Of more importance is their experience in providing care according to ATLS® principles, particularly their exposure to a wide spectrum of clinical scenarios. They require broad knowledge concerning how to handle challenging situations and the ability to direct the team while making crucial decisions. They must be prepared to take ultimate responsibility for team actions. Regardless of their clinical background, team leaders and their team members share a common goal: to strive for the best possible outcome for the patient. Principles of communication can be challenged in stressful situations with critically ill or injured patients. However, communication between the team leader and team members is vital and a key factor of a successful trauma team. Communication encompasses information about the patient’s physical state (according to the ABCDEs) and directions from the team leader in response to this information. Frequently, additional members join the team after resuscitation has begun. The team leader must then communicate to incoming team members the roles they will perform and what their contributions should be. (Additional information about communication within a trauma team is provided later in this appendix.) Many trauma teams have no opportunity to train or work as a consistent team, so cohesion and mutual respect may be more difficult to foster. ATLS® gives team members a common language for understanding each other’s actions and thought processes, particularly when prioritizing interactions during the primary survey. Feedback—“after-action” review or debriefing once the patient has been transferred to definitive care—can be valuable in reinforcing effective team behavior and highlighting areas of excellence. Equally, it can provide individuals with opportunities to share opinions and discuss management. Roles AND RespoNSIBILITIES of THE TEAM LEAdeR The team leader is ultimately responsible for the team and its work. Several elements of team leadership can affect the team’s efficacy as well as the clinical outcome. These include preparing the team, receiving the handover, directing the team, responding to information, debriefing the team, and talking with the patient’s family/friends. A checklist for the trauma team leader is presented in n BOX E-1. Preparing the Team Preparation is one of the team leader’s most important roles. n BOX E-2 summarizes the process for briefing the trauma team. Receiving the Handover The act of handover involves relinquishing authority (or property) from one control agency to another. In medicine, this often means the transfer of professional responsibility and accountability. In managing victims of major trauma, the central handover is usually between the prehospital care staff and the trauma team leader in the emergency department (ED). It is critical to relay important and relevant 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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240 CHAPTER 13 n Transfer to Defini
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Page 303 and 304: 250 CHAPTER 13 n Transfer to Defini
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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
Page 320 and 321: 267 APPENDIX B n Hypothermia and He
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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Page 370 and 371: Appendix F TRIAGE SCENARIOS OBJECTI
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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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