Advanced Trauma Life Support ATLS Student Course Manual 2018

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305 APPENDIX E n ATLS and Trauma Team Resource Management box e-1 checklist for the trauma team leader • Introduce the team and assign roles. • Identify the scribe. • Explain how the team will communicate and use time-outs. • Check results of investigations once performed (e.g., review CT scan report). • Make sure relatives are aware of what is happening. • Call additional specialist team members when needed. • Ensure that all team members adhere to universal precautions. • Ensure assistants are available to help team members. • Prioritize patient management during the primary survey. • Order appropriate diagnostic interventions and clinical procedures, and ensure that they are carried out rapidly and accurately. • Arrange for definitive care and communicate with receiving physician, when appropriate. • Check that documentation is inclusive. • Debrief the team. box e-2 team leader briefing the trauma team • Introduce yourself, and ensure all team members know you are the team leader. • Ask team members to introduce themselves to you and other members as they arrive. • Establish the skill levels of team members, especially their competency to perform practical procedures, and assign roles appropriately. Establish that nurse assistants are familiar with the environment, particularly the location of equipment. • Emphasize that important information about the primary survey must be communicated directly to you, the team leader. • Give clear instructions for any lifesaving procedures required during the primary survey, and establish the priority of these procedures. • Explain that “time-outs” occur at approximately 2, 5, and 10 minutes. These give the opportunity to review the condition of the patient and plan further resuscitation. • Allocate the role of scribe to a suitable member of the team and ensure that documentation is timely. • Ensure that team members use universal precautions to appropriately protect themselves from infectious hazards. • Explain the procedure for taking handover of the patient. • Ensure that team members know how to communicate important positive and negative findings during the primary survey, especially when the patient’s condition deteriorates. • Emphasize that team members who need additional support, equipment, drugs, or resources must communicate directly to you, the team leader. • Greet any additional providers who arrive to assist the team, although their help may not be immediately required. Assign roles and responsibilities when appropriate. For example, a neurosurgical consultant may not be required during the primary survey, but may be necessary when deciding if a patient requires craniotomy or intracranial pressure monitoring. information to the team taking over without delay or prolonged discussion. The MIST mnemonic is an excellent handover tool that can be used in a time-pressured environment to ensure safe transfer of information without loss of important details: •• Mechanism •• Injuries sustained •• Signs •• Treatment and travel n BACK TO TABLE OF CONTENTS
306 APPENDIX E n ATLS and Trauma Team Resource Management Handover processes may vary by country and among healthcare institutions and municipalities; however, there are two main options: 1. The prehospital team hands over to the team leader while the trauma team transfers the patient to the ED setting and continues resuscitation. The team leader then relates the important information to his or her team during the primary survey. 2. The prehospital team hands over to the entire team on arrival in the ED. This process necessitates a brief period of silence as the team listens to the information. Either option is acceptable as long as information is handed over clearly and concisely (n BOX E-3). It can be helpful for the prehospital team to record the history of injury on a whiteboard to which the team and its leader can refer. This information may include an AMPLE history (see Chapter 1: Initial Assessment and Management). Directing the Team and Responding to Information The team leader is responsible for directing the team and responding to information during patient care. Because he or she must maintain overall supervision at all times and respond rapidly to information from the team, the team leader does not become involved in performing clinical procedures. box e-3 taking handover from the prehospital team The leader gives clear instructions regarding procedures, ensures that they are performed safely and according to ATLS® principles. He or she makes decisions regarding adjuncts to the primary survey, directs reevaluation when appropriate, and determines how to respond to any unexpected complications, such as failed intubation or vascular access, by advising team members what to do next or calling in additional resources. The team leader also arranges appropriate definitive care, ensures that transfer is carried out safely and promptly, and oversees patient handover to the doctor providing definitive care. The SBAR acronym provides a standard template to ensure inclusion of all pertinent information when communicating with referring or receiving facilities (see Chapter 13 Transfer to Definitive Care). Debriefing the Team The team debriefing offers an opportunity for team members to reflect on the care provided to the patient. Areas of success and areas that require improvement can be identified that may improve future team performance. Ideally, the team debriefing occurs immediately or as soon as possible after the event and includes all team members. Follow a recognized protocol that includes questions such as: •• What went well? •• What could we have done differently? •• What have we learned for next time? •• Are there any actions we need to take before next time (e.g., receiving special training, requesting additional resources or equipment? • Ask for silence from the team. • Direct one person to speak at a time. • Ensure that an immediate lifesaving procedure is not needed (e.g., management of obstructed airway). • Use tools such as MIST and AMPLE to ensure complete information is gathered. • Focus on the ABCDEs, and establish which interventions have been performed and how the patient has responded. • Make note of critical time intervals, such as time for extrication and transport. • Record contact information for the patient’s family/friends. Talking with the Patient’s Family/Friends The trauma team leader is responsible for communicating with the patient’s family/friends about the patient’s injuries and immediate care. Therefore, the team leader should be an individual who is experienced in talking to patients and relatives about difficult situations. If necessary, team leaders can seek further training in these skills. Resuscitation of patients with major trauma is one of the most difficult areas of communication between doctors and families. The team leader should ensure that communication lines with the relatives are maintained at all times while continuing to lead the team and ensure the best possible trauma care. This work can be one of the most 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 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
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
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Page 370 and 371: Appendix F TRIAGE SCENARIOS OBJECTI
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Page 390 and 391: Skill Station A AIRWAY Part 1: Basi
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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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