Advanced Trauma Life Support ATLS Student Course Manual 2018

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xxxv COURSE OVERVIEW 8. Chile (ACS Chapter and Committee on Trauma) 9. Colombia (ACS Chapter and Committee on Trauma) 10. Costa Rica (College of Physicians and Surgeons of Costa Rica) 11. Cuba (Brazilian Committee on Trauma) 12. Curaçao (ACS Chapter and Committee on Trauma) 13. Cyprus (Cyprus Surgical Society) 14. Czech Republic (Czech Trauma Society) 15. Denmark (ATLS Denmark Fond) 16. Ecuador (ACS Chapter and Committee on Trauma) 17. Egypt (Egyptian Society of Plastic and Reconstructive Surgeons) 18. Estonia (Estonia Surgical Association) 19. Fiji and the nations of the Southwest Pacific (Royal Australasian College of Surgeons) 20. France (Société Française de Chirurgie d’Urgence) 21. Georgia (Georgian Association of Surgeons) 22. Germany (German Society for Trauma Surgery and Task Force for Early Trauma Care) 23. Ghana (Ghana College of Physicians and Surgeons) 24. Greece (ACS Chapter and Committee on Trauma) 25. Grenada (Society of Surgeons of Trinidad and Tobago) 26. Haiti (Partnership with Region 14) 27. Honduras (Asociacion Quirurgica de Honduras) 28. Hong Kong (ACS Chapter and Committee on Trauma) 29. Hungary (Hungarian Trauma Society) 30. India (Association for Trauma Care of India) 31. Indonesia (Indonesian Surgeons Association) 32. Iran (Persian Orthopedic and Trauma Association) 33. Ireland (Royal College of Surgeons in Ireland) 34. Israel (Israel Surgical Society) 35. Italy (ACS Chapter and Committee on Trauma) 36. Jamaica (ACS Chapter and Committee on Trauma) 37. Jordan (Royal Medical Services/NEMSGC) 38. Kenya (Surgical Society of Kenya) 39. Kingdom of Saudi Arabia (ACS Chapter and Committee on Trauma) 40. Kuwait (Kingdom of Saudi Arabia ACS Chapter and Committee on Trauma) 41. Lebanon (Lebanese Chapter of the American College of Surgeons) 42. Lithuania (Lithuanian Society of Traumatology and Orthopaedics) 43. Malaysia (College of Surgeons, Malaysia) 44. Mexico (ACS Chapter and Committee on Trauma) 45. Moldova (Association of Traumatologists and Orthopedics of Republic of Moldova - ATORM) 46. Mongolia (Mongolian Orthopedic Association and National Trauma and Orthopedic Referral Center of Mongolia) 47. Myanmar (Australasian College of Emergency Medicine, International Federation for Emergency Medicine and Royal Australasian College Of Surgeons. The local stakeholders included the Myanmar Department of Health and Department of Medical Science). 48. Netherlands, The (Dutch Trauma Society) 49. New Zealand (Royal Australasian College of Surgeons) 50. Nigeria (Nigerian Orthopaedic Association) 51. Norway (Norwegian Surgical Society) 52. Oman (Oman Surgical Society) 53. Pakistan (College of Physicians and Surgeons Pakistan) 54. Panama (ACS Chapter and Committee on Trauma) 55. Papua New Guinea (Royal Australasian College of Surgeons) 56. Paraguay (Sociedad Paraguaya de Cirugía) 57. Peru (ACS Chapter and Committee on Trauma) 58. Philippines (Philippine College of Surgeons) 59. Portugal (Portuguese Society of Surgeons) 60. Qatar (Kingdom of Saudi Arabia ACS Chapter and Committee on Trauma) 61. Republic of China, Taiwan (Surgical Association of the Republic of China, Taiwan) 62. Republic of Singapore (Chapter of Surgeons, Academy of Medicine) 63. Slovenia (Slovenian Society of Trauma Surgeons) 64. Republic of South Africa (South African Trauma Society) 65. Somoa (Royal Australasian College of Surgeons) 66. Spain (Spanish Society of Surgeons) 67. Sri Lanka (College of Surgeons, Sri Lanka) 68. Sweden (Swedish Society of Surgeons)
xxxvi COURSE OVERVIEW 69. Switzerland (Swiss Society of Surgeons) 70. Syria (Center for Continuing Medical and Health Education) 71. Taiwan (Taiwan Surgical Association) 72. Thailand (Royal College of Surgeons of Thailand) 73. Trinidad and Tobago (Society of Surgeons of Trinidad and Tobago) 74. United Arab Emirates (Surgical Advisory Committee) 75. United Kingdom (Royal College of Surgeons of England) 76. United States, U.S. territories (ACS Chapters and State Committees on Trauma) 77. Uruguay (Uruguay Society of Surgery) 78. Venezuela (ACS Chapter and Committee on Trauma) The Concept The concept behind the ATLS course has remained simple. Historically, the approach to treating injured patients, as taught in medical schools, was the same as that for patients with a previously undiagnosed medical condition: an extensive history including past medical history, a physical examination starting at the top of the head and progressing down the body, the development of a differential diagnosis, and a list of adjuncts to confirm the diagnosis. Although this approach was adequate for a patient with diabetes mellitus and many acute surgical illnesses, it did not satisfy the needs of patients suffering life-threatening injuries. The approach required change. Three underlying concepts of the ATLS Program were initially difficult to accept: 1. Treat the greatest threat to life first. 2. Never allow the lack of definitive diagnosis to impede the application of an indicated treatment. 3. A detailed history is not essential to begin the evaluation of a patient with acute injuries. The result was the development of the ABCDE approach to evaluating and treating injured patients. These concepts also align with the observation that the care of injured patients in many circumstances is a team effort that allows medical personnel with special skills and expertise to provide care simultaneously with surgical leadership of the process. The ATLS course emphasizes that injury kills in certain reproducible time frames. For example, the loss of an airway kills more quickly than does loss of the ability to breathe. The latter kills more quickly than loss of circulating blood volume. The presence of an expanding intracranial mass lesion is the next most lethal problem. Thus, the mnemonic ABCDE defines the specific, ordered evaluations and interventions that should be followed in all injured patients: Airway with restriction of cervical spine motion Breathing Circulation, stop the bleeding Disability or neurologic status Exposure (undress) and Environment (temperature control) The Course The ATLS course emphasizes the rapid initial assessment and primary treatment of injured patients, starting at the time of injury and continuing through initial assessment, lifesaving intervention, reevaluation, stabilization, and, when needed, transfer to a trauma center. The course consists of precourse and postcourse tests, core content, interactive discussions, scenario-driven skill stations, lectures, interactive case presentations, discussions, development of lifesaving skills, practical laboratory experiences, and a final performance proficiency evaluation. Upon completing the course, participants should feel confident in implementing the skills taught in the ATLS course. The Impact ATLS training in a developing country has resulted in a decrease in injury mortality. Lower per capita rates of deaths from injuries are observed in areas where providers have ATLS training. In one study, a small trauma team led by a doctor with ATLS experience had equivalent patient survival when compared with a larger team with more doctors in an urban setting. In addition, there were more unexpected survivors than fatalities. There is abundant evidence that ATLS training improves the knowledge base, the psychomotor skills and their use in resuscitation, and the confidence and performance of doctors who have taken part in the program. The organization and procedural skills taught in the course are retained by course participants for at
Page 1 and 2: TENTH EDITION ATLS ® Advanced Trau
Page 3 and 4: Chair of Committee on Trauma: Ronal
Page 6: FOREWORD My first exposure to Advan
Page 9 and 10: viii PREFACE MyATLS Mobile Applicat
Page 11 and 12: x PREFACE Gary A. Vercruysse, MD, F
Page 13 and 14: xii PREFACE Jacqueline Bustraan, MS
Page 16 and 17: ACKNOWLEDGMENTS It is clear that ma
Page 18 and 19: xvii ACKNOWLEDGMENTS Bertil Bouillo
Page 20 and 21: xix ACKNOWLEDGMENTS Oscar Guillamon
Page 22 and 23: xxi ACKNOWLEDGMENTS Mahesh Misra, M
Page 24 and 25: xxiii ACKNOWLEDGMENTS James Vosswin
Page 26 and 27: xxv ACKNOWLEDGMENTS James A. Geilin
Page 28: xxvii ACKNOWLEDGMENTS Tone Slåke R
Page 31 and 32: xxx COURSE OVERVIEW m. Protection o
Page 33 and 34: xxxii COURSE OVERVIEW Atls and Trau
Page 35: xxxiv COURSE OVERVIEW a systematize
Page 39 and 40: xxxviii COURSE OVERVIEW United Stat
Page 41 and 42: xl COURSE OVERVIEW 67. Hendrickson
Page 43 and 44: xlii COURSE OVERVIEW 122. Palusci V
Page 46: BRIEF CONTENTS Foreword Preface Ack
Page 49 and 50: xlviii DETAILED CONTENTS Teamwork 5
Page 51: l DETAILED CONTENTS Introduction 21
Page 55 and 56: 1 INITIAL ASSESSMENT AND MANAGEMENT
Page 57 and 58: 4 CHAPTER 1 n Initial Assessment an
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Page 75 and 76: 2 AIRWAY AND VENTILATORY MANAGEMENT
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34 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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Appendix A OCULAR TRAUMA OBJECTIVES
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259 APPENDIX A n Ocular Trauma In c
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261 APPENDIX A n Ocular Trauma to t
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Appendix B HYPOTHERMIA AND HEAT INJ
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267 APPENDIX B n Hypothermia and He
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Appendix C TRAUMA CARE IN MASS-CASU
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277 APPENDIX C n Trauma Care in Mas
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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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