Advanced Trauma Life Support ATLS Student Course Manual 2018

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Skill Station C CIRCULATION LEARNING OBJECTIVES 1. Diagnose the presence of shock, both compensated and uncompensated. 2. Determine the type of shock present. 3. Choose the appropriate fluid resuscitation. 4. Demonstrate on a model the application of a staged approach to control external hemorrhage by using direct pressure, wound packing, and application of a tourniquet. 5. Demonstrate on a model placement of intraosseous access, and discuss other options for vascular access and their indications. indications and contraindications for the use of traction devices for femur fractures. 7. Recognize the need for patient reassessment and additional resuscitation based on the patient’s response to treatment. 8. Recognize which patients require definitive hemorrhage control (i.e., operative and/or catheter based) and/or transfer to a higher level of care. 9. Describe and demonstrate (optional) the indications and techniques of central intravenous access, peripheral venous cutdown, diagnostic peritoneal lavage (DPL), and pericardiocentesis. 6. Demonstrate the application of a pelvic stabilization device for pelvic fractures and understand the Skills Included in this Skill Station •• Wound Packing •• Application of Combat Application Tourniquet •• Application of Traction Splint (Demonstration) •• Placement of Intraosseous Device, Humeral Insertion •• Placement of Intraosseous Device, Proximal Tibial Insertion •• Application of Pelvic Binder or Other Pelvic Stabilization Device •• Diagnostic Peritoneal Lavage (DPL) —Optional Skill •• Femoral Venipuncture: Seldinger Technique— Optional Skill •• Subclavian Venipuncture: Infraclavicular Approach—Optional Skill •• Venous Cutdown—Optional Skill •• Pericardiocentesis Using Ultrasound—Optional Skill Wound Packing STEP 1. Fully expose the wound and cut clothing, if not previously done. STEP 2. Use gauze pads to mop bleeding and identify the general area that is bleeding. STEP 3. Place a stack of gauze pads over that area and press down firmly. Hold for 5-10 minutes if using gauze or 3 minutes if using hemostatic gauze. n BACK TO TABLE OF CONTENTS 349
350 APPENDIX G n Skills STEP 4. If bleeding is controlled, secure the gauze pads with roll gauze, an elastic bandage, or self-adhering wrap (3M Coban). Consult trauma, vascular, or orthopedic surgeon, based on injury type. STEP 5. If bleeding is not controlled and there is a cavity, use gloved finger or forceps to place gauze into wound, ensuring that the gauze reaches the base of the wound. Place more gauze until the wound is tightly packed. Hold pressure for an additional 3 minutes, and reassess. Gauze impregnated with a topical hemostatic agent can be used, if available. Gauze without a hemostatic agent may be just as effective for wound packing as gauze treated with a hemostatic agent. Large wounds may require multiple gauze dressings to fully pack the wound. Pack in as much gauze as will fit into the wound, and push in even more if you can. If these steps fail to control the bleeding, proceed with placing tourniquet while awaiting surgical consultation. Application of Combat Application TouRNiquet STEP 1. Insert the wounded extremity (arm or leg) through the combat application tourniquet (CAT). STEP 2. Place the tourniquet proximal to the bleeding site, as distal as possible. Do not place at a joint. STEP 3. Pull the self-adhering band tight, and securely fasten it back on itself. Be sure to remove all slack. STEP 4. Adhere the band around the extremity. Do not adhere the band past the clip. STEP 5. Twist the windlass rod until the bleeding has stopped. STEP 6. Ensure arterial bleeding is arrested. Tourniquet should be tight and painful if the patient is conscious. STEP 7. Lock the windlass rod in place in the windlass clip. Bleeding is now controlled. STEP 8. Adhere the remaining self-adhering band over the rod, through the windlass clip, and continue around the patient’s arm or leg as far as it will go. STEP 9. Secure the rod and the band with the windlass strap. Grasp the strap, pull it tight, and adhere it to the opposite hook on the windlass clip. STEP 10. Note the time the tourniquet was applied. If you have a marker, you can write it directly on the tourniquet. STEP 11. If the bleeding is not stopped with one tourniquet and it is as tight as you can get it, place a second one, if available, just above the first. Tighten it as before. STEP 1. Application of Traction Splint Consider need for analgesia before applying a traction splint, and select the appropriate splint to use. STEP 2. Measure splint to the patient’s unaffected leg for length. STEP 3. Ensure that the upper cushioned ring is placed under the buttocks and adjacent to the ischial tuberosity. The distal end of the splint should extend beyond the ankle by approximately 6 inches (15 cm). STEP 4. Align the femur by manually applying traction though the ankle. STEP 5. After achieving realignment, gently elevate the leg to allow the assistant to slide the splint under the extremity so that the padded portion of the splint rests against the ischial tuberosity. STEP 6. Reassess the neurovascular status of the injured extremity after applying traction. STEP 7. Ensure that the splint straps are positioned to support the thigh and calf. STEP 8. Position the ankle hitch around the patient’s ankle and foot while an assistant maintains 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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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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Page 350 and 351: 297 APPENDIX D n Disaster Preparedn
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Page 370 and 371: Appendix F TRIAGE SCENARIOS OBJECTI
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Page 392 and 393: 339 APPENDIX G n Skills One-Person
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Page 421: 368 APPENDIX G n Skills less than 1
Page 425 and 426: 372 APPENDIX G n Skills G. Inspect
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Page 431 and 432: 378 INDEX LTA for, 31-32, 32f Malla
Page 433 and 434: 380 INDEX atlanto-occipital disloca
Page 435 and 436: 382 INDEX Frostbite, 181-183, 182f
Page 437 and 438: 384 INDEX Kussmaul’s sign, 69 Lac
Page 439 and 440: 386 INDEX PEA. See Pulseless electr
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Page 443 and 444: 390 INDEX Tibial fractures, 163 Tou
Page 445 and 446: TRAUMA SCORES Correct triage is ess
Page 447 and 448: 394 TRAUMA SCORES on Field Triage,
Page 449 and 450: 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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