Advanced Trauma Life Support ATLS Student Course Manual 2018

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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
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