Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX G n Skills
manual traction on the leg. The bottom
strap should be slightly shorter than, or
at least the same length as, the two upper
crossing straps.
STEP 9. Attach the ankle hitch to the traction hook
while an assistant maintains manual traction
and support. Apply traction in increments,
using the windlass knob until the extremity
appears stable or until pain and muscle
spasm are relieved.
STEP 10. Recheck the pulse after applying the
traction splint. If perfusion of the extremity
distal to the injury appears worse after
applying traction, gradually release it.
STEP 11. Secure the remaining straps.
STEP 12. Frequently reevaluate the neurovascular
status of the extremity. Document the
patient’s neurovascular status after every
manipulation of the extremity.
Placement of Intraosseous
Device, HumeRAl Insertion
STEP 1. Flex the patient’s elbow and internally
rotate the arm, placing the patient’s hand
on the abdomen with the elbow close to the
body and the hand pronated. The insertion
site is the most prominent aspect of the
greater tubercle.
STEP 2. Use your thumb(s) to slide up the anterior
shaft of the humerus until you can feel the
greater tubercle, about 1 cm (1/3 in.) above
the surgical neck.
STEP 3. Prepare the site by using an antiseptic
solution.
STEP 4. Remove the needle cap and aim the needle
tip downward at a 45-degree angle to the
horizontal plane. The correct angle will
result in the needle hub lying perpendicular
to the skin. Push the needle tip through the
skin until the tip rests against the bone. The
5-mm mark must be visible above the skin
for confirmation of adequate needle length.
STEP 5. Gently drill into the humerus 2 cm (3/4 in.)
or until the hub reaches the skin in an adult.
Stop when you feel the “pop” or “give” in
infants. (When using a needle not attached to
a drill, orient the needle perpendicular to the
entry site and apply pressure in conjunction
with a twisting motion until a “loss of
resistance” is felt as the needle enters the
marrow cavity.)
STEP 6. Hold the hub in place and pull the driver
straight off. Continue to hold the hub
while twisting the stylet off the hub with
counterclockwise rotations. The needle
should feel firmly seated in the bone (first
confirmation of placement). Place the stylet
in a sharps container.
STEP 7. Place the EZ-Stabilizer dressing over the hub.
Attach a primed EZ-Connect extension
set to the hub, firmly secure by twisting
clockwise. Pull the tabs off the EZ-Stabilizer
dressing to expose the adhesive and apply
it to the skin.
STEP 8. Aspirate for blood/bone marrow (second
confirmation of placement).
STEP 9. Secure the arm in place across the abdomen.
STEP 10. Attach a syringe with saline to the needle
and flush, looking for swelling locally or
difficulty flushing. Inject with lidocaine if
the patient is alert and experiences pain
with infusion.
Placement of Intraosseous
Device, Proximal Tibial
iNsertion
STEP 1. Place the patient in the supine position.
Select an uninjured lower extremity, place
sufficient padding under the knee to effect
approximate 30-degree flexion of the
knee, and allow the patient’s heel to rest
comfortably on the gurney or stretcher.
STEP 2.
Identify the puncture site—the anteromedial
surface of the proximal tibia, approximately
one fingerbreadth (1 to 3 cm) below
the tubercle.
STEP 3. Cleanse the skin around the puncture site
well and drape the area.
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