Advanced Trauma Life Support ATLS Student Course Manual 2018

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Skill Station D DISABILITY LEARNING OBJECTIVES 1. Perform a brief neurological examination, including calculating the Glasgow Coma Scale (GCS) score, performing a pupillary examination, and examining the patient for lateralizing signs. 2. Identify the utility and limitations of CT head decision tools. 3. Identify the utility and limitations of cervical spine imaging decision tools. 5. Identify the signs, symptoms, and treatment of neurogenic shock. 6. Demonstrate proper helmet removal technique. 7. Identify the signs and symptoms of spinal cord injury in a simulated patient. 8. Demonstrate the hand-over of a neurotrauma patient to another facility or practitioner. 4. Perform proper evaluation of the spine while restricting spinal motion, including evaluating the spine, logrolling the patient, removing the backboard, and reviewing cervical spine and head CT images. Skills Included in this Skill Station •• Brief or Focused Neurological Examination •• Evaluation of Cervical Spine •• Transfer Communication •• Helmet Removal •• Detailed Neurological Exam •• Removal of Spine Board •• Evaluation of Head CT Scans •• Evaluation of Cervical Spine Images Brief or Focused Neurological ExamiNAtion Examine Pupils STEP 2. Shine light into eyes and note pupillary response. Determine New GCS Score STEP 3. Assess eye opening. A. Note factors interfering with communication, ability to respond, and other injuries. B. Observe eye opening. C. If response is not spontaneous, stimulate patient by speaking or shouting. D. If no response, apply pressure on fingertip, trapezius, or supraorbital notch. E. Rate the response on a scale of not testable (NT), 1–4. STEP 1. Note size and shape of pupil. STEP 4. Assess verbal response. n BACK TO TABLE OF CONTENTS 357
358 APPENDIX G n Skills A. Note factors interfering with communication, ability to respond, and other injuries. B. Observe content of speech. C. If not spontaneous, stimulate by speaking or shouting. D. If no response, apply pressure on fingertip, trapezius, or supraorbital notch. E. Rate the response on a scale of NT, 1–5. STEP 5. Assess motor response. A. Note factors interfering with communication, ability to respond, and other injuries. B. Observe movements of the right and left sides of body. C. If response is not spontaneous, stimulate patient by speaking or shouting. D. If no response, apply pressure on fingertip, trapezius, or supraorbital notch (if not contraindicated by injury). E. Rate the response on a scale of NT, 1–6. STEP 6. Calculate total GCS score and record its individual components. Evaluate for Any Evidence of Lateralizing Signs STEP 7. Assess for movement of upper extremities. STEP 8. Determine upper extremity strength bilaterally, and compare side to side. STEP 2. Inform the patient that you are going to examine him or her. The patient should answer verbally rather than nodding the head. STEP 3. Palpate the posterior cervical spine for deformity, swelling, and tenderness. Note the level of any abnormality. Look for any penetrating wounds or contusions. If the cervical spine is nontender and the patient has no neurological deficits, proceed to Step 4. If not, stop, replace the cervical collar, and obtain imaging. STEP 4. Ask the patient to carefully turn his or her head from side to side. Note if there is pain, or any paresthesia develops. If not, proceed to Step 5. If yes, stop, reapply the cervical collar, and obtain imaging. STEP 5. Ask the patient to extend and flex his or her neck (i.e., say, “Look behind you and then touch your chin to your chest.”). Note if there is pain or any paresthesia develops. If not, and the patient is not impaired, head injured, or in other high-risk category as defined by NEXUS Criteria or the Canadian C-Spine Rule (CCR), discontinue using the cervical collar. If yes, reapply the cervical collar and obtain imaging. Transfer Communication STEP 1. Use the ABC SBAR method of ensuring complete communication. A. Airway B. Breathing STEP 9. Assess for movement of the lower extremities. C. Circulation STEP 10. Determine lower extremity strength bilaterally, and compare side to side. Evaluation of Cervical Spine STEP 1. Remove the front of the cervical collar, if present, while a second person restricts patient’s cervical spinal motion. D. Situation •• Patient name •• Age •• Referring facility •• Referring physician name •• Reporting nurse name •• Indication for transfer •• IV access site 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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Pitfall Inadequate security Failed
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Appendix E ATLS AND TRAUMA TEAM RES
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Page 370 and 371: Appendix F TRIAGE SCENARIOS OBJECTI
Page 372 and 373: 319 APPENDIX F n Triage Scenarios T
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Page 392 and 393: 339 APPENDIX G n Skills One-Person
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Page 404 and 405: 351 APPENDIX G n Skills manual trac
Page 406 and 407: 353 APPENDIX G n Skills STEP 3. Aft
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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
Page 427: 374 APPENDIX G n Skills in the inju
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
Page 441 and 442: 388 INDEX for musculoskeletal traum
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
Page 451 and 452: 398 INJURY PREVENTION providers to
Page 453 and 454: BIOMECHANICS OF INJURY Injuries occ
Page 455 and 456: 402 BIOMECHANICS OF INJURY Ejection
Page 457 and 458: 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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