Advanced Trauma Life Support ATLS Student Course Manual 2018

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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
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