Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX G n Skills
STEP 1.
STEP 2.
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IV fluid and rate
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Other interventions completed
E. Background
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Event history
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AMPLE assessment
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Blood products
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Medications given (date and time)
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Imaging performed
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Splinting
F. Assessment
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Vital signs
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Pertinent physical exam findings
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Patient response to treatment
G. Recommendation
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Transport mode
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Level of transport care
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Meds intervention during transport
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Needed assessments and interventions
Helmet Removal
One person stabilizes the patient’s head and
neck by placing one hand on either side of
the helmet with the fingers on the patient’s
mandible. This position prevents slippage if
the strap is loose.
The second person cuts or loosens the helmet
strap at the D-rings.
STEP 3. The second person then places one hand
on the mandible at the angle, positioning
the thumb on one side and the fingers on
the other. The other hand applies pressure
from under the head at the occipital region.
This maneuver transfers the responsibility
for restricting cervical motion to the
second person.
STEP 4. The first person then expands the helmet
laterally to clear the ears and carefully
removes the helmet. If the helmet has a face
cover, remove this device first. If the helmet
STEP 5.
provides full facial coverage, the patient’s
nose will impede helmet removal. To clear
the nose, tilt the helmet backward and raise
it over the patient’s nose.
During this process, the second person must
restrict cervical spine motion from below to
prevent head tilt.
STEP 6. After removing the helmet, continue
restriction of cervical spine motion from
above, apply a cervical collar.
STEP 7. If attempts to remove the helmet result in
pain and paresthesia, remove the helmet
with a cast cutter. Also use a cast cutter to
remove the helmet if there is evidence of
a cervical spine injury on x-ray film or by
examination. Stabilize the head and neck
during this procedure; this is accomplished
by dividing the helmet in the coronal plane
through the ears. The outer, rigid layer
is removed easily, and the inside layer
is then incised and removed anteriorly.
Maintaining neutral alignment of the head
and neck, remove the posterior portions of
the helmet.
Detailed Neurological Exam
STEP 1. Examine the pupils for size, shape, and
light reactivity.
STEP 2. Reassess the new GCS score.
STEP 3. Perform a cranial nerve exam by having
patient open and close eyes; move eyes
to the right, left, up, and down; smile
widely; stick out the tongue; and shrug
the shoulders.
STEP 4. Examine the dermatomes for sensation
to light touch, noting areas where there
is sensory loss. Examine those areas for
sensation to pinprick, noting the lowest
level where there is sensation.
STEP 5.
Examine the myotomes for active movement
and assess strength (0–5) of movement,
noting if limited by pain.
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Raises elbow to level of shoulder—deltoid,
C5
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