Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX G n Skills
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Flexes forearm—biceps, C6
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Extends forearm—triceps, C7
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Flexes wrist and fingers, C8
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Spreads fingers, T1
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Flexes hip—iliopsoas, L2
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Extends knee—quadriceps, L3–L4
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Flexes knee—hamstrings, L4–L5 to S1
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Dorsiflexes big toe—extensor hallucis
longus, L5
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Plantar flexes ankle—gastrocnemius, S1
STEP 6. Ideally, test patient’s reflexes at elbows,
knees, and ankles (this step is least
informative in the emergency setting).
Note: Properly securing the patient to a long spine board
is the basic technique for splinting the spine. In general,
this is done in the prehospital setting; the patient arrives
at the hospital with spinal motion already restricted by
being secured to a long spine board with cervical collar
in place and head secured to the long spine board. The
long spine board provides an effective splint and permits
safe transfers of the patient with a minimal number of
assistants. However, unpadded spine boards can soon
become uncomfortable for conscious patients and pose
a significant risk for pressure sores on posterior bony
prominences (occiput, scapulae, sacrum, and heels).
Therefore, the patient should be transferred from the spine
board to a firm, well-padded gurney or equivalent surface
as soon as it can be done safely. Continue to restrict spinal
motion until appropriate imaging and examination have
excluded spinal injury.
STEP 1.
STEP 2.
Removal of Spine Board
Assemble four people and assign roles: one to
manage the patient’s head and neck and lead
the movement; one to manage the torso; and
one to manage the hips and legs. The fourth
person will examine the spine, perform
the rectal exam, if indicated, and remove
the board.
Inform the patient that he or she will be turned
to the side to remove the board and examine
the back. Instruct the patient to place his
or her hands across the chest if able and to
respond verbally if he or she experiences pain
during examination of the back.
STEP 3.
Remove any blocks, tapes, and straps securing
the patient to the board, if not already
done. The lower limbs can be temporarily
secured together with roll gauze or tape to
facilitate movement.
STEP 4. All personnel assume their roles: The
head and neck manager places his or
her hands under the patient’s shoulders,
palms up, with elbows and forearms
parallel to the neck to prevent cervical
spinal motion. The torso manager places
his or her hands on the patient’s shoulder
and upper pelvis, reaching across the
patient. The third person crosses the
second person’s hand, placing one hand at
the pelvis and the other at the lower
extremities. (Note: If the patient has
fractures, a fifth person may need to be
assigned to that limb.)
STEP 5. The head and neck manager ensures the
team is ready to move, and then the team
moves the patient as a single unit onto his
or her side.
STEP 6. Examine the back.
STEP 7. Perform rectal examination, if indicated.
STEP 8. On the direction of the head and neck
manager, return the patient to the supine
position. If the extremities were tied or
taped, remove the ties.
Evaluation of Head CT ScANs
Note: The steps outlined here for evaluating a head CT
scan provide one approach to assessing for significant,
life-threatening pathology
STEP 1.
STEP 2
STEP 3
Confirm the images are of the correct patient
and that the scan was performed without
intravenous contrast.
Assess the scalp component for contusion
or swelling that can indicate a site of
external trauma.
Assess for skull fractures. Remember that
suture lines can be mistaken for fractures.
Missile tracts may appear as linear areas of
low attenuation.
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