Advanced Trauma Life Support ATLS Student Course Manual 2018

361
APPENDIX G n Skills
STEP 4
STEP 5
STEP 6
STEP 7
STEP 8
Assess the gyri and sulci for symmetry.
Look for subdural hematomas and
epidural hematomas.
Assess the cerebral and cerebellar
hemispheres. Compare side to side for
density and symmetry. Look for areas of high
attenuation that may represent contusion
or shearing injury.
Assess the ventricles. Look for symmetry
or distortion. Increased density represents
intraventricular hemorrhage.
Determine shifts. Hematoma or swelling
can cause midline shift. A shift of more than
5 mm is considered indicative of the need
for surgery.
Assess the maxillofacial structures. Look
for fractures and fluid in the sinuses.
Remember the four things that cause increased
density: contrast, clot, cellularity
(tumor), and calcification.
STEP 3. Assess the cartilage, including examining
the cartilaginous disk spaces for narrowing
or widening.
STEP 4. Assess the dens.
A. Examine the outline of the dens.
B. Examine the predental space (3 mm).
C. Examine the clivus; it should point to the dens.
STEP 5. Assess the extraaxial soft tissues.
A. Examine the extraaxial space and soft tissues:
••
7 mm at C3
••
3 cm at C7
Links to Future LeARNing
“New” Glasgow Coma Scale: www.glasgowcomascale.org
Note: Before interpreting the x-ray, confirm the patient
name and date of examination.
STEP 1.
Evaluation of Cervical
Spine images
Assess adequacy and alignment.
A. Identify the presence of all 7 cervical
vertebrae and the superior aspect
of T1.
B. Identify the
••
Anterior vertebral line
••
Anterior spinal line
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Posterior spinal line
••
Spinous processes
STEP 2. Assess the bone.
A. Examine all vertebrae for preservation of
height and integrity of the bony cortex.
B. Examine facets.
C. Examine spinous processes.
Brain Trauma Foundation Guidelines: Carney M,
Totten AM, Reilly C, Ullman JS et al. “Guidelines for
the Management of Severe Traumatic Brain Injury,
4th Edition” 2016: Brain Trauma Foundation. www.
braintrauma.org
“New Orleans Criteria” for CT scanning in minor
head injury: Haydel MJ, Preston CA, Mills TJ, Luber S,
Blaudeau E, DeBlieux PMC. Indications for computed
tomography in patients with minor head injury. N Engl
J Med. 2000;343:100-105
“Canadian Head CT rules”:
••
Stiell IG, Lesiuk H, Wells GA, et al. The
Canadian CT Head Rule Study for patients
with minor head injury: rationale, objectives,
and methodology for phase I (derivation).
Ann Emerg Med. 2001;38:160-169. 25. Stiell
IG, Lesiuk H, Wells GA, et al. Canadian CT
Head Rule Study for patients with minor head
injury: methodology for phase II (validation
and economic analysis). Ann Emerg Med.
2001;38:317-322.
••
NEXUS criteria: Hoffman JR, Wolfson AB, Todd
K, Mower WR (1998). “Selective cervical spine
radiography in blunt trauma: methodology
of the National Emergency X-Radiography
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