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 •• 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 n BACK TO TABLE OF CONTENTS
362 APPENDIX G n Skills Utilization Study (NEXUS).”. Ann Emerg Med. 32 (4): 461–9. Canadian C-spine rules: •• Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17. 286(15):1841-8. •• Stiell IG, Clement CM, O’Connor A, Davies B, Leclair C, Sheehan P, et al. Multicentre prospective validation of use of the Canadian C-Spine Rule by triage nurses in the emergency department. CMAJ. 2010 Aug 10. 182(11):1173-9. Post-ATLS—Evaluate what procedures exist in your practice setting for rapidly evaluating patients for traumatic brain injury (TBI). Does your practice setting have a protocol for prevention of secondary brain injury once TBI is diagnosed? Also evaluate what procedures exist in your practice setting for spine immobilization. Are all staff members who deal with trauma patients adequately educated in these procedures? Evaluate your practice setting regarding how the cervical spine is evaluated and cleared (if appropriate). Are all staff members who evaluate trauma patients adequately educated in the existing, evidence-based criteria for evaluation and clearance of the cervical spine? n BACK TO TABLE OF CONTENTS
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- Page 402 and 403: Skill Station C CIRCULATION LEARNIN
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- Page 406 and 407: 353 APPENDIX G n Skills STEP 3. Aft
- Page 408: 355 APPENDIX G n Skills STEP 2. If
- Page 411 and 412: 358 APPENDIX G n Skills A. Note fac
- Page 413: 360 APPENDIX G n Skills •• Flex
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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
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- 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
- Page 459 and 460: 406 BIOMECHANICS OF INJURY in a 30-
- Page 461 and 462: 408 TETANUS IMMUNIZATION •• Wou
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362<br />
APPENDIX G n Skills<br />
Utilization Study (NEXUS).”. Ann Emerg Med. 32<br />
(4): 461–9.<br />
Canadian C-spine rules:<br />
••<br />
Stiell IG, Wells GA, Vandemheen KL, Clement<br />
CM, Lesiuk H, De Maio VJ, et al. The Canadian<br />
C-spine rule for radiography in alert and<br />
stable trauma patients. JAMA. 2001 Oct 17.<br />
286(15):1841-8.<br />
••<br />
Stiell IG, Clement CM, O’Connor A, Davies<br />
B, Leclair C, Sheehan P, et al. Multicentre<br />
prospective validation of use of the Canadian<br />
C-Spine Rule by triage nurses in the emergency<br />
department. CMAJ. 2010 Aug 10. 182(11):1173-9.<br />
Post-<strong>ATLS</strong>—Evaluate what procedures exist in your<br />
practice setting for rapidly evaluating patients for<br />
traumatic brain injury (TBI). Does your practice setting<br />
have a protocol for prevention of secondary brain injury<br />
once TBI is diagnosed? Also evaluate what procedures<br />
exist in your practice setting for spine immobilization.<br />
Are all staff members who deal with trauma patients<br />
adequately educated in these procedures? Evaluate<br />
your practice setting regarding how the cervical spine<br />
is evaluated and cleared (if appropriate). Are all staff<br />
members who evaluate trauma patients adequately<br />
educated in the existing, evidence-based criteria for<br />
evaluation and clearance of the cervical spine?<br />
n BACK TO TABLE OF CONTENTS
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