Advanced Trauma Life Support ATLS Student Course Manual 2018
Skill Station F SECONDARY SURVEY LEARNING OBJECTIVES 1. Assess a simulated multiply injured patient by using the correct sequence of priorities and management techniques for the secondary survey assessment of the patient. 2. Reevaluate a patient who is not responding appropriately to resuscitation and management. 3. Demonstrate fracture reduction in a simulated trauma patient scenario. 4. Demonstrate splinting a fracture in a simulated trauma patient scenario. 5. Evaluate a simulated trauma patient for evidence of compartment syndrome. 6. Recognize the patient who will require transfer to definitive care. 7. Apply a cervical collar. •• Perform a Secondary Survey in a Simulated Trauma Patient •• Reduce and Splint a Fracture in a Simulated Trauma Patient •• Apply a Cervical Collar in a Simulated Trauma Patient •• Evaluate for the Presence of Compartment Syndrome STEP 1. Skills Included in this Skill Station Perform Secondary Survey in a Simulated tRAuma Patient Obtain AMPLE history from patient, family, or prehospital personnel. •• A—allergies •• M—medications •• P—past history, illnesses, and pregnancies •• L—last meal •• E—environment and exposure STEP 2. Obtain history of injury-producing event and identify injury mechanisms. HEAD AND MAXILLOFACIAL STEP 3. Assess the head and maxillofacial area. A. Inspect and palpate entire head and face for lacerations, contusions, fractures, and thermal injury. B. Reevaluate pupils. C. Reevaluate level of consciousness and Glasgow Coma Scale (GCS) score. D. Assess eyes for hemorrhage, penetrating injury, visual acuity, dislocation of lens, and presence of contact lenses. E. Evaluate cranial nerve function. F. Inspect ears and nose for cerebrospinal fluid leakage. n BACK TO TABLE OF CONTENTS 371
372 APPENDIX G n Skills G. Inspect mouth for evidence of bleeding and cerebrospinal fluid, soft-tissue lacerations, and loose teeth. CERVICAL SPINE AND NECK STEP 4. Assess the cervical spine and neck. CHEST A. Inspect for signs of blunt and penetrating injury, tracheal deviation, and use of accessory respiratory muscles. B. Palpate for tenderness, deformity, swelling, subcutaneous emphysema, tracheal deviation, and symmetry of pulses. C. Auscultate the carotid arteries for bruits. D. Restrict cervical spinal motion when injury is possible. STEP 5. Assess the chest. ABDOMEN A. Inspect the anterior, lateral, and posterior chest wall for signs of blunt and penetrating injury, use of accessory breathing muscles, and bilateral respiratory excursions. B. Auscultate the anterior chest wall and posterior bases for bilateral breath sounds and heart sounds. C. Palpate the entire chest wall for evidence of blunt and penetrating injury, subcutaneous emphysema, tenderness, and crepitation. D. Percuss for evidence of hyperresonance or dullness. STEP 6. Assess the abdomen. A. Inspect the anterior and posterior abdomen for signs of blunt and penetrating injury and internal bleeding. B. Auscultate for the presence of bowel sounds. C. Percuss the abdomen to elicit subtle rebound tenderness. D. Palpate the abdomen for tenderness, involuntary muscle guarding, unequivocal rebound tenderness, and a gravid uterus. PERINEUM/RECTUM/VAGINA STEP 7. Assess the perineum. Look for •• Contusions and hematomas •• Lacerations •• Urethral bleeding STEP 8. Perform a rectal assessment in selected patients to identify the presence of rectal blood. This includes checking for: •• Anal sphincter tone •• Bowel wall integrity •• Bony fragments STEP 9. Perform a vaginal assessment in selected patients. Look for •• Presence of blood in vaginal vault •• Vaginal lacerations MUSCULOSKELETAL STEP 10. Perform a musculoskeletal assessment. •• Inspect the upper and lower extremities for evidence of blunt and penetrating injury, including contusions, lacerations, and deformity. •• Palpate the upper and lower extremities for tenderness, crepitation, abnormal movement, and sensation. •• Palpate all peripheral pulses for presence, absence, and equality. •• Assess the pelvis for evidence of fracture and associated hemorrhage. • • Inspect and palpate the thoracic and lumbar spines for evidence of blunt and penetrating injury, including contusions, n BACK TO TABLE OF CONTENTS
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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
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- Page 449 and 450: 396 INJURY PREVENTION Safety Admini
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372<br />
APPENDIX G n Skills<br />
G. Inspect mouth for evidence of bleeding and<br />
cerebrospinal fluid, soft-tissue lacerations,<br />
and loose teeth.<br />
CERVICAL SPINE AND NECK<br />
STEP 4. Assess the cervical spine and neck.<br />
CHEST<br />
A. Inspect for signs of blunt and penetrating<br />
injury, tracheal deviation, and use of<br />
accessory respiratory muscles.<br />
B. Palpate for tenderness, deformity, swelling,<br />
subcutaneous emphysema, tracheal deviation,<br />
and symmetry of pulses.<br />
C. Auscultate the carotid arteries for bruits.<br />
D. Restrict cervical spinal motion when injury<br />
is possible.<br />
STEP 5. Assess the chest.<br />
ABDOMEN<br />
A. Inspect the anterior, lateral, and<br />
posterior chest wall for signs of blunt<br />
and penetrating injury, use of accessory<br />
breathing muscles, and bilateral<br />
respiratory excursions.<br />
B. Auscultate the anterior chest wall and posterior<br />
bases for bilateral breath sounds and<br />
heart sounds.<br />
C. Palpate the entire chest wall for evidence<br />
of blunt and penetrating injury,<br />
subcutaneous emphysema, tenderness,<br />
and crepitation.<br />
D. Percuss for evidence of hyperresonance<br />
or dullness.<br />
STEP 6. Assess the abdomen.<br />
A. Inspect the anterior and posterior abdomen<br />
for signs of blunt and penetrating injury and<br />
internal bleeding.<br />
B. Auscultate for the presence of bowel sounds.<br />
C. Percuss the abdomen to elicit subtle<br />
rebound tenderness.<br />
D. Palpate the abdomen for tenderness, involuntary<br />
muscle guarding, unequivocal rebound<br />
tenderness, and a gravid uterus.<br />
PERINEUM/RECTUM/VAGINA<br />
STEP 7. Assess the perineum. Look for<br />
••<br />
Contusions and hematomas<br />
••<br />
Lacerations<br />
••<br />
Urethral bleeding<br />
STEP 8. Perform a rectal assessment in selected<br />
patients to identify the presence of rectal<br />
blood. This includes checking for:<br />
••<br />
Anal sphincter tone<br />
••<br />
Bowel wall integrity<br />
••<br />
Bony fragments<br />
STEP 9. Perform a vaginal assessment in selected<br />
patients. Look for<br />
••<br />
Presence of blood in vaginal vault<br />
••<br />
Vaginal lacerations<br />
MUSCULOSKELETAL<br />
STEP 10. Perform a musculoskeletal assessment.<br />
••<br />
Inspect the upper and lower extremities<br />
for evidence of blunt and penetrating<br />
injury, including contusions, lacerations,<br />
and deformity.<br />
••<br />
Palpate the upper and lower extremities<br />
for tenderness, crepitation, abnormal<br />
movement, and sensation.<br />
••<br />
Palpate all peripheral pulses for presence,<br />
absence, and equality.<br />
••<br />
Assess the pelvis for evidence of fracture<br />
and associated hemorrhage.<br />
• • Inspect and palpate the thoracic and<br />
lumbar spines for evidence of blunt and<br />
penetrating injury, including contusions,<br />
n BACK TO TABLE OF CONTENTS
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