Advanced Trauma Life Support ATLS Student Course Manual 2018

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INDEX ABCDEs. See Primary survey ABC priorities, 6 ABC-SBAR template, 247, 247t Abdomen anatomy of, 84–85, 84f anterior, 84 physical examination of, 17 Abdominal and pelvic trauma anatomy of, 84–85, 84f assessment and management of, 86–98 contrast studies for, 92–93 CT for, 90t, 91–92, 93, 94 diagnostic laparoscopy for, 92, 93 diaphragm injuries, 95 DPL for, 90–91, 90t, 91f duodenal injuries, 95 evaluation of, 93–94 anterior abdominal wounds, 93 diaphragm injuries, 95 duodenal injuries, 95 flank and back injuries, 93–94 genitourinary injuries, 95 hollow viscus injuries, 95 pancreatic injuries, 95 solid organ injuries, 95–96 thoracoabdominal wounds, 93 FAST for, 91f gastric tubes for, 88–89 genitourinary injuries, 95 history of, 87 laparotomy for, 94f indications for, 94–95 mechanisms of injury blast, 85–86 blunt, 85, 85f penetrating, 85 missed injuries, 86 other studies, 89 pancreatic injuries, 95, 202 in pediatric patients, 200–202 assessment of, 200 CT scanning in, 200–201 DPL for, 201 FAST for, 201 nonoperative management of, 201–202 visceral injuries, 202 pelvic fractures and associated injuries, 17, 17f, 96f in geriatric patients, 221–222 hemorrhagic shock and, 98, 98f management of, 97–98, 97f mechanism of injury and classification, 96–97 in pregnancy, 228–229 physical examination of, 87–93 adjuncts to, 88–93 auscultation, 87 inspection, 87 palpation, 87 pelvic assessment, 87–88 percussion, 87 pitfall of, 88 urethral, perineal, rectal, vaginal, and gluteal examination, 88 pitfalls of, 86, 89, 92, 93, 94, 96 small bowel injuries, 85, 202 solid organ injuries, 95–96 teamwork in, 98 thoracoscopy for, 92 urinary catheters for, 88–89 x-rays for, 89 Abdominal breathing, 26 ABG. See Arterial blood gases ABLS. See American Burn Life Support Abruptio placentae, 233, 234f Abuse burn patterns indicating, 180 child, 207–208 elder, 222, 222b intimate partner, 235, 237, 237b Acidosis, 54, 173 ACLS. See Advanced Cardiac Life Support Acquired immunodeficiency syndrome (AIDS), 6 ACS. See American College of Surgeons Active shooters, 283–285 Acute care, 290b Acute radiation syndrome (ARS), 298b Advanced Cardiac Life Support (ACLS), 70, 90, 90t Advanced Trauma Life Support (ATLS) delivering within team, 308–309 origins of, 275 team members, 307–308 “After Action” sessions, 20 Afterload, 44f, 45 Aging. See also Geriatric patients; Older adults, effects of, on organ systems, 218t AIDS. See Acquired immunodeficiency syndrome Air bag injury, 86t Airway definitive. See Definitive airway preventable deaths from problems with, 24 Airway equipment, 6 Airway loss, progressive, 8f Airway management airway decision scheme for, 28, 29f, 30 for burn injuries, 170–171, 170f definitive airways, 32–36 criteria for establishing, 32–33 drug-assisted intubation, 35–36 endotracheal intubation, 33–35, 34f indications for, 33t needle cricothyroidotomy, 36, 36f surgical airway, 36 surgical cricothyroidotomy, 36, 37f in geriatric patients, 217, 218f, 219 in head trauma, 117–118 for hemorrhagic shock, 51 ILMA for, 31 LEMON assessment for, 28, 28b–29b LMA for, 31, 31f, 194 n BACK TO TABLE OF CONTENTS 377
378 INDEX LTA for, 31–32, 32f Mallampati classification for, 28b needle cricothyroidotomy for, 36, 36f oxygenation management for, 36, 38 in pediatric patients, 190, 192– 194, 219t anatomy and physiology in, 192–193, 192f cricothyroidotomy, 194 oral airway, 193 orotracheal intubation, 193–194, 193f predicting difficult, 28 problem recognition, 24–26 laryngeal trauma, 25–26 maxillofacial trauma, 25, 25f neck trauma, 25 with restriction of cervical spine motion, 7–8, 8f surgical cricothyroidotomy for, 36, 37f teamwork in, 38–39 techniques for, 27–28, 30–32 chin-lift maneuver, 30, 30f extraglottic devices, 31 intubating LMA, 31 intubating LTA, 31–32 jaw-thrust maneuver, 30, 30f laryngeal mask airway, 31, 31f laryngeal tube airway, 31–32, 32f multilumen esophageal airway, 32, 32f nasopharyngeal airway, 30 oropharyngeal airway, 31, 31f supraglottic devices, 31, 32f for thoracic trauma, 64–65 by trauma teams, 308 ventilation in management of, 38 objective signs of inadequate, 26–27 problem recognition for, 26 Airway obstruction assessment for, 7 objective signs of, 26 partial, 26 in thoracic trauma, 64 Alcohol abuse, 244 American Burn Association, 172 American Burn Life Support (ABLS), 171 American College of Surgeons (ACS), 4 Disaster Management and Emergency Preparedness (DMEP) course, 275 Trauma Quality Improvement Program, 111 American Spinal Injury Association (ASIA), 132 Amnesia, 115 AMPLE history, 13 Amputation, traumatic, 150–151 Analgesia, 19 Analgesics brain injury and, 120 for burn injuries, 178 for pain control, 163 Anatomy of abdomen, 84–85, 84f cranial, 105f, 106 of eye, 257–258, 258f of pregnant patients, 228–231 Anesthetics, brain injury and, 120 Angioembolization, 201–202 Ankle fractures, 163, 164f joint dislocation deformities, 155t, 156f Anterior abdomen, 84 Anterior abdominal wounds, 93 Anterior chamber, of eye, 257, 260 Anterior cord syndrome, 135–136 Anterior exam, of eye, 259–260 Anterior-posterior (AP) compression fracture, 96, 96f Anterior wedge compression injury, 137–138 Antibiotics for burn injuries, 179 intravenous, weight-based dosing guidelines, 158t Anticoagulation therapy, 56 brain injury and, 120–121 geriatric patients and, 222 reversal, 121t Anticonvulsants, brain injury and, 122 Antiplatelet medications, 56 brain injury and, 120–121, 121t geriatric patients and, 222 Aortic rupture, 75–76, 75f Aqueous humor, 257 Arachnoid mater, 105, 106f, 107 Area of operations, 290b ARS. See Acute radiation syndrome Arterial bleeding, management of, 151 Arterial blood gases (ABGs), 11 Arterial pH, 230t Arteriography, 151 Asphyxia, traumatic, 77 Asphyxiants, 297 Aspiration, 10, 24, 30 Assault, 231t Atherosclerotic vascular occlusive disease, 220 shock and, 57 Athletes initial assessment of, 13 shock and, 57 Atlanto-occipital dislocation, 136 Atlas (C1) fracture, 136, 137f ATLS. See Advanced Trauma Life Support ATLS in the Operational Environment (ATLS-OE), 280–283 Atropine sulfate, 194 Austere environments, 275, 278–279 Automobile collisions. See Motor vehicle crashes Autotransfusion, 55 Axillary nerve, 161t Axis (C2) fractures, 137 Baby milestones, 207t Back, 84 Back injuries, 93–94 Backward, upward, and rightward pressure (BURP), 33 Bag-mask ventilation, 38 Balanced resuscitation, 53, 56, 59 Barbiturates, brain injury and, 122 BCI. See Blunt cardiac injury BCU. See Body cooling unit Beta blockers, 222 Bilateral femur fractures, 152 Bladder injuries, 202 Blast injuries, 85–86, 278, 296 Bleeding arterial, management of, 151 control of, 9, 285 Blood loss antiplatelet or anticoagulant medications and, 56 hemorrhagic shock and, 49–50, 49t pathophysiology, 45 in pediatric patients, 196, 196t soft-tissue injuries and, 51 n BACK TO TABLE OF CONTENTS
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TENTH EDITION ATLS ® Advanced Trau
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Chair of Committee on Trauma: Ronal
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FOREWORD My first exposure to Advan
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viii PREFACE MyATLS Mobile Applicat
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x PREFACE Gary A. Vercruysse, MD, F
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xii PREFACE Jacqueline Bustraan, MS
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ACKNOWLEDGMENTS It is clear that ma
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xvii ACKNOWLEDGMENTS Bertil Bouillo
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xix ACKNOWLEDGMENTS Oscar Guillamon
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xxi ACKNOWLEDGMENTS Mahesh Misra, M
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xxiii ACKNOWLEDGMENTS James Vosswin
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xxv ACKNOWLEDGMENTS James A. Geilin
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xxvii ACKNOWLEDGMENTS Tone Slåke R
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xxx COURSE OVERVIEW m. Protection o
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xxxii COURSE OVERVIEW Atls and Trau
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xxxiv COURSE OVERVIEW a systematize
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xxxvi COURSE OVERVIEW 69. Switzerla
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xxxviii COURSE OVERVIEW United Stat
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xl COURSE OVERVIEW 67. Hendrickson
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xlii COURSE OVERVIEW 122. Palusci V
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BRIEF CONTENTS Foreword Preface Ack
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xlviii DETAILED CONTENTS Teamwork 5
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l DETAILED CONTENTS Introduction 21
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1 INITIAL ASSESSMENT AND MANAGEMENT
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4 CHAPTER 1 n Initial Assessment an
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10 CHAPTER 1 n Initial Assessment a
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2 AIRWAY AND VENTILATORY MANAGEMENT
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24 CHAPTER 2 n Airway and Ventilato
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3 SHOCK The first step in the initi
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44 CHAPTER 3 n Shock The first step
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46 CHAPTER 3 n Shock Recognition of
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48 CHAPTER 3 n Shock However, the a
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50 CHAPTER 3 n Shock Class II Hemor
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52 CHAPTER 3 n Shock hypothermia, a
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54 CHAPTER 3 n Shock replacement du
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56 CHAPTER 3 n Shock aggregation an
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58 CHAPTER 3 n Shock Presence of Pa
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60 CHAPTER 3 n Shock rate can be ac
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4 THORACIC TRAUMA Thoracic injury i
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64 CHAPTER 4 n Thoracic Trauma Thor
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66 CHAPTER 4 n Thoracic Trauma shoc
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68 CHAPTER 4 n Thoracic Trauma comp
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70 CHAPTER 4 n Thoracic Trauma Norm
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72 CHAPTER 4 n Thoracic Trauma Seco
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74 CHAPTER 4 n Thoracic Trauma A B
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76 CHAPTER 4 n Thoracic Trauma Spec
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78 CHAPTER 4 n Thoracic Trauma temp
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80 CHAPTER 4 n Thoracic Trauma 18.
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ABDOMINAL AND 5 PELVIC TRAUMA When
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84 CHAPTER 5 n Abdominal and Pelvic
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100 CHAPTER 5 n Abdominal and Pelvi
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6 HEAD TRAUMA The primary goal of t
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104 CHAPTER 6 n Head Trauma Head in
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106 CHAPTER 6 n Head Trauma fibrous
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108 CHAPTER 6 n Head Trauma n FIGUR
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110 CHAPTER 6 n Head Trauma table 6
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112 CHAPTER 6 n Head Trauma covery.
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120 CHAPTER 6 n Head Trauma necessa
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122 CHAPTER 6 n Head Trauma Use 0.2
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124 CHAPTER 6 n Head Trauma not rea
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126 CHAPTER 6 n Head Trauma 18. Mar
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CHAPTER 7 Outline Objectives iNtrod
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ANATOMY AND PHYSIOLOGY 131 B A n FI
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RIGHT INTERNATIONAL STANDARDS FOR N
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DOCUMENTATION OF SPINAL CORD INJURI
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SPECIFIC TYPES OF SPINAL INJURIES 1
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RADIOGRAPHIC EVALUATION 139 Penetra
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GENERAL MANAGEMENT 141 When the low
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GENERAL MANAGEMENT 143 them to the
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BIBLIOGRAPHY 145 Bibliography 1. Bi
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8 MUSCULOSKELETAL TRAUMA Injuries t
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150 CHAPTER 8 n Musculoskeletal Tra
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9 THERMAL INJURIES The most signifi
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170 CHAPTER 9 n Thermal Injuries Th
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172 CHAPTER 9 n Thermal Injuries Ch
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174 CHAPTER 9 n Thermal Injuries Pi
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176 CHAPTER 9 n Thermal Injuries th
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178 CHAPTER 9 n Thermal Injuries ju
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180 CHAPTER 9 n Thermal Injuries Im
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182 CHAPTER 9 n Thermal Injuries lo
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184 CHAPTER 9 n Thermal Injuries 4.
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10 PEDIATRIC TRAUMA Injury remains
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188 CHAPTER 10 n Pediatric Trauma I
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190 CHAPTER 10 n Pediatric Trauma c
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192 CHAPTER 10 n Pediatric Trauma A
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194 CHAPTER 10 n Pediatric Trauma b
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196 CHAPTER 10 n Pediatric Trauma b
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198 CHAPTER 10 n Pediatric Trauma t
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200 CHAPTER 10 n Pediatric Trauma f
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202 CHAPTER 10 n Pediatric Trauma t
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204 CHAPTER 10 n Pediatric Trauma G
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206 CHAPTER 10 n Pediatric Trauma C
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208 CHAPTER 10 n Pediatric Trauma
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210 CHAPTER 10 n Pediatric Trauma 1
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212 CHAPTER 10 n Pediatric Trauma 6
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CHAPTER 11 Outline Objectives iNtro
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PRIMARY SURVEY WITH RESUSCITATION 2
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PRIMARY SURVEY WITH RESUSCITATION 2
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SPECIFIC INJURIES 221 table 11-6 ph
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BIBLIOGRAPHY 223 comprise only 12%
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12 TRAUMA IN PREGNANCY AND INTIMATE
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228 CHAPTER 12 n Trauma in Pregnanc
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240 CHAPTER 13 n Transfer to Defini
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Appendix A OCULAR TRAUMA OBJECTIVES
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259 APPENDIX A n Ocular Trauma In c
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261 APPENDIX A n Ocular Trauma to t
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Appendix B HYPOTHERMIA AND HEAT INJ
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267 APPENDIX B n Hypothermia and He
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Appendix C TRAUMA CARE IN MASS-CASU
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277 APPENDIX C n Trauma Care in Mas
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Appendix D DISASTER PREPAREDNESS AN
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291 APPENDIX D n Disaster Preparedn
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Pitfall Inadequate security Failed
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Appendix E ATLS AND TRAUMA TEAM RES
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305 APPENDIX E n ATLS and Trauma Te
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Appendix F TRIAGE SCENARIOS OBJECTI
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319 APPENDIX F n Triage Scenarios T
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Page 378 and 379: 325 APPENDIX F n Triage Scenarios T
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Page 390 and 391: Skill Station A AIRWAY Part 1: Basi
Page 392 and 393: 339 APPENDIX G n Skills One-Person
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Page 404 and 405: 351 APPENDIX G n Skills manual trac
Page 406 and 407: 353 APPENDIX G n Skills STEP 3. Aft
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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 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
Page 463 and 464: 410 TETANUS IMMUNIZATION Summary Gu
Page 465 and 466: SAMPLE TRAUMA FLOW SHEET Page 1 of
Page 467 and 468: 414 SAMPLE TRAUMA FLOW SHEET Page 3
Page 473 and 474: 420 SAMPLE TRAUMA FLOW SHEET Some h
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