Advanced Trauma Life Support ATLS Student Course Manual 2018

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383 INDEX Hemorrhagic shock, 45 blood replacement for, 54–56, 55f confounding factors, 50–51 definition of, 48–49 fluid changes secondary to softtissue injury, 51 hypothermia and, 57 initial management of, 51–54 initial fluid therapy for, 52–54, 53t patient response to, 53–54 physical examination for, 51–52 vascular access, 52 overview of, 46–47 pelvic fractures and, 98, 98f physiological classification of, 49–50, 49t Hemothorax, 73 Heparin, 121t Hepatitis, 6 HICS. See Hospital Incident Command System Hip, joint dislocation deformities, 155t History, of mechanism of injury, 13, 15 Hollow viscus injuries, 95 Homicide, of child, 207 Hospital Incident Command System (HICS), 290b, 291–292 Hospital phase, 6 Hospital preparedness, 292–293 Hot zone, 295 HVA. See Hazard vulnerability analysis Hypertonic saline, brain injury and, 122 Hyperventilation, brain injury and, 121 Hypocapnia, 230 Hypotensive resuscitation, 53 Hypothermia, 10f, 265–269 in children, 266 defined, 265 management of, 267–269 in older patients, 265–266 in pediatric patients, 199 physiological effects of, 266–267 prevalence of, 265, 266 prevention of, 10, 51–52, 55 rewarming techniques, 267t, 268f shock and, 57 signs of, 266 staging and management of, 265, 266t systemic, 183 Hypovolemia in burn patients, 178 in pediatric patients, 196 Hypovolemic shock, 9, 44, 196 Hypoxemia, 178 Hypoxia, 195 IC. See Incident command/commander ICS. See Incident Command System IED. See Improvised explosive devices I-gel supraglottic airway, 32f ILMA. See Intubating laryngeal mask airway ILTA. See Intubating laryngeal tube airway Implantable cardioverter-defibrillator, shock and, 58 Improvised explosive devices (IEDs), 278 Incident command/commander (IC), 290b Incident command post, 290b Incident Command System (ICS), 276, 290b, 291–292, 292b Incomplete spinal cord injury, 131 Inferior gluteal nerve, 161t Inhalational burns, 14t Initial assessment of airway, 24–26 consent for treatment in, 19 definitive care and, 19 determining need for patient transfer during, 12, 19 elements of, 4 forensic evidence in, 19 preparation for, 4, 4f hospital phase, 6 prehospital phase, 4 primary survey for, 7–12 records during, 19 reevaluation in, 19 secondary survey for, 13–18 of special populations, 13 teamwork in, 19–20, 20f triage, 5f, 6–7 Insidious respiratory compromise, 24, 24f Interhospital transfer guidelines, 19. See also Patient transfers to definitive care International Standards for Neurological Classification of Spinal Cord Injury, 132, 133f Intimate partner violence, 235, 237, 237b Intracerebral hematomas, 111, 111f Intracranial compartments, 106–107 Intracranial hematomas, 111, 111f Intracranial lesions, 110–111 Intracranial mass lesions, 123 Intracranial pressure (ICP), 107 Intraocular pressure, 259 Intraosseous puncture, 52 Intravenous access, in pediatric patients, 197–198, 197f Intravenous antibiotics, weightbased dosing guidelines, 158t Intravenous fluids for brain injury, 120 for spine injury, 144 Intravenous pyelogram (IVP), for abdominal and pelvic trauma, 92 Intubating laryngeal mask airway (ILMA), 31 Intubating laryngeal tube airway (ILTA), 31–32 Intubation drug-assisted, 35–36 endotracheal, 33–35, 34f LEMON assessment for difficult, 28, 28b–29b orotracheal, 33, 193–194, 193f pitfalls of, 35 unsuccessful, 8f Ionizing radiation, pediatric patients and, 190 Iris, 257, 260 IV fluid therapy, for hypovolemic shock, 9 IVP. See Intravenous pyelogram Jaw-thrust maneuver, 30, 30f Jefferson fracture, 136, 137f Joint dislocation deformities, 155t, 156f Joints dislocations, neurological injury secondary to, 161 injuries to, 162 open injuries, 156–157 Joint stability, 156 Jugular venous distention, 8 Kleihauer-Betke test, 235 Knee, joint dislocation deformities, 155t Knee injuries, 163 n BACK TO TABLE OF CONTENTS
384 INDEX Kussmaul’s sign, 69 Lacerations, 161–162 Lacrimators, 297 Laparotomy, 94–95, 94f Lap-belt injury, 85f, 86t, 202 Laryngeal mask airway (LMA), 31, 31f, 34f, 194 Laryngeal trauma, 25–26 Laryngeal tube airway (LTA), 31–32, 32f Lateral compression injury, 96, 96f LEMON assessment, 28, 28b–29b Level of consciousness, 9, 10 altered, 24 Ligament injuries, 162 LMA. See Laryngeal mask airway Logrolling, 143–144, 143f Lower extremities, peripheral nerve assessment of, 161t Low molecular weight heparin, 121t LTA. See Laryngeal tube airway Lumbar spine fractures of, 138 radiographic evaluation of, 141 screening for suspected injuries to, 142b Magnetic resonance imaging (MRI) of cervical spine, 141 for spinal cord injury, 206 Major arterial hemorrhage, 150–151 Malignant hyperthermia, 271 Mallampati classification, 28b Mannitol (Osmitrol), 121–122 MAP. See Mean arterial blood pressure Mass-casualty care, 275–276 challenges of, 277–278 management priorities in, 277 pitfalls of, 276 resource considerations in, 276 tools for effective, 276–278 triage in, 276–277, 276b Mass-casualty events (MCEs), 6–7, 289, 290b improving survival from, 283–285 Massive hemothorax, 67–69, 68t cause and development of, 68, 69f differentiating from tension pneumothorax, 68t management of, 68–69 Massive transfusion protocol (MTP), 54, 55 Mass volunteerism, 277–278 Maxillofacial structures, physical examination of, 16 Maxillofacial trauma, 25, 25f MCEs. See Mass-casualty events MDCT. See Multidetector CT Mean arterial blood pressure (MAP), 108 Median, anterior interosseous nerve, 161t Median distal nerve, 161t Medical evacuation (MEDEVAC) platform, 280 Medical triage, 294 Medications. See also specific medications geriatric patients and, 222 for heat injuries, 271, 271b shock and, 57 for spine injury, 144 Medulla, 106 Meningeal arteries, 106 Meninges, 104, 105f, 106, 106f Metabolic acidosis, 54, 173 Midbrain, 106 Midline shifts, 111f Mild brain injury CT for, 115, 115t discharge instructions, 116f management of, 112, 112t–113t, 114f, 115 Military trauma care, 279–283 <strong>ATLS</strong> in the operational environment, 280–283 Care Under Fire, 280 tactical combat casualty care, 279–280 tactical evacuation care, 280 tactical field care, 280 Minimally acceptable care, 290b Minimal or no response, to fluid therapy, 54 MIST mnemonic, 303–304 Mitigation, 290b Moderate brain injury, 112t–113t, 120 Monro-Kellie doctrine, 107, 108f Morel-Lavallée lesion, 162 Motor level of injury, 135 Motor vehicle crashes (MVCs), 75, 188, 188t in geriatric patients, 217 as mechanism of injury, 14t in pregnant patients, 231t MRI. See Magnetic resonance imaging MTP. See Massive transfusion protocol Multiple-casualty incidents (MCIs), 289 Multidetector CT (MDCT) of cervical spine, 140–141 of thoracic and lumbar spine, 141 Multidimensional injuries, 278 Multilumen esophageal airway, 32, 32f Multiple casualties, 6 Multiple-casualty incident (MCI), 290b Musculocutaneous nerve, 161t Musculoskeletal system, 17–18 effects of aging on, 218t in pregnancy, 231 Musculoskeletal trauma associated injuries, 164–165, 164t contusions, 161–162 fracture immobilization for, 152–153, 152f fractures, 162–163 immobilization for ankle fractures, 163, 164f femoral fractures, 163 knee injuries, 163 tibial fractures, 163 upper extremity and hand injuries, 163 joint and ligament injuries, 162 joint dislocation deformities, 155t lacerations, 161–162 life-threatening bilateral femur fractures, 152 crush syndrome, 152 major arterial hemorrhage, 150–151 traumatic amputation, 150–151 limb-threatening compartment syndrome, 159–160, 159b, 159f, 161f neurological injury secondary to fracture or dislocation, 161 open fractures and open joint injuries, 156–157, 157f vascular injuries, 157–159 occult skeletal injuries, 165 pain control for, 163–164 patient history for environment information in, 154 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 386: 333 APPENDIX F n Triage Scenarios 4
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 402 and 403: Skill Station C CIRCULATION LEARNIN
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 415: 362 APPENDIX G n Skills Utilization
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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
Page 427: 374 APPENDIX G n Skills in the inju
Page 431 and 432: 378 INDEX LTA for, 31-32, 32f Malla
Page 433 and 434: 380 INDEX atlanto-occipital disloca
Page 435: 382 INDEX Frostbite, 181-183, 182f
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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