Advanced Trauma Life Support ATLS Student Course Manual 2018

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391 INDEX Vertical displacement, of sacroiliac joint, 96–97, 96f Vertical shearing, 96–97, 96f Vesicant agents, 297 Vision exam, 258 Visual acuity tests, 15–16 Vital functions, assessment of, 7 Vitreous humor, 257 Volume–pressure curve, 107f Vomiting aspiration after, 25 management of, 25 Warm zone, 295 War wounds, 279 WBC. See White blood cell (WBC) count Weapons of mass destruction (WMDs), 290b, 291 White blood cell (WBC) count, in pregnancy, 229, 230t WMDs. See Weapons of mass destruction Wound care, in burn injuries, 178 Wounds gunshot, 14t, 85, 93, 231t, 232t scalp, 122, 123f stab, 14t, 85, 86f, 93, 232t tetanus risk and, 162 war, 279 X-ray examinations, 12, 12f for abdominal trauma, 89 for musculoskeletal trauma, 153, 156, 162f Zero survey, 281–282, 281f n BACK TO TABLE OF CONTENTS
TRAUMA SCORES Correct triage is essential to the effective functioning of regional trauma systems. Over-triage can inundate trauma centers with minimally injured patients and delay care for severely injured patients, and under-triage can produce inadequate initial care and cause preventable morbidity and mortality. In fact the National Study on the Costs and Outcomes of Trauma (NSCOT) found a relative risk reduction of 25% when severely injured adult patients received their care at a Level I trauma center rather than a nontrauma center. Unfortunately, the perfect triage tool does not exist. For this reason, most experts now advocate using the “Guidelines for Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage, 2011” in lieu of trauma scores per se. A recent review of the sensitivity and specificity of these guidelines found the sensitivity to be 66.2% and the specificity to be 87.3% for an injury severity score of greater than 16; sensitivity was 80.1% and specificity was 87.3% for early critical resource use. The sensitivity decreased as a function of age. However, because many emergency medical services (EMS) systems still rely on trauma scores and scales as tools for field triage, some of the most commonly used are described here. None of these are universally accepted as completely effective triage tools. The Glasgow Coma Score (GCS) is used worldwide to rapidly assess the level of consciousness of the trauma patient (see Table 6-2 in Student Manual Chapter 6). Many studies have demonstrated a good correlation between GCS and neurological outcome. The motor response contributes the greatest to the discriminatory power of the score. The Trauma Score (TS) calculation is based on five variables: GCS, respiratory rate (RR), respiratory effort, systolic blood pressure (SBP), and capillary refill. Values range from 16 to 1 and are derived by adding the scores assigned to each value. This system was revised in 1989 based on the analysis of 2000 cases. The Revised Trauma Score (RTS) is calculated based on values (0–4) assigned to three variables: GCS, SBP, and RR. These values are assigned a weight and then the score is calculated; it varies between 0 and 7.8408. Higher scores are associated with higher probability of survival. The Pediatric Trauma Score (PTS) was developed to address concerns that RTS may not apply directly to the pediatric population. This score is based on the sum of six measures including the child’s weight, SBP, level of consciousness, presence of fracture, presence of open wound, and state of the airway. The score correlates with injury severity, mortality, resource utilization, and need for transport to a pediatric trauma center. The PTS serves as a simple checklist, ensuring that all components critical to initial assessment of the injured child have been considered. It is useful for paramedics in the field as well as doctors in facilities other than pediatric trauma units. All injured children with a PTS of less than 8 should be triaged to an appropriate pediatric trauma center because they have the highest potential for preventable mortality, morbidity, and disability. According to National Pediatric Trauma Registry statistics, this group represents approximately 25% of all pediatric trauma victims and clearly requires the most aggressive monitoring and observation. Studies comparing the PTS with the RTS have identified similar performances of both scores in predicting potential for mortality. Unfortunately, the RTS produces what most experts believe to be unacceptable levels of under-triage, which is an inadequate trade-off for its greater simplicity. Traumatic injuries can be classified using an Abbreviated Injury Severity (AIS) score. The scale was first published in 1971 and graded the severity of tissue injury associated with automotive trauma. It is now widely used to grade injuries related to all types of blunt and penetrating trauma. The scale ranges from 1 (minor) to 6 (unsurvivable). It is the basis of Injury Severity Score (ISS). This score was first proposed in 1974 and is derived from the sum of the squares of highest three scores in six body regions (head and neck, face, chest, abdomen, limbs, and external). Scores range from a minimum of 1 to a maximum of 75 (when a score of 6 is given in any area, a score of 75 is assigned regardless of other injuries). Mortality increases with injury severity. A score of less than 15 generally indicates mild injury. ISS tends to underestimate injury in penetrating trauma because injuries in the same body region are not accounted for. The New Injury Severity Score (NISS) was developed to address this issue. The sum of the squares of the most severely injured areas, disregarding body region, is used to improve score sensitivity. Similarly to pediatrics, previously described tools may not accurately predict the impact of injury in the n BACK TO TABLE OF CONTENTS 392
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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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333 APPENDIX F n Triage Scenarios 4
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Skill Station A AIRWAY Part 1: Basi
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339 APPENDIX G n Skills One-Person
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Page 421: 368 APPENDIX G n Skills less than 1
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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
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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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