Advanced Trauma Life Support ATLS Student Course Manual 2018

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393 TRAUMA SCORES geriatric patient. The Geriatric Trauma Outcome Score (GTOS) was developed to address this concern. It is based on three a priori variables: age, ISS, and 24-hour transfusion requirement. GTO = Age + (2.5 × ISS) + 22 (if any pRBCs are transfused in the first 24 hours after injury). A nomogram correlating GTOS to probability of mortality was created. Timely initiation of massive transfusion protocols has been shown to impact survival and decrease waste of blood products. Precise approaches to implement this strategy have, however, not been defined. Several scoring systems have been developed to aid the clinician in making this difficult decision. To be useful, the score must be easily calculated and based on data available either immediately or shortly after patient admission to the emergency department. The simplest is the ABC score. It requires four data points: penetrating trauma mechanism, SBP < 90 mm Hg, HR > 120 bpm, and positive FAST. Each variable receives a score of 1 if present, for a maximum score of 4. The need for massive transfusion is defined by a score of 2 or greater. The Trauma Associated Severe Hemorrhage (TASH) Score is more complex. It is calculated from seven variables: SBP, hemoglobin, FAST, presence of long-bone or pelvic fracture, HR, base excess (BE), and gender. The variables are weighted and the score is calculated by adding the components. (n TABLE X-1) A 50% probability of need for massive transfusion was predicted by a score of 16, and a score of greater than 27 was 100% predictive of the need for massive transfusion. The McLaughlin score uses four variables to predict the need for massive transfusion: HR > 105, SBP >110 mm Hg, PH < 7.25, and hematocrit < 32%. Each variable present indicates a 20% incidence of massive transfusion. When all four variables are present, an 80% likelihood of the need for massive transfusion was present. Bibliography 1. Centers for Disease Control and Prevention. Guidelines for Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage, 2011. http://www.cdc. gov/mmwr/preview/mmwrhtml/rr6101a1.htm. Accessed April 18, 2017. 2. Cotton BA, Dossett LA, Haut ER, et al. Multicenter validation of a simplified score to predict massive transfusion in trauma. J Trauma 2010 July;69(1):S33–S39. 3. Guidelines for field triage of injured patients: recommendations of the National Expert Panel table x-1 tash score calculation VARIABLE RESULT SCORE Gender Male 1 Female 0 Hemoglobin < 7 g/dL 8 < 9 g/dL 6 < 10 g/dL 4 < 11 g/dL 3 < 12 g/dL 2 ≥ 12 g/dL 0 Base excess < –10 mmol/L 4 Systolic blood pressure < –6 mmol/L 3 < –3 mmol/L 1 ≥ –2 mmol/L 0 < 100 mm Hg 4 < 120 mm Hg 1 ≥ 120 mm Hg 0 Heart rate > 120 2 ≤ 120 0 Positive FAST Yes 3 Unstable pelvis fracture Open or dislocated femur fracture No 0 Yes 6 No 0 Yes 3 No 0 Data from: Holcomb JB, Tilley BC, Baraniuk S, Fox EE, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 2015 Feb 3;313(5):471-482. n BACK TO TABLE OF CONTENTS
394 TRAUMA SCORES on Field Triage, 2011. Morbidity and Mortality Weekly Report 2012;61:1–21. 4. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 2015 Feb 3;313(5):471–482. 5. MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of traumacenter care on mortality. N Engl J Med 2006 Jan 26; 354(4):366–378. 6. McLaughlin DF, Niles SE, Salinas J, et al. A predictive model for massive transfusion in combat casualty patients. J Trauma 2008;64:S57–S63. 7. Newgard CD, Zive D, Holmes JF, et al. Prospective Validation of the National Field Triage Guidelines for Identifying Seriously Injured Persons. J Am Coll Surg 2016 Feb;222(2):146–158. 8. Yücel N, Lefering R, Maegele M, et al. Polytrauma Study Group of the German Trauma Society. Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma 2006 Jun;60(6):1228–1236; discussion 1236-7. PubMed PID: 16766965. 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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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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341 APPENDIX G n Skills STEP 5. Con
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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
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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 443 and 444: 390 INDEX Tibial fractures, 163 Tou
Page 445: TRAUMA SCORES Correct triage is ess
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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