Advanced Trauma Life Support ATLS Student Course Manual 2018

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397 INJURY PREVENTION to be studied to determine what kinds of injuries are involved and where, when, and why they occur. Injuryprevention strategies may begin to emerge with this additional information. Some trauma problems vary from community to community; however, certain risk factors are likely to remain constant across situations and socioeconomic boundaries. Abuse of alcohol and other drugs is an example of a contributing factor that is likely to be pervasive regardless of whether the trauma is blunt or penetrating, whether the location is the inner city or the suburbs, and whether fatality or disability occurs. Data are most meaningful when the injury problem is compared between populations with and without defined risk factors. In many instances, the injured people may have multiple risk factors, and clearly defined populations may be difficult to sort out. In such cases, it is necessary to control for the confounding variables. Build Local Coalitions Strong community coalitions are required to change the perception of a problem and to design strategies that are likely to succeed in an individual community. What works in one community may not work in another, and the most effective strategy will fail if the community targeted for intervention does not perceive the problem as important. Communicate the Problem Although sentinel events in a community may identify an individual trauma problem and raise public concern, high-profile problems do not lend themselves to effective injury prevention unless they are part of a larger documented injury-control issue/ injury-prevention strategy. Local coalitions are an essential part of any communication strategy—not only in getting the word out, but in designing the message that is most likely to be effective. Members of the media are also key partners in any communication plan. Develop and Implement Prevention Activities The next step is to develop and test interventions. This is the time to review best practices, and if there are none, it may be appropriate to develop pilot programs to test intervention effectiveness. Rarely is an intervention tested without some indication that it will work. It is important to consider the views and values of the community if an injury prevention program is to be accepted. End points must be defined up front, and outcomes reviewed without bias. Sometimes it is not possible to determine the effectiveness of a test program, especially if it is a small-scale trial intervention. For example, a public information program on safety-belt use conducted at a school can be assessed by monitoring the incoming and outgoing school traffic and showing a difference, even when safety-belt usage rates in the community as a whole may not change. Nonetheless, the implication is clear—broad implementation of public education regarding safety-belt use can have a beneficial effect in a controlled community population. Telephone surveys are not reliable measures to confirm behavioral change, but they can confirm that the intervention reached the target group. With confirmation that a given intervention can effect favorable change, the next step is to implement injuryprevention strategies. From this point, the possibilities are vast. Evaluate the Impact of an Intervention With implementation comes the need to monitor the impact of the program or evaluation. An effective injury-prevention program linked with an objective means to define its effectiveness can be a powerful message to the public, the press, and legislators. It ultimately may bring about a change in injury rates or a permanent change in behavior. Injury prevention seems like an immense task, and in many ways it is. Yet, it is important to remember that a pediatrician in Tennessee was able to validate the need for infant safety seats, and that work led to the first law requiring use of infant safety seats. A New York orthopedic surgeon gave testimony that played an important role in achieving the first safety-belt law in the United States. Although not all healthcare providers are destined to make as significant an impact, they can influence their patients’ behaviors. Injuryprevention measures do not have to be implemented on a grand scale to make a difference. Individual healthcare providers may not be able to statistically prove a difference in their own patient population, but if all doctors and other healthcare providers make injury prevention a part of their practice, the results will be significant. As preparations for hospital or emergency department discharge are being made, consideration should be given to patient education and community partner referral to prevent injury recurrence. Whether it is alcohol abuse, returning to an unchanged hostile home environment, riding a motorcycle without wearing head protection, or smoking while refueling the car, there are many opportunities for healthcare n BACK TO TABLE OF CONTENTS
398 INJURY PREVENTION providers to make a difference in their patients’ future trauma vulnerability. Bibliography 1. American Association for the Surgery of Trauma. Trauma Prevention Coalition. Trauma Source. http://www.aast.org/trauma-preventioncoalition. Accessed August 3, 2016. 2. American College of Surgeons. Statement on Firearm Injuries (2013). Statements of the College. https://www.facs.org/about-acs/ statements/12-firearm-injuries. Accessed August 3, 2016. 3. American College of Surgeons. Injury Prevention and Control Position Statements. https://www. facs.org/quality-programs/trauma/ipc. Accessed August 3, 2016. 4. American College of Surgeons Committee on Trauma. Resources for Optimal Care of the Injured Patient 2014. https://www.facs.org/quality%20 programs/trauma/vrc/resources. 5. Cooper A, Barlow B, Davidson L, et al. Epidemiology of pediatric trauma: importance of population-based statistics. J Pediatr Surg 1992;27:149–154. 6. Curry P, Ramaiah R, Vavilala MS. Current trends and update on injury prevention. Int J Crit Illn Inj Sci 2011;1(1):57–65. 7. Haddon W, Baker SP. Injury control. In: Clark DW, MacMahon B, eds. Prevention and Community Medicine. 2nd ed. Boston, MA: Little Brown; 1981:109–140. 8. Kendrick D, Mulvaney CA, Ye L, et al. Parenting interventions for the prevention of unintentional injuries in childhood. Cochrane Database Syst Rev 2013 Mar 28;(3):CD006020. 9. Knudson MM, Vassar MJ, Straus EM, et al. Surgeons and injury prevention: what you don’t know can hurt you! J Am Coll Surg 2001;193:119–124. 10. National Committee for Injury Prevention and Control. Injury Prevention: Meeting the Challenge. New York, NY: Education Development Center; 1989. 11. Rivera FP. Traumatic deaths of children in United States: currently available prevention strategies. Pediatrics 1985;85:456–462. 12. Schermer CR. Alcohol and injury prevention. J Trauma 2006;60:447–451. 13. Sise MJ, Sise CV. Measuring trauma center injury prevention activity: an assessment and reporting tool. J Trauma 2006; 60:444–447. 14. Smith R, Evans A, Adams C, et al. Passing the torch: evaluating exportability of a violence intervention program. Am J Surg 2013;206(2):223–228. 15. Sommers MS, Lyons MS, Fargo JD, et al. Emergency department-based brief intervention to reduce risky driving and hazardous/harmful drinking in young adults: a randomized controlled trial. Alcohol Clin Exp Res 2013;37(10):1753–1762. 16. Spears GV, Roth CP, Miake-Lye IM, et al. Redesign of an electronic clinical reminder to prevent falls in older adults. Med Care 2013;51(3 suppl 1):S37–43. Resources British Columbia Injury Research and Prevention Unit, Centre for Community Health and Health Research, Vancouver, BC, Canada. www.injuryresearch.bc.ca. Children’s Safety Network, National Injury and Violence Prevention Resource Center, Education Development Center, Inc., Newton, MA. http://www. childrenssafetynetwork.org/. Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA. http://depts. washington.edu/hiprc/. Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA. www.hsph. harvard.edu/hicrc. Injury Control Research Center, University of Alabama– Birmingham. www.uab.edu/icrc. Injury Free Coalition for Kids, Columbia University, Mailman School of Public Health, New York, NY. www. injury-free.org. Injury Prevention and Research Center, University of North Carolina, Chapel Hill. www.iprc.unc.edu. Johns Hopkins Center for Injury Research and Policy, Hampton House, Baltimore, MD. http:// www.jhsph.edu/research/centers-and-institutes/ johns-hopkins-center-for-injury-research-and-policy/. National Center for Injury Prevention and Control. Centers for Disease Control, Atlanta, GA. http://www. cdc.gov/injury/. San Francisco Center for Injury Research and Prevention, San Francisco General Hospital, San Francisco, CA. www.surgery.ucsf.edu/sfic. 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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343 APPENDIX G n Skills STEP 13. Co
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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 431 and 432: 378 INDEX LTA for, 31-32, 32f Malla
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Page 437 and 438: 384 INDEX Kussmaul’s sign, 69 Lac
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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: 396 INJURY PREVENTION Safety Admini
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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