Advanced Trauma Life Support ATLS Student Course Manual 2018
CHAPTER 1 Outline Objectives iNtroduction pRepARAtion • Prehospital Phase • Hospital Phase Triage • Multiple Casualties • Mass Casualties Primary Survey with Simultaneous Resuscitation • Airway Maintenance with Restriction of Cervical Spine Motion • Breathing and Ventilation • Circulation with Hemorrhage Control • Disability (Neurologic Evaluation) • Exposure and Environmental Control Adjuncts to the PrimARy Survey with Resuscitation • Electrocardiographic Monitoring • Pulse Oximetry • Ventilatory Rate, Capnography, and Arterial Blood Gases • Urinary and Gastric Catheters • X-ray Examinations and Diagnostic Studies Consider Need for Patient tRANsfer Special Populations SecondARy Survey • History • Physical Examination Adjuncts to the SecondARy Survey Reevaluation Definitive Care Records and Legal ConsideRAtions • Records • Consent for Treatment • Forensic Evidence Teamwork Chapter Summary BibliogRAphy OBJECTIVES After reading this chapter and comprehending the knowledge components of the ATLS provider course, you will be able to: 1. Explain the importance of prehospital and hospital preparation to facilitate rapid resuscitation of trauma patients. 2. Identify the correct sequence of priorities for the assessment of injured patients. 3. Explain the principles of the primary survey, as they apply to the assessment of an injured patient. 4. Explain how a patient’s medical history and the mechanism of injury contribute to the identification of injuries. 5. Explain the need for immediate resuscitation during the primary survey. 6. Describe the initial assessment of a multiply injured patient, using the correct sequence of priorities. 8. Explain the management techniques employed during the primary assessment and stabilization of a multiply injured patient. 9. Identify the adjuncts to the assessment and management of injured patients as part of the primary survey, and recognize the contraindications to their use. 10. Recognize patients who require transfer to another facility for definitive management. 11. Identify the components of a secondary survey, including adjuncts that may be appropriate during its performance. 12. Discuss the importance of reevaluating a patient who is not responding appropriately to resuscitation and management. 13. Explain the importance of teamwork in the initial assessment of trauma patients. 7. Identify the pitfalls associated with the initial assessment and management of injured patients and describe ways to avoid them. n BACK TO TABLE OF CONTENTS 3
4 CHAPTER 1 n Initial Assessment and Management When treating injured patients, clinicians rapidly assess injuries and institute lifepreserving therapy. Because timing is crucial, a systematic approach that can be rapidly and accurately applied is essential. This approach, termed the “initial assessment,” includes the following elements: •• Preparation •• Triage • Primary survey (ABCDEs) with immediate resuscitation of patients with life-threatening injuries •• Adjuncts to the primary survey and resuscitation •• Consideration of the need for patient transfer •• Secondary survey (head-to-toe evaluation and patient history) •• Adjuncts to the secondary survey •• Continued postresuscitation monitoring and reevaluation •• Definitive care The primary and secondary surveys are repeated frequently to identify any change in the patient’s status that indicates the need for additional intervention. The assessment sequence presented in this chapter reflects a linear, or longitudinal, progression of events. In an actual clinical situation, however, many of these activities occur simultaneously. The longitudinal progression of the assessment process allows clinicians an opportunity to mentally review the progress of actual trauma resuscitation. ATLS® principles guide the assessment and resuscitation of injured patients. Judgment is required to determine which procedures are necessary for individual patients, as they may not require all of them. prepARAtion Preparation for trauma patients occurs in two different clinical settings: in the field and in the hospital. First, during the prehospital phase, events are coordinated with the clinicians at the receiving hospital. Second, during the hospital phase, preparations are made to facilitate rapid trauma patient resuscitation. Prehospital Phase Coordination with prehospital agencies and personnel can greatly expedite treatment in the field (n FIGURE n FIGURE 1-1 Prehospital Phase. During the prehospital phase, personnel emphasize airway maintenance, control of external bleeding and shock, immobilization of the patient, and immediate transport to the closest appropriate facility, preferably a verified trauma center. 1-1). The prehospital system ideally is set up to notify the receiving hospital before personnel transport the patient from the scene. This allows for mobilization of the hospital’s trauma team members so that all necessary personnel and resources are present in the emergency department (ED) at the time of the patient’s arrival. During the prehospital phase, providers emphasize airway maintenance, control of external bleeding and shock, immobilization of the patient, and immediate transport to the closest appropriate facility, preferably a verified trauma center. Prehospital providers must make every effort to minimize scene time, a concept that is supported by the Field Triage Decision Scheme, shown in (n FIGURE 1-2) and MyATLS mobile app. Emphasis also is placed on obtaining and reporting information needed for triage at the hospital, including time of injury, events related to the injury, and patient history. The mechanisms of injury can suggest the degree of injury as well as specific injuries the patient needs evaluated and treated. The National Association of Emergency Medical Technicians’ Prehospital Trauma Life Support Committee, in cooperation with the Committee on Trauma (COT) of the American College of Surgeons (ACS), has developed the Prehospital Trauma Life Support (PHTLS) course. PHTLS is similar to the ATLS Course in format, although it addresses the prehospital care of injured patients. The use of prehospital care protocols and the ability to access online medical direction (i.e., direct medical control) can facilitate and improve care initiated in the field. Periodic multidisciplinary review of patient care through a quality improvement process is an essential component of each hospital’s trauma program. n BACK TO TABLE OF CONTENTS
- Page 6: FOREWORD My first exposure to Advan
- Page 9 and 10: viii PREFACE MyATLS Mobile Applicat
- Page 11 and 12: x PREFACE Gary A. Vercruysse, MD, F
- Page 13 and 14: xii PREFACE Jacqueline Bustraan, MS
- Page 16 and 17: ACKNOWLEDGMENTS It is clear that ma
- Page 18 and 19: xvii ACKNOWLEDGMENTS Bertil Bouillo
- Page 20 and 21: xix ACKNOWLEDGMENTS Oscar Guillamon
- Page 22 and 23: xxi ACKNOWLEDGMENTS Mahesh Misra, M
- Page 24 and 25: xxiii ACKNOWLEDGMENTS James Vosswin
- Page 26 and 27: xxv ACKNOWLEDGMENTS James A. Geilin
- Page 28: xxvii ACKNOWLEDGMENTS Tone Slåke R
- Page 31 and 32: xxx COURSE OVERVIEW m. Protection o
- Page 33 and 34: xxxii COURSE OVERVIEW Atls and Trau
- Page 35 and 36: xxxiv COURSE OVERVIEW a systematize
- Page 37 and 38: xxxvi COURSE OVERVIEW 69. Switzerla
- Page 39 and 40: xxxviii COURSE OVERVIEW United Stat
- Page 41 and 42: xl COURSE OVERVIEW 67. Hendrickson
- Page 43 and 44: xlii COURSE OVERVIEW 122. Palusci V
- Page 46: BRIEF CONTENTS Foreword Preface Ack
- Page 49 and 50: xlviii DETAILED CONTENTS Teamwork 5
- Page 51: l DETAILED CONTENTS Introduction 21
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- Page 75 and 76: 2 AIRWAY AND VENTILATORY MANAGEMENT
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- Page 95 and 96: 3 SHOCK The first step in the initi
- Page 97 and 98: 44 CHAPTER 3 n Shock The first step
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- Page 103 and 104: 50 CHAPTER 3 n Shock Class II Hemor
- Page 105 and 106: 52 CHAPTER 3 n Shock hypothermia, a
CHAPTER 1 Outline<br />
Objectives<br />
iNtroduction<br />
pRepARAtion<br />
• Prehospital Phase<br />
• Hospital Phase<br />
Triage<br />
• Multiple Casualties<br />
• Mass Casualties<br />
Primary Survey with Simultaneous<br />
Resuscitation<br />
• Airway Maintenance with<br />
Restriction of Cervical Spine Motion<br />
• Breathing and Ventilation<br />
• Circulation with Hemorrhage<br />
Control<br />
• Disability (Neurologic Evaluation)<br />
• Exposure and Environmental Control<br />
Adjuncts to the PrimARy Survey<br />
with Resuscitation<br />
• Electrocardiographic Monitoring<br />
• Pulse Oximetry<br />
• Ventilatory Rate, Capnography, and<br />
Arterial Blood Gases<br />
• Urinary and Gastric Catheters<br />
• X-ray Examinations and Diagnostic<br />
Studies<br />
Consider Need for Patient<br />
tRANsfer<br />
Special Populations<br />
SecondARy Survey<br />
• History<br />
• Physical Examination<br />
Adjuncts to the SecondARy<br />
Survey<br />
Reevaluation<br />
Definitive Care<br />
Records and Legal ConsideRAtions<br />
• Records<br />
• Consent for Treatment<br />
• Forensic Evidence<br />
Teamwork<br />
Chapter Summary<br />
BibliogRAphy<br />
OBJECTIVES<br />
After reading this chapter and comprehending the knowledge<br />
components of the <strong>ATLS</strong> provider course, you will be able to:<br />
1. Explain the importance of prehospital and hospital<br />
preparation to facilitate rapid resuscitation of<br />
trauma patients.<br />
2. Identify the correct sequence of priorities for the<br />
assessment of injured patients.<br />
3. Explain the principles of the primary survey, as they<br />
apply to the assessment of an injured patient.<br />
4. Explain how a patient’s medical history and<br />
the mechanism of injury contribute to the<br />
identification of injuries.<br />
5. Explain the need for immediate resuscitation during<br />
the primary survey.<br />
6. Describe the initial assessment of a multiply injured<br />
patient, using the correct sequence of priorities.<br />
8. Explain the management techniques employed<br />
during the primary assessment and stabilization of a<br />
multiply injured patient.<br />
9. Identify the adjuncts to the assessment and<br />
management of injured patients as part of the<br />
primary survey, and recognize the contraindications<br />
to their use.<br />
10. Recognize patients who require transfer to another<br />
facility for definitive management.<br />
11. Identify the components of a secondary survey,<br />
including adjuncts that may be appropriate during<br />
its performance.<br />
12. Discuss the importance of reevaluating a<br />
patient who is not responding appropriately to<br />
resuscitation and management.<br />
13. Explain the importance of teamwork in the initial<br />
assessment of trauma patients.<br />
7. Identify the pitfalls associated with the initial<br />
assessment and management of injured patients and<br />
describe ways to avoid them.<br />
n BACK TO TABLE OF CONTENTS<br />
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