Advanced Trauma Life Support ATLS Student Course Manual 2018

12
CHAPTER 1 n Initial Assessment and Management
Pitfall
Gastric catheter
placement can
induce vomiting.
Pulse oximeter
findings can be
inaccurate.
prevention
• Be prepared to logroll the
patient.
• Ensure suction is immediately
available.
• Ensure placement of the pulse
oximeter is above the BP cuff.
• Confirm findings with ABG
values.
X-ray Examinations and Diagnostic
Studies
Use x-ray examination judiciously, and do not
delay patient resuscitation or transfer to definitive
care in patients who require a higher level of care.
Anteroposterior (AP) chest and AP pelvic films often
provide information to guide resuscitation efforts of
patients with blunt trauma. Chest x-rays can show
potentially life-threatening injuries that require
treatment or further investigation, and pelvic films
can show fractures of the pelvis that may indicate the
need for early blood transfusion. These films can be
taken in the resuscitation area with a portable x-ray
unit, but not when they will interrupt the resuscitation
process (n FIGURE 1-5). Do obtain essential diagnostic
x-rays, even in pregnant patients.
FAST, eFAST, and DPL are useful tools for quick
detection of intraabdominal blood, pneumothorax,
and hemothorax. Their use depends on the clinician’s
skill and experience. DPL can be challenging to perform
in patients who are pregnant, have had prior laparoto-
mies, or are obese. Surgical consultation should be
obtained before performing this procedure in most
circumstances. Furthermore, obesity and intraluminal
bowel gas can compromise the images obtained by
FAST. The finding of intraabdominal blood indicates
the need for surgical intervention in hemodynamically
abnormal patients. The presence of blood on FAST or
DPL in the hemodynamically stable patient requires
the involvement of a surgeon as a change in patient
stability may indicate the need for intervention.
Consider Need for
pAtient Transfer
During the primary survey with resuscitation, the
evaluating doctor frequently obtains sufficient
information to determine the need to transfer the
patient to another facility for definitive care. This
transfer process may be initiated immediately by
administrative personnel at the direction of the
trauma team leader while additional evaluation
and resuscitative measures are being performed. It
is important not to delay transfer to perform an indepth
diagnostic evaluation. Only undertake testing
that enhances the ability to resuscitate, stabilize, and
ensure the patient’s safe transfer. Once the decision
to transfer a patient has been made, communication
between the referring and receiving doctors is essential.
n FIGURE 1-6 shows a patient monitored during critical
care transport.
n FIGURE 1-5 Radiographic studies are important adjuncts to the
primary survey.
n FIGURE 1-6 Vigilant care is also required when transfer takes
place within an institution.
n BACK TO TABLE OF CONTENTS