Advanced Trauma Life Support ATLS Student Course Manual 2018

20
CHAPTER 1 n Initial Assessment and Management
includes a team leader, airway manager, trauma nurse,
and trauma technician, as well as various residents
and medical students. The specialty of the trauma
team leader and airway manager are dependent on
local practice, but they should have a strong working
knowledge of ATLS principles.
To perform effectively, each trauma team should
have one member serving as the team leader. The
team leader supervises, checks, and directs the
assessment; ideally he or she is not directly involved in
the assessment itself. The team leader is not necessarily
the most senior person present, although he or she
should be trained in ATLS and the basics of medical
team management. The team leader supervises the
preparation for the arrival of the patient to ensure a
smooth transition from the prehospital to hospital
environment. He or she assigns roles and tasks to
the team members, ensuring that each participant
has the necessary training to function in the
assigned role. The following are some of the possible
roles, depending on the size and composition of
the team:
••
Assessing the patient, including airway
assessment and management
••
Undressing and exposing the patient
••
Applying monitoring equipment
••
Obtaining intravenous access and drawing blood
••
Serving as scribe or recorder of resuscitation
activity
On arrival of the patient, the team leader supervises
the hand-over by EMS personnel, ensuring that no
team member begins working on the patient unless
immediate life-threatening conditions are obvious
(i.e., a “hands-off hand-over”). A useful acronym to
manage this step is MIST:
••
Mechanism (and time) of injury
••
Injuries found and suspected
••
Symptoms and Signs
••
Treatment initiated
As the ABC assessment proceeds, it is vital that
each member knows what the other members have
found and/or are doing. This process is facilitated
by verbalizing each action and each finding out loud
without more than one member speaking at the same
time. Requests and orders are not stated in general
terms, but instead are directed to an individual, by
name. That individual then repeats the request/order
and later confirms its completion and, if applicable,
its outcome.
The team leader checks the progress of the assessment,
periodically summarizes the findings and the
patient’s condition, and calls for consultants as required.
He or she also orders additional examinations
and, when appropriate, suggests/directs transfer of
the patient.
Throughout the process, all team members are
expected to make remarks, ask questions, and offer
suggestions, when appropriate. In that case, all other
team members should pay attention and then follow
the team leader’s directions.
When the patient has left the ED, the team leader
conducts an “After Action” session. In this session,
the team addresses technical and emotional aspects
of the resuscitation and identifies opportunities for
improvement of team performance.
All subsequent chapters contain a special end-ofchapter
feature entitled “Teamwork.” This feature
highlights specific aspects of the trauma team that
relate to the chapter. The topic of teamwork is also
explored in detail in Appendix E: ATLS and Trauma
Team Resource Management.
1. The correct sequence of priorities for assessment
Chapter Summary
n FIGURE 1-8 In many centers, trauma patients are assessed by
a team. To perform effectively, each team has one member who
serves as team leader.
of a multiply injured patient is preparation; triage;
primary survey with resuscitation; adjuncts to the
primary survey and resuscitation; consider need
for patient transfer; secondary survey, adjuncts to
secondary survey; reevaluation; and definitive care
again considering the need for transfer.
n BACK TO TABLE OF CONTENTS