Advanced Trauma Life Support Manual Pdf Free Download

Imaging is most useful and efficient if consulting with a radiologist becomes routine [3, 4]. We extrapolate this advice to the trauma setting and endorse consultation with clinicians strongly; however, consulting a radiologist is not mentioned once in the ATLS manual!

If a CT is positive, the ATLS manual states that the trauma surgeon is in the best position to determine which, if any other, diagnostic imaging is warranted. The possibility to construct multiplanar reconstructions (MPRs), maximum intensity projections (MIPs), volumetric, and virtual angioscopic three-dimensional views from MDCT data, making diagnostic angiography superfluous, is not stated [7]. The same post-processing tools can be used to differentiate between traumatic aortic injury and normal variants [7]. Neither consulting with a radiologist nor endovascular treatment of traumatic aortic injury are mentioned in the ATLS manual.

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According to the ATLS manual, an upper GI contrast study is the imaging method of choice in suspected diaphragm rupture. CT is not mentioned as an option. On the contrary, it is stated that CT misses diaphragmatic injuries. Although CT is not 100% sensitive, neither are GI contrast studies. A comparative study is not available. MDCT has the advantage that it is much easier and quicker to perform in trauma patients [1, 13]. Although no consensus of opinion exists, coronal, and sagittal multiplanar reconstructions (MPRs) might improve the accuracy of MDCT for the diagnosis of blunt traumatic diaphragm rupture [14, 15].

Advanced Trauma Care for Nurses (ATCN) is an advanced course designed for the registered nurse interested in increasing his/her knowledge in management of the multiple trauma patient. The ATCN course is taught concurrently with the American College of Surgeons (ACS) Advanced Trauma Life Support (ATLS).

The ATLS Program emphasises the first hour of initial assessment and primary management of the injured patient, starting at the point in time of injury and continuing through initial assessment, life-saving intervention, re-evaluation, stabilisation, and when needed, transfer to a facility in which the patient can receive specialised care, such as a trauma centre.

Trauma continues to be the leading cause of morbidity and mortality in the 1 to 44 age group, killing more young Americans than cancer, heart disease, and stroke combined. Trauma claims a life every six minutes and is responsible for serious disability every three seconds, yet more people are surviving critical injuries than ever before. This is due to the training of expert trauma care providers with advanced trauma skills.

In many countries, trauma care is based on Advanced Trauma Life Support (ATLS) [1]. Although the ATLS manual and course are neither evidence based nor up-to-date concerning several parts of radiology in trauma, surgeons use the ATLS recommendations, if present, routinely to support indications for diagnostic imaging. In addition, surgeons refer to the ATLS unjustly with indications for imaging that are not supported by the ATLS at all. Radiologists must be aware of this to intervene appropriately when sub-optimal imaging indications are presented. In this respect, knowing the content and the language of the ATLS can be helpful.

ATLS is a method to establish priorities in emergency trauma care. There are three underlying premises. (1) Treat the greatest threat to life first. (2) Indicated treatment must be applied even when a definitive diagnosis is not yet established. (3) A detailed history is not necessary to begin evaluation and treatment.

Therefore, the assessment of a trauma patient is divided in a primary and a secondary survey. In the primary survey, life-threatening injuries are diagnosed and treated simultaneously. All other injuries are evaluated in the secondary survey.

A chest radiograph must be obtained to document the position of tubes and lines and to evaluate for pneumothorax or hemothorax and mediastinal abnormalities. When not obtained in the primary survey, it should be done in the secondary survey. From the ATLS manual, it is not clear if a chest radiograph should be performed in every patient [1]. However, this is in accordance with the literature. At present, no clinical decision rule is available concerning the indication for chest radiography in trauma patients.

Trauma Care has evolved into a specialty in many local and regional hospitals over recent years. Historically called emergency rooms, trauma centers have established high quality, comprehensive medical services for patients. The public relies on trauma centers to provide quality care from initial injury to final disposition, whether at the local hospital or tertiary care center. Regardless of where the trauma program is located, it provides critical services in a timely manner to patients who often need lifesaving measures. As a Trauma Program Manager (TPM), it is a primary responsibility to ensure patients are receiving the best care possible. This is often accomplished by compilation and analysis of data, policy review, and continuous quality improvement initiatives. The following chapters will provide an overview of many aspects of trauma care and acts as a guide to help the TPM succeed in their role. TPM will be referenced throughout the manual and will be the collective title for the role.

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Trauma is a complex pathology that requires an experienced multidisciplinary team with an inherent quick decision-making capacity, given that a few minutes could represent a matter of life or death. These management decisions not only need to be quick but also accurate to be able to prioritize and to efficiently control the injuries that may be causing impending hemodynamic collapse. In essence, this is the cornerstone of the concept of damage control trauma care. With current technological advances, physicians have at their disposition multiple diagnostic imaging tools that can aid in this prompt decision-making algorithm. This manuscript aims to perform a literature review on this subject and to share the experience on the use of whole body computed tomography as a potentially safe, effective and efficient diagnostic tool in cases of severely injured trauma patients regardless of their hemodynamic status. Our general recommendation is that, when feasible, perform a whole body computed tomography without interrupting ongoing hemostatic resuscitation in cases of severely injured trauma patients with or without signs of hemodynamic instability. The use of this technology will aid in the decision-making of the best surgical approach for these patients without incurring any delay in definitive management and/or increasing significantly their radiation exposure.

Trauma is a complex pathology that requires an experienced multidisciplinary team with an inherent quick decision-making capacity, given that a few minutes could represent a matter of life or death 1. These management decisions not only need to be quick but also accurate to be able to prioritize and to efficiently control the injuries that may be causing impending hemodynamic collapse. In essence, this is the cornerstone of the concept of damage control trauma care. With current technological advances, physicians have at their disposition multiple diagnostic imaging tools that can aid in this prompt decision-making algorithm. This manuscript aims to perform a literature review on this subject and to share the experience from the Trauma and Emergency Surgery Group of Cali, Colombia on the use of whole body computed tomography as a potentially safe, effective and efficient diagnostic tool in cases of severely injured trauma patients regardless of their hemodynamic status.

The result is both a venous and arterial phase in a single high-resolution image (Figure 1). From January 2017 to December 2018, an observational, prospective study was performed at our Level I Trauma Center where we tabulated a total of 263 severely injured trauma patients who underwent whole body computed tomography as part of their initial evaluation. One hundred and sixty-eight had blunt trauma and were hemodynamically stable (Group 1), 50 patients had blunt trauma and were hemodynamically unstable (Group 2) and 45 had penetrating trauma with or without hemodynamic instability (Group 3). Median injury severity score was 22 (IQR= 16-22) and 172 (65.4%) patients received non-operative management, without significant differences between groups. Median time between emergency department and whole body computed tomography was 28 minutes (IQR= 14-5) and the median radiation dose was less than 20 mSv, which is considered to be the optimal range of exposure that does not increase significantly long-term cancer risks 23-25. Ninety-one (34%) patients required surgical management, without significant differences among groups [Group 1: 59 (35.1%); Group 2: 15 (30%); Group 3: 17 (37.7%); p= 0.23]. All patients who required surgery had positive findings during their procedure 26. These results provide supporting evidence towards our claims that whole body computed tomography is a safe, effective and efficient tool in the initial workup and subsequent management of the severely injured trauma patient regardless of their hemodynamic status. Furthermore, it could potentially avoid unnecessary procedures in patients that could be managed otherwise non-operatively, decreasing overall costs and morbidity in these patients. 17dc91bb1f