 Some new changes to ATLS 10th Ed:
■ RSI (rapid sequence intubation) --> DAI (drug assisted intubation). ■ Needle decompression of pneumothorax: # Adults --> 4th/5th ICS anterior to midaxillary line. # Pediatric --> 2nd ICS midclavicular line. ■ Chest tube size: 28-32F (pig-tail only for small pneumothorax). ■ CXR reading mnemonic: DRSABCDE. ■ Fluid resuscitation: 1L warm crystalloid, 18G peripheral access x 2. ■ Massive transfusion: > 10U in 24h or > 4U in 1h. (1U in USA = 2U in Taiwan). ■ Tranexamic acid 1g over 10 min stat and 1g over 8h given within 3h of trauma. ■ Blunt aortic injury: targets HR = 80 MAP = 60-70 mmHg. ■ Blunt cardiac injury: emphasize ECG monitor, Tn-I inconclusive. ■Pelvic fracture without hemoperitoneum: both preperitoneal packing and TAE are acceptable. ■ High-riding prostate: not equal to urethral rupture. ■ No more DRE to detect high-riding prostate. Note that DRE still indicated in selected patients in order to detect anal sphincter tone, bowel wall integrity, and bony fragments. ■ Traumatic brain injury: # HPI: should inform neurosurgeon if patient under anticoagulation. # GCS: "to speech" --> "to sound". # GCS: "to pain" --> "to pressure". # GCS: can document as "NT (non-testable)". # Prolonged hyperventilation with PCO2 <25mmHg not recommended. # If 50-69Y: keep SBP ≥ 100mmHg. # If 15-49Y or >70Y: keep SBP ≥ 110mmHg. # Caution, high-dose propofol can produce significant morbidity. # Mannitol 0.25-1 g/Kg to control ICP, avoid arterial hypotension. # High-dose barbiturate to control refractory IICP, avoid arterial hypotension. # Phenytoin can reduce incidence of early post-traumatic seizure (within 7 days). ■ Spine: "spinal immobilization" --> "spinal motion restriction". ■ Burns > 20% TBSA: IVF = 2ml LR x KG x % TBSA burn, avoid fluid boluses unless the patient is hypotensive (pediatric: 3ml x KG x % TBSA). ■ Hypovolemia resuscitation in children: # 20 ml/kg bolus crystalloid. # 10-20 ml/kg of PRBC. # 10-20 ml/kg of FFP or platelet. ■ Trauma in Pregnancy: If vaginal fluid pH > 4.5 --> amniotic fluid leak (+). #FOAMED #Trauma #ATLS Read more at... https://www.slideshare.net/sunny_8162/atls-10th-edition-compendium-of-change Comments are closed.
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