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
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