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Military Perspective in Trauma Care
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
As per the ATLS protocol, in the secondary survey the identification of all injuries in a head-to-toe examination is done. In tertiary survey, reassessment for the identification of any undetected injuries is performed.
Facial Trauma
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
If in doubt, assess as per ATLS principles to avoid missing severe injuries. Key points within the ATLS survey are:Airway
Surgery and traumatology: Surgical management of severely injured patients when resources are limited
Published in Jan de Boer, Marcel Dubouloz, Handbook of Disaster Medicine, 2020
The ATLS regimen has not been accepted uncritically. Its applicability in centres that deal with a heavy load of trauma has been questioned. In such centres, the different steps in trauma management are usually run in parallel by a large team of specialised physicians, nurses and technicians. When it comes to more primitive conditions with less experienced people, however, the ATLS regimen is of benefit and it has been clearly shown that its wide application has resulted in significant improvements in trauma care.
Tourniquet Application for Bleeding Control in a Rural Trauma System: Outcomes and Implications for Prehospital Providers
Published in Prehospital Emergency Care, 2022
Hala Bedri, Hadeal Ayoub, Jacklyn M. Engelbart, Michele Lilienthal, Colette Galet, Dionne A. Skeete
Our data supports the need for standardized educational courses and trauma center outreach education on bleeding control for EMS providers (41,42) as well as the need to assess knowledge retention and skill decay. Rural providers have less exposure to injured patients compared to urban settings (7), which may contribute to skill decay. Continued education and skill development are already of utmost concern in rural states like ours where a large percentage of EMS providers are volunteer. Requiring PHTLS certification at regular intervals like Advanced Trauma Life Support (ATLS®) certification requirements could help with skill decay and continued education as this course is updated with the current EMS literature and ATLS principles. Regrettably, these uncompensated providers may have limited time and resources to devote to additional PHTLS training.
Training in polytrauma management in medical curricula: A scoping review
Published in Medical Teacher, 2020
Junior doctors in the emergency department are amongst the first to manage PT patients and provide them with initial resuscitation and care (Price and Hughes 1998; Carley and Driscoll 2001). Yates et al. conducted a study on the management of patients with major trauma presenting to 33 UK hospitals over a 2-year period and found that in 57% (826/1556) of cases of severe trauma (injury severity score ≥16) a senior house officer was in charge of the initial resuscitation (Yates et al. 1992). Training of surgical trainees, such as senior house officers, in the management of PT, is therefore, of clinical relevance, particularly when initial management during the ‘golden hour’ is correlated with clinical outcomes. At the postgraduate level many surgical trainees complete the Advanced Trauma Life Support (ATLS®) course, which provides training on early care of PT patients; however not all surgical trainees working in emergency departments or in acute surgical specialties have completed this training. A study by Graham and Sinclair (1996) found only 24% (28/119) of surgical trainees in acute surgical specialties in the West of Scotland had completed the ATLS®, while a study in the Republic of Ireland by Moholkar et al. (2004), across 26 hospitals providing acute trauma care, reported only 34% (167/488) were ATLS® trained (Graham and Sinclair 1996; Moholkar et al. 2004). Therefore, many surgical trainees, who take charge of the initial management of PT in their day-to-day clinical work may only have had training in PT in their undergraduate medical education.
Suspicion of abdominal injuries in high-energy trauma patients: which clinical factors influence decision making for diagnostic imaging?
Published in Acta Chirurgica Belgica, 2020
Bart G. J. Candel, Yvonne Admiraal-van de Pas, Fenneke Smit-van de Wiel
This study was performed at a single-institution level II trauma centre in the Netherlands. This trauma centre is staffed with emergency physicians 24 h a day. The annual census of this hospital is around 28,000 ED visits. A standard trauma work-up was performed in all trauma patients who presented in the ED. This work-up comprised a primary survey, resuscitation of vital functions and a secondary survey with ‘head-to-toe’ examination according to the ATLS guidelines [33]. During the primary survey a FAST examination was performed by an emergency physician or a radiologist, if indicated according to the emergency physician. Additional abdominal CT was performed if FAST showed free fluid, was inconclusive or if a high suspicion of abdominal injury persevered. Patients were admitted to the hospital, followed by tertiary survey the next day, or discharged home, depending on the outcomes.