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ATLS

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ATLS UPDATE 2018

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ATLS

  1. 1. ATLS 2018 UPDATE DR MOHAMED ABOUELFETOUH
  2. 2. AIRWAY  cervical spine protection” changed to ”Restriction of Cervical Spine Motion”  RSI changed to ”Drug Assisted Intubation”  Trauma teamaa
  3. 3. CIRCULATION  Initial resuscitation: Adult: 1 L isotonic solution; Child < 40 kg:20ml/kg  If a patient is unresponsive to initial crystalloid therapy, he should receive a blood transfusion  Tranexamic acid: 1 g over 10 min within 3 hr, then 1 g over 8 hr  Hemorrhagic shock classification table amended: Base excess  Early resuscitation wit blood and blood product must be considered in stage 3 and 4  Earle administered of blood at low ratio of PRBCS TO PLASMA AND PLATLET help to prevent coagulopaty  teamwork
  4. 4. CHEST TRAUMA  Life threatening chest injury: flail chest out, tracheobrochial injury now in  Tension pneumothorax:  Needle thoracocentesis 5th ICS mid-axillary line for adult  UNCHANGED 2nd ICS mid-clavicular line for child  28-32 Fr chest drain for hemothorax (not 36-40 Fr)  eFAST (extended FAST):E- fast help to diagnose pneumo / hemothorax  better and faster than c-xr  Aortic rupture management with Beta Blocker (esmolol): goal heart rate <80 bpm and MAP 60-70 mmHg  Algorithm for circulation arrest approach
  5. 5. Abdominal and Pelvic Trauma  Palpation of prostate gland no longer recommended for urethral injury
  6. 6. Head Trauma  Classification: “minor” changed to “mild” head trauma  Detailed guidance on SBP management  Maintain SBP at ≥ 100 mmHg for patients 50-69 years or at ≥ 110 mmHg for patients 15-49 years or older than 70 years.  Anticoagulation reversal guidance  teamwork
  7. 7. Musculoskeletal Trauma  Highlighting risk factor of bilateral femur fractures  Weigted based antibiotic regimen
  8. 8. Thermal injuries
  9. 9. Transfer to Definitive Care  Specific mention of avoiding CT in primary hospital  SBAR template for communication
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ATLS UPDATE 2018

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