ATLS 8th Edition UPDATE , By: Fatma Al- Ghaithi
Difficult Airway • This content was not included in the 7th edition. • It is important to assess the patient’s airway before attempting intubation to predict the likely difficulty. • Factors which may predict difficulties with airway maneuvers include significant maxillofacial trauma, limited mouth opening and anatomical variation such as receding chin, overbite, or a short thick neck. • Use mnemonic LEMON (look, evaluate, mallampatti, obstruction, neck) 8 th edtion
LMA • The LMA’s role in the resuscitation of the injured patient has not been defined • There is established role for the LMA in the management of a patient with a difficult airway, particularly if attempts at tracheal intubation or bag mask ventilation have failed. • The LMA does not provide definitive airway. 8 th edition
Airway Carbon Dioxide Detectors • A CO2 detector (colorimetric CO2 monitoring device) is indicated to help confirm proper intubation • CO2 detector (ideally capnography but if not available by a colorimetric CO2 monitoring device) is indicated to help confirm proper intubation of the airway. 8 th edition
Laryngeal Tube Airway • This content was not included in the 7th edition. • The laryngeal tube airway (LTA) is an extraglottic airway device with similar capability to provide successful ventilation to the patient as that of the LMA. The LTA is not a definitive airway device and plans to provide a definitive airway must be implemented. 8 th edition
Gum Elastic Bougie • This content was not included in the 7th edition. • It is employed when vocal cords cannot be visualized on direct laryngoscopy. • In multiple operating room studies, successful intubation is seen at rates greater than 95% with bougie use. • In cases where potential cervical spine injury is suspected, Bougie aided intubation was successful in 100% of cases in less than 45s. • It allowed rapid intubation of nearly 80% of prehospital patients with difficult direct laryngoscopy. 8 th edition
Shock Crystalloid • Warmed isotonic electrolyte solutions are used for initial resuscitation. • RL Is the initial fluid of choice. • Normal saline is the second choice. • Warmed isotonic solutions are used for initial resuscitation. This type of fluid provides transient intravascular expansion and further stabilizes the vascular volume by replacing accompanying fluid losses into the interstitial and intracellular spaces. An alternative initial fluid is hypertonic saline although current literature does not demonstrate any survival advantage.
Shock Fluid Resuscitation • Initial fluid resuscitation based on the 4 ATLS classes of hemorrhage is presented. • Assess the patient’s response to fluid resuscitation and evidence of adequate end organ perfusion Use of IV fluids is guided by the goal of restoring a normal BP.
You've reached the end of your free preview.
Want to read all 37 pages?
- Fall '17
- Traumatic brain injury, hemorrhage, Penetrating trauma