ATLS versjon 10 -Hva er nytt-

Jørgen Joakim Jørgensen ATLS Norge og ATLS Europa

Avdeling for traumatologi, Karavdelingen Oslo Universitetssykehus

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ATLS EUROPE

1.  UK (1988) 2.  Israel (1990) 3.  Ireland (1991) 4.  South Africa (1992) 5.  Greece (1993) 6.  Italy (1994) 7.  Netherlands (1995) 8.  Sweden (1996) 9.  Switzerland (1998) 10.  Denmark (1998) 11.  Portugal (1999) 12.  Spain (2000) 13.  Germany (2003) 14.  Norway (2004) 15.  Lithuania (2004) 16.  Hungary (2005) 17.  France (2010) 18.  Slovenia (2010) 19.  Czech Republic (2012) 20.  Cyprus (2013) 21.  Georgia (2013) 22.  Estonia (2015) 23.  Kenya (2016) 24.  Moldova (2017) 25.  Ghana (2017)

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Planlagt mars 2017 Kommer primo 2018

Forberedelser •  iBook, eBook, Printet manual (desember 2017) •  Alt tilgjengelig online •  mLearning (mai 2018)

–  Hybrid kurs på 1,5 dager –  13 kapitler med 5-6 leksjoner

Forberedelser •  iBook, eBook, Printet manual (desember 2017) •  Alt tilgjengelig online •  mLearning (mai 2018)

–  Hybrid kurs på 1,5 dager –  13 kapitler med 5-6 leksjoner

Innhold •  Kompendium – mindre forandringer •  NICE Major Trauma Guidelines 2016

Initial Assessment

•  1 liter væske, forsiktig

•  Massiv transfusjonsprotokoll

•  Cyklokapron

•  Koagulopati

•  CCSR

•  Traumeteam

Airway and Ventilation

•  RSI endret til Drug Assisted Intubation

•  Videolaryngoskopi

•  Traumeteam

Shock

•  Utvidet sjokklassifikasjon –  BE

•  Tidlig bruk av blodprodukter

•  Fokus på koagulopati

•  Massiv transfusjon definisjon –  >10SAG/24t eller 4SAG/1t

•  Cyklokapron

•  Traumeteam

Class I! Class II (mild)!

Class III (moderate)!

Class IV (severe)!

Approximate blood loss' < 15 % ' 15–30%' 31–40%' > 40%'

Heart rate '/ ' ' / '

Blood pressure' / ' '

Pulse pressure' ' ' '

Respiratory rate' / ' '

Urine Output'' '

GCS'' '

Base deficita' 0 to –2 mEq/L'

–2 to –6 mEq/L'

–6 to –10 mEq/L'

–10 mEq/L or more'

Need for Blood Products'

Monitor' Possible' Yes' MTP '

/

/

/

ANTICOAGULANT TREATMENT COMMENTS Antiplatelets (e.g. asiprin, plavix)

Platelets May need to repeat; consider DDAVP deamino-delta-d-arginine vasopressin (Desmopressin acetate)

Coumadin (warfarin) FFP, Vitamin K Normalize INR; avoid fluid overload in elderly patients and patients who sustained cardiac injury

Heparin Protamin sulfate Monitor PTT

Low molecular weight heparin e.g. lovenox (enoxaparin)

Protamine sulfate N/A

Direct thrombin inhibitors Pradaxa (dabigatran etexilate)

Praxbind (idarucizumab) May benfit from (PCC) prothrombin complex concentrate (e.g. K cenetra)

Rivaroxaban Xarelto (ribaroxaban)

N/A May benefit from PCC

Thoracic Trauma

•  Trykkpneumothorax –  SV vs IPPV

•  Livstruende: –  Flail ut og tracheobronchial in

•  5ic for nåldekompresjon

•  Åpen thoracostomi

•  Algoritme for sirkulasjonsstans –  Clamshell

•  28-32F dren (ikke 36-40F)

•  Aortaruptur med Betablokker

•  Traumeteam

Abdominal and Pelvic Trauma

•  Ikke palpere prostata for uretra skade

•  Oppdatert protokoll for blødende bekkenskader

•  Traumeteam

Head Trauma

•  GCS endret – ”pressure, sound, NT”

•  Guide for SBT mål –  >100mmHg (50-69) –  >110mmHg (15-49 eller over 70)

•  Klassifikasjon – ”mild” hodeskade

•  Profylakse kramper

•  Traumeteam

Spine and Spinal Cord Trauma

•  Nytt myotom diagram –  ASIA

•  ”Redusere spinal bevegelse”

•  CCSR

•  Traumeteam

Musculoskeletal Trauma

•  Vektbasert antibiotika regime

•  Bilaterale femurfrakturer

•  Traumeteam

Thermal injuries

•  Voksen: 2ml/kg x vekt x % brannskade

•  Barn: 3ml/kg x vekt x % brannskade

•  Væskeresussitering relatert til urinproduksjon

•  Traumetema

Paediatric Trauma

•  DOPE mnemonic –  Påminner

•  Nåldekompresjon forblir i 2 IC rom

•  Begrense krystalloider –  Maks bolus x 2

•  Traumeteam

Geriatric Trauma

•  Mortalitet/Morbiditet –  KOLS –  IHS –  DM –  Cirrhose –  Koagulopati

•  Bekkenskade –  4 x mortalitet –  Økt LOS –  Transfusjoner

•  Traumeteam

Trauma in Pregnancy and Intimate Partner Violence

•  Fostervannslekkasje: Vaginal pH>4,5

•  Traumeteam

Transfere to Definitive Care

•  Unngå CT ved primær sykehus

•  ABC-SBAR som kommunikasjon

•  Traumeteam

ATLS and Trauma Team Resource Management

•  Nytt kapittel

•  Valgfritt

Kurset: •  Timeplan: relativt uforandret

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Kurset: •  Timeplan: relativt uforandret •  Interaktive diskusjoner og IKKE FORELESNINGER

1 Initial Assessment and Management !"#$%&'()*+#&

1 Initial Assessment and Management

5 of 22

1Discussion Questions: 1.! How would you prepare for the arrival

of this patient?

2.! What other information would be helpful to know in order to prepare?

3.! From the history, what are the potential injuries this patient may have suffered?

Initial Assessment and Management

5 of 22

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Kurset: •  Timeplan: relativt uforandret •  Interaktive diskusjoner og IKKE FORELESNINGER •  Skills stations – stor forandring (8 stasjoner, 60 min)

–  Scenariebasert –  A-I: Basic and Advanced Airway Management –  A-II: Pediatric Airway and Cricothyrotomy –  B: Breathing –  C: Circulation –  D: Disability –  E: Adjuncts –  F. Secondary Survey –  G: Initial Assessment and Team Training

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Kurset: •  Timeplan: relativt uforandret •  Interaktive diskusjoner og IKKE FORELESNINGER •  Skills stations – stor forandring (8 stasjoner, 60 min)

–  Scenariebasert –  A-I: Basic and Advanced Airway Management –  A-II: Pediatric Airway and Cricothyrotomy –  B: Breathing –  C: Circulation –  D: Disability –  E: Adjuncts –  F. Secondary Survey –  G: Initial Assessment and Team Training

•  Eksamen og triage: Uforandret

Forandres ikke •  Prinsipper og prioriteringer •  Mest av innhold •  Triage •  Initial assessment og MCQ For deltagerne •  Må være forberedt. Ingen forelesninger

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ATLS NORGE INVITERER TIL

UPDATE 2017

BERGEN

1 4 . N O V E M B E R 2 0 1 7

Preliminært program

09.00-09.30: Registrering

09.30-09.45: Velkommen – Slåke/Jørgensen

09.45-10.00: Versjon 10, hva er nytt? - Jørgensen

10.00-10.30: Demo diskusjon – Jørgensen/Eriksson

10.30-10.45: ”5 step model” skill teaching - Eriksson

10.45-11.00: Pause

11.00-12.20: Rotasjon skills grupper (20 minutter A, B, C, D) – Eriksson/kursledere

12.20-13.00: Plenumsdiskujon og veien videre - Jørgensen

13.00-14.00: Lunsj

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