ATLS versjon 10 -Hva er nytt- -...
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ATLS versjon 10 -Hva er nytt- Jørgen Joakim Jørgensen ATLS Norge og ATLS Europa Avdeling for traumatologi, Karavdelingen Oslo Universitetssykehus
Transcript of ATLS versjon 10 -Hva er nytt- -...
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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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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– 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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skills $ included $ in $ this$skill $ station
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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