SKILLS VIDEOYou'll also note the inclusion of a DVD with this edition.This new course component includes video of critical skillsthat doctors should be familiar with before taking thecourse. Skill Stations during the course will allow doctorsthe opportunity to fine tune skill performance inpreparationfor the practical assessment. Review of the demonstratedskills prior to participating in the skills stations willenhance the learner's experience.

TEXTBOOK FEATURESThis edition features a new full-color design, along withnew color photographs and medical illustrations. Contentwas presented in a narrative format rather than outline forease of readability. In addition, an effort was made toaugment the pedagogical features of the textbook to improvestudent comprehension and retention of knowledge. Lookfor the following features:

CHAPTER OUTLINE: This feature provides a "road map" to the,ihaPter content ':,..:

terms to facilitate understanding by all students and teachersof the Program.

Advanced Trauma Life Support@ and ATLS@ areproprietary trademarks and service marks owned by theAmerican College of Surgeons and cannot be used byindividuals or entities outside the ACS COT organizationfor their goods and services without ACS approval.Accordingly, any reproduction of either or both marks indirect conjunction with the ACS ATLS Program within theACS Committee on Trauma organization must beaccompanied by the common law symbol of trademarkownership.

American College of SurgeonsCommittee on Trauma

]ohn Fildes, MD, FACSCommittee on Trauma, ChairProfessor of Surgery, Vice Chair DEartrnent of Surgery, ProgramDirector, General Surgery Residency Chief Diaision of Traumat Critical CareUniversity of Nevada School of MedicineLas Vegas, NevadaUnited States

J. Wayne Meredith, MD, FACSDirector of the Division of Surgical Sciences, Richard T.MyersProfessor and ChairmanWake Forest UniversitySchool of MedicineWinston-Salem, North CarolinaUnited States

$ubcommittee on Advanced TraumaLife Support of the American Collegeof Surgeons Committee on Trauma

]ohn B. Kortbeelg MD, FRCSC, FACSProfessor Departments of Surgery and Critical CareUniversity of Calgary and Calgary Health RegionCaIgary, AlbertaCanada

Christoph R. Kaufmann, MD, MPH, FACSAssociate Medical DirectorTrauma Services, Legacy Emanuel HospitalPortland, OregonUnited States

KEY QUESTI0NS: pfn.r, questions are aligned with the

KEY POINTS:

instructof s PowerPoint presentations toprepare students for key discussionsduring lectures

Sentences appear in red font toattract the reader's attention to keypoints of information.

J Cross+eferences to other chapters,Skill Stations, and additional resourceshelp to pull all of the information together

PITFALLS J'ITETTT}.

LINKS

*"ruThese boxes highlight critical pitfalls toavoid while caring for trauma patients

SUMMARYChapter summaries tie back to the ChapterObjectives io ensure understanding ofthe most pertinent chapter content

Editorial Notes

The ACS Committee on Trauma is referred to as the ACSCOT or the Committee, and the State/Provincial Chair (s)is referred to as S/P Chair(s).

The international nature of this edition of the ATLSStudent Manual may necessitate changes in commonly used

vllt Adaanced Trauma Life Support

fameel Ali, MD, M.Med.E4 FRCS, FACSProfessor of SurgeryUniversity of TorontoSt. Michael''92s Hospitaf Division of General Surgery/TraumaToronto, OntarioCanada

Karen Brasel, MD, FACSAssociate Professor Trauma Surgery I Critical CareFroedtert Hospital & Medical College of Wisconsiry TraumaSurgery DivisionMilwaukee, WisconsinUnited States

David G. Burris, MD, FACSProfessor I ChairmanUSUHS, Norman M Rich Department of SurgeryBethesda, MarylandUnited States

William G. Cioffi" MD, FACSChief of SurgeryRhode Island Hospital, Department of SurgeryProfessor and ChairmanThe Warren Alpert Medical School of Brown University,Department of SurgeryProvidence, Rhode IslandUnited States

Arthur Cooper, MD, MS, FACS, FAAP, FCCMProfessor of SurgeryColumbia University Medical CenterAffiliation at Harlem HospitalNew York, New YorkUnited States

Michael Hollands, MB BS, FRACS, FACSHead of Hepatobiliary and Gastro-oesophageal SurgeryWestmead HospitalSydney, New South WalesAustralia

Claus Falck Larsen, MD, dr.med., MPA, FACSMedical DirectorThe Abdominal Centre, University of Copenlngeo RigshopitaletDenmarkCopenhagenDenmark

West Livaudais, Jr, MD FACSThoracic SurgeonSouthwest Wound Healing Center, Southwest WashingtonMedical CenterVancouver, WashingtonUnited States

Fred A. Luchette, MD FACSDirector, Diaision of Trauma, Critical Care, and BurnsDepartment of Surgery, Stritch School of Medicine, LoyolaUniversity of ChicagoMa)rwood, IllinoisUnited States

fohn H. McVicker, MD, FACSNeurosurgeonColorado Neurological Institute, Swedish Medical CenterEngelwood, ColoradoUnited States

Charles N. Mock, MD, PhD, MPHProfessor of Surgery, loint appointment, Professor ofEpidemiologyDepartment of Surgery, Harborview Medical Center, Universityof WashingtonSeattle, WashingtonUnited States

Frederick Moore, MD, FACSHead, Diaision of Surgical Critical Care and Acute Care SurgeryMethodist HospitalHouston, TexasUnited States

Steven N. Parks, MD, FACSProfessor of Clinical SurgeryUniversity of Califomia, San Francisco, Department of Surgery,Community Regional Medical CenterFresno, CaliforniaUnited States

Renato Sergio Poggefti, MD, FACSDirector of Emergency Surgical SerciceHospital das Clinicas Universidad de 56o PauloBrazil

Thomas M. Scalea, MD, FACSPhysician in ChiefR Adams Cowley Shock Trauma CenterFrancis X Kelly Professor of Trauma Surgery, Director Programin TraumaUniversity of Maryland School of MedicineBaltimore, MarylandUnited States

R. Stephen Smith MD, RDMS, FACSVice Chair and Director of Surgical EducationDepartment of Slxgery, The Virginia Tech - Carilion MedicalSchoolRoanoke, VirginiaUnited States

Richard Bell, MD, FACS (CON)Professor and Chairman, Department of SurgeryUniversity of South CarolinaColumbia, South CarolinaUnited States

Brent E. Krantz, MD, FACS (CON)Professor of SurgeryUniversity of South CarolinaColumbia, South CarolinaUnited States

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Associate Members to the$ubcommittee on Advanced TraumaLife $upport of the American Collegeof $urgeone eommittee on TraumaReginald Burton, MD, FACSDirector, Trauma Program and Surgical Critical CareBryan LGH Medical Center, WestLincolry NebraskaUnited States

Ronald Gross, MD, FACSAssociate Director of TraumaDepartment of Emergency Medicine/Trauma, HartfordHospitalHartford, ConnecticutUnited States

Sharon M. Henry, MD, FACSAssociate Professor of SurgeryDirector Wound Healing Seraice and Metabolism SeraiceUniversity of Maryland, R. Adams Cowley Shock TraumaCenterBaltimore, MarylandUnited States

Salvador Martin Mandujano, MD, FACSGeneral SurgeonMedical DirectorCozumel Medical CenterCozumel, Quintana RooMexico

Charles E. Morrow, ]r, MD, FACSAssistant ProfessorAssistant Program Director, General SurgeryMedical Director, Trauma SurgeryDepartment of Trauma, Spartanburg Regional MedicalCenterSpartanburg, South CarolinaUnited States

Frnnk Sacco, MD, FACSDirector of Trauma, Chief of SurgeryAlaska Native Medical Center, Department of SurgeryAnchorage, AlaskaUnited States

Martin A. Schreiber, MD, FACSAssociate Professor of SurgeryChief of Trauma and Surgical Critical CareOregon Health & Science University, Trauma & CriticalCare SectionPortland, OregonUnited States

Mary van Wijngaarden-Stephens, MD, FACSAssociate Clinical Professor Department of Surgery/DiaisionCritical CareTrauma DirectorUniversity of Alberta HospitalsEdmonton, AlbertaCanada

Robert j. Winchell, MD, FACSHead, Diaision of Trauma and Burn SurgeryMaine Medical CenterAssociate Clinical Professor of SurgeryUniversity of Vermont School of MedicinePortland, MaineUnited States

American $ociety of AnesthesiologyLiasion to the $ubcommittee onAdvanced Trauma Life Support of theAmerican 0ollege of $urgeonsCommittee on Traumafill A. Antoine, MDAssociate Professor of Clinical AnesthesiaUniversity of California, San Francisco, Department ofAnesthesia and Perioperative CareSan Francisco, CaliforniaUnited States

American College of EmergencyPhysicians Liasion to the$ubcommittee on Advanced TraurnaLife Support of lhe American Collegeol $urgeons Committee on TraumaRichard C. Hunt, MD, FACEPDirector, Diztision of Injury ResponseCenters for Disease Control and PreventionAtlanta, GeorgiaUnited States

Adaanced Trauma Life Support

Acknowledgments

CONTRIBUTORSDuring development of this revision, we receiveda great deal of assistance from manyindividuals - whether reviewing information atmeetings, submitting images, or evaluatingresearch. ATIS@ thanks the following contributorsfor their time and effort in the development of the8th edition:

Melissa V. AbadRegional Program Coordinator, CMECoordinator for Trauma ProgramsAmerican College of Surgeons ATIS ProgramOfficeChicago, IllinoisUnited States

Joe Acker,III, Mt MPH, EMT-PExecutiae DirectorBirmingham Regional EMSBirmingham, AlabamaUnited States

Saud AI Turki, MD, FRCS, ODTS, FACA, FACSDirectotTrauma Courses Office, Postgraduate Education& Academic Affairs, King Abdulaziz Medical GtyRiyadhKingdom of Saudi Arabia

Fatimah Albarracin, RNSenior OffcerLife Support Training Center, Tawam Hospital,affiliate of Johns Hopkins MedicineAl Ain, Abu DhabiUnited Arab Emirates

Celia AldanaATLS CoortlinatorCommittee on Trauma, ChileSantiagoChile

Donna AllertorL RNCitical Care, Coordinator - ATLS ProgramMcMaster University Medical CentreHamiltoru OntarioCanada

Heri Aminuddin, MDNeurosurgeonGatot Soebroto Central Amy HospitalJakarta Timur, JakartaIndonesia

|ohn A. Androulakis, MD FACSEmeitus Prcfessor of SurgeryUniversity Hospital of PatrasPatrasGreece

Guillermo Arana, MD FACSGmeral SurgeonNational HospitalPanama CityPanam6

Ivar AustlidDeptrtment of Anaesthesia and Intensive CareHaukeland University HospitalBergenNorwayMargreta Behrbohm Fallsberg PhD, BScConsultsntConsulting firm / small businessLinkdpingSweden

Renato Bessa de Melo, MDAssisEnte HospitalarSeruigo de Cirurgia Geral, Hospital de S.JoioPortoPortugal

Mike Betzner MDEmeryency PhysicianSmior Medical Director STARS Air AmbulanceCalgary Health Regior;Calgary, AlbertaCanadaClinical Lecturer, University o{ Calgary

Ken Boffard, MB BCh, FRCS, FRCS (Ed), FACSProfessor and Clinical HeadDepartment of Surgery, Johannesburg HospitafUniversity of the WitwatersrmdJohannesburgSouth Africa

Raphael Bonvin, MD, PhDUnite de pedagogie Medicale, Faculte debiologie et de medicineLausanneSwitzerlmd

Bertil Bouillon, MDProfessorUniversity of Witten Herdecke, Cologne,Merheim Medical Center, Department ofTrauma md Orthopedic SurgeryCologneGermany

Marianne BrandtSpecial E du cation TeacherDiabetes EducatorCmacas

Fred Brennemary MD FRCSC, FACSChief, Trauma ProgramSmybrook Health Sciences CenterAssociate ProfessorDepartment of Surgery, University of TorontoToronto, OntarioCanada

Ase Brinchmann-Hanserj PhDManagin g Educational ConsultantThe Norwegian Medical Association,Department of Professional AffairsOsloNorway

Peter Brinl MD, PhDChief, D epartment of Tr aumatologyUniversity Hospital Maastdcht, Department ofTraumatology

MaastrichtThe Netherlands

Karim Brohi, MDConsultant in Trauma, Vascular and CiticalCare SurgeryThe Royal London HospitalLondonUnited Kingdom

Laura Bruna, RNI talian N ational Coor dinatorAssitraumaTorinoItaly

Jacqueline Bustraan, MScEducational Consultant an d Rese ar cherPLATO, Centre for Research and Developmentof Education and Training, Leiden UniversityLeidenNetherlands

Vilma CabadingATLS National C-oordinator, Saudi ArabiaAcademic Affairs DepartmentKing Abdulaziz Medical City-NGHARiyadhKingdom of Saudi Arabia

Gerardo Cuauhtemoc Alvizo CudenasAssistant and Special Projects CoordinatorAmerican College of Surgeors ATIS kogram OfficeChicago, IllinoisUnited States

Carlos Caroajal Hafeman4 MD, FACSProfessor of SurgeryDirector of Surgery o{ the East CampusUniversidad de ChileSantiagoChile

Gustavo Castagneto, MD, FACSProfessor of SurgeryBuenos Aires British Hospital, Department ofSurgeryBuenos AilesArgentina

fune Sau-Hung ChanSkills Deoelopment Center, Uniaersity of HongKong Medical Cen*eQueen Mary Hospitat Deptrtment of SurgeryHongKongChina

Will Chapleau, EMT-B RN, TNSATLS Program ManagerAmerican College of Surgeons ATIS flogram OfficeChicago IllinoisUnited States

Zafmllah Chaudhry, MD, FRCS, FCP$ FACSProfessor of SurgeryNational Hospital and Medical CenterPresidentCollege of Physicims and Surgeons PakistanLahorePakistm

Adannced Trauma Life Support xt

Peggy Chehardy, EdD, CHESAssistsnt Professor and Director of SurgicalEducationTulane University School of MedicingDepartment of SurgeryNew Orleans, LouisimaUnited States

Robert A. Cherry, MD, FACSTrauma Program Medical DirectorPenn State Milton S. Hershey Medical CenterCollege of MedicineHershey, PennsylvaniaUnited States

Emmanuel Chrysos, MD, PhD, FACSAssociate Professor of SurgeryDepartment of General Surgery, UniversityHospital of CreteHeraklioo CreteGreece

Chin-Hung Chung, MB BS, FACSChief of SenticeDeparbnent of Accident & Emergency, NorthDistrict HospitalHongKongChina

Francisco Collet e Silva, MD, FACS, PhD (med)Medical DoctorEmergency Surgical Services, Hospital dasClinicas of the University of Sio PauloSio PauloBtazil

|aime Cortes, MDClief, Gmeral SurgeryNational Children's HospitalProfessorUniversity of Costa RicaSan JoseCosta Rica

Laura Lee Demmons, RN, MBAManagerCritical Care Transpod, University HosPitalBirmingham, AlabamaUnited States

Aleiandro De Gracia, MD FACS, MAACChief, General SurgeryAgudos Parmenio Piflero General HospitalBuenos AiresArgentina

Mauricio Di Silvio-Lopez, MD, FACSAinical Residency and Research Program Director20 de Noviembre National Medical Center,ISSSTEMexico City, Diskicto FederalMexico

Frank Doto, MSProfessor of Health EducationCounty College of MorrisRandolph, NewlerseyUnited States

Anne-Mich6le DrouxATLS National Coordinator, SwitzerlandSwiss Society of Surgeons

BaselSwitzerlandHermanus facobus Christoffel Du Plessis, MB,ChB, MMed(Surg), FCS(SA), FACSChief Surgeon, ColonelSAMHS (South African Military HealthServices)Head of the Department of Surgery andIntensive Carel Military HospitalAdjunct Professor of SurgeryUniversity of PretoriaPretoriaSouth Africa

Lesley DunstallEMST/ATLS N ational Coor dinator, AustualiaRoyal Australasian College of SurgeonsNorth Adelaide, South AustraliaAustralia

Candida Dur6oATLS N ational C-oordinator, PortugalPortuguese Society of SurgeonsLisbonPortugal

Ruth Dyson, BA(hons)ATLS Co-ordinatorThe Royal College of Surgeons of EnglandLondonUnited Kingdom

David Eduardo Eskenazi, MD, FACSChief, General and Thoracic SurgeryHtal. A. OffativiaBuenos AiresArgentina

Vagn Norgaud Eskesen, MDAssociate ProfessorUniversity Clinic of Neurosurgery, NationalHospital - Copenhagen University HospitalCopenhagenDenmark

Denis Evoy, MCH, FRCSIConsultant Gmeral Surgeon (Breast Entlocine)St Vincents l+ivate Hospital, Consultants ClinicDublinIreland

Froilan A. Fernandez, MDMedical Director Emergenry SeruiceHospital del TrabajadorSantiagoChile

Cornelia Rita Maria Getruda Fluit, MD,MEdSciSenior Consultant in Medical EducationUniversity Medical Centre Nijmegen, Qualityand Development of Medical EducationDepartmentNijmegenThe Netherlands

Jorge Esteban Foianini, MD, FACSGmed SurgeonDirectorFoianini ClinicSanta Cruz

Bolivia

Knut Fredriksen, MD PhDConsultant t Associate ProfessorDepartment of Emergency Medical Services,University Hospital of North NorwayFaculty of Medicine,University of TromsoTromsoNomay

Susanne Fristeen, RNEormer ATLS National Coordinator, DmmarkDanish Trauma SociefCopenhagenDenmark

Christine Gaarder, MDHead ofTrauma Unit, General and Gl surgeonEmergency Divisior; Ullevaal UniversityHospitalOsloNorway

Subash Gautam, MD, MBBS, FRC$ FACSSenior Consultant and Head of Depaimmt ofSurgeryFujairah HospitalFujairahUnited Arab Emirates

Aggelos Geranios, MDGmeral Sur geon, lntensiztistSur. Clinic of Livadeia Rural HospitalAthensGreece

Michael Gerazounis, MDGreece

favier Gonzilez-Uriarte, MD PhD, EBSQ,FSpCSGmeral SurgeonHospital de Cruces, Bilbao, Liver TransplantUnitBilbaoSpain

|ohn GreenwoodDircctorBurns Unite, Royal Adelaide HospitalAdelaide South AustraliaAustralia

Russell L. Gruen, MBBS, PhD, FRACSAssociate ProfusorUniversity of MelboumeTrauma SurgeonThe Royal Melboume HospitalMelboumeAustralia

Niels Gudmundsen-VestreMajorDanish Armed Forces Health ServiceHellerupDennark

Enrique A. Guzman Cottallat, MD, FACSNeutosurgeonDiplomat in Public HealthDirector, Neurosurgery Seruices

xll Adrsanced Trauma Life SuVport

Guayaquil HospitalGuayaquilEcuador

Arthur Hsie[ MA" NREMT-PSan Francisco Paramedic AssociationSan Francisco, CalifomiaUnited States

Richard Henn, RN, BSN, M.EDDirector, E ducation D epartmentNorthem Arizona HealthcareFlagstaff, ArizonaUnited States

Walter Henny, MDFormerly of Erasmus Medical CenterRotterdamNetherlands

Grace Herera-FernandezATLS CoordinstorCollege o{ Physicians and Surgeons of Costa RicaSan JoseCosta Rica

Fergal Hickey, FRC$ FRCS Ed.(A&E), DA(UK),FCEMConsultant in Emergency MeilicineEmergenry Departrnent, Sligo General HospitalSligoIreland

Scott HolmesDuke University Lifefl ightDurham, North CarolinaUnited States

fose Marla |over Navalon, MD FACSChief of Hepatopancreatic anil Biliary SurgeryHospital Universitario de Getafe, DepartmentofGeneral SurgeryGetafeSpain

Richard |udd PhD, EMSIDean, Emergenry Medical Services EducationalFoundationInstructors InstituteConsultantYale New Haven Health SystemsHartford, ConnecticutUnited States

Aage W. KarlsenATLS CoordinatorNorwegian Air AmbulanceDrobakNorway

Darren Kilroy, FRCSE4 FCEM, M.EdConsultant in Emergency MedicineStockport NFIS Foundation TrustCheshireUnited KingdomIena Klario RNFomer ATLS National Coordimtor, SwedenSahlgrenska UniversitetssiukhusetGdteborgSwedenPeggy Knudsoo MD, FACSProfessor ofSurgeryUniversitv of Califomia, San Francisco General

Hospital, Department of SugerySan Francisco, CalifomiaUnited States

Amy Koestner, RN, MSNTrauma Program ManagerBorgess Medical CenterKalamazoo, MichiganUnited States

Radko Komadina, MD, PhDGeneral Surgeon, Professor of Surgery, Head ofDepartment for Medical ResemchGeneral and Teaching Hospital CeljeCeljeSlovenia

Digna R. Kool MDRadiologis! Emergency RadiologyDepartment of Radiology, Radboud UniversityNijmegen Medical CentreNijmegenThe Netherlands

RomanKosir, MDAssistant of SurgeryUniversity Clinical Center Mmibor, Departmentof TraumatologyMariborSlovenia

Jon R. Krohmer, MD, FACEPDeputy Assistant Secretary for Health A{fairs,Deputy Chief Medical OfficerDepartment of Homeland SecurityWashingtor; DCUnited States

Ada Lai Yin KwokSkills Development Center, University of HongKong Medical CentreQueen Mary Hospital, Department of SurgeryHong KongChina

LAMSuk-Ching, BN MHMAdvanced Practice NurseQueen Mary HospitalHong KongChina

Maria Lampi, BSc, RNN a tional AT LS Coor dinato rCentre for Teaching & Research in DisasterMedicine and Traumatology, University HospitalLink0pingSweden

LEO Pien Ming MBBS, MRCS (Edin),M,Med(Orthopaedics)Changi General Hospital, GeneralOrthopaedics, Department of OrthopaedicsSingaporeRepublic o{Singapore

Wilson Li, MDSenior Medical OffcerDepartment of Orthopaedics & Traufiratology,Queen Elizabeth HospitalHongKongChina

Helen Livanios, RNlC Unit Staff NurseMediterraneo HospitaiAthensGreece

Chong-feh Lo, MD, FACSAssociate Profusor of SurgeryNatiornl Chen Kmg University MedicalCenterTainanTaiwan

Nur Rachmat Lubis, MDS taff D epahnent of SurgeryM. Hoesin General Hospital, Medical FacultySriwijaya UniversityPalembang, South SumatraIndonesia

|.S.K. Luitse, MDTraumasutgeonMedical D ire ctor Emer gency D epar fmmtTrauma CoordinatorAcademic Medical CenterAv TilburgNetherlmds

faime Manzano, MD, FACSGened SurgeonHospital MetropolitanoQuitoEcuador

Patrizio Mao, MD, FACSResponsabile Urgenze ChirurgicheChirurgia Generale Universitaria, A.S.O. SanLuigi Gonzaga di OrbassanoTorinoItaly

Emily MartensRegional P ro gr am C-oor dinator, Sur gical SkillsProgram CoordinatorAmerican College ofSurgeons ATLS ProgramOfficeChicago, IllinoisUnited States

Salvijus Mila5'9Aius, MDChief of Pimary Soldiers Health Care Centet inKaunasMlitary Medical Services, Lithuanian ArmedForcesKaunasLithuania

Soledad Montorl MDGeneral SutgeonDepartment of General Surgery, HospitalGarcia OrcoyenEstellaSpaio

Newton Djin Mori, MDGeneral SurgeonEmergency Sugical Services,Hospital das Clinicas Universidad de56o Paulo56o PauloBrazil

Adaanced Trauma Life Support x11l

Giorgio Olivero, MD, FACSProfessor of SurgeryUniversity of Torino, Department o{ Medicineand Surgery, St. John the Baptist HospitalTorinoIialy

Steve A. Olson, MD, FACSProfessor, Department of SurgeryChief Orthopaedic TraumaChief Medical OfficerDuke University HospitalDurham, North CarolinaUnited States

Goualo Ostria, MC, FACSDirectorCentro Medico FoianiniSanta CruzBoliviaFatima Pardo, MDGeneral SurgeonABC Medical CenterMexico City, Districto FederalMexico

Andrew Pearce, BSc Hons BMBS, FACEMEmer gency/Trauma Retieo al ConsultantTrauma Uni! Royal Adeiaide HospitalAdelaide, South AustraliaAustralia

Nicolas Peloponissios, MDGeneral, Truuma, and Abdominal SurgeonDepartment of Surgery, Daler HospitalFribourgSwitzerland

Pedro Moniz Pereira, MD, FACSGmeral SurgeonServigo de Cirurgi4 Hospital Garcia de OrtaAlmadaPortugal

Danielle Poretti RNSanuis, SARenens, VaudSwitzerland

fesper Ravn, MDConsultant, Head of General Thoracic DepartmmtCardiothoracic Sugery, Rigshospitalet,Copenhagen UniversityCopenhagenDenmark

Mrcelo Recalde Hidrobo, MD, FACSProfessor of Oncological and General SurgeiesLoja University, International University, Ecuador;Metropolitan HospitalQuito

_eriEcuador

Peter Rhee, MD, MPH, FACS, FCCI\4 DMCCProfesnr of SurgeryChief, Section ofTrauma, Citical Care, andEmergency SurgeryArizona Health Sciences Center, Department ofSurgeryTucsorL ArizonaUnited States

Martin RichardsonThe Epworth CentreRichmond, VictoriaAustralia

Bo RichterMajotDanish Armed Forces Health ServicesNestvedDenmark

Rosalind Roden" FFAEMConsultant in Emergency MedicineLeeds Teaching Hospitals NHS TrustYorkshireUnited Kingdom

Diego Rodriguez, MDMedical DirectorHospital Clinica San AgustinSmAgustinEcuador

Vicente Ro&iguez, MDProfessorHospital Clinica San AgustinSan AgustinEcuador

Olav Roise, MD, PhDChairman of the Dhtision ofNeuroscience andMu s culo skel e t al Me di cineUlievil University HospitalOsloNorway

Daniel Ruiz, MD, FACSCardioo ascular Sur geonCMIC ClinicNeuqu6nArgentina

Octavio Ruiz, MD FACSHead of Transplant SeraicesAmerican British Cowdray Medical CenierMexico City, Districto FederalMexico

feffrey P. Salomone, MD FACSAssociate Professor of SurgeryEmory University, Department of SurgeryDeputy Chief of SurgeryGrady Memorial HospitalAtlanta, GeorgiaUnited States

Rocio Sanchez-Aedo, RNFomer ATLS National Coordinator, MexicoCommittee on Trauma, MexicoMexico City, Districto FederalMexico

MArtin Sandberg, MD, PhDSenior Consultant in Anesthesiolo gyAir Ambulance Department, Lllleval UniversityHospitalOsloNorway

Nicole Schaapveld, RNMnnaging Director / Nfltiotxal CoodinatotATLS NLAdvanced Life Support Group - NL

RielThe Netherlands

Domenic Scharplatz, MD, FACSHead SurgeonHospital of ThusisThusis, GrisonsSwitzerland

Inger B. Schipper, MD, PhDMedical Director of the SouthWest NetherlandsTraumacenterUniversity Hospital Erasmus MC, Departmentof Trauma SurgeryRotterdamThe Netherlands

Patrick Schoettker, MD M.E.R.Staf SpecialistDepartment of Anesthesiology, UniversityHospital VaudLausanneSwitzerland

Kari Schroder Hansen, MDConsultant Genu al Sur geryDepartment of Surgery, Haukeland UniversityHospitalBergenNorway

Bolivar Serrano, MD FACSGeneral SurgeonHospital LatinoamericanoCuencaEcuador

Juan Carlos Serrano, MD, FACSDEartment of Trauma DirectorHospital Santa In6sCuencaEcuador

Mark Sheridan, MBBS, MMedSc, FRACSAssociate ProfessorDirector of Surgery and Director ofNeuosurgery, Liverpool HospitalSydney, New South WalesAustralia

Richard K. Simons, MB, BChir, FRCS, FRCSC,FACSAssociate Professor, Medieal Director, TraumtSeroicesDepartment of Surgery, UBC, VancouverCoastal HealthVancouver, British ColumbiaCanada

Preecha Siritongtaworn, MD, FACSChief, Diztision of Trauma SurgeryDepartment of Surgery, Faculty of MedicineSiriral Hospital, Mahidol UniversityBangkokThailand

Nils Oddvar Skaga, MDChief Anaesthesiologist for TraumaUllevAl University HospitalOsloNorway

xlv Ada anced Trauma Life Support

Peter Skippe4 MBBS, FRCPC,IJFICM,MHAMedical Director and Diaision HedClinical Associate Prcfessor ofCitical CareBC Childrenl'92s Hospital, Department ofPediatricsVancouver, British ColumbiaCanada

Tone SlAkeATLS National CoordinatoL NorusayNorwegian Air AmbulanceDrsbakNorway

Birgifte SoehusATLS National Coordinator, DmmarkDanish Trauma SocietyBrorshojDenrrrark

Elizabeth de Solezio, MA, PhDAdztisor, Ecuadoian Secretary of State CultureBuresuCommittee on Trauma, EcuadorQuitoEcuador

Michael Stawopoulos, MD, FACSAssistant Professor of SurgerySurgery Department Patras University MedicalfthoolPatrasGreece

Spyridon Stergiopoulos, MDAssociate Professor of SurgeryAttikon University Hospital 4th SurgicalDepartmentAthensGreece

Paul-Martin Sutter, MDDepartment of Surgery SpitalzentrumBielSwitzerland

Lars Bo Svendsen, MD, D M SciAssociaE P rcfessot SulgeryCopenhagen University, Department ofAbdominal Surgery and Transplantation,RigshospitaletCopenhagenDenmark

Vasso TagkalakisATLS Natianal Coordinator, GreeceUniversity of PatrasPatrasGreece

Wa"el S. Tah+ MDAssistant Professor of SurgeryDeputy Dfuector of Trauma Courses ProgramDepartment Orthopedic Surgery, KingAbdulaziz Medical CityRiyadhKingdom o{ Saudi Arabia

Gustavo Tisminetzky, MD, FACS, MAACProfessor of SurgeryUniversidad de Buenos Aires, Escuela deMedicina Hospital Italiano de Buenos Aires,Jefe Unidad de Urgencia Hospital Fem5adezBuenos AiresArgentina

Philip Truskett, MB BS, FRACSThe Prince of Wales HospitalSydney, New South WalesAustralia

Wolfgang Ummenhofer, MD, DEAAProfessor of Anesthesiology and lntensiae CareUniversity Hospital, Basel, Department ofAnesthesia and Intensive CareBaselSwitzerland

Yvonne van den EndeOfice ManagerStichting Advanced Li{e Support GroupRielThe Netherlands

Armand Robert van Kanten, MDGmeral Surgeon, Head of TraumaUniversity Hospital ParamariboParamariboSuriname

Endre Varga, MD, PhDVice Chnirman, Professor ofTrauma SurgeryDepartment of Traumatology, AlbertSzentgytirgyi Medical and PhmmaceuticalCenter, University of SzegedSzegedHungary

Edina ViirkonyiDepartment of Traumatology, University ofSzegedSzeged

Panteleimon VassilirL MD PhDAttending SurgeonGeneral Sugical ClinicAttikon University HospitalAthensGreece

Eugenia Vassilopouloq MDA tt en din g Ane stfu siolo gis tGeneral Hospital of AigionAigionGreece

Antigoni VavaroutaATLS CoordinatorUniversity of PatrasPahasGreece

Tore Vikstrdm, MD PhDDirector anil Heail, Consultant GeneralSugeryProfesssor of Disaster Medicine &TraumatologyCentre for Teaching & Research in DisasterMedicine and Traumatology, UniversityHospitalLinkii,pingSwedm

Eric Voiglio, MD, PhD, FACS, FRCSSmior Lecturer, Consultant SurgeonDepartrnent of Emergenry Surgery,University Hospitals of Lyo4 CentreHospitalier Lyon-SudPierre-B6niteFrmce

Daryl Williams, MBBS, FANZCA, cDipBusAdGdipCRAssociate Professor, Unioersity of MelboumeRoyal Melboume Hospital, Department ofAnaesthesiaDirector AnaesthesiaMelboume Hospital, University of MelbourneMelbourneAustralia

RobertWinter, FRCP, FRCA" DMConsultant in Critical Care MedicineMid Trent Critical Cae Network andNottingham University HospitalsNottinghamUnited Kingdorn

Nopadol Wora-Urai, MD, FACSPresident-Elec! Royal College of SurgeonsRoyal College of Surgeons of ThailandBaog

Wai-Key Yuery MB BS, FRCS, FRACS, FACSConsultantDeparhnent of Surgery, Queen MaryHospitalHong KongChina

HONOR ROLLOver the past 30 years, ATLS has grown froma local course training Nebraska doctors tocare for traurna patients to a family oftraurna specialists from more than 50 countrieswho volunteer their time to ensure thatour materials reflect the most current research

and that our course is designed to improvepat ient outcomes. The 8th edi t ion ofATLS reflects the efforts of the followingindividualswho contributed to the first seveneditons, md we honor them here.Sabas F. Abuabara. MD. FACSJoe E. Acker, III, Mt MPH, EMT

Raymond H. Alexander, MD, FACSFareed Ali, MD, FRCS (C)Jameel Ali, MD, MMed Ed, FRCS (C), FACSChales Aprahamian, MD, FACSGuillermo Arana, MD, FACSAna Luisa Argomedo ManriqueGonzalo Avil6sRichard Baillot. MD

Adv an ce d T r auma Life S upp or t XV

Barbara A. Barlow, MA, MD, FACSfames Barone, MD, FACSJohn Barrett, MD, FACSPierre Beaumont, MDRichard M. Bell, MD, FACSEugene E. Berg, MD, FACSRichard Bergerory MDFrangois Bertrand, MDEmidio Bianco, MD, JDDon E. Boyle, MD, FACSRea Browry MD, FACSAllen F. Browne, MD, FACSGerry Bunting, MDAndrew R. Burgess, MD, FACSRichard E. Burney, MD, FACSDavid Burris, MD, FACSSylvia Campbell, MD, FACSC. fames Carrico, MD, FACSC. Gene Caytery MD, FACSDavid E. Clark, MD, FACSPaul E. Collicott, MD, FACSArthur Cooper, MD, MS, FACSRonald D. Craig, MDDoug Davep MDElizabeth de Solezio, PhDSubrato J. Deb, MDRonald Denis, MD]esus Diaz Portocarrero, MD, FACSFrank X. Doto, MSMarguerite Dupr6, MDBrent Eastman, MD, FACSFrank E. Ehrlictr, MD, FACSMartin R. Eichelberger, MD, FACSDavid Eduardo Eskenazi, MD, FACSWilliam F. Fallory Jr, MD, FACSDavid V. Feliciano, MD, FACSFroilan Fernandez, MDCarlos Fernandez-Bueno, MDJohnJ. Fildes, MD, FACSRonald P. Fischer, MD, FACSLewis M. Flint, Jr, MD, FACSStevenson Flanigan, MD, FACSEsteban Foianini G., MD, FACSjorge E Foianini, MD, FACSRichard Fruehling MDSylvainGagnon, MDRichard Gamelli, MD, FACSThomas A. Gennarelli, MD, FACSPaul GebhardJames A. Geiling, MD, FCCPJohn H. George, PhDRoger Gilbertsoru MDRobert W. Gillespie, MD, FACSMarc Giroux, MDJ. Alex Haller, jr., MD, FACSBurton H. Harris, MD, FACSMichael L. Hawkins, MD, FACSIanHa)'wood, FRCS (Eng), MRCS, LRCPJames D. Heckmary MD, FACS

June E. Heilman, MD, FACSDavid M. Heimbach, MD, FACSDavid N. Herndon, MD, FACSErwin F. Hirsctu MD, FACSFrancisco Holguin, MDDavid B. Hoyt, MD, FACSIrvene K. Hughes, RNRichard C. Hunt, MD, FACEPMiles H. Irving, FRCS (Ed), FRCS (Eng)Jos6 MarlaJover Navalory MD, FACSRichard L. Judd, PhDGregoryJ. Jurkoviclu MD, FACSChristoph R. Kau-fmann, MD, FACSHoward B. Keith, MD, FACSJames F. Kellam, MD, FRCS, FACSStevenJ. Kilkerury, MD, FACSjohn B. Kortbeck, MD, FACSBrent Krantz. MD, FACS|on R. Krohmer, MD, FACEPKatherine Lane, PhDFrancis G. Lapiana, MD, FACSPedro Larios AznarAnna M. Ledgerwood, MD, FACSDerrris G. Leland, MD, FACSFrank Lewis. MD. FACSEdward B. Lucci, MD, FACEPEduardo Luck. MD, FACSThomas G. Luerssery MD, FACSArnold Lutermanu MD, FACSFernando Magallanes Negrete, MDDonald W. Marion, MD, FACSMichael R. Marohn, DO, FACSBarry D. Martin, MDSalvador Mar(n Mandujano, MD, FACSKimball I. Maull, MD, FACSMary C. McCarthy, MD, FACSGerald McCullougtr, MD, FACSJohn E. McDermott, MD, FACSJames A. McGehee, DVM, MSWilliam F. McManus, MD, FACSNorman E. McSwairy Jr., MD, FACSPhilip S. Metz, MD, FACSCynthia L. Meyer, MDFrank B. Miller, MD, FACSSidney F. Miller, MD, FACSErnest E. Moore, MD, FACSJohanne Morin, MDDavid Mulder, MD, FACSRaj K. Narayaru MD, FACSJames B. Nichols, DVM, MSMartin Odriozola, MD, FACSFranklin C. Olson, EdDGonzalo Ostria R MD, FACSArthur Pag6, MDJos6 Paiz TejadaSteven N. Parks, MD, FACSChester (Chet) Paul, MDMarkD. Pearlman, MDAndrew B. Peitzman, MD, FACS

jean P6loquin, MDPhilip W. Perdue, MD, FACSf.W. Rodney Peyton, FRCS (Ed), MRCPLawrence H. Pitts, MD FACSGalen V. Poole, MD, FACSErnest Pr6gent, MDRichard R. Price, MD, FACSHerbert Proctor, MD, FACSjacques Provost MDPaul Pudimat, MDMax L. Ramenofsky, MD, FACSMarcelo Recalde, MD, FACSJohn Reed, MDMarleta Reynolds, MD, FACSStuart A. Reynolds, MD, FACSBernard Riley, FFARCSCharles Rinker, MD, FACSAvraham Rivkind, MDRonald E. Rosenthal, MD, FACSGrace Rozycki, MD, FACSJ. Octavio Ruiz Speare, MD, MS, FACSJames M. Ryaru MCtu FRCS (Eng), RAMCJames M. Salander, MD, FACSGueider Salas, MDRocio S6nchez-Aedo LinaresThomas G. Saul, MD, FACSWilliamP. Schecter, MD, FACSThomas E. ftott, MD, FACSStuart R. Seiff. MD, FACSSteven R. Shackford, MD, FACSMarc J. Shapiro, MD, FACSThomas E. Shaver, MD, FACSRichard C. Simmonds, DVM, MSDavid V. Skinner, FRCS (Ed), FRCS (Eng)Arnold Sladeru MD, FACSRicardo Sonneborry MD, FACSGerald O. Strauch, MD, FACSLuther M. Strayer, III, MDJames K. Styner, MDjohn E. Suttort Jr, MD, FACSJoseph J. Tepas, III MD, FACSStephane T6traeault, MDGregory A. Timberlake, MD, FACSPeter G. Trafton, MD, FACSStanley Trooksiry MD, FACSDavid Tuggle, MD, FACSJay UprightAntonio Vera BoleaAlan Verdant, MDJ. Leonel Villavicencio, MD, FACSFranklin C. Wagner, MD, FACSRaymond L. Warpeha, MD, FACSClark Watts, MD, FACSJohnA. Weigelt, MD, FACSJohn West, MD, FACSRobertJ. 1/hite, MD, FACSFremont P. Wirth, MD, FACSBradley D. Wong, MD, FACSPeter H. Worlock, DIvI, FRCS (Ed), FRCS (Eng)

XV1 Adaanced Trauma Life

INSTRUKTUR YANG BERPARTISIPASI TERJEMAHAN BUKU ATLS

Prof. DR. Dr. Aryono D. Pusponegoro Dr. Heri AminuddinFKUI/RS Dr. Cipto Mangunkusumo, Jakarta RSP AD Gatot Soebroto, |akartaDr. Warko Karnadihardja Dr. Djoko RiadiFK Unpad/ RS Dr. Hasan Sadikin, Bandung RSP AD Gatot Soebroto, Jakarta

Dr. Suryadi Soedarmo Dr. Trisula UtomoFK UKI/ RS UKI Cawang fakarta FK UGM/ RS Dr. Sardjito, Yogyakarta

Dr. Nur Rachmat Lubis Dr. Tommy SunartomoFK UNSRI/ RS Dr. Moh. HoesirL Palembang FK UNAIR / RS Dr. Soetomo, Surabaya

Dr. Sahat Edison Sitorus Dr. Bagyo S. WinotoFK UNSRI/ RS Dr. Moh. Hoesin, Palembang FK UNAIR / RS Dr. Soetomo, Surabaya

Dr. Nurhayat Usman Prof. DR. Dr. Andi Asadul IslamFK UNPAD/ RS Dr. Hasan Sadikin, Bandung FK UNHAS/ RS Dr. Wahidin S., Makassar

Dr. Haryono Yarman Dr. BambangWahjuprajitnoFK UNPAD/ RS Dr. Hasan Sadikin, Bandung FK UNAIR / RS Dr. Soetomo, Surabaya

Dr. Sutrisno Dr. Andanu IndratnotoRSAL Dr. Ramelan, Surabaya Jakarta

DR. Dr. Heru Kusbianto Prof. Dr. Farid Nur MantuFK TINAIR / RS Dr. Soetomo, Surabaya FK UNHAS/ RS Dr. Wahidin S., Makassar

Dr. Ganda Parulian Sibabiat Dr. Laurens TB KalesaranFK UKII RS UKI Cawang, |akarta RS Malalayang, ManadoDr. Reno Rudiman Dr. BP SuryosubiantoFK UNPAD/ RS Dr. Hasan Sadikin, Bandung FK UNJANI /RS Dustira, Bandung

Dr. Robert Sinurat Dr. M. Alsen ArlanFK UKI/ RS UKI Cawang, |akarta FK UNSRI/ RS Dr. Moh. Hoesin, PalembangDr. Aditya Wicaksana Prof. DR. Dr. Respati S. DradjatRSPAD Gatot Soebroto, |akarta FK Unibraw/RS Dr. Syaiful Anwar, MalangDr. Bambang Sugeng Dr. Ismandiya Wirasugena (alm)FK UNISLILA" Semarang RS POLRI RS Soekamto, Jakarta

Dr. Gunadi Petrus Dr. Prasetyo Hestitoto (alm)RS IIKI, |akarta RS Sukmul, ]akartaDr. Arief Guntara Tetty Herawaty, SERS Soreang, Bandung Sekretariat Komisi Trauma-ATLS jakarra

Dr. B. Sunoko Instruktur lain yang membantuFK UGM/ RS Dr. Sardjito, Yogyakarta

Adaanced Trauma Life Support XVIl