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Advanced Trauma Life Support ® , 8 th  Edition,  The Evidence for Change Volume 64(6). June 2008.1638-1650 http://decode-medicine.blogspot.com/ summarized by sun yaicheng
History ,[object Object],Doctor James K. Styner
ATLS ®  Program Overview ,[object Object],[object Object],[object Object],[object Object],[object Object]
A Brief Summary of Wright et al. Levels of Evidence. JBJS(A) Treatment  Prognosis  Diagnosis  Economic and Decision analysis  Level of Evidence 1 RCT with significant difference or narrow confidence intervals Prospective study with single inception cohort and 80% follow-up Testing of previously  applied diagnostic criteria in a consecutive series against a gold standard Clinically sensible costs and alternatives; values obtained from many studies; multiway sensitivity analyses Systematic reviews of level 1 studies Systematic review of level 1 studies Systematic review of level 1 studies Systematic review of level 1 studies 2 Prospective cohort, poor quality RCT Retrospective study, untreated controls from a previous RCT Development of  diagnostic criteria on basis of consecutive patients against a gold standard Clinically sensible costs and alternatives, values cobtained from limited studies, multiway sensitivity analyses Systematic reviews of level 2 studies Systematic review of level 2 studies Systematic review of level 2 studies Systematic review of level 2 studies 3 Case–control study Study of nonconsecutive patients (no consistently applied gold standard) Limited alternatives and costs; poor estimates Retrospective cohort study Systematic review of level 3 studies Systematic review of level 3 studies Systematic review of level 3 studies 4 Case series Case series Case–control study Poor reference standard No sensitivity analyses 5 Expert opinion Expert opinion Expert opinion Expert opinion
Initial assessment
Rectal examination ,[object Object],[object Object],[object Object],[object Object]
Airway
Carbon dioxide detectors ,[object Object],[object Object],[object Object],[object Object]
Laryngeal mask airway (LMA) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laryngeal tube airway (LTA) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Gum Elastic Bougie ,[object Object],[object Object],[object Object],[object Object],[object Object]
Difficult airway ,[object Object],[object Object],[object Object],[object Object],[object Object]
Shock
Crystalloid ,[object Object],[object Object],[object Object],[object Object],[object Object]
Fluid resuscitation ,[object Object],[object Object]
Fluid resuscitation ,[object Object],[object Object],[object Object],[object Object]
Fluid resuscitation ,[object Object],[object Object],[object Object],[object Object]
Angio-embolization and  definitive control of hemorrhage ,[object Object],[object Object],[object Object],[object Object]
Treatment of cardiac  tamponade ,[object Object],[object Object],[object Object],[object Object],[object Object]
Base deficit & lactate ,[object Object],[object Object],[object Object],[object Object]
Thoracic trauma
Treatment of pneumothorax ,[object Object],[object Object],[object Object],[object Object]
ED thoracotomy ,[object Object],[object Object],[object Object]
ED thoracotomy  ,[object Object],[object Object],[object Object],[object Object]
Blunt traumatic aortic injury ,[object Object],[object Object],[object Object],[object Object]
Abdomen
Explosive devices ,[object Object],[object Object],[object Object],[object Object]
Hemo-dynamically abnormal pelvic fractures ,[object Object],[object Object],[object Object],[object Object],[object Object]
Head trauma
Classification and head CT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Canadian CT Head Rule for patients with minor head injury ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lancet. 2001 May 5;357(9266):1391-6.
Penetrating brain injury ,[object Object],[object Object],[object Object],[object Object]
Penetrating brain injury ,[object Object],[object Object],[object Object],[object Object]
Spine
Blunt carotid and vertebral vascular injuries (BCVI) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Steroids ,[object Object],[object Object],[object Object],[object Object]
CT evaluation of the cervical spine ,[object Object],[object Object],[object Object],[object Object]
Atlantooccipital dislocation ,[object Object],[object Object],[object Object],[object Object],Power's Ratio:   A = C1 anterior arch,  B = basion (anterior margin of foramen magnum),  C = anterior portion of the posterior ring of C1,  O = opsthion (posterior margin of foramen magnum).  If BC/AO greater than 1,  anterior occipitoatlantal dislocation exists.
Power’s ratio to diagnose AOD shown on plain radiographs and CT scans of a patient without injury From:  Dziurzynski: Spine, Volume 30(12). June 15, 2005.1427-1432
Musculoskeletal trauma and extremity trauma
Tourniquet ,[object Object],[object Object],[object Object],[object Object]
Compartment syndrome ,[object Object],[object Object],[object Object],[object Object]
Trauma in women
Restraints ,[object Object],[object Object],[object Object],[object Object]
Airbags ,[object Object],[object Object],[object Object],[object Object]
Pediatric trauma
Functional outcome ,[object Object],[object Object],[object Object],[object Object]
Abdominal imaging CT ,[object Object],[object Object],[object Object],[object Object]
Abdominal imaging FAST ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Abdominal bruising ,[object Object],[object Object],[object Object],[object Object]

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ATLS 8e, The Evidence for Change

  • 1. Advanced Trauma Life Support ® , 8 th Edition, The Evidence for Change Volume 64(6). June 2008.1638-1650 http://decode-medicine.blogspot.com/ summarized by sun yaicheng
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  • 4. A Brief Summary of Wright et al. Levels of Evidence. JBJS(A) Treatment Prognosis Diagnosis Economic and Decision analysis Level of Evidence 1 RCT with significant difference or narrow confidence intervals Prospective study with single inception cohort and 80% follow-up Testing of previously applied diagnostic criteria in a consecutive series against a gold standard Clinically sensible costs and alternatives; values obtained from many studies; multiway sensitivity analyses Systematic reviews of level 1 studies Systematic review of level 1 studies Systematic review of level 1 studies Systematic review of level 1 studies 2 Prospective cohort, poor quality RCT Retrospective study, untreated controls from a previous RCT Development of diagnostic criteria on basis of consecutive patients against a gold standard Clinically sensible costs and alternatives, values cobtained from limited studies, multiway sensitivity analyses Systematic reviews of level 2 studies Systematic review of level 2 studies Systematic review of level 2 studies Systematic review of level 2 studies 3 Case–control study Study of nonconsecutive patients (no consistently applied gold standard) Limited alternatives and costs; poor estimates Retrospective cohort study Systematic review of level 3 studies Systematic review of level 3 studies Systematic review of level 3 studies 4 Case series Case series Case–control study Poor reference standard No sensitivity analyses 5 Expert opinion Expert opinion Expert opinion Expert opinion
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  • 13. Shock
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  • 34. Spine
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  • 39. Power’s ratio to diagnose AOD shown on plain radiographs and CT scans of a patient without injury From: Dziurzynski: Spine, Volume 30(12). June 15, 2005.1427-1432
  • 40. Musculoskeletal trauma and extremity trauma
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