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    v Brief Contents CHAPTER 1 Initial Assessment and Management 2    SKILL STATION I:  Initial Assessment and Management 23 CHAPTER 2 Airway and Ventilatory Management 30    SKILL STATION II:  Airway and Ventilatory Management 50    SKILL STATION III:  Cricothyroidotomy 58 CHAPTER 3 Shock 62    SKILL STATION IV:  Shock Assessment and Management 82    SKILL STATION V:  Venous Cutdown (Optional Station) 92 CHAPTER 4 Thoracic Trauma 94    SKILL STATION VI:  X-Ray Identification of Thoracic Injuries 113    SKILL STATION VII:  Chest Trauma Management 118 CHAPTER 5 Abdominal and Pelvic Trauma 122    SKILL STATION VIII:  Focused Assessment Sonography in Trauma (FAST) 141    SKILL STATION IX:  Diagnostic Peritoneal Lavage (Optional) 145 CHAPTER 6 Head Trauma 148    SKILL STATION X:  Head and Neck Trauma: Assessment and Management 170 CHAPTER 7 Spine and Spinal Cord Trauma 174    SKILL STATION XI:  X-Ray Identification of Spine Injuries 194    SKILL STATION XII:  Spinal Cord Injury Assessment and Management 199 CHAPTER 8 Musculoskeletal Trauma 206    SKILL STATION XIII:  Musculoskeletal Trauma: Assessment and Management 224 CHAPTER 9 Thermal Injuries 230CHAPTER 10 Pediatric Trauma 246CHAPTER 11 Geriatric Trauma 272CHAPTER 12 Trauma in Pregnancy and Intimate Partner Violence 286CHAPTER 13 Transfer to Definitive Care 298APPENDICES 309 INDEX 355    xxxi Foreword viiPreface ixAcknowledgements xvCourse Overview xxiii CHAPTER 1Initial Assessment and Management 2 Preparation 4Triage 6Primary Survey 6Resuscitation 10 Adjuncts to Primary Survey and Resuscitation 11Consider Need for Patient Transfer 13Secondary Survey 13Adjuncts to the Secondary Survey 18Reevaluation 19Definitive Care 19Disaster 20Records and Legal Considerations 20Teamwork 20 CHAPTER SUMMARY 22BIBLIOGRAPHY 22    SKILL STATION I:  Initial Assessment and Management 23 Skill I-A:  Primary Survey Resuscitation 24 Skill I-B:  Secondary Survey and Management 25 Skill I-C:  Patient Reevaluation 28 Skill I-D:  Transfer to Definitive Care 28 Skill I-E:  After-Action Review 28 CHAPTER 2Airway and Ventilatory Management 30 Airway 32Ventilation 34Airway Management 34Management of Oxygenation 46 Management of Ventilation 46 CHAPTER SUMMARY 47BIBLIOGRAPHY 48    SKILL STATION II:  Airway and Ventilatory Management 50 Scenarios 51 Skill II-A:  Oropharyngeal Airway insertion 51 Skill II-B:  Nasopharyngeal Airway Insertion 52 Skill II-C:  Bag-Mask Ventilation: Two Person Technique 52 Skill II-D:  Adult Orotracheal Intubation 52 Skill II-E:  Laryngeal Mask Airway (LMA) and Intubating LMA (ILMA) Insertion 53 Skill II-F:  Laryngeal Tube Airway (LTA) Insertion 55 Skill II-G:  Infant Endotracheal Intubation 55 Skill II-H:  Pulse Oximetry Monitoring 56 Skill II-I:  Carbon Dioxide Detection 57    SKILL STATION III:  Cricothyroidotomy 58 Skill III-A:  Needle Cricothyroidotomy 59 Skill III-B:  Surgical Cricothyroidotomy 60 CHAPTER 3Shock 62 Shock Pathophysiology 64Initial Patient Assessment 65Hemorrhagic Shock 68Initial Management of Hemorrhagic Shock 70Evaluation of Fluid Resuscitation and Organ Perfusion 73Therapeutic Decisions Based on Response to Initial Fluid Resuscitation 73Blood Replacement 74Special Considerations 76Reassessing Patient Response and Avoiding Complications 77 CHAPTER SUMMARY 79BIBLIOGRAPHY 80    SKILL STATION IV:  Shock Assessment and Management 82 Scenarios 83 Skill IV-A:  Peripheral Venous Access 85 Skill IV-B:  Femoral Venipuncture: Seldinger Technique 85 Skill IV-C:  Subclavian Venipuncture: Infraclavicular Approach 87 Skill IV-D:  Internal Jugular Venipuncture: Middle or Central Route 88 Skill IV-E:  Intraosseous Puncture/Infusion: Proximal Tibial Route 88 Skill IV-F:  Identification and Management of Pelvic Fractures: Application of Pelvic Binder 90     SKILL STATION V:  Venous Cutdown (Optional Station) 92 Skill V-A:  Venous Cutdown 93 Contents   xxxii   CONTENTS CHAPTER 4Thoracic Trauma 94 Primary Survey: Life-Threatening Injuries 96Resuscitative Thoracotomy 102Secondary Survey: Potentially Life-Threatening Injuries 103Other Manifestations of Chest Injuries 108 CHAPTER SUMMARY 110BIBLIOGRAPHY 111    SKILL STATION VI:  X-Ray Identification of Thoracic Injuries 113 Scenarios 114 Skill VI-A:  Process for Initial Review of Chest X-Rays 114     SKILL STATION VII:  Chest Trauma Management 118 Skill VII-A:  Needle Thoracentesis 119 Skill VII-B:  Chest Tube Insertion 119 Skill VII-C:  Pericardiocentesis (Optional) 120 CHAPTER 5Abdominal and Pelvic Trauma 122 Anatomy of the Abdomen 124Mechanism of Injury 125Assessment 127Indications for Laparotomy in Adults 134Specific Diagnoses 134 CHAPTER SUMMARY 138BIBLIOGRAPHY 139    SKILL STATION VIII:  Focused Assessment Sonography in Trauma (FAST) 141 Scenarios 142  Skill VIII:  Focused Assessment Sonography in Trauma (FAST) 142    SKILL STATION IX:  Diagnostic Peritoneal Lavage (Optional) 145 Skill IX-A:  Diagnosistic Peritoneal Lavage– Open Technique 146 Skill IX-B:  Diagnositic Pertioneal Lavage– Closed Technique 146 CHAPTER 6Head Trauma 148 Anatomy Review 150 Physiology 153Classifications of Head Injuries 155Management of Minor Brain Injury (GCS Score 13–15) 158Management of Moderate Brain Injury (GCS Score 9–12) 160Management of Severe Brain Injury (GCS Score 3–8) 161Medical Therapies for Brain Injury 163Surgical Management 165Prognosis 167Brain Death 167 CHAPTER SUMMARY 168BIBLIOGRAPHY 168    SKILL STATION X:  Head and Neck Trauma: Assessment and Management 170 Scenarios 171 Skill X-A:  Primary Survey 171 Skill X-B:  Secondary Survey and Management 171 Skill X-C:  Evaluation of CT Scans of the Head 172 Skill X-D:  Helmet Removal 173  CHAPTER 7Spine and Spinal Cord Trauma 174 Anatomy and Physiology 176Classifications of Spinal Cord Injuries 180Specific Types of Spinal Injuries 182X-Ray Evaluation 185General Management 187 CHAPTER SUMMARY 192BIBLIOGRAPHY 192    SKILL STATION XI:  X-Ray Identification of Spine Injuries 194 Scenarios 195 Skill XI-A:  Cervical Spine X-Ray Assessment 195 Skill XI-B:  Atlanto-Occipital Joint Assessment 197 Skill XI-C:  Thoracic and Lumbar X-Ray Assessment 198 Skill XI-D:  Review Spine X-Rays 198    SKILL STATION XII:  Spinal Cord Injury Assessment and Management 199 Scenarios 200 Skill XII-A:  Primary Survey and Resuscitation– Assessing Spine Injuries 201 Skill XII-B:  Secondary Survey–Neurologic Assessment 201 Skill XII-C:  Examination for Level of Spinal Cord Injury 202 Skill XII-D:  Treatment Principles for Patients with Spinal Cord Injuries 202 Skill XII-E:  Principles of Spine Immobilization and Logrolling 203
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