ATLS 10th Edition Update

The new course

Content

• Compendium of changes - minor

• Completely compliant with NICE Major Trauma Guidance

2016
Initial Assessment

• 1 litre of fluid, judicious approach

• Focus on massive transfusion protocols

• Tranexamic acid

• Coagulopathy

• Canadian C Spine Rule

• Trauma team
Airway and Ventilation

• RSI changed to Drug Assisted Intubation

• Videolaryngoscopy

• Trauma team
Shock

• Class of haemorrhage table amended

• Base excess

• Early use of blood and blood products

• Management of coagulopathy

• Massive transfusion defined >10U pRBC in 24 hours or 4U in

one hour

• TXA

• Trauma team
Thoracic Trauma I

• Tension pneumothorax SV vs. IPPV

• Life Threatening Injuries

• Flail chest out
• Tracheobronchial injury now in

• 5th ICS MAL for needle thoracocentesis

• Open thoracostomy
Thoracic Trauma II

• Algorithm for circulatory arrest approach

• 28-32Fr chest drain for haemothorax (not 36-40Fr)

• Aortic rupture management with Beta Blocker

• Trauma team
Abdominal and Pelvic Trauma

• Palpation of prostate gland no longer recommended for

urethral injury

• Flow chart for pelvic fracture with haemorrahge amended

• Trauma team
Head Trauma

• GCS changed – ‘pressure’

• Detailed guidance on SBP management

• Classification – ‘mild’ head trauma

• Anticoagulation reversal guidance

• Seizure prophylaxis

• Trauma team
Spine and Spinal Cord Trauma

• New myotome diagram

• ‘Restriction of spinal motion’

• Canadian C Spine Rule

• Trauma team
Musculoskeletal Trauma

• Weight based IV antibiotic regime

• Highlighting risk factor of bilateral femur fractures

• Trauma team
Thermal injuries

• 2ml/kg x weight x % burn adults

• 3ml/kg x weight x % burn children

• Fluid titrated to urine output

• Trauma team
Paediatric Trauma

• DOPE mnemonic

• Needle thoracocentesis UNCHANGED 2ndICS

• Limiting crystalloid resuscitation

• Trauma team
Geriatric Trauma

• Mortality / Morbidity • Pelvic trauma

• COPD • 4x mortality
• IHD • Increased LOS
• DM • Transfusion
• Cirrhosis
• Coagulopathy
• Trauma Team
Trauma in Pregnancy and Intimate Partner
Violence

• Indication of amniotic fluid leak is vaginal pH of >4.5

• Trauma Team
Transfer to Definitive Care

• Specific mention of avoiding CT in primary hospital

• SBAR template for communication

• Trauma Team
Trauma Team - RKR
Delivery

• mLearning only
• Hybrid course
• Mandatory completion prior to course

• All materials available to everyone

• One interactive discussion only

• Skills stations – completely redesigned

Skills stations

• Unfolding scenario

• Clarity of demo / 4 stage teaching

• UK specific guidance
Skills stations I

• Airway – basic, advanced, surgical

• Breathing

• Circulation – Local Haemorrhage Control

• Disability
Skills stations II

• Secondary Survey

• Adjuncts

• Trauma team
Skills stations - Airway

• Airway assessment - demo/discuss

• Jaw thrust - demo/discuss
• Nasal airway, Suction, Oral airway - 4 stage
• Bag valve mask ventilation (1 and 2 person) - 4 stage
• Discussion of paediatric basic airway

• Laryngeal mask (or tube) airway insertion - 4 stage

• LEMON assessment - demo/discuss
• Oral endotracheal intubation - demo/discuss

• Surgical Airway
• Basic airway (paediatric vs adults) - demo/discuss
• Surgical cricothyrotomy - 4 stage
• Needle cricothyrotomy - 4 stage
Skills stations - Breathing

• Breathing assessment - demo/discuss

• Chest drain (thoracostomy tube) insertion - 4 stage
• Needle decompression (child) - 4 stage
• Elderly chest injury - demo/discuss
• Sucking chest wound - demo/discuss
• Severe chest injury scenario - demo/discuss
Skills stations - Circulation

• Assessment of shock - demo/discuss

• Wound packing - demo/discuss
• Application of tourniquet - demo/discuss
• Insertion of intraosseous needle - 4 stage
• Application of pelvic binder - demo/discuss
• Femoral access - 4 stage
• Non haemorrhagic shock - demo/discuss
Skills stations - Disability

• Assessment of neurological status - demo/discuss

• Evaluation of cervical spine injury - demo/discuss
• Reassessment of changing neurological status -
demo/discuss
• Referral process - demo/discuss
• Detailed neurological examination - demo/discuss
• Log roll - candidates and one faculty repeat it 5 times
changing roles
• Elderly patient assessment of neurological status -
demo/discuss
• Central cord syndrome assessment - demo/discuss
Skills stations – Secondary Survey

• Open fracture management - demo/discuss

• Perform secondary survey patient 1 - demo/discuss
• Perform secondary survey patient 2 - demo/discuss
• Application of hard collar - 4 stage
Skills stations - Adjuncts

• eFAST probe positioning - demo/discuss

• FAST scan - demo/discuss
• CXR interpretation - 4 stage
• Pelvic X-Ray interpretation - 4 stage
• Spine X-ray interpretation - 4 stage
Skills stations – Trauma Team

• Video

• Scripted interactive discussion

Electronic materials

• Mobile eLearning - demo to follow

• 13 chapters, each with 5-6 lessons

• PDF of each chapter

• eBook / iBook

• mATLS app
mLearning
Manual

• iBook

• eBook

• Hard copy
mATLS app – George Brighton
Not changing

• Principles and priorities • Moulages – simulator

use
• Most of content
• Assessment process
• Triage discussions • Moulage
• MCQ
Will be changing

• Reverification course
• Already well aligned

• Instructor course
• Microteaching

• Instructor recertification process

• No lecture
Day One

0800-0830 Welcome and Registration

0830-0850 Introduction and Course Overview 20 min - SB

0850-0950 Initial assessment interactive discussion 60 min - SB

0950-1000 Move to skill stations 10 min

1000-1200 Airway skill station 120 min

Group A Group B Group C Group D

NM, RO HW, GS SD, ACG LZ, SM
1000-1030 Basic Airway Basic Airway Basic Airway Basic Airway

1030-1100 Advanced Advanced Advanced Advanced

Airway Airway Airway Airway
1100-1120 Break Break Break Break
1120-1150 Ped/Surg Ped/Surg Ped/Surg Ped/Surg
Airway Airway Airway Airway
Day One
Group A Group B Group C Group D
1210-1310 Breathing Breathing Circulation Circulation

JF, ACG, RO SM, NM SB,GS, LZ SD, HW

1310-1400 Lunch
1400-1500 Circulation Circulation Breathing Breathing

SB,GS, LZ SD, HW JF, ACG, RO SM, NM

1500-1530 Post-test group discussion 30 min SB

1530-1550 Intro to afternoon skill stations/break 20 min SB

Group A Group B Group C Group D

1550-1650 Disability Secondary survey Disability Secondary survey

HW, ACG GS, RO SD, NM LZ, SM

1650-1750 Secondary survey Disability Secondary survey Disability

GS, RO HW ACG LZ, SM SD, NM

Day Two

0800-0825 Group Question and Answer 25 min - SB

Groups A & B Groups C & D
0825-0910 Adjuncts Trauma Team initial assessment

ACG, NM, RO, LZ SD, SM, HW, GS

0910-0955 Trauma Team initial assessment Adjuncts

SD, SM, HW, GS ACG, NM, RO, LZ

0955 -1015 Break 20 min

1015 - 1045 Faculty demonstration of moulage 30 min

1045 - 1145 Practice moulage in groups 60 min

Group A Group B Group C Group D
SD, ACG HW, SM NM, RO LZ, GS

1145 - 1315 Triage Scenarios / Written test / Moulage 90 min

1315 - 1400 Lunch (including retests)

1400 - 1545 Triage Scenarios / Written Test / Moulage (incl. retests) 105 min

1545 - 1600 Wrap up and close 15 min

 0850-0910 Introduction and Course Overview

Initial Assessment Interactive Discussion Half of course doing

Group A, B, C initial assessment
discussion and faculty
0910-0950
Or demo. Other half doing
basic and advanced
Basic Airway Group D, E, F airway

Faculty Demonstration of Moulage Group A,

B, C
0950-1020
Or

Advanced Airway Group D, E, F

1020-1040 Tea/Coffee & set up  

1040-1150
Initial Assessment Interactive Discussion and
Faculty Demonstration of Moulage Half of course doing
Group D, E, F initial assessment
discussion and faculty
Hybrid Or demo. Other half doing
basic and advanced
Basic airway Group A, B, C airway
course 1040-1120
1120-1150
Advanced Airway Group A, B, C

1150-1220 Surgical airway – 6 stations all candidates

1220-1310 Mentor Lunch & MCQ review

Breathing and Circulation Skills stations, 6

1310-1410
stations (3 Breathing and 3 Circulation), All
1410-1510
Groups. Timetable on page 9.

1510-1525 Break & set up

Disability and Secondary Survey Skills
1525-1625 stations, 6 stations (3 Disability and 3
1625-1725 Secondary Survey), All Groups. Timetable on
page 9.
1725-1740 Close of Day 1

1740-1810 Faculty meeting

 0800-0810 Q & A session
Trauma Team video and discussion (discussion in 2
0810-0855
groups)

Hybrid Adjuncts, groups D,E,F

course 0855-0955
Initial Assessment (Moulage) practice:
Patient 1 – Group A
Patient 2 – Group B
Patient 3 – Group C

0955 - 1015 Break

Adjuncts, groups A,B,C

1015–1115 Initial Assessment (Moulage) practice:

Patient 1 – Group D
Patient 2 – Group E
Patient 3 – Group F

Triage scenarios/written test/moulage test

1115-1245 Timetable for Groups A, B, C on page 11. Timetable for
Groups D, E, F page 12.

1245-1330 Lunch and retests

Triage scenarios/written test/moulage test

1330 - 1515 Timetable for Groups A, B, C on page 11. Timetable for
Groups D, E, F page 12.

1515- 1545 Faculty meeting

1645-1600 Summary, feedback and results

Please ensure you have all your personal belongings with you before you leave
Impact on faculty

• No lectures

• Less exposure to candidates – IP / support reqd

• Less down time

• Less peer learning - tips and tricks

• New skills stations
• Little change in clinical approach
Impact on candidates

• Full on

• Less reflective time

• Less opportunity for catch up

Impact on coordinators

• New programme

• Equipment

• Skills stations changeover

Implementation

• Alpha Pilots
• USA and Australia – January / Feb

• Beta Pilot
• London – May

• Refining model
• October x 2, November

• National roll out February 2018

Summary

• Changes
• Minor content
• Huge delivery

• Many benefits

• Careful roll out