Date: August 25th, 2018
Guest Skeptic: Dr. Neil Parry is an Associate Professor of Surgery and Critical Care at Western University. He is the Medical Director of the Trauma Program for London Health Sciences Centre and the Site Chief of Surgery at Victoria Hospital. Dr. Parry is also a national member of the Committee on Trauma for the America College of Surgeons where he serves as a member of the ATLS Committee and as the Chair of the Surgical Skills Committee.
This is an SGEM Xtra episode and will be the last show before staring Season #7 on September 1st. It has been an incredible ride. There are almost 37,000 subscribers to the SGEM.
Our goal continues to be to cut the knowledge translation window down from over ten years to less than one year using the power of social media. Ultimately, we want patients to get the best care based on the best evidence. We also want to teach critical thinking skills and encourage skepticism.
These are Dr. Parry’s personal choices for the top 10 changes to ATLS and do not reflect the opinions of the ATLS committee, the Committee on Trauma of the American College of Surgeons, Western University or anyone else.
Dr. Parry briefly tells the story of Dr. James K. Styner plane crash in 1976 that inspired him to start what became the Advanced Trauma and Life Support (ATLS) program. The ALTS program has been taught in 86 countries around the world and under gone a number of updates over last four decades.
Top 10 Changes to ATLS 10th Edition
#1 – No More Lectures
All interactive case – based discussions
Students need to read manuals!
True adult education – no spoon feeding
#2 – New Skills Stations
Case-based unfolding scenarios for A,B,C,D,E’s
No longer anatomy based
More student interaction
#3 – “New/Honed” Skills for Instructors
Must engage students
Five step method for skills teaching
#4 – Shock
One litre crystalloid and early administration of balanced blood products for Class III-IV shock
Updated shock classification table to include blood products
Introduce concept of damage control resuscitation
#5 – Thoracic Trauma
Needle decompression 4-5th intercostal space, anterior axillary line for adults
Smaller chest tubes for hemothorax
Early management of blunt aortic injury
#6 – Head Trauma
Revised Glasgow Coma Scale
Introduce Brain Trauma Foundation 4th Guidelines
Paediatric Emergency Care Applied Research (PECARN) CT head guideline for <2 years of age and >2 years of age
#7 – Spine Trauma
Introduce Canadian C-spine Rules and NEXUS Criteria for C-spine imaging
Use the American Spinal Injury Association (ASIA) International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) worksheet
#8 – Thermal Injury
Resuscitation for deep partial/full thickness burns > 20 % BSA is 2cc RL x body weight (kg) x % BSA in adults
Paediatric is 3cc x weight (kg) x % BSA
Titrate fluid to urine output
#9 – Emphasis on Team Approach
At the end of each chapter there is a real emphasis on team approach to resuscitation.
There is no “i” in the word “team”
#10 – Emphasis on Recognition of Intimate Partner Violence and Elderly Maltreatment
80% of intimate partner violence is suffered by women with a prevalence of 341/100,000 population in Canada
Most elderly maltreatment is perpetrated by a family member
- EM Ottawa: ALTS Trauma Update 2018
- Slide Share: ATLS 10th Edition Compendium of Change
- ACS Bulletin: ATLS 10th edition offers new insights into managing trauma patients
- EMDocs: Are you ready for the ATLS 10th Edition Updates?
The SGEM will be back next week starting Season #7 with a structured critical review of a recent publication about rudeness.