SGEM Xtra: The Top 10 Ch-ch-ch-changes to ATLS 10th Edition

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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.

DISCLAIMER:
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. Neil Parry

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.

Here are the top 10 changes to ATLS 10th Edition according to Dr. Parry. You can listen to the SGEM podcast on iTunes to hear Neil expand on all the points listed below.

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

Time management

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

Other FOAMed:

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.