ATLS 10 th Edition Update The new course

ATLS 10 th 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 >10 U p. RBC in 24 hours or 4 U in one hour • TXA • Trauma team

Thoracic Trauma I • Tension pneumothorax SV vs. IPPV • Life Threatening Injuries • Flail chest out • Tracheobronchial injury now in • 5 th ICS MAL for needle thoracocentesis • Open thoracostomy

Thoracic Trauma II • Algorithm for circulatory arrest approach • 28 -32 Fr chest drain for haemothorax (not 36 -40 Fr) • 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 • 2 ml/kg x weight x % burn adults • 3 ml/kg x weight x % burn children • Fluid titrated to urine output • Trauma team

Paediatric Trauma • DOPE mnemonic • Needle thoracocentesis UNCHANGED 2 nd. ICS • Limiting crystalloid resuscitation • Trauma team

Geriatric Trauma • Mortality / Morbidity • • • COPD IHD DM Cirrhosis Coagulopathy • Pelvic trauma • 4 x mortality • Increased LOS • Transfusion • Trauma Team

Trauma in Pregnancy and Intimate Partner Violence • Indication of amniotic fluid leak is vaginal p. H 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 • m. Learning 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 • • • e. FAST 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 e. Learning - demo to follow • 13 chapters, each with 5 -6 lessons • PDF of each chapter • e. Book / i. Book • m. ATLS app

m. Learning

Manual • i. Book • e. Book • Hard copy

m. ATLS app – George Brighton

Not changing • Principles and priorities • Moulages – simulator use • Most of content • Triage discussions • Assessment process • 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 0850 -0950 Initial assessment interactive discussion 20 min - SB 60 min - SB 0950 -1000 Move to skill stations 1000 -1200 Airway skill station 10 min 120 min Group A NM, RO Group B HW, GS Group C SD, ACG Group D LZ, SM 1000 -1030 Basic Airway 1030 -1100 Advanced Airway Break Ped/Surg Airway 1100 -1120 -1150

Day One Group A 1210 -1310 Breathing JF, ACG, RO Group B Breathing SM, NM Group C Circulation SB, GS, LZ Group D Circulation SD, HW 1310 -1400 Lunch 1400 -1500 Circulation SB, GS, LZ Circulation SD, HW Breathing JF, ACG, RO Breathing SM, NM 1500 -1530 1530 -1550 Post-test group discussion 30 min SB Intro to afternoon skill stations/break 20 min SB Group A 1550 -1650 Disability HW, ACG 1650 -1750 Secondary survey GS, RO Group B Secondary survey GS, RO Disability HW ACG Group C Disability SD, NM Secondary survey LZ, SM Group D Secondary survey LZ, SM Disability SD, NM

Day Two 0800 -0825 Group Question and Answer 0825 -0910 Groups A & B Adjuncts ACG, NM, RO, LZ Trauma Team initial assessment SD, SM, HW, GS 0910 -0955 -1015 - 1045 - 1145 Group A SD, ACG 1145 - 1315 25 min - SB Groups C & D Trauma Team initial assessment SD, SM, HW, GS Adjuncts ACG, NM, RO, LZ Break 20 min Faculty demonstration of moulage 30 min Practice moulage in groups 60 min Group B HW, SM Group C NM, RO Triage Scenarios / Written test / Moulage Group D LZ, GS 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

Hybrid course 0850 -0910 Introduction and Course Overview 0910 -0950 Initial Assessment Interactive Discussion Group A, B, C Or Basic Airway Group D, E, F Half of course doing initial assessment discussion and faculty demo. Other half doing basic and advanced airway 0950 -1020 Faculty Demonstration of Moulage Group A, B, C Or Advanced Airway Group D, E, F 1020 -1040 Tea/Coffee & set up 1040 -1150 1040 -1120 -1150 Initial Assessment Interactive Discussion and Faculty Demonstration of Moulage Group D, E, F Or Basic airway Group A, B, C Advanced Airway Group A, B, C Half of course doing initial assessment discussion and faculty demo. Other half doing basic and advanced airway 1150 -1220 Surgical airway – 6 stations all candidates 1220 -1310 Mentor Lunch & MCQ review 1310 -1410 -1510 Breathing and Circulation Skills stations, 6 stations (3 Breathing and 3 Circulation), All Groups. Timetable on page 9. 1510 -1525 Break & set up 1525 -1625 -1725 Disability and Secondary Survey Skills stations, 6 stations (3 Disability and 3 Secondary Survey), All Groups. Timetable on page 9. 1725 -1740 Close of Day 1 1740 -1810 Faculty meeting

Hybrid course 0800 -0810 Q & A session 0810 -0855 Trauma Team video and discussion (discussion in 2 groups) 0855 -0955 Adjuncts, groups D, E, F Initial Assessment (Moulage) practice: Patient 1 – Group A Patient 2 – Group B Patient 3 – Group C 0955 - 1015 Break 1015– 1115 Adjuncts, groups A, B, C Initial Assessment (Moulage) practice: Patient 1 – Group D Patient 2 – Group E Patient 3 – Group F 1115 -1245 Triage scenarios/written test/moulage test Timetable for Groups A, B, C on page 11. Timetable for Groups D, E, F page 12. 1245 -1330 Lunch and retests 1330 - 1515 Triage scenarios/written test/moulage test 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