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Trauma: Surviving ATLS

Charlotte Davies and Nina Whittle

Surviving New ATLS – the Instructor’s view
Teaching “old” ATLS was a bit of a doddle. You prepared a lecture (using their slides), delivered it, and ate bags of food whilst everyone else delivered their lecture. Then, supervised some practical sessions, worked hard at moulage, and everyone passed. Then came “new” ATLS – no lectures! Woohoo. But, there were many other things that changed:
– Content- base excess is now part of categorising shock. Needle decompression is in the 5th intercostal space midaxilary line. And more.
– No lectures – so you have to make sure your students know what they need to know by assessing them throughout the practical stations.
– Scenarios for everything – so there’s no hiding. EVERYONE teaches a scenario where there’s a bleeding patient and you demonstrate how to put on a tourniquet…how to put on a pelvic binder…how to put on a splint – you need to know everything.

That means that you have to be prepared before you come to the course, and there’s no chance to rest. But it also means that the course is better, and much improved. You talk things through in a much more real time fashion. Everyone is engaged, and gets a chance to practice.

There’s a few things that I always forget in ATLS, and I have a little crib sheet to make sure next time, I just rock up and teach, and have immersive fun!

Here’s a print friendly copy of the ATLSInstructor_Guide – hopefully you’ll find it useful!

Pendleton Plus: Hayley Allen, the ATLS educator has written a blog on this. Which is great to read, as I can never find pendleton plus in my pages of ATLS instructors manual!

Four Stage Approach: This can take a bit of time to go through, but does consolidate skills well.

Kendrick Splints – these are well described here. I’m not sure I’ve ever put one on for real as we don’t have them in my ED!

Pelvic Splints – there’s a great consensus statement on pelvic splints here, but sometimes you just need to know how to use the one you’ve got!
1. Improvise – a bed sheet would work if necessary, but you must remember to also tie the patient’s ankles together.
2. A SAM splint is blue, one size, with a big orange buckle. Apply the spint, then pull the orange buckle until it clicks. It shouldn’t let you over squeeze.
3. SAM or T-pod – log roll on, or scoop onto splint. Then position and tighten.

PELVIC SPLINT PLACEMENT
Those of you who use pelvic splints will know the importance of where exactly it is placed. For those unfamiliar it is NOT placed high where you fasten your trousers it’s much lower over the hips (greater trochanter) as shown below! Buckle to balls is one way of remembering it!
pic.twitter.com/9biBGknf9j

Active First Aid (@Active_FirstAid) January 2, 2018

IO Insertion – ATLS sensibly teaches humeral insertion. But whilst I know where to put the needle, I can never quite remember the official landmarks.

The Student’s Perspective
Of course there are differences between the ALS and the new style ATLS. The obvious difference is the medical causes for a cardiac arrest that you have to consider in ALS such as a PE are not there in the ATLS – but this does not mean that it is not relevant and only now really can I see the importance of the systematic approach and how both courses are really intertwined when treating a patient who is in peri or active cardiac arrest.

I have completed (and passed) the ALS four times within my career but it was only on the most recent occasion that I actually felt confident about passing. As a result I was more relaxed about it and concentrated more on the detail, understanding more of the course content and the language used, making sure that I didn’t have a panic attack during the ABG session (which has happened before). During the MCQ paper I was confident with myself and my answers and I was so proud that finally I gained instructor potential.

Now fast forward a month and the completion of the ATLS (old 3 day course). I have to admit that I started off really interested and going through the book, but this wavered and towards the end of it, the work felt relentless and I was wondering “What’s the point of going through the book when they are going to provide us with the information in the lectures?”. So I stopped reading. This was mistake number one.

The course generally went well and I passed the practical assessment but then it came to the MCQ. I could feel the panic setting in because I was not as prepared as I should have been. Mistake number two, losing concentration. Mistake number three was looking around to see what answers other people have put, panicking that I had not put the same and changing my answers. Needless to say I failed, not only on this occasion but the following three attempts as I was not reading the questions properly and was getting flustered.

When I was informed that I would need to complete the new eATLS I was disappointed as all the modules were online and there was no hard-copy book that I could carry around with me, but actually I think this was a big factor in helping me to pass this time around.

All modules and the pre course MCQ had to be completed at least 24 hours prior to the course start date. This meant that I could not get out of completing the components and it paid off. In addition I located some old ATLS papers via the internet and although they did not have the answers I practiced them and went through the answers with my supervisor.

When it came to the MCQ I was like I was at the ALS: I concentrated, forgot about anyone else in the room and as the answers came up I placed a cross next to the ones that I knew were wrong therefore leaving me with the possible ones to work through.

I suppose in a long-winded way my tips for completing both the ALS and ATLS are to:
– Don’t underestimate the amount of time that it takes to revise and understand the information that has been provided therefore start revision as early as possible.
– Use resources available to you such as colleagues to clarify things that you do not understand – do not leave this until you get to the course.
– Use the internet or ask the course provider if there are any past papers for you to practice on. The wording of the questions is what catches most people out.
– Block everyone else out of the room and from your brain. You have to remain focused. Remember it is only for 45 minutes.
– Mark off the answers that you know are wrong as you are going through them to reduce the selection of possible answers.
– Remember to breathe and enjoy your learning as I believe you will remember and take more in this way.

Please, share with us any of your thoughts, comments, tips and suggestions for teaching and learning basic trauma care! We’re on twitter @RCEMLearning, or you can comment below.

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