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SKILLS VIDEOYou'll also note the inclusion of a DVD with this edition.This new course component includes video of critical skillsthat doctors should be familiar with before taking thecourse. Skill Stations during the course will allow doctorsthe opportunity to fine tune skill performance inpreparationfor the practical assessment. Review of the demonstratedskills prior to participating in the skills stations willenhance the learner's experience.
TEXTBOOK FEATURESThis edition features a new full-color design, along withnew color photographs and medical illustrations. Contentwas presented in a narrative format rather than outline forease of readability. In addition, an effort was made toaugment the pedagogical features of the textbook to improvestudent comprehension and retention of knowledge. Lookfor the following features:
CHAPTER OUTLINE: This feature provides a "road map" to the,ihaPter content ':,..:
terms to facilitate understanding by all students and teachersof the Program.
Advanced Trauma Life Support@ and ATLS@ areproprietary trademarks and service marks owned by theAmerican College of Surgeons and cannot be used byindividuals or entities outside the ACS COT organizationfor their goods and services without ACS approval.Accordingly, any reproduction of either or both marks indirect conjunction with the ACS ATLS Program within theACS Committee on Trauma organization must beaccompanied by the common law symbol of trademarkownership.
American College of SurgeonsCommittee on Trauma
]ohn Fildes, MD, FACSCommittee on Trauma, ChairProfessor of Surgery, Vice Chair DEartrnent of Surgery, ProgramDirector, General Surgery Residency Chief Diaision of Traumat Critical CareUniversity of Nevada School of MedicineLas Vegas, NevadaUnited States
J. Wayne Meredith, MD, FACSDirector of the Division of Surgical Sciences, Richard T.MyersProfessor and ChairmanWake Forest UniversitySchool of MedicineWinston-Salem, North CarolinaUnited States
$ubcommittee on Advanced TraumaLife Support of the American Collegeof Surgeons Committee on Trauma
]ohn B. Kortbeelg MD, FRCSC, FACSProfessor Departments of Surgery and Critical CareUniversity of Calgary and Calgary Health RegionCaIgary, AlbertaCanada
Christoph R. Kaufmann, MD, MPH, FACSAssociate Medical DirectorTrauma Services, Legacy Emanuel HospitalPortland, OregonUnited States
KEY QUESTI0NS: pfn.r, questions are aligned with the
KEY POINTS:
instructof s PowerPoint presentations toprepare students for key discussionsduring lectures
Sentences appear in red font toattract the reader's attention to keypoints of information.
J Cross+eferences to other chapters,Skill Stations, and additional resourceshelp to pull all of the information together
PITFALLS J'ITETTT}.
LINKS
*"ruThese boxes highlight critical pitfalls toavoid while caring for trauma patients
SUMMARYChapter summaries tie back to the ChapterObjectives io ensure understanding ofthe most pertinent chapter content
Editorial Notes
The ACS Committee on Trauma is referred to as the ACSCOT or the Committee, and the State/Provincial Chair (s)is referred to as S/P Chair(s).
The international nature of this edition of the ATLSStudent Manual may necessitate changes in commonly used
vllt Adaanced Trauma Life Support
fameel Ali, MD, M.Med.E4 FRCS, FACSProfessor of SurgeryUniversity of TorontoSt. Michael''92s Hospitaf Division of General Surgery/TraumaToronto, OntarioCanada
Karen Brasel, MD, FACSAssociate Professor Trauma Surgery I Critical CareFroedtert Hospital & Medical College of Wisconsiry TraumaSurgery DivisionMilwaukee, WisconsinUnited States
David G. Burris, MD, FACSProfessor I ChairmanUSUHS, Norman M Rich Department of SurgeryBethesda, MarylandUnited States
William G. Cioffi" MD, FACSChief of SurgeryRhode Island Hospital, Department of SurgeryProfessor and ChairmanThe Warren Alpert Medical School of Brown University,Department of SurgeryProvidence, Rhode IslandUnited States
Arthur Cooper, MD, MS, FACS, FAAP, FCCMProfessor of SurgeryColumbia University Medical CenterAffiliation at Harlem HospitalNew York, New YorkUnited States
Michael Hollands, MB BS, FRACS, FACSHead of Hepatobiliary and Gastro-oesophageal SurgeryWestmead HospitalSydney, New South WalesAustralia
Claus Falck Larsen, MD, dr.med., MPA, FACSMedical DirectorThe Abdominal Centre, University of Copenlngeo RigshopitaletDenmarkCopenhagenDenmark
West Livaudais, Jr, MD FACSThoracic SurgeonSouthwest Wound Healing Center, Southwest WashingtonMedical CenterVancouver, WashingtonUnited States
Fred A. Luchette, MD FACSDirector, Diaision of Trauma, Critical Care, and BurnsDepartment of Surgery, Stritch School of Medicine, LoyolaUniversity of ChicagoMa)rwood, IllinoisUnited States
fohn H. McVicker, MD, FACSNeurosurgeonColorado Neurological Institute, Swedish Medical CenterEngelwood, ColoradoUnited States
Charles N. Mock, MD, PhD, MPHProfessor of Surgery, loint appointment, Professor ofEpidemiologyDepartment of Surgery, Harborview Medical Center, Universityof WashingtonSeattle, WashingtonUnited States
Frederick Moore, MD, FACSHead, Diaision of Surgical Critical Care and Acute Care SurgeryMethodist HospitalHouston, TexasUnited States
Steven N. Parks, MD, FACSProfessor of Clinical SurgeryUniversity of Califomia, San Francisco, Department of Surgery,Community Regional Medical CenterFresno, CaliforniaUnited States
Renato Sergio Poggefti, MD, FACSDirector of Emergency Surgical SerciceHospital das Clinicas Universidad de 56o PauloBrazil
Thomas M. Scalea, MD, FACSPhysician in ChiefR Adams Cowley Shock Trauma CenterFrancis X Kelly Professor of Trauma Surgery, Director Programin TraumaUniversity of Maryland School of MedicineBaltimore, MarylandUnited States
R. Stephen Smith MD, RDMS, FACSVice Chair and Director of Surgical EducationDepartment of Slxgery, The Virginia Tech - Carilion MedicalSchoolRoanoke, VirginiaUnited States
Richard Bell, MD, FACS (CON)Professor and Chairman, Department of SurgeryUniversity of South CarolinaColumbia, South CarolinaUnited States
Brent E. Krantz, MD, FACS (CON)Professor of SurgeryUniversity of South CarolinaColumbia, South CarolinaUnited States
Adaanced Trauma Life Support 1X
Associate Members to the$ubcommittee on Advanced TraumaLife $upport of the American Collegeof $urgeone eommittee on TraumaReginald Burton, MD, FACSDirector, Trauma Program and Surgical Critical CareBryan LGH Medical Center, WestLincolry NebraskaUnited States
Ronald Gross, MD, FACSAssociate Director of TraumaDepartment of Emergency Medicine/Trauma, HartfordHospitalHartford, ConnecticutUnited States
Sharon M. Henry, MD, FACSAssociate Professor of SurgeryDirector Wound Healing Seraice and Metabolism SeraiceUniversity of Maryland, R. Adams Cowley Shock TraumaCenterBaltimore, MarylandUnited States
Salvador Martin Mandujano, MD, FACSGeneral SurgeonMedical DirectorCozumel Medical CenterCozumel, Quintana RooMexico
Charles E. Morrow, ]r, MD, FACSAssistant ProfessorAssistant Program Director, General SurgeryMedical Director, Trauma SurgeryDepartment of Trauma, Spartanburg Regional MedicalCenterSpartanburg, South CarolinaUnited States
Frnnk Sacco, MD, FACSDirector of Trauma, Chief of SurgeryAlaska Native Medical Center, Department of SurgeryAnchorage, AlaskaUnited States
Martin A. Schreiber, MD, FACSAssociate Professor of SurgeryChief of Trauma and Surgical Critical CareOregon Health & Science University, Trauma & CriticalCare SectionPortland, OregonUnited States
Mary van Wijngaarden-Stephens, MD, FACSAssociate Clinical Professor Department of Surgery/DiaisionCritical CareTrauma DirectorUniversity of Alberta HospitalsEdmonton, AlbertaCanada
Robert j. Winchell, MD, FACSHead, Diaision of Trauma and Burn SurgeryMaine Medical CenterAssociate Clinical Professor of SurgeryUniversity of Vermont School of MedicinePortland, MaineUnited States
American $ociety of AnesthesiologyLiasion to the $ubcommittee onAdvanced Trauma Life Support of theAmerican 0ollege of $urgeonsCommittee on Traumafill A. Antoine, MDAssociate Professor of Clinical AnesthesiaUniversity of California, San Francisco, Department ofAnesthesia and Perioperative CareSan Francisco, CaliforniaUnited States
American College of EmergencyPhysicians Liasion to the$ubcommittee on Advanced TraurnaLife Support of lhe American Collegeol $urgeons Committee on TraumaRichard C. Hunt, MD, FACEPDirector, Diztision of Injury ResponseCenters for Disease Control and PreventionAtlanta, GeorgiaUnited States
Adaanced Trauma Life Support
Acknowledgments
CONTRIBUTORSDuring development of this revision, we receiveda great deal of assistance from manyindividuals - whether reviewing information atmeetings, submitting images, or evaluatingresearch. ATIS@ thanks the following contributorsfor their time and effort in the development of the8th edition:
Melissa V. AbadRegional Program Coordinator, CMECoordinator for Trauma ProgramsAmerican College of Surgeons ATIS ProgramOfficeChicago, IllinoisUnited States
Joe Acker,III, Mt MPH, EMT-PExecutiae DirectorBirmingham Regional EMSBirmingham, AlabamaUnited States
Saud AI Turki, MD, FRCS, ODTS, FACA, FACSDirectotTrauma Courses Office, Postgraduate Education& Academic Affairs, King Abdulaziz Medical GtyRiyadhKingdom of Saudi Arabia
Fatimah Albarracin, RNSenior OffcerLife Support Training Center, Tawam Hospital,affiliate of Johns Hopkins MedicineAl Ain, Abu DhabiUnited Arab Emirates
Celia AldanaATLS CoortlinatorCommittee on Trauma, ChileSantiagoChile
Donna AllertorL RNCitical Care, Coordinator - ATLS ProgramMcMaster University Medical CentreHamiltoru OntarioCanada
Heri Aminuddin, MDNeurosurgeonGatot Soebroto Central Amy HospitalJakarta Timur, JakartaIndonesia
|ohn A. Androulakis, MD FACSEmeitus Prcfessor of SurgeryUniversity Hospital of PatrasPatrasGreece
Guillermo Arana, MD FACSGmeral SurgeonNational HospitalPanama CityPanam6
Ivar AustlidDeptrtment of Anaesthesia and Intensive CareHaukeland University HospitalBergenNorwayMargreta Behrbohm Fallsberg PhD, BScConsultsntConsulting firm / small businessLinkdpingSweden
Renato Bessa de Melo, MDAssisEnte HospitalarSeruigo de Cirurgia Geral, Hospital de S.JoioPortoPortugal
Mike Betzner MDEmeryency PhysicianSmior Medical Director STARS Air AmbulanceCalgary Health Regior;Calgary, AlbertaCanadaClinical Lecturer, University o{ Calgary
Ken Boffard, MB BCh, FRCS, FRCS (Ed), FACSProfessor and Clinical HeadDepartment of Surgery, Johannesburg HospitafUniversity of the WitwatersrmdJohannesburgSouth Africa
Raphael Bonvin, MD, PhDUnite de pedagogie Medicale, Faculte debiologie et de medicineLausanneSwitzerlmd
Bertil Bouillon, MDProfessorUniversity of Witten Herdecke, Cologne,Merheim Medical Center, Department ofTrauma md Orthopedic SurgeryCologneGermany
Marianne BrandtSpecial E du cation TeacherDiabetes EducatorCmacas
Fred Brennemary MD FRCSC, FACSChief, Trauma ProgramSmybrook Health Sciences CenterAssociate ProfessorDepartment of Surgery, University of TorontoToronto, OntarioCanada
Ase Brinchmann-Hanserj PhDManagin g Educational ConsultantThe Norwegian Medical Association,Department of Professional AffairsOsloNorway
Peter Brinl MD, PhDChief, D epartment of Tr aumatologyUniversity Hospital Maastdcht, Department ofTraumatology
MaastrichtThe Netherlands
Karim Brohi, MDConsultant in Trauma, Vascular and CiticalCare SurgeryThe Royal London HospitalLondonUnited Kingdom
Laura Bruna, RNI talian N ational Coor dinatorAssitraumaTorinoItaly
Jacqueline Bustraan, MScEducational Consultant an d Rese ar cherPLATO, Centre for Research and Developmentof Education and Training, Leiden UniversityLeidenNetherlands
Vilma CabadingATLS National C-oordinator, Saudi ArabiaAcademic Affairs DepartmentKing Abdulaziz Medical City-NGHARiyadhKingdom of Saudi Arabia
Gerardo Cuauhtemoc Alvizo CudenasAssistant and Special Projects CoordinatorAmerican College of Surgeors ATIS kogram OfficeChicago, IllinoisUnited States
Carlos Caroajal Hafeman4 MD, FACSProfessor of SurgeryDirector of Surgery o{ the East CampusUniversidad de ChileSantiagoChile
Gustavo Castagneto, MD, FACSProfessor of SurgeryBuenos Aires British Hospital, Department ofSurgeryBuenos AilesArgentina
fune Sau-Hung ChanSkills Deoelopment Center, Uniaersity of HongKong Medical Cen*eQueen Mary Hospitat Deptrtment of SurgeryHongKongChina
Will Chapleau, EMT-B RN, TNSATLS Program ManagerAmerican College of Surgeons ATIS flogram OfficeChicago IllinoisUnited States
Zafmllah Chaudhry, MD, FRCS, FCP$ FACSProfessor of SurgeryNational Hospital and Medical CenterPresidentCollege of Physicims and Surgeons PakistanLahorePakistm
Adannced Trauma Life Support xt
Peggy Chehardy, EdD, CHESAssistsnt Professor and Director of SurgicalEducationTulane University School of MedicingDepartment of SurgeryNew Orleans, LouisimaUnited States
Robert A. Cherry, MD, FACSTrauma Program Medical DirectorPenn State Milton S. Hershey Medical CenterCollege of MedicineHershey, PennsylvaniaUnited States
Emmanuel Chrysos, MD, PhD, FACSAssociate Professor of SurgeryDepartment of General Surgery, UniversityHospital of CreteHeraklioo CreteGreece
Chin-Hung Chung, MB BS, FACSChief of SenticeDeparbnent of Accident & Emergency, NorthDistrict HospitalHongKongChina
Francisco Collet e Silva, MD, FACS, PhD (med)Medical DoctorEmergency Surgical Services, Hospital dasClinicas of the University of Sio PauloSio PauloBtazil
|aime Cortes, MDClief, Gmeral SurgeryNational Children's HospitalProfessorUniversity of Costa RicaSan JoseCosta Rica
Laura Lee Demmons, RN, MBAManagerCritical Care Transpod, University HosPitalBirmingham, AlabamaUnited States
Aleiandro De Gracia, MD FACS, MAACChief, General SurgeryAgudos Parmenio Piflero General HospitalBuenos AiresArgentina
Mauricio Di Silvio-Lopez, MD, FACSAinical Residency and Research Program Director20 de Noviembre National Medical Center,ISSSTEMexico City, Diskicto FederalMexico
Frank Doto, MSProfessor of Health EducationCounty College of MorrisRandolph, NewlerseyUnited States
Anne-Mich6le DrouxATLS National Coordinator, SwitzerlandSwiss Society of Surgeons
BaselSwitzerlandHermanus facobus Christoffel Du Plessis, MB,ChB, MMed(Surg), FCS(SA), FACSChief Surgeon, ColonelSAMHS (South African Military HealthServices)Head of the Department of Surgery andIntensive Carel Military HospitalAdjunct Professor of SurgeryUniversity of PretoriaPretoriaSouth Africa
Lesley DunstallEMST/ATLS N ational Coor dinator, AustualiaRoyal Australasian College of SurgeonsNorth Adelaide, South AustraliaAustralia
Candida Dur6oATLS N ational C-oordinator, PortugalPortuguese Society of SurgeonsLisbonPortugal
Ruth Dyson, BA(hons)ATLS Co-ordinatorThe Royal College of Surgeons of EnglandLondonUnited Kingdom
David Eduardo Eskenazi, MD, FACSChief, General and Thoracic SurgeryHtal. A. OffativiaBuenos AiresArgentina
Vagn Norgaud Eskesen, MDAssociate ProfessorUniversity Clinic of Neurosurgery, NationalHospital - Copenhagen University HospitalCopenhagenDenmark
Denis Evoy, MCH, FRCSIConsultant Gmeral Surgeon (Breast Entlocine)St Vincents l+ivate Hospital, Consultants ClinicDublinIreland
Froilan A. Fernandez, MDMedical Director Emergenry SeruiceHospital del TrabajadorSantiagoChile
Cornelia Rita Maria Getruda Fluit, MD,MEdSciSenior Consultant in Medical EducationUniversity Medical Centre Nijmegen, Qualityand Development of Medical EducationDepartmentNijmegenThe Netherlands
Jorge Esteban Foianini, MD, FACSGmed SurgeonDirectorFoianini ClinicSanta Cruz
Bolivia
Knut Fredriksen, MD PhDConsultant t Associate ProfessorDepartment of Emergency Medical Services,University Hospital of North NorwayFaculty of Medicine,University of TromsoTromsoNomay
Susanne Fristeen, RNEormer ATLS National Coordinator, DmmarkDanish Trauma SociefCopenhagenDenmark
Christine Gaarder, MDHead ofTrauma Unit, General and Gl surgeonEmergency Divisior; Ullevaal UniversityHospitalOsloNorway
Subash Gautam, MD, MBBS, FRC$ FACSSenior Consultant and Head of Depaimmt ofSurgeryFujairah HospitalFujairahUnited Arab Emirates
Aggelos Geranios, MDGmeral Sur geon, lntensiztistSur. Clinic of Livadeia Rural HospitalAthensGreece
Michael Gerazounis, MDGreece
favier Gonzilez-Uriarte, MD PhD, EBSQ,FSpCSGmeral SurgeonHospital de Cruces, Bilbao, Liver TransplantUnitBilbaoSpain
|ohn GreenwoodDircctorBurns Unite, Royal Adelaide HospitalAdelaide South AustraliaAustralia
Russell L. Gruen, MBBS, PhD, FRACSAssociate ProfusorUniversity of MelboumeTrauma SurgeonThe Royal Melboume HospitalMelboumeAustralia
Niels Gudmundsen-VestreMajorDanish Armed Forces Health ServiceHellerupDennark
Enrique A. Guzman Cottallat, MD, FACSNeutosurgeonDiplomat in Public HealthDirector, Neurosurgery Seruices
xll Adrsanced Trauma Life SuVport
Guayaquil HospitalGuayaquilEcuador
Arthur Hsie[ MA" NREMT-PSan Francisco Paramedic AssociationSan Francisco, CalifomiaUnited States
Richard Henn, RN, BSN, M.EDDirector, E ducation D epartmentNorthem Arizona HealthcareFlagstaff, ArizonaUnited States
Walter Henny, MDFormerly of Erasmus Medical CenterRotterdamNetherlands
Grace Herera-FernandezATLS CoordinstorCollege o{ Physicians and Surgeons of Costa RicaSan JoseCosta Rica
Fergal Hickey, FRC$ FRCS Ed.(A&E), DA(UK),FCEMConsultant in Emergency MeilicineEmergenry Departrnent, Sligo General HospitalSligoIreland
Scott HolmesDuke University Lifefl ightDurham, North CarolinaUnited States
fose Marla |over Navalon, MD FACSChief of Hepatopancreatic anil Biliary SurgeryHospital Universitario de Getafe, DepartmentofGeneral SurgeryGetafeSpain
Richard |udd PhD, EMSIDean, Emergenry Medical Services EducationalFoundationInstructors InstituteConsultantYale New Haven Health SystemsHartford, ConnecticutUnited States
Aage W. KarlsenATLS CoordinatorNorwegian Air AmbulanceDrobakNorway
Darren Kilroy, FRCSE4 FCEM, M.EdConsultant in Emergency MedicineStockport NFIS Foundation TrustCheshireUnited KingdomIena Klario RNFomer ATLS National Coordimtor, SwedenSahlgrenska UniversitetssiukhusetGdteborgSwedenPeggy Knudsoo MD, FACSProfessor ofSurgeryUniversitv of Califomia, San Francisco General
Hospital, Department of SugerySan Francisco, CalifomiaUnited States
Amy Koestner, RN, MSNTrauma Program ManagerBorgess Medical CenterKalamazoo, MichiganUnited States
Radko Komadina, MD, PhDGeneral Surgeon, Professor of Surgery, Head ofDepartment for Medical ResemchGeneral and Teaching Hospital CeljeCeljeSlovenia
Digna R. Kool MDRadiologis! Emergency RadiologyDepartment of Radiology, Radboud UniversityNijmegen Medical CentreNijmegenThe Netherlands
RomanKosir, MDAssistant of SurgeryUniversity Clinical Center Mmibor, Departmentof TraumatologyMariborSlovenia
Jon R. Krohmer, MD, FACEPDeputy Assistant Secretary for Health A{fairs,Deputy Chief Medical OfficerDepartment of Homeland SecurityWashingtor; DCUnited States
Ada Lai Yin KwokSkills Development Center, University of HongKong Medical CentreQueen Mary Hospital, Department of SurgeryHong KongChina
LAMSuk-Ching, BN MHMAdvanced Practice NurseQueen Mary HospitalHong KongChina
Maria Lampi, BSc, RNN a tional AT LS Coor dinato rCentre for Teaching & Research in DisasterMedicine and Traumatology, University HospitalLink0pingSweden
LEO Pien Ming MBBS, MRCS (Edin),M,Med(Orthopaedics)Changi General Hospital, GeneralOrthopaedics, Department of OrthopaedicsSingaporeRepublic o{Singapore
Wilson Li, MDSenior Medical OffcerDepartment of Orthopaedics & Traufiratology,Queen Elizabeth HospitalHongKongChina
Helen Livanios, RNlC Unit Staff NurseMediterraneo HospitaiAthensGreece
Chong-feh Lo, MD, FACSAssociate Profusor of SurgeryNatiornl Chen Kmg University MedicalCenterTainanTaiwan
Nur Rachmat Lubis, MDS taff D epahnent of SurgeryM. Hoesin General Hospital, Medical FacultySriwijaya UniversityPalembang, South SumatraIndonesia
|.S.K. Luitse, MDTraumasutgeonMedical D ire ctor Emer gency D epar fmmtTrauma CoordinatorAcademic Medical CenterAv TilburgNetherlmds
faime Manzano, MD, FACSGened SurgeonHospital MetropolitanoQuitoEcuador
Patrizio Mao, MD, FACSResponsabile Urgenze ChirurgicheChirurgia Generale Universitaria, A.S.O. SanLuigi Gonzaga di OrbassanoTorinoItaly
Emily MartensRegional P ro gr am C-oor dinator, Sur gical SkillsProgram CoordinatorAmerican College ofSurgeons ATLS ProgramOfficeChicago, IllinoisUnited States
Salvijus Mila5'9Aius, MDChief of Pimary Soldiers Health Care Centet inKaunasMlitary Medical Services, Lithuanian ArmedForcesKaunasLithuania
Soledad Montorl MDGeneral SutgeonDepartment of General Surgery, HospitalGarcia OrcoyenEstellaSpaio
Newton Djin Mori, MDGeneral SurgeonEmergency Sugical Services,Hospital das Clinicas Universidad de56o Paulo56o PauloBrazil
Adaanced Trauma Life Support x11l
Giorgio Olivero, MD, FACSProfessor of SurgeryUniversity of Torino, Department o{ Medicineand Surgery, St. John the Baptist HospitalTorinoIialy
Steve A. Olson, MD, FACSProfessor, Department of SurgeryChief Orthopaedic TraumaChief Medical OfficerDuke University HospitalDurham, North CarolinaUnited States
Goualo Ostria, MC, FACSDirectorCentro Medico FoianiniSanta CruzBoliviaFatima Pardo, MDGeneral SurgeonABC Medical CenterMexico City, Districto FederalMexico
Andrew Pearce, BSc Hons BMBS, FACEMEmer gency/Trauma Retieo al ConsultantTrauma Uni! Royal Adeiaide HospitalAdelaide, South AustraliaAustralia
Nicolas Peloponissios, MDGeneral, Truuma, and Abdominal SurgeonDepartment of Surgery, Daler HospitalFribourgSwitzerland
Pedro Moniz Pereira, MD, FACSGmeral SurgeonServigo de Cirurgi4 Hospital Garcia de OrtaAlmadaPortugal
Danielle Poretti RNSanuis, SARenens, VaudSwitzerland
fesper Ravn, MDConsultant, Head of General Thoracic DepartmmtCardiothoracic Sugery, Rigshospitalet,Copenhagen UniversityCopenhagenDenmark
Mrcelo Recalde Hidrobo, MD, FACSProfessor of Oncological and General SurgeiesLoja University, International University, Ecuador;Metropolitan HospitalQuito
_eriEcuador
Peter Rhee, MD, MPH, FACS, FCCI\4 DMCCProfesnr of SurgeryChief, Section ofTrauma, Citical Care, andEmergency SurgeryArizona Health Sciences Center, Department ofSurgeryTucsorL ArizonaUnited States
Martin RichardsonThe Epworth CentreRichmond, VictoriaAustralia
Bo RichterMajotDanish Armed Forces Health ServicesNestvedDenmark
Rosalind Roden" FFAEMConsultant in Emergency MedicineLeeds Teaching Hospitals NHS TrustYorkshireUnited Kingdom
Diego Rodriguez, MDMedical DirectorHospital Clinica San AgustinSmAgustinEcuador
Vicente Ro&iguez, MDProfessorHospital Clinica San AgustinSan AgustinEcuador
Olav Roise, MD, PhDChairman of the Dhtision ofNeuroscience andMu s culo skel e t al Me di cineUlievil University HospitalOsloNorway
Daniel Ruiz, MD, FACSCardioo ascular Sur geonCMIC ClinicNeuqu6nArgentina
Octavio Ruiz, MD FACSHead of Transplant SeraicesAmerican British Cowdray Medical CenierMexico City, Districto FederalMexico
feffrey P. Salomone, MD FACSAssociate Professor of SurgeryEmory University, Department of SurgeryDeputy Chief of SurgeryGrady Memorial HospitalAtlanta, GeorgiaUnited States
Rocio Sanchez-Aedo, RNFomer ATLS National Coordinator, MexicoCommittee on Trauma, MexicoMexico City, Districto FederalMexico
MArtin Sandberg, MD, PhDSenior Consultant in Anesthesiolo gyAir Ambulance Department, Lllleval UniversityHospitalOsloNorway
Nicole Schaapveld, RNMnnaging Director / Nfltiotxal CoodinatotATLS NLAdvanced Life Support Group - NL
RielThe Netherlands
Domenic Scharplatz, MD, FACSHead SurgeonHospital of ThusisThusis, GrisonsSwitzerland
Inger B. Schipper, MD, PhDMedical Director of the SouthWest NetherlandsTraumacenterUniversity Hospital Erasmus MC, Departmentof Trauma SurgeryRotterdamThe Netherlands
Patrick Schoettker, MD M.E.R.Staf SpecialistDepartment of Anesthesiology, UniversityHospital VaudLausanneSwitzerland
Kari Schroder Hansen, MDConsultant Genu al Sur geryDepartment of Surgery, Haukeland UniversityHospitalBergenNorway
Bolivar Serrano, MD FACSGeneral SurgeonHospital LatinoamericanoCuencaEcuador
Juan Carlos Serrano, MD, FACSDEartment of Trauma DirectorHospital Santa In6sCuencaEcuador
Mark Sheridan, MBBS, MMedSc, FRACSAssociate ProfessorDirector of Surgery and Director ofNeuosurgery, Liverpool HospitalSydney, New South WalesAustralia
Richard K. Simons, MB, BChir, FRCS, FRCSC,FACSAssociate Professor, Medieal Director, TraumtSeroicesDepartment of Surgery, UBC, VancouverCoastal HealthVancouver, British ColumbiaCanada
Preecha Siritongtaworn, MD, FACSChief, Diztision of Trauma SurgeryDepartment of Surgery, Faculty of MedicineSiriral Hospital, Mahidol UniversityBangkokThailand
Nils Oddvar Skaga, MDChief Anaesthesiologist for TraumaUllevAl University HospitalOsloNorway
xlv Ada anced Trauma Life Support
Peter Skippe4 MBBS, FRCPC,IJFICM,MHAMedical Director and Diaision HedClinical Associate Prcfessor ofCitical CareBC Childrenl'92s Hospital, Department ofPediatricsVancouver, British ColumbiaCanada
Tone SlAkeATLS National CoordinatoL NorusayNorwegian Air AmbulanceDrsbakNorway
Birgifte SoehusATLS National Coordinator, DmmarkDanish Trauma SocietyBrorshojDenrrrark
Elizabeth de Solezio, MA, PhDAdztisor, Ecuadoian Secretary of State CultureBuresuCommittee on Trauma, EcuadorQuitoEcuador
Michael Stawopoulos, MD, FACSAssistant Professor of SurgerySurgery Department Patras University MedicalfthoolPatrasGreece
Spyridon Stergiopoulos, MDAssociate Professor of SurgeryAttikon University Hospital 4th SurgicalDepartmentAthensGreece
Paul-Martin Sutter, MDDepartment of Surgery SpitalzentrumBielSwitzerland
Lars Bo Svendsen, MD, D M SciAssociaE P rcfessot SulgeryCopenhagen University, Department ofAbdominal Surgery and Transplantation,RigshospitaletCopenhagenDenmark
Vasso TagkalakisATLS Natianal Coordinator, GreeceUniversity of PatrasPatrasGreece
Wa"el S. Tah+ MDAssistant Professor of SurgeryDeputy Dfuector of Trauma Courses ProgramDepartment Orthopedic Surgery, KingAbdulaziz Medical CityRiyadhKingdom o{ Saudi Arabia
Gustavo Tisminetzky, MD, FACS, MAACProfessor of SurgeryUniversidad de Buenos Aires, Escuela deMedicina Hospital Italiano de Buenos Aires,Jefe Unidad de Urgencia Hospital Fem5adezBuenos AiresArgentina
Philip Truskett, MB BS, FRACSThe Prince of Wales HospitalSydney, New South WalesAustralia
Wolfgang Ummenhofer, MD, DEAAProfessor of Anesthesiology and lntensiae CareUniversity Hospital, Basel, Department ofAnesthesia and Intensive CareBaselSwitzerland
Yvonne van den EndeOfice ManagerStichting Advanced Li{e Support GroupRielThe Netherlands
Armand Robert van Kanten, MDGmeral Surgeon, Head of TraumaUniversity Hospital ParamariboParamariboSuriname
Endre Varga, MD, PhDVice Chnirman, Professor ofTrauma SurgeryDepartment of Traumatology, AlbertSzentgytirgyi Medical and PhmmaceuticalCenter, University of SzegedSzegedHungary
Edina ViirkonyiDepartment of Traumatology, University ofSzegedSzeged
Panteleimon VassilirL MD PhDAttending SurgeonGeneral Sugical ClinicAttikon University HospitalAthensGreece
Eugenia Vassilopouloq MDA tt en din g Ane stfu siolo gis tGeneral Hospital of AigionAigionGreece
Antigoni VavaroutaATLS CoordinatorUniversity of PatrasPahasGreece
Tore Vikstrdm, MD PhDDirector anil Heail, Consultant GeneralSugeryProfesssor of Disaster Medicine &TraumatologyCentre for Teaching & Research in DisasterMedicine and Traumatology, UniversityHospitalLinkii,pingSwedm
Eric Voiglio, MD, PhD, FACS, FRCSSmior Lecturer, Consultant SurgeonDepartrnent of Emergenry Surgery,University Hospitals of Lyo4 CentreHospitalier Lyon-SudPierre-B6niteFrmce
Daryl Williams, MBBS, FANZCA, cDipBusAdGdipCRAssociate Professor, Unioersity of MelboumeRoyal Melboume Hospital, Department ofAnaesthesiaDirector AnaesthesiaMelboume Hospital, University of MelbourneMelbourneAustralia
RobertWinter, FRCP, FRCA" DMConsultant in Critical Care MedicineMid Trent Critical Cae Network andNottingham University HospitalsNottinghamUnited Kingdorn
Nopadol Wora-Urai, MD, FACSPresident-Elec! Royal College of SurgeonsRoyal College of Surgeons of ThailandBaog
Wai-Key Yuery MB BS, FRCS, FRACS, FACSConsultantDeparhnent of Surgery, Queen MaryHospitalHong KongChina
HONOR ROLLOver the past 30 years, ATLS has grown froma local course training Nebraska doctors tocare for traurna patients to a family oftraurna specialists from more than 50 countrieswho volunteer their time to ensure thatour materials reflect the most current research
and that our course is designed to improvepat ient outcomes. The 8th edi t ion ofATLS reflects the efforts of the followingindividualswho contributed to the first seveneditons, md we honor them here.Sabas F. Abuabara. MD. FACSJoe E. Acker, III, Mt MPH, EMT
Raymond H. Alexander, MD, FACSFareed Ali, MD, FRCS (C)Jameel Ali, MD, MMed Ed, FRCS (C), FACSChales Aprahamian, MD, FACSGuillermo Arana, MD, FACSAna Luisa Argomedo ManriqueGonzalo Avil6sRichard Baillot. MD
Adv an ce d T r auma Life S upp or t XV
Barbara A. Barlow, MA, MD, FACSfames Barone, MD, FACSJohn Barrett, MD, FACSPierre Beaumont, MDRichard M. Bell, MD, FACSEugene E. Berg, MD, FACSRichard Bergerory MDFrangois Bertrand, MDEmidio Bianco, MD, JDDon E. Boyle, MD, FACSRea Browry MD, FACSAllen F. Browne, MD, FACSGerry Bunting, MDAndrew R. Burgess, MD, FACSRichard E. Burney, MD, FACSDavid Burris, MD, FACSSylvia Campbell, MD, FACSC. fames Carrico, MD, FACSC. Gene Caytery MD, FACSDavid E. Clark, MD, FACSPaul E. Collicott, MD, FACSArthur Cooper, MD, MS, FACSRonald D. Craig, MDDoug Davep MDElizabeth de Solezio, PhDSubrato J. Deb, MDRonald Denis, MD]esus Diaz Portocarrero, MD, FACSFrank X. Doto, MSMarguerite Dupr6, MDBrent Eastman, MD, FACSFrank E. Ehrlictr, MD, FACSMartin R. Eichelberger, MD, FACSDavid Eduardo Eskenazi, MD, FACSWilliam F. Fallory Jr, MD, FACSDavid V. Feliciano, MD, FACSFroilan Fernandez, MDCarlos Fernandez-Bueno, MDJohnJ. Fildes, MD, FACSRonald P. Fischer, MD, FACSLewis M. Flint, Jr, MD, FACSStevenson Flanigan, MD, FACSEsteban Foianini G., MD, FACSjorge E Foianini, MD, FACSRichard Fruehling MDSylvainGagnon, MDRichard Gamelli, MD, FACSThomas A. Gennarelli, MD, FACSPaul GebhardJames A. Geiling, MD, FCCPJohn H. George, PhDRoger Gilbertsoru MDRobert W. Gillespie, MD, FACSMarc Giroux, MDJ. Alex Haller, jr., MD, FACSBurton H. Harris, MD, FACSMichael L. Hawkins, MD, FACSIanHa)'wood, FRCS (Eng), MRCS, LRCPJames D. Heckmary MD, FACS
June E. Heilman, MD, FACSDavid M. Heimbach, MD, FACSDavid N. Herndon, MD, FACSErwin F. Hirsctu MD, FACSFrancisco Holguin, MDDavid B. Hoyt, MD, FACSIrvene K. Hughes, RNRichard C. Hunt, MD, FACEPMiles H. Irving, FRCS (Ed), FRCS (Eng)Jos6 MarlaJover Navalory MD, FACSRichard L. Judd, PhDGregoryJ. Jurkoviclu MD, FACSChristoph R. Kau-fmann, MD, FACSHoward B. Keith, MD, FACSJames F. Kellam, MD, FRCS, FACSStevenJ. Kilkerury, MD, FACSjohn B. Kortbeck, MD, FACSBrent Krantz. MD, FACS|on R. Krohmer, MD, FACEPKatherine Lane, PhDFrancis G. Lapiana, MD, FACSPedro Larios AznarAnna M. Ledgerwood, MD, FACSDerrris G. Leland, MD, FACSFrank Lewis. MD. FACSEdward B. Lucci, MD, FACEPEduardo Luck. MD, FACSThomas G. Luerssery MD, FACSArnold Lutermanu MD, FACSFernando Magallanes Negrete, MDDonald W. Marion, MD, FACSMichael R. Marohn, DO, FACSBarry D. Martin, MDSalvador Mar(n Mandujano, MD, FACSKimball I. Maull, MD, FACSMary C. McCarthy, MD, FACSGerald McCullougtr, MD, FACSJohn E. McDermott, MD, FACSJames A. McGehee, DVM, MSWilliam F. McManus, MD, FACSNorman E. McSwairy Jr., MD, FACSPhilip S. Metz, MD, FACSCynthia L. Meyer, MDFrank B. Miller, MD, FACSSidney F. Miller, MD, FACSErnest E. Moore, MD, FACSJohanne Morin, MDDavid Mulder, MD, FACSRaj K. Narayaru MD, FACSJames B. Nichols, DVM, MSMartin Odriozola, MD, FACSFranklin C. Olson, EdDGonzalo Ostria R MD, FACSArthur Pag6, MDJos6 Paiz TejadaSteven N. Parks, MD, FACSChester (Chet) Paul, MDMarkD. Pearlman, MDAndrew B. Peitzman, MD, FACS
jean P6loquin, MDPhilip W. Perdue, MD, FACSf.W. Rodney Peyton, FRCS (Ed), MRCPLawrence H. Pitts, MD FACSGalen V. Poole, MD, FACSErnest Pr6gent, MDRichard R. Price, MD, FACSHerbert Proctor, MD, FACSjacques Provost MDPaul Pudimat, MDMax L. Ramenofsky, MD, FACSMarcelo Recalde, MD, FACSJohn Reed, MDMarleta Reynolds, MD, FACSStuart A. Reynolds, MD, FACSBernard Riley, FFARCSCharles Rinker, MD, FACSAvraham Rivkind, MDRonald E. Rosenthal, MD, FACSGrace Rozycki, MD, FACSJ. Octavio Ruiz Speare, MD, MS, FACSJames M. Ryaru MCtu FRCS (Eng), RAMCJames M. Salander, MD, FACSGueider Salas, MDRocio S6nchez-Aedo LinaresThomas G. Saul, MD, FACSWilliamP. Schecter, MD, FACSThomas E. ftott, MD, FACSStuart R. Seiff. MD, FACSSteven R. Shackford, MD, FACSMarc J. Shapiro, MD, FACSThomas E. Shaver, MD, FACSRichard C. Simmonds, DVM, MSDavid V. Skinner, FRCS (Ed), FRCS (Eng)Arnold Sladeru MD, FACSRicardo Sonneborry MD, FACSGerald O. Strauch, MD, FACSLuther M. Strayer, III, MDJames K. Styner, MDjohn E. Suttort Jr, MD, FACSJoseph J. Tepas, III MD, FACSStephane T6traeault, MDGregory A. Timberlake, MD, FACSPeter G. Trafton, MD, FACSStanley Trooksiry MD, FACSDavid Tuggle, MD, FACSJay UprightAntonio Vera BoleaAlan Verdant, MDJ. Leonel Villavicencio, MD, FACSFranklin C. Wagner, MD, FACSRaymond L. Warpeha, MD, FACSClark Watts, MD, FACSJohnA. Weigelt, MD, FACSJohn West, MD, FACSRobertJ. 1/hite, MD, FACSFremont P. Wirth, MD, FACSBradley D. Wong, MD, FACSPeter H. Worlock, DIvI, FRCS (Ed), FRCS (Eng)
XV1 Adaanced Trauma Life
INSTRUKTUR YANG BERPARTISIPASI TERJEMAHAN BUKU ATLS
Prof. DR. Dr. Aryono D. Pusponegoro Dr. Heri AminuddinFKUI/RS Dr. Cipto Mangunkusumo, Jakarta RSP AD Gatot Soebroto, |akartaDr. Warko Karnadihardja Dr. Djoko RiadiFK Unpad/ RS Dr. Hasan Sadikin, Bandung RSP AD Gatot Soebroto, Jakarta
Dr. Suryadi Soedarmo Dr. Trisula UtomoFK UKI/ RS UKI Cawang fakarta FK UGM/ RS Dr. Sardjito, Yogyakarta
Dr. Nur Rachmat Lubis Dr. Tommy SunartomoFK UNSRI/ RS Dr. Moh. HoesirL Palembang FK UNAIR / RS Dr. Soetomo, Surabaya
Dr. Sahat Edison Sitorus Dr. Bagyo S. WinotoFK UNSRI/ RS Dr. Moh. Hoesin, Palembang FK UNAIR / RS Dr. Soetomo, Surabaya
Dr. Nurhayat Usman Prof. DR. Dr. Andi Asadul IslamFK UNPAD/ RS Dr. Hasan Sadikin, Bandung FK UNHAS/ RS Dr. Wahidin S., Makassar
Dr. Haryono Yarman Dr. BambangWahjuprajitnoFK UNPAD/ RS Dr. Hasan Sadikin, Bandung FK UNAIR / RS Dr. Soetomo, Surabaya
Dr. Sutrisno Dr. Andanu IndratnotoRSAL Dr. Ramelan, Surabaya Jakarta
DR. Dr. Heru Kusbianto Prof. Dr. Farid Nur MantuFK TINAIR / RS Dr. Soetomo, Surabaya FK UNHAS/ RS Dr. Wahidin S., Makassar
Dr. Ganda Parulian Sibabiat Dr. Laurens TB KalesaranFK UKII RS UKI Cawang, |akarta RS Malalayang, ManadoDr. Reno Rudiman Dr. BP SuryosubiantoFK UNPAD/ RS Dr. Hasan Sadikin, Bandung FK UNJANI /RS Dustira, Bandung
Dr. Robert Sinurat Dr. M. Alsen ArlanFK UKI/ RS UKI Cawang, |akarta FK UNSRI/ RS Dr. Moh. Hoesin, PalembangDr. Aditya Wicaksana Prof. DR. Dr. Respati S. DradjatRSPAD Gatot Soebroto, |akarta FK Unibraw/RS Dr. Syaiful Anwar, MalangDr. Bambang Sugeng Dr. Ismandiya Wirasugena (alm)FK UNISLILA" Semarang RS POLRI RS Soekamto, Jakarta
Dr. Gunadi Petrus Dr. Prasetyo Hestitoto (alm)RS IIKI, |akarta RS Sukmul, ]akartaDr. Arief Guntara Tetty Herawaty, SERS Soreang, Bandung Sekretariat Komisi Trauma-ATLS jakarra
Dr. B. Sunoko Instruktur lain yang membantuFK UGM/ RS Dr. Sardjito, Yogyakarta
Adaanced Trauma Life Support XVIl
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