Talk:Advanced trauma life support

Under "airways": Addition - Airways must be inspected visually for inhalation burn, hemorrhage, swelling and so on. Failure to do so may result in patient sufflicating as injury progresses. — Preceding unsigned comment added by 195.196.196.131 (talk) 10:33, 20 March 2012 (UTC)

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Hello, I'm a medical student who is taking part in a Wiki Course at my medical school. Part of the course's requirements is to peer-review and edit another medical article. I chose this article because of my interest in Emergency Medicine and ATLS. I think this is a really great article and has lots of good information, however, I think there are some ways to improve this so that it can be even better!

First, I used the Hemingway Editor app to assess for readability. Overall, the article is written at a grade 13 level and there are parts which are at a post-graduate level, which is unfortunately higher than the average reading level for adults. Of the total 86 sentences, 31 of them were found to be "very hard to read" by the Hemingway app. Adult literacy in the US is at a 7th or 8th grade level, so I think that many sentences can be made less complex. This is especially important since medical topics can be particularly difficult for the lay community to understand.

"Airway maintenance" section This was a good section; I liked including the part about patients being able to speak indicating that the airway was clear. I think this section can be improved by expanding on the different types of airway adjuncts. A broader discussion on oropharyngeal and nasopharyngeal airway devices can be included. You can even add in how to choose the correct airway adjunct and how to measure for the correct size (nose to tip of earlobe). Information about lubricating the NPA would also be a nice fact to add in. A discussion about surgical airways (cricothyrotomy) and their indications are important as well. I noticed that there wasn't anything really mentioned about cervical spine protection in this section. Cervical spine guidelines would be a huge addition to this section. The Canadian C-spine and Nexus criteria are used so often in the emergency department, so this would be great to include on an article discussing ATLS.

"Breathing and ventilation" section This had many good links for the thoracic conditions. I think that x-ray images of some of these would improve the look of the article and make it easier to read instead of having to refer to multiple links. There was a very small amount of information about how to recognize flail chest and subcutaneous emphysema. This could probably be expanded on a bit. If I were someone who didn't know how to recognize these, even just an additional sentence about what auscultation findings present in each would be helpful.

"Circulation with bleeding control" section Assessing and controlling for hemorrhage includes checking for pulse rate, blood pressure, capillary refill, and peripheral extremity warmth. Defining the normal rates of these and what constitutes hemorrhage and instability could be added in. Blood loss also needs to be checked in six main areas: chest, abdomen, retroperitoneum, pelvis, long bones, and externally. A FAST exam is very often performed in ED traumas, so this could be discussed here as well. Inserting large bore IVs was mentioned, however, there should be a comment about intraosseous access if the large bore IVs fail. There was no mention of obtaining a venous blood gas, cross-matching blood, or sending off initial blood tests (CBC, urea, electrolytes, creatinine, glucose, coagulation profile, and lipase).

"Disability/Neurologic Assessment" I'd really like to see an image that shows how GCS is scored. Pupil size and responsiveness can also assist in determining the presence and severity of neurological injuries, so this would be good to mention. Also important to mention checking for priaprism, loss of anal sphincter tone, and bulbocavernosus reflex. Disability also includes managing pain in patients, as well as treating anxiety and agitation.

I hope some of these suggestions are helpful! :) Hsamaha1 (talk) 20:34, 31 January 2019 (UTC)