We dedicate the Tenth Edition of ATLS to the memory of Dr. Norman E. McSwain Jr. His dynamic, positive, warm, friendly,
and uplifting approach to getting things done through his life’s work is a constant inspiration to those whose lives
His tenure with the American College of Surgeons Committee on Trauma (COT) spanned almost exactly the same 40 years of
the ATLS course.
Dr. McSwain’s time with the COT led him down a path where, without a doubt, he became the most important surgical
advocate for prehospital patient care.
He first worked to develop, and then led and championed, the Prehospital Trauma Life Support Course (PHTLS) as a vital
and integral complement to ATLS. Combined, these two courses have taught more than 2 million students across the globe.
Dr. McSwain received every honor the COT could bestow, and as a last tribute, we are pleased to dedicate this
edition of ATLS to his memory.
The creators of this Tenth Edition have diligently worked to answer Dr. McSwain’s most common greeting:
“What have you done for the good of mankind today?” by providing you with the Advanced Trauma Life Support Course,
10th Edition, along with our fervent hope that you will continue to use it to do good for all humankind.
Thank you, Dr. McSwain.
Sharon Henry, MD
Karen Brasel, MD
Ronald M. Stewart, MD, FACS
Course Overview xxix
CHAPTER 1 Initial Assessment and Management 2
CHAPTER 2 Airway and Ventilatory Management 22
CHAPTER 3 Shock 42
CHAPTER 4 Thoracic Trauma 62
CHAPTER 5 Abdominal and Pelvic Trauma 82
CHAPTER 6 Head Trauma 102
CHAPTER 7 Spine and Spinal Cord Trauma 128
CHAPTER 8 Musculoskeletal Trauma 148
CHAPTER 9 Thermal Injuries 168
CHAPTER 10 Pediatric Trauma 186
CHAPTER 11 Geriatric Trauma 214
CHAPTER 12 Trauma in Pregnancy and Intimate
Partner Violence 226
CHAPTER 13 Transfer to Definitive Care 240
APPENDIX A: Ocular Trauma 257
APPENDIX B: Hypothermia and Heat Injuries 265
APPENDIX C: Trauma Care during Mass-Casualty,
Austere, and Operational Environments 275
APPENDIX D: Disaster Preparedness and Response 289
APPENDIX E: ATLS and Trauma Team
Resource Management 303
APPENDIX F: Triage Scenarios 317
APPENDIX G: Skills 335