Professional Documents
Culture Documents
COURSE OBJECTIVES
THE NEED
ATLS CONCEPT
ABCs-approach to evaluation,
treatment
Treat greates threat to life first
Do no further harm
ATLS CONCEPT
A
B
C
D
E
Transfer
Injury
Stabilization
Initial Assesment
(Primary Survey)
First Hour
and
Re-Evaluation
Live-saving
Intervention
ATLS
EDUCATION FORMAT
Lectures
Demonstration
Group Discussions
Practical live-saving skills
Simulated patient scenarios
Tests
SUMMARY
Premise : Appropriate and timely care
can improve patient outcome
Provides : Safe, reliable method of
trauma care in the first hour
OBJECTIVES
CONCEPTS OF
INITIAL ASSESSMENT
PRIMARY SURVEY
AND RESUSCITATION
OF VITAL FUNCTION
ARE DONE SIMULTANEOUSLY
PREPARATION
Prehospital
: Closest, appropriate
facility
Inhospital
:
Preplanning essential
Equipment, personnel, services
Communicable disease protection
Transfer agreements
TRIAGE
PRIMARY SURVEY
Adult / pediatric priorities same
A Airway with c-spine control
B Breathing
C Circulation with hemorrhage control
D Disability : Neurologic status
E Exposure / Environment
PRIMARY SURVEY
Establish Patent Airway
CAUTION
PRIMARY SURVEY
Assume C-spine Injury
Multisytem trauma
Alteredlevel of consciousness
Blunt injury above clavicle
PRIMARY SURVEY
Breatching
Assess
Oxygenate
Ventilate
PRIMARY SURVEY
Circulation
Assess blood volume loss and
cardiac output
Level of consciousness
Skin color
Pulse
PRIMARY SURVEY
Disabilty (Neurological Evaluation)
Level of consciousness
A
Alert
V
Responds to voice
P
Responds to pain
U
Unresponsive
Pupils
PRIMARY SURVEY
Exposure / environment
Undress patient completely
Protect from hypothermia
RESUSCITATION
Protect / Secure airway
Ventilate / oxygenate
Vogorous shock therapy
Protect from hypothermia
Urinary / gastric catheters
CAUTION
Unless contraindicated
RESUSCITATION
Monitor
Vital sign
Urinary output
ABGs
*
*
*
ECG
Temperatur
Pulse oxymetry
End-tidal CO2
RESUSCITATION
SECONDARY SURVEY
SECONDARY SURVEY
History
A
Allergies
M Medication
P
Pass Illnesses
L
Last meal
E
Events / Environment
SECONDARY SURVEY
Mechanism of injury : Blunt
Direction of impact determines injury
pattern
History / Description of event
Age factors
SECONDARY SURVEY
Mechanism of injury: Penetrating
Anatomic factors
Energy transfer factors
* Velocity and caliber of bullet
* Trajectory
* Distance
SECONDARY SURVEY
Mechanism of injury: Burns / Cold
Burns
Inhalation / CO complication
Associated injury
Event history
COLD
Local or systemic
Event history
SECONDARY SURVEY
Mechanism of injury: Hazardous Materials
Risk to patient and care providers
Event history
SECONDARY SURVEY
Head
Pupils
Visual acuity
Injury
SECONDARY SURVEY
Maxillofacial
No airway obstruction or bleeding-treat later
Midfacial fracture cribriform plate fracture
Assume c-spine injury
SECONDARY SURVEY
C-spine and neck
Maintain immobilization
Complete evaluation
Cautious helmet removal
Penetrating : operation
SECONDARY SURVEY
Abdoment
Inspect, auscultate, palpate, end percuss
Re-evaluate frequently
Special studies
SECONDARY SURVEY
Perineum : Contusions, hematomas,
lacerations, urethral blood
Rectum
Vagina
: Blood, laceration
SECONDARY SURVEY
Muskuloskeletal
Extremities/ Contusions, deformity,
Pelvis
: pain, crepitation,
abnormal movement
Vascular
: Assess all peripheral
pulses
Spine
: Physical findings,
mechanism of injury
SECONDARY SURVEY
Neurologic
Determine GCS Score
Re-evaluate pupils
Sensory / motor evaluation
Maintain immobilization
Prevent secondary CNS injury
Early neurosurgical consultation
RE-EVALUATION
DEFITIVE CARE
Trauma centre or
Closest appropriate hospital
SUMMARY
Initial Assessment
Primary survey
Resuscisation
Secondary survey
Definitive care
OBJECTIVES
AIRWAY MANAGEMENT
First priority
Secure airway
oxygenate and ventilate
AIRWAY MANAGEMENT
Preventable Deaths
Failure to recognize airway need
Delay in establishing adequate
ventilation
Technical difficulties
Aspiration of gastric contents
AIRWAY COMPROMISE
Increased Risk
Head injury
Direct Airway injury
Facial fractures
Thoracic injury
Drugs / Alcohol
AIRWAY OBSTRACTION
Objective Sign
A Mental status
Retraction
Air movement
Cyanosis
Noisy breathing
Tracheal position
VENTILATORY COMPROMISE
Increased Risk
Airway obstruction
Impaired ventilation mechanics
CNS depresion
VENTILATORY COMPROMISE
Objective Sign
Chest asymmetry
Labored breathing tachyipnea
MANAGEMENT APPROACH
Adequate Oxygenation Requires
Airway
Maintenance * Ventilation
Techniques
or
Definitive
Airway
* Ventilation
CAUTION
DEFINITIVE AIRWAY
DEFINITIVE AIRWAY
Indications
Apnea
Risk of aspiration
Impending airway compromise
Insecure airway
Closed head injury
Poor oxygenation
DEFINITIVE AIRWAY
Based on urgency
Oximetry helpful during tube
placement
DEFINITIVE AIRWAY
Surgical airway
Inability to intubate
Immediate need for airway
OXYGENATION / VENTILATION
OXYGENATION / VENTILATION
Pulse Oximetry
Difficult intubation
Adequacy of oxygenation
Transport
OXYGENATION / VENTILATION
Pulse oximetry
Measures O2, saturation not
partial pressure of oxygen (PaO2)
SUMMARY
SUMMARY
If in doubt
Definitive airway
Type of definitive airway based on
Urgency of need
Physicians clinical judgment / skill