This document provides an overview of the ATLS (Advanced Trauma Life Support) protocol for assessing and managing trauma patients. It begins with an introduction to trauma education resources and describes the trauma response at a hypothetical hospital. It then outlines the key components of the primary and secondary surveys in ATLS, including airway, breathing, circulation, disability and exposure for the primary survey and a thorough head-to-toe examination for the secondary survey. The document concludes with a simulated trauma case presentation and discussion of differential diagnosis.

1. WELCOME TO THE KNIFE & GUNWELCOME TO THE KNIFE & GUN
CLUBCLUBDavid Marcus, MD
LIJ EM/IM October 2, 2013

2. GOALS
ATLS Review
Free
Associations
Spaced Repetition
@RegionsTrauma
Regionstraumapro.com
@shocktrauma (meh)
@traumadoctors (AAST)
@KarimBrohi

3. References/Sources
• Videos: Trauma Bay, by Vanderbilt EM:
http://traumabay.vanderbiltem.com/cases.html
• Trauma Case:
http://www.trauma.org/index.php/main/case/1465/
• Trauma Tribulation 33a - What Would Weingart Do?
http://lifeinthefastlane.com/2012/12/trauma-tribulation-033a/
• Various images: trauma.org

4. IT'S 4AM AT NUMC, AND THEIT'S 4AM AT NUMC, AND THE
TRAUMA PHONE RINGS...TRAUMA PHONE RINGS...

5. Thoughts?
• Debrief
• Do you do any of this?
• Good/Bad?
• Um, NUMC?

6. The Primary Survey
....Quick, Quick, Quick...

7. The Primary Survey
Airway + C-Spine
Breathing + Ventilation
Circulation
Disability
Exposure + Environment
DEAL WITH A PROBLEM
BEFORE MOVING ON
Airway + C-Spine
Breathing + Ventilation
Circulation
Disability
Exposure + Environment
DEAL WITH A PROBLEM
BEFORE MOVING ON

8. Thoughts?
• Debrief the Primary
Survey
• Good/Bad?
• Same/Different?
• Keep the medics?
• Um, NUMC?

9. Life in the Fast Lane
Trauma Tribulation 33
+
What Would Weingart Do?

11. The Secondary Survey
....A Thorough Exploration...

12. The Secondary Survey
Thorough Head-to-Toe exam
Start from the scalp and make your
way down to the toes
Examine all cavities & orifices
Explore all wounds
Includes:
• FAST
• Pelvis
• Everything else
Thorough Head-to-Toe exam
Start from the scalp and make your
way down to the toes
Examine all cavities & orifices
Explore all wounds
Includes:
• FAST
• Pelvis
• Everything else

13. Thoughts?
• Debrief the Secondary Survey
• Good/Bad?
• Same/Different?
• Tagging ballistic wounds?
• Board?
• Um, NUMC?

16. ATLS Overview
• The Primary Survey
• A
• B
• C
• D
• E
• Address problems as they
arise
• The Secondary Survey
• In depth
• Head to toe
• Orifices and wounds
• Pelvis
• FAST?
• Plan to fix all problems

17. It's Like a CPC
• A skydiver lost control
parachuting and landed in
shallow water. At scene the
attending doctor noted he was
suffering only from a pain in
his right knee. The patient
denied LOC or any
neurological symptoms and
was referred to the nearest
trauma center for further
evaluation.

18. It's Like a CPC
• At the trauma center
further interrogation
revealed the patient had
fallen on his right side and
twisted his right knee. He
had no past medical
history, took no medication
and was an occasional
smoker and consumer of
alcohol.

19. It's Like a CPC
• On examination the patient
was hemodynamically stable,
GCS 15 with a pain score of
4/10.
• He had a swollen right knee
which was tender on the lateral
aspect without suggestion of
neurovascular injury. A
radiograph of the right showed
avulsion of the lateral tibial
plateau and fracture of the
right head of fibula. Findings
were confirmed on CT within

20. It's Like a CPC
• The patient was sent for blood testing following the
CT, at this stage his condition deteriorated. He
became irritable and began salivating excessively.
• A primary survey was repeated showing a patent
airway, good bilateral air entry to the chest with
saturations of 100% on 10L of oxygen via mask. His
blood pressure was 127/82 with a heart rate of 86
BPM. By this point he was GCS 13 with bilateral
size 3mm pupils which were reactive to light.

21. It's Like a CPC
• The secondary survey showed a left sided upper motor
neuron facial palsy with left sided hemiplegia.
• A diagnostic study was done...

22. Differential Diagnosis?

23. CT Head

24. Final Diagnosis
• Post-Traumatic right middle cerebral artery thrombosis.
• Re-interviewing the MD at the scene revealed that the
patient had landed with the parachute twisted around his
neck at impact, causing compression of the right side of
his neck.

25. ONE LAST VIDEO...ONE LAST VIDEO...
THANK YOU!THANK YOU!
THANK YOU!THANK YOU!