Pitfalls in ATLS ธเนศ รังษีขจี

ATLS Advanced Trauma Life Support 7 th Edition

Advanced

Trauma

Life

Support

7 th Edition

ATLS PROVIDES A COMMON LANGUAGE

PROVIDES A COMMON LANGUAGE

THE BEGINNING DR. JAMES STYNER’S PLANE CRASHED IN RURAL NEBRASKA IN FEBRUARU 1976 3 OF 4 SUSTAINED SERIOUS HEAD INURIES

DR. JAMES STYNER’S PLANE CRASHED IN RURAL NEBRASKA IN FEBRUARU 1976

3 OF 4 SUSTAINED SERIOUS HEAD INURIES

DR. JAMES STYNER. MD,FACS - 1977 BETTER CARE IN THE FIELD WITH LIMITED RESOURCES SOMETHING WRONG WITH THE SYSTEM AND THE SYSTEM HAS TO BE CHANGED

BETTER CARE IN THE FIELD WITH LIMITED RESOURCES

SOMETHING WRONG WITH THE SYSTEM AND THE SYSTEM HAS TO BE CHANGED

TRIMODAL DEATH DISTRIBUTION IMMEDIATE DEATH EARLY DEATH FIRST 1-4 HOURS LATE DEATH 2 ND – 5 TH WEEK

IMMEDIATE DEATH

EARLY DEATH

FIRST 1-4 HOURS

LATE DEATH

2 ND – 5 TH WEEK

ATLS Concept ABCDE -approach to evaluation/treatment Treat greatest threat to life first Definite diagnosis not immediately important Time is of the essence Do no further harm

ABCDE -approach to evaluation/treatment

Treat greatest threat to life first

Definite diagnosis not immediately important

Time is of the essence

Do no further harm

ATLS Concept A Airway with C-spine protection B Breathing ; Ventilation/Oxygenation C Circulation ; Stop bleeding D Disability ; Neurological status E Expose / Environment / Body temperature

A Airway with C-spine protection

B Breathing ; Ventilation/Oxygenation

C Circulation ; Stop bleeding

D Disability ; Neurological status

E Expose / Environment / Body temperature

Committee on Trauma Presents Initial Assessment and Management

Initial Assessment and Management

Initial Assessment and Management Principles Primary Survey Secondary Survey Priority Management Resuscitate and Monitor procedures Patient’s History / Biomechanics of Injury Anticipate Pitfalls

Principles

Primary Survey

Secondary Survey

Priority Management

Resuscitate and Monitor procedures

Patient’s History / Biomechanics of Injury

Anticipate Pitfalls

Pitfalls What is a quick , simple way to assess the patient in 10 seconds ? How can I minimized the missed injuries ? Which patients do I transfer to a Higher levels of care ? When should the transfer occur ?

What is a quick , simple way to assess the patient in 10 seconds ?

How can I minimized the missed injuries ?

Which patients do I transfer to a Higher levels of care ?

When should the transfer occur ?

Quick / Simple to assess the patient Identify yourself Ask the patient his / her name Ask the patient what happened

Identify yourself

Ask the patient his / her name

Ask the patient what happened

GCS Glasgow Coma Score Mild Brain Injury 14 – 15 Moderate 9 – 13 Severe 3 - 8 AVPU *#* Alert Verbal response to voice Painful Unresponse

Glasgow Coma Score

Mild Brain Injury 14 – 15

Moderate 9 – 13

Severe 3 - 8

AVPU *#* Alert

Verbal response to voice

Painful

Unresponse

Concept of Initial Assessment Primary Survey A Airway with C-spine protection B Breathing ; Ventilation/Oxygenation C Circulation ; Stop bleeding D Disability ; Neurological status E Expose / Environment / Body temperature

Primary Survey

A Airway with C-spine protection

B Breathing ; Ventilation/Oxygenation

C Circulation ; Stop bleeding

D Disability ; Neurological status

E Expose / Environment / Body temperature

Concept of Initial Assessment ABCDE Patent Airway Suffidient Air Reserve to permit speech Clear Sensorium

ABCDE

Patent Airway

Suffidient Air Reserve to

permit speech

Clear Sensorium

ADJUNCT to Primary Survey FAST Focus Assessment Sonography in Trauma

FAST

Focus

Assessment

Sonography in

Trauma

THORACIC TRAUMA BECK’S TRIAD Elevate venous pressure Decline in arterial pressure Muffling heart sound CARDIAC INJURY

BECK’S TRIAD

Elevate venous pressure

Decline in arterial pressure

Muffling heart sound

CARDIAC INJURY

TENSION PNEUMOTHORAX DYSPNEA ELEVATE VENOUS PRESSURE DECLINE IN ARTERIAL PRESSURE TRACHEA SHIFT TO OPPOSIT

DYSPNEA

ELEVATE VENOUS PRESSURE

DECLINE IN ARTERIAL PRESSURE

TRACHEA SHIFT TO OPPOSIT

? ? ?

? ? ?

SECONDARY SURVEY The Complete History and Physical Examination Starts after ….. Primary Survey is complete ABCDEs are Reassessed Vital functions are returning to Normal

The Complete History and

Physical Examination

Starts after …..

Primary Survey is complete

ABCDEs are Reassessed

Vital functions are returning

to Normal

REEVALUATION Aims ; Minimized Missed injuries High Index of Suspecious Frequent Reevaluation and Monitoring

Aims ; Minimized Missed injuries

High Index of Suspecious

Frequent Reevaluation and

Monitoring

ADJUNCT

DEFINITIVE CARE Which patient do I transfer to another Hospital for Definite Care ? Multisystem or Complex Injuries Comorbidity or AGE Extremes

Which patient do I transfer to

another Hospital for Definite

Care ?

Multisystem or Complex Injuries

Comorbidity or AGE Extremes

ST0P BLEEDING

RESPONSE TO RESUSCITATION ?

THANK YOU

THANK YOU