Initial assessment of a trauma patient involves a primary survey using the ABCDE approach to identify life-threatening injuries. For the described trauma scenario, the initial steps would be:
1) Assess the airway and give high-flow oxygen. The patient's ability to speak suggests his airway is not compromised.
2) Evaluate breathing and circulation. His breathing is compromised as shown by the low respiratory rate and high pulse.
3) Expose the patient fully to identify injuries and monitor for hypothermia. The abrasion on his chest indicates potential internal injuries.
4) Begin resuscitation with IV fluids and monitor vitals closely given his unstable condition from potential internal bleeding and shock.
5)
4. HISTORY
▪ When I can provide better care in the field
with limited resources than what my children
and I received at the primary care facility,
there is something wrong with the system,
and the system has to be changed
So ATLS is a system
5. TRAUMA SCENARIO
▪ MALE PATIENT 34YEARS OLD COMINGTO ER
AFTER ROAD TRAFFIC ACCIDENT:
HOARSNESSOFVOICE
BP 90/50
RR 30
PULSE 130
ABRASION ON LT CHESY
WHAT DOYOU DO?
6.
7.
8. Initial assessment of trauma patient
Preparation
Triage
Primary survey (ABCDEs)
Adjuncts to the primary survey and resuscitation
Consideration of the need for patient transfer
Secondary survey (head-to-toe evaluation and patient history)
Adjuncts to the secondary survey
monitoring and reevaluation
Definitive care
9. Critical aspects of hospital preparation
A resuscitation
area is available for
trauma patients.
functioning
airway
equipment.
Warmed
intravenous
crystalloid
solutions.
A protocol to
summon additional
medical assistance
is in place,.
Transfer
12. ➢ suggests that there is no major airway compromise
(i.e., ability to speak clearly)
➢ breathing is not severely compromised (i.e., ability
to generate air movement to permit speech)
➢ the level of consciousness is not markedly
decreased (i.e., alert enough to describe what
happened)
MY NAME IS
MOHAMED
MEAN:
Airway opened, clear
Breathing adequate
Conscious
13. Breathing / ventilation / oxygenation
Circulation with hemorrhage control
Disability
Expose / Environment / body temp.
Primary Survey
Airway with c-spine protection
14. Airway
GIVE HIGH FLOW
O2TO ALL
TRAUMA PATIENT
IF EIGHT
INTUBATE
A
opened clear maintained
Chin lift Jaw thrust
Oropharyngeal airway nasopharyngeal suction
19. SIZING
•OPAs too large or too small may obstruct the airway.
•NPAs sized incorrectly may enter the esophagus.
•Always check for spontaneous respirations after insertion of either device.
26. Sequence of air way maneuvers
Chin lift&jaw trust
Finger sweep& suction
Airway adjuncts
Oropharyngeal/ orotrachial tube
LMA
BMV
Needle Cricothyroidotomy
Surgical cricothyroidotomy
Tracheostomy
27.
28. C- SPINE PROTECTION
▪ INLINE
IMMBOLIZATION
▪ NECK COLAR
▪ HEAD LOCK
▪ HARD BOARD
▪ BELLETS
29.
30. pearls
If the patient unconscious don’t remove
neck coller and back board till proved
radiographically that whole spine is intact
31. BREATHINGB
▪ Airway patency alone does not ensure adequate
ventilation. Adequate gas exchange is required to
maximize oxygenation and carbon dioxide
elimination
▪ Every injured patient should receive supplemental
oxygen. If the patient is not intubated, oxygen
should be delivered by a mask-reservoir device to
achieve optimal oxygenation
32.
33. Our task is to identify
▪ Five life threatening thoracic conditions:
▪ Tension Pneumothorax
▪ Massive Pneumothorax
▪ Open pneumothorax
▪ Flail segment
▪ Cardiac tamponade
34. Abnormal Findings
Un equality of chest movement
Hyper resonance on percussion
Decrease air entry
Tachypenic
Pneumo thorax
chest tube
35.
36. pearls
A simple pneumothorax can be converted to a tension
pneumothorax when a patient is intubated and
positive pressure ventilation is provided before
decompressing the pneumothorax with a chest tube.
37. Abnormal Findings
Un equality of chest movement
Hyper resonance on percussion
Decrease air entry ,tachypenic
Deviated trachea ,congested neck vein
Tension Pneumo thorax
Needle decompression & chest tube
38.
39.
40. Abnormal Findings
Un equality of chest movement
Dullness on percussion
Decrease air entry
Tachypenic
heamothorax
chest tube
43. Abnormal Findings
Un equality of chest movement
Dullness on percussion
Normal air entry ,muffled heart sounds
Tachypenic, congested neck veins
Cardiac tamponade
pericardiocentesis
44. ▪ (almost always seen with a penetrating
wound)
▪ Beck’s triad:
Hypotension
distended neck veins
Muffled heart sounds
Pulsus paradoxus
59. circulation
Check :
▪ Bp
▪ Pulse
▪ Capillary refill
▪ Search for External bleeding
▪ Search for Internal bleeding
▪ 2 wide bore cannula
▪ Blood sample for ABO compatibility,
creatinine,urea,ABG
▪ GIVE 2 liters warmed crystalloid
C
60. pearls
European and American military studies demonstrate
improved survival when tranexamic acid is administered
within 3 hours of injury.When bolused in the field follow
up infusion is given over 8 hours in the hospital
61. ▪ Hemorrhage is the predominant cause of
preventable deaths after injury.
▪ Tachycardia in a cold patient indicates shock
▪ Causes of shock following injury:
▪ Hypovolemic
▪ Cardiogenic
▪ Neurogenic
▪ Septic
62.
63. Aggressive and continued volume resuscitation is not a substitute for definitive
control of hemorrhage.
Shock associated with injury is most often hypovolemic in origin.
In such cases, initiate IV fluid therapy with crystalloids.All IV solutions should be warmed
either by storage in a warm environment (i.e., 37°C to 40°C, or 98.6°F to 104°F) or
administered through fluid warming devices.
A bolus of 1 L of an isotonic solution may be required to achieve
an appropriate response in an adult patient.
If a patient is unresponsive to initial crystalloid therapy, he or she
should receive a blood transfusion
pearls
64. ▪ Adults- 2 lit of Ringer lact solu as initial fluid
challenge
▪ Children- 20mg/kg of body wt
Response to initial fluid challenge:
▪ Immediate & sustained return of vital signs.
▪ Transient response with later deterioration
▪ No improvement.
65. ▪ Urine output –
▪ 0.5ml/kg/hr in adults
▪ 1ml/kg/hr in children
▪ 2ml/kg/hr in infants
66. Skills in C
▪ Direct compression in
site of external bleeding
▪ Splint of long bone
fractures
▪ Pelvic binder
▪ FAST( E- FAST)
▪ X-ray chest , pelvis
▪ Consult surgeon
67. Blood in the floor and 4 more
Chest
Abdomen
Pelvis
femur
68.
69.
70. Disability
▪ Determine Glasgow coma
scale
▪ Check pupil for (equality-
reactivity)
▪ Signs of lateralization
▪ Neurological assessment
D
A.-Alert
V.-Responds to
Voice
P.-Responds to
Pain
U.-Unresponsive
Pupil.-Size and
reaction
75. Hypothermia can be present when
the patient arrives, or it may develop
quickly in the ED if the patient is
uncovered and undergoes rapid
administration of room-temperature
fluids or refrigerated blood.
Because hypothermia is a potentially
lethal complication in injured
patients, tak aggressive measures to
prevent the loss of body heat and
restore body temperature to normal
pearls
79. Physiologic parameters for adequcy of resuscitation
such as pulse rate, blood
pressure, pulse pressure,
ventilatory rate, ABG levels,
body temperature, and
urinary output are assessable
measures that reflect the
adequacy of resuscitation
80.
81. CONSIDER EARLY PATIENT TRANSFER
➢Do not delay transfer for
diagnostic tests
➢Use time before transfer for
resuscitation
82.
83. The secondary survey does not
begin until the primary survey
(ABCDE) is completed, resuscitative
efforts are under way, and
improvement of the patient’s vital
functions has been demonstrated
Secondary Survey
94. ▪ The finding of active arterial bleeding, an
expanding hematoma, arterial bruit, or
airway compromise usually requires
operative evaluation.
▪ Unexplained or isolated paralysis of an upper
extremity should raise the suspicion of a
cervical nerve root injury and should be
accurately documented.
102. PELVIS
➢ Pelvic fractures can be suspected by the
identification
▪ of ecchymosis over the iliac wings, pubis, labia, or
▪ scrotum.
➢ Clinical assessment of stability
▪ X-ray
▪ stabilize pelvis with fixator/clamps –pelvic
binder
▪ urethral injury is suspected when
high up prostate in PR
▪ blood in meatus
▪ perineal haematoma
104. Perineum, Rectum, andVagina
▪ The perineum should be examined for contusions,
hematomas, lacerations, and urethral bleeding.
▪ A rectal examination may be performed to assess for
the presence of blood within the bowel lumen,
integrity of the rectal wall, and quality of sphincter
tone.
▪ Vaginal examination should be performed in patients
who are at risk of vaginal injury. The clinician should
assess for the presence of blood in the vaginal vault
and vaginal lacerations. In addition, pregnancy tests
should be performed on all females of childbearing
age.
109. diagnostic tests may be performed during the
secondary survey to identify specific
x-ray examinations of the spine and extremities
CT scans of the head, chest, abdomen, and spine
contrast urography and angiography
transesophageal ultrasound;
bronchoscopy
esophagoscopy; and other diagnostic procedures
ADJUCANTS
110. Reevaluation
Trauma patients must be reevaluated constantly to ensure that new
findings are not overlooked and to discover any deterioration in
previously noted findings.
Continuous monitoring of vital signs, oxygen saturation, and urinary
output is essential. For adult patients, maintenance of urinary
output at 0.5 mL/kg/h is desirable. In pediatric patients who are
older than 1 year, an output of 1 mL/kg/h is typically adequate.
PeriodicABG analyses and end-tidalCO2 monitoring are useful in
some patients.
111. Definitive care
▪ Whenever the patient’s treatment needs exceed
the capability of the receiving institution, transfer
is considered.
▪ This decision requires a detailed assessment of the
patient’s injuries and knowledge of the capabilities
of the institution, including equipment, resources,
and personnel.
112. Forensic Evidence
▪ If criminal activity is suspected in conjunction with
a patient’s injury, the personnel caring for the
patient must preserve the evidence.
▪ All items, such as clothing and bullets, are saved
for law enforcement personnel.
▪ Laborator determinations of blood alcohol
concentrations and other drugs may be
particularly pertinent and have substantial legal
implications.
115. Work up of any case of trauma:
LAB
▪ 1-cbc
▪ 2-blood chemistry (renal-liver-cardiac-electrolyte)
▪ 3-coagulation profile
▪ 4- Blood group, cross matching if multiple trauma
patient
▪ IMAGING:
▪ 1-x ray cervical vertebra
▪ 2-x ray chest
▪ 3-x ray pelvis
▪ 4-Abd U/S ( FAST)
▪
116. INDICATION OF CT INTRAUMA PATIENT:
▪
▪ CT HEAD FOR HEAD TRAUMA IF:
▪ 1-old age more than 65
▪ 2- Patient on warfarin
▪ 3- Loss of conscious level after trauma
▪ 4-GCS less than 15 for 2 hours
▪ 5-suspected depressed skull fracture
▪ 6-signs of basal skull fracture
▪ 7-pediatric with signs of increase ICT
▪ 8-convulsion after trauma
▪ 9-dangerous trauma
▪ 10-polytraumatized patient
117. ▪ CT CHEST IF:
▪ 1-chest pain after trauma
▪ 2-chest contusion
▪ 3-decrease air entry
▪ 4-any change in o2 sat
▪ 5-suspecting rib fracture
▪ 6-polytraumatized patient
118. CT abdomen must be with contrast if:
▪ 1- positive FAST scan
▪ 2- Cullen sign
▪ 3- turner sign
▪ 4- abdominal Contusion
▪ 5- unexplained shock
▪ 6- Part from pan scan of multiple trauma
patient
119. TRAUMA SCENARIO
▪ MALE PATIENT 34YEARS OLD COMINGTO ER
AFTER ROAD TRAFFIC ACCIDENT:
HOARSNESSOFVOICE
BP 90/50
RR 30
PULSE 130
ABRASION ON LT CHESY
WHATYOU DO?
