ATLS guidelines plays a critical role in managing triage patients, this seminar is a summary about the same

1. ATLS GUIDELINES
MODERATED BY: DR. SHIVAM AGGARWAL
PRESENTED BY: GAURI BARGOTI

2. WHAT IS ATLS?
• Advance trauma life support
Assessment
of patient’s
condition
Stabilization
of patient
according to
priority
Determine the
capability of
the operator
and resources
available
Ensure that
optimal level
of care is
provided

3. NEED OF ATLS
Distribution of global injury mortality by
cause

4. EVOLUTION OF ATLS
Discovered in 1976 following plane crash
Doctors in Nebraska; Lincoln medical center with surgeon ACS recognized its importance
Course was based on the fact that appropriate and timely care could improve the outcome of injured patients.
ATLS course was first conducted in 1980 under ACS

5. TRIAGE

6. PRIMARY SURVEY ATLS
Which now changed to CABDE by AHA

7. AIRWAY
Rapid assessment should be made to check for any obstruction or
laryngeal/tracheal obstruction; suction to clear the obstruction
Presence of non purposeful motor movement require definitive
airway management
If patient is communicating
verbally, less chance of airway
obstruction
Patient with GCS score of 8
require definitive airway
Cervical spine motion
restriction technique can be
used
Try for jaw- thrust or chin-lift
maneuver if no response
place oropharyngeal tube

9. BREATHING AND VENTILATION
• Ventilation requires adequate functioning of lungs, chest wall
and diaphragm
• To adequately check the jugular venous distention, position of
the trachea and chest wall excursion, expose the patient’s neck
and chest.

10. Visual examination Auscultation
Percussion of thorax
Any injuries that may impair
ventilation
Breathing and
ventilation assesment

11. MANAGEMENT OF BREATHING AND
VENTILATION
Supplement oxygen
Mask- reservoir if patent is
not intubated
Pulse oximeter to monitor
the breathing and
ventilation

12. CIRCULATION WITH HEMORRHAGE
CONTROL
• Hemorrhage is the predominant cause of preventable deaths
after injury.
• Identifying, quickly controlling hemorrhage, and initiating
resuscitation are therefore crucial steps in assessing and
managing such patients.
• The elements of clinical observation that yield important
information within seconds are level of consciousness, skin
perfusion, and pulse

13. ELEMENTS OF CLINICAL OBSERVATION
Level of
consciousness
Skin Perfusion Pulse

14. BLEEDING
External
bleeding Internal
bleeding

15. DISABILITY( NEUROLOGICAL EXAMINATION)

16. EXPOSURE AND ENVIRONMENTAL CONTROL
• During the primary survey, completely undress the patient,
usually by cutting off his or her garments to facilitate a
thorough examination and assessment.
• Warm intravenous fluids before infusing them, and maintain a
warm environment.
• When fluid warmers are not available, a microwave can be used
to warm crystalloid fluids, but it should never be used to warm
blood products

17. ADJUNCT TO PRIMARY SURVEY

18. THE NEED TO TRANSFER
• It is important not to delay transfer to perform an in-depth
diagnostic evaluation. Only undertake testing that enhances the
ability to resuscitate, stabilize, and ensure the patient’s safe
transfer.

19. SECONDARY SURVEY
• 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.
• The secondary survey is a head-to-toe evaluation of the trauma
patient—that is, a complete history and physical examination,
including reassessment of all vital signs.

20. HISTORY

21. MECHANISM AND TYPE ON INJURY

22. SECONDARY SURVEY

23. REEVALUATION
• Trauma patients must be reevaluated constantly to ensure that
new findings are not overlooked and to discover any
deterioration in previously noted findings.
• For adult patients, maintenance of urinary output at 0.5
mL/kg/h is desirable.
• The relief of severe pain is an important part of treatment for
trauma patients

24. 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.

25. RECORDS AND LEGAL CONSIDERATION
Records
Forensic
Evidence
Consent for
treatment

26. TEAM WORK IN MANAGEMENT OF TRAUMA
PATIENT
Assess the patient including
airway
Undressing and exposing the
patient
Applying the monitoring
appliance
Obtaining IV access and drawing
blood
Serving as scribe and recorder

27. CONCLUSION
Primary and secondary survey apply to all trauma patients
Medical history and mechanism of injury should be identified
Reassessment should be thoroughly assessed
Need of transfer to higher center should be assessed

28. REFERENCES
• ATLS Advanced Trauma Life Support- 10th edition