ATLS

1. GENERAL APPROACH TO A TRAUMA
PATIENT
DR. CH RAKESH SINGHA
2ND YEAR PGT , DEPT. OF ORTHOPAEDICS
SILCHAR MEDICAL COLLEGE & HOSPITAL

2. TRAUMA
• Trauma is defined as physiological
wound or injury caused by an
external source e.g.; road traffic
accidents, falls, industrial accidents,
burns etc.
• Trauma is the leading cause of death in
young population.

3. Concepts of ATLS
• Treat the greatest threat of life first.
• The lack of a definitive diagnosis should never interfere the application of an
indicated treatment.
• A detailed history is not essential to begin the evaluation.
• ABCDE approach

4. Basic of Trauma Assessment
• Preparation – Team assembly, Equipment check.
• Triage – Sort patient by level of acuity.
• Primary Survey – Designed to identify injuries that are immediately life threatening
& to treat them as they are identified.
• Resuscitation – Rapid procedure & treatment to treat injuries found in primary
survey before completing the secondary survey.
• Secondary survey- Full history & physical examination to evaluate the other
traumatic injuries.
• Monitoring & evaluation secondary adjuncts.
• Transfer to definitive care – ICU, ward, operating theatre or higher facility.

5. PRIMARY SURVEY
• Patients are assessed & treatment priorities
established based on their injuries, vital signs &
injury mechanisms.
A Airway & c-spine protection
B Breathing
C Circulation
D Disability (neurological status)
E Exposure/environmental control

6. A - Airway
• Airway should be assessed for patency
- is the patient able to communicate
verbally?
-inspect for any foreign bodies.
• Assume cervical spine injury in patients with
multisystem trauma.
• Apply cervical hard collar in suspected cervical
injury.

7. AIRWAY INTERVENTIONS:
• Supplemental oxygen
• Suction
• Chin lift or jaw thrust
• Definitive airways like intubation

8. B - Breathing
• General principle – Adequate gas exchange is
required to maximize patient oxygenation& CO2
elimination.
• Airway patency alone dose not ensure adequate
ventilation.
• Inspect, palpate & auscultate
- for crepitus, flail chest, sucking chest
wound etc.
• Chest Xray to evaluate lung fields.

9. BREATHING INTERVENTION:
• Ventilate with 100% oxygen.
• Needle decompression if tension
pneumothorax suspected.
• Chest tubes for pneumothorax.
• Occlusive dressing to sucking chest wound

10. C - Circulation
• Haemorrhagic shock should be
assumed in any trauma patient.
• Rapid assessment of hemodynamic
status-
- Level of consciousness
- Skin colour
- Distal pulse
- Blood pressure

11. CIRCULATION INTERVENTION:
• Establish IV access.
• Cardiac monitor.
• Apply pressure to sites of external
haemorrhage.
• Volume resuscitation by blood
transfusion.

12. D - Disability
• Abbreviated neurological examination:
- Level of consciousness
- Pupil size & reactivity
- Motor function
- GCS (Glasgow Coma Scale).

13. DISABILITY INTERVENTION:
• Spinal cord injury
- High dose of steroids.
• ICP monitor (intracranial pressure).
• Elevated ICP
- Head of bed elevated
- Mannitol
- Hyperventilation
- Emergent decompression.

14. E - Exposure
• Complete removal of clothing of the
patient.
• Logroll to inspect back.
• Rectal temperature.
• Warm blanket / external warming
devices to prevent hypothermia

15. SECONDARY SURVEY
AMPLE history:
- Allergies
- Medication
- Past medical history
- Last meal
- Events
• Physical examination from head to
toe, including rectal examination

16. • Frequent reassessment of vitals.
• Diagnostic studies after stabilisation
- X-rays
- Laboratory work
- FAST
- CT examination etc.

17. We should look for
• Battle sign
• Raccoon’s eye
• Seatbelt sign

18. • Cullen’s sign
• Grey-Turner’s sign

19. Adjuncts to Secondary Survey
• Radiological investigation:
- Emergency films
- Focussed Abdominal Sonography in
Trauma (FAST)
• Foley catheterisation
• Pain control by analgesic
• Tetanus injection
• Antibiotics for open fractures

20. Abdominal Injury
• Common source of traumatic injury.
• High suspicion with tachycardia,
hypotension & abdominal
tenderness.
• FAST examination can be early
screening tool.

21. • Look for
- Distension
- Tenderness
- Seatbelt marks
- Penetrating trauma
- Retroperitoneal ecchymosis.
• Be suspicious of free fluid without evidence of
solid organ injury.

22. FAST
• Focussed Abdominal Sonography in
Trauma
• To find free fluid (blood) around heart
or abdominal organ after trauma.
• 4 view’s:
-Cardiac
-Right upper quadrant
-Left upper quadrant
-Pelvic

23. Splenic Injury
• Most commonly injured organ in
blunt trauma.
• Often associated with other injuries.
• It can be managed non-operatively

24. Liver Injury
• Second most common solid organ
injury.
• It can be difficult to manage surgically.
• Often associated with other
abdominal injuries.

25. Hollow Viscous Injury
• Injury can involve stomach, bowel or
mesentery.
• Symptoms are a result from combination of
blood loss & peritoneal contamination.
• Small bowel & colon injuries result most
often from penetrating trauma.

26. DEFINITIVE CARE
• Secondary survey followed by radiographic evaluation.
• Consultation with
-Neurosurgery
-Orthopaedic
-Vascular surgery
• Transfer to Definitive Care
-Operating room
-ICU
-Higher level facility.

27. CONCLUSION
• Assessment of the trauma patients in a standard algorithm designed to ensure
life threatening injuries do not get missed.
• Primary Survey + Resuscitation
- Airway
- Breathing
- Circulation
- Disability
- Exposure
• Secondary Survey
• Definitive Care

28. THANK YOU