4. • “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”
5. • Today the ATLS method is accepted as a
standard for the first hour of trauma care
wherever the patient is being treated – be it
an isolated rural area or the state of the art
trauma centre.
8. Early management of trauma
• Components of early management
–Primary Survey & Resuscitation
–Secondary Survey
–Definitive management
9. Mechanisms predictive of serious injury
• Fall from >20 feet
• Pedestrian or cyclist hit by the car
• Death of other occupant in the same vehicle
• Ejection from the vehicle or bike
• Vehicular roll over
• Penetrating injury to head or torso
• All shotgun injuries
10. Primary Survey & Resuscitation
• A – Airway and cervical spine control
• B - Breathing
• C – Circulation and haemorrhage control
• D – Dysfunction of the CNS
• E - Exposure
– (treat as soon as you diagnose)
11. Primary survey
• It is essential that problems
are anticipated rather than
reacted to once they develop
12. AIRWAY
• Rapid assessment
– A patient who answers questions sensibly must
have a clear airway, reasonable breathing, and
reasonable cerebral perfusion.
• Noisy airway is a compromised airway
18. Airway compromise
• When there is no gag reflex the only safe
way of maintaining the airway is
–Cuffed endotracheal intubation
• Every patient with multiple injuries should
receive 100% oxygen.
19. Breathing
• Ensure that both sides are being ventilated
– Equal movement on both sides
– Auscultation both lungs
• Auscultation
– Both axillae
– Epigastrium
• Respiratory rate
20. Breathing -problems
• Not breathing
– To proceed to CPR
• Breathing with difficulty
– Dyspnoea
– Tachypnoea
22. Open chest wound
• Why it is dangerous?
• What is the immediate management?
– Occlusive dressing which is taped on three
sides only
– Followed by ICD and definitive closure
23. Tension pneumothorax
• Do not send the patient for X-ray
• Act on clinical suspicion
• How to differentiate simple from tension
pneumothorax?
24. Tension pneumothorax
• Immediate management
– Needle / Cannula decompression
– Midclavicular line in the 2nd intercostal space
• Followed by ICD
• What happens when you put a needle in the
absence of pneumothorax?
25. Breathing
• Respiratory rate and effort are very
sensitive indicators of underlying lung
pathology. They should therefore be
monitored and recorded at frequent
intervals
27. Overt bleeding
• How to stop?
– Local pressure (pressure dressing) over the site
of bleeding
– Tourniquets are better avoided
– Don’t plunge artery forceps in a pool of blood
blindly
28. Sites of bleeding
• Blood on the floor and four more
–Chest
–Abdomen and retroperitoneum
–Pelvis
–Long bone fractures
29. Hypovolaemia
• Blood loss Class Symptoms
• <750 ml I None
• 750 –1500 II Cardiovascular,catecholamine
release, thirst, weakness
• 1500-2000 III Systolic BP falls
• >2000 IV Systolic BP unreadable
36. Penetrating injuries
• Below the 5th rib &
• Above the gluteal fold
–Abdominal organs can be involved
• Do not remove the penetrating
agent
37. Haemoperitoneum
• Abdomen can hold 1500 – 2000 ml of fluid
without any evidence of distension
• When distension occurs in
haemoperitoneum, the patient will be in
profound shock
40. • CNS dysfunction ( drowsiness /
coma ) may be due to brain
injury or hypovolaemia
41. A case history
• 25 yr old male was stabbed in between the
shoulder blades. He is hypotensive. What
could be the cause for hypotension?
– Massive haemopneumothorax
– Haemoperitoneum
– Tension pneumothorax
– Cardiac tamponade
– Neurogenic shock
42. CNS Dysfunction
• Rapid assessment of Brain & Spinal Cord
– Examine the pupils &
• Ask the patient to
– Put the tongue out
– Move the toes
– Squeeze your fingers
• Later do GCS
45. Secondary survey
• Head to foot
• Orderly, systematic and complete
examination
• Actively rule out fractures of cervical
spine,ribs and pelvis
• Explore every orifice
