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By
     ANU SANDHYA
      PG WARD 3
OBJECTIVE
 Identify the correct sequence of priorities
  for assessment of a multiply injured pt.
 Apply the principles outlined in primary
  and secondary evaluation surveys of
  ATLS.
 Apply guidelines and techniques in the
  initial resusitative and definitive care
  phases of treatment.
ATLS
   PREPARATION AND TRIAGE.
   PRIMARY SURVEY
   RESUSITATION
   ADUNCTS TO PRIMARY SURVEY
   CONSIDER NEED FOR PATIENT TRANSFER
   SECONDARY SURVEY
   ADJUCTS TO SECONDARY SURVEY
   CONTINUED POSTRESUSITATION AND
    REEVALUATION OF THE PATIENT.
   DEFINITIVE CARE.
PREPARATION
•PREHOSPITAL PHASE

•HOSPITAL PHASE


 PREHOSPITAL PHASE:
Coordination with the prehospital agency and personel
can greatly fasten the treatment in the field. They inform
the receiving hospital which mobilizes the trauma team to
ED.

 HOSPITAL PHASE
Advance planning for the trauma pt. beneficial. It saves
time.
TRIAGE

The process of categorizing victims or mass
  casualties based on their need for
  treatment and the resources available.

ITS MAIN GOALS ARE.
 Prevent avoidable deaths.
 Ensure proper initial treatment with a
  minimal time frame.
 Avoid misusing assests on hopeless cases.
Multiple casualties
   No. of patients and the severity of their
    injuries do not exceed the ability of the
    facility to provide care.


 MASS      CASUALTIES
   The no. of patients and the severity of
    their injuries exceed the ability of the
    facility to provide care.
PRIMARY SURVEY
What is the quick ,simple way to assess
  the trauma patient in 10 seconds?
A comlete sentence spoken by pt. tells us:

1.   Airway is patent.
2.   Breathing intact.
3.   Good cerebral circulation.
AIRWAY MAINTAINENCE
WITH C-SPINE PROTECTION
    Assess for obstruction, foreign bodies, facial
    fractures, bleeding causing airway
    compromise… begin measures to establish
    airway.

PITFALLS

   Recognize impending obstruction early before
    intubation becomes too difficult.
   If unable to control airway surgical airway is
    must.
   Unknown tracheal or laryngeal disruption.
Simple maneuvers
 Chin lift
 Jaw thrust
 Suction
 Oropharyngeal and nasopharyngeal
  airway
 Laryngeal mask airway
 Laryngeal tube airway
 Gum elastic bougie.
 Definitive airway
 Surgical airway.
INDICATIONS OF DEFINITIVE
AIRWAY
 UNCONCIOUS
 GCS <8
 RISK OF ASPIRATION
 RISK OF IMPENDING OBSTRUCTION.
BREATHING
Inspection
Auscultation
Palpation
Percussion

   Identify and manage life threatening problems
    first
•   Tension pneumothorax
•   Cardiac temponade
•   Massive hemothorax
•   Open pneumothorax
•   Flail chest with pulmonary contusion
maneuvers
 Bag and mask ventilation
 Needle thoracocentesis
 Pericardiocentesis
 Chest tube intubation
CIRCULATION AND
HEMORRHAGE CONTROL
Assess for:
 Shock
 External bleeding
 Occult bleeding
 Estimate the blood loss on initial
  presentation of patient and the signs
  and symptoms
 Replace fluid accordingly, 2 litres of
  warm crystalloid solution.
DISABILITY
 GCS
 PUpillary reaction and size


                EXPOSURE
 Undress the patient completely but
  prevent hypothermia.
 Logrolling and looking for back of the pt.
  is very important.
ADJUCTS TO PRIMARY
SURVEY AND
RESUSSITATION
 ECG
   PULSE OXIMETRY
   Xray chest AP view
   Xray pelvis AP view
   URINARY CATHETER
   GASTRIC CATHETER
   BLOOD PRESSURE
   ABGS
   FAST
   DPL
NEED TO TRANSFER or
REFER?
SECONDARY SURVEY
Secondary survey does not begin until the primary
    survey is completed,resuscitative efforts are
    established and patient is demonstrating
    normalization of vital functions.
It includes:
 Head to toe evaluation
 AMPLE history
    •   Allergy
    •   Medications currently taking
    •   Past illness
    •   Last meal
    •   Event/environment related to injury.
   physical examination
   Reassessment of all vital organs.
Adjucts to secondary survey
 CT SCAN
 CONTRAST STUDIES
 EXTREMITY XRAY
 ENDOSCOPY
 ULTRASONOGRAPHY
POSTRESUSITATION
MONITORING AND
REEVALUATION
 Reevaluaion for new finding or
  overlooked.
 Continous monitoring of vital signs.
 Effective analgesia.
DEFINATIVE CARE
 AFTER identifying the patients injury.
 Managing life threatening problems
 Obtaining special studies.
 If the patients injuries exceed the
  capabilities of the institution.
Take home message
1.   ABCDE APPROACH.
2.   TREAT GREATEST THREAT TO LIFE.
3.   DEFINITIVE DIAGNOSIS IS NOT
     IMMEDIATELY IMPORTANT.
4.   TIME IS THE ESSENCE.
5.   DO NO FURTHER HARM THE
     PATIENT
CASE
 A 20 year old woman is found trapped in
 her automobile. Several hours are
 required to extricate her because her leg
 was trapped and twisted beneath the
 dash board. In the hospital she is
 hemodynamically unstable with pulse of
 120bpm, r/r 14, bp 80mmhg systolic
 only, she has a large wound in her left
 leg which is bleeding profusely..
Advanced trauma and life support (atls)

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Advanced trauma and life support (atls)

  • 1. By ANU SANDHYA PG WARD 3
  • 2. OBJECTIVE  Identify the correct sequence of priorities for assessment of a multiply injured pt.  Apply the principles outlined in primary and secondary evaluation surveys of ATLS.  Apply guidelines and techniques in the initial resusitative and definitive care phases of treatment.
  • 3. ATLS  PREPARATION AND TRIAGE.  PRIMARY SURVEY  RESUSITATION  ADUNCTS TO PRIMARY SURVEY  CONSIDER NEED FOR PATIENT TRANSFER  SECONDARY SURVEY  ADJUCTS TO SECONDARY SURVEY  CONTINUED POSTRESUSITATION AND REEVALUATION OF THE PATIENT.  DEFINITIVE CARE.
  • 4. PREPARATION •PREHOSPITAL PHASE •HOSPITAL PHASE  PREHOSPITAL PHASE: Coordination with the prehospital agency and personel can greatly fasten the treatment in the field. They inform the receiving hospital which mobilizes the trauma team to ED.  HOSPITAL PHASE Advance planning for the trauma pt. beneficial. It saves time.
  • 5. TRIAGE The process of categorizing victims or mass casualties based on their need for treatment and the resources available. ITS MAIN GOALS ARE.  Prevent avoidable deaths.  Ensure proper initial treatment with a minimal time frame.  Avoid misusing assests on hopeless cases.
  • 6. Multiple casualties  No. of patients and the severity of their injuries do not exceed the ability of the facility to provide care.  MASS CASUALTIES  The no. of patients and the severity of their injuries exceed the ability of the facility to provide care.
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  • 8. PRIMARY SURVEY What is the quick ,simple way to assess the trauma patient in 10 seconds? A comlete sentence spoken by pt. tells us: 1. Airway is patent. 2. Breathing intact. 3. Good cerebral circulation.
  • 9. AIRWAY MAINTAINENCE WITH C-SPINE PROTECTION Assess for obstruction, foreign bodies, facial fractures, bleeding causing airway compromise… begin measures to establish airway. PITFALLS  Recognize impending obstruction early before intubation becomes too difficult.  If unable to control airway surgical airway is must.  Unknown tracheal or laryngeal disruption.
  • 10. Simple maneuvers  Chin lift  Jaw thrust  Suction  Oropharyngeal and nasopharyngeal airway  Laryngeal mask airway  Laryngeal tube airway  Gum elastic bougie.  Definitive airway  Surgical airway.
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  • 18. INDICATIONS OF DEFINITIVE AIRWAY  UNCONCIOUS  GCS <8  RISK OF ASPIRATION  RISK OF IMPENDING OBSTRUCTION.
  • 19. BREATHING Inspection Auscultation Palpation Percussion  Identify and manage life threatening problems first • Tension pneumothorax • Cardiac temponade • Massive hemothorax • Open pneumothorax • Flail chest with pulmonary contusion
  • 20. maneuvers  Bag and mask ventilation  Needle thoracocentesis  Pericardiocentesis  Chest tube intubation
  • 21. CIRCULATION AND HEMORRHAGE CONTROL Assess for:  Shock  External bleeding  Occult bleeding  Estimate the blood loss on initial presentation of patient and the signs and symptoms  Replace fluid accordingly, 2 litres of warm crystalloid solution.
  • 22. DISABILITY  GCS  PUpillary reaction and size EXPOSURE  Undress the patient completely but prevent hypothermia.  Logrolling and looking for back of the pt. is very important.
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  • 24. ADJUCTS TO PRIMARY SURVEY AND RESUSSITATION  ECG  PULSE OXIMETRY  Xray chest AP view  Xray pelvis AP view  URINARY CATHETER  GASTRIC CATHETER  BLOOD PRESSURE  ABGS  FAST  DPL
  • 25. NEED TO TRANSFER or REFER?
  • 26. SECONDARY SURVEY Secondary survey does not begin until the primary survey is completed,resuscitative efforts are established and patient is demonstrating normalization of vital functions. It includes:  Head to toe evaluation  AMPLE history • Allergy • Medications currently taking • Past illness • Last meal • Event/environment related to injury.  physical examination  Reassessment of all vital organs.
  • 27. Adjucts to secondary survey  CT SCAN  CONTRAST STUDIES  EXTREMITY XRAY  ENDOSCOPY  ULTRASONOGRAPHY
  • 28. POSTRESUSITATION MONITORING AND REEVALUATION  Reevaluaion for new finding or overlooked.  Continous monitoring of vital signs.  Effective analgesia.
  • 29. DEFINATIVE CARE  AFTER identifying the patients injury.  Managing life threatening problems  Obtaining special studies.  If the patients injuries exceed the capabilities of the institution.
  • 30. Take home message 1. ABCDE APPROACH. 2. TREAT GREATEST THREAT TO LIFE. 3. DEFINITIVE DIAGNOSIS IS NOT IMMEDIATELY IMPORTANT. 4. TIME IS THE ESSENCE. 5. DO NO FURTHER HARM THE PATIENT
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  • 33. CASE A 20 year old woman is found trapped in her automobile. Several hours are required to extricate her because her leg was trapped and twisted beneath the dash board. In the hospital she is hemodynamically unstable with pulse of 120bpm, r/r 14, bp 80mmhg systolic only, she has a large wound in her left leg which is bleeding profusely..