This document provides an overview of advanced trauma life support (ATLS) procedures for treating polytrauma patients. It discusses the primary and secondary surveys, which involve assessing and stabilizing the airway, breathing, circulation, disability, and exposure. Key interventions include immobilizing the cervical spine, treating life-threatening injuries like tension pneumothorax, controlling hemorrhage, and giving intravenous fluids and blood. The goal is rapid diagnosis and intervention to prevent death, which often occurs within the first hour due to injuries like aortic rupture.
4. Management at site of
accident :
Access trapped & buried
Do not Pull or Twist
Priority
Freeing head, neck &
trunk by clearing
depress
Gently move out patient
5. Transport
Severely injured
Move patient on stretcher
Three people ideally
required
Transfer like one piece of
log
7. Death from trauma : trimodol
distribution
The first peak of death- sec-
min Cause: Aortic Rupture
The second peak of death –
min-hr This is the Golden
hour on which ATLS focuses
The third peak of death –
days-wks Causes: Sepsis,
SIRS
11. Secondary survey
Head-to-toe evaluation
Look, listen and feel
Examine each region
Neurological examination
X-ray of chest and cervical
spine
Tubes and fingers in every
orifice
12. Definitive care phase
All injuries managed
Comprehensive
management, fracture
stabilization operative
intervention and
transfer
13. Triage
Sorting of patients based on need for treatment
Two type
No. of patients and severity of their injuries do not
exceed ability of the facility. Here patient with life
threatening problems and there sustaining multiple
system are treated first
No. of patients and severity of their injuries exceed
capability of the facility and staff. Here patients with
the greatest chance of survival with the least
expenditure of time, equipment supplies and
personnel are managed first
14. Priority plan- treatment and
management
A.Primary survey
Airway and cervical spine
Assessment
Management- patent
airway
Chin lift or jaw thrust
Clear foreign bodies
Oropharyngeal airway
Orotracheal/ nasotracheal
intubation
Cricothyroidotomy
Cervical spine in a neutral
position
23. Assume a cervical spine injury in any
patient with Polytrauma who has
- Altered level of consciousness.
- Blunt or penetrating injury above the
level of clavicles.
24. Protecting the cervical spine
Aim to prevent damage or
transection of the spinal cord in
case patient has a fracture or
unstable dislocation of cervical
spine
One member of team holds head
in the line of the body
Another member applies a well-
fitting hard collar and immobilises
the head by placing sandbags on
either side of the head
Sticky-tape is passed from one
side of the bed across the
forehead to the opposite side of
bed to further reduce movement
of the head and neck
27. Breathing control
life-threatening chest
injuries, and treatment
should be expedited
immediately:
sucking chest wound
tension
pneumothorax/Hemothorax
large flail segment
cardiac tamponade
Management
High conc. of oxygen
Alleviate tension
pneumothorax
Seal open pneumothorax
28. Management of a Tension Pneumothorax
Insert a large-bore intravenous
cannula into second
intercostal space in
midclavicular line on affected
side
If there is a sudden release of
air, the diagnosis is confirmed
and should be followed
immediately by an intercostal
chest drain in the fifth
intercostal space in the
midaxillary line
If the diagnosis is in doubt,
order a chest x-ray and
proceed with the chest drain if
confirmatory
29.
30. Circulation and Hemorrhage control
Assessment
State of consciousness
Pulse
Color of skin
Capillary blanch test
Identity exsanguinating
hemorrhage
31. SHOCK
“Principle problem is poor
oxygen delivery.”
Shock should be
recognized before B.P.
figure is available.
Cool, pale skin, sweating
peripheries (Poor blood
flow in skin)
Anxiety, confusion &
restlessness (Poor blood
flow in brain)
Oliguria after
catheterization
( Poor blood flow in kidneys)
32. After recognition of shock
Initiate 2 I/V catheter
Blood for examination
Initiate ringer lactate and blood
replacement
Pneumatic antishock garment
E.C.G. monitor
Urinary and nasogastric catheter
Restore oxygen delivery
Immediate intervention
Stop external bleeding by local
pressure
For extremity bleeding compression
bandage
Elevate with traction
33. Difficult venous access
If access cannot be gained within
5 minutes and patient is shocked,
then further measures should be
taken until access is gained
Sites for cannulation include:
Cut-down in the antecubital fossa -
safest, most effective site
Cut-down to the long saphenous
vein in the groin, rather than at the
ankle, as intense vasospasm may
prevent infusion
Percutaneous cannulation of the
femoral vein - using the Seldinger
technique
Percutaneous cannulation of neck
veins using Seldinger technique
Intra-osseous infusion in a severely
ill child
34. Disability- brief neurological
Level of consciousness
using AVPU method
A-alert
V-Responds to vocal
stimuli
P-Responds to
painful stimuli
U-Unresponsive
The pupils for size,
equality and reaction
Glasgow coma scale
36. Exposure
Patient should be fully
exposed in the ATLS setting.
Clothes should be cut off, if
necessary.
Every orifice, i.e. ear, eye,
nostril, mouth, etc. should be
looked at
All limbs palpated for fractures
so that nothing is missed
Also, one should not forget to
perform a log roll and look at
the back
37. Secondary Survey
Head and face
Assessment
Inspection
Re-evaluate pupils
Palpation
Cranial nerve function
Management
Maintain airway
Hemorrhage control
41. Perineal and rectal
Evaluate for
Anal sphincter tone
Rectal blood
Bowel well integrity
Prostate position
Blood on urinary meat us
Scrotol hemotoma
46. Definitive care
Inter hospital triage
criteria help determine
the level, pace and
intensity of initial
management
Outline rationale for
patient transfer
48. Records and legal consideration
Records
Record keeping
Reporting
chronologically
Consent for treatment
Consent
In life-threatening
emergencies- treatment
first
Forensic evidence
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