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ATLS
ATLS
• A Advanced
• T Trauma
• L Life
• S Support
ATLS
Preparation
1. Prehospital phase
2. Inhospital phase
Triage
1. Multiple casualties
2. Mass casualties
ATLS
• ….
• Primary survey
• Resuscitation
• ….
• Secondary survey
• ….
• ….
• Definitive care
ATLS
• Preparation & Triage
• Primary survey
• Resuscitation
• Adjuncts to primary survey and resuscitation
• Secondary survey
• Adjuncts to secondary survey
• Post resuscitation monitoring and
reevaluation
• Definitive care
ATLS
• Preparation & Triage
– The used of the following protective devices is
recommended
• Goggles
• Gloves
• Fluid-impervious gowns or aprons
• Shoes covers and fluid- impervious leggings
• Mask
• Head covering
ATLS
• ….
• Primary survey
• Resuscitation
• ….
• Secondary survey
• ….
• ….
• Definitive care
ATLS
• Primary survey
– A Airway maintenance with cervical spine protection
– B Breathing and ventilation
– C Circulation with hemorrhage control
– D Disability : Neurological status
– E Exposure/Environmental control : completely
undress the patient,but prevent hypothermia
ATLS
• ….
• Primary survey
• Resuscitation
• ….
• Secondary survey
• ….
• ….
• Definitive care
ATLS
• Resuscitation
– Oxygenation and ventilation
– Shock management,intravenous lines,warmed
Ringer’s lactate solution
– Management of life-threatening problems
identified in the primary survey is continued
ATLS
• ….
• Primary survey
• Resuscitation
• ….
• Secondary survey
• ….
• ….
• Definitive care
ATLS
• Adjuncts to primary survey and resuscitation
– X-rays and diagnostic studies
• Chest
• Pelvis
• C-spine
• DPL or FAST
– Urinary and gastric catheters
– Monitoring
• ABG analysis and ventilatory rate
• End-tidal carbon dioxide
• EKG
• Pulse oximetry
• Blood pressure
ATLS
• ….
• Primary survey
• Resuscitation
• ….
• Secondary survey
• ….
• ….
• Definitive care
Secondary survey
• Secondary survey does not begin until
the primary survey (ABCDEs) is
completed, resuscitative efforts are
well established, and the patient is
demonstrating normalization of vital
functions.
Secondary survey
• Head-to-toe evaluation
• Complete history and physical examination
• Reassessment of all vital signs
ATLS
• Secondary survey
– Total patient evaluation
• history : AMPLE
• physical examination
– Complete neurologic examination
– Head and skull
– Maxillofacial
– Neck
– Chest
– Abdomen
– Perineum/rectum/vagina
– Musculoskeletal
– Tubes and fingers in every orifice
Secondary survey
• History
– A Allergies
– M Medications currently used
– P Past illnesses/Pregnancy
– L Last meal
– E Events/Environment related to the injury
Secondary survey
• History
– Blunt trauma
– Penetrating trauma
– Injuries due to burns and cold
– Hazardous environment
Secondary survey
• Physical examination
– Neurologic
– Head
– Maxilofacial
– Cervical spine and neck
– Chest
– Abdomen
– Perineum/rectum/vagina
– Musculoskeletal
Secondary survey
• Physical examination
– Neurologic
• level of consciousness
• pupillary size and response
• motor and sensory
• GCS
Glasgow Coma Scale
• Eye opening (E)
– Spontaneous 4
– To speech 3
– To pain 2
– None 1
• Best motor response (M)
– Obeys commands 6
– Localizes pain 5
– Normal flexion (withdrawal) 4
– Abnormal flexion (decorticate) 3
– Extension 2
– None (flaccid) 1
• Verbal response (V)
– Oriented 5
– Confused conversation 4
– Inappropriate words 3
– Incomprehensible sounds 2
– None 1
Secondary survey
• Physical examination
– Head
• Scalp
• Fractures
• Eyes edema
– VA - Pupil size - Penetrating injury
– Hemorrhage of conjunctivae,fundi
– Contact lenses - Dislocation of lenses
– Ocular entrapment
Secondary survey
• Physical examination
– Maxilofacial
• airway obstruction , major bleeding
• Fx of mid maxilla beware of NG tube insertion
• need frequent reassessment
Secondary survey
• Physical examination
– Cervical spine and neck
• Head injury pt.keep in mind of cervical spine injury
• Absence of neurologic deficit does not exclude
spine injury
• Inspection , palpation , auscultation , cervical spine
tenderness , subcutaneous emphysema , tracheal
deviation , laryngeal fracture
• Protection of C-spine injury , helmet removing
Secondary survey
• Physical examination
– Chest
• Visual evaluation of anterior and posterior chest
– open pneumothorax
– flail chest
• Pain , dyspnea , hypoxia
• Cardiac tamponade , tension pneumothorax
– distended neck veins
– distant heart sound
Secondary survey
• Physical examination
– Abdomen
• closed observation and frequent reevaluation
• unexplained hypotension
• neurologic injury
• equivocal abdominal finding
Secondary survey
• Physical examination
– Perineum/rectum/vagina
• contusion , hematoma , laceration , urethral bleeding
• rectal examination : blood , high-riding prostate ,
integrity of rectal wall , sphincter tone
• female :
– Vg exam.: blood , Vg laceration
– pregnancy test
Secondary survey
• Physical examination
– Musculoskeletal
• inspection : contusion , deformity
• palpation : tenderness , abnormal movement
• pelvic Fx : ecchymosis on iliac wings , pubis , labia ,
scrotum , pain on palpation of pelvic ring , PCT
• assessment of peripheral pulses
• patient’s back examination
ATLS
• Preparation & Triage
• Primary survey
• Resuscitation
• Adjuncts to primary survey and resuscitation
• Secondary survey
• Adjuncts to secondary survey
• Post resuscitation monitoring and reevaluation
• Definitive care
ATLS
• Adjuncts to secondary survey
– hemodynamic status
• CT scan
• Contrast x-ray studies
• Extremitry x-ray
• Endoscopy and ultrasonography
ATLS
• Preparation & Triage
• Primary survey
• Resuscitation
• Adjuncts to primary survey and resuscitation
• Secondary survey
• Adjuncts to secondary survey
• Post resuscitation monitoring and reevaluation
• Definitive care
ATLS
• Post resuscitation monitoring and
reevaluation
– reevaluation for new findings or overlooked
– continuous monitoring of vital signs , urinary
output
• 0.5 ml/kg/hr
• 1 ml/kg/hr
– ABG , EKG , pulse oximetry
– effective analgesia
ATLS
• Preparation & Triage
• Primary survey
• Resuscitation
• Adjuncts to primary survey and resuscitation
• Secondary survey
• Adjuncts to secondary survey
• Post resuscitation monitoring and reevaluation
• Definitive care
ATLS
• Definitive care
– After identifying the patient’s injuries
– Managing life-threatening problems
– Obtaining special studies
• Transfer
– If the patient’s injuries exceed the institution’s
treatment capabilities
advanced trauma life support

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advanced trauma life support

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  • 6. ATLS • A Advanced • T Trauma • L Life • S Support
  • 7. ATLS Preparation 1. Prehospital phase 2. Inhospital phase Triage 1. Multiple casualties 2. Mass casualties
  • 8. ATLS • …. • Primary survey • Resuscitation • …. • Secondary survey • …. • …. • Definitive care
  • 9. ATLS • Preparation & Triage • Primary survey • Resuscitation • Adjuncts to primary survey and resuscitation • Secondary survey • Adjuncts to secondary survey • Post resuscitation monitoring and reevaluation • Definitive care
  • 10. ATLS • Preparation & Triage – The used of the following protective devices is recommended • Goggles • Gloves • Fluid-impervious gowns or aprons • Shoes covers and fluid- impervious leggings • Mask • Head covering
  • 11. ATLS • …. • Primary survey • Resuscitation • …. • Secondary survey • …. • …. • Definitive care
  • 12. ATLS • Primary survey – A Airway maintenance with cervical spine protection – B Breathing and ventilation – C Circulation with hemorrhage control – D Disability : Neurological status – E Exposure/Environmental control : completely undress the patient,but prevent hypothermia
  • 13. ATLS • …. • Primary survey • Resuscitation • …. • Secondary survey • …. • …. • Definitive care
  • 14. ATLS • Resuscitation – Oxygenation and ventilation – Shock management,intravenous lines,warmed Ringer’s lactate solution – Management of life-threatening problems identified in the primary survey is continued
  • 15. ATLS • …. • Primary survey • Resuscitation • …. • Secondary survey • …. • …. • Definitive care
  • 16. ATLS • Adjuncts to primary survey and resuscitation – X-rays and diagnostic studies • Chest • Pelvis • C-spine • DPL or FAST – Urinary and gastric catheters – Monitoring • ABG analysis and ventilatory rate • End-tidal carbon dioxide • EKG • Pulse oximetry • Blood pressure
  • 17. ATLS • …. • Primary survey • Resuscitation • …. • Secondary survey • …. • …. • Definitive care
  • 18. Secondary survey • Secondary survey does not begin until the primary survey (ABCDEs) is completed, resuscitative efforts are well established, and the patient is demonstrating normalization of vital functions.
  • 19. Secondary survey • Head-to-toe evaluation • Complete history and physical examination • Reassessment of all vital signs
  • 20. ATLS • Secondary survey – Total patient evaluation • history : AMPLE • physical examination – Complete neurologic examination – Head and skull – Maxillofacial – Neck – Chest – Abdomen – Perineum/rectum/vagina – Musculoskeletal – Tubes and fingers in every orifice
  • 21. Secondary survey • History – A Allergies – M Medications currently used – P Past illnesses/Pregnancy – L Last meal – E Events/Environment related to the injury
  • 22. Secondary survey • History – Blunt trauma – Penetrating trauma – Injuries due to burns and cold – Hazardous environment
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  • 27. Secondary survey • Physical examination – Neurologic – Head – Maxilofacial – Cervical spine and neck – Chest – Abdomen – Perineum/rectum/vagina – Musculoskeletal
  • 28. Secondary survey • Physical examination – Neurologic • level of consciousness • pupillary size and response • motor and sensory • GCS
  • 29. Glasgow Coma Scale • Eye opening (E) – Spontaneous 4 – To speech 3 – To pain 2 – None 1 • Best motor response (M) – Obeys commands 6 – Localizes pain 5 – Normal flexion (withdrawal) 4 – Abnormal flexion (decorticate) 3 – Extension 2 – None (flaccid) 1 • Verbal response (V) – Oriented 5 – Confused conversation 4 – Inappropriate words 3 – Incomprehensible sounds 2 – None 1
  • 30. Secondary survey • Physical examination – Head • Scalp • Fractures • Eyes edema – VA - Pupil size - Penetrating injury – Hemorrhage of conjunctivae,fundi – Contact lenses - Dislocation of lenses – Ocular entrapment
  • 31. Secondary survey • Physical examination – Maxilofacial • airway obstruction , major bleeding • Fx of mid maxilla beware of NG tube insertion • need frequent reassessment
  • 32. Secondary survey • Physical examination – Cervical spine and neck • Head injury pt.keep in mind of cervical spine injury • Absence of neurologic deficit does not exclude spine injury • Inspection , palpation , auscultation , cervical spine tenderness , subcutaneous emphysema , tracheal deviation , laryngeal fracture • Protection of C-spine injury , helmet removing
  • 33. Secondary survey • Physical examination – Chest • Visual evaluation of anterior and posterior chest – open pneumothorax – flail chest • Pain , dyspnea , hypoxia • Cardiac tamponade , tension pneumothorax – distended neck veins – distant heart sound
  • 34. Secondary survey • Physical examination – Abdomen • closed observation and frequent reevaluation • unexplained hypotension • neurologic injury • equivocal abdominal finding
  • 35. Secondary survey • Physical examination – Perineum/rectum/vagina • contusion , hematoma , laceration , urethral bleeding • rectal examination : blood , high-riding prostate , integrity of rectal wall , sphincter tone • female : – Vg exam.: blood , Vg laceration – pregnancy test
  • 36. Secondary survey • Physical examination – Musculoskeletal • inspection : contusion , deformity • palpation : tenderness , abnormal movement • pelvic Fx : ecchymosis on iliac wings , pubis , labia , scrotum , pain on palpation of pelvic ring , PCT • assessment of peripheral pulses • patient’s back examination
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  • 39. ATLS • Preparation & Triage • Primary survey • Resuscitation • Adjuncts to primary survey and resuscitation • Secondary survey • Adjuncts to secondary survey • Post resuscitation monitoring and reevaluation • Definitive care
  • 40. ATLS • Adjuncts to secondary survey – hemodynamic status • CT scan • Contrast x-ray studies • Extremitry x-ray • Endoscopy and ultrasonography
  • 41. ATLS • Preparation & Triage • Primary survey • Resuscitation • Adjuncts to primary survey and resuscitation • Secondary survey • Adjuncts to secondary survey • Post resuscitation monitoring and reevaluation • Definitive care
  • 42. ATLS • Post resuscitation monitoring and reevaluation – reevaluation for new findings or overlooked – continuous monitoring of vital signs , urinary output • 0.5 ml/kg/hr • 1 ml/kg/hr – ABG , EKG , pulse oximetry – effective analgesia
  • 43. ATLS • Preparation & Triage • Primary survey • Resuscitation • Adjuncts to primary survey and resuscitation • Secondary survey • Adjuncts to secondary survey • Post resuscitation monitoring and reevaluation • Definitive care
  • 44. ATLS • Definitive care – After identifying the patient’s injuries – Managing life-threatening problems – Obtaining special studies • Transfer – If the patient’s injuries exceed the institution’s treatment capabilities