The document discusses Advance Trauma Life Support (ATLS). It describes ATLS as a general guideline for managing trauma patients that focuses on urgent problems during the critical "Golden Hour" period. The key components of ATLS include triage, primary survey and resuscitation (addressing ABCDE - Airway, Breathing, Circulation, Disability, Exposure), secondary survey to identify all injuries, and definitive care involving specialist treatment of injuries identified. The goal of ATLS is to prioritize assessment and rapid intervention for life-threatening injuries during the initial stages after trauma occurs.

1. Advance Trauma Life Support
Dr.Farjana Nasrin Ina
Resident,Phase-A
Cardiovascular and Thoracic surgery

2. Trauma
 Trauma is the study of medical problems associated with
physical injury.
 It is usually the adverse consequence of a mechanical force
on a patient.
 Management of trauma depends on time, assessment and
response.

3. Trauma assessment
 Know the timelines for important diagnoses
 Prioritise the assessment accordingly
 Positively exclude critical diagnoses
 If required,screen at risk patients before clinical signs are
apparent

4. The response to trauma
 Guidelines and protocols speed and streamline
management
 Pre-empt time limiting steps to avoid delay
 Respond to the evolving condition of the patients

5. ATLS:Advance Trauma Life Support
 ATLS is a general guideline which deals with aspects of
patient management in case of trauma.
 This focus on urgent problems is first captured by the
“Golden hour” catch phrase and is one of the most
important lessons of ATLS.
 The Golden hour, the first hour after a traumatic injury,
when emergency treatment is most likely to be successful
 The advance trauma life support(ATLS) principles were
introduced into practice in late 1970s and hav since
revolutionized the management of trauma.

6. Objectives of ATLS
 To identify – the sequence of priorities in the early assessment of the
injured patient
 To learn – the principle of triage in immediate management of the
injured patient
 To apply- the principles of primary and secondary surveys in the
assessment and management of trauma
 Techniques for the initial resuscitative and definitive care aspects of
trauma
 To recognize-patients whose managements should differ from the
normal

7. Assessment and management of the seriously
injured
 Trimodal distribution of death:
The three peaks as follows:
1.immediate: 50% of all deaths.these are probably not possible to save. They
are usually the result of massive head injury or severe cardio-pulmonary
shunt.
2.Early: within the first few hours.these will result from airway or breathing
problem or circulatory problems.
3.Late:20% of deaths.usually from multiorgan failure and sepsis,influenced by
inadequate early resuscitation.
The ATLS principles are aimed primarily at the “early” group of patients.

8. Triage:
 Triage is a system of medical sorting in an order of priority for evacuation and
treatment.
 There are two stages applicable in the pre-hospital environment:
 triage sieve : The triage sieve is a quick and uncomplicated system based on
simple clinical observation of a casualty’s ability to walk, breathe and maintain a
pulse. It can be performed by trained but non-clinical personnel.
 triage sort: The triage sort requires a degree of clinical training and uses
physiological measurements to score casualties and place them into priority
groups.
Priority 1 Immediate
Priority 2 Urgent
Priority 3 Delayed
Priority 4 Dead

9. The steps in the ATLS principles:
 Primary survey with simultaneous resuscitation : identify
and treat what is killing the patient
 Secondary survey: proceed to identify all other injuries
 Definitive care: develop a definitive management plan

11. Primary survey and resuscitation:
 The primary survey comprises the fundamental principles of the ATLS
system, the ABCDE of trauma care
ABCDE of trauma care
A, Airway with cervical spine protection
B, Breathing and ventilation
C, Circulation with haemorrhage control
D, Disability: neurological status
E, Exposure: completely undress the patient and
assess for
other injuries

12. Airway with cervical spine protection
 Ensure cervical spine
immobilization and check for
vocal response
 Clear mouth and airway if
obvious foreign bodies
 Jaw trust and chin lift, if
required
 Consider airway adjuncts
 If Glasgow Coma Score 8,
consider a definitive airway(such
as endotracheal intubation)

14. Breathing and ventilation
 100% Oxygen administration to all trauma patients at high flow
 Inspection
 Palpation
 Auscultation
 Purcussion
 Identify and manage life threatening problems first
• Tension pneumothorax – needs immediate decompression with needle insertion
or chest tube insertion
• Cardiac temponade - Pericardiocentesis
• Massive hemothorax(>1.5L of blood) – insertion of chest drain tube with
controlling major vessel bleeding within the chest
• Open pneumothorax
• Flail chest with pulmonary contusion

16. Circulation and control of bleeding
 Assessment here centres on three critical clinical observations:
1. Conscious level
2. Skin colour
3. Pulse and blood pressure

17. Resuscitation:
 2 large-caliber intravenous channel for fluid resuscitation
 Control of bleeding - Potential sites for major blood loss
include the chest cavity, the abdomen, the pelvis and long
bone fractures.
 – Direct pressure
 – Operative control

18. Disability
 Neurological status
 Level of consciousness (APVU/GCS)
 Pupil size & Light reaction
 Spinal cord injury level
● A: Alert
● V: Verbal command
● P: Painful stimuli
● U: Unresponsive

19. Factors affect level of consciousness
 Oxygenation
 Ventilation
 Perfusion
 Hypoglycemia
 Drugs / Alcohol

20. Exposure and environment
 The patient must be fully exposed and
examined front and back using a
carefully controlled log roll.
 Spinal alignment must be maintained
during this procedure with in-line
traction.
 Hypothermia can be rapid following
trauma, and warming air blankets are
vitally important in the resuscitative
phase.

22. Adjuncts to the primary survey
• Blood tests – full blood count, urea and electrolytes, clotting
screen, glucose, toxicology, cross-match
• Vital signs
• ECG
• Pulse oximetry
• End-tidal carbon dioxide
• Arterial blood gases
• Urinary output
• Urethral catheter (unless contra-indicated)
• Naso-gastric tube (unless contra-indicated)
• Chest x-ray
• Pelvic x-ray
• Spine Xray

23. Secondary survey:
 The secondary survey is a detailed, head-to-toe evaluation to identify all
injuries not recognized in the primary survey.
 It takes place after the primary survey has been completed, if the
patient is stable enough and not in immediate need of definitive care;
 it may, infact, take place after surgery, or on the intensive care unit
(ICU).

24. The components of the secondary survey are:
 • history (AMPLE)
Allergy
Medication, including tetanus status
Past medical history
Last meal
Events of the incident

25.  • physical examination
 Head and face
 Neck
 Chest
 Neurological
 Abdomen and pelvis
 Extremities
 Log roll

26.  • ‘tubes and fingers in every orifice’
 • neurological examination
 • further diagnostic tests
 • re-evaluation
 Reevaluaion for new finding or overlooked.
 Continous monitoring of vital signs.
 Effective analgesia.

27. Adjucts to secondary survey
 CT SCAN
 MRI
 EXTREMITY XRAY
 ENDOSCOPY
 ULTRASONOGRAPHY

28. Definitive care:
 Definitive care describes the specialist care required to manage the injuries
identified during the initial assessment and subsequent investigations.
 This may be specialist surgery to address a particular problem (e.g.
neurosurgical evacuation of an intracerebral bleed), or critical care
management on an ICU to provide systemic support.

29. Algorithm of ATLS initial assessment and
management
Injury
Primary survey
Resuscitation
Re-evaluation
Definitive care
Transfer
Re-evaluation
Secondary survey