1) ATLS was developed in the 1970s by Dr. James Styner after a tragic plane crash injured his children and he found the emergency care provided was inadequate. 2) The goals of ATLS are to save lives through identifying and treating life threats in trauma situations within the "golden hour" window. 3) The ATLS approach involves a primary survey to address airway, breathing, circulation, disability and exposure, followed by secondary and tertiary surveys.

1. ADVANCE TRAUMA
LIFE SUPPORT
DR KAPIL DEV
RESIDENT GENERAL
SURGERY

2. HISTORY
• ATLS has its origins in the United
States in 1976, when James K.
Styner, an orthopedic surgeon
piloting a light aircraft, crashed his
plane into a field in Nebraska. His
wife Charlene was killed instantly
and three of his four children,
sustained critical injuries.

3. HISTORY
• He carried out the initial triage of his
children at the crash site. Dr. Styner
had to flag down a car to transport
him to the nearest hospital; upon
arrival, he found it closed. Even once
the hospital was opened and a doctor
called in, he found that the emergency
care provided at the small regional
hospital where they were treated was
inadequate and inappropriate.

4. HISTORY
• Upon returning to Lincoln, Dr. Styner declared: "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.
• On returning to work, he set about developing a system for saving lives in
medical trauma situations. Which is nowadays recognized worldwide as a
Advance Trauma Life Support.

5. TRAUMA & GOLDEN HOUR CONCEPT
• Trauma can be defined as an injury to any part of the human body as the
result of energy transfer from an inflicting source that is beyond the body
resistance.
• In ATLS the golden hour refers to a time period lasting for one hour or less
following traumatic injury during which there is highest possibility that
adequate treatment will prevent death.

7. ATLS PROVIDER TEAM
• The trauma team is basically
comprised of a group of doctors ,
nurses , operating department
assistants , radiographers and other
support personnel.

8. TRIAGE
• Triage is derived from French word means TO SORT.
• It is the process of determining the priority of patients treatment based on their
severity of their condition to get RIGHT PATIENT at RIGHT PLACE at the
RIGHT TIME with RIGHT CARE PROVIDER.
• This is applicable where resources are insufficient for all to be treated immediately.

9. COLOR CODING

10. STEPS IN ATLS PRINCIPLES
PRIMARY SURVEY AND RESUSCITATION : The aim is to identify and treat
what is killing the patient.
SECONDARY SURVEY : It includes head to toe examination to identify all
other injuries.
TERTIARY SURVEY : A definitive management plan is developed.

11. PRIMARY SURVEY AND
RESUSCITATION
THE PRIMARY SURVEY INCLUDES FOLLOWING COMPONENTS
• c Control of massive external hemorrhage
• A airway maintenance with cervical spine protection
• B breathing and ventilation
• C circulation and hemorrhage control
• D disability / neurological status
• E exposure / environment control

12. CONTROL OF MASSIVE HEMORRHAGE
STEPS
APPLY DIRECT PRESSURE
PACK WOUND WITH DRESSINGS APPLY
PRESSURE
ELEVATE THE AFFECTED LIMB
IF STILL BLEEDING PERSIST
THEN APPLY TORNIQUET PROXIMAL TO
BLEEDING WOUND
NOTE THE TIME
SHIFT TO OPERATION THEATRE FOR
SURGICAL CONTROL.

13. AIRWAY WITH CERVICAL SPINE CONTROL
• Quick assessment
• What is the quick simple way to access patient in 10 seconds?
• Ask the patient his or her name ?
• Ask the patient what happened ?

14. APPROPRIATE RESPONSE CONFIRMS
• Patent airway
• Sufficient air reserve to permit speech
• Sufficient perfusion
• Clear sensorium

15. MANAGEMENT
Clear the airway using suction and remove foreign bodies if present.
Chin lift and jaw thrust maneuverer
Oropharyngeal and nasopharngeal airway
Definitive airway(endotracheal tube intubation)
Surgical airway( cricothyroidotomy / tracheostomy)

19. BREATHING AND VENTILATION
• Once a secure airway is maintained , adequate oxygenation and ventilation
must be ensured.
• All trauma patients should receive supplemental oxygen and monitored by
pulse oximetry.
• Evaluate chest wall , lungs ,heart and diaphragm by inspection , palpation ,
percussion and auscultation.

21. TENSION PNEUMOTHORAX
EVALUATION
• Air hunger
• Distended neck veins
• Absent breath sounds
• Tracheal shift
• Hyper resonant percussion note
MANAGEMENT
• Needle decompression 2nd ICS
(mid clavicular line)
• Chest tube intubation 5thICS (mid
axillary line)

23. MASSIVE HEMOTHORAX
EVALUATION
• Hemodynamic instability
• Absent breath sounds
• Respiratory distress
• Dull percussion note
MANAGEMENT
• Vigorous circulatory support
• Chest tube intubation
• Thoracotomy

24. OPEN PNEUMOTHORAX
EVALUATION
• Respiratory distress
• Sucking chest wound
MANAGEMENT
• Three sided occlusive dressings of
the wound
• Followed by chest tube intubation

26. FLAIL CHEST
EVALUATION
• Respiratory distress
• Paradoxical chest wall movements
MANAGEMENT
• Conservative with good analgesics
• Chest intubation
• Rib fixation
• Endotracheal intubation

28. CARDIAC TAMPONADE
EVALUATION
• BECKS TRIAD
• Juggler venous distension
• Muffled heart sounds
• Hypotension
MANAGEMENT
• Needle pericardiocentesis
• Thoracotomy

30. CIRCULATION AND HEMORRHAGE
CONTROL
EVALUATION
• Assess the pulse and blood pressure
• Look for blood soakage of clothes
• Looks for the signs of injury
• Hydration status and skin color
• Fast scan for evaluation of concealed abdominal hemorrhage.

32. MANAGEMENT
• Stop the external hemorrhage as discussed
• Pass 2 large bore IV cannulas
• Draw blood for cross matching and lab investigations
• Infuse warm fluids(Crystalloids/Colloids)and blood products(1:1:1)
• Apply pelvic binder until pelvic fracture ruled out
• Immobilize fractures

33. DIABILITY / NEUROLOGICAL STATUS
KEY PRINCIPLES
• Prevention of further injury and identification of neurological injury is the goal.
• Maintenance of adequate cerebral perfusion is key to prevent further brain injury.
• Adequate oxygenation
• Avoid hypotension
• Early neurosurgeon involvement for intracranial pathologies.

34. DISABILITY/NEUROLOGICAL STATUS
• Assess the level of
consciousness(GCS, AVPU Score)
• Assess pupils size and reactivity
• Look for lateralizing signs
• Raised ICP should be ruled out

36. SECONDARY SURVEY
• Secondary survey is started after completion of primary survey once patient
has been adequately resuscitated.
• No patient with abnormal vital signs should proceed for secondary survey.
• Secondary survey includes brief history and complete clinical
examination.

37. SECONDARY SURVEY

38. SECONDARY SURVEY
• Head and neck
• Chest and abdomen
• Pelvis and genitourinary
• Extremities
• Neurological including spine