The document outlines the history and development of Advanced Trauma Life Support (ATLS). It describes the initial assessment process for trauma patients, including the primary and secondary surveys, with a focus on identifying and treating life-threatening injuries immediately. Specific types of injuries are discussed such as head trauma, thoracic trauma, abdominal/pelvic trauma. The goal of ATLS is to provide a standardized approach to trauma care through systematic assessment and simultaneous resuscitation to reduce mortality from traumatic injuries.
Approach to a trauma patient - Advanced Trauma Life SupportParthasarathi Ghosh
Approach to a trauma patient from a Critical Care Medicine perspective with basics of Advanced Trauma Life Support.
References - ATLS Manual 10th Edition
INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
Approach to a trauma patient - Advanced Trauma Life SupportParthasarathi Ghosh
Approach to a trauma patient from a Critical Care Medicine perspective with basics of Advanced Trauma Life Support.
References - ATLS Manual 10th Edition
INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
The concept of golden hour of trauma patients is the opportunity for the institution of Life-and -limb measures. Nurses play a great role in this, this ppt view the facts and figures of patients in a hospital reso room.
Carotid artery injuries, Joel Arudchelvam, SLSC 2022, Carotid artery injuries
Causes
Hard signs of vascular injury
Associated signs
Anatomy and neck zones
Management
Factors to consider
Preoperative imaging
Management – changing concepts
Vascular surgical intervention
Open surgery
The concept of golden hour of trauma patients is the opportunity for the institution of Life-and -limb measures. Nurses play a great role in this, this ppt view the facts and figures of patients in a hospital reso room.
Carotid artery injuries, Joel Arudchelvam, SLSC 2022, Carotid artery injuries
Causes
Hard signs of vascular injury
Associated signs
Anatomy and neck zones
Management
Factors to consider
Preoperative imaging
Management – changing concepts
Vascular surgical intervention
Open surgery
2018 ATLS PROTOCOL
FOCUSING ON THE PRIMORDIAL MANAGEMENT OF PT IN THE APPROACH OF IMPROVING TRAUMA PT MANAGEMENT AND REDUCING MORTALITY OF TRAUMA PT AT OUR RESPECTIVE HEALTH FACILITIES AS DOCTORS AND CLINICIANS WORKING IN THE EMERGENCY DEPARTMENT.
GIVEN THE NECESSARY EQUIPMENT AND FAVOURABLE AMBIENT WORKING ENVIRONMENT WE SHOULD BE ABLE TO OFFER OUR HUMANITY RACE QUALITY SERVICES BEARING IN MIND THAT LIFE COME FIRST AND ALL THE OTHER ATTRIBUTES IN LIFE FOLLOWS
Detailed information on assessing the trauma patients with time dependent principle management and selection between early total care and damage control surgery.
Natural farming @ Dr. Siddhartha S. Jena.pptxsidjena70
A brief about organic farming/ Natural farming/ Zero budget natural farming/ Subash Palekar Natural farming which keeps us and environment safe and healthy. Next gen Agricultural practices of chemical free farming.
Artificial Reefs by Kuddle Life Foundation - May 2024punit537210
Situated in Pondicherry, India, Kuddle Life Foundation is a charitable, non-profit and non-governmental organization (NGO) dedicated to improving the living standards of coastal communities and simultaneously placing a strong emphasis on the protection of marine ecosystems.
One of the key areas we work in is Artificial Reefs. This presentation captures our journey so far and our learnings. We hope you get as excited about marine conservation and artificial reefs as we are.
Please visit our website: https://kuddlelife.org
Our Instagram channel:
@kuddlelifefoundation
Our Linkedin Page:
https://www.linkedin.com/company/kuddlelifefoundation/
and write to us if you have any questions:
info@kuddlelife.org
Diabetes is a rapidly and serious health problem in Pakistan. This chronic condition is associated with serious long-term complications, including higher risk of heart disease and stroke. Aggressive treatment of hypertension and hyperlipideamia can result in a substantial reduction in cardiovascular events in patients with diabetes 1. Consequently pharmacist-led diabetes cardiovascular risk (DCVR) clinics have been established in both primary and secondary care sites in NHS Lothian during the past five years. An audit of the pharmaceutical care delivery at the clinics was conducted in order to evaluate practice and to standardize the pharmacists’ documentation of outcomes. Pharmaceutical care issues (PCI) and patient details were collected both prospectively and retrospectively from three DCVR clinics. The PCI`s were categorized according to a triangularised system consisting of multiple categories. These were ‘checks’, ‘changes’ (‘change in drug therapy process’ and ‘change in drug therapy’), ‘drug therapy problems’ and ‘quality assurance descriptors’ (‘timer perspective’ and ‘degree of change’). A verified medication assessment tool (MAT) for patients with chronic cardiovascular disease was applied to the patients from one of the clinics. The tool was used to quantify PCI`s and pharmacist actions that were centered on implementing or enforcing clinical guideline standards. A database was developed to be used as an assessment tool and to standardize the documentation of achievement of outcomes. Feedback on the audit of the pharmaceutical care delivery and the database was received from the DCVR clinic pharmacist at a focus group meeting.
WRI’s brand new “Food Service Playbook for Promoting Sustainable Food Choices” gives food service operators the very latest strategies for creating dining environments that empower consumers to choose sustainable, plant-rich dishes. This research builds off our first guide for food service, now with industry experience and insights from nearly 350 academic trials.
UNDERSTANDING WHAT GREEN WASHING IS!.pdfJulietMogola
Many companies today use green washing to lure the public into thinking they are conserving the environment but in real sense they are doing more harm. There have been such several cases from very big companies here in Kenya and also globally. This ranges from various sectors from manufacturing and goes to consumer products. Educating people on greenwashing will enable people to make better choices based on their analysis and not on what they see on marketing sites.
Willie Nelson Net Worth: A Journey Through Music, Movies, and Business Venturesgreendigital
Willie Nelson is a name that resonates within the world of music and entertainment. Known for his unique voice, and masterful guitar skills. and an extraordinary career spanning several decades. Nelson has become a legend in the country music scene. But, his influence extends far beyond the realm of music. with ventures in acting, writing, activism, and business. This comprehensive article delves into Willie Nelson net worth. exploring the various facets of his career that have contributed to his large fortune.
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Introduction
Willie Nelson net worth is a testament to his enduring influence and success in many fields. Born on April 29, 1933, in Abbott, Texas. Nelson's journey from a humble beginning to becoming one of the most iconic figures in American music is nothing short of inspirational. His net worth, which estimated to be around $25 million as of 2024. reflects a career that is as diverse as it is prolific.
Early Life and Musical Beginnings
Humble Origins
Willie Hugh Nelson was born during the Great Depression. a time of significant economic hardship in the United States. Raised by his grandparents. Nelson found solace and inspiration in music from an early age. His grandmother taught him to play the guitar. setting the stage for what would become an illustrious career.
First Steps in Music
Nelson's initial foray into the music industry was fraught with challenges. He moved to Nashville, Tennessee, to pursue his dreams, but success did not come . Working as a songwriter, Nelson penned hits for other artists. which helped him gain a foothold in the competitive music scene. His songwriting skills contributed to his early earnings. laying the foundation for his net worth.
Rise to Stardom
Breakthrough Albums
The 1970s marked a turning point in Willie Nelson's career. His albums "Shotgun Willie" (1973), "Red Headed Stranger" (1975). and "Stardust" (1978) received critical acclaim and commercial success. These albums not only solidified his position in the country music genre. but also introduced his music to a broader audience. The success of these albums played a crucial role in boosting Willie Nelson net worth.
Iconic Songs
Willie Nelson net worth is also attributed to his extensive catalog of hit songs. Tracks like "Blue Eyes Crying in the Rain," "On the Road Again," and "Always on My Mind" have become timeless classics. These songs have not only earned Nelson large royalties but have also ensured his continued relevance in the music industry.
Acting and Film Career
Hollywood Ventures
In addition to his music career, Willie Nelson has also made a mark in Hollywood. His distinctive personality and on-screen presence have landed him roles in several films and television shows. Notable appearances include roles in "The Electric Horseman" (1979), "Honeysuckle Rose" (1980), and "Barbarosa" (1982). These acting gigs have added a significant amount to Willie Nelson net worth.
Television Appearances
Nelson's char
1. ATLS
Advanced Trauma Life Support
Supervised by: Prof. Mahmoud Abu-Ebeeleh
Done by: Dr. Faisal Rawagah
2. History
Dr James Styner, An orthopedic surgeon crashed his plane in February 1976
“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”
-Advanced Trauma Life Support Student Course Manual 10th edition
-Journal of Trauma Nursing April/June 2006, Volume :13 Number 2 , page 41 - 44
3. Do we Need ATLS?
ATLS Methods is accepted as a standard for the “first hour” of trauma care by
many who provide care for the injured.
5.8 million people die every year from unintentional injuries and violence.
Motor vehicle crashes alone case:
1.3 million deaths annually.
20 million to 50 million significant injuries.
Trauma the leading cause of death in persons 1 through 44 years of age in most
developed countries.
-Advanced Trauma Life Support Student Course Manual 10th edition
-https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries
4. The trimodal distribution of deaths
Classically:
Immediate (seconds to minutes)
Severe brain or high spinal cord injury
Rupture of the heart, aorta, or other large blood
vessels
Early (minutes to several hours)
Subdural and epidural hematomas,
Hemopneumothorax
Ruptured spleen, lacerations of the liver, pelvic
fractures.
Late (Several days to weeks)
sepsis and multiple organ system dysfunctions.
-Advanced Trauma Life Support Student Course Manual 10th edition
-Gunst M, Ghaemmaghami V, Gruszecki A, Urban J, Frankel H, Shafi S. Changing epidemiology of trauma deaths leads
to a bimodal distribution. Proc (Bayl Univ Med Cent). 2010 Oct;23(4):349-54. doi: 10.1080/08998280.2010.11928649.
PMID: 20944754; PMCID: PMC2943446.
5. The “initial assessment”
Timing is crucial, systematic approach that can be rapidly and accurately applied is essential
•• Preparation
•• Triage
•• Primary survey (ABCDEs) with immediate resuscitation of patients with life-threatening injuries
•• Adjuncts to the primary survey and resuscitation
•• Consideration of the need for patient transfer
•• Secondary survey (head-to-toe evaluation and patient history)
•• Adjuncts to the secondary survey
•• Continued postresuscitation monitoring and reevaluation
•• Definitive care
6. Preparation
Prehospital Phase
Airway maintenance, Control of external bleeding and shock.
Immobilization of the patient, and immediate transport to the closest appropriate facility.
Obtaining and reporting information needed for triage at the hospital.
Time of injury events related to the injury, and patient history.
Hospital Phase
Resuscitation area.
Properly functioning airway equipment.
Warmed intravenous crystalloid solutions (37c-40c) + appropriate monitoring devices.
Protocol to summon additional medical assistance + laboratory and radiology personnel.
Transfer agreements with verified trauma centers.
PPE- standard precautions (face mask, eye protection, water-impervious gown,and gloves)
7. Triage
based on the ABC
The severity of injury.
Ability to survive.
Available resources.
Multiple-casualty event
Mass-casualty event
-Advanced Trauma Life Support Student Course Manual 10th edition
-CDC, MMWR, Guidelines for Field Triage of Injured Patients:
Recommendations of the National Expert Panel on Field Triage, 2011
8. Primary Survey with
Simultaneous Resuscitation
During the primary survey, life-threatening conditions are identified and treated in a
prioritized sequence based on the effects of injuries on the patient’s physiology,
because at first it may not be possible to identify specific anatomic injuries.
• Airway maintenance with restriction of cervical spine motion.
• Breathing and ventilation.
• Circulation with hemorrhage control.
• Disability(assessment of neurologic status).
• Exposure/Environmental control.
9. Airway maintenance with restriction of cervical
spine motion.
Asking the patient for his or her name, and asking what happened.
Inspecting for foreign bodies.
Identifying facial, mandibular, and/or tracheal/laryngeal fractures and other injuries that
can result in airway obstruction.
Suctioning to clear accumulated blood or secretions.
Jaw-thrust or chin-lift.
Oropharyngeal airway.
Establish a definitive airway.
Cervical In-line stabilization.
Cervical collar.
-Advanced Trauma Life Support Student Course Manual 10th edition
-Austin N, Krishnamoorthy V, Dagal A. Airway management in cervical spine injury. Int J Crit Illn Inj Sci.
2014 Jan;4(1):50-6. doi: 10.4103/2229-5151.128013. PMID: 24741498; PMCID: PMC3982371.
10. Breathing and ventilation
Expose the patient’s neck and chest
Assess jugular venous distention.
Position of the trachea
Chest wall excursion
Tension pneumothorax, Massive hemothorax, Open pneumothorax, and tracheal or
bronchial injuries.
O2 mask-reservoir device.
Pulse oximeter to monitor.
Ask but do not stop at; Portable CXR.
NOT in Primary Survey: Simple pneumothorax, simple hemothorax, fractured ribs, flail
chest, and pulmonary contusion.
11. Circulation with hemorrhage control.
cABCDE; Catastrophic Haemorrhage Control.
Blood Volume and Cardiac Output
If there is no tension pneumothorax then consider that hypotension following injury is
due to blood loss until proven otherwise.
Evaluation:
Level of Consciousness
Skin Perfusion
Pulse
BP
Bleeding
Blood on the floor and four more
12. External hemorrhage is identified and controlled during the primary survey.
Direct manual pressure
Tourniquet: carry a risk of ischemic injury
Do NOT do Blind clamping.
Internal hemorrhage; Four More
Physical examination and imaging;
Chest x-ray, Pelvic x-ray, focused assessment with sonography for trauma [FAST], or diagnostic
peritoneal lavage [DPL].
Chest decompression, and application of a pelvic stabilizing device and/ or extremity splints.
Definitive management may require surgical or interventional radiologic treatment and pelvic and
long-bone stabilization.
Definitive bleeding control is essential, along with appropriate replacement of intravascular
13. Vascular access
Two large-bore peripheral venous catheters (g16 cannula)
Send 5 Blood samples
CBC
Blood gases and/or lactate level
Blood Group/ Xmach
Pt Ptt INR
Toxicology
+/- pregnancy test
Peripheral sites cannot be accessed
Intraosseous infusion, central venous access(Cordis catheter), or venous cutdown.
-Advanced Trauma Life Support Student Course Manual 10th edition
-Schwartz’s Principles of Surgery Eleventh Edition: chapter 7, page 183- 249
14. Aggressive and continued volume resuscitation is NOT a substitute for definitive
control of hemorrhage.
Bolus of 1 L warm (37°C to 40°C) normal saline IV
Unresponsive; activate massive blood transfusion protocol (1:1:1)
Your target is permissive hypotension
Tranexamic acid; best within 1 h of trauma, up to 3 h, followed by 2nd dose infusion
over 8 hours in the hospital.
15. Disability(assessment of neurologic status).
Patient’s level of consciousness and pupillary size and reaction.
Identifies the presence of lateralizing signs.
Determines spinal cord injury level, if present.
GCS
Decrease in a patient’s level of consciousness may indicate:
Decreased cerebral oxygenation and/or perfusion,
Direct cerebral injury
Hypoglycemia, alcohol, narcotics, and other drugs
Call neurosurgeon once a brain injury is recognized
Your main goal to Prevent secondary brain injury by maintaining adequate oxygenation and
perfusion.
16. Exposure/Environmental control
Cutting off his or her garments
Examine the anterior surface
Examine areas that not easy to access; axilla, perineum
Log rolling maneuver; Examine the back, PR.
Cover the patient with warm blankets or an external warming device.
Use only warm IV fluids.
Hypothermia one of the trauma’s lethal triad.
17. Adjuncts to the Primary Survey with
Resuscitation
Physiologic parameters such as pulse rate, blood pressure, pulse pressure,
ventilatory rate, ABG levels, body temperature, and urinary output are assessable
measures that reflect the adequacy of resuscitation. Values for these parameters
should be obtained as soon as is practical during or after completing the
primary survey, and reevaluated periodically.
It is important not to delay transfer to perform an indepth diagnostic evaluation.
19. Secondary Survey
The secondary survey does not begin until the primary survey (ABCDE) is completed,
resuscitative efforts are under way, and improvement of the patient’s vital functions
has been demonstrated.
History (Allergies, Medications, Past illnesses/Pregnancy, Last meal,
Events/Environment)
Blunt Trauma
Penetrating Trauma
Thermal Injury
Hazardous Environment
20. Physical Examination
Head
Maxillofacial Structures
Cervical Spine and Neck
Chest
Abdomen and Pelvis
Perineum, Rectum, and Vagina
Musculoskeletal System
Neurological System
29. -Resuscitative endovascular balloon occlusion of the aorta: current evidence Open Access Emerg Med. 2019; 11: 29–38. Published online 2019 Jan 14. doi: 10.2147/OAEM.S166087
-Sridhar, Srikanth MD*; Gumbert, Sam D. MD*; Stephens, Christopher MD*; Moore, Laura J. MD†; Pivalizza, Evan G. MBChB, FFASA* Resuscitative Endovascular Balloon Occlusion of the Aorta: Principles, Initial Clinical Experience, and Considerations for
the Anesthesiologist, Anesthesia & Analgesia: September 2017 - Volume 125 - Issue 3 - p 884-890 doi: 10.1213/ANE.0000000000002150
Resuscitative endovascular
balloon occlusion of the
aorta (REBOA)
30. ABDOMINAL AND PELVIC TRAUMA
Blunt
Spleen (40% to 55%)
Liver (35% to 45%)
Small bowel (5% to 10%)
Retroperitoneal hematoma
Pelvic Fractures
Penetrating
Stab wounds
Liver (40%), Small bowel (30%),
Diaphragm (20%), colon (15%)
High-energy low-energy
gunshot wounds
small bowel (50%), colon (40%),
liver (30%), and abdominal
vascular structures (25%).
33. References
Advanced Trauma Life Support Student Course Manual 10th edition
Journal of Trauma Nursing April/June 2006, Volume:13 Number 2 , page 41-44
https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries
Gunst M, Ghaemmaghami V, Gruszecki A, Urban J, Frankel H, Shafi S. Changing epidemiology of trauma deaths leads to a bimodal distribution. Proc
(Bayl Univ Med Cent). 2010 Oct;23(4):349-54. doi: 10.1080/08998280.2010.11928649. PMID: 20944754; PMCID: PMC2943446.
CDC, MMWR, Guidelines for Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage, 2011
Austin N, Krishnamoorthy V, Dagal A. Airway management in cervical spine injury. Int J Crit Illn Inj Sci. 2014 Jan;4(1):50-6. doi: 10.4103/2229-5151.128013.
PMID: 24741498; PMCID: PMC3982371.
Schwartz’s Principles of Surgery Eleventh Edition: chapter 7, page 183- 249
Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC,
Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017 Jan
1;80(1):6-15. doi: 10.1227/NEU.0000000000001432. PMID: 27654000.
Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension N Engl J Med 2016; 375:1119-1130, DOI: 10.1056/NEJMoa1605215
https://www.grepmed.com/images/2422/echocardiogram-tamponade-clinical-cardiac-pocus
Resuscitative endovascular balloon occlusion of the aorta: current evidence Open Access Emerg Med. 2019; 11: 29–38. Published online 2019 Jan
14. doi: 10.2147/OAEM.S166087
Sridhar, Srikanth MD*; Gumbert, Sam D. MD*; Stephens, Christopher MD*; Moore, Laura J. MD†; Pivalizza, Evan G. MBChB, FFASA* Resuscitative
Endovascular Balloon Occlusion of the Aorta: Principles, Initial Clinical Experience, and Considerations for the Anesthesiologist, Anesthesia & Analgesia:
September 2017 - Volume 125 - Issue 3 - p 884-890 doi: 10.1213/ANE.0000000000002150
34. Thank you
Supervised by:
Prof. Mahmoud Abu-Ebeeleh
Cardiothoracic surgery consultant
Done by:
Dr. Faisal Rawagah
Critical Care Fellow
Jordan University Hospital 17.03.2022