2. History Introduced by Dr. James Styner, an orthopedic surgeon in 1970s. Now considered the ‘Gold standard’ in initial management and resuscitation of trauma cases.
5. Aims of ATLS Primary survey – To identify what is KILLING the patient. Resuscitation – To treat what is killing the patient. Secondary survey – To identify all other injuries. Definitive care – Develop a definitive management plan.
6. Pre hospital care Objectives – assessment of the injury scene; stabilization and monitoring of the injured patient; and safe and rapid transportation of critically ill patients to the appropriate trauma center.
9. Primary survey A – Airway with cervical spine control B – Breathing C – Circulation D – Disability E - Exposure
10. Airway Establishing a patent airway is highest priority. To prevent irreversible brain damage . A patient who is able to respond verbally has a patent airway. For every patient - Oxygen administered (via nasal cannula or bag valve facemask) and an oxygen saturation monitor (i.e., pulse oximeter) placed.
12. Airway (contd.) Basic maneuvers Simple suctioning. Jaw-thrust maneuver. Oropharyngeal airway. Tracheal intubation indicated in any patient in whom concern for airway integrity exist. Adequacy of ventilation should be verified .
13. Airway (contd.) Direct cricoid membrane airways. Cricothyrotomy is the method of choice . Percutaneoustranstracheal ventilation.
14. Breathing Once an airway is established, attention is directed at assessing the patient's breathing . The chest wall motion is observed and axillae are auscultated to check delivery to the peripheral lung. Life threats Tension pneumothorax Pneumothorax/hemothorax Flail chest Open pneumothorax
17. Circulation To identify and treat the presence of shock in the patient. Initially, all active external hemorrhage is controlled with direct pressure. The pulse is characterized, and a blood pressure (BP) is obtained. Shock is defined as the inadequate delivery of oxygen and nutrients to tissue.
19. Hypovolemic shock Most common in trauma(Haemmorhagic shock). Decreased intravascular volume secondary to blood loss . S/S - rapid pulse, decreased pulse pressure, diminished capillary refill, and cool, clammy skin.
20. Management two large-bore intravenous lines placed (14- or 16-gauge). The antecubital veins are the preferred sites. A blood specimen should be simultaneously obtained for cross-matching. Resuscitation should consist of an initial bolus of 2 L of a balanced salt solution, typically Ringer's solution.
21. Classification of hypovolemicShock Class EBLTreatment I <15% (<750ml) Fluids II 15-30% (750-1.5L) Fluids III 30-40% (1.5L-2.0L) Fluids + Blood IV >40% (>2.0L) Fluids + Blood
22. Cardiogenic shock heart is unable to provide adequate cardiac output. In the trauma setting, such shock can occur in one of two ways: (1) extrinsic compression of the heart or (2) myocardial injury causing inadequate myocardial contraction and decreased cardiac output.
23. Management I.V. fluids E.C.G. Chest x ray Tube thoracostomy if tension pneumothorax is the cause.
24. Distributive shock as a result of an increase in venous capacitance leading to decreased venous return. Loss of peripheral sympathetic tone is responsible. often respond to an initial fluid bolus but will eventually require pharmacologic support. Phenylephrine is the drug of choice.
25. Disability Assessment of the neurologic status. to identify and treat life-threatening neurologic injuries. Intracranial injuries(Mannitol, 0.25–1.00 g/kg) Spinal cord injuries(methylprednisolone) Neurosurgical consultation.
26.
27. Exposure Last step Exposure with environmental control. Remove clothes and look for other dangerous injuries.
28. Completion of primary survey Monitoring. Laboratory values. Adequacy of resuscitation. Radiographic investigations. FAST(focussed abdominal sonography for trauma) CT SCAN.
30. Secondary surveyKEY COMPONENTS History Complete head-to-toe examination “Tubes and Fingers in every orifice” Complete Neuro exam Special diagnostic tests Reevaluation
31. HISTORY A Allergies MMedications PPast Medical/Surgical History/Pregnancy LLast meal EEvents/Environment related to injury
39. Neurologic Spine/Cord: complete motor and sensory exams reflexes imaging as indicated CNS: frequent reevaluation prevent secondary brain injury Early neurosurgical consultation
40. Definitive care Definitive hospital care is undertaken . Ranging from emergent celiotomy to admission and further assessment. Diagnostic evaluations are completed and therapeutic interventions performed.
41. Roles of the Trauma Team Airway Nurse Team Member Team Member Boss Attending Nurse
42. Roles of the Trauma Team Boss Directs the team, communicates decisions Free to roam Attending speaks through Boss (or teaches directly)
43. Roles of the Trauma Team Airway A & B of primary survey Intubation (if needed) Head / Neck in secondary survey Nurses Attach monitors, give blood / fluids / meds Recording nurse records at foot of bed
44. Roles of the Trauma Team Team Members Expose, examine (secondary survey) Procedures as directed (by boss) Chest Tubes Lac repairs Rectals, foleys routinely assigned to team member.
