ATLS Advanced Trauma Life Support

Seminar prepared by : Stephanie Ammari .

Trauma

Trauma deaths have a trimodal distribution

Overall approach to trauma care

I. PREHOSPITAL CARE.

II. Primary Survey.

III. ADJUNCTS TO THE PRIMARY SURVEY.

IV. SECONDARY SURVEY.

I. Prehospital Care

1) Emergency medical services Evaluation The MVIT (mechanism, vital signs, injury inventory, treatment)

system

2) Prehospital Treatment .

3) Preparation of the Trauma Bay .

Primary Survey

• Aims to identify & manage the most immediately life-threatening pathologies first & follows

c :

A:

B:

C:

D:

E:

• First thing when you encounter a trauma patient is to speak to him ….

A complete sentence spoken by the patient tells you that :

1. airway is patent

2. breathing is intact

3. Good cerebral circulation

Airway

1. Basic maneuvers.

Jaw thrust

oropharyngeal airway

Nasopharyngeal airway

Caution

Airway

2. Tracheal intubation .

is indicated in any patient in whom concern for airway

integrity exists

3. Cricothyrotomy . establishing a surgical airway in adults after unsuccessful orotracheal attempts or with massive facial trauma.

4. Percutaneous transtracheal ventilation

Breathing

• Signs of Dysfunctional Breathing

Pneumothorax

• Tension , simple & open .

• Definition …

• Signs of tension pneumothorax …

• Management

Hemothorax

• Definition …

• Signs …

• Management …

Flail Chest

• Definition

• Paradoxical chest wall motion with spontaneous respirations indicates a flail chest .

• Pulmonary contusion often accompanies such an injury.

• Chest x-ray …

Tracheobronchial disruption

Severe subcutaneous emphysema with respiratory compromise is suggestive .

Diagnosis

Treatment

Circulation

• Identify & treat SHOCK .

• Pulse , BP , Skin perfusion : CRT & temperature .

• Obvious fractures are stabilized …

1. Hemorrhagic Shock

• Classification

• Control external bleeding

• Access

• Resuscitation.

Rapid resuscitation without hemorrhage control worsens the “lethal

triad” of hypothermia, acidosis, and coagulopathy .

• Internal hemorrhage control.

Internal hemorrhage control

1. Pelvic Hemorrhage

2. The emergency department thoracotomy (EDT)

3. Resuscitative endovascular balloon occlusion of the aorta (REBOA)

EDT

2. Cardiogenic shock

• Presentation

• Cardiac Tamponade

3. Neurogenic shock

• Presentation

• Management

Disability

• Glasgow Coma Scale score is determined

• A thorough neurologic exam includes evaluation of pupillary response, ability to follow commands, and gross asymmetry of limb movement to painful stimuli.

• Neurosurgical consultation

Exposure with Environmental Control

• complete visual inspection of the injured patient while preventing excessive heat loss.

• Remove all clothing

• Logroll the patient to examine the back …

Palpate along thoracic & lumber spine

Rectal examination should be performed to assess for rectal tone and blood.

• resuscitation room should be kept warm and the patient promptly covered with warm blankets.

III. ADJUNCTS TO THE PRIMARY SURVEY

A. Cervical ,Chest and Pelvic Radiographs

B. FAST .

C. Invasive monitoring . 1. Respiratory Status (ABGs , End tidal Co2 monitoring )

2. Urine output ( Foley Catheter ) Contraindication for Foley placement without radiographic confirmation of

an intact urethra …

• No patient with abnormal vital signs should proceed to secondary survey …

IV. SECONDARY SURVEY

• It is a complete head-to-toe examination of the patient designed to inventory all injuries sustained in the trauma.

Questions …