2. OBJECTIVE
Identify the correct sequence of priorities
for assessment of a multiply injured pt.
Apply the principles outlined in primary
and secondary evaluation surveys of
ATLS.
Apply guidelines and techniques in the
initial resusitative and definitive care
phases of treatment.
3. ATLS
PREPARATION AND TRIAGE.
PRIMARY SURVEY
RESUSITATION
ADUNCTS TO PRIMARY SURVEY
CONSIDER NEED FOR PATIENT TRANSFER
SECONDARY SURVEY
ADJUCTS TO SECONDARY SURVEY
CONTINUED POSTRESUSITATION AND
REEVALUATION OF THE PATIENT.
DEFINITIVE CARE.
4. PREPARATION
•PREHOSPITAL PHASE
•HOSPITAL PHASE
PREHOSPITAL PHASE:
Coordination with the prehospital agency and personel
can greatly fasten the treatment in the field. They inform
the receiving hospital which mobilizes the trauma team to
ED.
HOSPITAL PHASE
Advance planning for the trauma pt. beneficial. It saves
time.
5. TRIAGE
The process of categorizing victims or mass
casualties based on their need for
treatment and the resources available.
ITS MAIN GOALS ARE.
Prevent avoidable deaths.
Ensure proper initial treatment with a
minimal time frame.
Avoid misusing assests on hopeless cases.
6. Multiple casualties
No. of patients and the severity of their
injuries do not exceed the ability of the
facility to provide care.
MASS CASUALTIES
The no. of patients and the severity of
their injuries exceed the ability of the
facility to provide care.
7.
8. PRIMARY SURVEY
What is the quick ,simple way to assess
the trauma patient in 10 seconds?
A comlete sentence spoken by pt. tells us:
1. Airway is patent.
2. Breathing intact.
3. Good cerebral circulation.
9. AIRWAY MAINTAINENCE
WITH C-SPINE PROTECTION
Assess for obstruction, foreign bodies, facial
fractures, bleeding causing airway
compromise… begin measures to establish
airway.
PITFALLS
Recognize impending obstruction early before
intubation becomes too difficult.
If unable to control airway surgical airway is
must.
Unknown tracheal or laryngeal disruption.
19. BREATHING
Inspection
Auscultation
Palpation
Percussion
Identify and manage life threatening problems
first
• Tension pneumothorax
• Cardiac temponade
• Massive hemothorax
• Open pneumothorax
• Flail chest with pulmonary contusion
20. maneuvers
Bag and mask ventilation
Needle thoracocentesis
Pericardiocentesis
Chest tube intubation
21. CIRCULATION AND
HEMORRHAGE CONTROL
Assess for:
Shock
External bleeding
Occult bleeding
Estimate the blood loss on initial
presentation of patient and the signs
and symptoms
Replace fluid accordingly, 2 litres of
warm crystalloid solution.
22. DISABILITY
GCS
PUpillary reaction and size
EXPOSURE
Undress the patient completely but
prevent hypothermia.
Logrolling and looking for back of the pt.
is very important.
23.
24. ADJUCTS TO PRIMARY
SURVEY AND
RESUSSITATION
ECG
PULSE OXIMETRY
Xray chest AP view
Xray pelvis AP view
URINARY CATHETER
GASTRIC CATHETER
BLOOD PRESSURE
ABGS
FAST
DPL
26. SECONDARY SURVEY
Secondary survey does not begin until the primary
survey is completed,resuscitative efforts are
established and patient is demonstrating
normalization of vital functions.
It includes:
Head to toe evaluation
AMPLE history
• Allergy
• Medications currently taking
• Past illness
• Last meal
• Event/environment related to injury.
physical examination
Reassessment of all vital organs.
29. DEFINATIVE CARE
AFTER identifying the patients injury.
Managing life threatening problems
Obtaining special studies.
If the patients injuries exceed the
capabilities of the institution.
30. Take home message
1. ABCDE APPROACH.
2. TREAT GREATEST THREAT TO LIFE.
3. DEFINITIVE DIAGNOSIS IS NOT
IMMEDIATELY IMPORTANT.
4. TIME IS THE ESSENCE.
5. DO NO FURTHER HARM THE
PATIENT
31.
32.
33. CASE
A 20 year old woman is found trapped in
her automobile. Several hours are
required to extricate her because her leg
was trapped and twisted beneath the
dash board. In the hospital she is
hemodynamically unstable with pulse of
120bpm, r/r 14, bp 80mmhg systolic
only, she has a large wound in her left
leg which is bleeding profusely..