Atls presentation
Download as PPTX, PDF4 likes5,131 views
This document provides an overview of Advance Trauma Life Support (ATLS) principles from a presentation. It discusses the importance of the "golden hour" in trauma care. The objectives of ATLS are to prioritize patient assessment and management. It covers the basics of trauma assessment including preparation, triage, primary survey, resuscitation, secondary survey, and transfer to definitive care. The primary survey focuses on addressing life threats in order of airway, breathing, circulation, disability and exposure.
Atls presentation
- 1. ADVANCE TRAUMA LIFE SUPPORT(ATLS) PRESENTER: DR RAVI BHUSHAN MODERATOR : DR NEERAJ DHAMEEJA SIR GANGARAM HOSPITAL NEW DELHI
- 2. This focus on urgent problems is first captured by the “Golden hour” catch phrase and is one of the most important lessons of ATLS
- 3. Objectives: To identify – the sequence of priorities in the early assessment of the injured patient To learn – the principle of triage in immediate management of the injured patient To apply- the principles of primary and secondary surveys in the assessment and management of trauma Techniques for the initial resuscitative and definitive care aspects of trauma To recognize-patients whose managements should differ from the normal
- 5. Basics of Trauma Assessment Preparation – Team Assembly – Equipment Check Triage Primary Survey Resuscitation Secondary Survey Monitoring and Evaluation, Secondary adjuncts Transfer to Definitive Care
- 6. The steps in the ATLS principles: Primary survey with simultaneous resuscitation : identify and treat what is killing the patient Secondary survey: proceed to identify all other injuries Definitive care: develop a definitive management plan
- 7. TRIAGE The process of categorizing victims of mass casualties based on their need for treatment and the resources available MAIN GOALS : Prevent avoidable deaths. Ensure proper initial treatment with a minimal time frame. Avoid misusing assests on hopeless cases
- 8. TRIAGE
- 9. Multiple Casualties Vs Mass Casualties
- 10. PRIMARY SURVEY What is the quick ,simple way to assess the trauma patient in 10 seconds? 1. Airway is patent. 2. Breathing intact. 3. Good cerebral circulation
- 11. PRIMARY SURVEY Airway and Protection of Spinal Cord Breathing and Ventilation Circulation Disability Exposure and Control of the Environment
- 12. PRIMARY SURVEY Airway and Protection of Spinal Cord Why first in the algorithm? – Loss of airway can result in death in < 3 minutes – Prolonged hypoxia = Inadequate perfusion, End-organ damage Airway Assessment – Vital Signs = RR, O2 sat – Mental Status = Agitation, Coma – Airway Patency = Secretions, Stridor, Obstruction – Ventilation Status = Accessory muscle use, Retractions, Wheezing
- 13. PRIMARY SURVEY Clinical – Patients who are speaking normally generally do not have a need for immediate airway management – Hoarse or weak voice may indicate a subtle tracheal or laryngeal injury – Noisy respirations frequently indicates an obstructed respiratory pattern
- 14. AIRWAY MANAGEMNT Maintenance of Airway Patency –Suction of Secretions –Chin Lift/Jaw thrust –Nasopharyngeal Airway –Definitive Airway
- 15. AIRWAY MANAGEMNT Airway Support – Oxygen – Bag Valve Mask Definitive Airway – Endotracheal Intubation In-line cervical stabilization – Surgical Crichothyroidotomy
- 16. AIRWAY MANAGEMNT Needle- Cricothyroidotomy • Insertion of a needle through the cricothyroid membrane or Into the trachea • provide temporary, supplemental oxygenation so that intubation can be accomplished on an urgent rather than an emergent basis.
- 17. Surgical- Cricothyroidotomy Palpate the thyroid notch, cricothyroid interval, and the sternal notch for orientation. Make a transverse skin incision over the cricothyroid membrane and carefully incise through the membrane transversely. Insert hemostat or tracheal spreader into the incision and rotate it 90 degrees to open the airway. Insert a proper-size, cuffed endotracheal tube or tracheostomy tube into the cricothyroid membrane incision, directing the tube distally into the trachea.
- 18. Breathing and Ventilation General Inspection (Look) Absence of spontaneous breathing Paradoxical chest wall movement Auscultation to assess for gas exchange Diminished or Absent breath sounds Palpation (FEEL) Deviated Trachea Broken ribs Injuries to chest wall
- 19. Breathing and Ventilation 100% Oxygen administration to all trauma patients at high flow Identify and manage life threatening problems first Tension pneumothorax – needs immediate decompression with needle insertion or chest tube insertion Cardiac temponade – Pericardiocentesis Massive hemothorax(>1.5L of blood) -insertion of chest drain tube Open pneumothorax Flail chest with pulmonary contusion
- 20. Breathing and Ventilation Needle Thoracostomy – Midclavicular line – 14 gauge angiocath – Over the 2nd rib – Rush of air is heard
- 22. Chest Tube Insertion STEP1. Determine the insertion site, usually at the nipple level (fifth intercostal space), just anterior to the midaxillary line on the affected side. A second chest tube may be used for a hemothorax. STEP2. Surgically prepare and drape the chest at the predetermined site of the tube insertion. STEP3. Locally anesthetize the skin and rib periosteum. STEP4. Make a 2- to 3-cm transverse (horizontal) incision at the predetermined site and bluntly dissect through the subcutaneous tissues, just over the top of the rib.
- 23. Chest Tube Insertion STEP5. Puncture the parietal pleura with the tip of a clamp and put a gloved finger into the incision to avoid injury to other organs and to clear any adhesions, clots, and so on. Once the tube in the proper place, remove the clamp from the tube. STEP6. Clamp the proximal end of the thoracostomy tube and advance it into the pleural space to the desired length. The tube should be directed posteriorly along the inside of the chest wall.
- 24. Chest Tube Insertion STEP7. Look for “fogging” of the chest tube with expiration or listen for air movement. STEP8. Connect the end of the thoracostomy tube to an underwater-seal apparatus. STEP9. Suture the tube in place. STEP10. Apply an occlusive dressing and tape the tube to the chest. STEP11. Obtain a chest x-ray film. STEP12. Obtain arterial blood gas values and/or institute pulse oximetry monitoring as necessary.
- 25. Circulation Shock The first step in the initial management of shock in trauma patients is to recognize its presence ?Is the patient in ? “Any injured patient who is cool and has tachycardia is considered to be in shock until proven otherwise”
- 26. Circulation Clinical Signs of Shock Altered mental status Tachycardia (HR > 100) Most common sign Arterial Hypotension (SBP < 90) Inadequate Tissue Perfusion Pale skin color , Cool clammy skin ,Delayed cap refill (> 3 seconds) , LOC , Decreased Urine Output (UOP < 0.5 ml/kg/hr) Reliance solely on systolic blood pressure as an indicator of shock can result in delayed recognition of the shock state.
- 27. Circulation The second step in the initial management of shock is to identify the probable cause of the shock state. What is the cause of shock? Hemorrhagic Shock Nonhemorrhagic Shock Cardiogenic Shock NeurogenicShock
- 28. Most injured patients in shock have hypovolemia, but they may suffer from cardiogenic, obstructive, neurogenic, and, rarely, septic shock Hemorrhage is the most common cause of shock in the injured patient
- 29. THANK YOU
Editor's Notes
- #5: ATLS is focused mainly at Early group of patients
- #10: Multiple: No. of patients and the severity of their injuries do not exceed the ability of the facility to provide care
- #11: A copmlete sentence spoken by pt. tells us:
- #17: The jet insufflation technique is performed by placing a large-caliber plastic cannula, 12- to 14-gauge for adults, and 16- to 18-gauge in children, through the cricothyroid membrane into the trachea below the level of the obstruction (n FIGURE2-15). The cannula is then connected to oxygen at 15 L/min (40 to 50 psi) with a Y-connector or a side hole cut in the tubing between the oxygen source and the plastic cannula 1 second on and 4 seconds off, can then be achieved by placing the thumb
- #19: Airway patency alone does not ensure adequate ventilation. Adequate gas exchange is required to maximize oxygenation and carbon dioxide elimination.
- #25: Complications of Chest Tube Placement Injury to intercostal nerve, artery, vein Injury to lung Injury to mediastinum Infection Allergic reaction to lidocaine Inappropriate placement of chest tube
- #28: Hemorrhage is the most common cause of shock after injury