Advanced Trauma Life Support- An overview

ADVANCED TRAUMA
LIFE SUPPORT (ATLS)
AANN OOVVEERRVVIIEEWW
A
P
O
L
L
O
L
O
G
A

DR.B.SELVARAJ,MMSS;;MMcchh;;FFIICCSS;;
• General & Pediatric Surgeon
• Endoscopist & Laparoscopic Surgeon
• Apollo Loga Hospital
• Karur
•India
A
P
O
L
L
O
L
O
G
A

ADVANCED TRAUMA
LIFE SUPPORT
•ATLS In US
•EMST In Australia
•PTC In UK
•Most Countries having an epidemic of trauma
•In India one of the major killer is trauma 60,000
deaths/year ; In TN5000/year
A
P
O
L
L
O
L
O
G
A

AATTLLSSOOBBJJEECCTTIIVVEESS
•To rapidly accurately assess trauma patients
•Early recognition timely intervention of life
threatening conditions
•To resuscitate stabilise trauma patients
•To understand the priorities in trauma management
Triage
•To organise quality trauma care in your hospital
A
P
O
L
L
O
L
O
G
A

TRAUMA MANAGEMENT
Six Phases
• Access Phase
• Pre hospital Triage Phase
• Early Hospital or Resuscitation Phase
• Operative Phase
• Intensive care Phase
• Rehabilitative Phase
A
P
O
L
L
O
L
O
G
A

ATLS TRIMODAL DEATH
By Arnold D.Trunkey
• Within Seconds to Minutes
Brainstem injury
Aortic rupture
• Within Minutes to Hours
Sub dural Hematoma
Rupture of Liver Spleen
• Within Days to Weeks
Sepsis MODS
A
P
O
L
L
O
L
O
G
A

AATTLLSS
• Emergency life saving precedes examination of
trauma patients
• Once immediate survival is achieved definitive
assessment treatment begins
• Priorities in management must always be salvage of
Life, Limb, Function Cosmetic
A
P
O
L
L
O
L
O
G
A

Pre Hospital Trauma Life Support
•Scene size up Extrication
•Primary Survey Basic Life Support
•Spinal Protection in LSB
•Splinting Extremities
•Control of External Hemorrhage
•Aim: To Stabilize the Patient Platinum 10
Minutes
•Load Go within Golden first hour
A
P
O
L
L
O
L
O
G
A

Field Triage- CCoolloorr CCooddiinngg
•Triage- sorting of patients by injury severity and
need for transport
•RED-most critically injured-immediate transfer to
hospital
•YELLOW-less critically injured-delayed transfer
to hospital without endangering life
• GREEN-No life/limb threatening injury- patient
ambulatory-may not need IP treatment
•BLACK- Dead patient
A
P
O
L
L
O
L
O
G
A

ATLS-SSPPIINNAALL PPRROOTTEECCTTIIOONN
A
P
O
L
L
O
L
O
G
A

OOvveerrvviieeww ooff AATTLLSS
Primary Survey
(ABCDE's)
Resuscitation
Secondary Survey
Data / Information /
Response to Therapy
Definitive Care
A
P
O
L
L
O
L
O
G
A

AATTLLSSPPRRIIMMAARRYY SSUURRVVEEYY
•A- Airway Cervical Spine Control
•B-Breathing Ventilation
•C-Circulation Hemorrhage Control
•D-Disability Neurological Status
•E-Exposure Completely undress the patient
A
P
O
L
L
O
L
O
G
A

ATLS—PRIMARY SURVEY
Airway Cervical Spine Control
•Chin lift or Jaw Thrust
•Removal of FB,Blood Vomitus
•Oropharyngeal or Nasopharyngeal Airway
•Intubate With E T T
•Cricothyroidotomy
•Keep the neck immobilised
A
P
O
L
L
O
L
O
G
A

CHIN LLIIFFTT JJAAWW TTHHRRUUSSTT
A
P
O
L
L
O
L
O
G
A

ENDOTRACHEAL IINNTTUUBBAATTIIOONN
A
P
O
L
L
O
L
O
G
A

CCRRIICCOOTTHHYYRROOIIDDOOTTOOMMYY
A
P
O
L
L
O
L
O
G
A

ATLS-PRIMARY SURVEY
Breathing Ventilation
• Airway patency doesn’t assure adequate
ventilation- Look for bilateral breath sounds
• To ensure adequate oxygenation start Ambu bag
or ETT ventilation—FIO2 0.85
• Decompress Tension Pneumothorax
• Close open Chest Injury
• IPPV in large Flail Chest
A
P
O
L
L
O
L
O
G
A

BAG MMAASSKK VVEENNTTIILLAATTIIOONN
A
P
O
L
L
O
L
O
G
A

ATLS-PRIMARY SURVEY
Circulation Hemorrhage Control
•Post Traumatic Hypotension:
Hypovolemia
•Conscious PatientEnough blood for
cerebral perfusion
•Capillary Refill 2 seconds
•Pale Cold SkinBlood Volume Loss
30%
A
P
O
L
L
O
L
O
G
A

SURVEY
ATLSPRIMARY Circulation Hemorrhage Control
•Rapid Thready Pulse Hypovolemia
•Absent Pulse CPR
•External Exsanguinating Hemorrhage controlled
with MAST/ PASG, Never use Tourniquets
A
P
O
L
L
O
L
O
G
A

ATLS-PRIMARY SURVEY
Disability Neurological Status
•AVPU Describes Patient`s Level of
Consciousness
•A Alert
•V Responds to vocal stimuli
•P Responds to painful stimuli
•U Unresponsive
•GCS to be done in secondary survey
A
P
O
L
L
O
L
O
G
A

Common Life Threatening PPaatthhoollooggyy
A = Airway
B = Breathing
C = Circulation
Obstruction
Tension PTX or HTX
Open PTX
Flail Chest
Hypovolemic Shock
Massive hemorrhage
Spinal Shock
A
P
O
L
L
O
L
O
G
A

AATTLLSS--RREESSUUSSCCIITTAATTIIOONN
• Start 2 Large Bore IV Lines
• Infuse Crystalloids 2 to 3 Litres
• Then Transfuse Type Specific WB or O-ve Packed
RBCs
• Tissue Aerobic Metabolism is assured by Perfusion with
well oxygenated RBCs
• Never treat Hypovolemic Shock with Vasopressors,
Steroids or NaHco3
A
P
O
L
L
O
L
O
G
A

AATTLLSS --RREESSUUSSCCIITTAATTIIOONN
•CBD NGT aspiration if not contraindicated
•Careful ECG Monitoring Correction of
Arrhythmias
•Data Flow sheet of Vital Parameters to assess
effectiveness of Resuscitation
•Reevaluate Airway, Breathing and
Circulation. If needed CPR
A
P
O
L
L
O
L
O
G
A

Adjuncts ttoo PPrriimmaarryy SSuurrvveeyy
•Vital Signs/ECG monitoring
•ABGs
•POX/ETCO2
•Urinary/gastric catheters
•Urinary output
•Supplemental Oxygen
A
P
O
L
L
O
L
O
G
A

Adjuncts ttoo PPrriimmaarryy SSuurrvveeyy
•Diagnostic tools
•CXR, C-spine, Pelvis
•DPL
•Ultrasound FAST
A
P
O
L
L
O
L
O
G
A

SSeeccoonnddaarryy SSuurrvveeyy
•Secondary Survey does not begin until the
primary Survey( ABCDEs) is completed,
resuscitative efforts are well established, and
patient is demonstrating normalisation of vital
functions
A
P
O
L
L
O
L
O
G
A

ATLSSSEECCOONNDDAARRYY SSUURRVVEEYY
•Head and Skull
•Faciomaxillary Injuries
•Neck
•Chest Spine
•Abdomen
A
P
O
L
L
O
L
O
G
A

ATLSSSEECCOONNDDAARRYY SSUURRVVEEYY
•Perineum/ Rectum/ Vagina
•Extremities Fractures
•Complete Neurological Exam GCS
•Appropriate X-Rays, Lab Tests and Special
Studies
•“Tubes fingers” in every orifice
A
P
O
L
L
O
L
O
G
A

ATLS PPaattiieenntt``ss HHiissttoorryy
•A Allergies
•M Medications Currently Taken
•P Past Illness
•L Last Meal
•E Events/ Environment related to injury
A
P
O
L
L
O
L
O
G
A

ATLSMechanism ooff IInnjjuurryy
• Blunt Trauma
- Front Impact Myocardial contusion,
Pneumothorax, Flail Chest, Cervical Spine#
- Side Impact.# Spleen or Liver,# Pelvis, Flail
Chest, Opposite Cervical Spine Sprain/ #
-Rear Impact Whiplash Injury Cervical Spine
-Ejection from Vehicle Multiple Injuries
• Penetrating Trauma
-Sharp objects, Missiles
A
P
O
L
L
O
L
O
G
A

FFRROONNTT IIMMPPAACCTT
A
P
O
L
L
O
L
O
G
A

SIDE IMPACT PEDESTRIAN
INJURY
A
P
O
L
L
O
L
O
G
A

RReeeevvaalluuaattiioonn
•Minimizing missed injuries
•high index of suspicion
•frequent reevaluation and continuous monitoring
A
P
O
L
L
O
L
O
G
A

ATLSDDeeffiinniittiivvee CCaarree
•Comprehensive Treatment of all Injuries
•Fracture Stabilisation
•Necessary Operative Intervention
•Appropriate Intensive Care
•Rehabilitation
•Stabilisation Appropriate Transfer
A
P
O
L
L
O
L
O
G
A

AATTLLSSTTRRIIAAGGEE
• Sorting of patients based on severity of injuries
and availability of resources
•Number of patients severity of injuries do not
exceed facility multiple casualties treat the
most critically injured first
•The same exceed the facility Mass casualties
treat as many as salvageable patients as possible
A
P
O
L
L
O
L
O
G
A

AATTLLSSSSKKIILLLL SSTTAATTIIOONNSS
•Airway Management
•Vascular access and Fluid Resuscitation
•ECG Monitoring CPR including defibrillation
•Pediatric Priorities
•Transport of Critically Ill Patients
•Disaster Management
A
P
O
L
L
O
L
O
G
A

IINNTTRRAAOOSSSSEEOOUUSS NNEEEEDDLLEE
A
P
O
L
L
O
L
O
G
A

DDIISSAASSTTEERR MMAANNAAGGEEMMEENNTT
A
P
O
L
L
O
L
O
G
A

Roles ooff tthhee TTrraauummaa TTeeaamm
Airway
Nurse
Boss
Team Member
Attending
Team Member
Nurse
A
P
O
L
L
O
L
O
G
A

Things to remember0
The Ideal Trauma Resuscitation
•Roles are pre-assigned Multidisciplinary team
•Clear direction communication
•Pertinent findings verbalized in proper order
•All team members know all findings
•Rapid, Efficient
•Calm Quiet!
A
P
O
L
L
O
L
O
G
A

CARRY HOME MESSAGE
“Joining Together is Beginning
Staying Together is Progress
Working Together is Success”
A
P
O
L
L
O
L
O
G
A

Advanced Trauma Life Support- An overview

More Related Content

What's hot (20)

Viewers also liked (20)

Similar to Advanced Trauma Life Support- An overview (20)

More from Selvaraj Balasubramani (20)

Recently uploaded (20)

Advanced Trauma Life Support- An overview