Pitfalls in ATLS 2007-12
- 1. Pitfalls in ATLS ธเนศ รังษีขจี
- 2. ATLS Advanced Trauma Life Support 7 th Edition
- 3. ATLS PROVIDES A COMMON LANGUAGE
- 5. THE BEGINNING DR. JAMES STYNER’S PLANE CRASHED IN RURAL NEBRASKA IN FEBRUARU 1976 3 OF 4 SUSTAINED SERIOUS HEAD INURIES
- 6. DR. JAMES STYNER. MD,FACS - 1977 BETTER CARE IN THE FIELD WITH LIMITED RESOURCES SOMETHING WRONG WITH THE SYSTEM AND THE SYSTEM HAS TO BE CHANGED
- 7. TRIMODAL DEATH DISTRIBUTION IMMEDIATE DEATH EARLY DEATH FIRST 1-4 HOURS LATE DEATH 2 ND – 5 TH WEEK
- 9. ATLS Concept ABCDE -approach to evaluation/treatment Treat greatest threat to life first Definite diagnosis not immediately important Time is of the essence Do no further harm
- 10. ATLS Concept A Airway with C-spine protection B Breathing ; Ventilation/Oxygenation C Circulation ; Stop bleeding D Disability ; Neurological status E Expose / Environment / Body temperature
- 11. Committee on Trauma Presents Initial Assessment and Management
- 12. Initial Assessment and Management Principles Primary Survey Secondary Survey Priority Management Resuscitate and Monitor procedures Patient’s History / Biomechanics of Injury Anticipate Pitfalls
- 13. Pitfalls What is a quick , simple way to assess the patient in 10 seconds ? How can I minimized the missed injuries ? Which patients do I transfer to a Higher levels of care ? When should the transfer occur ?
- 14. Quick / Simple to assess the patient Identify yourself Ask the patient his / her name Ask the patient what happened
- 16. GCS Glasgow Coma Score Mild Brain Injury 14 – 15 Moderate 9 – 13 Severe 3 - 8 AVPU *#* Alert Verbal response to voice Painful Unresponse
- 17. Concept of Initial Assessment Primary Survey A Airway with C-spine protection B Breathing ; Ventilation/Oxygenation C Circulation ; Stop bleeding D Disability ; Neurological status E Expose / Environment / Body temperature
- 18. Concept of Initial Assessment ABCDE Patent Airway Suffidient Air Reserve to permit speech Clear Sensorium
- 19. ADJUNCT to Primary Survey FAST Focus Assessment Sonography in Trauma
- 20. THORACIC TRAUMA BECK’S TRIAD Elevate venous pressure Decline in arterial pressure Muffling heart sound CARDIAC INJURY
- 21. TENSION PNEUMOTHORAX DYSPNEA ELEVATE VENOUS PRESSURE DECLINE IN ARTERIAL PRESSURE TRACHEA SHIFT TO OPPOSIT
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- 29. SECONDARY SURVEY The Complete History and Physical Examination Starts after ….. Primary Survey is complete ABCDEs are Reassessed Vital functions are returning to Normal
- 37. REEVALUATION Aims ; Minimized Missed injuries High Index of Suspecious Frequent Reevaluation and Monitoring
- 38. ADJUNCT
- 40. DEFINITIVE CARE Which patient do I transfer to another Hospital for Definite Care ? Multisystem or Complex Injuries Comorbidity or AGE Extremes
- 42. ST0P BLEEDING
- 46. THANK YOU