advance trauma life support

adls by kainat gulalai

1. Advanced
trauma life
support
ATLS
Trauma:
The cellular disintegration with superadded
cell death due to environmental energy transfer
which is beyond body resistance

2. Definitions
Golden hour
Steps in ATLS philosophy
FAST
Triage
Outcomes

3. ATLS provider team
Golden Hour
Golden hour refers to a time
period lasting one hour or less
following traumatic injury during
which there is highest possibility
that adequate treatment will
prevent death
ATLS
ATLS provides a structured approach
to the trauma patients with
standardized algorithms of care it
emphasizes the golden hour concept
that timely prioritized interventions are
necessary to prevent death and
disability
Trauma team is made up of a Group of
DOCTORS, NURSES, OPERATING DEPARTMENT ASSISTANTS , RADIOGRAPHERS AND OTHER SUPPORT PERSONNEL.

1) VERTICAL ORGANIZATION
One Doctor can look safely for a multiple injured patients.
2) HORIZONTAL ORGANIZATION
more than one member is available as a staff for patient.
ATLS

4. There are 3 steps ;
PRIMARY SURVEY
SECONDARY SURVEY
TERTIARY SURVEY
STEPS IN ATLS PHILOSOPHY
Click here to add your title

5. PRIMARY
SURVEY
•To identify and treat what is killing
the patient
•GOLDEN HOUR concept is used here
It has 5 components
A: Airway maintenance with cervical
protection
B: Breathing and ventilation
C: Circulation and hemorrhagic control
D: Disability/neurological status
E: Exposure/ environmental control

6. AIRWAY AND
CERVICAL SPINE
Evaluation:
Asking name--> conscious -->
airway is potent
Unable to talk--> Unconscious -->
go for management
Management:
Stabilize cervical spine with the
help of rigid cervical collar or
plancing a sand bags on both sides
of head.

•
•
•
•
•
•
•
Open mouth using chin lift or jaw thrust
maneuver to ensure airway patency
Clear oropharynx of blood, mucus and
foreign bodies with sucker
If fall back of tongue then use
oropharyngeal airway
If GCS <8 then use endotracheal
intubation+ oxygenate+cricoid
pressure+CO2 return+listen bilateral
breath sound+ chest X-ray
If EI is impossible then surgical airway in
the form of cricothyroidotomy
Spine injury ->use hard collars to
immobilize neck+long soinal board for body
immobility
Roll technique in shifting patient.

8. BREATHING AND
VENTILATION
Oxygenation and ventilation enure
-> monitored by pulse oximetry.
Six life threatening conditions
1. Aurway obstruction
2.Tension pneumothorax
3. Massive hemothorax
4. Open pneumothorax
5. Flail chest
6. Cardiac tamponade
Evaluation:
Inspect (symmetrical chest
movement+penetrating and blunt
traumas)
Palpate (trachea+ chest wall and
back of fractures+ crepitus or
emphysema)
Percussion (dull percussion
note+ absent breath sound -
> hemothorax &
hyperresonant note+ absent
breath sound->
pneumothorax
Auscultate chest and check
neck.

9. i.
ii.
iii.
iv.
v.
vi.
Management:
Attached pulse
oximeter for O2
saturation
100% O2 administration
Assisted ventilation
with BAG MASK device
Tension pneumothorax -
> Needle decompression
in the 2nd intercoastal
space
Massive hemothorax ->
vigorous circulatory
support followed by
chest intubation
Open pneumothorax ->
Managed by partial
occlusive dressing of
wound + chest intubation

Vii. Flail chest-> Good
anesthesia, if with
pulmonary contusion
causing hypoxia then
elective intubation and
oxygenation is warranted
Viii. Cardiac temponade -
> (if there is penetrating
wound medial to nipples
anteriorly or medial to
scapula posteriorly
Needle pericardiocentiesis is
life saving+ thoracotomy

10. Needle decompression Chest intubation

11. PERICARDIOCENTIESIS

12. Circulation and
hemorrhage control






Evaluation:
Asses pulse+BP
Asses blood soakage of
blood and visible
bleeding
Signs of injury->
abdomen+ thorax+
pelvis+ long bone
Assess hydration+ skin
color
FAST(for abdominal
concealed hemorrhages
Digital rectal examination




Management:
Control external
bleeding (direct
pressure+dressing
pads+ ligate visible
vessel bleeding)
Put two wide bore
cannulas-> large veins
of upper lims-> blood
taken for Grouping+
crossmatching+ serology
Warm crystalloid solution
-> ringer lactate
infusion
<6 years children ->
intraoseous infusion.





Vitals improvement
(responder, transient
responder and non
responder)
Blood and plasma
expanders-> dextrans
Typing but no
crossmatching ->10
mins
Fully typed and
crossmatching ->30
mins
Nasogastric tube->
stomach decompression
and Urinary catheter
-> urine output.

13. Nasogastric intubation Foley's catheter

14. •
•
•
Pelvic fractures -> use pelvic
wraps or binders ->create
temponade effect to stop
bleeding.
Hemodynamic instability ->
damage control laparotomy to
control bleeding.
Penetrating neck injury (venous
injury suspected then put
patient in Trendelenburg
position i.e head down to
prevent air emboli)

15. Disability and
neurological status
•
•
•
•
Use GCS for
assessing level of
consciousness
Assess pupil (size,
reactivity)
Lateralizing signs
(hemiparesis)
Rule out raised
intracranial pressure
and manage
immediately.
Exposure and
environmental control
•
•
•
•
Maintenan emergency
Room temperature
before uncovering the
patient
Undress for thorough
examination both front
and back for injury
sign
Warm blankets use
after examination
Warm crystalloids
solution used
•
•
Blood is transfused
with the help of blood
warmers.
Avoid hypothermia of
trauma patients as it
can lead to worsening
of coagulopathy and
further hemorhage.

16. History



Examination
Ask about few
history points
•
•
•
•
•


A- allergies
M- medication
P- past
illness/pregnancy
L- last meal
E- Exposure/Events
Head to Toe
examination
•
•
•
•
•
•
•


Head & face
Neck
Thorax
Abdomen
Pelvis
Extremities
Spine
Need to perform
•
•
•
•
Such as
CT Scan
FAST
Diagnostic peritoneal
Lavage
Click here to add your title
SECONDARY
SURVEY
Investiga
tion
It includes history, head to toe examination and advanced
investigations.

17. Head and
face
examination
l
l
l
l
Evaluation:
Inspect and palpate facial and scalp bone
for crepitus
Oral cavity, nose and ear examined for CSF
and blood
Eye examination for foreign body and
injury.
•
•
•
•
Evaluation:
Inspect
Bruise or penetrating wound
Palpation for tenderness and rebound
tenderness
Auscultate for bowel movements
Abdomen:
•
•
•
Evaluation:
Inspect, palpate,
percussion and
auscultate
Sucking wounds,
abraisions and
bruises
Entry and exit of
Thorax
•
•
Evaluation
Examine neck for
hematoma,
emphysema,
engorged veins
AND Auscultate for
bruit
Neck
Click here to add your title
•
•
•
•
Management:
Pack with warm moist packs if gut is eviscerated
FAST ultrasound
Diagnostic peritoneal Lavage to differ blood and gut contents
CT scan
•
•
•
Management:
Clean and dress all
bleeding wounds
Oxygenate patient with
cervical spinal care
•
•
Management
Radiological
tests like X
-rays, CT
scan or
duplex scan
Cervical
spine care
•
•
Wound is checked
Burns
Use if accessory muscles and
intercoastal recessions are
indications of labored
breathing.
•
•
•
Management:
High
oxygenatio
n
Ventilation
Deal life
threatening
conditions

18. Pelvis
•
•
Evaluation:
Compress for pain and
distract for stability
Blood at external meatus
indicate urethral injury
•
•
•
Management:
Pelvic binder for fracture
If pelvic fracture is present then it
means 2L of blood is already loss
and deal
Is urethral injury is suspected on
DRE then suprapubic Catherization
Extremities
•
•
•
•
Evaluation:
Asses limbs for injurues and fracture
Asses distal neurovascular status
Rule out compartment syndrome
Assess tenderness and deformity.
•
•
•
•
Management:
Stop external bleeding with pressure
dressing
Splint externally limb deformity
Fasciotomy for compartment syndrome
Vascular injury is treated with
surgery by surgeons

19. Spine
•
•
Evaluation
Inspect and
palpate spine
Assess focal
neurological
deficits in
form of
paresis or
plegia
•
•
•
•
Management:
Immobilize patient on spine
board
Use log roll technique for
shifting and back assessment
If spine injury then consultation
from neurosurgeon
Administration of analgesia,
antibiotics, tetanus prophylaxis
and other life saving drugs

20. TERTIARY
SURVEY
•
•
•
Patient is admitted to
the concerned ward
Multiple injuries
patient require
attention of multiple
specialists
General or
orthopaedic surgeon
is most appropriate
for the responsibility.

21. FAST: Focused Assessment
Sonogram for Trauma
•
•
•
•
Perfomed in C part of
primary survey for
concealed hemorhage
Portable hand held
ultrasound.
Pick free
intraperitoneal fluid
Show fluid in 1.
Hepatorenal angle
2.splenorenal angle
3.pericardium 4.pelvis.
A.
B.
C.
D.
Four areas
scanned
Right
hypochondrium
Left
hypochondrium
Subxyohoid
Hypogastric

22. Click here to add your title
TRIAGE
•
•
•
It is a process of
determining the priority of
patients ' treatments based
on severity of their
condition
Triage sieve-- quick survey
is made to separate dead
and walking from injured
Triage sort--these are:

24. THANKS
Click here to add your title