Advance trauma life support (tugas) - Reza

ATLS

1. ATLS Reza Devianto Hambali , dr

2. PRIMARY SURVEY AND RESUSCITATION A – A irway maintenance and cervical spine protection B – B reathing and ventilation C – C irculation with haemorrhage control D – D isability: neurological status E – E xposure: completely undress the patient and assess for other injuries

3. 1. Airway The airway must be evaluated first. If there is vocal response from the patient, then the patient’s airway is not immediately at risk, but repeated assessment is prudent. If there is no or limited response, then a rapid investigation and assessment for signs of airway obstruction should be undertaken. This includes inspection for foreign bodies, maxillofacial or mandibular fractures, tracheal or laryngeal injury or oedema

4. 1. Airway

5. 2. Breathing Oxygen must be administered to all trauma patients, usually at high flow and via a reservoir mask. Ventilation requires an adequately functioning chest wall, lungs and diaphragm, and each must be systematically evaluated. Signs of surgical emphysema, dilatation of the neck veins, symmetry of the chest wall, respiratory effort and rate should be evaluated and recorded. Percussion and auscultation should be performed both front and back after log rolling

6. Flail Chest

7. This young man fell off his bike and landed on his left side. His CXR shows a large left pneumothorax (pleural line indicated by white arrows) with shift of the trachea and mediastinum to the right side

8. Updated ATLS for Sho c k Class of haemorrhage table amended: Base excess Early use of blood and blood products Management of coagulopathy Tranexamic acid Trauma team

9. Early use of blood and blood products Early resuscitation with blood and blood products must be considered in patients with evidence of class III and IV hemorrhage. Early administration of blood products at a low ratio of packed red blood cells to plasma and platelets can prevent the development of coagulopathy and thrombocytopenia.

10. Management of coagulopathy Uncontrolled blood loss can occur in patients taking antiplatelet or anticoagulant medications. Prevention Obtain medication list as soon as possible. Administer reversal agents as soon as possible. Where available, monitor coagulation with thromboelastography (TEG) or rotational thromboelastometry (ROTEM). Consider administering platelet transfusion, even with normal platelet count.

11. Tranexamic acid (TXA) European and American military studies demonstrate improved survival when TXA is administered over 10 minutes within 3 hours of injury . When bolused in the field, follow up infusion TAX 1 gram over 8 hours in the hospital.

12. Indicators of adequate resuscitation urine output 0.5-1.0 ml/kg/hr (30 cc/hr) serum lactate levels (normal < 2.5 mmol/L) gastric mucosal pH (>7.3) base deficit normal -2 to +2

13. ATLS classification of hypovolemic shock *

14. Responder

15. National Emergency X-radiography utilization Study (NEXUS) Criteria

16. THANK YOU

17. National Emergency X-radiography utilization Study (NEXUS) Criteria