ATLS- Initial Assessment and Management.pptx

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1. ATLS- Initial Assessment and Management Dr.Mustafa Ata A lah Ziv Medical c enter

2. WHAT IS ATLS ? • Advance trauma life support - To rapidly & accurately assess trauma patients - Early recognition & timely intervention of life threatening conditions - To resuscitate & stabilize trauma patients - To understand the priorities in trauma management - To organize quality trauma care in your hospital

3. Need of ATLS According to ( WHO) and (CDC) >9 people die every minute from injuries or violence. And 5.8 million people of all ages and economic groups die every year from unintentional injuries and violence. Motor vehicle crashes alone cause >1 million deaths annually and an estimated 20 million to 50 million significant injuries .

4. Trimodal Death Distribution the trimodal distribution of deaths implies that death due to injury occurs in one of three periods/peaks : 1 st Peak occurs within seconds to minutes of injury : - Apnea due to severe brain injury - Or high spinal cord injury - Or rupture of the heart, aorta, or other large blood vessels Very few of these patients can be saved because of the severity of their injuries.

5. 2 nd Peak occurs within minutes to several hours following injury U sually due to : S ubdural and epidural hematomas H emopneumothorax Ruptured spleen Lacerations of the liver Pelvic fractures And/or multiple other injuries associated with significant blood loss

6. The 3 rd Peak , which occurs several days to weeks after the initial injury , Is most often due to S epsis Multiple organ system dysfunctions

7. The golden hour of care after injury is characterized by the need for rapid assessment and resuscitation, which are the fundamental principles of Advanced Trauma Life Support.

8. Components of The ATLS protocol Triage+ Preparation of team and equipment check Primary Survey with Simultaneous Resuscitation Adjuncts to the Primary Survey Consider Need for Patient Transfer Secondary Survey Adjuncts to the Secondary Survey Monitoring & Reevaluation

9. Field Triage – color coding Triage- sorting of patients by injury severity and need for transport . RED – most critically injured : immediate transfer to hospital YELLOW – lees critically injured : delayed transfer to hospital without endangering life GREEN - No life or limb threatening injury : patient ambulatory, MAY NOT NEED IP TREATMENT BLACK – dead patient

10. Primary survey Key Principles : When you find a problem during the primary survey, FIX IT. If the patient gets worse, restart from the beginning of the primary survey

11. A irway and Protection of Spinal Cord Consist of : Airway patency assessment Intervention to maintain airway Cervical spine immobilization

12. A irway and Protection of Spinal Cord Rapid assessment should be made to check for any obstruction or laryngeal/tracheal obstruction; suction to clear the obstruction. If patient is communicating verbally, less chance of airway obstruction

13. Intervention to maintain airway Initial measures to maintain Airway Patency : Finger swap and Suction of Secretions Chin Lift/Jaw thrust Nasopharyngeal Airway

14. Definitive measures to maintain Airway Patency indicated if initial measures fail to solve the problem , GCS <8 and in CPR, patients with severe head injuries with altered level of consciousness, nonpurposeful motor responses. Endotracheal Intubation Surgical Cricothyroidotomy Surgical tracheostomy

15. Protection of Spinal Cord All pt’s with blunt trauma or gun shot to neck, should presume to have C- spine injury Immobilization of C – spine is priority in primary survey, until injury has been excluded by radiography or clinical physical exam Rigid Cervical Spinal Collar On table immobilization by tabe

16. B reathing and Ventilation Steps should be taken in Breathing are First step is high flow oxygen supply to all pt’s via non re-breathable mask 15 L per MIN Second step is evaluation for adequacy breathing Third step is addressing the breathing injury that have immediate threat to life

17. Second step is Evaluation for breathing Evaluation for adequacy of breathing and oxygen delivery by exclusion for signs of respiratory distress via : -RR counting -Oxygen saturation by pulse oximetry -Cyanosis -and accessory muscle

18. Second step is Evaluation for breathing 2. Identification of underline problem responsible for inadequate breathing through inspection, palpation ,percussion and auscultation: jugular venous distention tracheal position symmetry of chest movement Subcutaneous emphysema open wound Auscultation for lung ( weezing , crepitation, crackling)

19. Third step is addressing the breathing injury that have immediate threat to life Tension pneumothorax Open pneumothorax Massive hemothorax Flail chest

20. C irculation Measure to be taken in circulation steps: Stop the catastrophic external source for bleeding (pressure, tourniquet) Assessment for circulation: -Inspection for skin perfusion - capillary refile - Blood pressure, Peripheral pulse - level of consciousness Establish Iv access

21. Resuscitation- based on class of hemorrhagic shock Aggresive and continued volume resuscitation is not a substitute definitive control of hemorrhage

22. Identification of bleeding source and bleeding control ABDOMIN, CHEST, PELVIS, MULTIPLE BONE FRACTURES. Physical examination chest x-ray pelvic x-ray FAST diagnostic peritoneal lavage [DPL ])

23. D isability A rapid neurologic evaluation to establish the patient’s level of consciousness: Pupillary Exam- Dilated pupil – suggests transtentorial herniation on ipsilateral side Rectal Exam ( sphincter Tone) Glasgow Coma Scale: 3-15

24. Decreased level of consciousness = Head injury until proven otherwise

25. E xposure Remove all clothing Examine for other signs of injury Logroll the patient to examine patient’s back Maintain cervical spinal immobilization Avoid hypothermia - Apply warm blankets/ IV fluids, after removing clothes Hypothermia = Coagulopathy, Increases risk of hemorrhage

26. Trauma Logroll

27. E xposure

28. Adjuncts to the Primary Survey

29. Consider Need for Patient Transfer It is important not to delay transfer to perform an in-depth diagnostic evaluation. Only undertake testing that enhances the ability to resuscitate, stabilize, and ensure the patient’s safe transfer.

30. Secondary Survey The secondary survey does not begin until the primary survey (ABCDE) is completed, resuscitative efforts are under way, and improvement of the patient’s vital functions has been demonstrated. The secondary survey is a head-to-toe evaluation +history.

31. History AMPLE History A llergies M edications P ast Medical History, Pregnancy L ast Meal E vents surrounding injury, Environment

32. Adjuncts to Secondary Survey additional x-ray of the spine and extremities CT scans CTA transesophageal ultrasound Bronchoscopy, Esophagoscopy these specialized tests should not be performed until the patient has been carefully examined and his or her hemodynamic status has been normalized

33. Monitoring & Reevaluation Trauma patients must be reevaluated constantly to ensure that new findings are not overlooked and to discover any deterioration in previously noted findings

34. Transfer to Definitive Care Operating Room ICU Higher level facility

35. REFERENCES ATLS Advanced Trauma Life Support- 10th edition