ATLS PPT.pptx

ADVANCE TRAUMA LIFE SUPPORT

1. ADVANCE TRAUMA LIFE SUPPORT DR KAPIL DEV RESIDENT GENERAL SURGERY

2. HISTORY ATLS has its origins in the United States in 1976, when James K. Styner, an orthopedic surgeon piloting a light aircraft, crashed his plane into a field in Nebraska. His wife Charlene was killed instantly and three of his four children, sustained critical injuries.

3. HISTORY He carried out the initial triage of his children at the crash site. Dr. Styner had to flag down a car to transport him to the nearest hospital; upon arrival, he found it closed. Even once the hospital was opened and a doctor called in, he found that the emergency care provided at the small regional hospital where they were treated was inadequate and inappropriate .

4. HISTORY Upon returning to Lincoln, Dr. Styner declared: "When I can provide better care in the field with limited resources than what my children and I received at the primary care facility, there is something wrong with the system and the system has to be changed. On returning to work, he set about developing a system for saving lives in medical trauma situations. Which is nowadays recognized worldwide as a Advance Trauma Life Support .

5. TRAUMA & GOLDEN HOUR CONCEPT Trauma can be defined as an injury to any part of the human body as the result of energy transfer from an inflicting source that is beyond the body resistance. In ATLS the golden hour refers to a time period lasting for one hour or less following traumatic injury during which there is highest possibility that adequate treatment will prevent death.

6. ATLS PROVIDER TEAM The trauma team is basically comprised of a group of doctors , nurses , operating department assistants , radiographers and other support personnel.

7. TRIAGE Triage is derived from French word means TO SORT. It is the process of determining the priority of patients treatment based on their severity of their condition to get RIGHT PATIENT at RIGHT PLACE at the RIGHT TIME with RIGHT CARE PROVIDER . This is applicable where resources are insufficient for all to be treated immediately.

8. COLOR CODING

9. STEPS IN ATLS PRINCIPLES PRIMARY SURVEY AND RESUSCITATION : The aim is to identify and treat what is killing the patient. SECONDARY SURVEY : I t includes head to toe examination to identify all other injuries. TERTIARY SURVEY : A definitive management plan is developed.

10. PRIMARY SURVEY AND RESUSCITATION THE PRIMARY SURVEY INCLUDES FOLLOWING COMPONENTS c Control of massive external hemorrhage A airway maintenance with cervical spine protection B breathing and ventilation C circulation and hemorrhage control D disability / neurological status E exposure / environment control

11. CONTROL OF MASSIVE HEMORRHAGE

12. AIRWAY WITH CERVICAL SPINE CONTROL Quick assessment What is the quick simple way to access patient in 10 seconds? Ask the patient his or her name ? Ask the patient what happened ?

13. APPROPRIATE RESPONSE CONFIRMS Patent airway Sufficient air reserve to permit speech Sufficient perfusion Clear sensorium

14. MANAGEMENT

15. BREATHING AND VENTILATION Once a secure airway is maintained , adequate oxygenation and ventilation must be ensured. All trauma patients should receive supplemental oxygen and monitored by pulse oximetry. Evaluate chest wall , lungs ,heart and diaphragm by inspection , palpation , percussion and auscultation.

16. TENSION PNEUMOTHORAX EVALUATION Air hunger Distended neck veins Absent breath sounds Tracheal shift Hyper resonant percussion note MANAGEMENT Needle decompression 2 nd ICS (mid clavicular line) Chest tube intubation 5 th ICS (mid axillary line)

17. MASSIVE HEMOTHORAX EVALUATION Hemodynamic instability Absent breath sounds Respiratory distress Dull percussion note MANAGEMENT Vigorous circulatory support Chest tube intubation Thoracotomy

18. OPEN PNEUMOTHORAX EVALUATION Respiratory distress Sucking chest wound MANAGEMENT Three sided occlusive dressings of the wound Followed by chest tube intubation

19. FLAIL CHEST EVALUATION Respiratory distress Paradoxical chest wall movements MANAGEMENT Conservative with good analgesics Chest intubation Rib fixation Endotracheal intubation

20. CARDIAC TAMPONADE EVALUATION BECKS TRIAD Juggler venous distension Muffled heart sounds Hypotension MANAGEMENT Needle pericardiocentesis Thoracotomy

21. CIRCULATION AND HEMORRHAGE CONTROL EVALUATION Assess the pulse and blood pressure Look for blood soakage of clothes Looks for the signs of injury Hydration status and skin color Fast scan for evaluation of concealed abdominal hemorrhage.

22. MANAGEMENT Stop the external hemorrhage as discussed Pass 2 large bore IV cannulas Draw blood for cross matching and lab investigations Infuse warm fluids( Crystalloids/Colloids) and blood products(1:1:1) Apply pelvic binder until pelvic fracture ruled out Immobilize fractures

23. DIABILITY / NEUROLOGICAL STATUS KEY PRINCIPLES Prevention of further injury and identification of neurological injury is the goal. Maintenance of adequate cerebral perfusion is key to prevent further brain injury. Adequate oxygenation Avoid hypotension Early neurosurgeon involvement for intracranial pathologies.

24. DISABILITY/NEUROLOGICAL STATUS Assess the level of consciousness( GCS , AVPU Score) Assess pupils size and reactivity Look for lateralizing signs Raised ICP should be ruled out

25. SECONDARY SURVEY Secondary survey is started after completion of primary survey once patient has been adequately resuscitated. No patient with abnormal vital signs should proceed for secondary survey. Secondary survey includes brief history and complete clinical examination .

26. SECONDARY SURVEY

27. SECONDARY SURVEY Head and neck Chest and abdomen Pelvis and genitourinary Extremities Neurological including spine