Atls primary survey

perfect atls primary survey ppt

1. Atls primary survey by dr.waseem arfaath

2. What is primary survey ? The primary survey is a quick way to find out how to treat any life threating conditions one may experience in an ER in the order of priority. We can use c ABCDE to do this.

3. Primary survey Control of Catastrophic Hemorrhage Airway with c-spine protection Breathing and ventilation Circulation with hemorrhage control Disability: Neuro status Exposure / Environmental control

4. Fastest way to assess a patient in 10 sec ASK THE PATIENT HIS/HER NAME ASK THE PATIENT WHAT HAPPENED PALPATE DORSALIS PEDIS ARTERY WHILE THE PATIENT IS BEING TRANSFERRED TO THE BED

5. WHAT WILL WE KNOW FROM THIS ? A Patent airway B Sufficient air reserve to permit speech C Sufficient perfusion ,(A MINIMUM OF 90/60 MMHG IF D.PEDIS IS PALPABLE) D Clear sensorium

6. BUT DOES THIS MEAN THE PATIENT IS GOING TO STAY IN THE SAME CONDITION ? MAY BE …… THE PRESENT GCS MIGHT BE CONSISTENT WITH THE PATIENT’S CONDITION IF THE INJURIES ARENT SEVERE ENOUGH ie MILD INJURIES. NO …. IN MAJOR TRAUMAS LIKE BEING THROWN FROM A VEHICLE ie WHEN THERE IS EPIDURAL HEMATOMA , THERE IS LUCID INTERVAL PHASE WHERE THE PATIENT IS NORMAL FOR FEW HOURS BEFORE COMPLETE DETERIORATION

7. THEN HOW DO WE KNOW IF THE PATIENT IS GOING TO DETERIORATE OR NOT ? HERE’S THE PLACE WHERE THE ROLE OF PRIMARY SURVEY KICKS IN… LETS DISCUSS A,B,C,D,E IN DETAIL NOW

8. Airway with C-spine Protection/PRECAUTION Begin by asking the victim a question…What is your name ? Are u alright ?what happened ? Meanwhile look for fractures , foreign bodies . Cervical spinal precautions should be instituted immediately on suspicion of injury to immobilize the cervical spine above and below the suspected level of injury, preventing flexion, extension, lateral rotation and lateral flexion. A well-fitting semirigid cervical collar is adequate until imaging can be conducted. If a cervical collar is not available, the patient can be placed in a neutral supine position on a rigid surface (spine board if available) and the head immobilized with sandbags or rolled towels and tape

9. What is nexus criteria ? Focal N eurologic deficit Midline S pine tenderness A ltered mental status Evidence of I ntoxication Painful D istracting injury If even one criteria is present c-spine imaging is necessary !

10. Canadian c-spine rule

11. AIRWAY Now that you have secured c-spine, proceed to airway management by looking for blood secretions , vomitus , stridor , foreign body If we find anything we can eventually clear the airway, suction if required and opening a secure airway . If airway obstruction is untreated it will lead to cardiac arrest. Perform either a chin lift or jaw thrust if airway obstruction is recognized; even though, jaw thrust is favored if cervical spine injury is suspected. Chin lift by placing hand on forehead of the victim and gently tilt his head back. At the same time, place fingertips under the point of the chin, lift the chin (do not push on the soft tissues under the chin as this may block the airway). Jaw thrust by placing the long fingers behind the angle of the mandible and pushing anteriorly and superiorly

12. What If airway isn’t secure ? Oral airway Nasal airway Endotracheal intubation (crash/ rsi ) Cricothyroidotomy Tracheostomy

13. Breathing and ventilation Only Airway route patency doesn't ensure adequate ventilation. Sufficient gas exchange is required to boost oxygenation and carbon dioxide disposal.

14. Breathing and ventilation Assess adequate oxygenation and ventilation. Inspect , palpate and auscultate . Respiratory Rate Deviated trachea Chest movement Sucking chest wound Absence of sounds O2 sats Required to assess the need for bag mask vent , needle/tube thoracostomy

15. breathing and ventilation Suspect pneumothorax or hemothorax if reduced lung sounds., This, combined with either tracheal deviation or hemodynamic compromise, can be a sign of a tension pneumothorax that should be treated with needle decompression followed by a thoracotomy tube placement.

16. 3 way seal for open chest wound

17. Circulation with haemorrhage control Blood volume, cardiac output, and bleeding are major circulatory issues to be addressed in C. Recognizing, rapidly controlling hemorrhage, and initiating resuscitation are therefore crucial steps in assessing and managing such victims. Once tension pneumothorax has been excluded as a cause of shock, consider that hypotension following injury is due to blood loss until proven otherwise. Any observable hemorrhage should be controlled during the primary survey, by applying a direct pressure on hemorrhagic site. Tourniquet is an effective in massive bleeding but has a risk of ischemic injury to the affected site. Utilize a tourniquet just when direct weight isn't viable and the person's life is compromised

18. Circulation and haemorrhage control The significant territories of inner drain are the chest, retroperitoneum, pelvis, and long bones. Normally recognized by physical assessment and imaging (e.g., chest x-ray, pelvic x-ray, FAST) Check pulse ( a rapid, thread like pulse is typically a sign of hypovolemia) , bp , capillary refill( A capillary refill time of more than 2 seconds may indicate poor perfusion unless an extremity is cold) , skin(warm or cold), pallor(normal , present , sev ) Ordinarily, two large bore intra venous catheters are put to direct crystalloids, blood, or plasma. Blood tests for pattern hematologic examinations are acquired, including a pregnancy test for all females of childbearing age and blood classification and cross coordinating. To survey level of shock, blood gases and additionally lactate level are acquired. placement of Foley’s catheter which will give more elaborated information about the patient’s circulatory functions.

19. Circulation and haemorrhage control Fast scan can be done to look at hepatic , cardiac , splenic and pelvic view . Depending upon the amount of blood present due to bleeding and other conditions, stage of shock can be assessed and treated accordingly .

20. Circulation and haemorrhage control It is important to remember that up to 30% loss of blood volume can occur before a reduction in blood pressure. But, the pressure may remain within normal limits after significant blood loss, especially in children. With no obvious signs of hemorrhage, and when there is a hemodynamic compromise, a pericardial tamponade must be considered, and if suspected, corrected through the creation of a pericardial window.

21. disability This is evaluated by Glasgow coma scale (GCS), pupil size and response. A diminishing degree of cognizance may demonstrate decreased cerebral oxygenation and perfusion . Hypoglycemia, liquor, opiates, and different medications can likewise modify degree of cognizance.

22. exposure Patient has to be totally stripped and uncovered (by removing their pieces of clothing to encourage a careful assessment and appraisal), to guarantee that no wounds are missed or indications of injury, dying, skin responses (rashes), needle marks, and so on., must be watched. After finishing the evaluation, spread the casualty with warm covers or an outside warming gadget to prevent that person from hypothermia . The effect of  hypothermia  can cause or contribute to serious conditions such as: Poor cardiovascular function, such as ischemia, decreased pumping function, myocardial infarction and cardiac dysrhythmias.  .

23. Log roll technique

24. Primary survey Vital signs ecg abgs Pulse oximeter and CO2 Urinary / gastric catheters unless contraindicated Urinary output Adjuncts to 1*survey

25. Finally … Repeat abcde if the patient deteriorates