GENERAL APPROACH TO A TRAUMA PATIENT , ATLS .pptx

ATLS

1. GENERAL APPROACH TO A TRAUMA PATIENT DR. CH RAKESH SINGHA 2 ND YEAR PGT , DEPT. OF ORTHOPAEDICS SILCHAR MEDICAL COLLEGE & HOSPITAL

2. TRAUMA Trauma is defined as physiological wound or injury caused by an external source e.g.; road traffic accidents, falls, industrial accidents, burns etc. Trauma is the leading cause of death in young population.

3. Concepts of ATLS Treat the greatest threat of life first. The lack of a definitive diagnosis should never interfere the application of an indicated treatment. A detailed history is not essential to begin the evaluation. ABCDE approach

4. Basic of Trauma Assessment Preparation – Team assembly, Equipment check. Triage – Sort patient by level of acuity. Primary Survey – Designed to identify injuries that are immediately life threatening & to treat them as they are identified. Resuscitation – Rapid procedure & treatment to treat injuries found in primary survey before completing the secondary survey. Secondary survey- Full history & physical examination to evaluate the other traumatic injuries. Monitoring & evaluation secondary adjuncts . Transfer to definitive care – ICU, ward, operating theatre or higher facility.

5. PRIMARY SURVEY Patients are assessed & treatment priorities established based on their injuries, vital signs & injury mechanisms. A Airway & c-spine protection B Breathing C Circulation D Disability (neurological status) E Exposure/environmental control

6. A - Airway Airway should be assessed for patency - is the patient able to communicate verbally? -inspect for any foreign bodies. Assume cervical spine injury in patients with multisystem trauma. Apply cervical hard collar in suspected cervical injury.

7. AIRWAY INTERVENTIONS: Supplemental oxygen Suction Chin lift or jaw thrust Definitive airways like intubation

8. B - Breathing General principle – Adequate gas exchange is required to maximize patient oxygenation& CO2 elimination. Airway patency alone dose not ensure adequate ventilation. Inspect, palpate & auscultate - for crepitus, flail chest, sucking chest wound etc. Chest Xray to evaluate lung fields.

9. BREATHING INTERVENTION: Ventilate with 100% oxygen. Needle decompression if tension pneumothorax suspected. Chest tubes for pneumothorax. Occlusive dressing to sucking chest wound

10. C - Circulation Haemorrhagic shock should be assumed in any trauma patient. Rapid assessment of hemodynamic status- - Level of consciousness - Skin colour - Distal pulse - Blood pressure

11. CIRCULATION INTERVENTION: Establish IV access. Cardiac monitor. Apply pressure to sites of external haemorrhage. Volume resuscitation by blood transfusion.

12. D - Disability Abbreviated neurological examination: - Level of consciousness - Pupil size & reactivity - Motor function - GCS (Glasgow Coma Scale).

13. DISABILITY INTERVENTION: Spinal cord injury - High dose of steroids. ICP monitor (intracranial pressure). Elevated ICP - Head of bed elevated - Mannitol - Hyperventilation - Emergent decompression.

14. E - Exposure Complete removal of clothing of the patient. Logroll to inspect back. Rectal temperature. Warm blanket / external warming devices to prevent hypothermia

15. SECONDARY SURVEY AMPLE history: - Allergies - Medication - Past medical history - Last meal - Events Physical examination from head to toe, including rectal examination

16. Frequent reassessment of vitals. Diagnostic studies after stabilisation - X-rays - Laboratory work - FAST - CT examination etc.

17. We should look for Battle sign Raccoon’s eye Seatbelt sign

18. Cullen’s sign Grey-Turner’s sign

19. Adjuncts to Secondary Survey Radiological investigation: - Emergency films - Focussed Abdominal Sonography in Trauma (FAST) Foley catheterisation Pain control by analgesic Tetanus injection Antibiotics for open fractures

20. Abdominal Injury Common source of traumatic injury. High suspicion with tachycardia, hypotension & abdominal tenderness . FAST examination can be early screening tool.

21. Look for - Distension - Tenderness - Seatbelt marks - Penetrating trauma - Retroperitoneal ecchymosis. Be suspicious of free fluid without evidence of solid organ injury.

22. FAST Focussed Abdominal Sonography in Trauma To find free fluid (blood) around heart or abdominal organ after trauma. 4 view’s: -Cardiac -Right upper quadrant -Left upper quadrant -Pelvic

23. Splenic Injury Most commonly injured organ in blunt trauma. Often associated with other injuries. It can be managed non-operatively

24. Liver Injury Second most common solid organ injury. It can be difficult to manage surgically. Often associated with other abdominal injuries.

25. Hollow Viscous Injury Injury can involve stomach, bowel or mesentery. Symptoms are a result from combination of blood loss & peritoneal contamination. Small bowel & colon injuries result most often from penetrating trauma .

26. DEFINITIVE CARE Secondary survey followed by radiographic evaluation. Consultation with -Neurosurgery -Orthopaedic -Vascular surgery Transfer to Definitive Care -Operating room -ICU -Higher level facility.

27. CONCLUSION Assessment of the trauma patients in a standard algorithm designed to ensure life threatening injuries do not get missed. Primary Survey + Resuscitation - Airway - Breathing - Circulation - Disability - Exposure Secondary Survey Definitive Care

28. THANK YOU