advancedtraumaandlifesupportatls-120704101451-phpapp02

7/29/2019 advancedtraumaandlifesupportatls-120704101451-phpapp02

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By

ANU SANDHYA

PG WARD 3



OBJECTIVE

Identify the correct sequence of prioritiesfor assessment of a multiply injured pt.

Apply the principles outlined in primary

and secondary evaluation surveys ofATLS.

Apply guidelines and techniques in the

initial resusitative and definitive carephases of treatment.



ATLS

PREPARATION AND TRIAGE.

PRIMARY SURVEY

RESUSITATION

ADUNCTS TO PRIMARY SURVEY CONSIDER NEED FOR PATIENT TRANSFER

SECONDARY SURVEY

ADJUCTS TO SECONDARY SURVEY

CONTINUED POSTRESUSITATION ANDREEVALUATION OF THE PATIENT.

DEFINITIVE CARE.



PREPARATION

•PREHOSPITAL PHASE

•HOSPITAL PHASE

PREHOSPITAL PHASE:Coordination with the prehospital agency and personelcan greatly fasten the treatment in the field. They informthe receiving hospital which mobilizes the trauma team to

ED.

HOSPITAL PHASEAdvance planning for the trauma pt. beneficial. It saves

time.



TRIAGE

The process of categorizing victims or masscasualties based on their need fortreatment and the resources available.

ITS MAIN GOALS ARE.

Prevent avoidable deaths.

Ensure proper initial treatment with aminimal time frame.

Avoid misusing assests on hopeless cases.



Multiple casualties

No. of patients and the severity of theirinjuries do not exceed the ability of thefacility to provide care.

MASS CASUALTIES

The no. of patients and the severity oftheir injuries exceed the ability of thefacility to provide care.





PRIMARY SURVEY

What is the quick ,simple way to assessthe trauma patient in 10 seconds?

A comlete sentence spoken by pt. tells us:

1. Airway is patent.

2. Breathing intact.

3. Good cerebral circulation.

AIRWAY MAINTAINENCE



AIRWAY MAINTAINENCEWITH C-SPINE PROTECTION

Assess for obstruction, foreign bodies, facialfractures, bleeding causing airwaycompromise… begin measures to establishairway.

PITFALLS

Recognize impending obstruction early beforeintubation becomes too difficult.

If unable to control airway surgical airway ismust.

Unknown tracheal or laryngeal disruption.



Simple maneuvers

Chin lift

Jaw thrust Suction

Oropharyngeal and nasopharyngeal

airway Laryngeal mask airway

Laryngeal tube airway

Gum elastic bougie.

Definitive airway

Surgical airway.















INDICATIONS OF DEFINITIVE



INDICATIONS OF DEFINITIVEAIRWAY

UNCONCIOUS

GCS <8

RISK OF ASPIRATION

RISK OF IMPENDING OBSTRUCTION.



BREATHING

Inspection

AuscultationPalpationPercussion

Identify and manage life threatening problemsfirst

• Tension pneumothorax• Cardiac temponade

• Massive hemothorax• Open pneumothorax• Flail chest with pulmonary contusion



maneuvers

Bag and mask ventilation

Needle thoracocentesis

Pericardiocentesis

Chest tube intubation

CIRCULATION AND



CIRCULATION ANDHEMORRHAGE CONTROL

Assess for:

Shock

External bleeding

Occult bleeding Estimate the blood loss on initial

presentation of patient and the signs

and symptoms Replace fluid accordingly, 2 litres of

warm crystalloid solution.



DISABILITY

GCS

PUpillary reaction and size

EXPOSURE

Undress the patient completely butprevent hypothermia.

Logrolling and looking for back of the pt.

is very important.



ADJUCTS TO PRIMARY



ADJUCTS TO PRIMARYSURVEY AND

RESUSSITATION ECG PULSE OXIMETRY Xray chest AP view

Xray pelvis AP view URINARY CATHETER GASTRIC CATHETER BLOOD PRESSURE

ABGS FAST DPL



NEED TO TRANSFER orREFER?



SECONDARY SURVEY

Secondary survey does not begin until the primarysurvey is completed,resuscitative efforts areestablished and patient is demonstratingnormalization of vital functions.

It includes:

Head to toe evaluation AMPLE history

• Allergy• Medications currently taking• Past illness

• Last meal• Event/environment related to injury.

physical examination

Reassessment of all vital organs.



Adjucts to secondary survey

CT SCAN

CONTRAST STUDIES

EXTREMITY XRAY

ENDOSCOPY

ULTRASONOGRAPHY



MONITORING ANDREEVALUATION

Reevaluaion for new finding oroverlooked.

Continous monitoring of vital signs.

Effective analgesia.



DEFINATIVE CARE

AFTER identifying the patients injury.

Managing life threatening problems

Obtaining special studies.

If the patients injuries exceed thecapabilities of the institution.



Take home message

1. ABCDE APPROACH.

2. TREAT GREATEST THREAT TO LIFE.

3. DEFINITIVE DIAGNOSIS IS NOTIMMEDIATELY IMPORTANT.

4. TIME IS THE ESSENCE.

5. DO NO FURTHER HARM THE

PATIENT







CASE

A 20 year old woman is found trapped inher automobile. Several hours arerequired to extricate her because her leg

was trapped and twisted beneath thedash board. In the hospital she ishemodynamically unstable with pulse of120bpm, r/r 14, bp 80mmhg systoliconly, she has a large wound in her leftleg which is bleeding profusely..



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