By ANU SANDHYA PG WARD 3

OBJECTIVE
Identify the correct sequence of priorities for assessment of a multiply injured pt. Apply the principles outlined in primary and secondary evaluation surveys of ATLS. Apply guidelines and techniques in the initial resusitative and definitive care phases 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 AND REEVALUATION OF THE PATIENT. DEFINITIVE CARE.

PREPARATION
PREHOSPITAL PHASE HOSPITAL PHASE

PREHOSPITAL PHASE: Coordination with the prehospital agency and personel can greatly fasten the treatment in the field. They inform the receiving hospital which mobilizes the trauma team to ED.
HOSPITAL PHASE Advance planning for the trauma pt. beneficial. It saves time.

TRIAGE
The process of categorizing victims or mass casualties based on their need for treatment and the resources available.

ITS MAIN GOALS ARE. Prevent avoidable deaths. Ensure proper initial treatment with a minimal time frame. Avoid misusing assests on hopeless cases.

Multiple casualties

No. of patients and the severity of their injuries do not exceed the ability of the facility to provide care.

MASS

CASUALTIES

The no. of patients and the severity of their injuries exceed the ability of the facility to provide care.

PRIMARY SURVEY
What is the quick ,simple way to assess the trauma patient in 10 seconds? A comlete sentence spoken by pt. tells us:
1. 2. 3.

Airway is patent. Breathing intact. Good cerebral circulation.

AIRWAY MAINTAINENCE WITH C-SPINE PROTECTION

Assess for obstruction, foreign bodies, facial fractures, bleeding causing airway compromise begin measures to establish airway. PITFALLS

Recognize impending obstruction early before intubation becomes too difficult. If unable to control airway surgical airway is must. 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 AIRWAY

UNCONCIOUS GCS <8 RISK OF ASPIRATION RISK OF IMPENDING OBSTRUCTION.

BREATHING
Inspection Auscultation Palpation Percussion

Identify and manage life threatening problems first 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 HEMORRHAGE 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 but prevent hypothermia. Logrolling and looking for back of the pt. is very important.

ADJUCTS TO PRIMARY SURVEY 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 or REFER?

SECONDARY SURVEY
Secondary survey does not begin until the primary survey is completed,resuscitative efforts are established and patient is demonstrating normalization 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

POSTRESUSITATION MONITORING AND REEVALUATION

Reevaluaion for new finding or overlooked. 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 the capabilities of the institution.

Take home message

ABCDE APPROACH. 2. TREAT GREATEST THREAT TO LIFE. 3. DEFINITIVE DIAGNOSIS IS NOT IMMEDIATELY IMPORTANT. 4. TIME IS THE ESSENCE. 5. DO NO FURTHER HARM THE PATIENT
1.

CASE
A 20 year old woman is found trapped in her automobile. Several hours are required to extricate her because her leg was trapped and twisted beneath the dash board. In the hospital she is hemodynamically unstable with pulse of 120bpm, r/r 14, bp 80mmhg systolic only, she has a large wound in her left leg which is bleeding profusely..