RCSI Royal College of Surgeons in Ireland Coliste Roga na Minle in

irinn

Management of acute trauma

IC3
Musculoskeletal Teaching week
Gavin OReilly
6/1/15

ATLS

ATLS was developed by the American College of Surgeons

Deals with acute trauma in a stepwise manner
Each step is completed in turn
The next step is not attempted until the previous one is
completed
Airway & c-spine
Breathing
Circulation
Disability (Neurological assessment)
Exposure and environmental control
A detailed secondary survey from head to toe is performed
once initial resuscitation takes place

PRIMARY SURVEY
Airway (& c-spine)

Is there any blockage in the airway?

Any signs of stridor?
If any blockage eg blood vomit this should be cleared
Airway should be opened (jaw thrust vs head tilt chin lift)
A definitive airway may be required
Endotracheal intubation

A patient who is speaking to (or shouting at) you has a patent

airway and is unlikely to have any breathing problems
It should be assumed there is a cervical spine injury present
unless proven otherwise
Unconscious trauma patients require c-spine immobilization and
spinal boards
Patients with neck pain require c-spine immobilization and a spinal
board
Moving a patient with a spinal injury could exacerbate the issue

PRIMARY SURVEY
Breathing
Chest is examined for breating by inspection, palpation,
percussion, auscultation
The quality of breathing is assessed
Tracheal deviation is assessed

Circulation
Pulses
Carotid
Radial

Blood pressure
Any active bleeding should be controlled with pressure applied

 Disability / Neurological assessment

GCS scale
Neurological assessment for spinal injury
Pupil size and reaction
Lateralizing signs

Exposure and environmental controls

Patient should be undressed and covered in warm blankets
Warmed IV fluid can be used

LIFE THREATENING THORACIC

CONDITIONS
Airway obstruction
Tension pneumothorax (occurs when a pneumothorax forms a one
way valve allowing air in but not out of the lung consequent
overexpansion compresses airway)
Massive haemothorax (blood in thoracic cavity)
Open pneumothorax (a pneumothorax that communicates with
outside)
Flail chest with pulmonary contusions (rib fractures resulting in a
floating segment that moves paradoxically with respiration)
Cardiac tamponade (Blood in pericardium compressing heart)

MANAGEMENT OF LIFE THREATENING

THORACIC CONDITIONS
Airway obstruction

Clear airway if possible

Open airway
Pass endotracheal tube
If all above unsuccessful cricothyroidotomy can be attempted

Tension pneumothorax
Needle decompression
This condition should be a clinical diagnosis and should NEVER
be diagnosed on x-ray

MANAGEMENT OF LIFE THREATENING

THORACIC CONDITIONS
Open pneumothorax
A bandage should be applied to a sucking chest wound
It should be applied to three sides of the wound so as to allow air
exit but prevent entry

Massive haemothorax
A chest drain should be applied to a haemothorax
Significant output and signs of hypovolemic shock are
indications for cardiothoracic surgeon involvement

Flail chest with pulmonary contusions

Management is supportive
Intubation if required

MANAGEMENT OF LIFE THREATENING

THORACIC CONDITIONS
Cardiac tamponade
Needle thoracocentesis to drain the excess blood causing the
tamponade effect