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ATLS- Advanced Trauma Life Support
1. ADVANCED TRAUMA
LIFE SUPPORT (ATLS)
AN OVERVIEW
Dr.B.Selvaraj MS;Mch;FICS
Professor of Surgery
Melaka Manipal Medical College
Melaka 75150 Malaysia
2. ADVANCED TRAUMA
LIFE SUPPORT
ā¢ ATLS In US
ā¢ EMST In Australia
ā¢ PTC In UK
ā¢ Most Countries having an epidemic of trauma
ā¢ In India one of the major killer is trauma
200,000 deaths/year ; In TNļ 25000/year
3. ATLSļ OBJECTIVES
ā¢ To rapidly & accurately assess trauma patients
ā¢ Early recognition & timely intervention of life
threatening conditions
ā¢ To resuscitate & stabilise trauma patients
ā¢ To understand the priorities in trauma
management ļ Triage
ā¢ To organise quality trauma care in your
hospital
4. TRAUMA MANAGEMENT
Six Phases
ā¢Access Phase
ā¢Pre hospital & Triage Phase
ā¢Early Hospital or Resuscitation Phase
ā¢Operative Phase
ā¢Intensive care Phase
ā¢Rehabilitative Phase
5. ATLSļ TRIMODAL DEATH
By Arnold D.Trunkey
ā¢Within Seconds to Minutes
ļ Brainstem injury
ļ Aortic rupture
ā¢Within Minutes to Hours
ļ Sub dural Hematoma
ļ Rupture of Liver & Spleen
ā¢Within Days to Weeks
ļ Sepsis & MODS
6. ATLS
ā¢ Emergency life saving preceeds examination of
trauma patients
ā¢ Once immediate survival is achieved definitive
assessment & treatment begins
ā¢ Priorities in management must always be
salvage of
ļ Life, Limb, Function & Cosmetic
7. Pre Hospital Trauma Life
Support
ā¢ Scene size up & Extrication
ā¢ Primary Survey & Basic Life Support
ā¢ Spinal Protection in LSB
ā¢ Splinting Extremities
ā¢ Control of External Hemorrhage
ā¢ Aim: To Stabilize the Patientļ Platinum 10
Minutes
ā¢ Load & Go within Golden first hour
8. Field Triage- Color Coding
ā¢ Triage- sorting of patients by injury severity
and need for transport
ā¢ RED-most critically injured-immediate
transfer to hospital
ā¢ YELLOW-less critically injured-delayed
transfer to hospital without endangering life
ā¢ GREEN-No life/limb threatening injury-
patient ambulatory-may not need IP
treatment
ā¢ BLACK- Dead patient
10. Overview of ATLS
D e fin itiv e C a re
D a ta / In f o rm a tio n /
R e s p o n s e to T h e r a p y
S e c o n d a r y S u r v e y
R e s u s c ita tio n
P r im a r y S u r v e y
( A B C D E 's )
11. ATLSļ PRIMARY SURVEY
ā¢ A- Airway & Cervical Spine Control
ā¢ B-Breathing & Ventilation
ā¢ C-Circulation & Hemorrhage Control
ā¢ D-Disability ļ Neurological Status
ā¢ E-Exposure ļ Completely undress the patient
12. ATLSāPRIMARY SURVEY
Airway&Cervical Spine Control
ā¢ Chin lift or Jaw Thrust
ā¢ Removal of FB,Blood & Vomitus
ā¢ Oropharyngeal or Nasopharyngeal Airway
ā¢ Intubate With ETT
ā¢ Cricothyroidotomy
ā¢ Keep the neck immobilised
16. ATLS-PRIMARY SURVEY
Breathing & Ventilation
ā¢ Airway patency doesnāt assure adequate
ventilation- Look for bilateral breath
sounds
ā¢ To ensure adequate oxygenation start
Ambu bag or ETT ventilationāFIO2 >0.85
ā¢ Decompress Tension Pneumothorax
ā¢ Close open Chest Injury
ā¢ IPPV in large Flail Chest
18. ATLS-PRIMARY SURVEY
Circulation & Hemorrhage Control
ā¢ Post Traumatic Hypotension: Hypovolemia
ā¢ Conscious Patientļ Enough blood for
cerebral perfusion
ā¢ Capillary Refill >2 seconds
ā¢ Pale, Cold & clammy Skinļ Blood Volume
Loss >30%
19. ATLSļ PRIMARY SURVEY
Circulation & Hemorrhage Control
ā¢ Rapid & Thready Pulseļ Hypovolemia
ā¢ Absent Pulseļ CPR
ā¢ External Exsanguinating Hemorrhage
controlled with MAST/ PASG, Never use
Tourniquets
20. ATLS-PRIMARY SURVEY
Disabilityļ Neurological Status
ā¢ AVPUļ Describes Patientās Level of
Consciousness
ā¢ Aļ Alert
ā¢ Vļ Responds to vocal stimuli
ā¢ Pļ Responds to painful stimuli
ā¢ Uļ Unresponsive
ā¢ GCS to be done in secondary survey
21. Common Life Threatening
Pathology
A = Airway
B = Breathing
C = Circulation
Obstruction
Tension PTX or HTX
Open PTX
Flail Chest
Hypovolemic Shock
Massive hemorrhage
Spinal Shock
22. ATLS-RESUSCITATION
ā¢ Start 2 Large Bore IV Lines
ā¢ Infuse Crystalloids 2 to 3 Litres
ā¢ Then Transfuse Type Specific WB or O-ve
Packed RBCs
ā¢ Tissue Aerobic Metabolism is assured by
Perfusion with well oxygenated RBCs
ā¢ Never treat Hypovolemic Shock with
Vasopressors, Steroids or NaHco3
23. ATLS -RESUSCITATION
ā¢ CBD & NGT aspiration if not contraindicated
ā¢ Careful ECG Monitoring & Correction of
Arrhythmias
ā¢ Data Flow sheet of Vital Parameters to assess
effectiveness of Resuscitation
ā¢ Reevaluate Airway, Breathing and
Circulation. If neededļ CPR
25. Adjuncts to Primary Survey
ā¢ Diagnostic tools
ļ¼CXR, C-spine, Pelvis
ļ¼DPL
ļ¼Ultrasoundļ FAST
26. Secondary Survey
ā¢ Secondary Survey does not begin until the
primary Survey( ABCDEs) is completed,
resuscitative efforts are well established,
and patient is demonstrating
normalisation of vital functions
30. ATLSļ Patient`s History
ā¢ Aļ Allergies
ā¢ Mļ Medications Currently Taken
ā¢ Pļ Past Illness
ā¢ Lļ Last Meal
ā¢ Eļ Events/ Environment related to
injury
31. ATLSļ Mechanism of Injury
ā¢ Blunt Trauma
- Front Impactļ Myocardial contusion,
Pneumothorax, Flail Chest, Cervical Spine#
- Side Impactļ .# Spleen or Liver,# Pelvis,
Flail Chest, Opposite Cervical Spine Sprain/ #
-Rear Impactļ Whiplash Injury Cervical Spine
-Ejection from Vehicleļ Multiple Injuries
ā¢Penetrating Trauma
-Sharp objects, Missiles
35. ATLSļ Definitive Care
ā¢ Comprehensive Treatment of all Injuries
ā¢ Fracture Stabilisation
ā¢ Necessary Operative Intervention
ā¢ Appropriate Intensive Care
ā¢ Rehabilitation
ā¢ Stabilisation & Appropriate Transfer
36. ATLSļ TRIAGE
ā¢ Sorting of patients based on severity of
injuries and availability of resources
ā¢ Number of patients & severity of injuries do
not exceed facilityļ multiple casualties
ļ treat the most critically injured first
ā¢ The same exceed the facility ļ Mass
casualtiesļ treat as many as salvageable
patients as possible
37. ATLSļ SKILL STATIONS
ā¢ Airway Management
ā¢ Vascular access and Fluid Resuscitation
ā¢ ECG Monitoring & CPR including
defibrillation
ā¢ Pediatric/ Pregnant patients
ā¢ Transport of Critically Ill Patients
ā¢ Disaster Management
42. Things to rememberā¦
The Ideal Trauma Resuscitation
ā¢ Roles are pre-assigned ļ Multidisciplinary
team
ā¢ Clear direction & communication
ā¢ Pertinent findings verbalized in proper order
ā¢ All team members know all findings
ā¢ Rapid, Efficient
ā¢ Calm & Quiet!