Pitfalls in ATLS

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ATLS

• Advanced• Trauma• Life• Support

• 7th Edition

ATLS

• PROVIDES A COMMON LANGUAGE

THE BEGINNING

• DR. JAMES STYNER’S PLANE CRASHED IN RURAL NEBRASKA IN FEBRUARU 1976

• 3 OF 4 SUSTAINED SERIOUS HEAD INURIES

DR. JAMES STYNER. MD,FACS - 1977

• BETTER CARE IN THE FIELD WITH LIMITED RESOURCES

• SOMETHING WRONG WITH THE SYSTEM AND THE SYSTEM HAS TO BE CHANGED

TRIMODAL DEATH DISTRIBUTION

• IMMEDIATE DEATH• EARLY DEATH• FIRST 1-4 HOURS• LATE DEATH• 2ND – 5TH WEEK

ATLS Concept

•ABCDE-approach to evaluation/treatment

• Treat greatest threat to life first• Definite diagnosis not immediately

important• Time is of the essence• Do no further harm

ATLS Concept

• A Airway with C-spine protection• B Breathing ; Ventilation/Oxygenation• C Circulation ; Stop bleeding• D Disability ; Neurological status• E Expose / Environment / Body temperature

Committee on Trauma Presents

•Initial Assessment and Management

Initial Assessment and Management

• Principles• Primary Survey• Secondary Survey• Priority Management• Resuscitate and Monitor procedures• Patient’s History / Biomechanics of Injury• Anticipate Pitfalls

Pitfalls

• What is a quick , simple way to assess the patient in 10 seconds ?

• How can I minimized the missed injuries ?

• Which patients do I transfer to a Higher levels of care ?

• When should the transfer occur ?

Quick / Simple to assess the patient

• Identify yourself• Ask the patient his / her name• Ask the patient what happened

GCS

• Glasgow Coma Score• Mild Brain Injury 14 – 15• Moderate 9 – 13• Severe 3 - 8

• AVPU *#* Alert• Verbal response to voice• Painful• Unresponse

Concept of Initial Assessment

•Primary Survey• A Airway with C-spine protection• B Breathing ; Ventilation/Oxygenation• C Circulation ; Stop bleeding• D Disability ; Neurological status• E Expose / Environment / Body temperature•

Concept of Initial Assessment

•ABCDE• Patent Airway• Suffidient Air Reserve to • permit speech• Clear Sensorium

ADJUNCT to Primary Survey

•FAST• Focus• Assessment• Sonography in• Trauma

THORACIC TRAUMA

• BECK’S TRIAD• Elevate venous pressure• Decline in arterial pressure• Muffling heart sound •

• CARDIAC INJURY

TENSION PNEUMOTHORAX

• DYSPNEA• ELEVATE VENOUS PRESSURE• DECLINE IN ARTERIAL PRESSURE• TRACHEA SHIFT TO OPPOSIT

• ? ? ?

SECONDARYSURVEY

• The Complete History and • Physical Examination

• Starts after …..• Primary Survey is complete• ABCDEs are Reassessed• Vital functions are returning • to Normal

REEVALUATION

• Aims ; Minimized Missed injuries

• High Index of Suspecious• Frequent Reevaluation and• Monitoring

ADJUNCT

DEFINITIVE CARE

• Which patient do I transfer to • another Hospital for Definite • Care ?

• Multisystem or Complex Injuries• Comorbidity or AGE Extremes

ST0P BLEEDING

RESPONSE TO RESUSCITATION ?

•THANK YOUTHANK YOU