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ADVANCED TRAUMA
LIFE SUPPORT (ATLS)
AN OVERVIEW
Dr.B.Selvaraj MS;Mch;FICS
Professor of Surgery
Melaka Manipal Medical College
Melaka 75150 Malaysia
ADVANCED TRAUMA
LIFE SUPPORT
• ATLS In US
• EMST In Australia
• PTC In UK
• Most Countries having an epidemic of trauma
• In India one of the major killer is trauma
200,000 deaths/year ; In TN25000/year
ATLSOBJECTIVES
• To rapidly & accurately assess trauma patients
• Early recognition & timely intervention of life
threatening conditions
• To resuscitate & stabilise trauma patients
• To understand the priorities in trauma
management  Triage
• To organise quality trauma care in your
hospital
TRAUMA MANAGEMENT
Six Phases
•Access Phase
•Pre hospital & Triage Phase
•Early Hospital or Resuscitation Phase
•Operative Phase
•Intensive care Phase
•Rehabilitative Phase
ATLS TRIMODAL DEATH
By Arnold D.Trunkey
•Within Seconds to Minutes
Brainstem injury
 Aortic rupture
•Within Minutes to Hours
 Sub dural Hematoma
 Rupture of Liver & Spleen
•Within Days to Weeks
Sepsis & MODS
ATLS
• Emergency life saving preceeds examination of
trauma patients
• Once immediate survival is achieved definitive
assessment & treatment begins
• Priorities in management must always be
salvage of
 Life, Limb, Function & Cosmetic
Pre Hospital Trauma Life
Support
• Scene size up & Extrication
• Primary Survey & Basic Life Support
• Spinal Protection in LSB
• Splinting Extremities
• Control of External Hemorrhage
• Aim: To Stabilize the Patient Platinum 10
Minutes
• Load & Go within Golden first hour
Field Triage- Color Coding
• Triage- sorting of patients by injury severity
and need for transport
• RED-most critically injured-immediate
transfer to hospital
• YELLOW-less critically injured-delayed
transfer to hospital without endangering life
• GREEN-No life/limb threatening injury-
patient ambulatory-may not need IP
treatment
• BLACK- Dead patient
ATLS-SPINAL PROTECTION
Long Spinal Board
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 )
ATLSPRIMARY SURVEY
• A- Airway & Cervical Spine Control
• B-Breathing & Ventilation
• C-Circulation & Hemorrhage Control
• D-Disability  Neurological Status
• E-Exposure Completely undress the patient
ATLS—PRIMARY SURVEY
Airway&Cervical Spine Control
• Chin lift or Jaw Thrust
• Removal of FB,Blood & Vomitus
• Oropharyngeal or Nasopharyngeal Airway
• Intubate With ETT
• Cricothyroidotomy
• Keep the neck immobilised
CHIN LIFT & JAW THRUST
ENDOTRACHEAL INTUBATION
CRICOTHYROIDOTOMY
ATLS-PRIMARY SURVEY
Breathing & Ventilation
• Airway patency doesn’t assure adequate
ventilation- Look for bilateral breath
sounds
• To ensure adequate oxygenation start
Ambu bag or ETT ventilation—FIO2 >0.85
• Decompress Tension Pneumothorax
• Close open Chest Injury
• IPPV in large Flail Chest
BAG & MASKVENTILATION
ATLS-PRIMARY SURVEY
Circulation & Hemorrhage Control
• Post Traumatic Hypotension: Hypovolemia
• Conscious Patient Enough blood for
cerebral perfusion
• Capillary Refill >2 seconds
• Pale, Cold & clammy Skin Blood Volume
Loss >30%
ATLSPRIMARY SURVEY
Circulation & Hemorrhage Control
• Rapid & Thready Pulse Hypovolemia
• Absent Pulse CPR
• External Exsanguinating Hemorrhage
controlled with MAST/ PASG, Never use
Tourniquets
ATLS-PRIMARY SURVEY
Disability Neurological Status
• AVPU Describes Patient’s Level of
Consciousness
• A Alert
• V Responds to vocal stimuli
• P Responds to painful stimuli
• U Unresponsive
• GCS to be done in secondary survey
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
ATLS-RESUSCITATION
• Start 2 Large Bore IV Lines
• Infuse Crystalloids 2 to 3 Litres
• Then Transfuse Type Specific WB or O-ve
Packed RBCs
• Tissue Aerobic Metabolism is assured by
Perfusion with well oxygenated RBCs
• Never treat Hypovolemic Shock with
Vasopressors, Steroids or NaHco3
ATLS -RESUSCITATION
• CBD & NGT aspiration if not contraindicated
• Careful ECG Monitoring & Correction of
Arrhythmias
• Data Flow sheet of Vital Parameters to assess
effectiveness of Resuscitation
• Reevaluate Airway, Breathing and
Circulation. If needed CPR
Adjuncts to Primary Survey
• Vital Signs/ECG monitoring
• ABGs
• POX/ETCO2
• Urinary/gastric catheters
• Urinary output
• Supplemental Oxygen
Adjuncts to Primary Survey
• Diagnostic tools
CXR, C-spine, Pelvis
DPL
Ultrasound FAST
Secondary Survey
• 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
ATLSSECONDARY SURVEY
• Head and Skull
• Faciomaxillary Injuries
• Neck
• Chest & Spine
• Abdomen
ATLSSECONDARY SURVEY
• Perineum/ Rectum/ Vagina
• Extremities Fractures
• Complete Neurological Exam GCS
• Appropriate X-Rays, Lab Tests and Special
Studies
• “Tubes & fingers” in every orifice
ATLSSECONDARY SURVEY
ATLS Patient`s History
• A Allergies
• M Medications Currently Taken
• P Past Illness
• L Last Meal
• E Events/ Environment related to
injury
ATLSMechanism of Injury
• Blunt Trauma
- Front Impact Myocardial contusion,
Pneumothorax, Flail Chest, Cervical Spine#
- Side Impact.# Spleen or Liver,# Pelvis,
Flail Chest, Opposite Cervical Spine Sprain/ #
-Rear Impact Whiplash Injury Cervical Spine
-Ejection from Vehicle Multiple Injuries
•Penetrating Trauma
-Sharp objects, Missiles
FRONT IMPACT
SIDE IMPACT & PEDESTRIAN
INJURY
Reevaluation
• Minimizing missed injuries
high index of suspicion
frequent reevaluation and continuous
monitoring
ATLSDefinitive Care
• Comprehensive Treatment of all Injuries
• Fracture Stabilisation
• Necessary Operative Intervention
• Appropriate Intensive Care
• Rehabilitation
• Stabilisation & Appropriate Transfer
ATLSTRIAGE
• Sorting of patients based on severity of
injuries and availability of resources
• Number of patients & severity of injuries do
not exceed facility multiple casualties
treat the most critically injured first
• The same exceed the facility Mass
casualties treat as many as salvageable
patients as possible
ATLSSKILL STATIONS
• Airway Management
• Vascular access and Fluid Resuscitation
• ECG Monitoring & CPR including
defibrillation
• Pediatric/ Pregnant patients
• Transport of Critically Ill Patients
• Disaster Management
INTRAOSSEOUS NEEDLE
DISASTER MANAGEMENT
Roles of the Trauma Team
Airway
Nurse
Boss
Attending
Team Member
Team Member
Nurse
Roles of the Trauma Team
Things to remember…
The Ideal Trauma Resuscitation
• Roles are pre-assigned Multidisciplinary
team
• Clear direction & communication
• Pertinent findings verbalized in proper order
• All team members know all findings
• Rapid, Efficient
• Calm & Quiet!
Overview of ATLS
CARRY HOME MESSAGE
“Joining Together is Beginning
Staying Together is Progress
Working Together is Success”
https://www.youtube.com/
watch?v=M3D7o-TSlik

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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 • ATLS In US • EMST In Australia • PTC In UK • Most Countries having an epidemic of trauma • In India one of the major killer is trauma 200,000 deaths/year ; In TN25000/year
  • 3. ATLSOBJECTIVES • To rapidly & accurately assess trauma patients • Early recognition & timely intervention of life threatening conditions • To resuscitate & stabilise trauma patients • To understand the priorities in trauma management  Triage • To organise quality trauma care in your hospital
  • 4. TRAUMA MANAGEMENT Six Phases •Access Phase •Pre hospital & Triage Phase •Early Hospital or Resuscitation Phase •Operative Phase •Intensive care Phase •Rehabilitative Phase
  • 5. ATLS TRIMODAL DEATH By Arnold D.Trunkey •Within Seconds to Minutes Brainstem injury  Aortic rupture •Within Minutes to Hours  Sub dural Hematoma  Rupture of Liver & Spleen •Within Days to Weeks Sepsis & MODS
  • 6. ATLS • Emergency life saving preceeds examination of trauma patients • Once immediate survival is achieved definitive assessment & treatment begins • Priorities in management must always be salvage of  Life, Limb, Function & Cosmetic
  • 7. Pre Hospital Trauma Life Support • Scene size up & Extrication • Primary Survey & Basic Life Support • Spinal Protection in LSB • Splinting Extremities • Control of External Hemorrhage • Aim: To Stabilize the Patient Platinum 10 Minutes • Load & Go within Golden first hour
  • 8. Field Triage- Color Coding • Triage- sorting of patients by injury severity and need for transport • RED-most critically injured-immediate transfer to hospital • YELLOW-less critically injured-delayed transfer to hospital without endangering life • GREEN-No life/limb threatening injury- patient ambulatory-may not need IP treatment • 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. ATLSPRIMARY SURVEY • A- Airway & Cervical Spine Control • B-Breathing & Ventilation • C-Circulation & Hemorrhage Control • D-Disability  Neurological Status • E-Exposure Completely undress the patient
  • 12. ATLS—PRIMARY SURVEY Airway&Cervical Spine Control • Chin lift or Jaw Thrust • Removal of FB,Blood & Vomitus • Oropharyngeal or Nasopharyngeal Airway • Intubate With ETT • Cricothyroidotomy • Keep the neck immobilised
  • 13. CHIN LIFT & JAW THRUST
  • 16. ATLS-PRIMARY SURVEY Breathing & Ventilation • Airway patency doesn’t assure adequate ventilation- Look for bilateral breath sounds • To ensure adequate oxygenation start Ambu bag or ETT ventilation—FIO2 >0.85 • Decompress Tension Pneumothorax • Close open Chest Injury • IPPV in large Flail Chest
  • 18. ATLS-PRIMARY SURVEY Circulation & Hemorrhage Control • Post Traumatic Hypotension: Hypovolemia • Conscious Patient Enough blood for cerebral perfusion • Capillary Refill >2 seconds • Pale, Cold & clammy Skin Blood Volume Loss >30%
  • 19. ATLSPRIMARY SURVEY Circulation & Hemorrhage Control • Rapid & Thready Pulse Hypovolemia • Absent Pulse CPR • External Exsanguinating Hemorrhage controlled with MAST/ PASG, Never use Tourniquets
  • 20. ATLS-PRIMARY SURVEY Disability Neurological Status • AVPU Describes Patient’s Level of Consciousness • A Alert • V Responds to vocal stimuli • P Responds to painful stimuli • U Unresponsive • 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 • Start 2 Large Bore IV Lines • Infuse Crystalloids 2 to 3 Litres • Then Transfuse Type Specific WB or O-ve Packed RBCs • Tissue Aerobic Metabolism is assured by Perfusion with well oxygenated RBCs • Never treat Hypovolemic Shock with Vasopressors, Steroids or NaHco3
  • 23. ATLS -RESUSCITATION • CBD & NGT aspiration if not contraindicated • Careful ECG Monitoring & Correction of Arrhythmias • Data Flow sheet of Vital Parameters to assess effectiveness of Resuscitation • Reevaluate Airway, Breathing and Circulation. If needed CPR
  • 24. Adjuncts to Primary Survey • Vital Signs/ECG monitoring • ABGs • POX/ETCO2 • Urinary/gastric catheters • Urinary output • Supplemental Oxygen
  • 25. Adjuncts to Primary Survey • Diagnostic tools CXR, C-spine, Pelvis DPL Ultrasound FAST
  • 26. Secondary Survey • 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
  • 27. ATLSSECONDARY SURVEY • Head and Skull • Faciomaxillary Injuries • Neck • Chest & Spine • Abdomen
  • 28. ATLSSECONDARY SURVEY • Perineum/ Rectum/ Vagina • Extremities Fractures • Complete Neurological Exam GCS • Appropriate X-Rays, Lab Tests and Special Studies • “Tubes & fingers” in every orifice
  • 30. ATLS Patient`s History • A Allergies • M Medications Currently Taken • P Past Illness • L Last Meal • E Events/ Environment related to injury
  • 31. ATLSMechanism of Injury • Blunt Trauma - Front Impact Myocardial contusion, Pneumothorax, Flail Chest, Cervical Spine# - Side Impact.# Spleen or Liver,# Pelvis, Flail Chest, Opposite Cervical Spine Sprain/ # -Rear Impact Whiplash Injury Cervical Spine -Ejection from Vehicle Multiple Injuries •Penetrating Trauma -Sharp objects, Missiles
  • 33. SIDE IMPACT & PEDESTRIAN INJURY
  • 34. Reevaluation • Minimizing missed injuries high index of suspicion frequent reevaluation and continuous monitoring
  • 35. ATLSDefinitive Care • Comprehensive Treatment of all Injuries • Fracture Stabilisation • Necessary Operative Intervention • Appropriate Intensive Care • Rehabilitation • Stabilisation & Appropriate Transfer
  • 36. ATLSTRIAGE • Sorting of patients based on severity of injuries and availability of resources • Number of patients & severity of injuries do not exceed facility multiple casualties treat the most critically injured first • The same exceed the facility Mass casualties treat as many as salvageable patients as possible
  • 37. ATLSSKILL STATIONS • Airway Management • Vascular access and Fluid Resuscitation • ECG Monitoring & CPR including defibrillation • Pediatric/ Pregnant patients • Transport of Critically Ill Patients • Disaster Management
  • 40. Roles of the Trauma Team Airway Nurse Boss Attending Team Member Team Member Nurse
  • 41. Roles of the Trauma Team
  • 42. Things to remember… The Ideal Trauma Resuscitation • Roles are pre-assigned Multidisciplinary team • Clear direction & communication • Pertinent findings verbalized in proper order • All team members know all findings • Rapid, Efficient • Calm & Quiet!
  • 44. CARRY HOME MESSAGE “Joining Together is Beginning Staying Together is Progress Working Together is Success”