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primary survey
secondary survey


  1. 1. The Advanced Trauma Life Support A.T.L.S. Dr. Haydar Muneer Salih
  2. 2. ATLS has its origins in the United States in 1976, when James K Styner, an Orthopedic surgeon piloting a light aircraft, crashed his plane into a field in Nebraska. His wife Charlene was killed instantly and three of his four children, Richard, Randy, and Kim sustained critical injuries.
  3. 3. His son Chris suffered a broken arm. He carried out the initial Triage of his children at the crash site. Dr. Styner had to flag down a car to transport him to the nearest hospital; upon arrival, he found it closed. Even once the hospital was opened and a doctor called in, he found that the emergency care provided at the small regional hospital where they were treated was inadequate and inappropriate.
  4. 4. the initial ATLS course which was held in 1978. In 1980, the American College of Surgeons Committee on Trauma adopted ATLS and began US and international dissemination of the course. Styner himself recently recertified as an ATLS instructor, teaching his Instructor Candidate course in Nottingham in the UK, July 2007
  5. 5. • The Advanced Trauma Life Support (ATLS) system was therefore created initially in the USA and rapidly taken up globally. At present, over 50 countries worldwide are actively providing the ATLS course to their physicians
  6. 6. Triage Triage is an important concept in modern health-care systems, and three essential phases have developed: 1 pre-hospital triage – in order to dispatch ambulance and pre hospital care resources; 2 at the scene of trauma; 3 on arrival at the receiving hospital
  7. 7. 2 types of triage 1 Multiple casualties: Here, the number and severity of injuries do not exceed the ability of the facility to render care. Priority is given to the life-threatening injuries 2 Mass casualties: The number and severity of the injuries exceed the capability and facilities available to the staff. In this situation, those with the greatest chance of survival and the least expenditure of time, equipment and supplies are prioritized
  8. 8. Multiple causalities
  9. 9. Massive causalities
  10. 10. Types of injuries
  11. 11. 1. Blunt trauma
  12. 12. 2. Penetrating injuries
  13. 13. 3. Blast injury
  14. 14. 4. Crushed injuries
  15. 15. 5. Thermal Injuries
  16. 16. The steps in the ATLS philosophy ■ Primary survey with simultaneous resuscitation – identify And treat what is killing the patient ■ Secondary survey – proceed to identify all other injuries ■ Definitive care – develop a definitive management plan
  17. 17. PRIMARY SURVEY AND RESUSCITATION A – Airway maintenance and cervical spine protection B – Breathing and ventilation C – Circulation with haemorrhage control D – Disability: neurological status E – Exposure: completely undress the patient and assess for other injuries
  18. 18. 1. Airway The airway must be evaluated first. If there is vocal response from the patient, then the patient’s airway is not immediately at risk, but repeated assessment is prudent. If there is no or limited response, then a rapid investigation and assessment for signs of airway obstruction should be undertaken. This includes inspection for foreign bodies, maxillofacial or mandibular fractures, tracheal or laryngeal injury or oedema
  19. 19. 1. Airway
  20. 20. 2. Breathing • Oxygen must be administered to all trauma patients, usually at high flow and via a reservoir mask. • Ventilation requires an adequately functioning chest wall, lungs and diaphragm, and each must be systematically evaluated. • Signs of surgical emphysema, dilatation of the neck veins, symmetry of the chest wall, respiratory effort and rate should be evaluated and recorded. • Percussion and auscultation should be performed both front and back after log rolling
  21. 21. This young man fell off his bike and landed on his left side. His CXR shows a large left pneumothorax (pleural line indicated by white arrows) with shift of the trachea and mediastinum to the right side
  22. 22. 2. Breathing
  23. 23. 3. Circulation and control of bleeding 1. Conscious level: lost a significant amount of blood 2. Skin color: a pale, ashen, grey- looking patient 3. Pulse: a rapid, thready pulse or, worse still, one that is not peripherally palpable
  24. 24. 4. Disability : (G.C.S.)
  25. 25. 5. Exposure • The patient must be fully exposed and examined front and back using a carefully controlled log roll. Spinal alignment must be maintained during this procedure with in-line traction. Hypothermia can be rapid following trauma, and warming air blankets are vitally important in the resuscitative phase.
  26. 26. Adjuncts to the primary survey ■ Blood – FBC, urea and electrolytes, clotting screen, glucose, toxicology, cross-match ■ ECG ■ Two wide-bore cannulae for intravenous fluids ■ Urinary and gastric catheters ■ Radiographs of the cervical spine and chest
  27. 27. SECONDARY SURVEY This starts after completion of the primary survey and once initial resuscitative measures have commenced. The purpose of the secondary survey is to identify all injuries and perform a more thorough ‘head to toe’ examination.
  28. 28. Review of patient’s history (AMPLE) ■ Allergy ■ Medication including tetanus status ■ Past medical history ■ Last meal ■ Events of the incident
  29. 29. Definitive care and transfer Definitive care will be discussed in subsequent chapters, but it is important to recognize that there should be as little delay as possible in reaching this stage. Much has been made of the ‘golden hour’ concept, and one often finds that the majority of patients spend this hour at the scene of injury.
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ATLS primary survey secondary survey


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