ATLS primary survey secondary survey

1. The Advanced Trauma Life Support
A.T.L.S.
Dr. Haydar Muneer Salih

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. 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. 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. • 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. 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. 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. Multiple causalities

9. Massive causalities

10. Types of injuries

11. 1. Blunt trauma

12. 2. Penetrating injuries

13. 3. Blast injury

15. 4. Crushed injuries

16. 5. Thermal Injuries

17. 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

18. 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

20. 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

21. 1. Airway

23. 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

25. 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

26. 2. Breathing

31. 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

32. 4. Disability : (G.C.S.)

34. 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.

35. 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

36. 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.

37. Review of patient’s history (AMPLE)
■ Allergy
■ Medication including tetanus status
■ Past medical history
■ Last meal
■ Events of the incident

38. 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.