2. Objectives
• To understand the ATLS principles during
primary survey
• To know the application of adjuncts
3. Case scenario
• 25 years old male, unrestrained car driver
with high speed head-on collision,
brought by police ambulance
• HR 110/mt, RR 32/mt, BP 100/80, Pale skin
• Unresponsive with alcoholic smell
• Bleeding wound right thigh and left hand
with deformity
• Noisy breathing
• Bruises on anterior chest wall
4. Case scenario
• Should be managed by single person or
by a team?
• Is it important to assign work to different
team members?
• Prior basic information of patient’s
condition is helpful or not?
5. Case scenario
What is the sequence of priorities in assessing
this patient?
• Should we identify the specific injuries
before initial management of this patient?
• If not, how should we proceed?
6. ATLS way of trauma management
• Preparation
• Triage
• Primary survey (ABCDEs)
• Resuscitation
• Adjuncts to primary survey and
resuscitation
• Secondary survey
• Adjuncts to secondary survey
• Continuous post resuscitation monitoring
and re evaluation
• Definitive care
7. Preparation
• Take universal precautions
• Check the availability of medicines and
functioning of equipments
• Designate the role to each team member
• Utilize pre hospital information
10. Primary Survey – ATLS way
• Airway with c-spine protection
• Breathing and ventilation
• Circulation with hemorrhage control
• Disability: Neuro status
• Exposure with environmental control
11. Primary Survey
Always consider physiological
variations in special populations
● Elderly
● Infants and Children
● Pregnant Women
● Obese
● Athletes
The priorities are same for all the patients
12. Quick Assesment
What is a quick, simple way to assess a
patient in 10 seconds?
• Ask the patient his or her name?
• Ask the patient what happened?
17. Breathing and Ventilation
Assess
• Jugular venous distension
• Position of trachea
• Respiratory rate
• Percussion findings of chest
• Air entry
• Oxygen saturation
18. Breathing and ventilation
Recognise and treat early –
• Tension pneumothorax
• Flail chest with pulmonary contusion
• Massive haemothorax
• Open pneumothorax
Immediate Chest decompression with
Oxygen delivery
19. Circulation with haemorrhage control
After excluding tension pneumothorax,
cause of hypotension is hypovolemia until
proved otherwise
20. Circulation with haemorrhage control
Look for blood loss
– External bleeding
– Internal bleeding
• Chest
• Abdomen / Retroperitoneum
• Pelvis
• Long bones
One on floor four more
21. Circulation with haemorrhage control
Assess for organ perfusion
● Level of consciousness
● Skin color and temperature
● Pulse rate and character
23. D- Disability : Neurologic status
Rapid neurological examination is done for -
- Level of consciousness (GCS)
- Pupillary size and reaction
- Localizing signs
24. Primary survey - E
• Expose the patient
• Prevent hypothermia
• Cover with warm blanket
Patient’s body temperature is more
important than comfort of
healthcare providers
31. Transfer protocol
Inform the receiving doctor about
• Patient’s history including mechanism
• Physical findings
• Treatment instituted
• Patient’s response to therapy
• Diagnostics tests performed and result
• Need for transport
• Method of transportation
• Anticipated time of arrival
Continue ABCDEs with continuous monitoring
34. Take home message
• We should have competent and co-ordinated team
for trauma care
• Correct and sequential ATLS approach is needed
• Primary survey includes simultaneous assessment
and treatment of trauma patient
• Priorities of resuscitation remain same in various
population of trauma patients
• Proper transfer protocol should be followed
