ADVANCED

TRAUMA AND LIFE

SUPPORT (ATLS)
By
ANU SANDHYA
PG WARD 3

OBJECTIVE

Identify the correct sequence of priorities

for assessment of a multiply injured pt.
Apply the principles outlined in primary
and secondary evaluation surveys of
ATLS.
Apply guidelines and techniques in the
initial resusitative and definitive care
phases of treatment.

ATLS

PREPARATION AND TRIAGE.

PRIMARY SURVEY
RESUSITATION
ADUNCTS TO PRIMARY SURVEY
CONSIDER NEED FOR PATIENT TRANSFER
SECONDARY SURVEY
ADJUCTS TO SECONDARY SURVEY
CONTINUED POSTRESUSITATION AND
REEVALUATION OF THE PATIENT.
DEFINITIVE CARE.

PREPARATION
PREHOSPITAL PHASE
HOSPITAL PHASE
PREHOSPITAL PHASE:
Coordination with the prehospital agency and personel
can greatly fasten the treatment in the field. They inform
the receiving hospital which mobilizes the trauma team to
ED.
HOSPITAL PHASE
Advance planning for the trauma pt. beneficial. It saves
time.

TRIAGE
The process of categorizing victims or mass
casualties based on their need for treatment
and the resources available.
ITS MAIN GOALS ARE.
Prevent avoidable deaths.
Ensure proper initial treatment with a
minimal time frame.
Avoid misusing assests on hopeless cases.

Multiple casualties

No. of patients and the severity of their

injuries do not exceed the ability of the
facility to provide care.

MASS CASUALTIES

The no. of patients and the severity of

their injuries exceed the ability of the
facility to provide care.

PRIMARY SURVEY
What is the quick ,simple way to assess
the trauma patient in 10 seconds?
A comlete sentence spoken by pt. tells us:
1.
2.
3.

Airway is patent.
Breathing intact.
Good cerebral circulation.

AIRWAY MAINTAINENCE WITH C-SPINE

PROTECTION

Assess for obstruction, foreign bodies, facial

fractures, bleeding causing airway compromise
begin measures to establish airway.
PITFALLS

Recognize impending obstruction early before

intubation becomes too difficult.
If unable to control airway surgical airway is must.
Unknown tracheal or laryngeal disruption.

Simple maneuvers
Chin lift
Jaw thrust
Suction
Oropharyngeal and nasopharyngeal
airway
Laryngeal mask airway
Laryngeal tube airway
Gum elastic bougie.
Definitive airway
Surgical airway.

INDICATIONS OF DEFINITIVE AIRWAY

UNCONCIOUS
GCS <8
RISK OF ASPIRATION
RISK OF IMPENDING OBSTRUCTION.

BREATHING
Inspection
Auscultation
Palpation
Percussion

Identify and manage life threatening problems first

Tension pneumothorax
Cardiac temponade
Massive hemothorax
Open pneumothorax
Flail chest with pulmonary contusion

maneuvers

Bag and mask ventilation

Needle thoracocentesis
Pericardiocentesis
Chest tube intubation

CIRCULATION AND HEMORRHAGE CONTROL

Assess for:
Shock
External bleeding
Occult bleeding
Estimate the blood loss on initial
presentation of patient and the signs and
symptoms
Replace fluid accordingly, 2 litres of
warm crystalloid solution.

DISABILITY

GCS
PUpillary reaction and size
EXPOSURE
Undress the patient completely but
prevent hypothermia.
Logrolling and looking for back of the pt.
is very important.

ADJUCTS TO PRIMARY SURVEY

AND RESUSSITATION

ECG
PULSE OXIMETRY
Xray chest AP view
Xray pelvis AP view
URINARY CATHETER
GASTRIC CATHETER
BLOOD PRESSURE
ABGS
FAST
DPL

NEED TO TRANSFER or
REFER?

SECONDARY SURVEY
Secondary survey does not begin until the primary survey is
completed,resuscitative efforts are established and patient
is demonstrating normalization of vital functions.
It includes:
Head to toe evaluation
AMPLE history
Allergy
Medications currently taking
Past illness
Last meal
Event/environment related to injury.

physical examination
Reassessment of all vital organs.

Adjucts to secondary
survey

CT SCAN
CONTRAST STUDIES
EXTREMITY XRAY
ENDOSCOPY
ULTRASONOGRAPHY

POSTRESUSITATION MONITORING AND

REEVALUATION

Reevaluaion for new finding or

overlooked.
Continous monitoring of vital signs.
Effective analgesia.

DEFINATIVE CARE

AFTER identifying the patients injury.

Managing life threatening problems
Obtaining special studies.
If the patients injuries exceed the
capabilities of the institution.

Take home message

1.
2.
3.
4.
5.

ABCDE APPROACH.
TREAT GREATEST THREAT TO LIFE.
DEFINITIVE DIAGNOSIS IS NOT
IMMEDIATELY IMPORTANT.
TIME IS THE ESSENCE.
DO NO FURTHER HARM THE
PATIENT

CASE
A 20 year old woman is found trapped in
her automobile. Several hours are
required to extricate her because her leg
was trapped and twisted beneath the
dash board. In the hospital she is
hemodynamically unstable with pulse of
120bpm, r/r 14, bp 80mmhg systolic
only, she has a large wound in her left
leg which is bleeding profusely..