Advanced Trauma
Life Support (ATLS)
Advanced Trauma Life Support
(ATLS)
ATLS PROTOCOL OBJECTIVES:
A standardized approach to all traumatic patients.
A comprehensive assessment and management of patients in emergency.
Best utilization of golden hour which lies between life and death after a
traumatic event.
ATLS PROTOCOL
Primary Survey
Resuscitation
Secondary Survey
Tertiary Survey
PRIMARY SURVEY
A : Airway and cervical spine protection
B : Breathing and ventilation
C : Circulation and hemorrhage control
D : Disability (neurological status)
E : Exposure and environmental control
AIRWAY MANAGEMENT &
C. SPINE
◦ SUCTIONING OF NASOPHARYNGEAL AIRWAY
◦ CHIN LIFT
◦ JAW THRUST
ADVANCED METHODS:
◦ ENDOTRACHEAL INTUBATION
◦ CRICOTHYROIDOTOMY
◦ TRACHEOSTOMY
PREVENTION OF CERVICAL SPINE INJURY:
◦ IMMOBILIZE THE PATIENT
◦ AVOID HYPEREXTENSION OF NECK
◦ APPLY CERVICAL COLLAR
BREATHING / VENTILATION
◦ EXPOSE THE CHEST & ASSESS RR & RESP. TYPE.
◦ GIVE O2 INHALLATION
◦ CHECK CHEST WALL, LUNGS & DIAPHRAGM BY INSPECTION,
PALPATION, PERCUSSION & AUSCULTATION.
◦ PULSE OXIMETER
◦ LOOK FOR CONDITIONS THAT IMPAIR VENTILATION
◦ Tension pneumothorax
◦ Massive hemothorax
◦ Flail chest
◦ Rib fractures
◦ Open pneumothorax
◦ Pulmonary contusion
CIRCULATION
IMPAIRMENT IN CIRCULATION CAN LEAD TO SHOCK SO LOOK FOR SIGNS OF SHOCK i.e.
◦ SKIN COLOUR (PALLOR)
◦ NARROW PULSE PRESSURE
◦ HYPOTENSION
◦ TACHYCARDIA
◦ LEVEL OF CONSCIOUSNESS
◦ LOW URINE OUTPUT
CONTROL OF HEMORRHAGE :
◦ APPLY DIRECT PRESSURE
◦ PNEUMATIC SPLINTING DEVICES
◦ ACCESS THE NEED FOR SURGICAL INTERVENTION
CLINICAL CLASSIFICATION
OF SHOCK
CLASS I CLASS II CLASS III CLASS IV
BLOOD LOSS UPTO 750ml 750-1500ml 1500-2000ml 2000ml>
BLOOD % UPTO 15% 15-30% 30-40% 40%>
VOLUME
PULSE RATE 100< 100-120 120-140 140>
(bpm)
.SYSTOLIC B.P NORMAL NORMAL DECREASED DECREASED
PULSE PRESSURE NORMAL OR DECREASED DECREASED DECREASED
INCREASED
RESPIRATORY 14-20 20-30 30-40 35>
RATE
URINE OUTPUT 30> 20-30 5-15 NEGLIGIBLE
)ml/hr(
CNS/MENTAL SLIGHTLY MILDLY ANXIOUS, ,CONFUSED
STATUS ANXIOUS ANXIOUS CONFUSED LETHARGIC
FLUID CRYSTALLOIDS CRYSTALLOIDS CRYSTALLOIDS & CRYSTALLOIDS &
REPLACEMENT BLOOD BLOOD
FLUID REPLACEMENT
THERAPY
2 I/V LINES SHOULD BE MAINTAINED FOR FLUID REPLACEMENT
ADULTS SHOULD BE GIVEN 2 L BOLUS FLUID (PREFFERED FLUID IS RINGER LACTATE
BETTER IF WARM)
CHILDREN SHOULD BE GIVEN @ 20ml/Kg BOLUS FLUID
BLOOD TRANSFUSION
DISABILITY
CHECK THE LEVEL OF CONSCIOUSNESS (GCS )
CHECK PUPIL SIZE & LIGHT REACTION
EXPOSURE
+ENVIRONMENTAL
CONTROL
UNDRESS COMPLETELY (USE TRAUMA SCISSORS)
PREVENT HYPOTHERMIA ( WARM BLANKETS & WARM FLUIDS)
EARLY HEMORRHAGE CONTROL
WARM ROOM TEMPERATURE SHOULD BE MAINTAINED
Adjuncts to Primary
Survey and
Resuscitation
ELECTROCARDIOGRAPHIC MONITORING
URINARY CATHETERS
GASTRIC CATHETERS (NGT)
X-RAY EXAMINATIONS AND DIAGNOSTIC STUDIES
- Chest & Pelvis X rays AP view
- FAST / DPL
SECONDARY SURVEY
DOESNOT BEGIN UNTIL THE PRIMARY SURVEY (ABCDEs) IS
COMPLETED, RESUSCITATION EFFORTS ARE WELL
ESTABLISHED & THE PATIENT IS HAVING NORMALIZATION
OF VITAL [Link] INCLUDES:
◦ COMPLETE HISTORY
◦ COMPLETE HEAD TO TOE EXAMINATION
◦ REASSESSMENT OF VITAL SIGNS
◦ COMPLETE NEUROLOGICAL EXAMINATION (GCS)
◦ SPECIFIC PROCEDURES, SPECIFIC LAB. INVESTIGATIONS
COMPLETE HISTORY
A: ALLERGIES
M: MEDICATIONS
P: PAST ILLNESS/ PREGNANCY
L: LAST MEAL
E: EVENTS/ ENVIRONMENT/MECHANISM OF INJURY:
BLUNT TRAUMA: AUTOMOBILE COLLISIONS
PENETRATING TRAUMA: FIREARMS/STABBING
THERMAL INJURIES: BURNS/EXPLOSIONS
HAZARDOUS INJURIES: CHEMICALS/TOXINS/
RADIATIONS
PHYSICAL EXAMINATION
◦ HEAD
◦ MAXILLOFACIAL STRUCTURES
◦ CERVICAL SPINE & NECK
◦ CHEST
◦ ABDOMEN
◦ PERINEUM,RECTUM & VAGINA
◦ MUSCULOSKELETAL SYSTEM
◦ NEUROLOGICAL SYSTEM
HEAD
◦ VISUAL ACUITY
◦ PUPPILARY SIZE
◦ CONJUNCTIVAL HEMORRHAGE
◦ PENETRATING INJURY
◦ CONTACT LENSES (REMOVE BEFORE EDEMA DEVELOPS)
◦ DISLOCATION OF THE LENS
◦ OCULAR ENTRAPMENT
MAXILLOFACIAL STRUCTURES
◦ PALPATE ALL BONY STRUCTURES
◦ INTRAORAL EXAMINATION
◦ ASSESSMENT OF SOFT TISSUES
◦ TRAUMA NOT RELATED TO AIRWAY OR BLEDDING CAN BE DELAYED
CERVICAL SPINE AND
NECK
◦ PATIENTS WITH HEAD TRAUMA OR MAXILLOFACIAL TRAUMA SHOULDE BE PRESUMED TO
HAVE UNSTABLE CERVICAL INJURY (FRACTURE/LIGAMENT INJURY), NECK SHOULD BE
IMMOBILIZED IMMEDIATELY, UNTIL INVESTIGATED.
◦ CERVICAL SPINE TENDERNESS, SUBCUTANEOUS EMPHYSEMA, TRACHEAL DEVITATION &
LARYNGEAL FRACTURES OR PENETRATING INJURIES SHOULD BE SEEN DURING
EXAMINATION OF NECK.
CHEST
◦ A THOROUGH EXAMINATION OF CHEST WALL SHOULD BE DONE
TO RULE OUT OPEN OT TENSION PNEUMOTHORAX,
HEMOTHORAX, FLIAL CHEST OR CONTUSIONS.
ABDOMEN
AFTER INITIAL EXAMINATION, CLOSE OBSERVATION AND FREQUENT RE-EVALUATION
OF THE ABDOMEN SHOULD BE DONE BY THE SAME OBSERVER TO NOTE ANY
INTRAABDOMINAL INJURY AND IT SHOULD BE DEALT AGGRESSIVELY.
PERINEUM, RECTUM & VAGINA
◦ PERINEUM SHOULD BE EXAMINED FOR CONTUSIONS,LACERATIONS,HEMATOMA &
URETHRAL BLEEDING
◦ RECTUM MUST BE EXAMINED FOR BLOOD IN BOWEL LUMEN, PELVIC FRACTURES
OR HIGH RIDING PROSTATE.
◦ VAGINAL EXAMINATION SHOULD BE DONE IN WOMEN WITH PELVIC FRACTURES
FOR PRESENCE OF BLOOD.
MUSCULOSKELETAL
SYSTEM
◦ THE EXTREMITIES MUST BE INSPECTED FOR CONTUSIONS & DEFORMITIES.
◦ BONES SHOULD BE PALPATED & MOVEMENTS AT THE JOINTS SHOULD BE CHECKED.
◦ ASSESSMENT OF PERIPHERAL PULSES SHOULD BE DONE FOR VASCULAR INJURIES.
REASSESSMENT OF VITAL
SIGNS
DONE BY:
◦ CLINICAL REASSESSMENT
◦ MONITORING OF LOC, PR, BP MONITORING, ABGs & UOP
◦ REVIEW OF DIAGNOSTIC RESULTS
◦ USE OF ANALGESIA
COMPLETE NEUROLOGICAL
EXAMINATION
◦ LOC/GCS
◦ CNs EXAMINATION
◦ DETERIORATION/IMPROVEMENT IN LOC/GCS
SPECIFIC PROCEDURES, SPECIFIC LAB. INVESTIGATIONS
◦ AFTER HISTORY & EXAMINATION, RELEVANT INVESTIGATIONS SHOULD BE ADVISED e.g.
• Additional X-rays Extremities, Spine
• CT-SCAN
• Contrast X-rays, Urography, Angiography
• Endoscopy
ARE ADVISED ACCORDINGLY…
DEFINATIVE CARE &
TRANSFER
◦ ACCORING TO CLINICAL AND OTHER DATA PATIENT IS SHIFTED TO ICU , OT OR OTHERS
RESPECTIVELY.
◦ OR TRANSFRRED TO OTHER FACILITY ACCORDING TO PATIENT’S NEED OR INSTITUTION’S
CAPABILITY.
TERTIARY SURVEY
◦ DEFINED AS PATIENT’S EVALUATION THAT IDENTIFIES AND CATALOGUES ALL INJURIES AFTR
INITIAL RESUSSITATION AND OPERATIVE INTERVENTIONS
◦ PATIENT IS MORE AWAKE
◦ MORE INFORMATION ABOUT MODE OF INJURY BY PATIENT IS GATHERED
THANK YOU