بسم الله الرحمن الرحیم
Advanced
Trauma Life
Support
(ATLS)
Presented by: [Link] Safaei
Emergency Medicine Specialist
References
ATLS
Its goal is to teach a simplified and standardized
approach for trauma patients
The philosophy of the ATLS program is to treat the
greatest threat to life first and then reassess and treat
again
MIST
Initial assesment
ATLS
Treat the greatest threat to life first using the ABCDE
approach, (don’t start with history)
Full diagnosis is not needed to treat a life
threatening emergency. Lack of a definitive diagnosis
should not impede the application of indicated
treatment.
Death following Injuries
Immediate within minutes (50%) On road , due to
widespread damage to brain, ruptured heart or great vessels (only
preventive measures).
Within Hours -Golden hours – 30% Life threatening
injuries like facial injuries leading to airways obstruction, altered
breathing mechanism , massive blood loss.
Within Days (20%)
Sepsis and multi organ failure
Dangerous Injuries
Crash greater than 20mile/h
Fall from height of 20ft or more
Death of another person
Ejection of patient
Primary survey
X
The area of exsanguination is completely exposed.
All clothing is removed around and proximal to the
injury.
Direct pressure is applied with a gauze dressing as
precisely as possible over the site of bleeding. Larger
and deeper wounds are packed with gauze while
pressure is applied
c
Blunt injury above clavicle
Multi system trauma
Altered level of consciousness
Airway
• Airway Problems are a common cause of
Preventable Deaths
Airway
Failure to recognize airway need
Inability to establish airway
Failure to correct an incorrectly placed airway
Dislodgement of a correctly placed airway
Delay in establishing adequate ventilation
Aspiration of Gastric Contents
Airway
A rigid suction device is essential, all trauma victims
need supplemental O2
Airway maintenance
Chin lift
Modified Jaw thrust
Oral/nasopharyngeal airway
Surgical/needle cricothyriodotomy
Breathing & VENTILATION
The chest must be examined by inspection, palpation,
percussion and auscultation.
Subcutaneous emphysema and tracheal deviation
must be identified if present.
Breathing & VENTILATION
Life threatening Chest Injuries which may impair ventilation
Airway obstruction
Open pneumothorax
Tension pneumothorax
Massive hemothorax >1500ml
Flail chest with pulmonary contusion
Cardiac tamponade
Circulation
blood pressure
Pulse rate
Skin color
Urine output
Level of consciousness
Circulation
Radial pulse is palpable with BP of 80mm of Hg
Femoral pulse is palpable with BP of 70mm of Hg
Carotid Pulse is palpable with BP of 60mm of Hg
Technique
Hypovolemic shock
Two large-bore intravenous lines are established and
crystalloid solution given. If the patient does not respond
to this, type-specific blood, or O-negative should be given
Don’t wait for BP drop to make a diagnosis of
hypovolemic shock. At least 30 % volume loss is needed
for BP to drop
Disability
Level of consciousness
Pupils
Disability
Exposure / Environment
Undress patient completely
Do not forget the back of the patient
Protect from hypothermia: Intravenous fluids should
be warmed and a warm environment maintained.
Patient privacy should be maintained.
Resucitation Phase
Secure large bore IV access
Shock therapy
Continuous ECG monitoringa
Blood samples – CBC , ABGs, Cross match, Glucose,
coagulation studies
NG & Folley’s catheter (if not contraindicated)
Monitoring
Vital signs
(Temp, Pulse, Respiration & BP)
Urinary output
ECG
Pulse oximetery / ABGs
Secondary Survey
• Initiate resuscitation and reassess ABCs
before secondary survey
Prevention of Trauma
Primary prevention-Antidrinking driving,speed limit
Secondary-Active –Helmet-Seat belts-Passive -
ABS,Air bags
Tertiary -minimize the effects of injury by improving
health care delivery
Junctional tourniquet
?
Thank you