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ATLS

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ATLS

  • Primary survey
  • Resuscitation
  • Secondary survey
  • Definitive care

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ATLS

  • Preparation & Triage
    • The used of the following protective devices is recommended
      • Goggles
      • Gloves
      • Fluid-impervious gowns or aprons
      • Shoes covers and fluid- impervious leggings
      • Mask
      • Head covering

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ATLS

  • Primary survey
  • A
  • B
  • C
  • D

Airway maintenance with cervical spine protection

Breathing and ventilation Circulation with hemorrhage control Disability : Neurological status

– E Exposure/Environmental control/E-FSAT : completely undress the patient,but prevent hypothermia

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ATLS

  • Resuscitation
    • Oxygenation and ventilation
    • Shock management,intravenous lines,warmed Ringer’s lactate solution
    • Management of life-threatening problems identified in the primary survey is continued

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ATLS

  • Adjuncts to primary survey and resuscitation
    • X-rays and diagnostic studies
      • Chest
      • Pelvis
      • C-spine
      • DPL or FAST
    • Urinary and gastric catheters
    • Monitoring
      • ABG analysis and ventilatory rate
      • End-tidal carbon dioxide
      • EKG
      • Pulse oximetry
      • Blood pressure

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SECONDARY SURVEY

  • Secondary survey does not begin until the primary survey (ABCDEs) is completed, resuscitative efforts are well established, and the patient is demonstrating normalization of vital functions.

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SECONDARY SURVEY

  • Head-to-toe evaluation
  • Complete history and physical examination
  • Reassessment of all vital signs

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ATLS

  • Secondary survey
    • Total patient evaluation
      • history : SAMPLE
      • physical examination
        • Complete neurologic examination
        • Head and skull
        • Maxillofacial
        • Neck
        • Chest
        • Abdomen
        • Perineum/rectum/vagina
        • Musculoskeletal
        • Tubes and fingers in every orifice

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SECONDARY SURVEY

  • History
    • S Signs and symptoms
    • A Allergies
    • M Medications currently used
    • P Past illnesses/Pregnancy
    • L Last meal
    • E Events/Environment related to the injury

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SECONDARY SURVEY

  • History
    • Blunt trauma
    • Penetrating trauma
    • Injuries due to burns and cold
    • Hazardous environment

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SECONDARY SURVEY

  • Physical examination
    • Neurologic
    • Head
    • Maxilofacial
    • Cervical spine and neck
    • Chest
    • Abdomen
    • Perineum/rectum/vagina
    • Musculoskeletal

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SECONDARY SURVEY

  • Physical examination
    • Neurologic
      • level of consciousness
      • pupillary size and response
      • motor and sensory
      • GCS

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GLASGOW COMA SCALE

  • Eye opening (E)
    • Spontaneous
    • To speech
    • To pain
    • None
  • Best motor response (M)
    • Obeys commands
    • Localizes pain
    • Normal flexion (withdrawal)
    • Abnormal flexion (decorticate)
    • Extension
    • None (flaccid)
  • Verbal response (V)
    • Oriented
    • Confused conversation
    • Inappropriate words
    • Incomprehensible sounds
    • None

4

3

2

1

6

5

4

3

2

1

5

4

3

2

1

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SECONDARY SURVEY

  • Physical examination
    • Head
      • Scalp
      • Fractures
      • Eyes edema
        • VA - Pupil size - Penetrating injury
        • Hemorrhage of conjunctivae,fundi
        • Contact lenses - Dislocation of lenses
        • Ocular entrapment

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SECONDARY SURVEY

  • Physical examination
    • Maxilofacial
      • airway obstruction , major bleeding
      • Fx of mid maxilla beware of NG tube insertion
      • need frequent reassessment

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SECONDARY SURVEY

  • Physical examination
    • Cervical spine and neck
      • Head injury pt.keep in mind of cervical spine injury
      • Absence of neurologic deficit does not exclude spine injury
      • Inspection , palpation , auscultation , cervical spine tenderness , subcutaneous emphysema , tracheal deviation , laryngeal fracture
      • Protection of C-spine injury , helmet removing

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SECONDARY SURVEY

  • Physical examination
    • Chest
      • Visual evaluation of anterior and posterior chest
        • open pneumothorax
        • flail chest
      • Pain , dyspnea , hypoxia
      • Cardiac tamponade , tension pneumothorax
        • distended neck veins
        • distant heart sound

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SECONDARY SURVEY

  • Physical examination
    • Abdomen
      • closed observation and frequent reevaluation
      • unexplained hypotension
      • neurologic injury
      • equivocal abdominal finding

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SECONDARY SURVEY

  • Physical examination
    • Perineum/rectum/vagina
      • contusion , hematoma , laceration , urethral bleeding
      • rectal examination : blood , high-riding prostate , integrity of rectal wall , sphincter tone
      • female :
        • Vg exam.: blood , Vg laceration
        • pregnancy test

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SECONDARY SURVEY

  • Physical examination
    • Musculoskeletal
      • inspection : contusion , deformity
      • palpation : tenderness , abnormal movement
      • pelvic Fx : ecchymosis on iliac wings , pubis , labia , scrotum , pain on palpation of pelvic ring , PCT
      • assessment of peripheral pulses
      • patient’s back examination

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ATLS

  • Adjuncts to secondary survey
    • hemodynamic status
      • CT scan
      • Contrast x-ray studies
      • Extremitry x-ray
      • Endoscopy and ultrasonography

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ATLS

  • Post resuscitation monitoring and reevaluation
    • reevaluation for new findings or overlooked
    • continuous monitoring of vital signs , urinary output
      • 0.5 ml/kg/hr
      • 1 ml/kg/hr
    • ABG , EKG , pulse oximetry
    • effective analgesia

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ATLS

  • Definitive care
    • After identifying the patient’s injuries
    • Managing life-threatening problems
    • Obtaining special studies
  • Transfer
    • If the patient’s injuries exceed the institution’s treatment capabilities

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