Atls PDF
Atls PDF
ATLS
The
Primary
Survey
Jason
Smith
MD
DMI
FRCS(Gen.Surg)
Consultant
Surgeon
Trauma
- expression comprising a spectrum of
severity of mechanical violation of tissues,
from a little scratch to a multiply injured
patient.
- also surgical intervention.
Trauma
Mx
involves:
! 1. Preparation
! 2.
Triage
! 3.
Primary
Survey
(ABCDEs)
! 4.
Resuscitation
! 5.
Adjuncts
to
primary
survey
&
resuscitation
! 6.
Secondary
Survey
(head
to
toe
evaluation
&
history)
! 7.
Adjuncts
to
secondary
survey
! 8.
Continued
post-resuscitation
monitoring
&
re-evaluation
! 9.
DeTinite
care.
1/00
Resuscita0on
! Airway
control
! Ensure
oxygena0on
/
ven0la0on
! Needle
/
tube
thoracostomy
1/00
10
Pulse
oximeter
Cardiac
monitor
Foley
catheter
NG
tube
! Diagnos%c tests
CXR
Pelvic
x-ray
C-spine
x-ray
ECG
Pregnancy
test
Bloods
PRIMARY SURVEY
13
1/00
PRIMARY SURVEY
denite
airway.
! Protec%on
of
the
spine
&
spinal
cord
is
the
important
management
principle.
! Neurological
exam
alone
does
not
exclude
a
cervical
spine
injury.
! Always
assume
a
cervical
spine
injury
in
any
pt
with
mul%-system
trauma,
especially
with
an
altered
level
of
consciousness
or
blunt
injury
above
the
clavicle.
A
How
To?
! Chin
LiP
or
Jaw
thrust??
! Inspect
airway?
! Maintain
or
assist?
! Op%ons:
! Simply
open
it!
! Deliver
O2
as
much
as
possible?
! Bag
Valve
mask?
! Guedel
/
Nasopharyngeal?
! Laryngeal
mask?
! Endo/Naso
Tracheal
tube?
! Surgical
Airway
! And
you
dont
forget???????
20
1/00
B
How
to?
! Need
an
adequate
airway
! Provide
high
ow
O2
! Decompress
tension
pneumo
! Thoracostomy?
! Chest
Drain
! Flail
Chest?
Primary
Survey
! Airway
obstruc0on
! Tension
pneumothorax
! Open
pneumothorax
! Flail
chest
! Massive
haemothorax
! Cardiac
tamponade
Breathing
Tension
Pneumothorax:
Signs
/
Symptoms
! Respiratory
distress
! Distended
neck
veins
! Unilateral
in
breath
sounds
! Hyper-resonance
! Cyanosis,
late
Breathing
Open Pneumothorax
! Cover
defect
! Chest
tube
! Deni%ve
opera%on
Breathing
Flail Chest
!
a.
consciousness.
! b.
skin
color
! c.
Pulse.
!
external
bleeding
is
iden%ed
&
C
How
to?
! Adequate
airway
! Adequate
Ven%lla%on
! 2
large
bore
venons(Poiseuille
Law)
! 2
litres
crystalloid
! Control
bleeding
points
! Resuscita%ve
laparotomy
! Resuscita%ve
thoracotomy
F 1/l and F d
Class II
Class III
Class IV
750
750-1500
1500-2000
>2000
15%
15-30%
30-40%
>40%
HR
<100
>100
>120
>140
BP
PP
N or
RR
14-20
20-30
30-40
>35
UO
>30
20-30
5-15
--
CNS
Slightly
anxious
Mildly anxious
Anxious &
confused
Confused &
lethargic
Crystalloid
Crystalloid
Crystalloid &
blood
Crystalloid &
blood
Fluid replacement
OUTCOME
(secondary Survey).