Atls (Advanced Trauma Life Support) Teaching Protocol

ATLS (Advanced Trauma Life Support) Teaching Protocol

1. 
   Pretest (30 min)
   
2. 
   Context of Tutorial (2 hours)
   

1. 
   General Principles
   

• 
  Concept
  
• 
  Inhospital phase clinical procedure/process
  
• 
  Important points/ cautions/ pitfalls
  
• 
  Brief discussion on traumatic shock/ blood transfusion
  

2. 
   Thoracic Trauma
   
3. 
   Abdominal Trauma
   

3. 
   Answers of pretests (30 min)
   
4. 
   Skills: (1hour)
   

1. 
   Airway and Ventilatory management
   

1. 
   Jet insufflation
   
2. 
   Laryngoscope / Magill forcep / Suction device
   
3. 
   Adult intubation
   
4. 
   Infant intubation
   
5. 
   Cricothyroidotomy
   

2. 
   Immobilization
   

a. In-line immobilization/ log-roll techniques

b. Cervical collar

1. 
   Long spine Backboard
   
2. 
   Scoop stretcher
   
3. 
   Traction Splint
   

3. 
   Adjuncts to surveys /monitoring/ resuscitation
   

1. 
   Pulse Oximeter
   
2. 
   DPL
   
3. 
   FAST
   
4. 
   Needle decompression
   
5. 
   Tube thoracostomy
   
6. 
   Seal Open peumothorax
   
7. 
   Pericardiocentesis
   
8. 
   Intraosseous puncture
   

Avanced Trauma Life Support

General Principles:

• 
  The concept:
  

Three underlying concepts of ATLS program :

Treat the greatest threat to life first The lack of a definite diagnosis should never impede the application of an indicated treatment A detailed history was not essential to begin the evaluation of an acutely injured patient

• 
  Specific principles govern the management of trauma patients in ED:
  

Organized team approach Priorities Assumption of the most serious injury Treatment before diagnosis Thorough examination Frequent reassessment Monitoring

• 
  Inhospital phase clinical process:
  

• 
  Systemic, organized approach to seriously injured patients is mandatory.
  

Preparation Triage Primary survey (ABCDEs) Resuscitation Adjuncts to primary survey & resuscitation Secondary survey (Head to toe Evaluation) Adjuncts to secondary survey Continued postresuscitation monitoring and reevaluation Definitive care

• 
  The primary and secondary surveys should be repeated frequently
  
• 
  In the actual clinical situation, many of these activities occur in parallel or simultaneously.
  

• 
  Organized Team Approach:
  

• 
  Team Captain : Coordinate, control the resuscitation
  

Assessing the patient, ordering needed procedures/ studies

Monitring the patient’s progress.

• 
  Procedures by other physician team members.
  
• 
  Nurses
  

• 
  Priorities In Management and Resuscitation
  

• 
  Immediate / potential threats to life
  
• 
  1. High-priority areas
  

Airway/ breathing

Shock/ external hemorrhage

Impending cerebral hemorrhage

Cervical spine

2. Low-priority areas

Neurologic

Abdominal

Cardiac

Musculoskeletal

Soft tissue injury

• 
  Assumption of the Most Serious Injury
  

• 
  Assume the worst possible injury
  
• 
  Mechanism of injury
  

• 
  Treatment Before Diagnosis
  

• 
  Based on initial brief assessment
  
• 
  The more unstable the patient, the less necessary to confirm alife-threatening diagnosis before it is expeditiously treated
  

• 
  Thorough Examination
  

• 
  When time and the patient’s stability permit.
  
• 
  Unconscious/ alcohol intoxicated patients
  

• 
  Frequent Reassessment
  

• 
  Dynamic process
  
• 
  Some injuries take time to manifest
  
• 
  Any sudden worsening in the physiologic status of the patients mandates a return to the “ABCDEs”
  

• 
  Monitoring
  

• 
  Vital signs
  
• 
  Pulse oximetry
  
• 
  I/O
  
• 
  Lab: ABG, Ht
  
• 
  CVP