Atls (Advanced Trauma Life Support) Teaching Protocol



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Pitfalls :

  • If the ventilation problem is produced by a pneumothrax, intubation with MV could lead to deterioration.

  • The procedure itself may produce a pneumothorax


Circulation with Hemorrhage Control

  • Q : What are the elements that provide the information about the hemodynamic status of the injured patients.

These elements are:


1. Level of consciousness

2. Skin color

3. Pulse ( quality, rate, regularity )

  • Presence of a carotid pulse  SBP 60 mmHg

femoral pulse  SBP 70 mmHg

radial puse  SBP 80 mmHg




  • External bleeding is identified and controlled in the primary survey.

  • Operative intervention for internal bleeding control.




  • Q : What are the injuries that may acutely impair circulation status ?

These injuries are :

1. External/internal bleeding with hypovolemic shock

2. Massive hemothorax

3. Cardiac tamponade




  • Assessment:

  • Management:

  • Apply direct pressure to external bleeding site.

  • Internal hemorrhage ? Need for surgical intervention ?

  • Establish IV access / central line / IO

  • Fluid resuscitation / blood replacement

  • Important Notes :

  • Hypotension following injury must be considered to be hypovolemic in origin until proved otherwise.
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