Atls (Advanced Trauma Life Support) Teaching Protocol



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Pitfalls :

Exposure / Environment Control

  • Completely undressed the patient.

  • Prevent hypothermia

  • Injured patients may arrive in hypothermic condition

  • Log-roll



  • RESUSCITATION

TREATMENT PRIORITY

NECCESSARY PROCEDURE

Airway

  1. Jaw thrust/chin lift/

  2. Suction

  3. Intubation

  4. Cricothyroidotomy

( with protection of C-spine )

Breathing/Ventilation/oxygenation

  1. Chest needle decompression

  2. Tube thoracostomy

  3. Supplemental oxygen

  4. Seal open pneumothorax

Circulation/hemorrhage control

  1. IV line/ central line

  2. Venous cutdown

  3. Fluid resuscitation/Blood transfusion

  4. Thorocostomy for massive hemothorax

  5. Pericardiocentesis for cardiac tamponade

Disability

  1. Burr holes for trans-tentorial herniation

  2. IV mannitol

Exposure/Environment

  1. Warmed crystalloid fluid

  2. Temperature




  • Electrocardiographic Monitoring.

  • Urinary Catheter

  • Gastric Catheter

  • Monitoring

  • ABG

  • Pulse oximeter

  • X-rays

  • AP CXR

  • AP pelvis

  • C-spine

  • Diagnostic peritoneal lavage

  • Abdominal ultrasonography (FAST)




  • CONSIDER NEED FOR PATIENT TRANSFER




  • SECONDARY SURVEY

  • The secondary survey does not begin until:

  • the primary survey is completed,

  • resuscitation efforts are well established,

  • the patient is demonstrating normalization of vital functions.

  • Head-to-toe evaluation

  • Complete history and PE

  • Reassessment of all vital signs.

  • Complete NE.

  • Indicated x-rays are obtained.

  • Special procedures

  • Tubes and fingers in every orifice




  • History:

AMPLE history

Allergies

Medications currently used

Past illness/ Pregnancy

Last meal

Events/ Environment related to the injury

Mechanism/blunt/penetrating/burns/cold/hazardous environment




  • Physical Examination:

Table 1.


  • Pitfalls:

  • Facial edema in patients with massive facial injury or patients in coma can preclude a complete eye examination.

  • Blunt injury to the neck may produce injuries in which clinical signs and symptoms develop late.(e.g. Injury to the intima of the carotid a.)

  • The identification of cervical n. root/brachial plexus injury may not be possible in the comatose patient.

  • Decubitus ulcer from immobilization on a rigid spine board/cervical collar.

  • Children often sustain significant injury to the intrathoracic structures without evidence of thoracic skeletal trauma.

  • A normal initial examination of the abdomen does not exclude a significant intraabdominal injury.

  • Patients with impaired sensorium secondary to alcohol/drugs are at risk.

  • Injury to the retroperitoneal organs may be difficult to identify.

  • Female urethral injury are difficult to detect.

  • Blood loss from pelvic fractures can be difficult to control and fatal hemorrhage may result.

  • Fractures involving the bones of extremities are often not diagnosed.

  • Most of the diagnostic and therapeutic maneuvers increase ICP.



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