04 overview of atls
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Overview of ATLSOverview of ATLS
William P. Bozeman, MD, FACEPAssistant Professor, Dept. of Emergency Medicine
University of Florida Health Sciences Center / Jacksonville
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Overview of ATLSOverview of ATLS
D e fin it ive C a re
D a ta / In fo rm a tio n /R e spo n se to T h era py
S e co nd a ry S u rvey
R e su sc ita tion
P rim a ry S u rvey(A B C D E 's )
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Overview of ATLSOverview of ATLS
•Primary Survey (ABCDE’s)•Resuscitation
•Secondary Survey
•Definitive Care
•Things to remember...
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Primary Survey - Immediate Primary Survey - Immediate Threats to Life (Only!)Threats to Life (Only!)
A = Airway
B = Breathing
C = Circulation
Obstructed?
Breath Sounds Present?
Bilaterally?
Peripheral Pulse?
Femoral? Carotid?
(Not BP Measurement.)
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Primary Survey - Immediate Primary Survey - Immediate Threats to Life (Only!)Threats to Life (Only!)
D = Disability
E = Exposure
Global (AVPU or GCS)
Gross Motor Function
(i.e. spinal cord integrity)
Nekkid!
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Common Life Threatening PathologyCommon Life Threatening Pathology
A = Airway
B = Breathing
C = Circulation
Obstruction
Tension PTX or HTX
Open PTX
Flail Chest
Hypovolemic Shock
Massive hemorrhage
Spinal Shock
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Overview of ATLSOverview of ATLS
•Primary Survey (ABCDE’s)
•Resuscitation•Secondary Survey
•Definitive Care
•Things to remember...
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ResuscitationResuscitation
• IV’s (Two. Large.)
•Control Bleeding
•Fluids
•Blood
•Screening X-Rays
“3” = C Spine, Chest, Pelvis.
“5” = 3 + T&L Spine.
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Overview ATLSOverview ATLS
•Primary Survey (ABCDE’s)
•Resuscitation
•Secondary Survey•Definitive Care
•Things to remember...
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Secondary SurveySecondary Survey
Now find out what happened, what’s injured.
• History (AMPLE)
• Physical. •Organized, complete head to toe exam.
• Roll, check back.
• Remember TM’s and rectal.
• Foley. NG or OG tube.
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Overview of ATLSOverview of ATLS
•Primary Survey (ABCDE’s)
•Resuscitation
•Secondary Survey
•Definitive Care
•Things to remember...
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Definitive diagnostics and Definitive diagnostics and care...care...
• Diagnostic Xrays (?)
• CT Scans (?)
• Ultrasound (?)
•MRI (?)
• DPL (?)
• Operating Room (?)
• Laceration Repairs (?)
• Antibiotics,Tetanus (?)
• Other Medications (?)
• Hyperbarics (?)
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Overview of ATLSOverview of ATLS
D e fin it ive C a re
D a ta / In fo rm a tio n /R e spo n se to T h era py
S e co nd a ry S u rvey
R e su sc ita tion
P rim a ry S u rvey(A B C D E 's )
![Page 14: 04 overview of atls](https://reader034.fdocuments.in/reader034/viewer/2022042614/555cc503d8b42a64718b533c/html5/thumbnails/14.jpg)
Overview of ATLSOverview of ATLS
•Primary Survey (ABCDE’s)
•Resuscitation
•Secondary Survey
•Definitive Care
•Things to remember...
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Roles of the Trauma TeamRoles of the Trauma TeamAirway
Nurse
BossAttending
Team Member
Team Member
Nurse
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Roles of the Trauma TeamRoles of the Trauma Team
•Boss•Directs the team, communicates decisions
•Free to roam
•Attending speaks through Boss (or teaches directly)
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Roles of the Trauma TeamRoles of the Trauma Team
•Airway•A & B of primary survey
•Intubation (if needed)
•Head / Neck in secondary survey
•Nurses•Attach monitors, give blood / fluids / meds
•Recording nurse records at foot of bed
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Roles of the Trauma TeamRoles of the Trauma Team
•Team Members•Expose, examine (secondary survey)
•Procedures as directed (by boss)•Chest Tubes
•Lac repairs
•Rectals, foleys routinely assigned to team member.
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Things to remember…Things to remember…The Ideal Trauma ResuscitationThe Ideal Trauma Resuscitation
•Roles are pre-assigned
•Clear direction & communication
•Pertinent findings verbalized in proper order
•All team members know all findings
•Rapid, Efficient
•Calm & Quiet!
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Things to remember… Things to remember… The The FASTFAST Exam Exam
•4 views (RUQ, LUQ, SP, Pericard.)
•A “noninvasive DPL”
•Sensitive for free fluid ( __ - __ %)
•Not specific.
•Not good for solid organ injury.
•Not good for hollow organ injury.
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Things to remember…Things to remember…Classification of ShockClassification of Shock
Class EBL Pulse BP Mental Treatment
I <15% (<750ml) - - nl Fluids
II 15-30% (750-1.5L) - +/-anxious Fluids
III 30-40% (1.5L-2.0L) anxious Fluids + Blood
IV >40% (>2.0L) confused Fluids + Blood
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A Special Case: A Special Case: Penetrating Trauma to trunk Penetrating Trauma to trunk
(especially GSW’s)(especially GSW’s)
•Need to rapidly find all penetrating injuries and all retained thoracoabd. projectiles
•Therefore...
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A Special Case: A Special Case: Penetrating Trauma to trunk Penetrating Trauma to trunk
(especially GSW’s)(especially GSW’s)
• Examine for entry/exit wounds immediately after the primary survey. (Wait to take BP start IV’s, take history.)
•Mark all entry and exit sites with radiopaque “arrow” markers.
• Take xrays immediately. (Team member wearing lead may start IV’s, place chest
tubes, etc. during xrays.)
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