Advanced Trauma Life Support(1)

7/25/2019 Advanced Trauma Life Support(1)

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Advanced Trauma Life

Support

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DEFINITION 0F TRAUMA

A term derived from the Greek for WOUND It refers to any bodily injury.

It defined as tissue injury due to direct effects ofexternally applied energy Energy !ay "e!ec#anical$ t#er!al$ electrical$ electro!agnatic ornuclear

Included%"urns$ dro&ning$ s!o'e$ in#alation$

slip ( fall Excluded% poisoning)toxic ingestion

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TRIMODAL DISTRIBUTION OF TRAUMA DEATHS.

THE FIRST PEAK OF DEATHS OCCURS WITHIN FEW SECONDS

TO MINUTES AFTER INJURY(50% OF ALL DEATHS).Virtuallyinevitable & very little can be dne.

THE SECOND PEAK OCCURS BETWEEN A FEW MINUTES AND

AN HOUR AFTER INJURY. !an be reduced by "r#"t initial care in t$e"re%$"ital "$ae'by early $"ital reucitatin and by "r#"t and

c#"etent de(initive care.T$i "erid $a been labelled a )THE *OLDENHOUR+. Mana,e#ent at t$i ti#e -ill a((ect t$e t$ird "ea ( deat$.

THE THIRD PEAKOCCURS SEVERAL DAYS OR WEEKS AFTER

THE INITIAL INJURY.

The e!"#$ #$ &h'$ e* h"+,$ -e e$e$ "&e#&',,/ee#&-,e.

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GENERAL CATEGORIES OF TRAUMA.

DI*IDED INTO T+REE ,ATE-ORIE.:

I!DIA"!#$ #I%! "&'!A"!NING.

A%%!(" A)OU" *+,A((OUN" %O' *-+ O% A## IN&O/0I"A#

"'AUA D!A"&/.

U'G!N".

(O0'I/!/ A00'O1IA"!#$ A)OU" 2-2* + O% A## 0A"I!N"/.

NONU'G!N".

A00'O1IA"!#$ 3- + O% A## IN4U'I!/.

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1. Preparation

2. Triage

3. Primary Survey (ABCDEs

4. !esus"itation

#. A$%un"ts to primary survey & resus"itation

'. Se"on$ary Survey (ea$ to toe eva)uation & istory

*. A$%un"ts to se"on$ary survey

+. Continue$ post,resus"itation monitoring & re,eva)uation

-. Deinite "are.

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1. PREPARATION

A Pre-hospital phase Receiving hospital is notified first.

Send to the closest, appropriate facility.

B In Hospital Phase

Advanced planning for the trauma pt arrival.

Method to summon extra medical assistance

ransfer agreement !ith verified trauma center esta"lished.

Protect from communica"le disease.

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2. TRIAGE

A Multiple #asualties

no of severity $ pt do not exceed the a"ility of

the facility.B Mass #asualties

no $ severity of pt %%%' the capa"ility of

the facility $ staff.

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3. PRIAR! S"R#E!

A $Air!ay !ith cervical spine protect.

B $(reathing

% $ #irculation --control external "leeding.

& $'isa"ility or neurological status

E $%xposure )undress* $ Environment )temp control*

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PRIMAR+ SR%+Priorities for the care of Adult , Pediatrics$ Pregnancy !omen are all the same.

'uring the primary survey life threateningconditions are identified and management isinstituted SIMA/%0S+.

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A. Air'a( aintenance 'it) %ervica* SpineProtection.

1 2#S score of 3 or less re4uire the placement of definiteair!ay.

1Protection of the spine $ spinal cord is the importantmanagement principle.

1/eurological exam alone does not exclude a cervical spinein5ury.

1Al!ays assume a cervical spine in5ury in any pt !ith multi-system trauma, especially !ith an altered level of consciousness

or "lunt in5ury a"ove the clavicle.

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B. Breat)in+ , #enti*ation1 Air!ay patency does not assure ade4uate ventilation.

%. %ircu*ation 'it) -emorr)a+e %ontro*.

6. (lood olume $ #ardiac 0utput

a. level of consciousness.

". s7in color

c. Pulse.

8. (leeding

1external "leeding is identified $ controlled in the

primary survey.

1ourni4uets should not "e use.

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&. &ia/i*it( 0 Neuro*o+ica* Eva*uation

Simple Mnemonic to descri"e level of consciousnessA 9 Alert

9 Responds to ocal stimuli

P 9 Responds to Painful stimuli

9 nresponsive to all stimuli

/ot forget to use also 2lasco! #oma Scale.

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E. Epoure Environmenta* %ontro*

1It is the pt:s "ody temp that is most important, not hecomfort of the health care provider.

1Intravenous fluid should "e !arm.

1;arm environment )room tem* should "e maintained.

1early control of hemorrhage.

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4. RES"S%ITATIONA. Air'a(

1definite air!ay if there is any dou"t a"out the pt:s a"ility tomaintain air!ay integrity.

B. Breat)in+ #enti*ationO(+enation

1every in5ured pt should received supplement oxygen

%. %ircu*ation

1control "leeding "y direct pressure or operative intervention

1 minimum of t!o large cali"er I should "e esta"lished

1pregnancy test for all female of child "earing age.

1 actated Ringer is preferred $ "etter if !arm.

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5. A&6"N%T TO PRIAR! S"R#E! ,

RES"S%ITATION

A. E*ectro7cardio+rap)ic onitorin+ B. "rinar( , Gatric %at)eter

6. rinary catheter.

rethral in5ury should "e suspected if

1(lood at the penile meatus

1Perineal ecchymosis

1(lood in the scrotum

1High riding or nonpalpa"le prostate 1Pelvic fracture

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%. onitorin+

6. entilatory rate $ A(2

8. Pulse oximetry

does not measure ventilation or partial 08 pressure


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: SE%ON&AR! S"R#E!

'oes not "egin until the primary survey )A(#'%s* is completed, resuscitative effort are !ell esta"lished

$ the pt is demonstrating normali=ation of vital sign.

1 Head to oe evaluation $ reassessment of all vital

signs.

1 A complete neurological exam is performed including

a 2#S score.

1 Special procedure is order.

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History

A 9 Allergies.

M 9 edication currently used.

P 9 Past illness>Pregnancy.

9 Last Meal

% 9 Events>Environment related to the in5ury.

1"lunt trauma>penetrating trauma>in5uries due

to cold $ "urn>ha=ardous environment?

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PH+SI#A %&AMI/AI0/

1. -ead isual acuity

Pupillary si=e

Hemorrhage of con5unctiva and fundi

Penetrating in5ury

#ontact lenses)remove "efore edema occurs*

'islocation of lens

0cular movement

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2. ai**ofacia* In;ur(

no /2 tu"e, definite air!ay?

3. %ervica* Spine , Nec7g>hr

Pediatric urine output 6mg>7g>hr

1Pain relief -- IM should "e avoid.

?. &E@INITE %ARE

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Indication @or &efinite Air'a(1 nconscious

1 Severe maxillo-facial fracture

1 Ris7 for aspiration 9 (leeding> vomiting

1 Ris7 for o"struction 9 nec7 hematoma>laryngeal,tracheal

in5ury> stridor1 Apnea 9 /euromuscular paralysis>unconscious

1 Inade4uate respiratory effort9 tachypnea>hypoxia>hypercapnia>cyanosis

1 Severe closed head in5ury need for hyperventilation

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Norma* B*ood Amount$

/ormal adult "lood volume 9 BC of "ody !eight/ormal "lood volume for child 9 3-DC of "ody !eight

-emorr)a+e %*aification $

#lass I Hemorrhage 9 up to 6C loss#lass II Hemorrhage 9 6-


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3 for 1 Ru*e

a rough guideline for the total amount ofcrystalloid volume acutely is to replace each

Mof "lood loss !ith < Mof crystalloidfluid, thus allo!ing for restitution of plasmavolume lost into the interstitial $intracellular space

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Initia* @*uid T)erap(

actated Ringer is preferred

1 Gor adult 6-8 liters "olus 1 Gor child 8@ml>7g "olus

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Intraoeou PunctureInfuion

#hildren less than y>o for I access isimpossi"le due to circulatory collapse or

for !hom percutaneous peripheral venouscannulation had failed on t!o attempt.

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Head In5ury #lassification9

Mild 9 2#S 6E-6

Moderate 9 2#S D-6< Severe 9 2#S


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&ia+notic Peritonea* Lava+e Indication

A. #hange in sensorium--Head in5ury>alcohol>drug.

(. #hange in sensation--Spinal cord in5ury.

#. In5ury to ad5acent structure--lo!er

ri"s>pelvic>lum"ar spine.

'. %4uivocal physical examination.

%. Prolong loss of contact !ith patient anticipated.

111 Poitive Tet$ F6@@,@@@ R(#>mmmm


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&eterminin+ t)e *eve* of uadrip*e+ia

a. Raise el"o! to level of shoulder -- 'eltoid #

". Glexes the forearm -- (iceps #

c. %xtend the forearm -- riceps #B

d. Glexes !rist $ finger -- #3

e. Spread finger -- 6

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&etermine t)e *eve* of parap*e+ia

a. Glexes the hip -- Iliopsoas 8

". %xtend 7nee -- Juadriceps

Advanced Trauma Life Support(1)

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