ATLS Summery of Book Chapter 2-5

8/18/2019 ATLS Summery of Book Chapter 2-5

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ATLS summery of bookChapter 2, 3, 4 and 5

Chapter 2 Airway• Maintain oxy enation and pre!ent hyper"arbia• Maxi##ofa"ia# trauma prob#emati"

o Trauma to midfa"eo $ra"ture of mandib#e espe"ia##y bi#atera# body fra"ture "ause

stru"tura# support prob#em%o Sometimes di&"u#ty in airway when #yin downo 'ro!idin anesthesia sedation or mus"#e re#axation "an #ead to

tota# #oss of airway due to diminis"hed or absent mus"#e tone%• (e"k

o 'enetratin in)ury *+ !as"u#ar prob#emLead to hematoma and disp#a"ement and obstru"tion ofairway

• Laryn ea# traumao oarsnesso Sub"utaneous emphysemao 'a#pab#e fra"ture

• Comp#ete obstru"tion or se!er respiratory distress warrant anattempt at intubation -rst.

o /f unsu""essfu#, emer en"y tra"heostomy is indi"atedo 0therwise sur i"a# "ri"othyroidotomy

• 'enetratin trauma of #arynxo 0ften esopha us, "arotid, )u u#ar !ein

• /f fra"ture of #arynx is suspe"ted based on me"hanism of in)uryo Then CT s"an to he#p identify%

• Si ns of airway obstru"tiono A itation *+ hypoxiao 0btunded *+ hyper"arbiao Abnorma# soundso $ee# #o"ation of tra"hea, mid#ineo Abusi!e be##i erent patient may ha!e hypoxiao 'hreni" ner!es C3*C4

• Chesto Symmetryo 1xtra use of mus"#es and stoma"h

• Cribiform p#ate fra"tureo on t use any tube throu h the nose be"ause "an o throu h

to "ranium• L1M0(

o L *+ #ooko 1 *+ e!a#uate 3*3*2

3 -n ers between in"isor3 -n ers between "hin and hyoid2 -n er between oor of mouth and thyroid not"h


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o M *+ ma##ampatuC#ass / to /

o 0 *+ obstru"tion Trauma or ab"ess

o ( *+ ne"k mobi#ity• $#uma6eni# is used to "ountera"t ben6odia6epines• Sur i"a# airway

o 1dema of the #ottiso $ra"ture of the #arynxo Se!ere oropharyn ea# hemorrha e obstru"tiono 0r an endotra"hea# tube "annot be p#a"ed throu h !o"a# "ordso Cri"othyroidotomy preferab#e to a tra"heostomy

7ui"ker, #ess b#ood• (eed#e "ri"othyroidotomy

o Short term basis, ur ent rather than emer ent basiso 82*84 au e adu#to 89*8: "hi#dreno 02 85L;min and 4< to 5< psio /ntermittent insu=ation 8se" on and 4 se" o> o Max 3


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Minima# to no response• $ai#ure to respond to uid or b#ood *+ dire"t

operation or an ioembo#sation or otherinter!ention to stop the b#eedin .

• Kare o""asions be"ause of pump fai#ure resu#t ofb#unt "ardia" in)ury

• 0r possib#y non hemorrha i" sho"k• C ' monitorin and "ardia" u#trasono raphy he#p

to di>erentiate• on t for et abdomina# distention

o Type of b#ood Transient responders

• Type spe"i-" b#ood is i!eno Compatib#e with A?0 and Kh b#oodtype but

in"ompatib#e with other anitbodies mayexist

(o response• Type 0 and Kh ne ati!e in women of ferti#e a e

o 're!ent hypothermiaeat uid to 3JC

?#ood "an pass by heated i! tubeso Autotransfusion

Dith patients with massi!e hemothorax• Keuse of own b#ood

o Massi!e transfusisone-ned +8< units of pK?C within 24 hours

1ar#y administration of pK?Cs, p#asma and p#ate#ets andminima#y uid he#ps

o Coa u#ation prob#emsHp 3


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Artheros"#erosis redu"es or an b#ood ow're*exisitin !o#ume dep#etion from

• iureti" use of ma#nutritiono ?#ood#oss poor#y to#erated

?eta*b#okker• *+ mask ta"hy"ardia

#ess pu#monary "omp#ian"ee"rease di>usion "apa"ity in #une"reased kidney response to stress hormone

Less "apa"ity of kidney to ho#d uidsLess "apa"ity of kidney to absorb dama e

o Ath#etes85*2


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• Cardia" dysfun"tion• Cardia" tamponade• /n"reased thora"i" pressure *+ tension

pneumothorax• Catheter ma#position

/dea# position of tip of "atheter in superior !ena "a!a, )ust proxima# to ri ht atriumLots of "omp#i"ations possib#e, needs tohappen steri#eand ree!a#uated

• as"u#ar in)ury, thrombosis, embo#i6ation, ner!ein)ury, pneumothorax

oes not re e"t #eftside of heart, abnorma# pu#monary"ir"u#ation or myo"ardia# dysfun"tion

o oes not respond to therapy "onsider?#eedinCardia" tamponade

Tension pneumohthoraxenti#atory prob#ems

$#uid #ossA"ute astri" distentionMyo"ardia# infar"tion

iabeti" a"idosisypoadrena#ism

(euro eni" sho"k

• Dhen per"utaneous periphera# !enous "an"u#ation has fai#ed on twoattempts intraoseous infusion is used

Chapter 4 Thora"i" trauma• (e"k !eins maybe be at in hypotension;hypo!o#emia patients• 'osterior dis#o"ation of "#a!i"u#ar "an "ause airway obstru"tion

o *+ stridor• Tenstion pneumothorax

o :"m #on need#e best +J


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o un shot media# of nipp#e or media# of s"apu#a *+ may needthora"otomy

?e"ause of "han"e of in)ured !essa# or hi#iar stru"ture• Cardia" tamponade

o Triadeenous pressure e#e!ation, "entra# !eneus druk Ce"#ine in arteria# pressure

Mu=ed heart toneso Shou#d be worse when #yin downO Like peri"arditisOo Tension pneumothorax "an mimi" "ardia tamponadeo Eussmau# si n

Kise in !enous pressure with inspiration when breathspontaneous#y *+ true parado"ia# !enous pressureabnorm

• C#osed heart massa e for "ardia" arrest ine>e"ti!e in patients withhypo!o#emia

o 'enetratin thora"i" in)ury, arri!in pu#se#ess but withmyo"ardia# e#e"tri"a# a"ti!ity

Are "andidates for immediate resus"itati!e thora"otomyo ?#unt in)ury and arri!e pu#se#ess but with myo"ardia# e#e"tri"a#

a"ti!ity not "andidiates for emer en"y resus"itati!ethora"otomy

• Se"ondary sur!eyo 1C , xthorax, arteria# b#ood aso Didenin mediastinumo /f 8 st or 2 nd or 3 rd rib fra"ture, s"apu#a or sternum*+ then

means se!ere trauma35F morta#ity and "han"e of in)ury to ne"k head orspine

o Mu#tip#e rib fra"ture in youn patients*+ hi h for"e trauma be"ause norma##y !ery exib#erib"a e

o $ra"ture of 8


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ypoxia *+ 'a02 B95mm :%9k'aNor Sa02BJ


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• Can "ome from b#unt for"e to epi astri" and #ooks#ike post emeti" rupture%

• ?#ood !omitin , air in mediastinumSub "utaneous emphysemaCrusin in)ury to "hest *+ traumati" asphyxia

o Simp#e

Chapter 5 Abdomen• emodynami"a##y abnorma# patient with mu#tip#e b#unt in)uries

shou#d be rapid#y assessed for intraabdomina# b#eedin or"ontamination from astrointestina# tra"t by $AST

• CT s"an indi"ationo emodynami"a##y abnorma# patients, don t o to CT be"ause

of time "onsumptiono emodynami"a##y norma# patient with tenderness

Hne!a#uab#e abdomen'ain

Tendernesso $ree uid on CT in trauma patient *+ operate

• Abdomina# 'enetratin woundso ypotension, peritonitis, e!is"eration if not *+ then wound

exp#orationN1mer ent #aparotomy

• unshot woundso 'eritonea# "a!ity or !is"era#;!as"u#ar area of Ketro*peritoneum

Laparotomy• Asymptomati" anterior abdomina# stab wounds *+ #o"a# wound

exp#oration *+ penetrate fas"ia or peritoneumo Ke uire further e!a#uation, $AST

• Asymptomati" ank or ba"k stab that are not super-"ia#o Seria# physi"a# examination or "ontrast enhan"ed CTo 1xp#oratory #aparotomy is a""epted

• Asymptomati" unshot wound to ba"k or anko Safer to preform #aparotomy

Ketroperitoneum• uodenum, as"endin and des"endin "o#on, re"tum, bi#iary tra"t,

pan"reas%

/ndi"ations $AST• Hnstab#e b#unt trauma

/ndi"ations CT• Stab#e b#unt trauma• 'enetratin ba"k; ank trauma

/ndi"ations 'L


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• CT or / 'o Ma"ros"opi" or mi"ros"opi" hematuria

'enetratin abdomina# wounds?#unt trauma and episode of hypotension be#owJ

ATLS Summery of Book Chapter 2-5

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