Student course manual

ADVANCED TRAUMA LIFE SUPPORT

CHAPTER
Initial assesment and management
2. Airway and ventilatory management
3. Shock
4. Thoracic trauma
5. Abdominal and pelvic trauma
6. Head trauma
7. Spine and spinal cord trauma
8. Musculoskletal trauma
9. Thermal injuries
10. Pediatric trauma
11. Geriatric trauma
12. Trauma in pregnancy and intimate partner violence
13. Transfer to definitive care
1.

INITIAL ASSESMENT AND

MANAGEMENT
Primary survey
Resuscitation
Secondary survey

PREPARATION

Pre hospital phase

Post hospital phase

TRIAGE

Green, yellow, red, black tag

Multiple casualities or mass casualities

PRIMARY SURVEY

First 10 second
Airway maintenance with cervical
spine protection
Breathing and ventilation
Circulation with hemorrhage control
Disability : neurologic status
Esposure/enviromental control
Special population

SPECIFIC POPULATION

Pediatric
Pregnant female
Older adults
Athletes
Obese patient

AIRWAY MAINTENANCE WITH CERVICAL SPINE

PROTECTION

Able or unable to communicate?

Protect the cervical spine
Chin lift or jaw thrust
GCS 8 require definitive airway
Assume a cervical spine injury in patient
with blunt multisystem trauma,
especially those with an altered level of
conciousness or a blunt injury abole the
clavicle

AIRWAY MAINTENANCE WITH CERVICAL SPINE PROTECTION

Pitfall

there are circumstance which airway

management is exceptionally difficult and
occasionally even impossible to achieve
Intubation of a patient with an unknown
laryngeal fracture or incomplete upper
airway transection can precipitated total
airway occlusion or complete airway
transection

BREATHING AND VENTILATION

Neck and chest exposed

Asses jugular neck vein, trachea,chest
wall excursion
Find tension pneumothorax, open
pneumothorax, massive hematothorax,
rupture diafragm, flail chest with
pulmonary contusion

BREATHING AND VENTILATION

Pitfall

Patients who have profound dyspneu and

tachypnea
If the ventilation problem caused by
pneumothorax intubation with vigorous
bag-mask can rapidly lead to further
deterioration
Procedure intubation can mask or
aggravated a pneumothorax

CIRCULATION WITH HEMORRHAGE CONTROL

Blood volume and cardiac output

Level of consciousness
Skin color
pulse

Bleeding

Identify source of bleeding

Direct manual pressure
Torniquet

CIRCULATION WITH HEMORRHAGE CONTROL

Pitfall

Elderly have a limited abilty to increase their

heart rate, anticoagulation therapy can increase
blood loss
Childern usually have abundant physiologic
reserve and often have few sign of hypovolemia,
even after severe volume depletion
Well trained athled have similiar compensatory
mechanism, may have bradycardia, may have
not usual level of tachycardia
Often the AMPLE history is not available

DISABILITY (NEUROLOGICAL
EVALUTION)

Glasgow coma scale

Decrese cerebral oxygenation or direct
cerebral injury
Hypoglicemia, alcohol, narcotics, and
other drug can alter level of
consciousness

DISABILITY

Pitfall

Despite proper attention to all aspect of

treating a patient with a closed head
injury, neurological deterioration can occur
The lucid interval : talk and die

EXPOSURE AND ENVIROMENTAL

FACTOR

Completely undressed
Cutting of her or his garments
Cover with warm blanklet or external
warming device
The patients body temperature is more
important than the comfort of the
healthcare providers

RESUSCITATION
Follows the ABC sequence and occurs simultaneously
with evaluation

AIRWAY

Should be protected in all patient

Jaw thrust and chin lift manuever may suffice an
inital intervention
Collar neck
An oropharyngeal airway may be helpful temporary
A definitive airway should be established if there is
any doubt about the patients ability to maintain
airway integrity
Needle cricothyrodotomi
tracheostomi

BREATHING

Chest decompression
Needle thoracocentesis
Water sealed drainage
pericardiocentesis

CIRCULATION AND HEMORRHAGE CONTROL

Definitive bleeding control is essential

along with appropiate replacement of
intravascular volume
Two large caliber IV catheter
Type and cross match, CBC, blood
gases and lactate, pregnancy test
Upper extremity iv access is preferred

Aggresive and continued volume

resuscitation is not a substitute for
definitive control of hemorrhage
Warmed 1-2 L isotonic fluid

ADJUCT TO PRIMARY SURVEY AND RESUSCITATION

EKG monitoring
Urinary and gastric catheters
Pulse oximetry
Blood pressure
X-ray examination
Arterial blood gas and lactate
FAST
DPL

SECONDARY SURVERY
It doesnt begin until primary survey is completed,
resuscitative effort is underway, and the
normalization of vital function has been
demonstrated

HISTORY

AMPLE
Blunt trauma :

Mechanism of injury
Side impact, rear impact or frontal impact
Suspected injury pattern

Penetrating trauma
Thermal injury
Hazardous material

PYSICAL EXAMINATION

Head
Maxilofacial structures
Cervical spine and neck
Chest
Abdomen
Perineum, rectum and vagina
Musculoskletal system
Neurological system

REEVALUATION

Trauma patients must be reevaluated

constantly to ensure the new findings
are not overlooked and to discover
deterioration in previously noted
findings
Use analgesic and anti anxiety
judisiously

DEFINITIVE CARE

Should considered whenever the

patients treatment needs exceed the
capability of the receiving institution

RECORDS AND LEGAL

CONSIDERATIONS

Accurate record keeping during

resuscitation can be facilitated by
nursing staff
Medicolegal problems arise frequently
and precise medical records is helpful
Consent for treatment
Forensic evidence

TEAMWORK

Team member with role team leader

Should be trained in ATLS course
On arrival from pre hospital team
hands-off hand-over format is MIST

Mechanism of injury
Injuries found and suspected
Symptoms and signs
Treatment initiated