Atls (Advanced Trauma Life Support) Teaching Protocol



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ATLS (Advanced Trauma Life Support) Teaching Protocol





  1. Pretest (30 min)

  2. Context of Tutorial (2 hours)

  1. General Principles

  • Concept

  • Inhospital phase clinical procedure/process

  • Important points/ cautions/ pitfalls

  • Brief discussion on traumatic shock/ blood transfusion

  1. Thoracic Trauma

  2. Abdominal Trauma

  1. Answers of pretests (30 min)

  2. Skills: (1hour)

  1. Airway and Ventilatory management

  1. Jet insufflation

  2. Laryngoscope / Magill forcep / Suction device

  3. Adult intubation

  4. Infant intubation

  5. Cricothyroidotomy




  1. Immobilization

a. In-line immobilization/ log-roll techniques

b. Cervical collar



  1. Long spine Backboard

  2. Scoop stretcher

  3. Traction Splint




  1. Adjuncts to surveys /monitoring/ resuscitation

  1. Pulse Oximeter

  2. DPL

  3. FAST

  4. Needle decompression

  5. Tube thoracostomy

  6. Seal Open peumothorax

  7. Pericardiocentesis

  8. Intraosseous puncture

Avanced Trauma Life Support



General Principles:


  • The concept:

Three underlying concepts of ATLS program :



  1. Treat the greatest threat to life first

  2. The lack of a definite diagnosis should never impede the application

of an indicated treatment

  1. A detailed history was not essential to begin the evaluation of an

acutely injured patient





  • Specific principles govern the management of trauma patients in ED:




  1. Organized team approach

  2. Priorities

  3. Assumption of the most serious injury

  4. Treatment before diagnosis

  5. Thorough examination

  6. Frequent reassessment

  7. Monitoring







  • Inhospital phase clinical process:

  • Systemic, organized approach to seriously injured patients is mandatory.



  • Preparation

  • Triage

  • Primary survey (ABCDEs)

Resuscitation

Adjuncts to primary survey & resuscitation


  • Secondary survey (Head to toe Evaluation)

Adjuncts to secondary survey


  • Continued postresuscitation monitoring and reevaluation

  • Definitive care






  • The primary and secondary surveys should be repeated frequently

  • In the actual clinical situation, many of these activities occur in parallel or simultaneously.




  • Organized Team Approach:

  • Team Captain : Coordinate, control the resuscitation

Assessing the patient, ordering needed procedures/ studies

Monitring the patient’s progress.



  • Procedures by other physician team members.

  • Nurses




  • Priorities In Management and Resuscitation

  • Immediate / potential threats to life

  • 1. High-priority areas

Airway/ breathing

Shock/ external hemorrhage

Impending cerebral hemorrhage

Cervical spine


2. Low-priority areas

Neurologic

Abdominal

Cardiac


Musculoskeletal

Soft tissue injury




  • Assumption of the Most Serious Injury

  • Assume the worst possible injury

  • Mechanism of injury




  • Treatment Before Diagnosis

  • Based on initial brief assessment

  • The more unstable the patient, the less necessary to confirm alife-threatening diagnosis before it is expeditiously treated




  • Thorough Examination

  • When time and the patient’s stability permit.

  • Unconscious/ alcohol intoxicated patients




  • Frequent Reassessment

  • Dynamic process

  • Some injuries take time to manifest

  • Any sudden worsening in the physiologic status of the patients mandates a return to the “ABCDEs”




  • Monitoring

  • Vital signs

  • Pulse oximetry

  • I/O

  • Lab: ABG, Ht

  • CVP


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