Atls (Advanced Trauma Life Support) Teaching Protocol

Pitfalls :

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  Lucid interval of acute EDH, reevaluation is important.
  

Exposure / Environment Control

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  Completely undressed the patient.
  
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  Prevent hypothermia
  
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  Injured patients may arrive in hypothermic condition
  
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  Log-roll
  

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  RESUSCITATION
  

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  To reverse immediately life-threatening situations and maximize patient survival
  

TREATMENT PRIORITY	NECCESSARY PROCEDURE
Airway	Jaw thrust/chin lift/ Suction Intubation Cricothyroidotomy ( with protection of C-spine )
Breathing/Ventilation/oxygenation	Chest needle decompression Tube thoracostomy Supplemental oxygen Seal open pneumothorax
Circulation/hemorrhage control	IV line/ central line Venous cutdown Fluid resuscitation/Blood transfusion Thorocostomy for massive hemothorax Pericardiocentesis for cardiac tamponade
Disability	Burr holes for trans-tentorial herniation IV mannitol
Exposure/Environment	Warmed crystalloid fluid Temperature

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  ADJUNCTS TO PRIMARY SURVEY AND RESUSCITATION
  

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  Electrocardiographic Monitoring.
  

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  Urinary Catheter
  

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  Gastric Catheter
  

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  Monitoring
  

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  ABG
  

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  Pulse oximeter
  

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  Blood pressure
  

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  X-rays
  

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  AP CXR
  

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  AP pelvis
  

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  C-spine
  

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  Diagnostic peritoneal lavage
  

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  Abdominal ultrasonography (FAST)
  

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  CONSIDER NEED FOR PATIENT TRANSFER
  

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  SECONDARY SURVEY
  

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  The secondary survey does not begin until:
  

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  the primary survey is completed,
  
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  resuscitation efforts are well established,
  
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  the patient is demonstrating normalization of vital functions.
  

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  Head-to-toe evaluation
  
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  Complete history and PE
  
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  Reassessment of all vital signs.
  
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  Complete NE.
  
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  Indicated x-rays are obtained.
  
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  Special procedures
  
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  Tubes and fingers in every orifice
  

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  History:
  

AMPLE history

Allergies

Medications currently used

Past illness/ Pregnancy

Last meal

Events/ Environment related to the injury

Mechanism/blunt/penetrating/burns/cold/hazardous environment

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  Physical Examination:
  

Table 1.

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  Pitfalls:
  

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  Facial edema in patients with massive facial injury or patients in coma can preclude a complete eye examination.
  
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  Blunt injury to the neck may produce injuries in which clinical signs and symptoms develop late.(e.g. Injury to the intima of the carotid a.)
  
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  The identification of cervical n. root/brachial plexus injury may not be possible in the comatose patient.
  
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  Decubitus ulcer from immobilization on a rigid spine board/cervical collar.
  
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  Children often sustain significant injury to the intrathoracic structures without evidence of thoracic skeletal trauma.
  
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  A normal initial examination of the abdomen does not exclude a significant intraabdominal injury.
  
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  Patients with impaired sensorium secondary to alcohol/drugs are at risk.
  
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  Injury to the retroperitoneal organs may be difficult to identify.
  
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  Female urethral injury are difficult to detect.
  
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  Blood loss from pelvic fractures can be difficult to control and fatal hemorrhage may result.
  
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  Fractures involving the bones of extremities are often not diagnosed.
  
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  Most of the diagnostic and therapeutic maneuvers increase ICP.
  

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