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Overview of ATLS

Overview of ATLS. William P. Bozeman, MD, FACEP Assistant Professor, Dept. of Emergency Medicine University of Florida Health Sciences Center / Jacksonville. Overview of ATLS. Overview of ATLS. Primary Survey (ABCDE’s) Resuscitation Secondary Survey Definitive Care Things to remember.

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Overview of ATLS

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  1. Overview of ATLS William P. Bozeman, MD, FACEP Assistant Professor, Dept. of Emergency Medicine University of Florida Health Sciences Center / Jacksonville

  2. Overview of ATLS

  3. Overview of ATLS • Primary Survey (ABCDE’s) • Resuscitation • Secondary Survey • Definitive Care • Things to remember...

  4. A = Airway B = Breathing C = Circulation Obstructed? Breath Sounds Present? Bilaterally? Peripheral Pulse? Femoral? Carotid? (Not BP Measurement.) Primary Survey - Immediate Threats to Life (Only!)

  5. D = Disability E = Exposure Global (AVPU or GCS) Gross Motor Function (i.e. spinal cord integrity) Nekkid! Primary Survey - Immediate Threats to Life (Only!)

  6. A = Airway B = Breathing C = Circulation Obstruction Tension PTX or HTX Open PTX Flail Chest Hypovolemic Shock Massive hemorrhage Spinal Shock Common Life Threatening Pathology

  7. Overview of ATLS • Primary Survey (ABCDE’s) • Resuscitation • Secondary Survey • Definitive Care • Things to remember...

  8. Resuscitation • IV’s (Two. Large.) • Control Bleeding • Fluids • Blood • Screening X-Rays “3” = C Spine, Chest, Pelvis. “5” = 3 + T&L Spine.

  9. Overview ATLS • Primary Survey (ABCDE’s) • Resuscitation • Secondary Survey • Definitive Care • Things to remember...

  10. Secondary Survey Now find out what happened, what’s injured. • History (AMPLE) • Physical. • Organized, complete head to toe exam. • Roll, check back. • Remember TM’s and rectal. • Foley. NG or OG tube.

  11. Overview of ATLS • Primary Survey (ABCDE’s) • Resuscitation • Secondary Survey • Definitive Care • Things to remember...

  12. Diagnostic Xrays (?) CT Scans (?) Ultrasound (?) MRI (?) DPL (?) Operating Room (?) Laceration Repairs (?) Antibiotics,Tetanus (?) Other Medications (?) Hyperbarics (?) Definitive diagnostics and care...

  13. Overview of ATLS

  14. Overview of ATLS • Primary Survey (ABCDE’s) • Resuscitation • Secondary Survey • Definitive Care • Things to remember...

  15. Roles of the Trauma Team Airway Nurse Team Member Team Member Boss Attending Nurse

  16. Roles of the Trauma Team • Boss • Directs the team, communicates decisions • Free to roam • Attending speaks through Boss (or teaches directly)

  17. Roles of the Trauma Team • Airway • A & B of primary survey • Intubation (if needed) • Head / Neck in secondary survey • Nurses • Attach monitors, give blood / fluids / meds • Recording nurse records at foot of bed

  18. Roles of the Trauma Team • Team Members • Expose, examine (secondary survey) • Procedures as directed (by boss) • Chest Tubes • Lac repairs • Rectals, foleys routinely assigned to team member.

  19. Things to remember…The Ideal Trauma Resuscitation • Roles are pre-assigned • Clear direction & communication • Pertinent findings verbalized in proper order • All team members know all findings • Rapid, Efficient • Calm & Quiet!

  20. Things to remember… The FAST Exam • 4 views (RUQ, LUQ, SP, Pericard.) • A “noninvasive DPL” • Sensitive for free fluid ( __ - __ %) • Not specific. • Not good for solid organ injury. • Not good for hollow organ injury.

  21. Things to remember…Classification of Shock Class EBLPulseBPMental Treatment I <15% (<750ml) - - nl Fluids II 15-30% (750-1.5L)  - +/-anxious Fluids III 30-40% (1.5L-2.0L)  anxious Fluids + Blood IV >40% (>2.0L)   confused Fluids + Blood

  22. A Special Case: Penetrating Trauma to trunk (especially GSW’s) • Need to rapidly find all penetrating injuries and all retained thoracoabd. projectiles • Therefore...

  23. A Special Case: Penetrating Trauma to trunk (especially GSW’s) • Examine for entry/exit wounds immediately after the primary survey. (Wait to take BP start IV’s, take history.) • Mark all entry and exit sites with radiopaque “arrow” markers. • Take xrays immediately. (Team member wearing lead may start IV’s, place chest tubes, etc. during xrays.)

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