Overview of ATLS

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Overview of ATLS

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

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Overview of ATLS
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Overview of ATLS

• Primary Survey (ABCDEs)
• Resuscitation
• Secondary Survey
• Definitive Care
• Things to remember...

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Primary Survey - Immediate Threats to Life (Only!)

• A Airway
• B Breathing
• C Circulation

• Obstructed?
• Breath Sounds Present?
• Bilaterally?
• Peripheral Pulse?
• Femoral? Carotid?
• (Not BP Measurement.)

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Primary Survey - Immediate Threats to Life (Only!)

• D Disability
• E Exposure

• Global (AVPU or GCS)
• Gross Motor Function
• (i.e. spinal cord integrity)
• Nekkid!

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Common Life Threatening Pathology

• A Airway
• B Breathing
• C Circulation

• Obstruction
• Tension PTX or HTX
• Open PTX
• Flail Chest
• Hypovolemic Shock
• Massive hemorrhage
• Spinal Shock

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Overview of ATLS

• Primary Survey (ABCDEs)
• Resuscitation
• Secondary Survey
• Definitive Care
• Things to remember...

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Resuscitation

• IVs (Two. Large.)
• Control Bleeding
• Fluids
• Blood
• Screening X-Rays
• 3 C Spine, Chest, Pelvis.
• 5 3 TL Spine.

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Overview ATLS

• Primary Survey (ABCDEs)
• Resuscitation
• Secondary Survey
• Definitive Care
• Things to remember...

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Secondary Survey

• Now find out what happened, whats injured.
• History (AMPLE)
• Physical.
• Organized, complete head to toe exam.
• Roll, check back.
• Remember TMs and rectal.
• Foley. NG or OG tube.

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Overview of ATLS

• Primary Survey (ABCDEs)
• Resuscitation
• Secondary Survey
• Definitive Care
• Things to remember...

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Definitive diagnostics and care...

• Diagnostic Xrays (?)
• CT Scans (?)
• Ultrasound (?)
• MRI (?)
• DPL (?)

• Operating Room (?)
• Laceration Repairs (?)
• Antibiotics,Tetanus (?)
• Other Medications (?)
• Hyperbarics (?)

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Overview of ATLS
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Overview of ATLS

• Primary Survey (ABCDEs)
• Resuscitation
• Secondary Survey
• Definitive Care
• Things to remember...

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

• Boss
• Directs the team, communicates decisions
• Free to roam
• Attending speaks through Boss (or teaches
  directly)

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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

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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.

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Things to rememberThe 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!

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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.

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Things to rememberClassification of Shock
Class EBL Pulse BP Mental
Treatment I lt15 (lt750ml)
- - nl
Fluids II 15-30 (750-1.5L) ?
- /-anxious
Fluids III 30-40 (1.5L-2.0L) ?
? anxious Fluids
Blood IV gt40 (gt2.0L) ? ? ? ?
confused Fluids Blood
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A Special Case Penetrating Trauma to trunk
(especially GSWs)

• Need to rapidly find all penetrating injuries and
  all retained thoracoabd. projectiles
• Therefore...

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A Special Case Penetrating Trauma to trunk
(especially GSWs)

• Examine for entry/exit wounds immediately after
  the primary survey.
• (Wait to take BP start IVs, take history.)
• Mark all entry and exit sites with radiopaque
  arrow markers.
• Take xrays immediately.
• (Team member wearing lead may start IVs, place
  chest tubes, etc. during xrays.)

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