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ATLS Presentation CME TILAGAAN MARIUMUTTHU.pdf
- 1. ADVANCED TRAUMA& LIFE SUPPORT A BRIEFOVERVIEW by TILAGAAN MARIUMUTTHU
- 2. THREE UNDERLYING CONCEPTSof the ATLS Treat the greatest threat to life first NEVER ALLOW the lack of definitive diagnosis to impede the application of an indicated treatment. A detailed history is NOT ESSENTIAL to begin the evaluation of a patient with acute injuries.
- 3. Principles of managementof trauma patients in ETD • Organized team approach • Priorities • Assumption of most severe injuries / mechanism of injury • Treatment before diagnosis • Frequent reassessment (some injuries may take time to manifest) • Monitoring (Vitals, I/O, SpO2, Blood Gases, CVP)
- 4. Understanding the principlesof PRIMARY & SECONDARY SURVEY
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- 6. A : AIRWAYOBSTRUCTION T : TENSION PNEUMOTHORAX O : OPEN PNEUMOTHORAX M : MASSIVE HAEMOTHORAX F : FLAIL CHEST C : CARDIAC TAMPONADE
- 7. A B CD E
- 8. D R AB C D E
- 9. DANGER IN A PROTECTEDENVIRONMENT?
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- 14. AIRWAY & CERVICAL SPINESTABILIZATION
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- 17. AIRWAY PROBLEMS Airway obstruction •Swelling/ Bleeding/Vomitus • Laryngeal Injury • Posterior dislocation of clavicular head • Penetration trauma of head and neck What to look for? • Air hunger • Intercostal and supraclavicular muscle recession • Inspect for obstruction • Listen for air movement @ nose/mouth/lung fields • Stidor / marked change in voice quality • Anterior neck crepitus • Sternoclavicular joint defect
- 18. AIRWAY PROBLEMS Tracheo-brochial treeinjury • Injury to the trachea / mainstem bronchus • The majority of TBT injuries occur within 1 inch from the carina • Patient either die at the scene or has a high mortality Rapid deceleration trauma, blast injuries or penetrating trauma can cause this injury What to look for? • Hemoptysis • Cervical subcutaneous emphysema • Tension pneumothorax +/- cyanosis • Incomplete lung expansion / large air leak following chest tube placement suggest TBT Injury • BRONCHOSCOPY confirms the diagnosis
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- 23. What are theinjuries that may acutely impair ventilation?
- 24. THORACIC TRAUMA Hypoxia • Hypovolemia •Pulmonary V/Q Mismatch (contusion/hematoma/alveolar collapse) • Changes in intrathoracic pressure (tension pneumothorax/open pneumothorax) Hypercarbia • Inadequate ventilation due to changes in intrathoracic pressure • Depressed level of consciousness Metabolic Acidosis • Tissue hypoperfusion (shock)
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- 26. TENSION PNEUMOTHORAX • Accumulationof air in the pleural space compressing the lungs thus decreasing venous return to the heart • A clinical diagnosis • Signs to look for: 1. Respiratory distress / Air hunger 2. Distended neck veins 3. Cyanosis 4. Tracheal deviation 5. Tachycardia 6. Hyper-resonant percussion 7. Unilateral absent breath sound 8. Hypotension • Mx : Needle thoracocentesis (temporary) and chest tube insertion (28 -32Fr)
- 33. UNDERWATER SEAL Creates a one-wayvalve that prevents air/fluid from entering the thoracic cavity
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- 35. OPEN PNEUMOTHORAX • Open“sucking chest wound” • Air follow the path of least resistance (opening more than or ~ 2/3 of tracheal diameter) • Impairing effective ventilation = hypoxia + hypercarbia • Signs to look for: 1. Respiratory distress / tachypneic 2. Pain 3. Noisy movement of air through chest wall injury Immediate management : 3-way occlusive dressing (Flutter-valve effect) Mx : Chest tube insertion and definitive surgical closure
- 37. FLAIL CHEST A TO M F C
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- 45. CIRCULATION & CONTROL :HEMORRHAGE
- 46. SHOCK in Trauma •Hemorrhagic vs. Non-Hemorrhagic • Sites of possible blood loss “on the floor + 4” • Chest • Abdomen • Pelvis & Retroperitoneum • Long Bones and soft tissues • How to identify? • CXR / AXR • Pelvic X-Ray • FAST Scan / DPL • Bladder cathetherization • Types of Non-Hemorrhagic Shock • Cardiogenic Shock • Cardiac Tamponade • Tension Pneumothorax • Neurogenic Shock • Septic Shock
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- 49. MASSIVE HAEMOTHORAX • Rapidaccumulation of > 1500mL of blood (neck veins flat due to severe hypovolemia) • Commonly caused by penetrating chest wound / blunt trauma • Massive haemothorax = shock + absent breath sound/ unilateral dullness on percussion • Mx: Rapid volume restoration and Decompression (Chest tube 28-32Fr) Indications for urgent thoracotomy: • Immediate return of 1.5L or more • 200mL/hr for 2-4 hours • Persistent need for blood transfusion • Wound medial to nipple line • Posterior wound medial to scapula Mediastinal Box
- 52. THE TRIAD OFTRAUMA Lethal
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- 59. HEAD – TO– TOE EXAMINATION
- 60. Head to toeexamination A – Allergy M – Medication P – Past Medical illness / Pregnancy L – Last meal E – Events/ Environment related to the injury B : Blunt Cardiac Injury B : Blunt Esophageal Rupture F : Flail Chest H : Hemothorax P : Pulmonary contusion P : Simple Pneumothorax T : Traumatic Diaphragmatic Injury T : Traumatic Aortic Disruption THE HIDDEN
- 61. ADJUNCTS TO PRIMARY SURVEY& SECONDARY SURVEY
- 62. Adjuncts to primarysurvey 1. Electrocardiographic Monitoring 2. Urinary bladder catheterization 3. Gastric Decompression / catheterization 4. Monitoring (BP/ Pulse Oximeter/ ABG) 5. X-Ray ( CXR/Pelvis/C-Spine) 6. DPL 7. FAST (Abdominal Ultrasonography)
- 63. Adjuncts to secondarysurvey 1. Additional X-Ray of Spine and extremities 2. CT Head/Chest/Abdomen/Spine 3. Contrast Urography 4. Angiography 5. Bronchoscopy 6. OGDS
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