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Advanced Trauma Life Support
Advanced Trauma Life Support
Support
Dr Osama Bawazir
Assistant Professor , Consultant Pediatric surgeon
FRCSI, FRCS(Ed), FRCS (glas), FRCSC,
FAAP,FACS.
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DEFINITION 0F TRAUMA
A term derived from the Greek for WOUND
It refers to any bodily injury.
It defined as tissue injury due to direct effects of
externally applied energy. Energy may be mechanical,
thermal, electrical, electromagnatic or nuclear.
Included:burns, drowning, smoke, inhalation,
slip & fall.
Excluded: poisoning/toxic ingestion.
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URGENT.
COMPRISES APPROXIMATELY ABOUT 10-15 % OF ALL PATIENTS.
NON-URGENT.
APPROXIMATELY 80 % OF ALL INJURIES.
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1. Preparation
2. Triage
3. Primary Survey (ABCDEs)
4. Resuscitation
5. Adjuncts to primary survey & resuscitation
6. Secondary Survey (head to toe evaluation & history)
7. Adjuncts to secondary survey
8. Continued post-resuscitation monitoring & re-evaluation
9. Definite care.
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1. PREPARATION
A Pre-hospital phase
Receiving hospital is notified first.
Send to the closest, appropriate facility.
B In Hospital Phase
Advanced planning for the trauma pt arrival.
Method to summon extra medical assistance
Transfer agreement with verified trauma center established.
Protect from communicable disease.
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2. TRIAGE
A Multiple Casualties
no of severity & pt do not exceed the ability of
the facility.
B Mass Casualties
no & severity of pt EXCEED the capability of
the facility & staff.
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3. PRIMARY SURVEY
A : Airway with cervical spine protect.
B : Breathing
C : Circulation --control external bleeding.
D : Disability or neurological status
E : Exposure (undress) & Environment (temp control)
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PRIMARY SURVEY
Priorities for the care of Adult , Pediatrics
& Pregnancy women are all the same.
During the primary survey life threatening
conditions are identified and management is
instituted SIMULTANEOUSLY.
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4. RESUSCITATION
A. Airway
*definite airway if there is any doubt about the pts ability to
maintain airway integrity.
B. Breathing /Ventilation/Oxygenation
*every injured pt should received supplement oxygen
C. Circulation
*control bleeding by direct pressure or operative intervention
* minimum of two large caliber IV should be established
*pregnancy test for all female of child bearing age.
* Lactated Ringer is preferred & better if warm.
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C. Monitoring
1. Ventilatory rate & ABG
2. Pulse oximetry
does not measure ventilation or partial O2 pressure
3. Blood pressure
poor measure of actual tissue perfusion.
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6 SECONDARY SURVEY
Does not begin until the primary survey (ABCDEs)
is completed, resuscitative effort are well established
& the pt is demonstrating normalization of vital sign.
* Head to Toe evaluation & reassessment of all vital
signs.
* A complete neurological exam is performed including
a GCS score.
* Special procedure is order.
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History
A : Allergies.
M : Medication currently used.
P : Past illness/ Pregnancy.
L : Last Meal
E : Events/Environment related to the injury.
*blunt trauma/penetrating trauma/injuries due
to cold & burn/hazardous environment?
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PHYSICAL EXAMINATION
1. Head
Visual acuity
Pupillary size
Hemorrhage of conjunctiva and fundi
Penetrating injury
Contact lenses(remove before edema occurs)
Dislocation of lens
Ocular movement
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2. Maxillofacial Injury
no NG tube, definite airway?
3. Cervical Spine & Neck
*Pt with maxillofacial or head trauma should be presumed
to have and unstable cervical spine.
4. Chest
*elderly pt are not tolerant of even relatively minor
chest injury.
*Children often sustain significant injury to the
intrathoracic structure without evidence of thoracic
skeletal trauma.
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5. Abdomen
*excessive manipulation of the pelvic should be avoided.
6. Perineum/rectum/vagina
7. Musculoskeletal
8. Neurologic
* Protection of spinal cord is required at all times until a
spine injury excluded, especially when the pt is transfer.
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8. RE-EVALUATION
Adult urine output 0.5ml/kg/hr
Pediatric urine output 1mg/kg/hr
*Pain relief -- IM should be avoid.
9. DEFINITE CARE
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Hemorrhage Classification :
Class I Hemorrhage :
up to 15% loss
Class II Hemorrhage :
15-30% loss
30-40% loss
Class IV Hemorrhage :
>40% loss
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3 for 1 Rule
a rough guideline for the total amount of
crystalloid volume acutely is to replace each
ML of blood loss with 3 ML of crystalloid
fluid, thus allowing for restitution of plasma
volume lost into the interstitial &
intracellular space
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Intraosseous Puncture/Infusion
Children less than 6 y/o for IV access is
impossible due to circulatory collapse or
for whom percutaneous peripheral venous
cannulation had failed on two attempt.
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: GCS 14-15
: GCS 3-8
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Thoracic Trauma
8 lethal Injury
1. Simple pneumothorax
2. Hemothorax
3. Pulmonary contusion
4. Tracheo-bronchial tree injury
5. Blunt cardiac injury
6. Traumatic aortic disruption
7. Traumatic diaphragmatic injury
8. Mediastinal traversing wounds.
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Fluid Therapy in
2nd or 3rd Degree Burn
Total amount of first 24 hours:
4 ml of Ringer lactate x BW(kg) x BSA
* give 1/2 in first 8 hrs
* 1/2 in remaining 16 hrs
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2.
Abdominal hemorrhage
3.
Pelvic Hemorrhage
4.
Extremity Hemorrhage
5.
Intra-cranial Injury
6.
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