MULTIPLE TRAUMA

MANAGEMENT
 Epidemiology

ATLS 10th edition.2018.American College of Surgeons

 Epidemiology

ATLS 10th edition.2018.American College of Surgeons

Trimodal Death Distribution:
(ACS,97) .
Periode I: immediate → cedera CNS, Cor,Aorta

Periode II: Early → kelainan multiple

(fr.iga, pneumotoraks, hemotoraks, dll.) + blood
lost

Periode III: hari – minggu → sepsis atau MOF

Sobrino J, Shafi S. Timing and Causes of Death after Injuries. Proc (Bayl Univ Med Cent)
2013;26(2):120–123
 Initial Assesment
• Preparation
• Triage
• Primary survey (ABCDEs) with immediate resuscitation of
patients with life-threatening injuries
• Adjuncts to the primary survey and resuscitation
• Consideration of the need for patient transfer
• Secondary survey (head-to-toe evaluation and patient
history)
• Adjuncts to the secondary survey
• Continued post resuscitation monitoring and reevaluation
• Definitive care
ATLS 10th edition.2018.American College of Surgeons
 Field Triage Decision

ATLS 10th edition.2018.American College of Surgeons

ATLS 10th edition.2018.American College of Surgeons
ATLS 10th edition.2018.American College of Surgeons
PRIMARY SURVEY
 • In many centers, trauma
patients are assessed by
a team.
• Effectively, each team
has one member who
serves as team leader

ATLS 10th edition.2018.American College of Surgeons

 • Airway with restriction of cervical spine
A motion

• Breathing and ventilation

B

• Circulation, stop the bleeding

C

ATLS 10th edition.2018.American College of Surgeons

 • Disability or neurologic status
D

• Exposure (undress) and

Environment (temperature control)
E

ATLS 10th edition.2018.American College of Surgeons

C - Spine control

ATLS 10th edition.2018.American College of Surgeons

 Log Roll Technique

ATLS 10th edition.2018.American College of Surgeons

 Diagnostic Tools in Primary Survey
• X – ray ( Chest AP and Pelvic AP)
• FAST
• DPL
• Use x-ray examination judiciously, and do not delay
patient resuscitation or transfer to definitive care in
patients who require a higher level of care

ATLS 10th edition.2018.American College of Surgeons

SECONDARY SURVEY
 • The secondary survey does not begin until the primary
survey (ABCDE) is completed
• The secondary survey is a head-to-toe evaluation of
the trauma patient
• Complete history
• Physical examination
• Each region of the body is completely examined

ATLS 10th edition.2018.American College of Surgeons

 AMPLE (History)
• Allergies
• Medications currently used
• Past illnesses/Pregnancy
• Last meal
• Events/Environment related to the injury

ATLS 10th edition.2018.American College of Surgeons

 MIST (History)
• Mechanism (and time) of injury
• Injuries found and suspected
• Symptoms and Signs
• Treatment initiated

ATLS 10th edition.2018.American College of Surgeons

 Specialized Diagnosed Test
• X-ray examinations of the spine and extremities
• CT scans of the head, chest, abdomen, and spine;
• Contrast urography
• Angiography
• Transesophageal ultrasound
• Bronchoscopy
• Esophagoscopy
• etc

ATLS 10th edition.2018.American College of Surgeons

Male, 27 Years old
 SUMMARY
• Trimodal deaths
• Principles of the primary and secondary surveys and
the guidelines and techniques in the initial resuscitative
and definitive care phases of treatment apply to all
multiply injured patients.
• A patient’s medical history and the mechanism of
injury are critical to identifying injuries.
 SUMMARY
• The primary survey should be repeated frequently, and
any abnormalities will prompt a thorough
reassessment.
• Early identification of patients requiring transfer to a
higher level of care improves outcomes.