ATLS

Pembimbing : Dr. Adrian, Sp.OT

Presentan : M. Ilmul Yaqin Amha
Kepanitraan klinik FK UIN Syarif Hidayatullah Jakarta
RSUD dr. Chasbullah Abdulmadjid
Advance Traumatic Life Support
Hospital
Phase
 Triage
Multiple casualtise
 number of patients and the severity of
their injuries do not exceed the
capability of the facility to render care.
 In such cases, patients with life-
threatening problems and those
sustaining multiple-system injuries are
treated first.
Mass casualtise
 the number of patients and the severity
of their injuries does exceed the
capability of the facility and staff
 . In such cases, patients having the
greatest chance of survival and
requiring the least expenditure of time,
equipment, supplies, and personnel
are treated first
ABCDE
 Primary Survey with
Simultaneous
Resuscitation
•• Airway maintenance with restriction of cervical spine motion
•• Breathing and ventilation
•• Circulation with hemorrhage control
•• Disability(assessment of neurologic status)
•• Exposure/Environmental control
Airway
 Assesment
Open the airway
Look Obstruction
Feel air blowing
Listen gurgling, snoring, stridor,
LMA
 ETT Intubation
Maintain airway patency
High O2 delivery
Providing adequate Ventilation
Aspiration prevention
Suctioning into trachea
Drug deliv
 Difficult Airway
Management
C-Spine injury,severe arthritis of spine, significant maxilofacial or
mandibulat rauma, limited mouth opening, obesity, anatomical
variation, pediatric
 Look externally
 Evaluate 3-3-2
 Malampati
 Obstruction
 Neck mobility
 Surgical airway

Needle cricothyroidotomy
cricothyroidotomy
tracheostomy
Breathing
 Brething
Inspect, palpate, and auscultate
Deviated trachea, crepitus, flail chest, sucking
chest wound, absence of breath sounds

Look – naik turunnya dinding dada dan

simetrikal
Listen – dengar suara nafas
Feel --- prediksi gagal nafas
Flail
Chest/Paradoxal
Movement
 Assesment

Rate 01 02 Adequacy

Pattern 03 04 SpO2
 Breathing Interventions
Ventilate with 100% oxygen
Needle decompression if tension pneumothorax
suspected
Chest tubes for pneumothorax / hemothorax
Occlusive dressing to sucking chest wound
If intubated, evaluate ETT position
SpO2 Clicnical Devices
95-100 Normal NK
90- Mild-Moderat Hypoxia Simple Mask, w/Reservoir
94%
85-90 Severe Hypoxia Assisted Ventilation
<85 Live Thretening Severe Assisted ventilation
Hypoxia

Device Flow %O2

NK 1-5l/m 21-40%
Simple mask 6-10l/m 35-60%
SM w/ Reservoir 6l/m
9l/m 90%
10-15l/m 95-100%
Venturi Mask 4-8l/m 24-35%
10-15l/m 40-50%
 Ventilation
Assisted Ventilation Mechanic vs Manual
Positive pressure
Indication: no breathing, nonadequate
spontan breathing,
Circulation
 Circulation with
Hemorrhage Control
Rapid assessment of hemodynamic status
Level of consciousness
Skin color
Pulses in four extremities
Blood pressure and pulse pressure
“ Look, Listen, Feel “
 Recognition of
shock
Hemorrhagiac shock
Cardiogenic shock
Cardiac tamponade
Tention pneumothoraks
Neurogenic shock
Septic shock
 Intervention
Cardiac monitor
Apply pressure to sites of external hemorrhage
Establish IV access
2 large bore IVs
Central lines if indicated
Cardiac tamponade decompression if indicated
Volume resuscitation
Have blood ready if needed
Level One infusers available
Foley catheter to monitor resuscitation
Disability
 D - Assesment
Abbreviated neurological exam
Level of consciousness
Pupil size and reactivity
Motor function
GCS
Utilized to determine severity of injury
Guide for urgency of head CT and ICP monitoring
 D - Intervention
Spinal cord injury
Stabilize and steroid
ICP monitor- Neurosurgical consultation
Elevated ICP
Head of bed elevated 30 degree
Mannitol
Hyperventilation
Emergent decompression
Exposure
 Examine
• Neck
• Chest
• Abdomen
• Hip
• Upper leg

Complete disrobing of patient

Logroll to inspect back
Rectal temperature
Warm blankets/external warming device to prevent hypothermia
Trauma
 ` RAPID TRAUMA
ASSESSMENT

DCAP BTLS
• D - Deformities • B - Burns

• C - Contusions • T - Tenderness

• A - Abrasions • L - Lacerations

• P - Punctures/Penetrations • S - Swelling
 S-A-M-P-L-E
Even Sign & symptoms

06 01

Last meal Allergies

05 02

04 03
Pass illness Medication
Thank’s