ATLS ( advance trauma life support )

ATLS
10 yr old boy brought to you after a fall from a 2 story building ?

? Pt stable / not ?
= unstable
? Can you tell me about his GCS?
12
Then i will go from A B C
? Assess airway ,
I will secure his cervical spine by apply a cervical collar
And i will chin lift
Connect to monitor
Can you tell me about his RR ,O2 , PR , BP
NL
Insert a oropharyngeal airway
If So2 <92 % give 100%
I will assess his breathing
For symetrical chest moments ( Tension Penumothorax)
I will insert 2 wide bore cannular
Take blood for
• CFC ( HB)
• BS -hypoglycemia 20mg / dl
• Blood grouping RH to areange a blood pack
Takr a breaf Hx
• What happen prior to this
= yesterfay night had cold( infection
Drank lot of water ( polydypsea)
• Vomit / fit after fall ? Intra cranila bleed
• PMed Hx - depression / DM
• Lasy meal
• Drug allergy
• Hx poisoning
• Suspicious non accidantal
Brief Ex
• Eyes ( increased ICP - papilledema
• Intra cranial heamareage signs
• Focal neurological signs
• Kernig - Subarachnoid Hemorrhage
• Abd bleed
• Leg fractures
Dissability , Esposure

Ix
BS low
ECG in adults
SE ( hyperkaleamia in rabdomyalysis )
RFT
LFT

Imaging
• FAST USS
• Non contrast CT Head & neck ) - for fall more than 1 m

Mx

Hypoglycemia

<4mmol / dl o 60mg/dl
• Children 10% Dextrose 05g/kg IV bolus
• ( Adult 50% Dextrose 20-50ml OV bolus

Assess BS in 10min
• If still low
• Adult -IV 10% Dextrose 150-160ml over 15min infusion
• Childen - IV 10% Dextrose 05g/kg bolus
Then if NL keep it not inform and transver
 ATLS
36yr man cut his hand with a can when he try to put it in to garbage can.There is
lot of bleeding.
? Pt stable / not
= stable
But i will apply compression dressing to stop bleeding
?when did this happen
=today morning
?how many towels did u use to soak blood
= 2 -3
? Did u have previous episodes ?
=no this is the first time
? Are you in severe pain?
=yes
?are you faintish ?
=no
? Did you have Tetanus immunization up to date?
Yes
? Are you taking medicine to thin your blood or do you have disorder which
prolong bleeding?
?Pmed Hx
= depression
? Are you live alone?
= yes
? Alcohol / drugs / smoking?
=no
Dominant hand / not?
Non dominant hand
Can you move your fingers?
Yes

Ex
Vitals
Pallor
=mild
BP - NL PR - tachy RR SO2 NL

Ex his hand - cut how deep

1cm
NERVES , ARTERY , TENDON
SO2 prob insert to index finger
CRFT <2 each finger
Apply pressure on wound
But ask him to move all fingers = can
Inspect non dominant hand for diformity #
Inspect for parelel scars near by wound ? ( previous suicidal attempts)

CVS , RS , abdomen , limb examination

Ix
• CFC = Jb
• Blood grouping Rh - secure blood pack
Mx
Compression dressing of wound
• Inform plastic Surgery team and transver pt
• Give PCM 1g 6 hrly
• No need to give Tranaxemic acid 1g over 1min then 1g over 8 hours as
this is not catastropic bleeding within 3 hr
• No need Tetanus toxoid
• Give oral Antibiotic not a major trauma no need IV Cefuroxime 8hrly for
1day

ATLS
25yr old woman brough to you after RTA?
Pt stable/ not?
Stable
? Is it a
• High speed colloid
• Run over
• Vehicle ejection
• Prolong ectrication
• Pedestrian run over
• Fall >2 ft ( 1m)
• Some one died due to this
•
but no one died.. his husband is serious
? So this is not a major trauma and pt is stable
Can go with Hx Ex ...bla bla
? What has happen?
= colloided
?are you have a headache / SOB / chest pain / abd pain / leg pain
=cant remember i'm Worried about my husband
? Do you have any illness?
No
Do you takr mdication ?
No
Alcohol / smoke / drug
No
Are you pregnant ?
Not known
When is your last meal?
6pm
Do you have allergy
No
What is your tetanus toxoid status =
Up to date

Ex
General appearance – NL
Pallor = no
Bruises / Lacerations ?
No
Headache
Neck pain stiff – no
BP PR RR SO2 = NL
CVS , RS, Abd , Focal neurological / LEGS ?
Compound # left leg

Meanwhile came to know her husband is dead

So this become a major trauma now..
I should go back and start from A B C

Assess Airway
Breathing tachypnic
Secure cevical spine
Connect monitor for continous monitoring PR , RR SO2
BP 90/60 going downs
SO2 drop ( left hyper resonance , trachea deviate to right )
Give SO2 - O2
Insert 2 wide bore cannular
Take blood
• HB
• Blood group Rh
• BS
• give bolus IV N/S 1000ml over 30mins.. )
• Give anaelgesics
• Give IV Cefuroxime 1g 8 hrly for 1 day
• Catastrophic bleed may Bleed IV Tranaxamic acid 1g / 1hr then 1g /8hr
• Do ECG
• Insert catheter - no heamaturia
Mean while Mx Tension Penumothorax
• Dont wait for CXR
• High flow O2
• Insert 14-16 G wide bore needle to 2nd intercostal line mid clavicular line of
left chest
• Then insert a tube

Headache
• Send pt to do non contrast CT head and neck
• Fast – NL
Compound #
• X ray L leg A- P and Lateral
• Stabilize leg
• Check fingers NERVEs , tendons
• CRFT SO2 = ARTERy
• Back slab
• Inform Ortho
• Transver

11.ATLS
• Primary
• Secondary survey?
• glassgow coma scale?
• What is the commonly use size of endo tracheal tube?
= 7 , 7.5 , 8