ATLS (Advanced Trauma Life Support)
Teaching Protocol
A. Pretest (30 min)
B. Context of Tutorial (2 hours)
1. General Principles
⚫ Concept
⚫ Inhospital phase clinical procedure/process
⚫ Important points/ cautions/ pitfalls
⚫ Brief discussion on traumatic shock/ blood transfusion
2. Thoracic Trauma
3. Abdominal Trauma
C. Answers of pretests (30 min)
D. Skills: (1hour)
1. Airway and Ventilatory management
a. Jet insufflation
b. Laryngoscope / Magill forcep / Suction device
c. Adult intubation
d. Infant intubation
e. Cricothyroidotomy
2. Immobilization
a. In-line immobilization/ log-roll techniques
b. Cervical collar
a. Long spine Backboard
b. Scoop stretcher
c. Traction Splint
3. Adjuncts to surveys /monitoring/ resuscitation
a. Pulse Oximeter
b. DPL
c. FAST
d. Needle decompression
e. Tube thoracostomy
f. Seal Open peumothorax
g. Pericardiocentesis
h. Intraosseous puncture
, Advanced Trauma Life Support
General Principles:
➢ The concept:
Three underlying concepts of ATLS program :
1. Treat the greatest threat to life first
2. The lack of a definite diagnosis should never impede the application
of an indicated treatment
3. A detailed history was not essential to begin the evaluation of an
acutely injured patient
➢ Specific principles govern the management of trauma patients in ED:
1. Organized team approach
2. Priorities
3. Assumption of the most serious injury
4. Treatment before diagnosis
5. Thorough examination
6. Frequent reassessment
7. Monitoring
➢ Inhospital phase clinical process:
➢ Systemic, organized approach to seriously injured patients is mandatory.
Preparation
Triage
Primary survey (ABCDEs)
Resuscitation
Adjuncts to primary survey & resuscitation
Secondary survey (Head to toe Evaluation)
Adjuncts to secondary survey
Continued postresuscitation monitoring and reevaluation
Definitive care
➢ The primary and secondary surveys should be repeated frequently
➢ In the actual clinical situation, many of these activities occur in parallel or simultaneously.
➢ Organized Team Approach:
Team Captain : Coordinate, control the resuscitation
Assessing the patient, ordering needed procedures/ studies
Monitring the patient’s progress.
, Procedures by other physician team members.
Nurses
➢ Priorities In Management and Resuscitation
Immediate / potential threats to life
1. High-priority areas
Airway/ breathing
Shock/ external hemorrhage
Impending cerebral hemorrhage
Cervical spine
2. Low-priority areas
Neurologic
Abdominal
Cardiac
Musculoskeletal
Soft tissue injury
➢ Assumption of the Most Serious Injury
Assume the worst possible injury
Mechanism of injury
➢ Treatment Before Diagnosis
Based on initial brief assessment
The more unstable the patient, the less necessary to confirm a life-threatening diagnosis
before it is expeditiously treated
➢ Thorough Examination
When time and the patient’s stability permit.
Unconscious/ alcohol intoxicated patients
➢ Frequent Reassessment
Dynamic process
Some injuries take time to manifest
Any sudden worsening in the physiologic status of the patients mandates a return to the
“ABCDEs”
➢ Monitoring
Vital signs
Pulse oximetry
Teaching Protocol
A. Pretest (30 min)
B. Context of Tutorial (2 hours)
1. General Principles
⚫ Concept
⚫ Inhospital phase clinical procedure/process
⚫ Important points/ cautions/ pitfalls
⚫ Brief discussion on traumatic shock/ blood transfusion
2. Thoracic Trauma
3. Abdominal Trauma
C. Answers of pretests (30 min)
D. Skills: (1hour)
1. Airway and Ventilatory management
a. Jet insufflation
b. Laryngoscope / Magill forcep / Suction device
c. Adult intubation
d. Infant intubation
e. Cricothyroidotomy
2. Immobilization
a. In-line immobilization/ log-roll techniques
b. Cervical collar
a. Long spine Backboard
b. Scoop stretcher
c. Traction Splint
3. Adjuncts to surveys /monitoring/ resuscitation
a. Pulse Oximeter
b. DPL
c. FAST
d. Needle decompression
e. Tube thoracostomy
f. Seal Open peumothorax
g. Pericardiocentesis
h. Intraosseous puncture
, Advanced Trauma Life Support
General Principles:
➢ The concept:
Three underlying concepts of ATLS program :
1. Treat the greatest threat to life first
2. The lack of a definite diagnosis should never impede the application
of an indicated treatment
3. A detailed history was not essential to begin the evaluation of an
acutely injured patient
➢ Specific principles govern the management of trauma patients in ED:
1. Organized team approach
2. Priorities
3. Assumption of the most serious injury
4. Treatment before diagnosis
5. Thorough examination
6. Frequent reassessment
7. Monitoring
➢ Inhospital phase clinical process:
➢ Systemic, organized approach to seriously injured patients is mandatory.
Preparation
Triage
Primary survey (ABCDEs)
Resuscitation
Adjuncts to primary survey & resuscitation
Secondary survey (Head to toe Evaluation)
Adjuncts to secondary survey
Continued postresuscitation monitoring and reevaluation
Definitive care
➢ The primary and secondary surveys should be repeated frequently
➢ In the actual clinical situation, many of these activities occur in parallel or simultaneously.
➢ Organized Team Approach:
Team Captain : Coordinate, control the resuscitation
Assessing the patient, ordering needed procedures/ studies
Monitring the patient’s progress.
, Procedures by other physician team members.
Nurses
➢ Priorities In Management and Resuscitation
Immediate / potential threats to life
1. High-priority areas
Airway/ breathing
Shock/ external hemorrhage
Impending cerebral hemorrhage
Cervical spine
2. Low-priority areas
Neurologic
Abdominal
Cardiac
Musculoskeletal
Soft tissue injury
➢ Assumption of the Most Serious Injury
Assume the worst possible injury
Mechanism of injury
➢ Treatment Before Diagnosis
Based on initial brief assessment
The more unstable the patient, the less necessary to confirm a life-threatening diagnosis
before it is expeditiously treated
➢ Thorough Examination
When time and the patient’s stability permit.
Unconscious/ alcohol intoxicated patients
➢ Frequent Reassessment
Dynamic process
Some injuries take time to manifest
Any sudden worsening in the physiologic status of the patients mandates a return to the
“ABCDEs”
➢ Monitoring
Vital signs
Pulse oximetry
