ATLS and Trauma management with 100% correct answers

Advanced Trauma Life Support, or ATLS for short, is a: concise approach to assessing and managing the multiply injured patient...which hopes to reduce the morbidity and mortality related to trauma Most deaths after injury occur in one of three time periods: at the time of injury or within 60 minutes, within the following few hours, or several days / weeks after the injury. ATLS focuses on the first___________ following injury the "Golden Hour" What are the stages of ATLS? - preparation before the patient has even arrived. -On arrival the primary survey and resuscitation should begin. This targets the most life threatening problems. -After this an AMPLE history and secondary survey should be completed. - your work is not done until after continued monitoring and the patient is transferred for further management or discharged. Which people make up a trauma team? -Two team leaders - One doctor and one nurse. -One "airway" doctor and one "airway" nurse, plus two "circulation" doctors and two "circulation" nurses -A "relatives" nurse -A radiographer In order to prepare appropriately you need to know what to expect before the casualty arrives so you contact the crew while they are in transit. So what should you ask the ambulance crew? "What type of incident is it?" e.g. car crash, chemical spill "How many casualties are there?" "What are their ages and sexes?" "What is the status of the casualties" e.g. ABC - airway, breathing, circulation and conscious level (GCS). "What treatment have you given so far and what were the effects?" "Estimated time of arrival?" ("ETA" if you want to sound like you're on ER.) A is for Airway and cervical spine protection. What is the ASSESMENT? Check airway patency whilst manually stabilising the C-spine (if not already in collar/blocks/tape) A is for Airway and cervical spine protection. What is the MANAGEMENT (if not patent)? Perform a Jaw Thrust. (not a head tilt/chin lift which will move the C-spine) Clear foreign bodies e.g. fractures, dentures, chewing gum. Insert an oropharyngeal or nasopharyngeal airway if required. If necessary establish a definitive airway by orotracheal or surgical cricothyroidotomy. Protect the cervical spine as above. When would you intubate a patient? Ventilation during anaesthetic surgery, if muscle relaxant is required, patient cant protect the airway (GCS <8, aspiration risk, muscle relaxant) Potential airway obstruction (burns, trauma, neck haemotoma, inadequate ventilation/oxygenation (COPD, head injury, ARDS) B is for Breathing and ventilation, ASSESSMENT? Expose the neck and chest (while keeping the cervical spine immobilised) What is the rate and depth of the patient's respirations? Inspect, Palpate, Percuss and Auscultate the neck and chest. Look for a tension pneumothorax, flail chest, pulmonary contusion, massive haemothorax and an open pneumothorax. MANAGEMENT of a Tension Pneumothorax MANAGEMENT - Give 15l/min oxygen through a tight fitting non-rebreathing, reservoir mask - Put on the pulse oximeter - Immediately treat a tension pneumothorax (Thorencentisis mid clavicular line, 2nd intercostal space, Wide bore cannula 14/16 bore) - Seal an open pneumothorax with a 3-sided dressing which will act as a flap valve. - Consider the need for intubation to provide ventilatory support in a patient with , flail chest / pulmonary contusion - Consider inserting a chest drain in a patient with a massive haemothorax Subdural Haemorrhage - Describe what you would see on xray Describe this Venous bleed Slower Subdural Haemorrhage- Describe what you would see on xray Describe this Venous bleed Slower Subdural Haemorrhage- Describe what you would see on xray Describe this Venous bleed Slower Extradural Haemorrhage- Describe what you would see on xray Describe this Arterial Bleed faster Extradural Haemorrhage- Describe what you would see on xray Arterial Bleed faster Extradural Haemorrhage- Describe what you would see on xray Describe this Arterial Bleed faster Cerebral Haemorrhage - Describe what you would see on xray Describe this Cerebral Haemorrhage -Describe what you would see on xray SAH can be caused by a ruptured aneurysm, AVM, or head injury. Tension Pneumothorax Tension Pneumothorax Tension Pneumothorax Tension Pneumothorax Chest drain How would you know if a patients airway is patent? They can form words Symptoms of Tension Pneumothorax: Symptoms Chest pain. Tachypnoea. Air hunger Confusion If a chest wound forms a one way valve into the potential pleural space between parietal and visceral pleura, letting air in but not out, the pressure in the thoracic cavity will increase with each inspiration. What would happen if it was not treated? If nothing is done to remove the trapped air, cardiorespiratory arrest will occur. Signs of Tension Pneumothorax: Chest is hyperexpanded on the affected side. Chest excursion is reduced on the affected side. Percussion note is increased on the affected side. Breath sounds are decreased on the affected side. Tracheal and therefore Mediastinal shift away from the affected side. Respiratory distress. Tachycardia. Hypotension. Distended neck veins. Emergency Treatment of a Tension Pneumothorax, what are the steps? Get a large bore cannula. Insert it into the second intercostal space, in the midclavicular line on the affected side. Remove the needle to allow the trapped air to escape with a hiss. Tape the cannula in place, avoid kinking it. Then depending on improving clinical status get a chest x-ray and insert a chest drain and repeat the CXR. C is for Circulation and haemorrhage control, what are you looking for in the assessment? Look for signs of shock and possible haemorrhage (into the chest, abdomen, pelvis, long bone fractures or externally) What are the quality, rate and regularity of the pulse? What is the patient's blood pressure? C is for Circulation and haemorrhage control, what are you looking for in the managment? Give O Neg (definitively if woman) (O Pos if man) Reduce haemorrhage: apply direct pressure to a bleeding wound, reduce and splint long bone fractures. Replace fluids: a minimum of 2 large calibre intravenous cannulae, 2l crystalloid initially. Take blood samples for type and cross match and other baseline studies. If there is not time for the Glasgow coma scale, what can you use instead? The AVPU system can be used to assess conscious level: A = Alert V = responds to Voice P = responds to Pain U = Unconscious Glasgow Coma Scale how are they categorised? ie severe Severe: GCS 8 or less Moderate: GCS 9-12 Mild: GCS 13-15 Glasgow Coma Scale, Eyes. What are the different levels? Eye Opening (E) 4 = spontaneous 3 = to sound 2 = to pressure 1 = none NT = not testable Glasgow Coma Scale, motor response. What are the different levels? Motor Response (M) 6 = obeys command 5 = localizing 4 = normal flexion 3 = abnormal flexion 2 = extension 1 = none NT = not testable Glasgow Coma Scale, Verbal Response (V). What are the different levels? 5 = orientated 4 = confused 3 = words, but not coherent 2 = sounds, but no words 1 = none NT = not testable