Overview of ATLSOverview of ATLS

William P. Bozeman, MD, FACEPAssistant Professor, Dept. of Emergency Medicine

University of Florida Health Sciences Center / Jacksonville

Overview of ATLSOverview of ATLS

D e fin it ive C a re

D a ta / In fo rm a tio n /R e spo n se to T h era py

S e co nd a ry S u rvey

R e su sc ita tion

P rim a ry S u rvey(A B C D E 's )

Overview of ATLSOverview of ATLS

•Primary Survey (ABCDE’s)•Resuscitation

•Secondary Survey

•Definitive Care

•Things to remember...

Primary Survey - Immediate Primary Survey - Immediate Threats to Life (Only!)Threats to Life (Only!)

A = Airway

B = Breathing

C = Circulation

Obstructed?

Breath Sounds Present?

Bilaterally?

Peripheral Pulse?

Femoral? Carotid?

(Not BP Measurement.)

Primary Survey - Immediate Primary Survey - Immediate Threats to Life (Only!)Threats to Life (Only!)

D = Disability

E = Exposure

Global (AVPU or GCS)

Gross Motor Function

(i.e. spinal cord integrity)

Nekkid!

Common Life Threatening PathologyCommon Life Threatening Pathology

A = Airway

B = Breathing

C = Circulation

Obstruction

Tension PTX or HTX

Open PTX

Flail Chest

Hypovolemic Shock

Massive hemorrhage

Spinal Shock

Overview of ATLSOverview of ATLS

•Primary Survey (ABCDE’s)

•Resuscitation•Secondary Survey

•Definitive Care

•Things to remember...

ResuscitationResuscitation

• IV’s (Two. Large.)

•Control Bleeding

•Fluids

•Blood

•Screening X-Rays

“3” = C Spine, Chest, Pelvis.

“5” = 3 + T&L Spine.

Overview ATLSOverview ATLS

•Primary Survey (ABCDE’s)

•Resuscitation

•Secondary Survey•Definitive Care

•Things to remember...

Secondary SurveySecondary Survey

Now find out what happened, what’s injured.

• History (AMPLE)

• Physical. •Organized, complete head to toe exam.

• Roll, check back.

• Remember TM’s and rectal.

• Foley. NG or OG tube.

Overview of ATLSOverview of ATLS

•Primary Survey (ABCDE’s)

•Resuscitation

•Secondary Survey

•Definitive Care

•Things to remember...

Definitive diagnostics and Definitive diagnostics and care...care...

• Diagnostic Xrays (?)

• CT Scans (?)

• Ultrasound (?)

•MRI (?)

• DPL (?)

• Operating Room (?)

• Laceration Repairs (?)

• Antibiotics,Tetanus (?)

• Other Medications (?)

• Hyperbarics (?)

Overview of ATLSOverview of ATLS

D e fin it ive C a re

D a ta / In fo rm a tio n /R e spo n se to T h era py

S e co nd a ry S u rvey

R e su sc ita tion

P rim a ry S u rvey(A B C D E 's )

Overview of ATLSOverview of ATLS

•Primary Survey (ABCDE’s)

•Resuscitation

•Secondary Survey

•Definitive Care

•Things to remember...

Roles of the Trauma TeamRoles of the Trauma TeamAirway

Nurse

BossAttending

Team Member

Team Member

Nurse

Roles of the Trauma TeamRoles of the Trauma Team

•Boss•Directs the team, communicates decisions

•Free to roam

•Attending speaks through Boss (or teaches directly)

Roles of the Trauma TeamRoles of the Trauma Team

•Airway•A & B of primary survey

•Intubation (if needed)

•Head / Neck in secondary survey

•Nurses•Attach monitors, give blood / fluids / meds

•Recording nurse records at foot of bed

Roles of the Trauma TeamRoles of the Trauma Team

•Team Members•Expose, examine (secondary survey)

•Procedures as directed (by boss)•Chest Tubes

•Lac repairs

•Rectals, foleys routinely assigned to team member.

Things to remember…Things to remember…The Ideal Trauma ResuscitationThe Ideal Trauma Resuscitation

•Roles are pre-assigned

•Clear direction & communication

•Pertinent findings verbalized in proper order

•All team members know all findings

•Rapid, Efficient

•Calm & Quiet!

Things to remember… Things to remember… The The FASTFAST Exam Exam

•4 views (RUQ, LUQ, SP, Pericard.)

•A “noninvasive DPL”

•Sensitive for free fluid ( __ - __ %)

•Not specific.

•Not good for solid organ injury.

•Not good for hollow organ injury.

Things to remember…Things to remember…Classification of ShockClassification of Shock

Class EBL Pulse BP Mental Treatment

I <15% (<750ml) - - nl Fluids

II 15-30% (750-1.5L) - +/-anxious Fluids

III 30-40% (1.5L-2.0L) anxious Fluids + Blood

IV >40% (>2.0L) confused Fluids + Blood

A Special Case: A Special Case: Penetrating Trauma to trunk Penetrating Trauma to trunk

(especially GSW’s)(especially GSW’s)

•Need to rapidly find all penetrating injuries and all retained thoracoabd. projectiles

•Therefore...

A Special Case: A Special Case: Penetrating Trauma to trunk Penetrating Trauma to trunk

(especially GSW’s)(especially GSW’s)

• Examine for entry/exit wounds immediately after the primary survey. (Wait to take BP start IV’s, take history.)

•Mark all entry and exit sites with radiopaque “arrow” markers.

• Take xrays immediately. (Team member wearing lead may start IV’s, place chest

tubes, etc. during xrays.)

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