1. By
ANU SANDHYA
PG WARD 3

2. OBJECTIVE
 Identify the correct sequence of priorities
for assessment of a multiply injured pt.
 Apply the principles outlined in primary
and secondary evaluation surveys of
ATLS.
 Apply guidelines and techniques in the
initial resusitative and definitive care
phases of treatment.

3. ATLS
 PREPARATION AND TRIAGE.
 PRIMARY SURVEY
 RESUSITATION
 ADUNCTS TO PRIMARY SURVEY
 CONSIDER NEED FOR PATIENT TRANSFER
 SECONDARY SURVEY
 ADJUCTS TO SECONDARY SURVEY
 CONTINUED POSTRESUSITATION AND
REEVALUATION OF THE PATIENT.
 DEFINITIVE CARE.

4. PREPARATION
•PREHOSPITAL PHASE
•HOSPITAL PHASE
 PREHOSPITAL PHASE:
Coordination with the prehospital agency and personel
can greatly fasten the treatment in the field. They inform
the receiving hospital which mobilizes the trauma team to
ED.
 HOSPITAL PHASE
Advance planning for the trauma pt. beneficial. It saves
time.

5. TRIAGE
The process of categorizing victims or mass
casualties based on their need for
treatment and the resources available.
ITS MAIN GOALS ARE.
 Prevent avoidable deaths.
 Ensure proper initial treatment with a
minimal time frame.
 Avoid misusing assests on hopeless cases.

6. Multiple casualties
 No. of patients and the severity of their
injuries do not exceed the ability of the
facility to provide care.
 MASS CASUALTIES
 The no. of patients and the severity of
their injuries exceed the ability of the
facility to provide care.

8. PRIMARY SURVEY
What is the quick ,simple way to assess
the trauma patient in 10 seconds?
A comlete sentence spoken by pt. tells us:
1. Airway is patent.
2. Breathing intact.
3. Good cerebral circulation.

9. AIRWAY MAINTAINENCE
WITH C-SPINE PROTECTION
Assess for obstruction, foreign bodies, facial
fractures, bleeding causing airway
compromise… begin measures to establish
airway.
PITFALLS
 Recognize impending obstruction early before
intubation becomes too difficult.
 If unable to control airway surgical airway is
must.
 Unknown tracheal or laryngeal disruption.

10. Simple maneuvers
 Chin lift
 Jaw thrust
 Suction
 Oropharyngeal and nasopharyngeal
airway
 Laryngeal mask airway
 Laryngeal tube airway
 Gum elastic bougie.
 Definitive airway
 Surgical airway.

18. INDICATIONS OF DEFINITIVE
AIRWAY
 UNCONCIOUS
 GCS <8
 RISK OF ASPIRATION
 RISK OF IMPENDING OBSTRUCTION.

19. BREATHING
Inspection
Auscultation
Palpation
Percussion
 Identify and manage life threatening problems
first
• Tension pneumothorax
• Cardiac temponade
• Massive hemothorax
• Open pneumothorax
• Flail chest with pulmonary contusion

20. maneuvers
 Bag and mask ventilation
 Needle thoracocentesis
 Pericardiocentesis
 Chest tube intubation

21. CIRCULATION AND
HEMORRHAGE CONTROL
Assess for:
 Shock
 External bleeding
 Occult bleeding
 Estimate the blood loss on initial
presentation of patient and the signs
and symptoms
 Replace fluid accordingly, 2 litres of
warm crystalloid solution.

22. DISABILITY
 GCS
 PUpillary reaction and size
EXPOSURE
 Undress the patient completely but
prevent hypothermia.
 Logrolling and looking for back of the pt.
is very important.

24. ADJUCTS TO PRIMARY
SURVEY AND
RESUSSITATION
 ECG
 PULSE OXIMETRY
 Xray chest AP view
 Xray pelvis AP view
 URINARY CATHETER
 GASTRIC CATHETER
 BLOOD PRESSURE
 ABGS
 FAST
 DPL

25. NEED TO TRANSFER or
REFER?

26. SECONDARY SURVEY
Secondary survey does not begin until the primary
survey is completed,resuscitative efforts are
established and patient is demonstrating
normalization of vital functions.
It includes:
 Head to toe evaluation
 AMPLE history
• Allergy
• Medications currently taking
• Past illness
• Last meal
• Event/environment related to injury.
 physical examination
 Reassessment of all vital organs.

27. Adjucts to secondary survey
 CT SCAN
 CONTRAST STUDIES
 EXTREMITY XRAY
 ENDOSCOPY
 ULTRASONOGRAPHY

28. POSTRESUSITATION
MONITORING AND
REEVALUATION
 Reevaluaion for new finding or
overlooked.
 Continous monitoring of vital signs.
 Effective analgesia.

29. DEFINATIVE CARE
 AFTER identifying the patients injury.
 Managing life threatening problems
 Obtaining special studies.
 If the patients injuries exceed the
capabilities of the institution.

30. Take home message
1. ABCDE APPROACH.
2. TREAT GREATEST THREAT TO LIFE.
3. DEFINITIVE DIAGNOSIS IS NOT
IMMEDIATELY IMPORTANT.
4. TIME IS THE ESSENCE.
5. DO NO FURTHER HARM THE
PATIENT

33. CASE
A 20 year old woman is found trapped in
her automobile. Several hours are
required to extricate her because her leg
was trapped and twisted beneath the
dash board. In the hospital she is
hemodynamically unstable with pulse of
120bpm, r/r 14, bp 80mmhg systolic
only, she has a large wound in her left
leg which is bleeding profusely..