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Pitfalls in ATLS 2007-12

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Pitfalls in ATLS 2007-12

  1. 1. Pitfalls in ATLS ธเนศ รังษีขจี
  2. 2. ATLS <ul><li>Advanced </li></ul><ul><li>Trauma </li></ul><ul><li>Life </li></ul><ul><li>Support </li></ul><ul><li>7 th Edition </li></ul>
  3. 3. ATLS <ul><li>PROVIDES A COMMON LANGUAGE </li></ul>
  4. 5. THE BEGINNING <ul><li>DR. JAMES STYNER’S PLANE CRASHED IN RURAL NEBRASKA IN FEBRUARU 1976 </li></ul><ul><li>3 OF 4 SUSTAINED SERIOUS HEAD INURIES </li></ul>
  5. 6. DR. JAMES STYNER. MD,FACS - 1977 <ul><li>BETTER CARE IN THE FIELD WITH LIMITED RESOURCES </li></ul><ul><li>SOMETHING WRONG WITH THE SYSTEM AND THE SYSTEM HAS TO BE CHANGED </li></ul>
  6. 7. TRIMODAL DEATH DISTRIBUTION <ul><li>IMMEDIATE DEATH </li></ul><ul><li>EARLY DEATH </li></ul><ul><li>FIRST 1-4 HOURS </li></ul><ul><li>LATE DEATH </li></ul><ul><li>2 ND – 5 TH WEEK </li></ul>
  7. 9. ATLS Concept <ul><li>ABCDE -approach to evaluation/treatment </li></ul><ul><li>Treat greatest threat to life first </li></ul><ul><li>Definite diagnosis not immediately important </li></ul><ul><li>Time is of the essence </li></ul><ul><li>Do no further harm </li></ul>
  8. 10. ATLS Concept <ul><li>A Airway with C-spine protection </li></ul><ul><li>B Breathing ; Ventilation/Oxygenation </li></ul><ul><li>C Circulation ; Stop bleeding </li></ul><ul><li>D Disability ; Neurological status </li></ul><ul><li>E Expose / Environment / Body temperature </li></ul>
  9. 11. Committee on Trauma Presents <ul><li>Initial Assessment and Management </li></ul>
  10. 12. Initial Assessment and Management <ul><li>Principles </li></ul><ul><li>Primary Survey </li></ul><ul><li>Secondary Survey </li></ul><ul><li>Priority Management </li></ul><ul><li>Resuscitate and Monitor procedures </li></ul><ul><li>Patient’s History / Biomechanics of Injury </li></ul><ul><li>Anticipate Pitfalls </li></ul>
  11. 13. Pitfalls <ul><li>What is a quick , simple way to assess the patient in 10 seconds ? </li></ul><ul><li>How can I minimized the missed injuries ? </li></ul><ul><li>Which patients do I transfer to a Higher levels of care ? </li></ul><ul><li>When should the transfer occur ? </li></ul>
  12. 14. Quick / Simple to assess the patient <ul><li>Identify yourself </li></ul><ul><li>Ask the patient his / her name </li></ul><ul><li>Ask the patient what happened </li></ul>
  13. 16. GCS <ul><li>Glasgow Coma Score </li></ul><ul><li>Mild Brain Injury 14 – 15 </li></ul><ul><li>Moderate 9 – 13 </li></ul><ul><li>Severe 3 - 8 </li></ul><ul><li>AVPU *#* Alert </li></ul><ul><li>Verbal response to voice </li></ul><ul><li>Painful </li></ul><ul><li>Unresponse </li></ul>
  14. 17. Concept of Initial Assessment <ul><li>Primary Survey </li></ul><ul><li>A Airway with C-spine protection </li></ul><ul><li>B Breathing ; Ventilation/Oxygenation </li></ul><ul><li>C Circulation ; Stop bleeding </li></ul><ul><li>D Disability ; Neurological status </li></ul><ul><li>E Expose / Environment / Body temperature </li></ul>
  15. 18. Concept of Initial Assessment <ul><li>ABCDE </li></ul><ul><li>Patent Airway </li></ul><ul><li>Suffidient Air Reserve to </li></ul><ul><li>permit speech </li></ul><ul><li>Clear Sensorium </li></ul>
  16. 19. ADJUNCT to Primary Survey <ul><li>FAST </li></ul><ul><li>Focus </li></ul><ul><li>Assessment </li></ul><ul><li>Sonography in </li></ul><ul><li>Trauma </li></ul>
  17. 20. THORACIC TRAUMA <ul><li>BECK’S TRIAD </li></ul><ul><li>Elevate venous pressure </li></ul><ul><li>Decline in arterial pressure </li></ul><ul><li>Muffling heart sound </li></ul><ul><li> </li></ul><ul><li>CARDIAC INJURY </li></ul>
  18. 21. TENSION PNEUMOTHORAX <ul><li>DYSPNEA </li></ul><ul><li>ELEVATE VENOUS PRESSURE </li></ul><ul><li>DECLINE IN ARTERIAL PRESSURE </li></ul><ul><li>TRACHEA SHIFT TO OPPOSIT </li></ul>
  19. 27. <ul><li>? ? ? </li></ul>
  20. 29. SECONDARY SURVEY <ul><li>The Complete History and </li></ul><ul><li>Physical Examination </li></ul><ul><li>Starts after ….. </li></ul><ul><li>Primary Survey is complete </li></ul><ul><li>ABCDEs are Reassessed </li></ul><ul><li>Vital functions are returning </li></ul><ul><li>to Normal </li></ul>
  21. 37. REEVALUATION <ul><li>Aims ; Minimized Missed injuries </li></ul><ul><li>High Index of Suspecious </li></ul><ul><li>Frequent Reevaluation and </li></ul><ul><li>Monitoring </li></ul>
  22. 38. ADJUNCT
  23. 40. DEFINITIVE CARE <ul><li>Which patient do I transfer to </li></ul><ul><li>another Hospital for Definite </li></ul><ul><li>Care ? </li></ul><ul><li>Multisystem or Complex Injuries </li></ul><ul><li>Comorbidity or AGE Extremes </li></ul>
  24. 42. ST0P BLEEDING
  25. 43. RESPONSE TO RESUSCITATION ?
  26. 46. <ul><li>THANK YOU </li></ul>

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