7/25/2019 ok ATLS 2

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Initial

Assessment and

Management

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Objectives

Indentify Management Priorities. Apply principles of primary and

secondary survey. Institute appropriate resuscitation

and monitoring. Recognize value of patients history

and biomechanics of injury. Anticipate pitfalls.

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oncepts of Initial

Assessment Rapid Primary survey

Resuscitation

Adjuncts to primary survey !resuscitation "etailed secondary survey

Adjuncts to secondary survey

Reevaluation "efinitive care

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Initial Assessment

Primary survey and

resuscitation of vital

functions are donesimultaneously #

a team approach

7/25/2019 ok ATLS 2

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Preparation

Prehospital $ystem %ransport guidelines !protocols

On&line medical direction

Mobilization of resources

Periodic revie' of care

losest appropriate facility

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Preparation

Inhospital Preplanning essential

()uipment* personnel* services

$tandard precautions

%ransfer agreement

7/25/2019 ok ATLS 2

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$tandard Precautions

ap

+o'n

+loves Mas,

$hoe covers

+oggles!face $hields

7/25/2019 ok ATLS 2

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%riage

$orting of patients according to -

A"(s

Available resources

Multiple casualties

Mass casualties

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Primary $urvey

Adult* children* pregnant 'omen #

Priorities are the same /

A Air'ay 'ith c&spine protection reathing

irculation 'ith hemorrhage control

" "isability( (0posure!(nvironment

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$pecial onsiderations

%rauma in the (lderly

1thleading cause of death

2Physiologic reserve

omorbidities - "iseases!medications

Outcome depends on early*aggressive care

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Primary $urvey

&spine injury

Pitfalls

()uipment failure

Inability to intubate

Occult air'ay injury

Progressive loss of air'ay

Establish Patent Airway

Caution

7/25/2019 ok ATLS 2

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Primary $urvey

$uspect &$pine Injury

Spinal protection

C-spine X-ray when

appropriate

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Primary $urvey

reathing

Assess

O0ygenate 3entilate

Pitfalls

Air'ay vs ventilation problem 4 5atrogenic pneumothora0

!tension pneumothora0

7/25/2019 ok ATLS 2

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Primary $urvey

Assessment of Organ Perfusion

5evel of consciousness

$,in color and temperature Pulse rate and character

7/25/2019 ok ATLS 2

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Primary $urvey

irculatory Management

ontrol hemorrhage

Restore volume Reassess

Pitfalls

(lderly hildren

Athletes MedicationCaution

7/25/2019 ok ATLS 2

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Primary $urvey

"isability

Baseline neurologic evaluation

GCS scoring

Pupillary response

Observe for

neurologic

deteriorationCaution

7/25/2019 ok ATLS 2

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Primary $urvey

(0posure ! (nvironment

Completely undress the patient

Prevent

hypothermiaCaution

7/25/2019 ok ATLS 2

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Resuscitation

Protect and secure airway

entilate and o!ygenate

Stop the bleeding

igorous shoc" therapy

Protect from hypothermia

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Adjuncts to Primary $urvey

ital sign

#CG $BGs

%rinary Adjuncts Pulse

Output o!imeter

and CO

%rinary&gastric catheters

unless contraindicated

7/25/2019 ok ATLS 2

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Adjuncts to Primary $urvey

"iagnostic %ools Chest and pelvic

!-ray

'P(

%ltrasound

7/25/2019 ok ATLS 2

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Adjuncts to Primary $urvey

onsider (arly %ransfer

'o notdelay transfer for diagnostic

tests %se time before transfer for

resuscitation

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Reevaluate

Proceed to $econdary $urvey After - Primary survey completed

A" (s are reassessed

3ital functions are returning to

normal

7/25/2019 ok ATLS 2

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$econdary $urvey

)he

completehistory and

physical

e!amination

7/25/2019 ok ATLS 2

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$econdary $urvey

6ey omponents 7istory

Physical e0amination - 7ead&to&toe

8%ubes and finger in every orifice9

omplete neuro e0am

$pecial diagnostic tests

Reevaluation

7/25/2019 ok ATLS 2

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$econdary $urvey

7istory

A $llergies

M *edications

P Past +llnesses

5 (ast meal( #ventsnvironment

7/25/2019 ok ATLS 2

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$econdary $urvey

Mechanisms of Injury

7/25/2019 ok ATLS 2

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$econdary $urvey

7ead Complete neurologic e!amination

GCS score determination

Comprehensive eye&ear e!amPitfalls

%nconscious patient

Periorbital edema Occluded auditory canal

7/25/2019 ok ATLS 2

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$econdary $urvey

Ma0illofacial Bony crepitus&stability Palpable deformity

Pitfalls

Potential airway obstruction Cribriform plate fracture

,reuently missed in.ury

7/25/2019 ok ATLS 2

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$econdary $urvey

ervical $pine

Palpate for

tenderness Complete motor&

sensory e!ams

/efle!es C-spine imaging

Pitfalls

$ltered (OC forany reason

Other severe 0

painful in.ury

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$econdary $urvey

:ec, ;soft tissues< *echanism 1 Blunt

vs penetrating Symptoms 1 $irway

obstruction 0

hoarseness

,indings 1Crepitushematoma 0stridor

bruit

Pitfalls

'elayed symptoms and signs

Progressive airway

obstruction Occult in.uries

7/25/2019 ok ATLS 2

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$econdary $urvey

hest

+nspect

Palpate Percuss

$uscultate

X-ray

Pitfalls

#lderly

Children

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$econdary $urvey

Abdominal (valuation

Blunt trauma Penetrating trauma

7/25/2019 ok ATLS 2

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$econdary $urvey

Abdomen

+nspect0 auscultate0 palpate0 and percuss

/eevaluate freuently

Special studies

Pitfalls

2ollow viscus and retroperitoneal in.uries

#!cessive pelvic manipulation

7/25/2019 ok ATLS 2

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$econdary $urvey

Perineum

Rectum

3agina

Pitfalls

Contusions0 hematomas0

lacerations0 urethral blood

Sphincter tone 0 high 3riding

prostate pelvic fracture0

rectal wall integrity0 blood

Blood lacerations

%rethral in.ury in women0pregnancy

7/25/2019 ok ATLS 2

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$econdary $urvey

Musculos,eletal - (0treminities

Contusion 0 deformity

Pain Perfusion

Peripheral neurovascular status

X- rays as needed

7/25/2019 ok ATLS 2

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$econdary $urvey

Musculos,eletal - Pelvis

Pain on palpation

Symphysis width = (eg length uneual

+nstability

X-rays as needed

7/25/2019 ok ATLS 2

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$econdary $urvey:eurologic

$pine ! ord

omplete motor

and sensory e0ams

Imaging as

indicated

Refle0es

(arly neurosurgical

consultation

:$

>re)uentreevaluation

Prefent secondary

brain injury

7/25/2019 ok ATLS 2

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Adjuncts to $econdary

$urvey $pecial diagnostic test as indicated Pitfalls

Patient deterioration

"elay of transfer

7/25/2019 ok ATLS 2

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$econdary $urvey

:eurologic

Pitfalls

Incompleteimmobilization $uble = in IP 'ith manipulation

Rapid deterioration

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Reevaluation

Minimizing Missed Injuries

7igh inde0 of suspicion

>re)uent reeveluation andmonitoring

7/25/2019 ok ATLS 2

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Reevaluation

Pain Management

Relief of pain !an0iety as

appropriate

Administer intravenously

areful monitoring is essential

7/25/2019 ok ATLS 2

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"efinitive are

(ocal ,acility

44)ransfer agreements

44(ocal resources 44

44

)rauma Specialty

Center ,acility

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Record * 5egal

onsiderations oncise* chronologicdocumentation

onsent for treatment >orensic evidence

7/25/2019 ok ATLS 2

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?uestions

4

7/25/2019 ok ATLS 2

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$ummary

Primary $urvey

Resuscitation

Adjuncts $econdary $urvey

Adjuncts

"efinitive care

7/25/2019 ok ATLS 2

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