ATLS and Trauma management
2023/2024
Advanced Trauma Life Support, or ATLS for short, is a: – ANSWER
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: – ANSWER
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 – ANSWER
“Golden Hour”
What are the stages of ATLS? – ANSWER – 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? – ANSWER –
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? – ANSWER
“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? – ANSWER 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)? – ANSWER 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? – ANSWER
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)
ATLS Prep
What are the elements of the initial assessment? – ANSWER
preparation, triage, primary survey, adjuncts to the primary survey and
resuscitation, consideration for transfer, secondary survey, adjuncts to the
secondary survey, continued post resuscitation monitoring, definitive care
What’s the difference between multiple and mass casualties? – ANSWER
does the number and severity of patients exceed the capability of the facility and
staff
What is the primary survey? – ANSWER airway (with
restriction of c-spine motion), breathing and ventilation, circulation, disability,
exposure
What are injuries that significantly impair ventilation in the short term? –
ANSWER tension pneumothorax, massive hemothorax, open
pneumothorax, tracheal and bronchial injuries
How can a simple pneumothorax be converted to a tension pneumothorax? –
ANSWER when a patient is intubated and positive pressure
ventilation is provided before decompressing the pneumothorax
What are the elements of clinical observation that yield important information
about hemodynamic status? – ANSWER level of
consciousness, skin perfusion, pulse
Where are the major areas of internal hemorrhage? – ANSWER
chest, abdomen, retroperitoneum, pelvis, long bones
Other than CNS injury, what can alter a patient’s level of consciousness? –
ANSWER hypoglycemia, alcohol, narcotics, other drugs
What are adjuncts used during the primary survey? – ANSWER
EKG, pulse oximetry, CO2 monitoring, ABG, urinary catheter, gastric catheter,
lactate, XR, FAST
If there is blood at the urethral meatus or perineal ecchymosis…think? –
ANSWER urethral injury, retrograde urethrogram before
inserting a catheter
What does AMPLE stand for? – ANSWER allergies,
medications, past illnesses/pregnancy, last meal, events/environment related to
the injury
During the secondary survey, what is the sequence of the physical exam? –
ANSWER head, maxillofacial structures, cervical spine and
neck, chest, abdomen and pelvis, perineum/rectum/vagina, musculoskeletal,
neurological
What is the MIST acronym for EMS handoff? – ANSWER
mechanism and time of injury, injuries found and suspected, symptoms and signs,
treatment initiated