Advanced Trauma Life Support (ATLS)

• ATLS stands for Advanced Trauma Life Support.
• It is a systematic approach to trauma care developed by the American College of Surgeons (ACS).
• The primary goal of ATLS is to provide a safe and reliable method for immediate management of injured patients.
• ATLS emphasizes the "golden hour" concept where rapid assessment and intervention can significantly improve patient outcomes.

Primary Survey

• The primary survey is a rapid assessment to identify and treat life-threatening conditions.
• It follows the mnemonic ABCDE: Airway, Breathing, Circulation, Disability, Exposure.

Airway (A)

• Assess airway patency: Look, listen, and feel for signs of obstruction.
• Interventions include:
  • Chin lift or jaw thrust maneuver to open the airway.
  • Suctioning to remove blood, vomit, or secretions.
  • Insertion of an oropharyngeal or nasopharyngeal airway.
  • Definitive airway management: endotracheal intubation or surgical airway (cricothyroidotomy) if needed.
• Protect the cervical spine by immobilizing it during airway management.

Breathing (B)

• Assess breathing effectiveness: respiratory rate, depth, and effort.
• Look for signs of:
  • Tension pneumothorax.
  • Open pneumothorax.
  • Flail chest.
• Interventions include:
  • Supplemental oxygen administration.
  • Ventilatory support (bag-valve-mask or mechanical ventilation).
  • Needle thoracostomy or chest tube insertion for pneumothorax.
  • Occlusive dressing for open pneumothorax.

Circulation (C)

• Assess for signs of shock: level of consciousness, skin color, and temperature, pulse, blood pressure.
• Identify sources of bleeding.
• Interventions include:
  • Direct pressure to control external bleeding.
  • Intravenous access (two large-bore IVs).
  • Fluid resuscitation with crystalloid solutions (e.g., Ringer's lactate).
  • Blood transfusion if indicated.
  • Pelvic binder for pelvic fractures.

Disability (D)

• Brief neurological assessment to determine the patient's level of consciousness.
• Assess using the AVPU scale: Alert, Verbal, Pain, Unresponsive.
• Evaluate pupils for size, equality, and reactivity.
• Rapid assessment of gross motor and sensory function.

Exposure (E)

• Completely undress the patient to assess for injuries.
• Prevent hypothermia by using warming blankets and increasing the ambient temperature.
• Log-roll the patient to examine the back while maintaining spinal precautions.

Adjuncts to the Primary Survey

• After addressing immediate life threats, consider adjuncts to the primary survey:
  • Electrocardiogram (ECG) monitoring.
  • Urinary catheter insertion to monitor urine output (contraindicated with suspected urethral injury).
  • Gastric tube insertion to decompress the stomach and reduce aspiration risk.
  • Monitoring of vital signs (continuous).
  • Blood gas analysis.
  • Radiological studies (chest X-ray, pelvic X-ray).
  • Focused Assessment with Sonography for Trauma (FAST) exam to detect free fluid in the abdomen.

Secondary Survey

• The secondary survey is a more detailed head-to-toe examination to identify all injuries.
• It is performed after the primary survey and resuscitation are underway.
• Includes a complete history (AMPLE) and physical examination.

History (AMPLE)

• Allergies.
• Medications.
• Past illnesses/Pregnancy.
• Last meal.
• Events related to the injury.

Physical Examination

• Head and face: inspect and palpate for injuries.
• Maxillofacial region: check for fractures, malocclusion.
• Cervical spine and neck: palpate for tenderness, crepitus; maintain immobilization.
• Chest: inspect, palpate, and auscultate.
• Abdomen: inspect, auscultate, palpate, and percuss.
• Pelvis: assess for stability.
• Extremities: inspect, palpate, and assess neurovascular status.
• Back: inspect and palpate.
• Neurological examination: detailed assessment of cranial nerves, motor and sensory function, reflexes.

Adjuncts to the Secondary Survey

• Further imaging studies: CT scans, angiography.
• Consultation with specialists (e.g., neurosurgery, orthopedics).
• Continued monitoring of vital signs and response to treatment.

Reassessment

• Continuous reassessment of the patient's condition: vital signs, response to interventions.
• Identify any deterioration and adjust management accordingly.

Transfer to Definitive Care

• Prepare the patient for transfer to a higher level of care if needed.
• Communicate all relevant information to the receiving facility:
  • Patient history.
  • Injuries identified.
  • Interventions performed.
  • Current status.

Special Considerations

• Traumatic Brain Injury (TBI):
  • Manage airway, breathing, and circulation to optimize cerebral perfusion.
  • Control intracranial pressure (ICP).
  • Consider hypertonic saline or mannitol for elevated ICP.
• Spinal Cord Injury (SCI):
  • Maintain spinal immobilization.
  • Assess neurological function.
  • Consider early neurosurgical consultation.
• Shock:
  • Hypovolemic shock (hemorrhagic): fluid resuscitation, blood transfusion, control bleeding.
  • Cardiogenic shock: inotropic support, treat underlying cause.
  • Neurogenic shock: fluid resuscitation, vasopressors.
• Pediatric Trauma:
  • Anatomical and physiological differences compared to adults.
  • Use age-appropriate vital sign ranges and equipment.
  • Calculate medication dosages based on weight.
• Geriatric Trauma:
  • Increased susceptibility to injuries and complications.
  • Pre-existing medical conditions.
  • Polypharmacy.
• Pregnant Trauma Patients:
  • Prioritize maternal stabilization while considering fetal well-being.
  • Left lateral decubitus position to avoid aortocaval compression.
  • Rh-negative mothers should receive Rh immunoglobulin.
• Trauma in the Obese Patient:
  • Challenges with airway management, ventilation, and vascular access.
  • Difficulties with imaging studies.
  • Increased risk of complications.