Advanced Trauma Life Support
Tri-modal distribution of mortality
immediate cause of death
early deaths within 1-3 hours
- pneumothorax
- late deaths
Prevention
- laws
- seat belts
- helmets
- play a role in teachable moments
golden hour
- rapid transport
- early recognition of injury
- definitive care
trauma systems are organized approach to acutely injured people providing personnel, facilities, and equipment for optimal care on an emergency basis, within a defined geographical area
Primary survey & resuscitation
The ABCDEs
- Airway and C-spine
- Breathing and ventilation
- Circulation
- Disability
- Exposure
- Airway and cervical spine protection
- Breathing
- Circulation/control external hemorrhage
- Deficit
- Exposure/environment (temperature, risks: needles, chemicals, etc)
The primary survey provides a rapid assessment of critical functions and resucscitate simultaneously.
Fix problems immediately as they are identified
Check airway protection
Obtain and maintain the airway
predict and protect
oxygenate and ventilate
MVCs often follow trips to restaurants.
Facial smash.
Airway patency
- foreign bodies
- maxillofacial fractures
- ethanol
- C-spine control
Airway and c-spine
Breathing and Ventilation
Always use 100% supplemental oxygen at 15L/min
- examine thorax and neck
- auscultate chest
threats:
- tension pneumothorax
- open pneumothorax
- flail chest and pulmonary contusion
- massive hemothorax
- cardiac tamponade
Circulation
pulse
blood pressure
respiratory rate
capillary refill
urine output
fluid replacement
Exposure
Completely expose the patient
logroll the patient
rectal examination (rectal tone, high-riding prostate, gross blood)
urethral meatus for blood
- Foley catheter
Definitive Management
Trauma series: CXR, lateral C-spine, pelvis
DPL, US, CT
FAST: focused abdominal sonography for trauma
- pericardial
- perihepatic
- perisplenic
- pelvic
bedside screening test to identify free fluid
Pediatrics
Children are at risk of damage to various organ systems, for the following reasons:
- head: large head relative to their body, as well as poor protective reflexes
- neck: shorter
- airway: large tongue can obstruct airway; larynx more anterior; epiglottis floppier
- chest: ribs flexible and less protective; abdominal breathing with a full stomach can compromise breathing
- abdomen: less protected by muscle and ribs; liver and spleen more exposed; major injury can have only minor outward signs
- bones: growth plate weaker than ligaments - Salter-Harris fractures more common
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