Initial Assessment and Management
Initial Assessment and Management
Initial Assessment and Management
GOALS
Rapid and accurate assessment
Resuscitate and stabilize by priority
Determine needs and capabilities of your
hospital
Arrange for transfer to definitive care
Ensure optimum care
The primary survey should be repeated frequently to
identify any deterioration in the patient's status that
indicates the need for additional intervention.
Kunwari okay ung airaway, okay din ung B, okay din ung
C, then biglang nahirapan huminga ang pasyente? Go
back to A! You don't need to proceed hangga't may
problema pa.
PROTECTIVE GEARS
Cap
Gown
Gloves
Mask
Shoe covers
Protective eyewear / face shield
ATLS CONCEPT
1. ABCDE approach to evaluation and treatment
Airway
Breathing
Circulation
Deficit neurologic status
Exposure/Environmental control
-You have to undress the patient, look for
possible missed injuries but you have to cover
her/him with blanket after to prevent
hypothermia
Why airway first?
Without oxygen patient will die. Accdg to Doc:
"Sinong mas mauunang mamatay? Yung hindi humihingi
o yung nagblebleed?"
2. Treat greatest threat to life first
3. Definitive diagnosis not immediately important
4. Time is of the essence (First hour is important)
2 causes of death:
(1) on site (2) after complications
How can we decrease the incidence of death due
to complications? Managing correctly the patient in the
ER so that we can decrease mortality because of
complications
5. Do no further harm
1
PITFALLS
Occult airway injury
Progressive loss of airway
Equipment failure
Inability to intubate
MUST KNOW!!!
What is the Glascow Coma Scale that it is mandatory to intubate the patient?
8 AND BELOW! 7 means severe head injury
PRIMARY SURVEY
Airway with c-spine protection
Breathing and ventilation
Circulation with hemorrhage control
Disability: Neuro status
Exposure / Environmental control
Goal of Primary Survey: Identify and treat lifethreatening injury
AIRWAY
Establish patent airway and protect c-spine
Make sure that the airway is patent and put a collar if
blunt injury (in fall and vehicular accident, it is mandatory
to put collar). There is no need to put collar if the injury
is penetrating in mechanism.
cricothyrotomy
(also
called
2
BREATHING
Assess and ensure adequate oxygenation and
ventilation
Respiratory rate (Normal RR= 12-20)
Chest movement (Normal: symmetrical)
Air entry (Normal: equal)
Oxygen saturation
During the primary survey, you are allowed to put
O2 Sat machine)
General rule: You don't do diagnostic exam on an
unstable patient
Pulse ox is an adjunct for primary survey
Level of consciousness
Skin color and temperature
Pulse rate and character
Palpable radial pulse= the patient's BP is at least
80mmHg
If wala, go to femoral pulse= 70mmHg, then
carotid= 60mmHg
Sites of bleeding???
External (laceration)
Chest- hindi mo agad makikita
Abdomen
Pelvic fracture- retroperitoneal hematoma (massive
bleeding)
Long bone fracture- massive bleeding (minsan hindi
life threatening)
Chest, abdomen and retroperitoneum- LIFE
THREATENING!!!
In trauma patients, kapag nasa C (circulation) ka na,
lagyan mo agad ng IV fluid= 1L bolus, fast drip! (ATLS
Concept)
From Doc:
Dyspneic ang patient, nagkakamali kasi intubate agad. Ooops! Check mo muna yung B (Breathing).
Kapag okay ka sa B, then you can intubate the patient. Malay mo tension pneumothorax, na-aggravate
mo pa kasi kapag nag-intubate ka you need to pre-oxygenate the patient.
CIRCULATION
Assess for organ perfusion
3
Do mandatory intubation if
the GCS is 8 and below
Pupillary response
Dilate? There is impending
uncal herniation
PITFALLS
Observe for neurologic deterioration
EXPOSURE
Completely undress the patient
Prevent hypothermia
Missed injuries
SECONDARY SURVEY
5
Allergies
Medications
Past illnesses / Pregnancy
Last meal
Events / Environment / Mechanism
Detailed Head to foot examination
Radiologic examination
Definitive Care
Admit
Transfer
Operating room
MUST KNOWS!!! Isaksak mo sa isip mo! Pwede din naman sa puso mong bigo! :)
What is the Glascow Coma Scale that it is mandatory to intubate the
For example, in a 50kg male, the total blood volume is 4L (50kg x 0.08)
A 50kg male, tachycardic, how much blood volume ang nawawala sa
kanya?
30% of 4L= 1.2L
If the weight is given, you remember the percent!