Kuliah ATLS
Kuliah ATLS
Kuliah ATLS
Trauma is leading cause of death in the first 4 decades of life in most developed countries. 3.8 million deaths / year worldwide 312 million injured / year worldwide 3 patients permanently disabled / death
ATLS Concept
ABCDE-approach to evaluation / treatment Treat greatest threat to life first Definitive diagnosis not immediately important Time is of the essence Do no further harm
s
Airway with c-spine protection Breathing / ventilation / oxygenation Circulation : Stop the bleeding !
Documented improvements in care of injured patient after implementation of program Injury mortality Lower per capita injury death Retention of organizational and procedural skills
Standard Precautions
Cap Gown Gloves Mask Shoe Covers Goggles / face shield
Primary Survey
Special Considerations
Trauma in the elderly Pediatric trauma Trauma in pregnant women
Primary Survey
Establish patent airway Protect c-spine Pitfalls? Equipment failure Inability to intubate Occult airway injury Progressive loss of airway
Primary Survey
Assess and ensure adequate oxygenation and ventilation Pitfalls? Airway vs ventilation problem? Iatrogenic pneumothorax or tension pneumothorax
Primary Survey
Circulatory Management
Control hemorrhage Restore volume Reassess parameters Pitfalls? Elderly Children Athletes Medications
Primary Survey
Disability Baseline neurologic evaluation GCS scoring Pupillary response Observe for neurologic deterioration
Primary Survey
Exposure / Environment Completely undress the patient
Prevent hypothermia
Resuscitation
Protect and secure airway Ventilate and oxygenate Stop the bleeding Vigorous shock therapy Protect from hypothermia
Secondary Survey
History
Allergies Medications Past illnesses Last meal Events / Environment
Secondary Survey
Head
GCS Score Neurologic exam Comprehensive eye and ear exam
Secondary Survey
Maxillofacial
Bony crepitus Deformity Malocclusion Pitfalls? Potential airway obstruction Cribriform plate fracture Frequently missed
Secondary Survey
Cervical Spine Tenderness Complete motor/ sensory exams Reflexes Imaging studies
Secondary Survey
Neck (soft tissues) Mechanism: Blunt vs penetrating Symptoms: Airway obstruction, hoarseness Findings: Crepitus, hematoma, stridor, bruit
Secondary Survey
Neck (soft tissues): Pitfalls
Delayed symptoms and signs Progressive airway obstruction Occult injuries
Secondary Survey
Chest Inspect Palpate Percuss Auscultate Obtain x-rays
Secondary Survey
Abdomen
Inspect Auscultate Palpate Percuss Reevaluate Special studies
Secondary Survey
Abdomen: Pitfalls?
Hollow viscus injury Retroperitoneal injury Excessive pelvic manipulation
Secondary Survey
Perineum
Rectum
Contusions, hematomas, lacerations, urethral blood
Sphincter tone , highriding prostate, pelvic fracture, rectal wall integrity, blood
Vagina
Pitfalls
Blood, lacerations
Urethral injury in women, pregnancy
Secondary Survey
Musculoskeletal: Extremities
Contusion, deformity Pain Perfusion Peripheral neurovascular status X-rays as needed
Secondary Survey
Musculoskeletal: Pelvis Pain on palpation Symphysis width Leg length unequal Instability X-rays as needed
Secondary Survey
Musculoskeletal: Pitfalls Potential blood loss Missed fractures Soft-tissue or ligamentous injury Compartment syndrome (especially with altered sensorium / hypotension)
Secondary Survey
Neurologic: Brain
GCS Score Lateralizing signs Frequent reevaluation Prevent secondary brain injury
Secondary Survey
Neurologic: Spine and Cord
Complete motor and sensory exams Imaging as indicated Reflexes Early neurosurgical / orthopaedic consult
Secondary Survey
Neurologic: Pitfalls Incomplete immobilization Subtle in ICP with manipulation Rapid deterioration
Pain Management
Relief of pain /anxiety as appropriate Administer intravenously Careful monitoring is essential