ATLS (Dr Grace Yong):
DEFINITION:
Rapid sequential steps (within 2 minutes), for initial assessment to detect life threathening
condition and management.
1. AIRWAY + CERVICAL SPINE CONTROL
Ask patient name.
What to assess?
● Intubated?
● Speaking full sentence
● Any maxillofacial injury
● Cyanosis
● On Cervical Collar? Any cervical tenderness
● Stridor (Do jaw thrust. If it is resolved by jaw thrust, therefore it is not due to tongue).
Grunting, hoarseness voice?
● Check ?gag reflex
●
For cervical spine control:
● Head immobalization
○ Cervical collar
○ Strap
○ Spinal board (if more than 2 hours: can lead to sore!)
2. BREATHING AND VENTILATION:
What to assess?
● Ventilated?
● RR, SPO2
● Use of accessory respiratory muscles
● Distended neck vein*, raised JVP*
● Tracheal deviation
● Chest spring (Anterior, lateral, central)
● Subcutaneous emphysema
● Respiratory system (equal air entry, crepitation, ronchi)
● Percussion
Causes of airway obstruction (ATOM-TC):
CAUSE DEFINITION MANAGEMENT
Tension Chest tube bubbling: exhalation Percussion: Hyperresonant
, Pneumothorax
Needle thoracocentesis followed by
chest tube insertion
Open Chest tube bubbling: exhalation 3 way occlusive sterile dressing followed
Pneumothorax? by chest tube
If need chest tube, cannot put same
wound
Massive Hypotension Chest tube insertion
Hemothorax Reduced air entry Management of shock
Percussion: Dull
200ml/hour for 2-4 hours.
Tracheo Chest tube bubbling: Placement of more than one chest tube,
bronchial injury Continuous kiv intubation (anticipate difficult airway)
Cardiac Distended neck Pericardiocentesis
Tamponade Beck’s triad: muffled heart
sound, hypotension, raised
JVP.
3. CIRCULATION AND HEMORRHAGE CONTROL
What to assess?
● Peripheries, pulse volume, CRT
● BP, PR, DXT
● JVP, neck vein
● Radioradial delay
● CVS: muffled heart sound? Cardiac tamponade
● Per Abdomen: TRO abdominal injury (Guarding, tension)
● FAST scan:
○ If FAST negative, but abdomen guarded?
■ Suspect intraabdominal injury until proven otherwise
○ If first FAST is negative, doesn’t mean nothing. Need to repeat FAST until vitals
stable
● Pelvic spring: TRO pelvic fracture
○ How to put:
■ Pelvic binder?
■ Immobalizer?
● Counter traction, then put immobalizer
● Need to assess pulse, movement, sensation before and after
procedure
● External bleeding
DEFINITION:
Rapid sequential steps (within 2 minutes), for initial assessment to detect life threathening
condition and management.
1. AIRWAY + CERVICAL SPINE CONTROL
Ask patient name.
What to assess?
● Intubated?
● Speaking full sentence
● Any maxillofacial injury
● Cyanosis
● On Cervical Collar? Any cervical tenderness
● Stridor (Do jaw thrust. If it is resolved by jaw thrust, therefore it is not due to tongue).
Grunting, hoarseness voice?
● Check ?gag reflex
●
For cervical spine control:
● Head immobalization
○ Cervical collar
○ Strap
○ Spinal board (if more than 2 hours: can lead to sore!)
2. BREATHING AND VENTILATION:
What to assess?
● Ventilated?
● RR, SPO2
● Use of accessory respiratory muscles
● Distended neck vein*, raised JVP*
● Tracheal deviation
● Chest spring (Anterior, lateral, central)
● Subcutaneous emphysema
● Respiratory system (equal air entry, crepitation, ronchi)
● Percussion
Causes of airway obstruction (ATOM-TC):
CAUSE DEFINITION MANAGEMENT
Tension Chest tube bubbling: exhalation Percussion: Hyperresonant
, Pneumothorax
Needle thoracocentesis followed by
chest tube insertion
Open Chest tube bubbling: exhalation 3 way occlusive sterile dressing followed
Pneumothorax? by chest tube
If need chest tube, cannot put same
wound
Massive Hypotension Chest tube insertion
Hemothorax Reduced air entry Management of shock
Percussion: Dull
200ml/hour for 2-4 hours.
Tracheo Chest tube bubbling: Placement of more than one chest tube,
bronchial injury Continuous kiv intubation (anticipate difficult airway)
Cardiac Distended neck Pericardiocentesis
Tamponade Beck’s triad: muffled heart
sound, hypotension, raised
JVP.
3. CIRCULATION AND HEMORRHAGE CONTROL
What to assess?
● Peripheries, pulse volume, CRT
● BP, PR, DXT
● JVP, neck vein
● Radioradial delay
● CVS: muffled heart sound? Cardiac tamponade
● Per Abdomen: TRO abdominal injury (Guarding, tension)
● FAST scan:
○ If FAST negative, but abdomen guarded?
■ Suspect intraabdominal injury until proven otherwise
○ If first FAST is negative, doesn’t mean nothing. Need to repeat FAST until vitals
stable
● Pelvic spring: TRO pelvic fracture
○ How to put:
■ Pelvic binder?
■ Immobalizer?
● Counter traction, then put immobalizer
● Need to assess pulse, movement, sensation before and after
procedure
● External bleeding
