Trauma

 

https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534159/all/ATLS_Algorithms

 

Bat call:

Patient

·      Adult?

·      Child?

·      Pregnant?

·      Elderly?

·      Coagulopathic?

·      Obese?

·      Comorbid?

Mechanism

·      Sharp?

·      Blunt?

·      Electrical?

·      Chemical?

Injuries

·      Brain?

·      C-spine?

·      Thorax?

·      Abdomen?

·      Limbs?

Status

·      Vital signs?

·      Conscious state?

 

Zero point survey:

Briefing

·      Situation

·      Priorities

Role allocation

·      Team leader

·      Airway

·      Vascular access

·      Blood products

·      Surgery

Heads up

·      Specialty teams

·      Theatre

·      Blood bank

·      Radiology

 

Primary survey:

Questions

·      Threat to life?

·      Threat to limb?

·      Threat to organ?

Airway

·      Patent?

·      Protected?

·      C-spine instability?

Breathing

·      Is oxygenation ok?

o  Colour

o  SpO2

·      Is ventilation ok?

o  Look (both sides)

o  Listen (both sides)

o  Capno

Circulation

·      Is there shock?

o  Brain: GCS

o  Kidneys: urine

o  Skin: colour, CRT

·      If shock, what is the cause?

o  External bleeding?

o  Internal bleeding? (E-FAST*)

o  Tension pneumothorax?

o  Tamponade?

o  Neurogenic?

·      If bleeding, how much?

o  Responding: <20%

o  Transiently responding: 20-40%

o  Not responding: >40%

Disability

·      Is there a head injury?

o  GCS

o  Pupils

o  Lateralising signs

Exposure

·      Are there any injuries we can’t see?

·      Is temperature ok?

*E-FAST: bilat anterior thorax + pericardium + perihepatic + perisplenic + pelvic

 

Primary response:

Goals

·      Fix problems in order of priority

·      Don’t make existing problems worse (esp brain and C-spine)

1.Team leader

·      Co-ordinate resuscitation

·      Arrange theatre

2.Airway & breathing

·      Observe

·      Auscultate

·      Manual in-line stabilisation

·      ±Jaw support

·      ±Bag & mask

·      ±Intubate

3.Circulation

3a. Access:

·      2 x big PIVC

·      Arterial line

·      Urinary catheter

3b. Blood:

·      Activate MTP

·      Take samples

·      Give crystalloid max 2L

·      Give blood products

·      Give adjuncts (TXA, calcium)

·      Keep warm

4.Surgery

·      Thorax: chest tubes

·      Abdomen: packing

·      Pelvis: binder

·      Limbs: reduce and splint

 

Secondary survey:

History

·      Patient + bystander + family

Examination

·      Head to toe

Investigations

·      Blood tests

·      Formal imaging