| How is epidemiology of trauma? | Trauma is the leading cause of Death <45y
10% of Global Mortality
40% of Trauma Deaths could be avoided
50% of passenger vehicle occupants killed were unrestrained
M/F: 2,5/1
2 Peaks of Trauma Death(3 peaks) |
| When is the time of death usually caused by trauma? | . |
| What are the leading causes of trauma death? | . |
| What are the 4 levels of trauma care ACS? | 4 levels (1 (highest level of care) to 4) |
| How is assessment in ATLS? | First measure vitals and level of conscioussness
(if glasgow coma scale <13, sys BP <90, RR <10/>29)
Then assess anatomy of injury (penetrating, flail chest, bone fractures, amputations, paralysis)
if both positive then transport pt to trauma care center
If no injury anatomy then assess mechanism to injury and evidence of high energy impact (fall >feet or 2 floors for adults and 1 floor for children, or high risk auto crash [death of passenger...] or motorcycle accident >20mph) then transport to trauma center
If not assess special pt or system considerations if older or children or pregnancy then take to trauma center |
| What are the steps of ATLS? | 1- Primary Survey C Spine Stabilization
2- Resusication
3- Secondary survery, PE and Hx
4-Definitive tx |
| What is primary survery? | ABCDE
Airway
Breathing
Circulation
Disability
Exposure, Environment |
| How is airway management in primary survey? | Secure Airway , Protect C spine
1st Manoeuver : Chin Lift, Jaw Thrust
If Failure =>Endotracheal Intubation
If Failure => Crico-Thyroidotomy
O2 : 10-12 L/min
Repeated Assessment |
| What Glasgow coma scale requires intubation? | <8 |
| How is the structured approach to assessment of Glasgow coma scale? | . |
| How is assessment of breathing? | Oxygenation , Ventilation
Inspection ,Auscultation ,Percussion, Palpation
Treat Life Threatening Conditions
ex: Tension Pneumothorax, Massive Hemothorax, Open Pneumothorax, Flail Chest |
| How is needle decompression done? | 4th-5th intercostal space, mid axillary (also for chest tube place) used to be 2nd intercostal space
We may add a chest seal for penetrating trauma to stop tenion pneumothorax |
| How is flail chest made? | . |
| How is circulation management in first survery? | Secure Adequate Tissue Perfusion
Control Hemorrhage ( Pressure,Tourniquet,…)
Vascular Access: 2 Larges bore IV Lines
If Failure =>Central line - Intraosseous line
Give crystalloid 1L.(2 L)
Then 2de BOLUS
Blood Transfusion (2 units)
FFP (1:1 ; 2:3)
Platelet (1/5 unit of FFP)
Tranexamic Acid (1g over 10 min followed by 1g over 8 hours)
Monitor :ECG ,BP ,RR ,Pulse Oximetry, Temperature , NGT ,Foley catheter |
| How is disability management in first survey? | Neurologic Injuries
(Mental status, GCS, Pupils)
Etiologies :Alcohol intoxication ,CNS stimulant or depressor, DKA, CVA, Hypovolemic shock
GCS (≠score in Intubated Patients) |
| What is environment exposure in first survey and other actiions to consider? | Full exam for exposure
ER thoracotomy for cardiac massage
Addition of REBOA balloon in aortic zones (1 or 2 or 3 in cases of occlusion) |
| How is resusicitative phase in ACLS? | Types of shock (hypovolemic, cardiogenic, neurogenic, and cardiac compressive
Labs done are CBC, HX and PE (alcohol, ABG, urine analysis, LFT, if blood in urine do cystourethrogram, coagulation test, toxicotest)
Imaging (CXR, CT, lateral C spine, CT neck, FAST (hemoperitoneum/pericadium unstable pt) CT if FAST - or stable pt) |
| What are differences between different types of shock? | . |
| What are classes of hypovolemic shock? | . |
| What are differences in S&S of different types of shock? | . |
| What is secondary survey for ATLS? | + Hyphema |
| How is definitive tx for ATLS? | . |
| What are zones of the neck>? | . |
