13.02.06 ATLS

Primary survery

    • Vitals

    • ABG

    • Pulse Ox

    • ETCO2

    • Catheters

      • Urine

      • Gastric

    • Urine o/p

    • ECG

AMPLE

    • Allergies

    • Medications

    • PMH

    • Last meal

    • Event / Environment

Guedel airway

    • Hard-to-hard

      • Incisors to angle of jaw

    • Soft-to-soft

      • Side of mouth to tragus

    • Put it in upside down + turn

Nasopharyngel airway

    • Size of their little finger

    • Length = Tip of nose to tragus

    • Put in the right side

Shock

    • Blood loss is like tennis:

      • 15%

        • 750 ml

        • Unlikely even to notice

      • 30%

        • 1.5 litres

        • Tachy but normotensive

          • This is the dangerous one!

      • 40%

        • 2 litres (e.g. femur/pelvis fracture)

        • Start to become hypotensive

      • Game (>40%)

        • Bradycardia

        • Catastrophic hypotension

Danger areas in assessing shock

    • The 30%-ers

      • Still normotensive

    • Athletes

      • 80 bpm may be very tachy.

    • Beta blockers

Rib fractures

    • 1-3

      • Need SEVERE force

      • Check for associated injuries

        • Brachial plexus

        • C. spine

        • Vessels

    • 4-9

      • Risk of pulmonary contusion + pneumothorax

    • 10-12

      • Look for abdo injury (spleen etc)

6 killers in thoracic trauma

    • Laryngeotracheal injury

      • Rare

      • Horseness

      • Subcut emphysaema

        • Walking on snow

    • Tension pneumothorax

      • Resp. distress

      • Shock (from VENOUS compression)

      • Distended neck veins (may be hidden by c. spine collar)

      • Cyanosis is a LATE sign

    • Open pneumothorax

      • Seal 3 sides => Valve to let air out

    • Flail chest / Pulmonary contusion

      • Multiple ribs broken in multiple places

      • => Sections sucked in on inspiration

      • => Contusion underneath => Blood in lung

      • Big ventilation problems appear in a few hours

    • Massive haemothorax

      • Requires a BIG vessel

      • Stage 3 shock

      • No breath sounds

      • Dull percussion

      • Fluid level on CXR but only if upright

    • Cardiac tamponade

      • PEA

      • Muffled heart sounds

      • Hypotension

      • Distended neck veins

Other serious thoracic traumas

    • Tracheobronchial tree injury

      • Causes a persistent pneumothorax (still bubbling after an hour)

    • Blunt cardiac injury

      • Bruising => Dysrhythmia

    • Oesophageal rupture

      • Pain + shock out of proportion to injury

      • Patriculate matter comes out of chest tube

      • Check with contrast swallow

    • Simple pneumothorax

      • Beware pressure changes (ventilation, air transfer)

    • Pulmonary contusion

      • May look like a haemothorax on CXR

    • Traumatic aortic disruption

Notes

    • SBP >80 to feel peripheral pulse

    • Careful with fluid resuscitation - Can dislodge clot

    • FAST scan for free fluid

      • Focused Assessment with Sonography for Trauma

    • Diagnostic peritoneal lavage - Only in resource-poor settings these days

    • Seesaw respiration => Obstructed airway

    • Women tend to be chest-breathers (to prepare for pregnancy?)

    • Pelvis = Polo mint => Look for secondary break

    • Abdo injury = Nipples to groin (trauma can be very high up!)