1. Overview of ATLS William P. Bozeman, MD, FACEP Assistant Professor, Dept. of Emergency Medicine University of Florida Health Sciences Center / Jacksonville

2. Overview of ATLS

3. Primary Survey (ABCDE’s) Resuscitation Secondary Survey Definitive Care Things to remember...

4. Primary Survey - Immediate Threats to Life (Only!) A = Airway B = Breathing C = Circulation Obstructed? Breath Sounds Present? Bilaterally? Peripheral Pulse? Femoral? Carotid? (Not BP Measurement.)

5. Primary Survey - Immediate Threats to Life (Only!) D = Disability E = Exposure Global (AVPU or GCS) Gross Motor Function (i.e. spinal cord integrity) Nekkid!

6. Common Life Threatening Pathology A = Airway B = Breathing C = Circulation Obstruction Tension PTX or HTX Open PTX Flail Chest Hypovolemic Shock Massive hemorrhage Spinal Shock

7. Overview of ATLS Primary Survey (ABCDE’s) Resuscitation Secondary Survey Definitive Care Things to remember...

8. Resuscitation IV’s (Two. Large.) Control Bleeding Fluids Blood Screening X-Rays “3” = C Spine, Chest, Pelvis. “5” = 3 + T&L Spine.

9. Overview ATLS Primary Survey (ABCDE’s) Resuscitation Secondary Survey Definitive Care Things to remember...

10. Secondary Survey Now find out what happened, what’s injured. History (AMPLE) Physical. Organized, complete head to toe exam. Roll, check back. Remember TM’s and rectal. Foley. NG or OG tube.

11. Overview of ATLS Primary Survey (ABCDE’s) Resuscitation Secondary Survey Definitive Care Things to remember...

12. Definitive diagnostics and care... Diagnostic Xrays (?) CT Scans (?) Ultrasound (?) MRI (?) DPL (?) Operating Room (?) Laceration Repairs (?) Antibiotics,Tetanus (?) Other Medications (?) Hyperbarics (?)

13. Overview of ATLS

14. Primary Survey (ABCDE’s) Resuscitation Secondary Survey Definitive Care Things to remember...

15. Roles of the Trauma Team Airway Nurse Boss Attending Team Member Nurse

16. Roles of the Trauma Team Boss Directs the team, communicates decisions Free to roam Attending speaks through Boss (or teaches directly)

17. Roles of the Trauma Team Airway A & B of primary survey Intubation (if needed) Head / Neck in secondary survey Nurses Attach monitors, give blood / fluids / meds Recording nurse records at foot of bed

18. Roles of the Trauma Team Team Members Expose, examine (secondary survey) Procedures as directed (by boss) Chest Tubes Lac repairs Rectals, foleys routinely assigned to team member.

19. Things to remember… The Ideal Trauma Resuscitation Roles are pre-assigned Clear direction & communication Pertinent findings verbalized in proper order All team members know all findings Rapid, Efficient Calm & Quiet!

20. Things to remember… The FAST Exam 4 views (RUQ, LUQ, SP, Pericard.) A “noninvasive DPL” Sensitive for free fluid ( __ - __ %) Not specific. Not good for solid organ injury. Not good for hollow organ injury.

21. Things to remember… Classification of Shock ClassEBL Pulse BP Mental Treatment I<15% (<750ml) - - nl Fluids II15-30% (750-1.5L)  - +/-anxious Fluids III30-40% (1.5L-2.0L)   anxious Fluids + Blood IV>40% (>2.0L)     confused Fluids + Blood

22. A Special Case: Penetrating Trauma to trunk (especially GSW’s) Need to rapidly find all penetrating injuries and all retained thoracoabd. projectiles Therefore...

23. A Special Case: Penetrating Trauma to trunk (especially GSW’s) Examine for entry/exit wounds immediately after the primary survey. (Wait to take BP start IV’s, take history.) Mark all entry and exit sites with radiopaque “arrow” markers. Take xrays immediately. (Team member wearing lead may start IV’s, place chest tubes, etc. during xrays.)

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