1. 急診創傷個案討論
新光醫院 急診科
張志華 醫師
2005 / 09 / 22

2. ATLS: 初級評估與處置

3. ATLS: 5 Steps Preparation Triage
Primary survey (ABCDE) + Resuscitation
Adjuncts to primary survey
Secondary survey
Adjuncts to secondary survey
Continued monitoring and reevaluation
Definite care / Transfer
Prehospital phase: airway maintenance, control of external bleeding and shock, immobilization of the patient, immediate transport to the closest appropriate facility.
Inhospital phase: advanced planning, resuscitation area, proper airway equipment…

4. Primary Survey Airway + C-spine protection
考題！
Airway + C-spine protection
Breathing + R/O tension pneumothorax
Circulation + stop bleeding
Disability (GCS) + pupils + MP x 4
Exposure + Environmental control

5. Adjuncts to Primary Survey
NG/OG, Foley
X-rays: Chest, pelvis, c-spine
DPL or FAST
Monitoring: ECG, BP, SpO2, ABG, ETCO2

6. Secondary Survey Does not begin until
Primary survey (ABCDE) is completed
Normalization of vital signs after resuscitation

7. Secondary Survey Complete History Complete PE AMPLE Head to toes
Finger to holes

8. Secondary Survey History: Allergies Medication
Past illness / pregnancy
Last meal
Events / environment

9. Adjuncts to Secondary Survey
Specialized diagnostic tests
CT scans
Contrast x-rays
Extremity x-rays
Endoscopy and ultrasonography

10. Reevaluation Reevaluation constantly (start with ABCDE)
To discover new findings
To discover deterioration
Continuous monitoring
Vital signs, EKG
U/O
ABG, SpO2
ETCO2

11. Definite Care and Transfer
Decision during the primary survey and resuscitation
D2D communication
Transfer after life-saving resuscitation

12. 謝謝聆聽