ATLS & BLS Shortlist

ATLS & BLS Shortlist

ATLS & BLS Shortlist

ATLS Algorithms

First Things First (assess & treat for the following)

Trauma is a consequence of harmful behavior that is planned or unplanned. Injury prevention starts with addressing these behaviors.

Goals of trauma patient management

Identify and treat threats to life, then limb, and then eyesight.

Prevent exacerbation of existing injuries or occurrence of additional injuries.

Return patient to a level of function as close to pre-injury as possible.

Outcomes for trauma patients are improved with a systematic, multispecialty, and interdisciplinary approach to pre-hospital, hospital, and rehabilitative care.

Principles of trauma patient management

Treat the greatest threat to life first.

Definitive diagnosis is not immediately important.

Time matters (“golden hour” emphasizes urgency).

Do no further harm.

Assess, intervene, reassess

Did the intervention work?

Is the patient’s physiology returning to or staying normal?

Preparation

Training by discipline and as a team

Capabilities defined by established and integrated pre-hospital and hospital care protocols

Equipment maintained and ready for rapid use

Appropriate supplies available

Universal precautions enforced

Referral resources and transfer policies clearly defined

Field triage to a trauma center in four steps (from the Centers for Disease Control & Prevention expert panel with support from the National Highway Traffic Safety Administration, 2006)

Assess basic physiology.

Systolic blood pressure < 90

Respiratory rate < 10 or >29

Glasgow Coma Scale < 14

Assess anatomy of injury.

Penetrating injury to head, neck, torso, and extremities proximal to elbow and knee

Flail chest

>1 proximal long bone fracture

Crushed, degloved, or mangled extremity

Amputation proximal to wrist and ankle

Pelvic fractures

Open or depressed skull fracture

Paralysis

Assess mechanism of injury and evidence of high-energy impact.

Falls >20 feet (6 meters) in adults and >10 feet (3 meters) or 2-3 times height in children

High-risk auto crash

Intrusion >12 inches occupant site or 18 inches any site

Ejection (partial or complete) from vehicle

Death in same passenger compartment

Vehicle telemetry data consistent with high risk of injury

Auto vs. pedestrian/bicyclist thrown, run over, or with significant (>20 mph) impact

Assess special patient or system considerations.

Age: older adults and children

Anticoagulation and bleeding disorders

Burns

Time-sensitive extremity injury (open fractures, vascular compromise)

End-stage renal disease requiring dialysis

Pregnancy >20 weeks

EMS provider judgment

Initial assessment

Primary survey

Resuscitation

Adjuncts to primary survey

Secondary survey

Adjuncts to secondary survey

Ongoing post-resuscitation monitoring & reevaluation

Definitive care

Tertiary survey