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    Atls (C, D, Secondary Survey)

    Uploaded by

    mohammadreza esmaeili

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Atls (C, D, Secondary Survey)

    Uploaded by

    mohammadreza esmaeili
    7 views26 pages

    Original Title

    Atls (c,d,Secondary Survey)

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7 views26 pages

    Atls (C, D, Secondary Survey)

    Uploaded by

    mohammadreza esmaeili

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 26

    Primary Survey

    Circulatory Management

    Pitfalls

    ● Control hemorrhage ● Elderly


    ● Restore volume ● Children
    Athletes
    Reassess patient
    ●
    ●
    ● Medications
    Pelvic Fractures

    Management of Pelvic Fractures


    • AB, as usual
    • C: Control hemorrhage
    • Wrap / Binder
    • Rule out abdominal
    hemorrhage
    • Angiography, fixation
    • Pelvic packing
    Recognition of Shock

    Is the patient in shock?


    • Alteration in level of consciousness, anxiety
    • Cold, diaphoretic skin
    • Tachycardia
    • Tachypnea, shallow respirations
    • Hypotension
    • Decreased urinary output
    Primary Survey

    Disability

    ● Baseline neurologic Caution

    evaluation
    Observe for
    ● Glasgow Coma Scale neurologic
    score deterioration

    ● Pupillary response
    Management

    Medical
    • Mannitol
    • Use only with signs of tentorial
    herniation
    • Avoid in patients with hypovolemia
    • Dose 1.0 gram / kg IV bolus
    • Hypertonic saline
    • Anticonvulsants
    • Sedation Neurological examination
    before prolonged
    • Paralytics sedation/paralysis
    logroll

    Neurologic: Spine and Spinal Cord

    Conduct an in-depth
    evaluation of the
    patient’s spine and
    spinal cord

    Early neurological /
    orthopedic consult
    Primary Survey

    Exposure / Environment

    Completely undress Caution


    the patient
    Prevent
    hypothermia

    Pitfalls

    Missed injuries
    Resuscitation

    • Protect and secure airway

    • Ventilate and oxygenate

    • Stop the bleeding!

    • Crystalloid / blood resuscitation

    • Protect from hypothermia


    Adjuncts to Primary Survey

    Vital signs
    ECG ABGs

    PRIMARY SURVEY
    Pulse
    Urinary oximeter
    output and CO2
    Urinary / gastric catheters
    unless contraindicated
    Adjuncts to Primary Survey

    Diagnostic Tools
    Adjuncts to Primary Survey

    Diagnostic Tools

    • FAST

    • DPL
    Transfer to Definitive Care

    When should the transfer occur?


    Adjuncts to Primary Survey

    Consider Early Transfer

    • Use time before


    transfer for
    resuscitation

    • Do not delay
    transfer for
    diagnostic tests
    Transfer to Definitive Care

    When should the transfer occur?

    As soon as possible after stabilizing measures are


    completed:

    ● Airway and ventilatory control


    ● Hemorrhage control (operation)
    Secondary Survey

    What is the
    secondary survey?

    The complete
    history and
    physical
    examination
    Secondary Survey

    When do I start the secondary survey?

    After

    ● Primary survey is completed


    ● ABCDEs are reassessed
    ● Vital functions are returning
    to normal
    Secondary Survey

    Components of the secondary survey

    • History
    • Physical exam: Head to toe
    • Complete neurologic exam
    • Special diagnostic tests
    • Reevaluation
    Indications for CT Scan

    • GCS score still < 15 two


    hours after injury
    • Neurologic deficit
    • Open skull fracture
    • Sign of basal skull
    fracture
    • Vomiting (> 2 episodes)
    • Extremes of age
    • Retrograde amnesia
    • Severe headache
    Secondary Survey

    History
    A llergies
    M edications
    P ast illnesses / Pregnancy

    L ast meal

    E vents / Environment / Mechanism


    Secondary Survey

    Mechanisms of Injury
    Pain Management

    ● Relief of pain /
    anxiety as
    appropriate
    ● Administer
    intravenously
    ● Careful monitoring is
    essential
    Questions?
    Summary

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