ATLS Inglese

8/7/2019 ATLS Inglese

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GOALGOAL1. Recognize different surgical

emergencies2. Learn a correct notion3. Decrease delayed diagnosis4. Prevent secondary injury


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GUIDELINES GUIDELINES 1. Surgical emergencies

2.

Pediatric surgery emergencies3. Urological emergencies4. ENT emergencies

5. Ophthalmic emergencies6. Gynecologic emergencies


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PR INCI P LES OF PR INCI P LES OF MANAGEMENT MANAGEMENT

1. Life-savinga. Identify life-threatening injury

b. Appropriate resuscitation2. Maintain vital status

a. Detailed physical examination b. Continuous resuscitation

3. Further evaluation and managementa. Laboratory examination

b. Consultation


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T R AUMAT R AUMA1. The 5th leading causes of death of

Taiwanese2 . The 1 st leading cause of death of

young adults

3.

Approximately 8,000 patients diedfrom trauma annually


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W OUND CA R E

W OUND CA R E

1. Copious irrigation

2. Remove foreign body3. Antiseptic solution4. Adequate debridement

5. Primary / Delayed suture


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PR IMA RY SU RV E Y PR IMA RY SU RV E Y A . Airway and C-spine control

B.

Breathing and ventilationC . Circulation and hemorrhage controlD . Disability

E.

ExposureM . Monitor (Foley: indication and contraindication )


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AIRWAY INTERVENTIONSAIRWAY INTERVENTIONSJaw thrust

AVOID HYPEREXTENSIONOR FLEXION OF THE NECK

Log roll to side for emesis


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CERVICAL SPINE STABILIZATIONCERVICAL SPINE STABILIZATION

Place hands on either side of theheadMaintain neck midline


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BREATHING ASSESSMENTBREATHING ASSESSMENTLook, listen, and feel

Observe chest symmetry Note work of breathing

Jugular vein distentionTracheal deviation


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BREATHING INTERVENTIONSBREATHING INTERVENTIONS

If breathing is absent, begin mouthto mask ventilationsIf breathing is shallow or labored,

maintain airway control


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CIRCULATORY ASSESSMENTCIRCULATORY ASSESSMENTLevel of consciousness

Carotid pulse (absent or present)Capillary refillSkin color Skin temperatureSites of bleeding


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SECU R E AI RW

AY SECU R E AI RW

AY Assist airwayOral airway, nasal airway, LMA

Endotracheal intubationOral, nasal

Surgical airwayCricothyroidotomyTracheostomy


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LMA and Intubating LMALMA and Intubating LMA


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Intubating LMAIntubating LMA


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Contraindication: < 11y/oContraindication: < 11y/o


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Needle Cricothyroidotomy Needle Cricothyroidotomy


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NEUROLOGICAL ASSESSMENT NEUROLOGICAL ASSESSMENTLevel of consciousness

AVPU scale Awake Verbal response

P ain response Unresponsive


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Traumatic SAHTraumatic SAHMost common: 30-40%

Blood within the CSF andsubarachnoid (SA) space

Tearing of small SA vesselsBlood often seen in the basilar cisterns, interhemispheric fissuresand sulci


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Epidural HematomaEpidural Hematoma (EDH)(EDH)0.5-1% of head injuries

Blood between the skull and

duraMiddle meningeal artery

(MMA) > dural sinuses, veins,fracture line

Classic LOC then lucid(30%)

80% associated with skull #


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Acute Subdural HematomaAcute Subdural Hematoma (SDH)(SDH)30% of head injuriesForceful acceleration-

deceleration injuriesBlood between the dura and

brainHyperdense, crescent shaped,

extend beyond suture linesQuick clinical coursePrognosis: 60-80% mortality


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I I C P I I C P SymptomsHeadache, vomiting, cons changeSignsIncrease BP, decrease HR & PR

papilledemaNeurological findings

Focal sign, pupil size and lightreflexCushing's triad: hypertension,bradycardia, and Cheyne-Stokesrespiration (irregular breathing)

Increased BP

Slow PulseAltered Breathing


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BATTLEBATTLE S SIGNS SIGN


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RACCOON EYESRACCOON EYES


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Brain ConcussionBrain ConcussionTemporary disturbance in brain functionProbably due to brain being rattled insidethe skull by a blow to the headUsually confused or unconsciousRetrograde amnesia--What happened?Effects clear without residual effects


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OBSE RV ATION OF OBSE RV ATION OF HEAD INJU RY HEAD INJU RY

Progressive headache

VomitingConsciousnessDyspnea

Extremity weaknessSeizure


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LIFE LIFE- -TH R EATENING TH R EATENING CHEST INJU RY CHEST INJU RY

1. Airway obstruction

2. Tension pneumothorax3. Open pneumothorax4. Massive hemothorax

5. Pericardiac tamponade6. Flail chest combined pulmonary

contusion


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Pericardial EffusionPericardial Effusion


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PneumothoraxPneumothorax


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BECKS T R IAD BECKS T R IAD1. Decrease blood pressure

2. Distended neck vein3. Distant or muffled heart

sounds


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Pulsus Paradoxicus Pulsus ParadoxicusThe inspiratory diminution in systolic arterial pressureexceeds 10 mmHg.To measure pulsus paradoxus, a sphygmomanometer

sphygmomanometer is employed for blood pressuremeasurement in the standard fashion except that the cuff isdeflated more slowly than usual. During deflation, the firstKorotkoff sounds are audible only during expiration, butwith further deflation, Korotkoff sounds are heardthroughout the respiratory cycle. The difference betweenthe systolic pressure at which the first Korotkoff soundsare heard during expiration and the pressure at which theyare heard throughout the respiratory cycle quantifies pulsus

paradoxus.


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LIFE LIFE- -TH R EATENING TH R EATENING

ABDOMINAL INJU RY ABDOMINAL INJU RY

1. Liver laceration2. Spleen laceration3. Large vessel injury

4. Pelvic fracture


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PELVISPELVISApply pressure on pelvis to determine itsstability

Perform genitalia exam at one sdiscretion


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EXTREMITIESEXTREMITIESObserve for deformities, impaled objects,open woundsPalpate for pulses, crepitus, or swellingDetermine capillary refill, skin color,temperatureAssess for pain/tenderness


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INSPECT THE BACK INSPECT THE BACK Log roll student with assistanceSchool nurse must maintain cervicalspine controlInspect and palpate the back forbruising, impaled objects, pain andtenderness


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T R AUMATIC SHOCK T R AUMATIC SHOCK 1. Hypovolemic shock

2. Neurogenic shock 3. Cardiogenic shock 4. Septic shock


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Neurogenic shock Neurogenic shock Spinal cord injury may produce hypotensiondue to loss of sympathetic tone.Hypotension without tachycardia or cutaneous vasoconstriction.


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FLUID R ESUSCITATION FLUID R ESUSCITATION

1. AccessTwo large bore IV catheter

2.

FluidCrystalloid, colloid, blood component

3 . Amount

a. Bolus: 2 liter for adults20 ml/ kg for child

b. maintain amount based on urine output


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DIFFICULT DIFFICULT

CATHETE R IZATION CATHETE R IZATION

1. Venous cut down2. Intraosseous infusion (


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THE R MAL INJU RY THE R MAL INJU RY 1. Major burn

2. High-voltage electric injury3. Inhalation injury4. Chemical burn


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ACUTE ABDOMEN ACUTE ABDOMEN Differential diagnosisSurgical abdomen / medical abdomen

Pain history

Onset, location, intensity, duration,radiation, quality, associated symptoms

Symptoms sequence


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SE V E R E ABDOMINAL P AIN SE V E R E ABDOMINAL P AIN

1. Hollow organ perforation2. Acute pancreatitis3. Colic pain

a . Biliary systemb . Renal system

4. Ischemia pain5. Others


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COMMON DISEASES COMMON DISEASES

1. Acute cholecystitis

2 . (Perforated) Peptic ulcer

3 . Acute appendicitis4 . Acute pancreatitis5 . Small bowel obstruction6 . Colon obstruction7 . Vascular occlusion8 . Others


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P EDIAT R IC SU RGE RY P EDIAT R IC SU RGE RY

EME RGENC Y EME RGENC Y 1. Respiratory distress

* Esophageal atresia* Diaphragmatic hernia

2. Skin defect* Gastroschisis* Omplalocele* Menigocele


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P EDIAT R IC SU RGE RY P EDIAT R IC SU RGE RY

EME RGENC Y EME RGENC Y 3 . Bowel obstruction

Pyloric stenosis, intussusceptionAdhesion, incarcerated hernia,Malroatation

4.

Abdominal pain*Acute gastroenteritis*Acute appendicitis

*Mesenteric lymphadenitis


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G Y NECOLOGIC G Y NECOLOGIC EME RGENC Y EME RGENC Y

Vaginal bleeding

1. Dysfunctional uterine bleeding2 . Uterine myoma3 . Hypermenorrhea

4 . Abortion5 . Atony uterus


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G Y NECOLOGIC G Y NECOLOGIC

EME RGENC Y EME RGENC Y

Ectopic pregnancy* Missed period* Vaginal spotting

* Abdominal pain


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G Y NECOLOGIC G Y NECOLOGIC

EME RGENC Y EME RGENC Y Abdominal pain

* Pelvic inflammatory disease* Acute appendicitis* Ovarian cyst (torsion)

* Ileus* Menstruction


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U rological Eme rg en cyU rological Eme rg en cy

Painful conditionsBleeding conditionsTrauma conditionsOthers


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ENT Eme rg en cy ENT Eme rg en cy

Foreign bodyEpistaxisDeep neck infectionOthers


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Ophth ologic Eme rg en cyOphth ologic Eme rg en cy

Red eye

Foreign body

Blurred visionOthers


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R EE V ALUATION R EE V ALUATION

Time intervalSame personnelVital signsLaboratory examination

Early suspicionEarly consultation


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MEDICAL ETHICS MEDICAL ETHICS

Treat a person not a diseaseTreat a patient as your familyBe patient to a patients complaintBe kind and more smile

Careful explanation


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Suggestive ReadingsSuggestive Readings

Advanced Trauma Life Support (ATLS) for Doctors (American College of SurgeonsCommittee on Trauma, 1997)

(, , 1999)

ATLS Inglese

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