Advanced Trauma Life Support An Introduction to management of the trauma patient

1. Advanced Trauma Life SupportAn Introduction to management of the trauma patient Rob Simpson Acute Block Teaching

2. The Pre-hospital phase • Good Trauma Care starts at the road side • Moving towards hub and spoke model in the UK

3. Trauma Resuscitation • Preparation (call for senior help!!) • Primary Survey (cA&cBCDE) • Resuscitation / Adjuncts to primary survey • Secondary Survey (head-to-toe) • Continued monitoring and re-evaluation • Definitive Care

4. Preparation • Assemble team • Prepare equipment • Delegate tasks • MIST handover

5. Airway Primary survey Lines and bloods Radiographer / radiology Scribe Specialty opinions “The trauma team”

6. Arrival of the patient • MIST handover • M Mechanism of injury • I Injuries Identified • S Vital signs • T Treatment & timings

7. Control of massive haemmorhage • Stepwise process • Direct pressure • Elevation • Tourniquet

8. Assessment Look & listen Airway

10. Airway with cervical spine control • Manual in-line immobilization • Collar, blocks & tape • Airway manouvers • Jaw thrust • Simple adjuncts • Advanced airway techniques • High-flow oxygen

13. Breathing • Rapid assessment • Inspection • Auscultation • Percussion • Palpation • Trachea • crepitus

14. Immediately life “B” problems • TOM FC

15. Tension Pneumothorax • Open pneumothorax • Massive haemothorax • Flail segment • Cardiac tamponade

16. Do you have a confident management plan for each of these ?

17. Tension pneumothorax • What is it ? • How does it present ? • What is the immediate action ? • What should be done next ?

18. Open Pneumothorax • What is it ? • Why does it cause a problem ? • What is the immediate management ? • What should be done next ?

20. Massive haemothorax • What is the definition of a massive haemothorax ? • What is the management ? • Theatre ?

21. What is the definition ? What is the management? What is the principal concern ? Flail chest

22. Cardiac tamponade • Suspect if resistant hypotension in the absence of bleeding • What is the definitive investigation? • What is the treatment ?

23. Circulation • Assessment • Where has it all gone ? Rule of 5 • Basics of trauma resuscitation – not just sea water! • Massive Transfusion protocol

24. Assessment • Same as any other “c” assessment • but – • control life threatening haemorrhage

25. Where has it all gone • 1. Chest • 2. Abdomen • 3. Retroperitoneum /pelvis • 4. Limbs • 5. On the floor • Remember losses at scene

26. Assessung sites of potential blood loss • Chest xray • Pelvic xray • FAST scan • CT scan

27. Resuscitation • IV lines • Concept of balanced resuscitation • Radial pulse • Mentation • BP • Use blood as first line fluid – or nothing! • MTP • Military model 1:1:1 • CRASH 2 trial

28. STOP the bleeding! • Compression of active bleeding sites • Early imaging • Early surgical involvement • Splinting of femoral fractures

29. Disability • Optimisation of ABCs • Careful BP management • Early CT scan • Early involvement of neurosurgeons • Consider head up if isolated head injury

30. Exposure/environmental control • Fully expose the patient • Assess for other potentially life/limb threating injuries • Cover the patient

31. Monitoring • Cardiac monitor • pulse oximeter • automated blood pressure • serial blood gases • urine output • Nurses should institute this during the primary survey / resuscitation phase

32. Analgesia • Makes assessment easier • patient easier to manage • less stressful for staff • intravenous opiate • titrate to effect • remember anti-emetic

34. Secondary survey • Head to toe examination for as yet undiscovered injuries • X-ray relevant areas if patient stable enough

35. DEFINITIVE CARE • essential investigations • necessary specialists • stabilization/protection/safe transfer • further investigation/intervention

36. Questions?

37. Summary • Robust pre-hospital care • Experienced and effective team leadership • Rapid identification and treatment of life-threatening injuries • Stabilisation and definitive care