Trauma + ATLS

The Advanced Trauma Life Support (ATLS)
Safe and reliable method for

ABCDE:

Airway with cervical spine protection
Breathing
Circulation, stop the bleeding
Disability or neurologic status
Exposure

A and B:

Speech

Chin-Lift Maneuver:
In the chin-lift maneuver, the fingers of one hand are

Jaw-Thrust Maneuver : The jaw-thrust maneuver is performed by grasping the

Rapid sequence intubation (RSI)

The technique for rapid sequence intubation (RSI) is

Approximate PaO2 Versus O2 Hemoglobin Saturation Levels
PaO2 LEVELS O2 HEMOGLOBIN

Surgical Cricothyroidotomy

B: Breathing

Evaluation:
visualizing chest movement
auscultating breath sounds
measuring oxygen saturation

What

C-circulation

In most cases, tachycardia is the earliest measurable circulatory sign of

C:

Venous access
Intraosseous

C: Circulation

5 Life-threating blood loss causes:
external blood loss
chest
abdomen,
Retroperitoneum (pelvic

Resuscitative Thoracotomy

When? ? critic injury and Cardiac arrest
For what?
Opportunity to

REBOA resuscitative endovascular balloon occlusion of the aorta

Obtainig temporary hemorrhage control in

D

D: Disability

Neurological function evaluation:
Neurogenic shock?
Spinal cord injury?
Body temprature?
?

:E

Head to toe
PR
Xray
FAST
NGT
Urine catheter

FAST

Focused abdominal sonography in trauma:

HEAD INJURY

Epidural hematomas typically result from a lateral fracture of the cranium

Parenchymal contusions of brain tissue result from the direct transmission of

Diffuse axonal injury describes the phenomenon of disruption of the axon

pupils reactivity
A, B, C management
CT without Contrast agent
Usually Epi-/

Injuries to the Neck

Neck injuries are uncommon but result in the

Blunt mechanisms can cause compression, with fracture of the larynx or

Neck Injury

Zone I: from the thoracic inlet to the cricoid

CHEST INJURY

With more than 65% of blunt trauma patients sustaining

Flail Chest : This condition usually results from trauma associated with

Flail chest

> Solitary independent movement of the Fx
Paradoxical breathing

Thoracic injury

Thoracic injury

Tension pneumothorax is a clinical diagnosis reflecting air under pressure

Cardiac tamponade is indicated by the presence of the classic diagnostic

Massive hemothorax results from the rapid accumulation of more than 1500

Thoracic injury

Pulmonary injuries. Lung injuries are common after chest trauma, with

Cardiac injuries uncommon, but most severe injuries sustained by patients after

Blunt injury to the heart occurs less commonly, being seen in

Tracheobronchial injuries
Tracheobronchial tree injuries are uncommon but are associated with significant

Esophageal injuries:
The thoracic esophagus is uncommonly injured
Penetrating injury is more

The esophagus is best evaluated through a combination of contrast esophagography

The upper and midthoracic esophagus is best approached through a right

Diaphragmatic injury

1.6% of blunt trauma
20% mortality (due to high energy?)

Abdominal trauma

Indication for OR

Penetration of fascia
Unstable patient
NGT-blood
PR- blood

SPLEEN

The spleen is the most commonly injured abdominal organ with 23.8%

AAST Spleen Injury Scale

Management of spleen Injury

No preferable management
Depends on surgeon’s preference
Recommended:

Hepatic injuries:
Liver injuries are extremely common after blunt trauma; only the

Hepatic Injury

Mechanism: compression with direct parenchymal damage and shearing forces ?

Hepatic Injury - Management

Hemodynamically instable patient ? OPERATION
Conditions or non-operative management:

Non-surgical hepatic injury treatment Complications

abdominal compartment syndrome
bile duct injury leading to bile

Surgical management of liver Injury options

Packing
Pringle
Push
Plug

Surgical management of liver Injury

Perihepatic sponges
Manual pressure
When stable – remove

Gastric injuries

Penetrating mechanisms are the most common cause of injuries to

Traumatic Gastric Injury
Blunt injury – due to high energy mechanism

Duodenal injuries

Duodenal injuries are uncommon after blunt and penetrating trauma but

Duodenal injury
Children bicycle handlebar or steering wheel stucking in drivers
Clinic:

Duodenal injury

Management:
Operation:
Kocher-Maneuver – mobilization of the duodenum
Primary

Small bowel injuries

The small intestine is one of the more frequently

Small bowel injury

Management:
Primary repair – when no stricture
Resection with

Colon injuries

Colon and rectal injuries occur most commonly after penetrating

Colon Injury

Retroperitoneal location of asc. Desc. ? obscure indings and

Pancreatic injuries

Pancreatic injuries commonly occur in association with injury to the

Pancreas tissue injury can result from direct laceration of the organ

Management of Pancreatic Injury

Operation in any significance
Location of injury determines

Abdominal great vessel injuries

The major blood vessels of the abdomen are predominantly located within

The retroperitoneum can be divided into three zones:
Zone 1 hematomas require

Abdominal great vessel Injuries

I – central hematoma
Aorta, prox. visceral vessels, inferior

Genitourinary injuries
The genitourinary organs include the kidneys, ureters, bladder, and urethra,

Intraperitoneal bladder injuries can be repaired in two layers of absorbable

Genitourinary Injury

Kidney ureter bladder urethra
Clinic: (gross hematuria), Bleeding ,

Pelvis and extremities injuries

Danger of retroperitoneal hematoma
Low mortality but long-term morbidity

Injuries to the Pelvis and Extremities

In which of the following the pulse pressure is normal? A.

A 30 - year - old male is brought to the

22 - year - old male is brought to the trauma

A 36 years old male was involved in a vehicle accident

21-years old​ ​man​ ​arrives​ ​in​ ​the​ ​emergency​ ​department​ ​with​ ​a​ ​stab​

A 40 years old male is status post-splenectomy following a motor

A 15-years-old girl fall while cycling. in the ER. 8 hours

A 40 year old male is admitted to the ER following