Evaluation Of Trauma Patients ATLS Protocol - Everything You Need To Know - Dr. Nabil Ebraheim скачать в хорошем качестве

Evaluation Of Trauma Patients ATLS Protocol - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video illustrates evaluation of trauma patients - ATLS protocol. The advanced trauma life support is the ABC: Airway: establish airway and protect the cervical spine. Breathing and ventilation. Circulation and hemorrhage control. Disability evaluation and checking neurological status. Exposure: environmental control. Adherence to the ATLS protocol during evaluation of an injured patient in the emergency room improves the patient’s outcome and decreases initial management errors. Evaluation of the multiple trauma patient is very important, and we start with airway always, the first priority is airway control, usually with intubation when needed. Following intubation, the management should consist of ventilation and placement of a chest tube when needed. Circulation stabilization, vascular access, then get x-ray. When you do airway control, you also need to have cervical spine control. Nasotracheal intubation has the advantage in patients with suspected cervical spine trauma because this doesn’t require hyperextension of the neck. Evaluate the airway for obstruction. If there is a facial trauma and swelling in the area of the airway, you probably will need to do a cricothyroidotomy, it is an emergency procedure that is used when routine methods of intubation are not effective or contraindicated. Breathing and ventilation: clinical evaluation: Chest x-ray evaluation. Arterial blood gases. • Scenarios: Patient has: scapular body fracture, rib fracture, x-ray shows lung consolidation, tachypnea. Patient was in a car accident and is in respiratory distress, and after emergency intubation the arterial blood gases showed that oxygenation is poor with absence of breath sounds on one side and there is resonance on percussion on the same side. There may be tracheal deviation to the other side. There’s a tension pneumothorax and you will put a needle into the second intercostal space, midclavicular line. The air is trapped in the plural space between the lung and the chest wall which is compressing the lung and shifting the mediastinum. Need to decompress the pleural space urgently by needle or placing a chest tube. Watch out for the patient with scapular fracture because that can injure the lungs also. So if you have a patient with hypoxia that is not getting better with intubation and you have decreased breath sound in one side, you need to put a chest tube because the patient has a pneumothorax. Circulation and Hemorrhage control: • Clinical evaluation: Radiographic chest x-ray Pelvic x-ray CT scan • This means initiation of resuscitation, direct pressure on the bleeding site, pelvic binder. Disability evaluation and checking neurological status: • Check if the patient has neurological deficit Exposure and environmental control: • Clinical evaluation: Look for open fractures Rewarm the patient What causes the patient’s death? It is usually the injury severity score (ISS) plus the age of the patient, that is used to predict mortality in the patient with blunt trauma and multiple injuries. • So in the first few minutes, the patient will die from massive blood loss or from head injury. • In the first few days after the injury, the patient dies from the head injury. • If the patient survives the first week of injury, they will die later due to sepsis and multiple organ failure. • The question always comes as: life or limb? Obviously: saving the life is more important than saving the limb. • Physicians should strive to preserve the LIFE and the LIMB. • Adherence to the ATLS protocol will help to achieve this goal. The Secondary Survey: • Done 12- 24 hours after injury. • Complete exam and updates • The whole idea is that when you do the secondary survey, it decreases the incidence of missed injuries by more than a 1/3. • We all know that about 10- 12% of injuries are missed in the first 24 hours in patients with multiple trauma. • So secondary survey is good. Become a friend on facebook:   / drebraheim   Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund: https://www.utfoundation.org/foundati...