Major Trauma and ATLS

Question 1

What is ATLS?

Answer 1

Advances Trauma Life Support:
A training programme and system of treatment for health professions in the management of major trauma. Used worldwide as a team response to trauma

Question 2

What are the stages of assessment in ATLS?

Answer 2

• Preparation
• Triage
• Primary survey
• Resuscitation
• Adjuncts to primary survey and resuscitation
• Secondary survey
• Adjuncts to the secondary survey
• Continued post resuscitation monitoring and re-evaluation
• Definitive care

Question 3

What is triage?

Answer 3

The sorting of patients based on the need for treatment and the available resources to allow that treatment.

Question 4

What is the primary survey?

Answer 4

A – airway maintenance with cervical spine protection
B – breathing and ventilation
C – circulation with haemorrhage control
D – disability:  neurologic status
   -- Glasgow Coma Scale
E – exposure/environmental control

Question 5

What is the resuscitation stage?

Answer 5

Aggressive resuscitation and the management of life-threatening injuries.
This would be dealing with airway establishment, oxygenation, control of bleeding etc.

Question 6

What are the adjuncts to primary survey and resuscitation?

Answer 6

• ECG monitoring
• Urinary and gastric catheters
• Monitoring – ventilatory rate, arterial blood gases, pulse oximetry, blood pressure
• X-rays and diagnostic tests – normally lateral c-spine, chest and pelvis only in resus.

Question 7

What is the secondary survey?

Answer 7

Head-to-toe examination of the patient – complete history and physical examination.

The secondary survey does not begin until the primary survey is completed, resuscitative efforts are well established, and the patient is demonstrating normalisation of vital functions.

Question 8

What are the adjuncts to the secondary survey?

Answer 8

Specialised tests that require the patient to be moved, e.g. additional X-rays, CT, ultrasound.

Question 9

What is definitive care?

Answer 9

Asking whether the patient needs to be transferred to a specialist hospital, will they have to go to theatre, and which ward will they need to go to?

Question 10

What is the role of imaging in ATLS?

Answer 10

• Primary survery:
  – Lateral C-spine
  – AP Chest
  – AP Pelvis
  (all in resus)
  – CT Head&Neck (if indicated)
• Secondary survey
  – other imaging procedures (patient may be transported
• Theatre fluoroscopy

Question 11

What is important when imaging as part of the trauma team?

Answer 11

• Communication
• Knowledge of the patient’s condition
• Co-operation
• Space
• Time
• Accuracy
• Knowledge of procedure, equipment and exposure factors
• Radiation protection
• Availability of radiographic/radiological colleagues
• Appropriateness and availability of other imaging modalities, e.g. CT, MRI, Ultrasound, Angiography