Advanced Trauma Life Support ( ATLS )

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  •     reception
  •     primary survey
  •     secondary survey
  •     radiology
  •     procedures
  •     limb injuries
  •     spinal injuries


  •     Prehospital Information
  •   Nature of Incident
  •   Number, age & sex of casualties
  •   ABCD
  •   Management & Effect
  •   ETA

Airway  & Cervical Spine control

Assess:  Ask name, facial/neck injuries, vomit

Clear Airway: with sucker or Magill  forceps

Chin Lift – one hand on chin, thumb in mouth, pull forward.

Jaw Thrust

Orotracheal intubation with in-line neck stabilisation: absent gag & poor  ventilation, head injury..

100% oxygen at flow rate 15 l/min.

Full cervical spine immobilisation – hard collar & lateral supports with straps across forehead & chin.


Inspect neck & thorax – NB trachea, neck veins

Respiratory Rate


    Life Threatening thoracic conditions: (Trauma Clinicians Often Miss Fractures )

  •   Tension pneumothorax
  •   Cardiac tamponade
  •   Open chest wound
  •   Massive haemothorax
  •   Flail chest


Shock assessment:   skin colour, capillary refill, mental state, pulse, blood pressure

control haemorrhage

2 large(14g) cannulas peripherally.

Withdraw 20ml blood for FBC, U&E, Gluc., X-match.

warmed crystalloids


  •   full x-match
  •   type specific
  •   O Neg.


pupils – size, equal, response to light.

conscious level:

  •  Alert
  •  Verbal stimuli
  •  Pain stimuli
  •  Unresponsive


   clothing – remove all

cold – be aware of Hypothermia, keep warm (warmed blankets)

secondary survey



PR (& PV)

tubes – 2 large peripheral IV; urinary catheter, NGT, (chest drain, DPL, central line, arterial line)

analgesia, anti-tetanus, antibiotics

    X-Rays: (done after Primary Survey)

  •   lateral cervical spine (followed by AP &  peg view in X-Ray dept. when patient stable- do not remove collar until all 3 films cleared)
  •   chest
  •   pelvis

ATLS- C-spine, pelvis, chest AP

A- adequacy & alignment

B- bones – margins & architecture – follow bone margins & comment on general density & architecture.

C- cartilage/joints – joint spaces, surfaces.

S- soft tissues – swelling, air in tissues (open wound/ open fracture)

history (AMPLE)



Past medical history

Last meal

Events of injury


  • •last resort for airway control.dilational-cricothyrotomy
  • •Y connector with O2 at 15 l/min.
  • •Intermittent jet insufflation- sedate & paralyze, only for 30-45min., caution for FB


intercostal drain

  •      4th or 5th intercostal space, mid-axillary line
  •      local anaesthetic down to pleura
  •      ‘above the rib below’
  •      blunt dissection.  finger exploration
  •      pass large drain on forceps superior & posterior.
  •      underwater drain
  •      pursestring suture

intercostal drain


  •     Beck’s Triad- shock,distended neck veins, muffled heart souns
  •     ECG monitor
  •     wide bore long sheathed needle
  •     enter 2cm below left xiphochondral junction, aiming 45 degrees posterior towards tip of left scapula.
  •     positive  -> urgent thoracotomy


Limb injuries

Primary survey

Secondary survey

Immobilisation & reduction

Pain control

Wound Care:

  •  Antibiotic prophylaxis
  •  Tetanus cover
  •  Photograph
  •  Betadine dressing
  •     Culture swab
  •  Debridement (generous)
  •  Irrigation
  •  Fracture stabilisation

spinal injuries

primary suvey:

  •   A: cervical spine control, intubation(blind tracheal, fibre-optic laryngoscope, naso-tracheal), nasogastric tube (ileus)
  •   B: intercostal paralysis

immobilisation – scoop, spinal board

secondary survey:

  •   Log Roll -swelling, tenderness, steps, gaps
  •   Neurological exam. – NB. bulbocavernosus reflex

Neurogenic shock: – hypotension, bradycardia [be aware of Pt.s on B-blockers], warm periphery

Spinal Shock: flaccid limbs, reduced reflexes, reduced sensation, Urinary retention, paralytic ileus. [return of bulbocavernosus reflex indicates end of Spinal Shock]

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