Tiêu đề ATLS Scenario Cheatsheet.pdf ✅

Adult ATLS 1 Adult ATLS Reference ATLS Manual Primary survey NB life saving measures are initiated when problem is identified o “I will initiate my ATLS protocol by first activating the trauma team.” o “Simultaneous with my primary survey accessory staff will do this:” MOVIT 1. Monitored bed with pulse oximeter, BP, cardiac monitoring 2. Apply 100% O2 by non-rebreather face mask 3. Obtain serial Vitals 4. Start 2 large bore IVs running 2L warmed RL 5. Send Trauma bloodwork for a. CBC, SMA7, B-HCG, tox screen, type-screen-cross match, ABG, and get EKG b. Call for xray to be ready for lateral c spine, cxr, pelvis, others GCS A - Airway– airway maintenance and cervical spine protection (C Spine collar + spine board) o “I will start my primary survey according to the ATLS protocol as the trauma leader. o “Ensuring C-spine precautions and using a spine board I will assess the AIRWAY for patency” o “I will assess patient’s ability to verbally communicate and ensure there are no foreign bodies, facial, or tracheal lacerations or fractures” 1. If tongue or foreign object in mouth a. chin lift or jaw thrust b. clear airway of foreign objects c. and insert oropharyngeal or nasopharyngeal airway 2. IF the patient is a. GCS < 8 b. airway obstruction c. pt unconscious need to protect airway o “I will initiate rapid sequence intubation with C Spine precautions” 3. If asked how: (3:1:6) a. Setup i. 8mm endotracheal tube with working cuff ii. Laryngoscope with working light iii. Working suction b. Pre i. Pre-oxygenate patient with 100% O2 by non-rebreather face mask and jaw-thrust or chin lift manoever as needed c. Technique i. Give succynilcholine 1 mg/kg IV bolus (70mg Sux) and intubate when pt relaxed – crush or burn injury then Etomidate ii. Use 2 person technique with crichoid pressure applied ATLS Revision Resources at ATLSQuestionBank.com

Adult ATLS 3 ii. 200 cc/hr x 4 hrs iii. Call thoracic sx iv. If crashing crack chest and clamp aorta d. Open pneumothorax i. Occlusive dressing taped on 3 sides ii. Chest tube avoiding laceration o “I will perform an emergent needle thoracostomy into the 2nd intercostals space @ mid-clavicular line” 2. Needle Thoracotomy a. Setup i. Sterile prep and drapes + 2% lidocaine ii. Large bore IV needle b. Pre c. Technique i. Using sterile technique and under local anesthesia I would insert a large bore IV into the 2 nd intercostal space @ mid-clavicular line ii. Puncture parietal pleura and listen for air return iii. Remove needle and leave catheter in place iv. Plug catheter end and apply dressing v. Proceed with chest tube insertion o “I will insert a chest tube into the 4 th/5 th intercostal space at the anterior axillary line” 3. Chest Tube Insertion a. Setup i. Sterile prep and drape + 2% lidocaine ii. Surgical tray iii. 38 french chest tube + closed water suction b. Pre c. Technique i. Under sterile technique with local anesthesia I will insert the chest tube into the 5 th intercostal space along the anterior axillary line ii. Make a transverse incision on 5 th/6 th rib iii. Puncture parietal pleural with curved Kelly passed above rib iv. Enlarge and clear space with finger v. Advance clamped chest tube into the apex of the lung vi. Confirm placement by looking for fogging and listening for air movement vii. Secure with sutures viii. Connect under H2O seal apparatus ix. Apply dressing x. Order CxR o “I will perform an emergent thoracotomy (for penetrating trauma, pulseless, with myocardial activity) 4. Emergent Thoracotomy a. Need thoracics or trauma gen surg b. Left anterior thoracotomy c. Evacuation of pericardial blood d. Direct control of intra-thoracic hemorrhage e. Open cardiac massage f. Cross clamping aorta ATLS Revision Resources at ATLSQuestionBank.com
Adult ATLS 4 C- circulation and hemorrhage control o “I will assess the patient’s CIRCULATION by obtaining vitals including HR and BP o “If pt is hypotensive despite initial resuscitation I will a. transfuse 2u of cross matched blood. b. If unavailable I will transfuse 2u of type specific blood. c. If unavailable I will use O negative blood. o “I will assess the pulse for rate, quality, and regularity o “I will assess the patient’s level of consciousness and skin color o “I will look for and control all external sources of bleeding with direct pressure o “I will identify possible sources of life threatening bleeding including internal sources o Thorax o Abdomen o Pelvis o Long bone o “I will inspect the thorax for venous distension and auscultate for presence and quality of breath and heart sounds o “I will inspect the abdomen for distention, auscultate for presence of bowel sounds, and palpate for guarding, rebound tenderness, or any peritoneal signs o “I will inspect the pelvis for deformity, lacerations, and assess vertical and horizontal stability o “I will inspect long bones for deformity, lacerations 1. Fluid resuscitation = bolus 2L crystalloid - warmed Ringer’s a. if unresponsive i. type specific x-matched blood (takes 1hr). ii. Unmatched type specific blood (takes 10 minutes) is preferred over O negative. b. if unavailable O negative (available immediately) c. if unresponsive need surgical intervention d. Shock i. CO= HR x SV 1. BP= CO/SVR ii. Types 1. Hypovolemic 2. Cardiogenic 3. Neurogenic 4. Septic iii. Hypovolemic shock 1. Until proven otherwise 2. Classes a. I (<15%) i. Tachy <100 ii. crystalloid b. II (15-30%) i. Tachy >100 ii. Tachypnea iii. Decreased pulse pressure iv. crystalloid c. III (30-40%) i. Tachycardia ii. Tachypnea iii. Change in mental status iv. Decreased BP v. u/o 20-30 cc/hr ATLS Revision Resources at ATLSQuestionBank.com