ATLS & BLS Shortlist

ATLS & BLS Shortlist


ATLS Algorithms
First Things First (assess & treat for the following)
Trauma is a consequence of harmful behavior that is planned or unplanned. Injury prevention starts with addressing these behaviors.
Goals of trauma patient management
Identify and treat threats to life, then limb, and then eyesight.
Prevent exacerbation of existing injuries or occurrence of additional injuries.
Return patient to a level of function as close to pre-injury as possible.
Outcomes for trauma patients are improved with a systematic, multispecialty, and interdisciplinary approach to pre-hospital, hospital, and rehabilitative care.
Principles of trauma patient management
Treat the greatest threat to life first.
Definitive diagnosis is not immediately important.
Time matters (“golden hour” emphasizes urgency).
Do no further harm.
Assess, intervene, reassess
Did the intervention work?
Is the patient’s physiology returning to or staying normal?
Preparation
Training by discipline and as a team
Capabilities defined by established and integrated pre-hospital and hospital care protocols
Equipment maintained and ready for rapid use
Appropriate supplies available
Universal precautions enforced
Referral resources and transfer policies clearly defined
Field triage to a trauma center in four steps (from the Centers for Disease Control & Prevention expert panel with support from the National Highway Traffic Safety Administration, 2006)
Assess basic physiology.
Systolic blood pressure < 90
Respiratory rate < 10 or >29
Glasgow Coma Scale < 14
Assess anatomy of injury.
Penetrating injury to head, neck, torso, and extremities proximal to elbow and knee
Flail chest
>1 proximal long bone fracture
Crushed, degloved, or mangled extremity
Amputation proximal to wrist and ankle
Pelvic fractures
Open or depressed skull fracture
Paralysis
Assess mechanism of injury and evidence of high-energy impact.
Falls >20 feet (6 meters) in adults and >10 feet (3 meters) or 2-3 times height in children
High-risk auto crash
Intrusion >12 inches occupant site or 18 inches any site
Ejection (partial or complete) from vehicle
Death in same passenger compartment
Vehicle telemetry data consistent with high risk of injury
Auto vs. pedestrian/bicyclist thrown, run over, or with significant (>20 mph) impact
Assess special patient or system considerations.
Age: older adults and children
Anticoagulation and bleeding disorders
Burns
Time-sensitive extremity injury (open fractures, vascular compromise)
End-stage renal disease requiring dialysis
Pregnancy >20 weeks
EMS provider judgment
Initial assessment
Primary survey
Resuscitation
Adjuncts to primary survey
Secondary survey
Adjuncts to secondary survey
Ongoing post-resuscitation monitoring & reevaluation
Definitive care
Tertiary survey