The Advanced Trauma Life Support® (ATLS®) program can teach you a systematic, concise approach to the care of a trauma patient. ATLS was developed by the American College of Surgeons (ACS) Committee on Trauma (COT) and was first introduced in the US and abroad in 1980. Its courses provide you with a safe and reliable method for immediate management of injured patients. The course teaches you how to assess a patient’s condition, resuscitate and stabilize him or her, and determine if his or her needs exceed a facility’s capacity. It also covers how to arrange for a patient’s inter-hospital transfer and assure that optimum care is provided throughout the process. If you don’t treat trauma patients frequently, an ATLS course provides an easy method to remember for evaluation and treatment of a trauma victim.
Injured patients present a wide range of complex problems. The Advanced Trauma Life Support® (ATLS®) Student Course presents a concise approach to assessing and managing multiply injured patients. The course presents doctors with knowledge and techniques that are comprehensive and easily adapted to fit their needs. The skills described in the manual represent one safe way to perform each technique, and the American College of Surgeons (ACS) recognizes that there are other acceptable approaches. However, the knowledge and skills taught in the course are easily adapted to all venues for the care of patients.
The ACS and its Committee on Trauma (COT) have developed the ATLS program for doctors. This program provides systemic and concise training for the early care of trauma patients. The ATLS program provides participants with a safe, reliable method for immediate management of the injured patient and the basic knowledge necessary to:.
Airway maintenance with cervical spine protection: The first stage of the primary survey is to assess the airway. If the patient is able to talk, the airway is likely to be clear. If the patient is unconscious, he/she may not be able to maintain his/her own airway. The airway can be opened using a chin lift or jaw thrust. Airway adjuncts may be required. If the airway is blocked (e.g., by blood or vomit), the fluid must be cleaned out of the patient's mouth by the help of suctioning instruments. In case of obstruction, pass an endotracheal tube.
Breathing and ventilation: The chest must be examined by inspection, palpation, percussion and auscultation. Subcutaneous emphysema and tracheal deviation must be identified if present. The aim is to identify and manage six life-threatening thoracic conditions as Airway Obstruction, Tension Pneumothorax, Massive Haemothorax, Open Pneumothorax, Flail chest segment with Pulmonary Contusion and Cardiac Tamponade. Flail chest, tracheal deviation, penetrating injuries and bruising can be recognized by inspection. Subcutaneous emphysema can be recognized by palpation. Tension Pneumothorax and Haemothorax can be recognized by percussion and auscultation.
Circulation with hemorrhage control: Hemorrhage is the predominant cause of preventable post-injury deaths. Hypovolemic shock is caused by significant blood loss. Two large-bore intravenous lines are established and crystalloid solution may be given. If the person does not respond to this, type-specific blood, or O-negative if this is not available, should be given. External bleeding is controlled by direct pressure. Occult blood loss may be into the chest, abdomen, pelvis or from the long bones. As of 2012, use of rFVIIa is not supported by evidence. While it may help control bleeding, there is a risk of arterial thrombosis, and other than in those with factor VII deficiency, its use should be limited to clinical trials.
Disability/Neurologic assessment: During the primary survey a basic neurological assessment is made, known by the mnemonic AVPU (alert, verbal stimuli response, painful stimuli response, or unresponsive). A more detailed and rapid neurological evaluation is performed at the end of the primary survey. This establishes the patient's level of consciousness, pupil size and reaction, lateralizing signs, and spinal cord injury level. The Glasgow Coma Scale is a quick method to determine the level of consciousness, and is predictive of patient outcome. If not done in the primary survey, it should be performed as part of the more detailed neurologic examination in the secondary survey. An altered level of consciousness indicates the need for immediate reevaluation of the patient's oxygenation, ventilation, and perfusion status. Hypoglycemia and drugs, including alcohol, may influence the level of consciousness. If these are excluded, changes in the level of consciousness should be considered to be due to traumatic brain injury until proven otherwise.
Exposure and environmental control: The patient should be completely undressed, usually by cutting off the garments. It is imperative to cover the patient with warm blankets to prevent hypothermia in the emergency department. Intravenous fluids should be warmed and a warm environment maintained. Patient privacy should be maintained.