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Teori ATLS

The document outlines the steps of the Advanced Trauma Life Support (ATLS) protocol. It includes: 1. Preparation for trauma care with protective equipment. 2. Primary and secondary surveys to assess the patient's airway, breathing, circulation, disability, and exposure (ABCDE). Immediate life-saving interventions are provided based on these assessments. 3. Adjuncts including monitoring, procedures, and diagnostic imaging to further evaluate the patient's injuries and guide definitive care.

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Muhammad Cholis Hidayat
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507 views41 pages

Teori ATLS

The document outlines the steps of the Advanced Trauma Life Support (ATLS) protocol. It includes: 1. Preparation for trauma care with protective equipment. 2. Primary and secondary surveys to assess the patient's airway, breathing, circulation, disability, and exposure (ABCDE). Immediate life-saving interventions are provided based on these assessments. 3. Adjuncts including monitoring, procedures, and diagnostic imaging to further evaluate the patient's injuries and guide definitive care.

Uploaded by

Muhammad Cholis Hidayat
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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ATLS

A Advanced T Trauma L Life S Support

ATLS
1. Preparation 2. Triage 3. Primary survey (ABCDE) 4. Resusitation 5. Adjuncts to Primary Survey And Resusitation 6. Secondary Survey 7. Adjuncts to Secondary Survey 8. Monitoring Post Resusitation And Reevaluate 9. Definite care

PREPARATION
Essential equipment: universal precaution, trauma box, airway equipment, long back board The used of the following protective devices is recommended
Goggles Gloves Fluid-impervious gowns or aprons Shoes covers and fluid-impervious leggings Mask Head covering

Primary Survey Dewasa, anak, wanita hamil memiliki prioritas yang sama Mengidentifikasi kondisi yang mengancam nyawa Maksimal dikerjakan dalam 2 menit Pemeriksaan dilakukan dari neck to

knee

Primary survey
Patients are assessed and treatment priorities established based on their injuries, vital signs, and injury mechanisms ABCDEs of trauma care AAirway maintenance with cervical spineprotection BBreathing and ventilation CCirculation with hemorrhage control DDisability : Neurological status EExposure/Environmental control : completely undress the patient,but prevent hypothermia

Primary Survey

Airway
Airway dipertahankan dengan proteksi cervical spine Pasien dianggap cedera cervical spine pada : Trauma multisistem GCS menurun GCS 8 perlu pemasangan definite airway

Penyebab paling sering gangguan jalan napas:

Tanda gangguan jalan napas:

Lidah Benda asing Cairan (muntah) Pembengkakan lokal Trauma langsung pada jalan napas

Snoring Stridor Gargling Sesak

Steps
Cek Respons Buka jalan Nafas

Management
Head tilt chin lift (tak dilakukan pada cedera cervical) Jaw thrust Finger sweep Suction Artificial airways
Oropharyngeal Nasopharyngeal ETT LMA

Periksa jalan nafas


Pertahankan bila GCS < 8 :

A (AIRWAY)

Primary Survey

Breathing
Penatalaksanaan: 1. Pasang pulse oxymetri 2. Beri oksigen konsentrasi tinggi 3. Ventilasi dengan bag-valve mask Respirasi Neonatus 40 x/menit Bayi 30 x/menit Anak yang lebih tua 20 x/menit Respirasi > 40 x/menit curiga suatu distress nafas (kecuali pada neonatus)

Steps
Identifikasi : Look, Listen and Feel Look : Rate,Rhythm,,Kedalaman Listen : Quality Feel : Udara
Tanda pernapasan tidak adekuat: Napas abnormal Otot pernapasan tambahan Pernapasan cuping hidung sianosis

Management
Napas spontan: Nasal cannula, Face masks rebreathing non-rebreathing mask Tidak bernapas:
Mouth to mouth Mouth to mask ventilation Bag-Valve-Mask

Breathing

Step
Diperhatikan : Pengembangan dinding dada Laserasi dan cedera pada dada dan Deviasi trakea
Pneumothorax, hemothorax, kontusio pulmonal

Management
needle decompression tube thoracostomy

Breathing

Steps
Menilai fungsi sirkulasi:
Nadi sentral-perifer(carotis or radialis) Warna Kelembaban kulit

Management Kontrol perdarahan:


bebat tekan splint and elevate tourniquet

Menilai perdarahan yang mengancam nyawa: Cepat, berasal


dari arteri, jumlah masif, tensi, CRT

Menilai internal hemorrhage +/-

Circulation

Disability
Menilai tingkat kesadaran: AVPU & GCS Menilai ukuran dan respon pupil
Tanda-tanda sensoris dan motoris

GCS
EYE Spontaneous 4 Verbal Pain None 3 2 1 VERBAL Oriented Confused Words Sounds None 5 4 3 2 1 MOTOR Obeys Localizes Flexion Decorticate Decerebrate None 6 5 4 3 2 1

E (Exposure/Environment)
Melepas baju pasien jika diperlukan Pertahankan suhu tubuh -> Mencegah hypotermia Log roll untuk identifikasi bagian belakang tubuh

RAPID ASSESSMENT

Leher Inspeksi/palpasi : DCAP BTLS, JVD Nyeri, deviasi trakea Dada Inspeksi : DCAPP BTLS Palpasi : TIC Auskultasi suara napas Perkusi Abdomen Inspeksi : DCAP BTLS Palpasi: Tenderness

Pelvis Inspeksi/palpasi: DCAP BTLS, TIC Musculoskeletal (Femur) Inspeksi/palpasi DCAP BTLS, TIC, PMS Transport decision and critical interventions

Resusitasi
A

Pastikan Paten

Diberi Oksigenasi

Akses IV

Adjuncts to Primary Survey and Resusitasi


a) Monitor EKG b) Kateter dan NGT c) Monitor BGA d) Monitor pulse oximetry e) Monitor tekanan darah f) Pemeriksaan darah untuk cross-matching dan nilai Hb g) X-ray atau studi diagnostik lain yang perlu

Secondary Survey
Tidak bermula selagi primary survey tidak lengkap ! Tidak bermula selagi resusitasi belum selesai ! Tidak bermula selagi tanda-tanda vital pasien normal !

Secondary Survey
Evaluasi head to toe ! Anamnesa dan pemeriksaan fisik lengkap Dilakukan pemeriksaan dari head to toe Evaluasi ulang tanda-tanda vital Pemeriksaan dikerjakan dalam

10 menit !!

Anamnesa : SAMPLE

Sign and simptoms Allergies Medications currently used Past illness / pregnancy Last meal Events/Environment related to injury
History may need to be gathered from family members or ambulance service

HISTORY Mechanisms of injury


Blunt Automobile collisions Seat belt usage Steering wheel deformation Direction of impact Ejection of passenger from the vehicle Burns and Cold injury Inhalation injury and CO. intoxication in fire field Hazardous environment Penetrate Energy transfer factor Velocity and caliber of bullet Trajectory Distance

Pemeriksaan fisik
a) b) c) d) e) f) g) h) Pemeriksaan neurologi lengkap Kepala Trauma maxillofacial Leher dan cervical spine Thoraks Abdomen Perineum/rectum/vagina Muskuloskeletal

SECONDARY SURVEY
Physical Examination
Head and Maxillofacial Inspect and palpate head and face (DCAP BLS, TIC) Battles sign Pupils and LOC Raccoon eyes Ears and nose for CSF Mouth Skin : pale, cyanosis, diaphoresis

Physical Examination Head


Scalp Fractures Eyes edema Pupil size -Penetrating injury Hemorrhage of conjunctivae Contact lenses-Dislocation of lense

Physical Examination

Maxilofacial

Airway obstruction , major bleeding Mid maxilla beware of NG tube insertion Need frequent reassessment

SECONDARY SURVEY
Physical Examination

C-spine and Neck

Inspect for signs of injury (DCAP BLS), tracheal deviation Palpate for tenderness, subcutaneous emphysema Auscultate for carotid bruits

SECONDARY SURVEY
Physical Examination

Chest Inspect ant, lat and post chest for injury, use of accessory (DCAPP BLS) - Palpate for TIC - Auscultate for breath sounds - Percussion

Physical Examination

Chest
Visual evaluation of anterior and posterior chest Open pneumothorax Flail chest Pain , dyspnea, hypoxia Cardiac tamponade, tension pneumothorax Distended neck veins Distant heart sound

SECONDARY SURVEY

Physical Examination Abdomen - Inspect for signs of injury or bleeding DCAP BLS - Palpate for tenderness - Auscultate for bowel sounds - Percussion

Physical Examination

Perinieum/Rectum/Vagina
Contusion , hematoma, laceration , urethral bleeding Rectal examination : blood , high-riding prostate , Intergrity of rectal wall , sphincter tone Female : Vg exam. blood , Vg laceration Pregnancy test

Physical Examination

Musculoskeletal Inspect & Palpate extremities for signs of injury (DCAP BLS, TIC, PMS) Assess pelvis (DCAP BLS, TIC)

Musculoskeletal
Inspection : contusion , deformity Palpation : tenderness , abnormal movement Pelvic Fx: ecchymosison iliac wings , pubis , labia , Scrotum , pain on palpation of pelvic ring Assessment of peripheral pulses Patients back examination

SECONDARY SURVEY
Physical Examination

Neurologic Determine GCS score Re-evaluate pupils Sensory / motor evaluation Maintain immobilization Prevent secondary CNS injury Early neurosurgical consultation evel of consciousness pupillarysize and response motor and sensory GCS

Adjuncts to Secondary survey


Status hemodinamik CT scan Foto kontras Foto extremitas Endoskopi Ultrasonografi

Monitoring Post Resusitasi dan Evaluasi Ulang


Reevaluasi ulang untuk mencari kelainan baru atau yang tertinggal Monitoring tanda-tanda vital, output urin,BGA, pulse oximetry dan EKG urinary output
0.5 ml/kg/hr 1 ml/kg/hr

Analgesik jika diperlukan


Observasi perubahan kondisi yang terjadi pada pasien

Reassessment Survey
Tingkat kesadaran Nilai ulang A B C Leher, dada, abdomen, ekstremitas Pemeriksaan lebih detail terhadap area luka Pemeriksaan tindakan yang telah dilakukan, misal : posisi pipa ETT, infus, aliran O2, balut-bidai, posisi cervical collar

Definite Care
Setelah identifikasi cedera pada pasien Setelah mengatasi penyebab yang dapat mengancam nyawa

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