🔴Trauma Protocol (ATLAS)

▪︎It's An Injury To Any Part Of The Human Body Due To Energy Transfer From An Inflicting Source

▪︎Major (Severe) Trauma is Injury To >1 Body Region Or Organ Systems & ISS Score >15 (Injury Severity Score)

▪︎Severe Trauma is The Major Cause Of Death in Young Patients

▪︎Most Of Trauma Are Not Life Or Limb Threatening (Mild-Moderate in Severity)

▪︎Sources Of Trauma Could Be :
📍1. Mechanical
📍2. Chemical
📍3. Thermal
📍4. Ionizing Radiation

▪︎Most Common Causes Of Trauma Are :
📍1. Road Traffic Accidents (RTA)
📍2. Fall From Height (FFH)
📍3. Intentional Violence


🔷Mechanisms Of Injury
📍1. Blunt Trauma (Most Common) :
▪︎Direct Blunt Trauma ➡ Damage Localized To The Initial Site Of The Mechanism

▪︎Indirect Blunt Trauma ➡ Damage Occur At Distant Sites Away From The Initial Site Due To Force Transmission

▪︎Usually Due To RTA/FFH/Interpersonal Assault


📍2. Penterating Trauma ➡ Occurs Due To Sharp Objects Passing Directly Through The Tissue (Knife/Gunshots)


📍3. Combined Trauma (Blast Injury) Results in :
▪︎Tissue Penetration From Sharp Fragments

▪︎Tissue Disruption From Shock Wave

▪︎Tissue Burns

▪︎Traumatic Amputation


📍4. Burn Trauma (Leading Cause Of Accidental Death) Mechanisms :
▪︎Thermal Injury
▪︎Chemical Injury
▪︎Electrical Burns
▪︎Frostbite


📍5. Hidden Mechanisms :
▪︎When Patient Not Telling The Truth Due To Criminal Activity Or Abuse

▪︎Theses Are Called Non-Accidental Injuries (NAI)

▪︎Factors Goes With NAI :
🔻I. Signs Of Injuries Not Consistent With The Reported Mechanism

🔻II. Long Bone Fractures in Children (Child Abuse) & Posterior Rib Fractures

🔻III. Patient Changing History & Aggressive Behaviour From Relatives


🔷Mx Of Trauma Patients
🔸A. Primary Survey
▪︎Focus On Rapid Identification & Mx Of The Most Life-Threatening Injuries

▪︎Consist Of cABCDE Protocol :
📍1. Control Haemorrhage From Massive Arterial Bleeding :
▪︎Massive Arterial Bleeding Usually Seen Due To Gunshots & Blasts (Military Practice)

▪︎Mx By :
🔻I. Direct Pressure On The Source Of Bleeding

🔻II. Pack Application

🔻III. Tourniquets Application (Monitor Time Of Tourniquet Application)


📍2. Airway & Cervical Spine Protection :
🔻I. Spine Immobilization (Using Cervical Collar & Log-Rolling Technique For Transfer Of The Patient)

🔻II. Airway Suctioning & Protection From Aspiration

🔻III. Airway Opening Maneuvers :
▪︎Jaw Thrust & Chin Left

▪︎Insertion Of OroPharyngeal Or NasoPharyngeal Tube

▪︎CricoThyroidotomy

▪︎Insertion Of Endotracheal Tube


📍3. Breathing & Ventilation :
🔻I. High Flow Oxygen For All Patients

🔻II. Immediate Mx Of Tension Pneumothorax Or HaemoThorax

#Trauma Protocol (ATLAS)
#part1
#Surgery
https://t.me/Surgery_Practice

📍4. Circulation & Haemorrhage Control :
🔻I. Application Of Pelvic Binders To All Haemodynamically Unstable Patients (Not Removed Until Pelvic Fractures Excluded)


🔻II. Vascular Access :
▪︎At Least Two Large IV Cannula (Peripheral Access 1st Choice)

▪︎Central Access (SubClavian/Internal Jugular/Femoral Veins)

▪︎Intra-Osseous Venous Access (If No Venous Access Available)


🔻III. Blood Aspiration For :
▪︎HB Level
▪︎Cross Match
▪︎Venous Lactate


🔻IV. Assessment Of Haemodynamic State Through :
▪︎Blood Pressure Measurement

▪︎Hypotension is HypoVolaemic Shock Until Proven Otherwise

▪︎Signs Of Shock (Cold Sweaty Skin/Elevated Pulse >100BPM/Low BP)

▪︎Keep Systolic BP 70-90mmHg Or >90mmHg If Head Injury Present (Using 250ml O-Ve Blood Or Normal Saline)


🪀Control Bleeding By :
♻I. Control Source Of Bleeding :
▪︎Source Of Haemorrhage Usually From Chest/Abdomen/Pelvis/Long Bones/Arteries

▪︎Source Of Haemorrhage Should Identified Rapidly Using WBCT (Whole Body CT With Contrast) Or FAST (Focused Abdominal Sonography For Trauma)


♻II. Blood Transfusion (Massive Transfusion Protocol)


♻III. Tranexamic Acid (1g IV Over 10Min Then 1g Over 8h)


📍5. Neurological Dysfunction (Disability) Assessment Using :
🔻I. Glascow Coma Scale (GCS)

🔻II. Pupil Exam For Size & Reaction To Light

🔻III. All Four Limbs Movements Assessment

🔻IV. Rapid Identification Of Intra-Cranial Bleeding Using WBCT (CT Scan)

🔻V. Core Body Temperature Measurement & Recorded


📍6. Adequate Patient Exposure To Identify Hidden Injuries


🔸B. Secondary Survey
▪︎This Survey Done After Patient Stabilization & Haemodynamically Stable

▪︎Consist Of :
📍1. Full Clinical Examination (From Head To Toe)

📍2. Focused Hx About :
▪︎Allergies
▪︎Current Drugs Intake
▪︎Past Medical Hx
▪︎Events Related To The Trauma Injury

📍3. Imaging According To The Case (CT/MRI/Xray/US)


🔸C. Tertiary Survey
▪︎Repeating The Primary & Secondary Survey Within 24h To Identify Evolving Or Previously Missed Injuries

▪︎Usually Done in Intubated & Unresponsive Patients After Their Condition Improved

#Trauma Protocol (ATLAS)
#part2
#Surgery
https://t.me/Surgery_Practice