🧑‍⚕️ Approach to the Trauma Patient (ATLS)

🧤Preparation & Tools :
1- Gloves
2- Gown
3- ATLS protocol
4- Full trauma team readiness

✨Primary Survey " ABCDE "✨
☁️A – Airway with Cervical Spine Immobilization
· Assess airway patency → if patient can talk, airway is patent.
· If secretions present → suction.


🫧Airway adjuncts:
-Oropharyngeal airway (OPA)
-Nasopharyngeal airway (NPA)
-Chin lift / Jaw thrust (without cervical movement if C-spine injury suspected).


🫧Definitive airway (Endotracheal Intubation) – Indications:
1- Airway obstruction
2- Shock
3- Apnea
4- Massive maxillofacial trauma
5- Altered mental status
6- Expanding/pulsatile neck hematoma
7-Subcutaneous emphysema / tracheal injury


🫧Cricothyroidotomy → Contraindicated in children < 11 years.


❄️Before intubation → 6 Ps (Rapid Sequence Intubation "RSI" ) :
1. Preparation:
- Equipment (ETT, laryngoscope, suction, O₂ source, LMA, tracheostomy set, torch, drugs, monitor, IV access).

2. Position:
-Sniffing position with occiput elevation (~10 cm) unless cervical spine injury.

3. Preoxygenation:
- 100% O₂ for 3–5 min (to avoid hypoxia & brain damage).

4. Pretreatment/Paralytics & Sedatives: e.g., Midazolam, Propofol .

5. Placement of tube:
- Intubate.

6. Post-intubation confirmation:
-Bilateral chest auscultation , chest movement , portable chest X-ray.


☁️B – Breathing :
Look, Listen, and Feel for :
1- chest movement
2- breath sounds
3- air entry

🫧Assess for :
1- Cyanosis
2- Respiratory distress
3-Absent breath sounds

🫧Manage life-threatening conditions (e.g., tension pneumothorax → needle decompression + tube thoracostomy).


☁️C – Circulation
🫧Check: Pulse, BP, capillary refill, temperature, active bleeding.

🫧Control external bleeding (direct pressure, tourniquet if severe).

🫧Insert 2 large-bore IV lines → fluid resuscitation.

💡Note :
·If shock persists after fluids → consider FAST (E-FAST ultrasound) for internal bleeding.
·Pelvic binder if unstable pelvic fracture.
·If chest cause suspected → tube thoracostomy.


☁️D – Disability (Neurological)
·Assess GCS (Glasgow Coma Scale)
·Check for hypoglycemia, stroke, intoxication.


☁️E – Exposure & Environment :
🫧Fully expose patient to look for hidden injuries.

·Prevent hypothermia (warm blankets) .


✨Secondary Survey✨

🪧History: " AMPLE "
(Allergies, Medications, Past history, Last meal, Events/Mechanism of injury).

🪧Examination (head-to-toe) :
🫧Head:
scalp lacerations, subgaleal hematoma, skull fracture signs.

🫧Face :
raccoon eyes, panda eyes, periorbital ecchymosis , nasal deviation, epistaxis.

🫧Neck:
JVP, swelling, tracheal deviation, surgical scars.

🫧Chest:
symmetry, scars, visible veins, nipple position, breath sounds.

🫧Abdomen:
distension, contour, striae, scars , etc...

🫧Pelvis & limbs:
deformities, open fractures, distal pulses, motor/sensory function.


🪧Investigations:
🫧Labs:
CBC, electrolytes, ABG, coagulation profile.

🫧Imaging:
X-ray (C-spine, chest, pelvis), FAST, CT (if stable).


✍🏻/ أنوار المنتصر

#الدكتور_اشرف_الفقيه
#مستشفى_الشرطة
#Group_C
#اللجنة_العلمية_للدفعة_السادسة

⭕ most common in surgery

🔥من أفضل الكتب لل differential diagnosis.

#جراحة_عملي

ملف فخم لانواع الـ incision

#جراحة_عملي

Bed Sores.pdf

Examination of Thyroid gland د.الشهاري

تفريغ الدكتورة/ ليالي الحكمي
#_الدفعة_11_طب_بشري_جامعة_الحديدة

حق الـ
clinical approach of trauma
The art of history taking.

Lung hydatid cyst&chest ex. د.محمد الشهاري المعدل.pdf

🔻موضوع مهم وبتختبروا عليه عملي

اصحاب الجراحه....

هذا تلخيص بأربع صفحات يشمل كل ما يطلبه الدكاترة بإختبار العملي لحالات:
Cellulitis
Erysipelas
Necrotizing fasciitis
Compartment syndrome.

رجال
حالتين appendicitis
ثلاث حالات Truma
حالتين diabetic foot
حاله coma

نساء
حالتين Truma
Anal fissur
Piles
Gall bladder stone
Appendicitis
Intestinal obstruction


حالات مستشفى الكويت

رسلها لطلاب حالات مشتشفى الجمهوري
قسم النساء

بالنسبه لقسم الرجال الجمهوري جراحه
1.حالتين
Post cholecystectomy  with T tube

2.حاله واحده inguinal hernia .

3.حالتين trauma.
RTA + post burn with bed sore.

4.حالتين
  chest tube due to Pleural effusion.

5. أكثر من 6 حالات appendicitis.

6.حاله
intestinal obstruction with NGT

7.حاله واحد (acute pancreatitis)