intro to atls dr jorge concepcion
TRANSCRIPT
![Page 1: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/1.jpg)
INITIAL ASSESSMENT & ABCs in TRAUMA
Jorge M. Concepcion, MD,FPCS
General Surgery & Trauma
![Page 2: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/2.jpg)
ObjectivesAt the end of this session, the participant is
expected to be able to:
• Discuss the social impact of trauma and the importance of trauma prevention.
• Provide the correct sequence of priorities in assessing multiply injured patient.
• Provide guidelines and techniques in the initial management of multiply injured patient.
![Page 3: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/3.jpg)
INJURY (WHO definition)
-a bodily lesion resulting from exposure to energy Mechanical
Thermal
Electrical
Chemical
interacting with the body in the amounts thatexceed the limits of physiologic tolerance.
Radiation
![Page 4: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/4.jpg)
INJURIES
“NOT ACCIDENTS”
PREDICTABLE
PREVENTABLE
Not random events but occur in predictable patterns
VEHICULAR ACCIDENT“VEHICULAR CRASH”
![Page 5: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/5.jpg)
TRIMODAL PATTERN OF DEATH IN INJURY
FIRST PHASE 50 % PREVENTION
SECOND PHASE TRAUMA SYSTEM
THIRD PHASECRITICAL CARE &REHABILITATION
30 %
20 %
![Page 6: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/6.jpg)
YEAR MORTALITY MORBIDITYRANK RANK
1980
1985
1990
1995
1998
7th
7th
9th
6th
5th
7th
6th
5th
5th
5th
UNDERREPORTED???2002 3rd 4th
![Page 7: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/7.jpg)
Epidemiology
TRAUMA IS A DISEASE!!!
![Page 8: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/8.jpg)
Trauma Concepts
1. Treat the greatest threat to life.
2. Lack of definitive diagnosis should not impede the application of an indicated treatment.
3. Detailed history is not essential to begin the evaluation of an acutely injured patient.
![Page 9: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/9.jpg)
![Page 10: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/10.jpg)
1. PRIMARY SURVEY
2. RESUSCITATION
3. SECONDARY SURVEY
4. DEFINITIVE MANAGEMENT
REASSESSMENT
5. TERTIARY SURVEY
Approach To Severely Injured Patient
![Page 11: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/11.jpg)
A - AIRWAY & C-SPINE CONTROL
B - BREATHING
C - CIRCULATION – HEMORRHAGE CONTROL
D - DISABILITY (NEURO EXAM)
E - EXPOSURE / ENVIRONMENT
Primary Survey
![Page 12: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/12.jpg)
AIRWAY
![Page 13: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/13.jpg)
Assessment of Airway Patency
• Look
• Listen
• Feel
PCS Committee on Trauma
![Page 14: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/14.jpg)
Look
• Apprehension • Agitation/restlessness• Unresponsiveness• Sweating and pallor• Cyanosis• Dyspnea/tachypnea• Rib retraction on
inspiration
• Retracting cervical soft tissues
• Use of accessory muscles of respiration
• Alar flaring• Neck hematoma• Profuse bleeding • Gastric contents in
oropharynx
PCS Committee on Trauma
![Page 15: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/15.jpg)
Listen
• Cough• Hoarseness• Stridor• Decreased or absent
breath sounds• Gurgling
• “I can’t breathe!”• Snoring• No air entry• Wheezing
PCS Committee on Trauma
![Page 16: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/16.jpg)
Feel
• Subcutaneous emphysema
• Tracheal deviation
• Chest wall deformity/crepitus
• No air flow on exhalation
• Diaphoretic skin
PCS Committee on Trauma
![Page 17: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/17.jpg)
Factors Affecting Airway Patency
• Maxillofacial trauma– Direct trauma– Hemorrhage– Aspiration of broken
teeth, blood, dentures– Collapse of bony
support– Soft tissue edema– Altered sensorium 2°
to brain injury
PCS Committee on Trauma
![Page 18: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/18.jpg)
Factors Affecting Airway Patency
• Impaired sensorium– Due to associated brain injury or alcohol/drug
intoxication– Absent gag/cough reflex– Aspiration of blood/gastric contents– Inadequate ventilatory drive/apnea
PCS Committee on Trauma
![Page 19: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/19.jpg)
Factors Affecting Airway Patency
• Cervical trauma– Hematoma/swelling compressing airway– Direct airway injury
• Laryngeal fracture (e.g., direct blow, strangulation, clothesline injury)
• Vocal cord paralysis
– Cervical spine precautions mandatory
PCS Committee on Trauma
![Page 20: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/20.jpg)
Factors Requiring Airway Control
• Resuscitation of trauma patients in impending arrest due to shock / hypoxia
• Impaired ventilatory mechanics– Flail chest– Pneumo/hemothorax– Diaphragmatic breathing
• Transport/sedation requirements
PCS Committee on Trauma
![Page 21: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/21.jpg)
Factors Requiring Airway Control
• Continuing threats to airway patency– Soft tissue edema (eg, thermal inhalational
injury, massive fluid resuscitation, local trauma)
– Deteriorating sensorium– Aspiration risk:
• Full stomach/abdominal distention• Continued bleeding/hemoptysis
PCS Committee on Trauma
![Page 22: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/22.jpg)
Airway Risk Factors
I nstability, hemodynamicN eck hematoma/traumaT rauma to the face (maxillofacial)U nresponsive (GCS < 8)B leeding from oropharynxA pneaT hermal inhalational injuryE mesis/epistaxis/hemoptysis/
PCS Committee on Trauma
![Page 23: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/23.jpg)
Airway Algorithm
Trauma patient withairway risk factors
Oxygenate
Airway compromise No airway compromise
Ventilate/Intubate with cervical in-line stabilization
Unable to intubate
Cricothyroidotomy
Observe/reassess
Airway compromise?
Continue monitoring patient’s progress
Reassess adequacy of ventilation
YES
NO
![Page 24: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/24.jpg)
Airway Maintenance Measures
• Finger sweep
• Chin lift
• Jaw thrust
• Oropharyngeal/nasopharyngeal airway
• Laryngeal mask airway
• Needle cricothyroidotomy
PCS Committee on Trauma
![Page 25: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/25.jpg)
Oropharyngeal Airway
![Page 26: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/26.jpg)
Laryngeal Mask Airway
![Page 27: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/27.jpg)
Definitive Airway Methods
• Intubation– Orotracheal– Nasotracheal
• Surgical Airway– Cricothyroidotomy– Tracheostomy
PCS Committee on Trauma
![Page 28: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/28.jpg)
Orotracheal Intubation
PCS Committee on Trauma
![Page 29: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/29.jpg)
Cricothyroidotomy
PCS Committee on Trauma
![Page 30: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/30.jpg)
Associated Skills
• Assisted/bag-mask ventilation
• Esophageal compression
• Checking tube placement
• Anchoring
PCS Committee on Trauma
![Page 31: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/31.jpg)
BREATHING
• Guarantee adequate oxygenation and ventilation• Give supplemental oxygen• Ventilation (lungs, chest wall & diaphragm)• Assess respiratory effort, breath sounds &
oxygen delivery• Use of pulse oximetry
![Page 32: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/32.jpg)
BREATHING: Problem Recognition
• Objective Signs:• Inspection• Palpation• Percussion• Auscultation
![Page 33: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/33.jpg)
Oxygenation
Oxygen delivery
L/min. Approx. FiO2
Nasal cannula Face mask Face mask w/ reservoir
1246
5-66-77-868
10
0.240.280.350.420.400.500.600.600.801.00
![Page 34: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/34.jpg)
Management
• Ventilation
– Mouth to pocket face mask
– Bag-valve-mask – ( 2 person
technique)
• Pleural Decompression– Needle thoracentesis
– Closed-tube thoracostomy
– Three-sided dressing
![Page 35: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/35.jpg)
BREATHING
![Page 36: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/36.jpg)
Bag Mask Ventilation
PCS Committee on Trauma
![Page 37: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/37.jpg)
Needle Thoracentesis
• IndicationTension Pneumothorax
Complications: Local hematoma Pneumothorax Lung laceration
![Page 38: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/38.jpg)
Closed Tube Thoracostomy
• Indications– Simple Pneumothorax
– Massive Hemothorax
– Tension Pneumothorax
– Open Pneumothorax
![Page 39: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/39.jpg)
Closed Tube Thoracostomy
Complications:Laceration or puncture of
thoracic & abdominal organs
Pleural infectionDamage to intercostals
nerves, artery or veinIncorrect tube positionChest tube kinking, clogging
or dislodging
![Page 40: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/40.jpg)
Three-sided Dressing
• Indications– Open pneumothorax
![Page 41: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/41.jpg)
Pulse Oximetry
• The pulse oximeter is designed to measure oxygen saturation and pulse rate in peripheral circulation.
![Page 42: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/42.jpg)
CIRCULATION
![Page 43: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/43.jpg)
CIRCULATION
• Assure adequate oxygen delivery and control bleeding
• Assess vital signs • Control bleeding by
direct pressure• Reduction of fractures
in long bones and pelvis
![Page 44: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/44.jpg)
Recognition of Shock
• Tachycardia
• Cutaneous vasoconstriction
• Narrowed pulse pressure
• Hypotension
![Page 45: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/45.jpg)
Pitfalls of Shock Recognition
• Extremes of age
• Athletes
• Pregnancy
• Medications– beta blockers– pacemakers
• Hypothermia
![Page 46: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/46.jpg)
Classes of HemorrhageClass I Class II Class III Class IV
Blood Loss (ml) Up to 750 750-1500 1500-2000 >2000
Blood Loss (% blood volume)
Up to 15% 15-30% 30-40% >40%
Pulse Rate <100 >100 >120 >140
Blood Pressure normal normal decreased decreased
Pulse Pressure normal or decreased
decreased decreased decreased
Respiratory Rate 14-20 20-30 30-40 >35
Urine Output (mL/hr) >30 20-30 5-15 negligible
CNS/mental status Slightly anxious
Mildly anxious
Anxious, confused
Confused, lethargic
![Page 47: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/47.jpg)
Initial Management
• Recognize shock
• Stop the bleeding!
• Replace effective circulating volume
• Restore tissue perfusion
![Page 48: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/48.jpg)
Initial Management
• Physical examination– ABCDEs– gastric and bladder decompression
• Vascular access– basic principles– initial blood tests
• Fluid therapy– isotonic fluid
![Page 49: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/49.jpg)
Hemorrhage Control Techniques
• Direct pressure
• Inflow occlusion
• Tourniquets
• Reduction of pelvic volume maneuvers
• Application of folded sheets
• PASG
![Page 50: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/50.jpg)
Severe Pelvic Fractures
C-CLAMP
![Page 51: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/51.jpg)
Vascular Access
• 2 large bore peripheral IV lines
• Venous cutdown– saphenous vein
• Central access– femoral– jugular– subclavian
• Intraosseous• Obtain blood for type
and cross matching
![Page 52: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/52.jpg)
Fluid Therapy
• Warmed crystalloid solution
• Rapid fluid bolus– Adult 2 liters– Child 20 mL/kg
• “3 for 1 rule”
• Monitor response to therapy
![Page 53: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/53.jpg)
Size (gauge) Time
18
16
14
9 min.
12 min.
7 min.
Fluid Therapy
![Page 54: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/54.jpg)
Response to Fluid Resuscitation
• Rapid response
• Transient response
• Minimal or no response
![Page 55: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/55.jpg)
Response to Fluid Resuscitation
Rapid Response Transient Response
No response
Vital Signs Return to normal Transient improvement
Remain abnormal
Estimated blood loss
Minimal (10-20%) Moderate and ongoing (20-40%)
Severe (>40%)
Need for more fluids
Low High High
Need for blood Low Moderate to high Immediate
Blood preparation Type and crossmatch
Type specific Emergency blood release
Need for surgery Possibly Likely Highly likely
Early presence of surgeon
Yes Yes Yes
![Page 56: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/56.jpg)
Assess GCS, pulses, sensory and motor functions
GCS BEST MOTOR RESPONSE – 6BEST VERBAL RESPONSE – 5 EYE OPENING – 4
3 - 15
V = ? M = 4 E = 3 GCS = 7
V = M(0.5) + E(0.4)
V = 4 (0.5) = 2 + 3 (0.4) = 1.2
V = 2 + 1.2 = 3.2
V = 3 M = 4 E = 3 GCS = 10
?
Disability
![Page 57: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/57.jpg)
Exposure and Environmental Control
• Undress (cut clothing!)
• Keep patient warm
• Logroll
• Often missed injuries
Axilla
Perineum
Back
![Page 58: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/58.jpg)
ED THORACOTOMYEXPLORATORY LAPAROTOMY
X-FIX
PERICARDIOCENTESIS
CHEST TUBEINSERTION IV ACCESS
Resuscitation
![Page 59: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/59.jpg)
- ALLERGIES
- MEDICATIONS
- PAST ILLNESSES
- LAST MEAL
- EVENTS PRECEEDING THE INCIDENT
A
M
P
L
E
Secondary Survey
• History
![Page 60: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/60.jpg)
Secondary Survey
• Physical Examination
Detailed, meticulous head-to-toe exam
Finger and tubes in all orifices
Look, listen, feel everywhere
![Page 61: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/61.jpg)
DEFINITIVE MANAGEMENT
TERTIARY SURVEY
![Page 62: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/62.jpg)
PANIC
INSERT NGT IN PATIENT WITH SUSPECTED FACIAL FRACTURE
FORGET TO WARM THE PATIENT (ESP. CHILDREN)
OVERLOOK THE PERINEUM, BACK AND AXILLA
REMOVE IMPALED OBJECTS
INSERT A FOLEY CATHETER IN PATIENTSSUSPECTED OF URETHRAL INJURY
DON’T
![Page 63: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/63.jpg)
SPLINT PATIENTS WHERE THEY LIE
COMFORT THE PATIENT
ALLEVIATE PAIN
HONE YOUR SKILLS
ASK FOR HELP
PRIMUM NON NOCERE
DO
![Page 64: Intro to ATLS Dr Jorge Concepcion](https://reader035.vdocument.in/reader035/viewer/2022062614/5468f7e8b4af9fcc068b485d/html5/thumbnails/64.jpg)
Summary
1. Rapid but thorough assessment.
2. Treat the greatest threat to life: a. Control airway
b. Provide oxygen and adequate ventilation
c. Control bleeding and restore blood volume
3. Continuously monitor patient’s condition: treat continuing threats to life and limb
4. Prompt definitive treatment