Definition:
- ATLS : life threatening with pulse
- ACLS(cardiac): life threatening, no pulse
Common emergency cases: (ATOMTC)
- Airway obstruction
- Tension pneumothorax - silent chest, trachea deviated
- Open wound
- Massive hemothorax
- Tracheobronchio dissociation/ fistula
- empysema
- crepitus, poor air entry
- corrective surgery
- do X-ray - is it hyperventilated?
- Cardiac tamponade - JVP, increase HR, muffled heart sound
- Pericardial effusion?
OSCE ATLS steps:
1. What to do when the patient came in with emergency? (DR. AVPU)
- Danger
- access the situation, ensure you are safe first
- Response & role
- check for patient response and
- ask someone around you(assistants)to help
- prepare airway apparatus +cervical support
- chest tube, needle tube, SP02
- IV line - for fluid & BT & crossmatch
Check their response to...
- Alert
- Verbal
- Pain
- Unconscious
2. If all above indicates emergency case signs proceed with ABCDE
Airway - jaw thrust - open the mouth and inspect for foreign substances (yonker suction could help
removing them) - check for gag reflex -
- cervical support - can be confirmed by using the NEXUS criteria
(cervical spine evaluation in trauma)
Breathing - ventilation,
- inspection: check for ATOMTC (common emergency cases, in first paragraph)
- palpation: trachea location, rib intact? fracture?
- percussion: hyper-resonance? dull?
- auscultation: Air entry? Heart rhythm, HR?
- check Respiratory rate
- intubate if needed
Circulation - bleeding
- IV 2 large bonula
- IL warm NS
- BT urgent panel
- inspect head to toe for bleeding
- EENT, abdomen (peritonitis), pelvis(spring fracture), genitalia (hematoma, scrotum, perianal bleeding, urethral)
- peripheral bleeding (fracture)
Disability - pupil
- GCS scale!
Exposure - environmental - do they need a blanket? (hypothermia?)
- log roll for back examination (examine the spine - stepping sign)/ rectoperitoneal bleeding / prostate high riding / pelvic injury / abdominal injury / thoracolumbar injury
- DRE? anal tone lac?
Simple Management mnemonic:
2(CBD, NG tube)
+
2(X-ray : chest and pelvic)
+
2(drugs and analgesia IPTT)
+
2 investigation(ECG, FAST u/s)
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