A. Pretest (30 min) B. Context of Tutorial (2 hours) 1. General Principles ⚫ Concept ⚫ Inhospital phase clinical procedure/process ⚫ Important points/ cautions/ pitfalls ⚫ Brief discussion on traumatic shock/ blood transfusion 2. Thoracic Trauma 3. Abdominal Trauma C. Answers of pretests (30 min) D. Skills: (1hour) 1. Airway and Ventilatory management a. Jet insufflation b. Laryngoscope / Magill forcep / Suction device c. Adult intubation d. Infant intubation e. Cricothyroidotomy 2. Immobilization a. In-line immobilization/ log-roll techniques b. Cervical collar a. Long spine Backboard b. Scoop stretcher c. Traction Splint 3. Adjuncts to surveys /monitoring/ resuscitation a. Pulse Oximeter b. DPL c. FAST d. Needle decompression e. Tube thoracostomy f. Seal Open peumothorax g. Pericardiocentesis h. Intraosseous puncture Advanced Trauma Life Support General Principles: ➢ The concept: Three underlying concepts of ATLS program : 1. Treat the greatest threat to life first 2. The lack of a definite diagnosis should never impede the application of an indicated treatment 3. A detailed history was not essential to begin the evaluation of an acutely injured patient ➢ Specific principles govern the management of trauma patients in ED: 1. Organized team approach 2. Priorities 3. Assumption of the most serious injury 4. Treatment before diagnosis 5. Thorough examination 6. Frequent reassessment 7. Monitoring ➢ Inhospital phase clinical process: ➢ Systemic, organized approach to seriously injured patients is mandatory.  Preparation  Triage  Primary survey (ABCDEs) Resuscitation Adjuncts to primary survey & resuscitation  Secondary survey (Head to toe Evaluation) Adjuncts to secondary survey  Continued postresuscitation monitoring and reevaluation  Definitive care ➢ The primary and secondary surveys should be repeated frequently ➢ In the actual clinical situation, many of these activities occur in parallel or simultaneously. ➢ Organized Team Approach:  Team Captain : Coordinate, control the resuscitation Assessing the patient, ordering needed procedures/ studies Monitring the patient’s progress.  Procedures by other physician team members.  Nurses