Lisa, Lucy and Rebecca

Advanced Trauma Life Support The ATLS system is used to rapidly assess and manage trauma patients within the golden hour. It provides a systematic approach to managing trauma patients and allows for sequential assessment, resuscitation, management, prioritization of care and maximizing chances of survival. In the accident and emergency department it consists of a primary and secondary survey. The primary survey is performed as soon as the trauma patient arrives and involves the initial assessment and possible resuscitation to identify and treat any life threatening injuries quickly and efficiently. This is achieved by following an ABCDE process to ensure that priorities are identified. If any life threatening condition is identified, it is treated before moving onto the next stage. Airway Maintenance with Protection of the Cervical Spine The patients airway is assessed and if necessary maintained by using a jaw thrust or by inserting an artificial airway. At the same time the cervical spine is immobilized. It should be assumed that any patient who has suffered a blunt trauma injury may have a cervical spine injury. Manual immobilization by a nurse or full-immobilisation using a semi-rigid collar is used. Breathing and Ventilation All trauma patients should be given 100% oxygen via a re-breathable mask because of the risk of hypoxia caused by chest injury or hypovolaemia. A chest assessment should be made to detect any potential or actual life threatening thoracic problems that need intervention such as airway obstruction, cardiac tamponade, tension pneumothorax, massive haemothorax and open chest wounds. Nurses should assess respiration rate, depth, symmetry and observe the chest for bruises or other injury.

Lisa, Lucy and Rebecca

Circulation with Haemorrhage Control Nurses should check the heart rate, blood pressure, capillary refill time, skin colour and level of consciousness. This gives an indication of the volume of fluid that has been lost. Intravenous access should be established and blood samples (FBC, U&E, clotting screen and group and save/cross match). Hypovolaemia is the most common circulatory problem. External haemorrhage should be controlled by applying direct pressure using absorbent sterile dressings. Circulatory volume should be restored as rapidly as possible by infusing intravenous fluids and/or blood products which should be warmed to 39C. Two wide-bore peripheral cannulae should be inserted into large veins such as the antecubital fossa. Catheterisation should be performed so that urine output can be monitored at regular intervals. All findings should be recorded at regular intervals, initially every 5 minutes. Disability and Neurological Assessment The patients neurological status is assessed using the Glasgow Coma Scale. This assesses eye opening, verbal and motor response. In addition, pupil size and response to light should be recorded. An initial baseline assessment is used to observe for deterioration in patients condition. Exposure Ensuring Environmental Control All clothing should be removed so that the entire body can be observed and no injuries are missed. The patients front and back need to be checked which may require log rolling, using at least 4 people. The leader will manually immobilize the cervical spine while others control the thorax, pelvis and legs. The patients dignity should be preserved as much as possible. Exposed trauma patients can loose body heat rapidly so the room must be kept warm and warmed blankets can be used between procedures to prevent hypothermia.

Lisa, Lucy and Rebecca

Once the primary survey is complete, the secondary survey can be performed. This involves a complete head-to-toe examination, full neurological assessment and a clinical history. Allergies, medications, past medical history, the last time food/drink was consumed and events leading to the injury should be ascertained. If any deterioration is observed, the primary survey should be used to re-assess the patients condition. References Alexander, M.F, Fawcett, J.N. and Runciman, P.J. (2000) Nursing Practice Hospital and Home. 2nd ed. London: Churchill Livingstone. Cole, E. (2004) Assessment and Management of the Trauma Patient. Nursing Standard. 18 (41) p. 45-51. OMahoney, C. (2005) Widening the Dimensions of Care. Emergency Nurse. 13 (4) p. 18-24.