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AdvancedTraumaLifeSupport-ATLS高级创伤生命支持

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2023年4月27日发(作者：心电图入门)

Advanced Trauma Life Support

Advanced Trauma Life Support (ATLS) is a training program for doctors and Advanced Practice/Critical Care

Paramedics in the management of acute trauma cas, developed by the American College of Surgeons. The program

has been adopted worldwide in over 40 countries,sometimes under the name of Early Management of Severe

[1]

Trauma (EMST), especially outside North America. Its goal is to teach a simplified and standardized approach to

trauma patients. Originally designed for emergency situations where only one doctor and one nur are prent,

ATLS is now widely accepted as the standard of care for initial asssment and treatment in trauma centers. The

premi of the ATLS program is to treat the greatest threat to life first. It also advocates that the lack of a definitive

diagnosis and a detailed history should not slow the application of indicated treatment for life-threatening injury,

with the most time-critical interventions performed early. However, there is mixed evidence to show that ATLS

improves patient outcomes.

[1][2][3][4][5][6]

Primary Survey

The first and key part of the asssment of patients prenting with trauma is called the primary survey. During this

time, life-threatening injuries are identified and simultaneously resuscitation is begun. A simple mnemonic, ABCDE,

is ud as a memory aid for the order in which problems should be addresd.

AAirway

BBreathing

CCirculation

DDisabilities

EExpo/Environment

A - Airway Maintenance with Cervical Spine Protection

The first stage of the primary survey is to asss the airway. If the patient is able to talk, the airway is likely to be

clear. If the patient is unconscious, he/she may not be able to maintain his/her own airway. The airway can be

opened using a chin lift or jaw thrust. Airway adjuncts may be required. If the airway is blocked (e.g, by blood or

vomit), the fluid must be cleaned out of the patient's mouth by the help of sucking instruments.

B - Breathing and Ventilation

The chest must be examined by inspection, palpation, percussion and auscultation. Subcutaneous emphyma and

tracheal deviation must be identified if prent. Life-threatening chest injuries, including tension pneumothorax,

open pneumothorax, flail chest and massive haemothorax must be identified and rapidly treated. Flail chest,

penetrating injuries and bruising can be recognid by inspection.

Advanced Trauma Life Support

C - Circulation with Hemorrhage Control

Hemorrhage is the predominant cau of preventable post-inj口吻是什么意思 ury deaths. Hypovolemic shock is caud by significant

blood loss. Two large-bore intravenous lines are established and crystalloid solution given. If the patient does not

respond to this, type-specific blood, or O-negative if this is not available, should be given. External bleeding is

controlled by direct pressure. Occult blood loss may be into the chest, abdomen, pelvis or from the long bones.

D - Disability (Neurologic Evaluation)

During the primary survey a basic neurological asssment is made, known by the mnenomic AVPU (alert, verbal

stimuli respon, painful stimuli respon, or unresponsive). A more detailed and rapid neurological evaluation is

performed at the end of the primary survey. This establishes the patient's level of consciousness, pupil size and

reaction, lateralizing signs, and spinal cord injury level.

The Glasgow Coma Scale is a quick method to determine the level of consciousness, and is predictive of patient

outcome. If not done in the primary survey, it should be performed as part of the more detailed neurologic

examination in the condary survey. An altered level of consciousness indicates the need for immediate

reevaluation of the patient's oxygenation, ventilation, and perfusion status. Hypoglycemia and drugs, including

alcohol, may influence the level of consciousness. If the are excluded, changes in the level of consciousness should

be considered to be due to traumatic brain injury until proven otherwi.

E - Exposure / Environmental control

The patient should be completely undresd, usually by cutting off the garments. It is imperative to cover the patient

with warm blankets to prevent hypothermia in the emergency department. Intravenous fluids should be warmed and

a warm environment maintained. Patient privacy should be maintained.

Secondary Survey

When the primary survey is completed, resuscitation efforts are well established, and the vital signs are normalizing,

the condary survey can begin.

The condary survey is a head-to-toe evaluation of the trauma patient, including a complete history and physical

examination, including the reasssment of all vital signs. Each region of the body must be fully examined. X-rays

indicated by examination are obtained.

If at any time during the condary survey the patient deteriorates, another primary survey is carried out as a

potential life threat may be prent.

The person should be removed from the hard spine board and placed on a firm mattress as soon as reasonably

feasible as the spine board can rapidly cau skin breakdown and pain while a firm mattress provides equivalent

stability for potential spinal fractures.

[7]

Alternatives to ATLS

Anaesthesia Trauma and Critical Care (ATACC) is an international trauma cour bad in the United Kingdom. It is

an advanced trauma cour and reprents the next level for trauma care and trauma patient management post ATLS

certification. Accredited by two Royal Colleges and numerous emergency rvices, the cour runs numerous times

per year for candidates drawn from all areas of medicine and trauma care.Specific injuries, such as major burn

[8]

injury, may be better managed by modified ATLS protocols such as EMSB (Emergency Management of Severe

Burns: a training cour and protocols developed by the Australian and New Zealand Burn Association (ANZBA)

and also adopted by the British Burn Association).[9][10]

Advanced Trauma Life Support

Evidence

As of 2008 no evidence exist as to whether or not ATLS training improved outcomes.

[11]

History

ATLS has its origins in the United States in 1976, when orthopaedic surgeon Dr. James K. Styner, piloting a light

aircraft, crashed his plane into a field in Nebraska. His wife was killed instantly and three of his four children

sustained critical injuries. He carried out the initial夫字开头的成语 triage of his children at the crash site. Dr. Styner had to flag down

a car to transport him to the nearest hospital; upon arrival, he found it clod. Even once the hospital was opened and

a doctor called in, he found that the emergency care provided at the small regional hospital where they were treated

was inadequate and inappropriate.

[12]

Upon returning to work, he t about developing a system for saving lives in medical trauma situations. Styner and

his colleague Paul 'Skip' Collicott, with assistance from Advanced Cardiac Life Support personnel and the Lincoln

Medical Education Foundation, produced the initial ATLS cour which was held in 1978. In 1980, the American

College of Surgeons Committee on Trauma adopted ATLS and began US and international dismination of the

cour. Styner himlf recently recertified as an ATLS instructor, teaching his Instructor Candidate cour in the UK

and then in the Netherlands.

Since its inception, ATLS has become the standard for trauma care in American emergency departments and

advanced paramedical rvices. Since emergency physicians, paramedics and other advanced practitioners u ATLS

as their model for trauma care it makes n that programs for other providers caring for trauma would be designed

to interface well with ATLS. The Society of Trauma Nurs has developed the Advanced Trauma Care for Nurs

(ATCN) cour for Registered Nurs. ATCN meets concurrently with ATLS and shares some of the lecture

portions. This approach allows for medical and nursing care to be well coordinated with one another as both the

medical and nursing care providers have been trained in esntially the same model of care. Similarly, the National

Association of Emergency Medical Technicians has developed the Prehospital Trauma Life Support (PHTLS) cour

for basic Emergency Medical Technicians (EMT)s and a more advanced level class for Paramedics. The

International Trauma Life Support committee publishes the ITLS-Basic and ITLS-Advanced cours for prehospital

profesionals as well. This cour is bad around ATLS and allows the PHTLS-trained EMTs to work alongside

paramedics and to transition smoothly into the care provided by the ATLS and ATCN-trained providers in the

hospital.