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KMID : 0352119950110010019
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Journal of Kyung Hee University
1995 Volume.11 No. 1 p.19 ~ p.28
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Initial Assessment and Management in Advanced Trauma Life Support
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Abstract
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The injured patient must be evaluated rapidly and thoroughly. The physician must develop treatment priorities for the overall management of the patient, so no steps in the process are omitted. An adequate patient history and accounting of the
incident
are important in evaluating and managing the trauma patient.
1. Primary Survey-Assessment of ABCs
1) Airway and cervical spine control
2) Breathing
3) Circulation with hemorrhage control
4) Disability: Brief neurologic evaluation
5) Exposure/Environment: Completey undress the patient, but prevent hypothermia
2. Resuscitation
1) Oxygenation and ventilation
2) Shock management-intravenous lines. Ringer's lactate
3) The management of life-threatening problems identified in the primary survey is continued
4) Monitoring
(1) Arterial blood gases and ventilatory rate
(2) End-tidal carbon dioxide
(3) Electrocardiograph
(4) Pulse oximetry
(5) Blood pressure
3. Secondary Survey - Total Patient Evaluation
1) Head and skull
2) Maxillofacial
3) Neck
4) Chest
5) Abdomen
6) Perineum/rectum/vagina
7) Musculoskeletal
8) Complete neurologic examination
9) Apporopriate roentgenograms, laboratory tests, and special studies
10) "Tubes and fingers" in every orifice
4. Definitive Care
After identifying the patient's injuries, managing life-threatening problems, and obtaining special studies, definitive care begins.
5. Transfer
If the patient's injuries exceed the institution's immediate treatment capabilities, the process of transferring the patient is initiated as soon as the need is identified. Delay in transferring the patient to a facillity with higher level of
care
may
significantly increase the patient's risk of mortality.
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