ATLS | Initial Assessment

🫁 Airway Compromise & Obstruction (A)Pathophysiology: Life-threatening blockage → prevents gas exchange. Causes: foreign bodies, fractures, blood/secretions, trauma, ↓LOC (GCS ≤8). Failure to speak/respond = urgent airway issue. 💊 TXA: ↓bleeding, ↑survival if given ≤3 hrs post-injury. Continue infusion 8 hrs after bolus. Team Roles: 👨‍⚕️ Leader → directs & coordinates 👩‍⚕️ Airway manager → secures airway 👩‍🔬 Nurses → prep/test equip, stabilize c-spine 🩺 Surgeon → perform surgical airway if needed Key Signs: Can’t speak, GCS ≤8, visible obstruction, facial/laryngeal trauma. Nursing Focus:Assess speech → suction blood/secretions 💨Maintain c-spine alignment 🔒Monitor GCS & prep for intubation if ↓LOCReassess airway frequently 🔁 ⚡ Quick Tips:Airway first, spine protectedGCS ≤ 8 = intubateTest gear; frequent reevaluationSurgical airway if intubation fails🌬️ Breathing & Ventilation Failure (B)Patho: Airway patency ≠ ventilation. Check gas exchange. Threats: tension pneumo, hemothorax. 💊 O₂: All trauma pts need it; use mask-reservoir if not intubated. Team: Clinician = chest exam 🔍 | RT/Nurse = monitor O₂ & CO₂ | Surgeon = chest decompression. Signs: Dyspnea, pain, ↓SpO₂, distended neck veins, tracheal shift. Nursing:Monitor SpO₂, ABG, ETCO₂ 📊Give O₂ immediatelyAvoid PPV until decompressed if pneumo suspected 🚫 ⚡ Summary:Tension pneumo = clinical dx—treat fast!Pulse ox + capnography = vitalWatch for simple pneumo → tension after PPV💉 Hemorrhagic/Hypovolemic Shock (C)Patho: Blood loss = main preventable death. Hypotension → assume hemorrhage until ruled out. 💊 Fluids/Blood/TXA:Warm crystalloids (≤1.5 L) 🌡️MTP for transfusion; never microwave blood 🩸TXA within 3 hrs ↓mortality Team: Leader = find/control bleed | Nurse = IV access, warm fluids | Surgeon = definitive control. Signs: Rapid, thready pulse 💓, ashen skin, altered LOC, pelvic pain/ecchymosis. Nursing:2 large-bore IVs/IO for fluidsMonitor pulses, urine (≥0.5 mL/kg/hr) 💧Apply pelvic binder for suspected fracture ⚡ Summary:Warm all fluidsAvoid over-resuscitationTXA + balanced transfusion = best outcome🧠 Disability (D) & 🌡️ Exposure (E)Patho: LOC changes = possible brain injury; prevent hypoxia/hypoperfusion. Hypothermia = lethal. 💊 Small IV opiates/anxiolytics (avoid IM). Team: Neuro consult early 🧠 | Nurse = monitor temp & record events | All = PPE 🧤 Signs: ↓GCS, unequal pupils, cold skin. Nursing:Reassess ABCDEs if neuro declineWarm pt + fluids (39°C) 🔥Pain relief = careful titration ⚡ Summary:Complete primary survey before secondaryMaintain spine restrictionUrinary output = perfusion checkAvoid nasal tubes if facial fx✅ Overall Priorities: 1️⃣ Airway w/ spine protection 2️⃣ Breathing (O₂ & chest) 3️⃣ Circulation (bleeding control + warm fluids) 4️⃣ Disability (neuro status) 5️⃣ Exposure (prevent hypothermia)