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ADVANCED TRAUMA LIVESUPPORT

(ATLS)



Program pelatihan untuk tenaga medis dalammenangani kasus trauma akut.

The point are:Menggunakan cara sederhana namun sesuaistandar dalam penilaian dan penanganan awalterhadap trauma pada korban guna meminimalisirkecacatan.



GENERAL CATEGORIES OF TRAUMA

IMMEDIATELY LIFE TREATENINGAfect about 5% accou t !o" 5#%o! a$$ &o' ta$ t"au a *eat&'

URGENTCo " 'e' a "o+ ate$, about

-#.-5% o! a$$ at e t'/

NON.URGENTA "o+ ate$, 0#% o! a$$ 1u" e'



STEPS:-/ P"e a"at o2/ T" a3e4/ P" a", 'u" e, (A6CDE')7/ Re'u'c tat o5/ A*1u ct' to " e", 'u" e, 8 "e'u'c tat o9/ Seco *a", 'u" e, (&ea* to toe e a$uat o 8

& 'to",):/ A*1u ct' to 'eco *a", 'u" e,0/ Co t ue* o't."e'u'c tat o o to" 3 8 "e.

e a$uat o;/ De< e ca"e



•PRE HOSPITAL PHASE •IN HOSPITAL PHASE

Rece 3 &o' ta$' ot <e* <"'t

Se * to t&ec$o'e't=a "o " ate !ac $ t,

A* a ce* $a 3!o" t&e t"au a

Met&o* to 'u oe* ca$ tea

T"a '!e" a3"ee e t> t& e" <e* t"au a

ce te" e'tab$ '&e*P"otect !"oco u cab$e* 'ea'e

-/ PREPARATION



2/ TRIAGE

T" a'e a"t ,a e $ &/P"o'e' '?" 3 'eca"a ce at u tu?e 3 *e t <?a' ?ea*aa ?o"ba a3a" *a at e be" ?a

e a 3a a ,a 3 te at /



Priorities for the care of Adult , Pediatrics & Pregnancywomen are all the same.During the primary survey lifethreatening conditions are identified and management

is instituted SIMU !A"#$US %.A : Airway with cervical spine protect.

B : reathing

C : 'irculation ((control e)ternal *leeding.D : Disa*ility or neurological status

E : #)posure +undress & Environment +temp control

4/ PRIMARY SURVEY



CONT. PRIMARY SURVEY



B. Breathing & Ventilation

- Airway patency does not assure ade uate ventilation.C. Circulation with Hemorrhage Control.

/. lood 0olume & 'ardiac $utput

a. level of consciousness.

*. s1in color

c. Pulse.

2. leeding

-e)ternal *leeding is identified & controlled in theprimary survey.

-!ourni uets should not *e use.



D. Disa*ility + "eurological #valuationSimple Mnemonic to descri*e level of consciousness

A 3 Alert

0 3 4esponds to 0ocal stimuli

P 3 4esponds to Painful stimuli

U 3 Unresponsive to all stimuli

"ot forget to use also 5lascow 'oma Scale.



E. Exposure / Environmental ControlIt is the pt6s *ody temp that is most important,not he comfort of the health care provider.

Intravenous fluid should *e warm.

7arm environment +room tem should *e

maintained.early control of hemorrhage.



A. Airway-definite airway if there is any dou*t a*out the pt6s a*ility to

maintain airway integrity.B. Breathing /Ventilation/ xygenation

-every in8ured pt should received supplement o)ygenC. Circulation

-control *leeding *y direct pressure or operative intervention- minimum of two large cali*er I0 should *e esta*lished-pregnancy test for all female of child *earing age.- actated 4inger is preferred & *etter if warm.

7/ RESUSCITATION



A. Electro!car"iographic #onitoringB. $rinary & %astric Catheter /. Urinary catheter.

Urethral in8ury should *e suspected if- lood at the penile meatus

-Perineal ecchymosis

- lood in the scrotum -9igh riding or nonpalpa*le prostate -Pelvic fracture

. AD'$(C) ) *+,#A+- $+VE- & +E $ C,)A), (



C. #onitoring

/. 0entilatory rate & A 5 2. Pulse o)imetry

does not measure ventilation or partial $2 pressure

:. lood pressure

poor measure of actual tissue perfusion. D. !+ay & Diagnostic tu"ies

'(spine, ';4, Pelvic film

#ssential )(ray should not *e avoid in pregnant pt.

000 Consi"er the nee" 1or patient trans1er.



2. EC (DA+- $+VE-

Does not *egin until the primary survey +A 'D#s is completed, resuscitative effort are well esta*lished

& the pt is demonstrating normali<ation of vital sign.

- 9ead to !oe evaluation & reassessment of all vitalsigns.

- A complete neurological e)am is performed including a 5'S score.- Special procedure is order.



9istoryA 3Allergies.

M 3# edication currently used.

P 3*ast illness= * regnancy. 33ast Meal

# 3 Events=Environment related to the in8ury.

-*lunt trauma=penetrating trauma=in8uries dueto cold & *urn=ha<ardous environment>



P9%SI'A #;AMI"A!I$"4. Hea"

0isual acuity

Pupillary si<e

9emorrhage of con8unctiva and fundi

Penetrating in8ury

'ontact lenses+remove *efore edema occurs

Dislocation of lens

$cular movement

-@## -:



5. #axillo1acial ,n6ury

no "5 tu*e, definite airway>7. Cervical pine & (ec8

-Pt with ma)illofacial or head trauma should *e presumedto have and unsta*le cervical spine.

9. Chest

-elderly pt are not tolerant of even relatively minorchest in8ury.

-'hildren often sustain significant in8ury to theintrathoracic structure without evidence of thoracic

s1eletal trauma.

-@## -0



. A "omen

-e)cessive manipulation of the pelvic should *eavoided.

2. *erineum/rectum/vagina

;. #usculos8eletal<. (eurologic

- Protection of spinal cord is re uired at all times

until aspine in8ury e)cluded, especially when the pt istransfer.

-@## -;



;. AD'$(C) ) )HE EC (DA+- $+VE- include additional )(ray and all other special procedure.

<. +E!EVA3$A), ( Adult urine output ?.@ml=1g=hr

Pediatric urine output /mg=1g=hr -Pain relief (( IM should *e avoid.

=. DE>,(,)E CA+E

-@## 2#



,n"ication >or De1inite Airway

- Unconscious

- Severe ma)illo(facial fracture

- 4is1 for aspiration 3 leeding= vomiting- 4is1 for o*struction 3 nec1 hematoma=laryngeal,tracheal in8ury= stridor

- Apnea 3 "euromuscular paralysis=unconscious

- Inade uate respiratory effort3 tachypnea=hypo)ia=hypercapnia=cyanosis- Severe closed head in8ury need for hyperventilation

-@## 2-



EVAKUASI



I. Pertolongan 1 orang

a? a' e e 3 1a??a? e o$o 3

Pasien bisa jalan :



Pasien tdk bisa jalan1) 2)



Pasien tdk bisa jalan jarak jauh :



Evak a!" kor#an t$k !a$ar $" $aera% #a%a&a :

Fireman.



Po!"!" kor#an tengk ra' :1) 2)



II. Pertolongan ( orang

Po!"!" tangan



Po!"!" tangan



Pe "n$a%an kor#an ke!tret*%er+$" lorong !e '"t ,



Na"k+t r n tangga $ng k r!" :



Pengangk tan $" lorong !e '"t :



Evak a!" ( orang -arak -a % :



III. Pertolongan orang/or#an t"$ak !a$ar

1) 2)

3)



/or#an !a$ar t$k #"!a -alan :



IV.Pengangk tan $engantan$ 1. Tan$ 0 rle&+/anva!+Stan$ar

Macam-macam tandu :



(. Tan$ Pole /anva!



. Tan$ S*oo'



2. Tan$ Trolle&



3. Tan$ 4a!ket



Macam-macam tandu improvisasi :



1. Tan$ #a # $ng tal" :



B enis simpul !" di"unakan dlm tandu

bambu : S" ' l Pangkal

Jangkar



(. Tan$ #a # $ng !el" t :

a) b)



. Tan$ $ng ke e-a+-aket :



2. Tan$ $ng ka"n !ar ng+kar ng:



Me "n$a%kan kor#an ke ata!tan$62 'enolong) :

2.)

3.)

1.)



(.)1)

Memindahkan korban ke atastandu (3 penolong) :



1) 2)

eknik pemindahan korban keatas tandu di lorong sempit :

Pengangkatan kor#an $ng



Pengangkatan kor#an $ngtan$ :

1) 2)



Mel"nta! te #ok ,

1) 2)



Men r n" tangga ge$ ng :

Posisi rata-rata air



B Mel"nta! tana% t"$ak rata ,



B Mel"nta! ! nga" ,



V. Pengangk tan $ng

ken$araan ,



VI.Evak a!" $" te 'atke#akaran :

1). Penolong $an kor#an !a$ar erangkak$" #a7a% ket"ngg"an !at eter ,



(). Evak a!" kor#an t"$ak !a$ar$" areal ke#akaran ,



) Evak a!" kor#an ke#akaran$ng engg nakan 8re #lanket ,



2). Me #a7a kor#an en r n"tangga :

/or#an #era$a #era$a $" antara t # %'enolong $ng tangga/e$ a tangan 'enolong e eganganak tangga elal " ke$ a ket"ak

kor#an4erat #a$an kor#an #ert ' '$ ket"ak$" ke$ a tangan 'enolong $an#ergant"an #ert ' '$ !elangkangan$" ke$ a l t t 'enolongT r n !eta%a'9!eta%a' %"ngga $" #a7a%.

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