atls-100331020520-phpapp02.ppt - ATLS 8th Edition,UPDATE By...

ATLS 8th
Edition
UPDATE ,
By: Fatma Al-
Ghaithi

Difficult Airway
•
This content was not
included in the 7th
edition.
•
It is important to assess the
patient’s airway before
attempting intubation to
predict the likely difficulty.
•
Factors which may predict
difficulties with airway
maneuvers include
significant maxillofacial
trauma, limited mouth
opening and anatomical
variation such as receding
chin, overbite, or a short
thick neck.
•
Use mnemonic LEMON (look,
evaluate, mallampatti,
obstruction, neck)
8
th
edtion

LMA
•
The LMA’s role in
the resuscitation of
the injured patient
has not been
defined
•
There is established role
for the LMA in the
management of a patient
with a difficult airway,
particularly if attempts at
tracheal intubation or
bag mask ventilation
have failed.
•
The LMA does not provide
definitive airway.
8
th
edition

Airway Carbon
Dioxide Detectors
•
A CO2 detector
(colorimetric CO2
monitoring device)
is indicated to help
confirm proper
intubation
•
CO2 detector (ideally
capnography but if
not available by a
colorimetric CO2
monitoring device) is
indicated to help
confirm proper
intubation of the
airway.
8
th
edition

Laryngeal
Tube Airway
•
This content was not
included in the 7th edition.
•
The laryngeal tube
airway (LTA) is an
extraglottic airway
device with similar
capability to provide
successful ventilation to
the patient as that of
the LMA. The LTA is not a
definitive airway device
and plans to provide a
definitive airway must
be implemented.
8
th
edition

Gum Elastic
Bougie
•
This content was
not included in the
7th edition.
•
It is employed when vocal
cords cannot be visualized on
direct laryngoscopy.
•
In multiple operating room
studies, successful intubation
is seen at rates greater than
95% with bougie use.
•
In cases where potential
cervical spine injury is
suspected, Bougie aided
intubation was successful in
100% of cases in less than
45s.
•
It allowed rapid intubation of
nearly 80% of prehospital
patients with difficult direct
laryngoscopy.
8
th
edition

Shock
Crystalloid
•
Warmed isotonic
electrolyte solutions
are used for initial
resuscitation.
•
RL Is the initial fluid of
choice.
•
Normal saline is the
second choice.
•
Warmed isotonic solutions are
used for initial resuscitation.
This type of fluid provides
transient intravascular
expansion and further
stabilizes the vascular volume
by replacing accompanying
fluid losses into the interstitial
and intracellular spaces.
An alternative initial fluid is
hypertonic saline although
current literature does not
demonstrate any survival
advantage.

Shock Fluid
Resuscitation
•
Initial fluid
resuscitation based
on the 4 ATLS
classes of
hemorrhage is
presented.
•
Assess the
patient’s response
to fluid
resuscitation and
evidence of
adequate end
organ perfusion
Use of IV fluids is guided
by the goal of
restoring a normal BP.