TRAUMA STATS, CONSULTS, AND CARE OF THE TRAUMA PATIENT

Transcription

1 Witten: July, 1991 Reviewed: 3/98, 3/01 Revised: 6/94, 4/96, 5/04, 1/07, 8/07, 3/12 Policy: LSU Health Sciences Center-Shreveport, LA Page 1 of 5 TRAUMA STATS, CONSULTS, AND CARE OF THE TRAUMA PATIENT PURPOSE To provide guidelines for care of trauma patients in the Emergency Care Center To identify members and functions of the trauma team POLICY The trauma team will consist of two components, an in-house surgical team and the ECC trauma team: 1. The In-house Surgical Team will consist of the following: A. Faculty surgeon B. Chief surgical resident C. Senior surgical resident D. Junior surgical resident E. Anesthesia resident F. Orthopedic resident 2. A call schedule with beeper numbers for the in-house trauma team shall be posted in the code room daily. 3. The Emergency Care Center Trauma team will consist of the following: A. Emergency Care Center Staff Physician B. IV nurse C. Recorder nurse D. Circulatory nurse E. Leads and vital signs nurse F. Nursing Assistant G. Unit Clerk H. X-ray technicians I. Blood gas technician 4. Trauma team responses will be: A. Trauma Stat B. Tier 2 C. Trauma Consult 1

2 Trauma Stats, Consults, and Care of the Trauma Patient Page 2 of 5 TRAUMA STAT 1. A trauma stat will be instituted for any trauma patient with a real or perceived immediate threat to life or limb. A trauma stat will be initiated by the ECC Faculty Physician or nursing personnel. 2. Upon making the determination of a trauma stat, the ECC clerk will be instructed to dial and inform the telephone operator of a trauma stat. The operator will immediately activate the Trauma Stat Beeper system. TIER 2 or TRAUMA CONSULTS 1. A Tier 2 or Trauma Consult will be called when, after thorough evaluation of the patient by ATLS guidelines, the ECC Physician perceives a need for further evaluation. 2. In this situation, the senior resident (HO-III) should be paged by the ECC Physician and informed of the consult. 3. Examples of patients requiring Tier 2 or Trauma Consults include the following: A. Inability to clear C-spine B. Further evaluation of blunt abdominal trauma C. Further evaluation for real or potential head injury D. Polytrauma clearance for isolated injury 2

3 Trauma Stats, Consults, and Care of the Trauma Patient Page 3 of 5 Trauma Activation Criteria (Tiers 1 and 2) Trauma activations will be stratified into tiers dependent the presumed severity of the injury. Any patients with the following: Tier 1 Criteria 1. Airway compromise (intubated, apneic or obstructed airway) The only exception to this is a patient intubated because of head injury who is being transferred as an isolated head injury and who is otherwise stable. These patients will be considered Tier Penetrating wounds to the head, chest, abdomen, groin, or buttocks 3. Flail chest, open pneumothorax 4. Systolic blood pressure less than 100 or hypotension relevant to age/or signs of shock 5. Receiving blood or blood products during transfer 6. Glasgow Coma Scale (GCS) 12 or less 7. Extremity wound with absent pulse or amputation proximal to hand or foot 8. New onset paralysis 9. Any transfer patient meeting the above criteria who has not been fully resuscitated and stabilized prior to transfer. Patients initially meeting Tier 1 criteria at an outlying facility, who have been adequately resuscitated and stabilized, may be considered Tier 2 as determined by the Trauma Chief at the time of acceptance of the transfer. 10. Any patient in the Emergency Department (ED) who deteriorates and meets the above criteria. 11. The ED Physician s judgment based either on reports from the field or condition of the patient on arrival. 3

4 Trauma Stats, Consults, and Care of the Trauma Patient Page 4 of 5 Any patient meeting the following criteria: Tier 2 Criteria 1. Otherwise stable patient who meets one of the following: A. Patient ejected from vehicle B. Patient with documented loss of consciousness (LOC), GCS 8 or less for greater than 5 minutes who now has a GCS of 12 or higher 2. Stable patient where the ED Physician s judgment is as follows: that admission will be required and the patient meets one of the following criteria: A. Patient involved in accident with death of one of the other passengers B. Patient involved in a rollover C. High energy impact with significant structural damage or intrusion into the passenger space D. Fall from greater than 4 meters E. Pedestrian or bicyclist hit by vehicle 3. Stable patient with evidence of significant injury who is taking anticoagulants or found to have significantly elevated PT/PTT or INR. 4. Stable patient with significant comorbities as judged by the ED Physician or Trauma Chief. 5. ED Physician s judgment. 4

5 Trauma Stats, Consults, and Care of the Trauma Patient Page 5 of 5 COORDINATED SEQUENCE OF TRAUMA STAT 5