Trauma Guideline Manual - SUNY Upstate Medical University

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14____________ Trauma Guideline ManualUpstate Medial University Trauma CenterOPERATIONAL GUIDELINES: PREPARATION AND EQUIPMENT FORRESUSCITATIONOBJECTIVE:Provide guidelines describing the availability of equipment for major trauma patients in theEmergency Department.GUIDELINES:Prior to the arrival of the trauma patient, the following equipment must be made readily availableand every member of the Trauma Team must know its location:1. Intubation Tray:a. Complete set of endotracheal tubes and available stylet.b. Laryngoscope(s) with functional light.c. Magill forceps.d. Tracheostomy or cricothyrotomy tray with #6 Shiley tracheostomy tubes.2. IV – two liters of warm O.9% sodium chloride solution (NaCl) with rapid infuser/warmer.Two liters of warm NaCl readily available for Trauma II patients, spiked and hung forTrauma I patients.3. Head of the bed:a. Suction with Yankauer suction tip Ambu-bag with facemask for Adult & Peds.b. Oxygen flow device.c. Cardiac and hemodynamic monitor with EKG, non-invasive blood pressure, oxygensaturation and invasive pressure monitoring modules.d. EKG electrodes.4. Available at all times in the trauma room:a. PPE Cartb. Trauma Cartc. Broslow Cartd. Warm IV solutions (six liters LR, 6 liters NS).e. Blood warmers. ThermaCorf. Warm blankets.g. Foley catheters with Urimeterh. Trauma Line kiti. Arterial line (radial and femoral).j. Venous cutdown tray.k. Assorted chest tubes with Pleurovacl. DPL tray.m. Open thoracotomy set.n. T-Pod pelvic immobilizer.o. Surgical Airway Tray.p. Femoral Speed Splint
Trauma Guideline Manual______________Upstate Medical University Trauma Center15OPERATIONAL GUIDELINES: RESUSCITATION ROLE ASSIGNMENTSOBJECTIVES:1. Define the roles of the members of the Trauma Team during a trauma resuscitation.2. Provide optimal patient care by defining specific responsibilities for each member of theTrauma Team.3. Provide an appropriate educational experience for surgical and emergency medicineresidents.GUIDELINES:For a resuscitation to be efficient, every member of the team should understand their particularresponsibilities. These should be organized into tasks to be completed before the patientarrives, and during the initial assessment and evaluation of the trauma victim. When a patientwith multi-system trauma arrives who requires several procedures to be done simultaneously,the assignment of roles as outlined below should be strictly followed to prevent chaos. If, afteran initial evaluation, the patient is found to be stable, the junior resident (support physician: onthe patient’s right) may perform necessary evaluation and procedures on the left side of thepatient with the supervision of the left-sided senior resident (assessment physician). This willenhance the junior resident’s educational experience and allow the senior resident to functionas a supervisor. Flexibility of roles is expected under exceptional circumstances and appropriatecommunication should be maintained (see Figure 1).1. Team Leader (attending Trauma surgeon, EM attending, EM or Trauma senior/chiefresident):The Team Leader should be designated prior to the arrival of the patient and will usually bea senior resident. Supervision will be provided by the chief surgical resident and theemergency department attending physician until the trauma attending physician arrives inthe emergency department. Should the Team Leader be required to leave the bedside, theLeader must clearly transfer the responsibility to another senior team member.The Team Leader will direct the course of the primary survey and resuscitation and expect aresponse to his or her questions; all questions or information should be directed to thisperson. There should be no other extraneous conversation.a. Prior to patient arrival:i. Assembles the trauma team and makes specific role assignments.ii. The most senior surgeon calls anesthesia and/or OR personally if the patient is togo straight to the OR.iii. Confirms that everyone in the unit has gown, mask, cap, eye protection, andgloves.iv. Reviews information from ambulance radio report.b. Primary assessment and resuscitation:i. Receives verbal report directly from ambulance personnel.ii. Directs the “assessment physician” to perform the primary survey.iii. Supervises the “assessment physician” in the performance of the primary survey.iv. Makes the decision for intubation or cricothyrotomy.v. Decides on IV orders and additional venous assess.vi. Decides on the amount of blood and kind (O-negative, type specific, etc.) needed.
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