Trauma Guideline Manual - SUNY Upstate Medical University

Trauma Guideline Manual______________Upstate Medical University Trauma Center35OBJECTIVE:To define a standard set of laboratory studies that should be obtained for the trauma patient inan attempt to aid in diagnosis in an efficient, cost-effective manner.DEFINITION:Laboratory studies: An examination of the blood or other fluids to obtain information concerningphysiologic derangements in the trauma patients. Additionally, other bedside studies may fallinto this category including EKG, echocardiography, and ultrasound.GUIDELINES:1. At the Upstate Trauma Center, the trauma team has minimal “routine trauma bloods” thatare drawn on all patients according to injury status. The blood studies should beindividualized to the patient and the injuries that are being treated.2. In general, full trauma labs will be obtained for Trauma Level I & II patients. If patient willgo for an operative procedure, the pre-op labs will also be sent.a. Trauma labs (panel):i. ABG for critically injured patients with signs of shock / lactic acid at discretion.ii. CBC and BMP.iii. Type and screen, type and cross, if need for blood is anticipated.iv. Urinalysis.v. Urine for U-HCG for women older than 10 and younger than 55 yrs.vi. Coagulation studies PT/PTT on all and selected use of platelet function studies orthromobelstographic studies.3. The following laboratory studies should be considered for the multiply injured patient:a. Type and cross for four to six units of packed red blood cells:i. A patient who has obvious source of massive blood loss.ii. A patient with traumatic anemia.iii. A patient who is hypotensive from hemorrhagic shock.iv. A patient who is going to the operating room for a surgical procedure that mayresult in major blood loss.b. Type and screen:i. A patient with marginal blood loss (e.g., from lacerations) and no anticipatedfurther blood loss.ii.A patient going to the operating room for a procedure with a low likelihood of bloodloss.iii. A patient who was hypotensive at the scene but has stabilized with moderate fluidresuscitation.c. Repeat CBC:i. All trauma patients with a significant injury with evidence of hypoperfusion orbleeding.ii.Follow-up on patients who had marginally low hematocrit initially or who have hadslow continued blood loss (as in a chest tube).