>Trauma Reflections – December 2017

Thanks to Dr. Andrew Lohoar and Sue Benjamin for leading the discussions this month

 


 

Major points of interest:

 

A) Burns – Get out your crayons……

Accurate documentation of total body surface involved is key to determination of appropriate initial fluid resuscitation. Parkland formula = 4ml Ringer’s lactate x %BSA x kg – 1⁄2 in first 8 hours. Only count 2nd and 3rd degree burns. Lund and Browder documentation sheets. Urinary output will influence adjustment of fluid rates, so careful documentation of ins/outs is important.

B) Trauma in Maine – Get me out of here!

Canadian citizens injured in the U.S. often are transferred to NB for further investigation and management. TCP does NOT coordinate these transfers. Expectation is that the TTL will communicate with the sending physician and/or receiving consultant and manage as we would any other transfer from another facility.

C) Trauma transfers from other centers

Expectation is trauma activation for all major trauma transfers, even if “direct” for a consultant.

D) Crash 3- We are recruiting….

We are recruiting to the CRASH 3 study. Please familiarize yourself with eligibility criteria – adult, TBI < 3 hours isolated TBI.

E) Pre-alert of consultants – “Call me back when he gets there…”

In cases where immediate need for surgical consultation is clear, TTL should “pre-alert” consultants with ETA. Simultaneous arrival of consultant and patient is the goal.

F) Trauma activation package

Folder box on counter in room #19 has trauma activation packages – one stop shopping for all documents needed. Please fill out ‘MD Trauma Activation Log’ for every activation.
“SJRH ED Trauma Process Checklist” is in package and is a very useful prompt. Call it overhead. Put on a sticker.

G) Documentation

Documentation is important. Consider verbalizing full physical exam during secondary survey for documentation RN to chart on page 3 of trauma notes. MD can sign these notes. This will free up space on ED chart for “higher level” documentation such as list of injuries and treatments.

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