>Trauma Reflections – February 2019

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

 

Another highly informative and brilliantly written summary by Dr. Lohoar:


 

Major points of interest:

A) Are we still calling ‘Trauma Codes’ in post TTL era?

Yes. Call away. Activation rates for cases that qualify continue to hover around 80%. Patient care is always improved with a coordinated team approach – triggered by calling a trauma code overhead. Activation criteria are as follows:

B) Should RN Trauma notes continue to be used?

Yes. Folder box on counter in room #19 has trauma activation packages – one stop shopping for all documents needed. “SJRH ED Trauma Process Checklist” is in package and is a very useful prompt (see below). Put on a sticker, get into character.

C) Are you feeling lucky?

Symptomatic head injured patients seen in peripheral centers, with concern enough for an emergent CT head request should come by ambulance not car.

 

D)  What did this guy eat for supper?

Pizza and beer, and lots of it.

Ducanto suction catheters are available on all airway carts. They are much more efficient at decontaminating airways soiled with semi-solid material when compared to Yankauer suction catheters

 

E) Boom, ET tube is in – high five – I am going for coffee..

Not so fast Slick, there is more work to be done.

 

1/ Check for ET tube placement, check for cuff leaks

2/ Post intubation sedation and analgesia can be challenging. Key is to avoid starting medications that could potentially drop blood pressure at very high infusion rates, but we need sedation and analgesia promptly.

Consider bolus of sedatives and analgesics prior to initiating infusions and prn boluses afterwards. Reassess frequently. Inadequate analgesia is often the cause of continued agitation. See attached guidelines from NB trauma – page 5 in particular

3/ NG or OG tubes should be placed and position checked as well

F)   Transfers “just for imaging”

Calls from other facilities for imaging should be screened for potential trauma patients. Care is often substandard if we are not aware of these patients, and they are being managed remotely by MDs in other facilities (playing phone tag with a radiologist).

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