Trauma Guideline Manual - SUNY Upstate Medical University

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156____________ Trauma Guidelines ManualSUNY Upstate Trauma Centerreflection and superiorly to level of superior pulmonary hilum. Care must be taken toavoid injury to left atrial appendage and phrenic nerve. This is best accomplished bylifting tip of scissors laterally as incision is made.i. Manually lift heart from pericardial sac. If hemopericardium is present, then examine forcardiac perforation. Tamponade perforation with finger or Foley balloon. Teflonpledgetted 3-0 prolene sutures on a taper needle are present in thoracotomy suturepack for repair of cardiovascular wounds. Consider use of skin stapler. Ifhemopericardium is not present, then begin open cardiac compression. Aortic crossclamping,if not previously performed, is indicated if no hemodynamic response isnoted.
Trauma Guideline Manual______________SUNY Upstate Trauma Center157PROCEDURE GUIDELINES: EMPIRIC ANTIBIOTICS FOR TRAUMA AND CRITICAL CAREPATIENTSOBJECTIVE:Define the use of “empiric antibiotics” in multiply injured and critically ill patients.GUIDELINES:1. The following chart shows suggested “presumptive treatment” for potential infectionsencountered on the trauma and critical care service.2. Presumptive therapy should be administered for a maximum of three days.3. Antibiotics should then, if not sooner, be reassessed according to possible source ofinfection, any culture results or antibiotic sensitivities.4. Choice of antibiotic should be based on efficacy, toxicity (including resistance concerns)and cost5. Consult the hospital’s “Antibiogram” for current susceptibilities.
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Trauma Guideline Manual - SUNY Upstate Medical University

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