Trauma Guideline Manual - SUNY Upstate Medical University

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16____________ Trauma Guideline ManualUpstate Medial University Trauma Centervii. Categorizes the injuries.viii. Orders initial X-rays, determines order of priority, orders lab tests (type and cross,ABG, EKG, CT scan).ix. Determines need for early FAST, peritoneal lavage, or thoracostomy tube.x. Orders the emergency consults.xi. Performs ED thoracotomy or directs/supervises the “assessment physician” inperforming this procedure.xii. Determines need for arterial monitoring line.c. Secondary assessment and definitive care:i. Directs and supervises the “assessment physician” in the performance of thesecondary survey.ii. Examines X-rays.iii. Decides on the need for and priority of further X-rays.iv. Contacts consultants as needed.v. Decides on the disposition of the patient and discusses with consultants.vi. Talks with family.vii. Puts note in chart.2. Assessment physician (senior or junior surgery or emergency medicine resident). Standingon the patient’s right.a. Prior to patient arrival:i. Checks equipment.ii. PPE.b. Primary assessment and resuscitation:i. Generally, stands at the patient’s right arm.ii. Performs the primary and secondary survey.iii. Inserts the right chest tube at the direction of the Leader.iv. May insert right-side intravenous access.v. Performs cricothyrotomy at the direction of the Leader.vi. Performs or assists with ED thoracotomy.c. Secondary assessment and definitive care:i. Performs secondary survey.ii. Performs DPL.iii. Monitors right femoral pulse for rate and quality.iv. May insert right femoral line or subclavian as directed by Leader.v. Reports findings and interventions to the Leader.3. Airway physician (emergency medicine attending or resident, anesthesiology attending,surgery resident/attending):a. Remains at the head of the bed.b. Prior to patient arrival:i. Checks contents of intubation tray, checks that laryngoscopes are in workingorder.ii. Checks suction and oxygen at head of table.c. Primary assessment and resuscitation:i. Assesses and protects airway and neck from injury.ii. Recommends medications for rapid sequence intubation.iii.iv.Intubates patient at discretion of the Team Leader.Additional responsibilities:a) Ventilates and monitors the ventilatory status, assesses oxygenation.b) Suctions airway.
Trauma Guideline Manual______________Upstate Medical University Trauma Center17c) Controls bleeding from head and neck wounds.d) Inserts internal/external jugular large bore catheters as necessary.e) Inserts nasogastric or orogastric tube as directed by the Team Leader.f) Assists with cricothyrotomy if needed.g) Communicates all findings to the Team Leader.d. Secondary assessment and definitive care:i. Monitors ventilatory status.ii. Monitors neurologic changes as demonstrated by acute changes in pupil size ormentation.iii. Prepares patient for possible transport (e.g., secures airway, etc.).iv. Puts note in chart.4. Support physician (junior resident directly responsible to Team Leader).a. Prior to patient arrival: Checks that a all anticipated equipment and supplies areavailable and readyb. Primary assessment and resuscitation:i. Generally remains at the patient’s left side, between the middle and foot end of thestretcher.ii. Exposes the patient.iii. Inserts left-side IV’s, including femoral line or subclavian line.iv. Inserts left chest tube at the direction of the Leader.v. Performs FASTc. Secondary assessment and definitive care:i. Obtains ABG’s.ii. May insert Foley catheter.iii. Inserts arterial line if needed.iv. Ensures that H&P and orders are on chart.v. Reports findings and interventions to the Leader.5. Primary Nurse:a. Generally remains at the patient’s right side (Trauma Bay 1)b. Directs/supervises all non-physician personnel.c. Monitors vital signs (BP, P, RR, pulse oximetry, ongoing neuro signs, etc.). Initial BPmeasurement obtained manually.d. May insert right-sided IV’s.e. Communicates with/reassures patient.f. Communicates assessments and interventions to the Leader.g. Accepts medical orders from the Leader.h. Administers medications at the direction of the Leader.i. May insert nasogastric tube, Foley, etc.j. Delegates duties to nursing and ancillary personnel as appropriate.k. Monitors effects of medications and treatments and communicates patient response toLeader.l. Anticipates and sets up equipment and procedure trays.m. Sets up blood warming equipment and administers blood.n. Communicates problems, needs, current status to ED charge nurse.o. Responsible for proper completion of the Trauma Flow Sheet.6. Respiratory therapist:a. Assists “airway physician” at the head-of-bed.b. Assists with endotracheal intubation.
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Trauma Guideline Manual - SUNY Upstate Medical University

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