Code Red Flashcards
When must a trauma team leader declare a code red?
Systolic below 90
Poor response to initial fluid resus
Suspected active haemorrhage
What is contained in a code red pack A?
4 units RBC
4 units FFP
What is contained in a code red pack B?
6 units RBC
6 units FFP
2 cryo
1 pool platelets
When would you request or use a pack B?
If the patient is still bleeding
What blood type do you use for a female patient?
O neg
What type of blood do you use for a male patient?
O pos
What is essential for all blood products?
Traceability
Who must you inform when units are used from the resus fridge?
Blood bank so that stocks can be replaced
When should you switch from Group O to a patients blood type?
As soon as the cross match result is available
What type of blood do you use for a paediatric patient?
O neg
What blood level do you need to check after 6 units of RBC?
Calcium
What drug do you need to check has been given by Hems?
TXA
Who can declare a Code Red?
A pre hospital doctor (Hems)
Advanced paramedic practitioner (APP)
Consultant in charge
How do you prepare a bay for a Code Red?
Trauma of pack ordered
Bloods and CT ordered
Computer in bay
Trolley
Theatre lights turned on
2 name bands
Bear hugger available
Monitoring ready
Belmont primed
Ultrasound machine
Anaesthetic equipment
Arterial pressure transducer primed
IV access and venapuncture equipments
Sterile procedures preparation
Transfer kit available
What drugs may you require for a Code Red?
Anaesthetic drugs tray from fridge
Ketamine
Fentanyl
Propofol (big one)
TXA
Calcium chloride 10ml 10% (Hypocalcaemia and hyperkalaemia)
Act rapid and 50ml 50% dextrose (hyperkalaemia)
What is the ROTEM analyser used for?
To confirm or exclude Acute Traumatic Coagulopathy (ATC) in under 5 mins
How can normothermia be maintained in Code Red patients?
Keep patient covered up
Use Bear Hugger
Trauma mattress
Give blood units through Belmont
Who should the Nurse 1 notify if the Code Red patient moves to theatres or IR?
The transfusion lab
What should Code Red patients have requested prior to leaving for theatre or IR?
Pack B
What is Octaplex used for?
Reversal of warfarinised patients and other DOACs
Where is Octaplex stored?
Code Red cupboard
What speciality needs to be discussed with before Olaplex is given to a patient?
Haematology
How much Octaplex should be stocked in resus at any one time?
3,000 units
What can you find on the top shelf of the code red cupboard?
Adult pelvic splint
Blast bandage
Israeli bandage
Celox gauze
Tourniquet- CAT
What can you find on the middle shelf of the code red cupboard?
Coagucheck XS machine - fully charged
Test strip bottle
Lancets
Surgical airway kit - sealed
Tuff cut shears
What can you find on the bottom shelf of the code red cupboard?
Dental props - S,M,L
Epistats
What would you find in the small cupboard inside the code red cupboard?
TXA
Octaplex
Dosing sheet
Administration aide memoire
Octaplex administration sheet
Where do you find the priority card for the lift?
Door of code red cupboard
What is TXA?
An anti-fibrinolytic agent that helps to prevent haemorrhage
What is damage control surgery?
Surgery involving using limited surgical interventions to control haemorrhage and minimise contamination until the patient has sufficient physiological reserve to undergo definitive interventions. Survival is given precedence over morality
What are the ideal blood component ratios?
1 PRBC: 1 FFP : 1 Platelets
What is the aim of damage control resuscitation?
Maintain circulating volume, control haemorrhage and correct the triad of death
What is damage control resuscitation?
A systemic approach to the management of trauma patients with sever injuries. It starts in ED and carries through to theatres and ITU
What are the 5 sites of major trauma?
Chest
Abdo
Pelvis
Long bones
External e.g scalp
As nurse 1 in resus, how would you prepare for a code red?
Put out 2222
Ensure trauma team complete
Assign a primary and Belmont nurse
Call for a trauma pack
Call transfusion and request pack A and or B as per discussion with TTL
Ensure Belmont primed
Wristbands and bloods
Listen to handover when patient arrives
Where do you put the blood labels for used units?
In slot under blood fridge
Why do we use invasive pressure monitoring?
Allows continuous accurate blood pressure monitoring for critically unwell patients
Allows frequent ABG samples
What equipment will you need once an ART line has been placed?
Transducer cable - single
Pressure bag
500ml saline
Art line giving set primed
How do you zero an ART line?
Stop cock close to patient and open to air
Press zero on monitor
What is the aim of
haemostatic resuscitation?
To resuscitate the patient with blood component ratios resembling whole blood, therefore, avoiding acute traumatic coagulopathy with the aim to maintain circulating volume, limit ongoing bleeding and prevent/reverse the triad of death
What does damage control resuscitation involve?
Haemostatic resuscitation, permissive
hypotension and damage control surgery
What can cause acidosis to worsen in a trauma patient?
Administration of large volumes of crystalloids
How is acidosis defined?
Arterial pH of less than 7.35 and in trauma is likely secondary to poor tissue perfusion
What does the triad of death lead to?
Worsening haemorrhage and eventually death
What is the triad of death?
Hypothermia, acidosis and coagulopathy
When does acute traumatic coagulopathy occur?
Immediately after massive trauma when shock, hypoperfusion and vascular damage are present
