Trauma Basics Flashcards
5 Trauma Codes?
- RTE
- Trauma Transfer
- Modified Activation
- Full Activation
- Trauma CPR Inbound
PEDS:
1. Trauma Transfer
2. Modified Activation
3. Full Activation (includes CPR in progress)
All pts 20+ weeks pregnant get what added to code?
OB
3 components of Adult Modified Activation?
- Physiological and
- Anatomic alterations
- MOI
Modified Activation - physiological alterations?
- LOC greater than 5 min
- Suspected spine or spinal cord injury
3.GCS = 13 - Pregnancy greater than 12 weeks and 2nd criteria
Modified Activation - Anatomic alterations?
Pelvic instability and/or deformity OR 2+ long bone (femur, tibia, humerus)deformities
Major lacerations:
a. to trunk and extremities involving fascia OR
b. With active bleeding + Normal VS
Severe:
a. Chest tenderness w/ chest wall instability, subcutaneous air and/or asymmetry or chest
b. Abdominal tenderness w/ or w/out seatbelt sign
c. Open extremity fracture
Age 65+ w/ significant visible chest, abdominal, pelvic or extremity injury
Knee dislocation or suspected ischemia to extremity injury
Modified Activation - If no physiologic and/or Anatomic alterations - Consider MOI of?
Stab wound to head/neck/torso w/ weapon of questionable effectiveness AND stable vital signs
MVC, MCC, Bicycle crash or Ped struck where pt is:
Not ambulatory w/ at least 1 of these:
a. Ejection from motor vehicle
b. Unhelmeted cyclist
c. Unrestrained MV passenger/driver
d. Fatality in same vehicle
e. Age = 75+
Documented Falls where it is NOT ambulatory where Fall is greater than 20 ft
Modified and Full Activation Burn Criteria?
Preferentially taken for WHC but when direct transport is NOT available:
2nd and 3rd degree burns greater than 10% BSA
3rd degree burns greater than 5% BSA
Peds Modified vs Adult?
PEDS: Below 15 y.o.
Physiologic: GCS 14 (not 13), no pregnancy consideration
Anatomic: no difference
MOI: GCS less than 14 (so 13 or below)
Injury including seat belt sign, abrasions, contusions, lacerations, deformities, or subcutaneous air in head/neck/torso
FALLS:
GCS 13 or less
Fall from greater than 3x child’s height
Adult Full Activation?
Airway and breathing emergencies including airway compromise from inhalation injury
Systolic BP less than 90 w/ signs + symptoms of shock
GCS = 8
Paralysis
Penetrating injury to head/neck/torso
Crush to torso/upper thigh
Major amputations (proximal to wrist or ankle)
Transfer pts from hospitals receiving blood products to maintain Vital Signs
Hanging victim with coma or intubated
Pulseless limb
Tourniquet application
Adult Trauma CPR Inbound
Blunt trauma or penetrating injury to head or neck w/out pulses (or CPR in progress), no pupillary reactivity, no supra ventricular activity and NO motor function for more than 10 min
Penetrating injury to torso or extremities w/out pulses, no pupillary reactivity, no supra-ventricular activity and no motor function for more than 15 min
PEDS Full activation
CPR in progress
Airway emergencies
Respiratory arrest or distress
SHOCK:
Systolic BP:
Less than 60 or HR less than 90 (0-5mths)
Less than 70 or HR less than 70 (6mths - 5 yrs)
Less than 80 or HR less than 60 (6 yrs - 15 yrs)
Clinical signs of shock
Transfer pts from other hospitals receiving blood products to maintain VS
GCS = 8 OR decline in GCS by 2
Paralysis
Penetrating injury to head/neck/torso
Crush to torso/upper thighs
Major amputations (proximal to wrist or ankle)
Hanging victim with coma or intubated
Pulseless limb
Tourniquet application
Trauma transfer?
Sustained injuries to 2+ systems but didn’t meet any code criteria
Require Eval and potential admission to Critical Care Unit for traumatic injury
Pr deteriorates and experiences major change in VS or other unexpected event or requires ADVANCED INTERVENTIONS
Acutely injured pt is being transferred from another facility by air after sustaining an injury in past 24 hrs but no code criteria applied
Some pts (Eg those receiving blood products) require trauma activation on arrival (when discussed w/ trauma surgeon)
Staffing - full activation
ED Attending
Trauma Resident
Trauma Surgeon (arrives w/in 5 min of pt)
Anesthesia
Bedside ED RN
Documenting RN
TICU RN
Respiratory
X-ray
Social Worker
EMT w/ Documenting RN
Staffing - Adult Modified Trauma Activation
ED Attending
Trauma Resident
Bedside ED RN
Documenting RN
EMT (bedside)
Respiratory
X-ray
Social Worker
Difference in staffing between full vs modified activation?
Full:
Trauma Surgeon
TICU RN
Anesthesia
Modified doesn’t include these!
