INDEX
Trauma
Table of Contents:
Cross References:
Trauma Coverage
Resident Coverage:
Trauma Shift, Noon-Midnight
Pod 3 Resident, Midnight-Noon
Even Days: EM Resident leads trauma resuscitation.
Odd Days: EM Resident handles airway/procedures.
Attending Coverage:
The Trauma attending is in charge of all trauma resuscitations.
Pod 3 attendings respond to traumas but serve mainly as an educational role for the ED trauma resident.
Pod 3 Coverage:
When the Pod 3 Resident is needed in the trauma bay, attendings will continue care for any new or existing patients in the pod.
Thursday Mornings (No EM Residents):
Trauma residents and attending cover all trauma alerts
Anesthesia covers all airways on Thursday mornings
ED attendings should be available to assist if needed
Team Positions for Even/Odd Days:
Trauma Alert Criteria
Trauma alerts are generally activated in the field by EMS, however these are general guidelines for making a patient a trauma alert on arrival:
SBP less than 90
Respirations less than 10 or greater than 29
HR greater than 120
GCS 12 or less
Significant blood loss/shock
Level of consciousness: responds only to pain or not at all
Flail chest
Penetrating injury proximal to knee or elbow
Head penetration
Amputation
Long bone fractures
Pelvic fracture
Paralyzed limbs
Motorcycle/bicycle, thrown at least 10 feet
Auto vs Pedestrian, thrown at least 10 feet
Ejection
Fall greater than 20 feet
Downgrades
Trauma alert downgrades must involve a discussion and agreement between the EM and trauma attending/fellow.
Trauma-Specific Guidelines
Procedure Documentation
All intubations performed by ED residents and supervised by ED attendings should be documented in a procedure note and sent to the ED attending.
Use the “ED Procedure Note” template.
Importantly, this note contains the proper attending attestations and it defaults to the “Emergency Department” note type, which pushes the note to our coders for billing.
Forward to the ED attending as usual and the attending will need to add an attestation for the procedure.
All other procedures performed during trauma resuscitations should be documented and sent to the trauma attending per documentation guidelines of the Trauma department. One exception to this would be if the trauma attending was upstairs and the ED attending was the only attending-level staff present.
KEYWORDS: trauma, trauma alert, trauma alerts, criteria, alert criteria